The Offensive Line

Following on from his article earlier in the year, Stericycle’s David Williams analyses the results of its recent survey into offensive waste, and encourages healthcare organisations to “take a step back” and think about their actions

Earlier this year I wrote a piece for the Journal about the challenges in the management of offensive waste. I discussed the differing approaches to this waste stream in each of the UK countries and how the outcome of these differences has been an increase in diversion to landfill of wastes arising from healthcare, specifically in England and Wales.

Figure 1: key drivers for offensive waste segregation, biggest to smallest

I raised concerns about the legitimacy of this process and its implementation, in particular how it conflicts with the waste hierarchy and how it may be deployed for the wrong reasons.

I asked for stakeholders to respond to a short survey on the subject to try and better understand motives for segregating offensive waste in the acute healthcare sector, and to gauge opinion on the best environmental options for managing this waste stream and the technologies most commonly used in practice. Thank you to all those who responded, your views have proven invaluable in progressing this work.

I have also conducted a waste data review to try and quantify the impact of offensive waste segregation in the wider context of general waste management trends. The findings of the stakeholder survey and the waste data review are presented in the subsequent text, after which the current position is summarised and some recommendations made for change.

The Stakeholder Survey Findings

Figure 2: environmental options for offensive waste, best to worst

The survey drew responses from the full spectrum of industry stakeholders, with only one key stakeholder type not represented (no people identifying as regulators responded to the survey).

In the first question respondents were asked to rate the key drivers for offensive waste segregation, with 1 being the most important and 4 being the least important. Most people reported the regulatory driver as being the most important (61 percent of all respondents), with economic drivers second and environmental/other being the least important.

It is clear that people believe that offensive waste segregation is necessary to achieve legal compliance, but also that there are sound economic reasons for doing so. Very few people believe environmental drivers to be an important factor. Several comments were received relating to the “other” category, however none of these proposed an alternative important driver.

In the second question respondents were asked to rate the available management options for offensive waste from the best environmental option, to the worst environmental (where 1 is best and 6 is worst).

The following technologies all received comparable levels of support. They are listed in order of preference but there was no clear consensus:

  1. Municipal waste to energy incineration
  2. Healthcare waste to energy incineration
  3. Materials recovery / recycling
  4. Healthcare waste alternative treatment with recovery of residues

This indicates that there is unlikely to be a “one size fits all” solution for offensive waste, and that a range of techniques will remain appropriate. There was, however, a clear consensus that landfill is the least desirable environmental option, with over 60 percent of respondents rating it as the worst, and only five percent rating it as best.

Only two additional management techniques were proposed under the “other” category: reduction and gasification. Reduction is an important factor (as part of prevention strategies) but is outside the scope of this survey, which considers management options for the waste once it has been generated. Gasification should be given due consideration but, for the purposes of this analysis, could reasonably be considered as a sub-set of incineration.

In the third question respondents were asked to rate the management options currently used for offensive waste, from the most used to the least used (where 1 is most and 6 is least).

There was a clear consensus that landfill is the most widely used option, with almost two-thirds of respondents rating it as such. This contrasts starkly with the clear consensus that it is the worst environmental option.

Healthcare waste and municipal waste-to-energy incineration were considered to be the next most commonly used, followed by healthcare waste alternative treatment, other techniques, and finally materials recovery/recycling being the least used. This was despite its position as one of the four preferred environmental options. No additional commonly used techniques were proposed under the “other” category.

The survey findings are a useful gauge of opinion, and a general consensus is implied which suggests we are managing offensive waste in the wrong way, for the wrong reasons, potentially at detriment to the environment.

An important question to ask is whether there is evidence to support these opinions. Can the impact of offensive waste management in England and Wales over the last decade be quantified?

Quantifying The Landfill Burden

Figure 3: current options for offensive waste, most to least

The publicly available waste data archives for England provide the means to do this. Data for the 10 years from 2006 to 2015 was selected as appropriate for review, as the existing framework of regulation and guidance that started the process of change toward the current position dates back to 2005-06 (the Hazardous Waste Regulations 2005 introduced the ban on mixing and the Department of Health guidance HTM07-01 was first published in 2006), and 2015 is the most recent year for which published data is available.

The following chart shows the tonnes of offensive waste deposited in landfill each year from 2006 to 2015. Only data for England is shown as equivalent data for Wales has not been published since devolution of environmental regulation commenced in Wales in 2013.

Between 2006 and 2015 there was a 39.7 percent increase in landfill of offensive waste in England. For purposes of comparison, the following chart shows the trend in total landfill tonnages over the same period.

Between 2006 and 2015 there was a 36.3 percent decrease in landfill of all wastes in England. Although absolute tonnages of offensive waste are insignificant relative to the total volume of landfill, the trend is significant in that it is almost the exact opposite of the general reduction in landfill.

