It is several years ago that the Clinical Waste Discussion Forum predicted a substantial increase in community-based care with patients managed for an increasing complex range of conditions at local clinics or in their own home.

Since this will include a substantial proportion of chronic and life-long conditions, to provide enhanced [social] care for patients while removing the pressure on hospital beds.

As the New Year approaches, the NHS Confederation is echoing our prediction.

The implications for waste management will no doubt be an afterthought but deserves close consideration. Collections from expanded GP clinics – the polyclinics that Darzi tried, but failed, to create at ridiculous expense to the taxpayer! – should not be too difficult though the costs for more frequent collections from establishments with limited storage capacity may well create unforeseen cost pressures.

More troublesome still will be the collection of clinical and related wastes from patients treated in their own homes. Presently, the arrangements for domestic clinical waste collections are lacking. The results of the latest UK-wide audit will be published in Q1 2012 and as previously paint a disappointing picture. It must get better if domiciliary patients are to be properly managed.