It is reported in today’s Guardian that NHS managers have been “ordered” to consider the environmental impact of their decisions.

Quite right too. We all have an obligation to consider the environmental impact of our actions, including for managers the impact of the decisions that they make on behalf of their service. And, of course, we must all seek to reduce, reuse and recycle, and to minimise wastage of material resources, energy and time, especially so since in the NHS we are  operating entirely from the public purse.

It is reported that the key elements of a greener future for the National Health Service have been set out today by the NHS Sustainable Development Unit. With what will no doubt be a rather lavish launch meeting, there will be several important developments that will see health service managers handed a “route map” laying out some of the measures they need to take to meet the government’s greenhouse gas targets. The NHS  must cut its carbon emissions by 10% by 2015.

How will this be achieved?

The Guardian reports that several primary care trusts and treatment centres have already begun taking unusual steps to reduce their greenhouse gas emissions in ways they say will also result in better outcomes for patients. At one GP practice in London, older patients with leg ulcers are sent to flower arranging classes – improving their mobility and helping them heal faster, saving on carbon emissions for travel to hospitals.

“At one GP practice in London, older patients with leg ulcers are sent to flower arranging classes – improving their mobility and helping them heal faster, saving on carbon emissions for travel to hospitals.”

Yes, really!

More valuable – and believable – is the initiative to encourage medical staff to recycle correctly that is saving money for several trusts that have discovered they are wasting hundreds of thousands of pounds paying for expensive clinical waste disposal for bins stuffed with normal rubbish.

Sadly, the flyer about The Queen Victoria NHS Foundation Trust Hospital waste initiative is full of gaps and non sequiturs. The general principle of careful source segregation is, of course, entirely sound but in this non-peer reviewed overview there is no consideration of how this might be achieved on an overcrowded, busy yet understaffed ward housed in an old Victorian block that is critically limited for space and cannot accommodate the various waste receptacles that would be required.

Solve these problems, and the proposal for further segregation has a chance. But that does not make it safe. Nowhere is there reference to the essential risk assessment that must dictate and override any ‘rule of thumb’ segregation guide. That leans toward the various published studies that have claimed huge success in forcing better segregation and which judge success only on the decreasing amount of residual hazardous clinical waste with little of no consideration of what might be slipping out in the lesser waste streams.

 The project coordinator is quoted as saying that clinical wastes are incinerated as if to justify all further claims. This is of course not true and only a small fraction of clinical wastes need be incinerated while the remainder can travel a lesser distance to an alternate treatment facility. The relative carbon footprint of the various treatment options, including their locations and transport costs, are not considered. Nor is the carbon impact of the waste diverted from supposed incineration – in this case, it is not considered at all thus creating further flaws in the arguments that owe more to advertising that science.

I have no trouble with such initiatives, though the ‘evidence’ is lacking and much more needs to be done to investigate the best environmental option that is both cost-effective and safe, and which fits efficiently with the core activities of NHS care.

Waste segregation should be managed to support the available treatment options that might include post-process recovery or recycling. Waste regulation should acknowledge, and where appropriate, support those treatment options that may ultimately be more environmentally friendly and inherently safe. Where information is limited expert opinion may provide pointers but ex-Cathedra claims help nobody and additional research input is essential to establish the facts.

Good luck to The Queen Victoria NHS Foundation Trust Hospital and the NHS Sustainable Development Unit who, with others, are working hard to make a difference. Sadly, until that work is properly structured and supported by meaningful research studies that properly assess the impact and outcome of any interventions the case is not well made, but I have a feeling that it will be seized upon by the NHS, by various ‘waste consultants’ and by regulators eager to make a name for themselves without bothering too much about evidence and detail.