There are changing trends in community healthcare driven largely, though not exclusively, by the need for cost saving. This places many more patients into the community, from early hospital discharge and the increasingly diverse range of sometimes complex cases that can be treated at home.

Patients prefer it, and of course they are away from the high risk hospital environment so the risk of hospital-acquired infection is reduced. Its good all round, or is it?

Community services and increasing reliance of patient self-care generate substantial amounts of clinical waste including potentially amounts of pharma waste and sharps. What happens to it? The current stand-off between community nurses and Local Authorities about the ‘ownership’ of wastes generated during a community nurse visit is simply ridiculous, with wastes generated between 11.35am and 11.58am ‘belonging’ to the nurse and being packaged for shipment by car to a central point for disposal; of course, waste generated by patient self car at all other hours and on other days will be the LA’s problem!

Either way, there will be more patients in the community; more acute care and early hospital discharges and substantially more chronic care so it is likely that amounts of sanitary/offensive waste will increase too. Some patients may become regular clients while others might be generating waste only for days, weeks or months, though not indefinitely. Collection services must be responsive to these needs and, though we first raised this on the Clinical Waste Discussion Forum at least 5 years ago, now is the time to start planning.

Who pays? Who manages the service? How to resolve the tawdry spat with Community Nurses? And how to classify wastes that may be occasional arising that some suggest can be packaged and buried within domestic waste containers?

Before too long, the issue will be upon us. Simply expanding existing and generally ill-managed services just will not do, nor will it be appropriate to take Comunity Nurses out of their fleet cars and put them into vans in order to equip them for more regulated disposal of all care-related wastes. Those involved would be wise to start with a clean sheet of paper, an open mind and ideas for the future.