Who takes responsibility for healthcare waste

Who takes responsibility for healthcare waste?  There are many answers to this apparently simple question, but few are completely satisfactory.

Leave it all to front-line waste producers? I think not.

Nurses – they produce much of it – but also doctors, technicians, laboratory scientists and researchers, pharmacists. The list goes on, and that’s just for the clinical waste fraction!

An infection control nurse? Hardly appropriate, as it sits uncomfortably with their core duties though there is some overlap. And of course they have no experience of waste producers outside the clinical area, or of the local infrastructure and management issues associated with its management from the time at which it leaves the ward…..

How about the site Estates Manager, or a designated waste manager? Some of those I have met have been doing a great job, but with little real understanding of the hugely variable range of issues faced by front-line producers and generally seek to shoehorn everything into a relatively small number of waste streams with little understanding of why, except that HTM 07-01 says so. Sadly, some others are far less competent, and operate as little more that the manager of portering services.

An external consultant? There aren’t many of us, and some have so little understanding of the issues that their recommendations are at times quite ridiculous. Producers take no notice, resulting in friction and a combative approach that wastes time and money but achieves little, and may be counterproductive. Some have a background in the NHS, attached to an Estates Department, and claim vast knowledge of clinical services though that is not apparent in their work. Others may have a background in academia but with experience of healthcare activity limited to books, or a trip to the  local hospital with appendicitis, the salience of their advice is limited. This shows also in the quality of academic publications, where proposals for change can be seen not to stand scrutiny as viable proposals that could ever be workable in practice.

How about leaving it all to  contractor. It can be cost effective, but where s the experience of the diversity of clinical services from acute care to maternity, psychiatry, care homes, prisons etc, hospital and other laboratories, pharmacy, veterinary services and animal husbandry etc. And GPs, ambulance operation, dentists, community, drug litter, violence and trauma…….  It is one thing to collect waste from these locations, but without a proper understanding that contracted service will always be a compromise.

The regulators are of no great value in this role. Many have little real understanding of the entire operation and how its parts fit together, though they may profess to do so. Generally, workloads are too high to be able to devote the time to the subject.

In a recent report from South Africa, I saw reference to a regional framework of hospital waste managers reporting to a national waste executive. They were employed by the Department of Health.

How valuable this could be. With lines of communication to waste producers and the disposal sector, and to the relevant regulatory bodies, this would seem to be a pivotal role. With the relevant and comprehensive experience, the cost saving achieved through more efficient waste management could be close to self-funding, at least initially.

With our devolved NHS management, these central functions are sometimes difficult to justify when successive governments profess to provide a bottom-up health management framework. With dissolution of the PCTs, the role could be cross-charged to fit with the market model of healthcare financing.

In the NHS, we have an executive framework for just about everything. The Chief Nurse and Chief Medical Officer are well known posts but there are many more, and with the high cost of waste right across the NHS the post(s) seem well worthwhile.

Just don’t appoint those who say how good they agree but repeatedly fail to deliver.

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