Directors of nursing should be involved in tackling NHS waste management problems, say nurse leaders

RCN report on NHS England waste management reveals huge disparity in cost of processing waste

RCN report on NHS England waste management reveals huge disparity in cost of processing waste

  • Financial and environmental reasons for emphasising issue of waste at board level 
  • Respondents at 15% of NHS trusts surveyed never report on waste to their board
  • Nurses have 'significant role’ in reaching national target on carbon-dioxide-equivalent emissions

Picture: iStock

According to an RCN report on the management of waste in the NHS in England, organisations with ‘innovative strategies’ on waste management could deliver significant improvements, foster a culture of engagement and create data that would drive cost savings to the NHS at local and national level.

The report reveals huge variation across organisations in the cost of processing waste: from less than £100 to nearly £22,000 a tonne.

Nursing leaders stated that directors of nursing should use their influence to ensure waste management is seen as a board issue in NHS organisations. There are financial and environmental reasons for emphasising the issue of waste at board level, the report states.

Sustainability agendas

There are also opportunities for organisations to integrate the issue into their overall sustainability agendas.

However, according to staff at 15% of the 156 trusts that responded to the college’s survey on waste management say they never report on waste to the board, in contrast to 60% that report annually.

‘Nurses want to be part of the solution to the problem of waste management’

RCN chief executive Janet Davies

RCN professional lead for infection prevention and control Rose Gallagher says: ‘If 15% of trusts have no form of reporting at board level, it means they may be completely unaware of the potential to improve waste management processes.’

Ms Gallagher adds that discussion at board level could also be incorporated into conversations about sustainable plans. Directors of nursing can ask what their organisations should be discussing and how this can be brought together with other issues, such as sustainable plans, to produce impressive results.


fewer tonnes of waste were produced overall by the NHS in England in 2015-2016 than in 2009-2010

(Source: RCN)

‘How are organisations joining up these things and how are they making improvements to their carbon footprints?’ she asks. 

‘If waste management is not discussed at board level, it is not being discussed as a multi-professional issue.

‘My hope is that directors of nursing will read this RCN report and start asking questions; we want them going back to their organisations saying: “We need to discuss waste at board level.”’

RCN chief executive Janet Davies agrees with Ms Gallagher. ‘Nurses want to be part of the solution to the problem of waste management and help to reduce the striking variations between trusts that our report identifies,' she says.

‘We need to empower senior nurses to speak up about this; our research has identified significant savings for the NHS if nurses can be supported to manage waste segregation differently.’

The report highlights huge disparities across England in the costs of dealing with NHS waste, as well as the amounts of bagged tonnes being produced. 

The three categories of bagged waste are non-hazardous municipal, non-hazardous offensive and hazardous infectious waste.

Counting the cost

Costs of dealing with waste are steadily rising and the total cost of waste reported by 69% of NHS trusts was £33.3 million in 2015-2016.

Infectious and municipal waste has seen a reduction in overall tonnage when compared with a previous survey conducted by the RCN in 2009-2010.

‘Directors of nursing can be the spokesperson to get the support nurses need to do the right thing’

RCN professional lead for infection prevention and control Rose Gallagher

Infectious waste reduced by 33%, down to 60,780 tonnes in 2015-2016, while municipal waste reduced by 15%, down to 110,103 tonnes in the same period.

However, the amount of offensive waste has risen. This kind of waste can include items containing bodily fluids, but is thought to pose no infection risk. Examples include stoma and catheter bags and incontinence pads.

In 2009-2010, trusts reported 3,312 tonnes of offensive waste being produced, but in 2015-2016, this figure rose more than four times, to 14,350 tonnes.

£33.3 million 

Total cost of waste reported by 69% of NHS trusts in 2015-2016

(Source: RCN)

Ms Gallagher thinks that increasing awareness and education of nurses around the categorisation of waste may have led to the rise in the amount of offensive waste being produced.

The college released updated guidance for nurses in 2014 about how to assess and sort waste and is in the process of updating this guidance.  

‘We have been careful to stress that, although nurses are probably the largest producers of waste, forming 70% of the NHS workforce, the management of waste is not “a nursing issue”,’ says Ms Gallagher. ‘However, we need to do the right thing and segregate waste correctly.’

‘Directors of nursing can be the spokesperson to get the support nurses need to do the right thing, at the patients’ bedside, where we produce most of our waste.’

Need for support

The RCN report states that nurses ‘have a significant role’ in supporting their employing organisation to comply with relevant waste regulations, financial savings and the national target of a 34% reduction in carbon-dioxide-equivalent emissions by 2020. 

And it acknowledges the need for support in terms of local expertise on waste management, information and having appropriate systems in place to help manage waste correctly in all care settings.

In this vein, one of the recommendations is for NHS England to ensures that all NHS providers ‘use the expertise of a suitably qualified and experienced waste manager’ to support nursing teams and departments.

This would create quality-assured sustainable management of various waste streams, the report suggests.


reduction in carbon-dioxide-equivalent emissions is a national ambition for NHS trusts to meet by 2020

(Source: RCN)

Ms Gallagher says: ‘It is important that directors of nursing have got relationships with their waste managers, if trusts have them.

‘Or, if they don’t, they should actively influence the board to ensure a waste manager is available in the trust.’

She suggests that smaller trusts might be able to work together to share a manager.

‘Waste managers are experts; they know the industry and can provide education, training and support, as well as work with staff to find the best solutions locally.’

Ms Davies adds: ‘Our members tell us that the single thing that makes the biggest difference is whether trusts employ a dedicated waste manager. Senior nurses need to have the confidence to advocate for such positions when they are not in place.’

Low-carbon and renewable-energy solutions

According to a NHS Improvement spokesperson: ‘We are working with the NHS to make it the greenest, most future-fit organisation it can be.

'Over the next three years, we will be helping providers create and deliver plans which work towards low-carbon and renewable-energy solutions to help us significantly reduce the NHS’s carbon footprint and deliver at least £150 million of efficiencies each year by 2021.

‘As part of this transformation, we will be working with trusts to review the data collected across the sector to identify and reduce unwarranted variation across the system in all aspects of sustainability.’

Focus on procurement

An important recommendation of the RCN report on waste management is for the NHS to focus on the importance of procurement criteria. 

Consumables should be selected by organisations equally on quality and safety, as well as the ability to dispose of packaging or used items, says the RCN.

The college asks Category Tower Service Providers, organisations providing procurement services to the NHS in England, to publish an annual report on how procurement decisions affect waste and carbon-equivalent reductions.

RCN professional lead infection prevention and control Rose Gallagher says: ‘Directors of nursing can also influence procurement.

‘They can try to get the amount of waste reduced and help make decisions about products with excessive packaging.’

Other recommendations from the report include:

  • NHS Improvement (NHSI) should collect, compare and publish data on NHS trusts’ waste management systems
  • NHSI should investigate variations in waste types generated by NHS trusts and support ways to reduce variations in assessment and cost of waste
  • NHS England should ensure that all providers use the expertise of suitably qualified and experienced waste managers to support nursing teams and departments
  • The criteria for waste data collected through the Estates Return Information Collection system should be reviewed and amended so that the data are meaningful and can be compared


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