Major incident as hospital waste collections halted

More than 20 NHS trusts must store clinical waste, including human remains, at their premises for up to a fortnight after their scandal-hit contractor stopped collecting waste last week, prompting a major incident.

Extra containers for temporary storage of anatomical, hazardous and other forms of waste have been installed at hospitals across England, as part of a national incident response ordered by NHS chiefs.

It comes after Healthcare Environmental Services stopped collecting 24 trusts’ waste last Thursday, the government confirmed on Tuesday.

The company is subject to legal action by the Environment Agency after it was found to have stockpiled up to five times the permitted amount of clinical waste at its depots in July – prompting a COBRA meeting which agreed a £1m package of support for affected trusts.

The cessation of collections came a day after the company was told its waste management contract with the NHS in Scotland would not be renewed in April 2019, following a re-procurement of the contract.

HSJ understands NHS chiefs have initiated the NHS Emergency Preparedness Resilience and Response – which is used for major incidents.

A source told HSJ: ”Every trust serviced by HES is now into emergency plans. It’s a complete nightmare.”

Guidance issued to trusts by NHS chiefs, seen by HSJ, recommended compactors, skips, and trailers are installed on-site in which the waste should be stored.

These units will store waste such as infectious liquids, cytotoxic and pharmaceutical waste, surgical instruments, and sanitary products.

The guidance states anatomical waste, for example amputated limbs or human tissue, should be stored in refrigerated units at a hospital’s mortuary if it is unlikely to be collected by a contractor within 24 hours.

The temporary storage units must be placed on impermeable surfaces such as concrete or asphalt to prevent contamination of surface water.

Chiefs have given trusts the go-ahead to move their waste to a neighbour trust if they are unable to store more waste.

Regulators NHS England and NHS Improvement are taking legal advice over the contracts held between the trusts and HES.

Professor Keith Willett, medical director for acute care and emergency preparedness at NHS England, said contingency plans were in place and ”patients should be assured that their care will be unaffected”.

On Tuesday, health minister Stephen Hammond said NHS Improvement had “sought assurance from HES that it has not ceased trading and is capable of, and will continue to provide services”.

He said NHSI had not received that assurance from HES.

After HES’ problems came to light, the government negotiated a new waste management contract with outsourcing company Mitie for trusts which held contracts with HES.

In October, 19 trusts in Yorkshire and Humber terminated their contracts with HES – six weeks after the stockpiling first came to light – and moved to the Mitie contract.

Last month HSJ revealed this contract charged trusts three times the price offered by HES, which has denied under-bidding for the services.

The company claims there is a lack of incineration capacity in the UK, which was repeatedly denied by the government.

But documents leaked to HSJ showed officials from NHS Improvement and the Environment Agency had concerns about the amount of available capacity.

As part of the contingency plans for the Yorkshire and Humber trusts, the clinical waste was driven hundreds of miles south and incinerated in normally unsuitable facilities, which was only allowed after special permits were granted by the Environment Agency and the Department for Transport.

HSJ understands none of the trusts affected by HES’ halting of waste collection has moved onto Mitie’s contract yet, though this option has been made available for them.

The government is reviewing the way the NHS awards contracts for clinical waste management.

Unison’s head of health Sara Gorton said: “This intolerable situation should never have been allowed to happen.

“Trusts shouldn’t be left to deal with the consequences of a contractor’s gross incompetence.

”It raises huge doubts about how contracts are drawn up and bids assessed. NHS bosses need to think more carefully before outsourcing key parts of the health service.”

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