The Case for the Sustainable Management of NHS Waste

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The United Nations Conference on Environment and Development - the 'Earth Summit' held in Rio de Janeiro in 1992 - placed the concept of sustainable development as the key to environmental understanding into the international policy arena. The concept of sustainability was defined by the United Nations World Commission on Environment and Development in the Brundtland Report as: 'development that meets the needs of the present without compromising the ability of future generations to meet their own needs'.1

Significantly, the commitments achieved in Rio were for the first time - where national governments were concerned - representative of negotiated international agreement. The development of 'Agenda 21', an action plan for achieving sustainable development worldwide in the 21st century, emphasised the importance of this. In order to monitor progress in this programme, the Commission on Sustainable Development was created to receive annual reports submitted by the members.

The United Kingdom, in response to their commitment, produced and published the Government's Sustainable Development Strategy.2 This report outlined the environmental policies and gave guidance for waste management. It introduced the principle that the 'polluter pays' and is associated with the precautionary principle in This Common Inheritance3 that 'prevention is better than cure'. The Government viewed this as an important means of influencing potential polluters. As an adjunct to developing the ideas on waste management, a strategy was devised with three main objectives:4

* to reduce the amount of waste that society produces;

* to make best use of the waste that is produced;

* to choose waste management practices which minimise the risks of immediate, and thus future, environmental pollution and harm to human health.

The strategy also addressed a 'waste hierarchy' of reduction, re-use and recovery, which formed the Government's policy for achieving sustainable waste management.

The Waste Strategy for England and Wales produced revised targets5 with an actual 9% target-recycling rate for municipal waste identified in the Waste Strategy 2000. The strategy retained a voluntary target of reducing the amount of industrial and commercial waste to landfill to 85% of 1998 levels by 2005. The remainder of waste in the UK was classed as agricultural, and mine and quarry waste, and both remain exempt from waste licensing as controlled waste. This contrasted sharply with the statutory recycling target imposed for domestic waste.

The Government and the European Commission were committed to the safe and sustainable management of health service waste. Healthcare contributes significantly to environmental pollution, and as any increase in environmental pollution may result in health risks it could be argued that a commitment to the improvement and sustainability of the external environment is an intrinsic part of a healthcare strategy. The Government's strategy for Our Healthier Nation6 placed responsibility for the success of the health strategy with the National Health Service. The strategy included demonstrating a commitment to health and safety and addressing the potential environmental impact of NHS practice on the local communities and the environment.

In 1994/95, the NHS was the largest group of employers in Europe with around one million staff. An average acute hospital of 500 beds produced more than ten tonnes of waste a week. This was partly made up of household waste similar to that produced at home and cost in 1996 between £20 and £70 per tonne to be disposed of to landfill. Human tissue, infectious material and used syringes produced as a by-product of clinical processes, were classified as clinical waste and cost between £180 and £320 per tonne to dispose of because of their hazardous nature and special regulatory requirements. The annual NHS bill for clinical waste was between £60 million and £150 million. …