How Did We End Up Here?

The offensive waste transition over the last 10 years can be summarised in a few short sentences:

  • the healthcare sector in England and Wales has segregated ever increasing volumes of offensive waste, most of which has been deposited in landfill despite being suitable for treatment with some element of recovery
  • there is a consensus among stakeholders that this change has been driven primarily by regulatory factors, with economic factors of secondary importance and environmental factors largely unimportant
  • although better compliance with the legal ban on mixing may have been achieved, in the case of offensive waste this has been without any regard to the actual objectives of the ban
  • the outcome was a 39.7 percent increase in offensive waste landfill in England from 2006 to 2015 during the same period, total landfill in England decreased by 36.3 percent
  • if offensive waste had followed the same trend as total landfill, over 340,000 tonnes of waste could have been kept out of landfill
  • there is a consensus among stakeholders that landfill is the worst environmental option for managing offensive waste, despite it being the option most commonly used
  • evidence from a number of independent audits of offensive waste streams destined for landfill routinely identifies the presence of non-permitted items in the waste stream including pharmaceuticals, liquids, potentially infectious materials, and patient identifiable confidential information.
Figure 4: offensive waste, tonnes to landfill 2006-2015

So how did we end up here? An outcome that is not supported by the majority of stakeholders, is failing to achieve the objectives of legislation, and is not environmentally sustainable.

The starting point is the ban on mixing a hazardous waste with a non-hazardous waste, introduced in England and Wales by the Hazardous Waste Regulations 2005 (regulation 19; which implements Article 18 in the EU Waste Framework Directive).

The regulator in England and Wales has sought to promote the segregation of offensive waste from infectious clinical waste in the healthcare sector, on the basis that it is a legal requirement to comply with regulation 19 of HWR2005. This is the position that the EA (and now NRW in Wales) has maintained in all discussions with healthcare providers and has required that they implement after audit of healthcare facilities.

Since 2011, it has also been a legal requirement to take all reasonable measures necessary to apply the waste hierarchy for the management of any waste stream (regulation 12 of the Waste (England and Wales) Regulations 2011 which implements Article 4 of the EU Waste Framework Directive).

In the case of offensive waste it is clear that there is a potential conflict between the two articles of the directive (and corresponding domestic implementing legislation), so it is important to consider the objectives of the directive.

The purpose of the ban on mixing is to prevent poor waste management practice, such as the masking or dilution of waste with hazardous properties to enable a lower standard of treatment, and ultimately a lower level of environmental protection. The directive specifically allows derogation from the ban on mixing where the mixing does not pose any risk of harm and can be demonstrated as representing Best Available Techniques (BAT).

Given that the objective of BAT in the context of the directive should be techniques that facilitate transfer of the waste to the highest possible level up the hierarchy while ensuring environmental protection, a clear case can be made that mixing of the infectious and offensive waste streams produced in a healthcare environment is in fact BAT, and that the article 4 considerations should override those of article 18.

Where Do We Go From Here?

Figure 5: total waste, tonnes to landfill 2006-2015

The status quo is not sustainable. Continuing to landfill a waste stream for which there are viable recovery options (and which routinely contains wastes banned from landfill) does not make sense. Progress can be made to effect beneficial change; the challenge will be to be engage those in a position to act and to negotiate a pragmatic way forward.

The regulatory approach to waste classification and segregation should be rebalanced. For many waste streams a process driven approach has improved environmental outcomes, but this is demonstrably not the case for offensive waste. The regulators could take a lead on this now by reconsidering the advice given to healthcare providers.

Government also has a role to play. The healthcare waste sector is unique in that the vast majority of the waste is produced by the public sector. Both Defra and the Department of Health (DoH) have been too unengaged in waste management issues in recent years. The current political climate will continue to put resources under strain for the foreseeable future but there are also opportunities.

Defra has commenced a review of the national hazardous waste strategy and should engage with the DoH to understand the challenges of this niche but critical area of waste management.

There must also be a recognition that environmentally sound waste management comes at a price. The DoH must recognise that the NHS cannot expect to meet its environmental and de-carbonisation obligations whilst paying an ever lower price to have its waste removed. The savings made in the dash for offensive waste are masking the true environmental and economic costs.

When the economic base allows, industry must innovate and invest to meet future infrastructure needs. Viable options for recycling and recovery of materials from the offensive waste stream remain thin on the ground.

Healthcare organisations should take a step back and consider their processes. There are many examples of good practice at the operational level, but there are challenges at the policy and procurement level that are increasing the risk of non-compliance and poor environmental outcomes.

Has the right balance been struck between environmental and economic considerations? Is there any senior management involvement and do they understand what their organisation is sending to landfill?


Darrel Moore

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