Hospital trusts are driving efficiency, but are they missing a trick?

Written by: Dr Adam Read | Published:
Dr Adam Read, practice director for resource efficiency & waste management @ Ricardo Energy & Environment

Each month, Dr Adam Read, practice director for resource efficiency & waste management @ Ricardo Energy & Environment discusses the big issues from his point of view, and this month considers the drive for efficiency in the NHS and the implications for better waste management.

I have been most unfortunate since my last blog, having spent three weeks of July in a number of UK’s finest hospitals as I was treated for the symptoms of pancreatitis, and was then analysed in the hopes of determining why I suffer from this most painful of problems.

In that time I have seen two A&Es, been on four different wards, and experienced a number of different departments from radiology and general surgery, to ultra-sound and the circulation specialists. And what this has shown me is that hospitals are generally under-staffed (both doctors and nurses) and this has downstream implications for both patient care and resource management.

Reflections on my time laid up in hospital

Once I was over the first day or two of pain management and sleeping in each of my three stints in hospital, I started to take a more active look at what was happening around me. The inquisitive mind of a resource efficiency consultant cannot be dampened for too long!

Anyway that follows me on twitter will have noted the postings of new wards and more importantly the new bin configurations I could see from my bed. No surprises there I guess...... but what did surprise me was not the prevalence of bins, for every room was well-endowed with new, clean and colour co-ordinated bins, with excellent signs telling you (patients, visitors and the nursing staff) what should go where, but the obvious lack of compliance with these instructions.

Time after time, once I was allowed back on my feet, I would have to leave the ward to find a bin for my recyclables (newspapers, glass bottles and plastics, etc) as there was no obvious recycling bin in many of the wards I was stationed.

This is disappointing in today's world, and given how much of the stuff that was on my bedside table (and that of my fellow patients) that could be readily recycled if we were at home or even ‘on the go’ in the high streets across Britain, it was more than just a little annoying.

Do the trusts not know how much they could be saving by making recycling more readily available and encouraging ‘all of us’ to do our bit? Perhaps the drive for greater staffing efficiencies and cut backs in resources across hospitals in the UK is making things like resource management a lower priority, even when a good business case can be developed to show what might be achieved by doing things differently.

Money talks?

But perhaps worse than the whole lack of obvious recycling opportunities, was the blatant disregard by consultants, doctors, nurses, orderlies, and volunteer staff for the segregation of clinical waste from non-clinical on the wards and in the departments – well at least in those where I was a frequent visitor.

I was quite shocked by just how much general waste was ending up in the yellow clinical waste bins. Simply by observing the bin usage from my bed, you could see all staff would take the easy route and because they were opening up the clinical bin to deposit a used IV bag, a needle or dressing, they would also drop in the packaging they came in, the tablet containers and the general tissues/cloths used around the ward (all of which are not forms of clinical waste!).

Why is this? Perhaps ignorance of the staff of what is and what isn’t clinical waste? Probably not, because the signage in all the hospitals I spent time this summer was good, clear and visual. So perhaps it is more about convenience, and in my informed opinion speed of action.

All staff are under increasing demands, looking after several bays / wards etc. and with limited time to stop and think, or to do two or three actions, when one would do (segregate materials or discard everything), and with further cuts expected in many UK Hospital Trusts I can’t see things getting any better.

So why can’t we engage all staff about the true costs involved of disposing of non-clinical waste in the yellow bins? Should we be setting targets for each ward (an intra-hospital competition) for saving money by segregating better?

The answer is obviously yes, and some trusts are really pushing hard on reducing their overall waste management costs by increasing their coverage of bins (including recycling ones) and running campaigns to educate staff about the wasted money that comes from them not segregating properly.

Imperial have led the way, and my team at Ricardo have worked with a number of trusts in the last year who have recognised the need for change and have wanted help benchmarking their performance, designing new campaigns and signage, and developing staff support programmes to embed new habits and support new recruits.

Our recent work with NHS Scotland, the trusts in Birmingham and Essex, and on ongoing initiatives in other high profile hospitals suggests that the tide is turning, so perhaps I was just unlucky in having my recent visits to UK hospitals? I will let you be the judge of that.

On the med ...... and time for action ......

The good news is that I am now back at work after five weeks away, on a new diet, and awaiting the results of some recent tests - I have now visited a number of additional outpatient departments for an MRI, liver function tests, and blood clotting assessments etc.

Things are definitely improving, and now I have more energy and a clearer head, I will be challenging my resource efficiency and circular economy teams both in England and Wales to reflect on my experiences and reach out their networks of NHS Trusts to see just what they are doing locally, and whether it is good enough, and if we could help them make significant savings.

On the whole I can’t criticise the medical care I received in any of the hospitals I was based, but there is plenty of room for improvement around recycling, clinical waste bin contamination, and food wastage.

I know the staff where I was based soon understood what I did for a living as I asked them questions about their contracts, their staff training and their monitoring and evaluation programmes.

So perhaps I have done them some good, a fair exchange for the great medical care I received, but I fear that while budgets are being cut and staff have little time to think (they tend to react to life and death situations) that the wasted resources in our hospitals will go unchecked, and that is a drain on the public purse that need not be the case.

Come on, NHS you can do better and the money saved can be put to better use - a new scanner, lab or additional staff in critical departments might just be more affordable than you think.

Thank you all for you 'get well' wishes over the last month, they certainly helped cheer me up. I am almost back to normal service, and this experience has certainly given me a new issue to focus on, something for me to get my teeth into, and I expect to help drive the behaviours that we should expect from our public services. I will revisit this in a few months and see whether my renewed interest is having an impact.

As with all my ‘comments’ they are mine and mine alone. If you would like to get in touch or share your opinions then email me on For more of my blogs please refer to

Adam is global practice director for Ricardo Energy & Environment’s Resource Efficiency and Waste Management Practice, and is a Fellow of the Chartered Institution of Wastes Management and the Royal Geographical Society. He has more than 20 years of waste sector strategy, service design, procurement and communications experience, both in the UK and overseas, and is a regular industry commentator, author and conference speaker, both in the UK and around the world.

This material is protected by MA Business Ltd copyright.
See Terms and Conditions.


Please view our Terms and Conditions before leaving a comment.