“Waste management in Scottish hospitals”
Item 3 is for the committee to receive a briefing from the Auditor General for Scotland on his report "Waste management in Scottish hospitals: A follow-up report". I invite the Auditor General to brief the committee.
Mr Robert Black (Auditor General for Scotland):
With your agreement, convener, I shall ask Barbara Hurst to introduce the report to the committee.
Certainly.
Barbara Hurst (Audit Scotland):
The report follows up our previous baseline report, when we looked at waste management back in 2001. We kept the study fairly short and focused on those areas that we had previously identified as needing improvement. Those were issues around staff training, recycling and the sorting of domestic and clinical waste to keep them separate. Our initial decision to examine the issue was not primarily based on the expenditure, which, at £8 million a year, is a small proportion of the overall health budget. However, waste management is important for patient and staff safety and for environmental issues.
In the follow-up report, we found that progress had been made in a number of areas. The Scottish Executive Health Department made an active response to our previous report; it has provided a lot of support to boards and pursued our recommendations with them. The NHS Scotland property and environment forum has also provided support and guidance to health boards.
We found that, generally, training had improved since the previous audit. In every board area, there is now a senior person with responsibility for overseeing waste management. However, there are still a few areas in which improvements are needed.
We carried out a spot check in 53 hospitals and found that 15 had clinical waste in publicly accessible areas and nine had clinical waste bins with broken locks. Some hospitals fell into both categories. We should not make too much of the spot check, but we believe that it sends out a powerful message to senior managers that it is worth their walking the shop floor to ensure that policies are implemented in practice. We understand that, since the audit was carried out, the contractors have changed, significant progress has been made in dealing with the problem of broken locks on bins and far more waste audits are being carried out. That is good news.
The health service is a major producer of domestic waste. In 2001, we found very little evidence of recycling by hospitals. This time, we found that there have been some improvements, although it is fair to say that those are limited. We should credit hospitals that are doing a lot of work. We know that NHS Argyll and Clyde has won a United Kingdom national award for excellence in recycling. Borders general hospital and the Edinburgh royal infirmary also have good hospital-wide policies.
However, we believe that in the remainder of hospitals more effort needs to be put into recycling. There are a number of ward-level projects, but we found that two thirds of hospitals did not have a hospital-wide paper recycling scheme, more than half did not have a cardboard recycling scheme and a quarter had neither. The issue is not simple—hospitals need to have good storage and a good infrastructure for collection. We are not saying that the problem is the fault solely of hospitals. However, we think that more could be done.
There is evidence that some domestic waste is still being disposed of in the costlier clinical waste stream. That is not a safety issue, but it is a cost issue. We think that health boards could save about £1 million if there were better separation.
All boards have local reports and action plans, so we are hopeful that progress will be made on the issues that I have identified. I am happy to respond to comments or questions from members.
I will ask two questions, but I would like to preface them with an observation with which I am sure colleagues will agree. I welcome the fact that significant progress has been made on waste management and I believe that it is important that we recognise that progress. Audit Scotland's follow-up reports on the national health service do not always indicate that progress has been made. Can you unpick some of your insights into and observations on why there has been more effective progress on waste management than on other issues? We were told that the Health Department has taken a clear lead on waste management. How significant is that? Clear leaders on the issue have been appointed in NHS boards. How big a part has that played? How significant has the role of the property and environment forum been?
My second question relates to the issue of clinical waste being left in public areas. It strikes me that the problem will not be resolved first and foremost by major top-down policies and strategies or big investment programmes and that it is very much an issue of operational practice on the ground. Can you add to what you have said about why the practice of leaving clinical waste in public areas, which is a serious issue for a number of reasons, continues to occur in some instances?
External factors are one of the main reasons why progress has been made. A great deal of legislation and a large number of regulations are in the pipeline. There is also a clear recognition in the health service that the issue is important. In some ways, I am pleased about our previous report, which started to raise the profile of the issue. I hope that this report will continue to do that with waste managers.
You made an important point about leadership. The more that waste management is seen to be important to senior people in the health service and the more that it is linked to important initiatives on infection control, the better it is likely to be. In the report, we note some instances of clinical waste being left in corridors and outside wards. That is a real operational issue. It is fine to have policies in place and to have leadership, but we must ensure that everyone knows that they have a role to play in waste management. That is why we were careful to focus on staff awareness and training. There are likely to be local issues such as storage limitations or an insufficient number of porters to collect full bags of clinical waste. Those issues need to be addressed.
I was surprised that you did not mention St John's hospital in Livingston.
I am sorry.
I hope that shortly the hospital will be accredited at ISO 14001 level, which is an overall sustainability accreditation for energy management, as well as waste management. When producing the report, did you find evidence of other hospitals seeking accreditation?
I cannot answer the question, because we did not put it to hospitals.
You say in the report:
"The cost of clinical waste disposal could be reduced by £1.3 million if hospitals made sure that domestic waste is not disposed of as clinical waste."
Is that a net figure? To what extent will spending be required to achieve it? Can we estimate what hospitals might have to invest first?
That is a difficult question to answer. Obviously, the waste must be disposed of in some way. For understandable reasons, we did not look in the clinical waste bags to see what sort of domestic waste there was. Some of the waste might be able to be recycled, but some would have to be disposed of in landfill. It is difficult to isolate the pure costs, but clearly it would cost something to dispose of the domestic waste that is getting into the clinical waste stream.
Thank you for the briefing. When we discuss it later in the meeting, we will consider what action, if any, we wish to take.