Final Project Report 2006
Project number: A539
1


2006 CHESS (Cornwall Healthcare Estates and Support Services)
May 2006
This report was prepared for CET (County Environmental Trust) by CHESS
(Cornwall Healthcare Estates and Support Services).
Report authors:
Terry Tudor, Sharon Butler, Claire Marsh (nee Noonan) Judith Vanhorn, Clive
Hoskins, Claire Neal, Mark Summers, Claire Neal, Loveday Jenkin
All rights reserved, including the right to reproduction in whole or in part in any form.
Please address inquires for copies or further information to:
The Utilities Department. St. Lawrence’s Hospital. Bodmin. Cornwall UK. TR1 3LJ.
(See also page 44 for WIN Project contacts)
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TABLE OF CONTENTS_____________________________________________________ 4
List of Abbreviations and Acronyms ____________________________________________ 4
Executive summary _________________________________________________________ 5
CHAPTER 1 _______________________________________________________________ 6
Introduction _____________________________________________________________ 6
Structure of the report _____________________________________________________ 7
CHAPTER 2 _______________________________________________________________ 8
The county of Cornwall ____________________________________________________ 8
CHAPTER 3 ______________________________________________________________ 14
3.1 The NHS ___________________________________________________________ 14
3.2 The Cornwall NHS ____________________________________________________ 17
CHAPTER 4 ______________________________________________________________ 20
4.1 The WIN Project _____________________________________________________ 20
4.1.1 Background ________________________________________________________ 20
4.1.2 Project approach ____________________________________________________ 22
4.1.3 Overall WIN Project achievements ______________________________________ 22
4.1.3.1 Phase one ______________________________________________________ 23
4.1.3.1.1 Analysis of waste streams _____________________________________ 23
4.1.3.2 Phase two ______________________________________________________ 26
4.1.3.2.1 Logistical factors (waste trials, containment and collection systems) ____ 26
4.1.3.2.2 Social issues (building awareness and changing attitudes) ____________ 29
4.1.3.2.3 Up-stream management (sustainable procurement and use of recyclables) 33
4.1.3.2.4 Compliance and health and safety _______________________________ 36
4.1.4 Limitations ________________________________________________________ 38
CHAPTER 5 ______________________________________________________________ 41
Contacts about the WIN Project _____________________________________________ 44
Useful websites ____________________________________________________________ 44
APPENDICES ____________________________________________________________ 45
Appendix 1 – The initial WIN Project Team ___________________________________ 45
Appendix 2 - Promotional material used during the WIN Project ___________________ 46
Appendix 3 – An example of an Information sheet used during the WIN Project ______ 47
Appendix 4 – Long-term waste management plans for waste from the Cornwall NHS __ 48
REFERENCES ____________________________________________________________ 51
Personal communication __________________________________________________ 55
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List of Abbreviations and Acronyms
CES – County Environmental Services
CET – County Environmental Trust
CHESS – Cornwall Healthcare Estates and Support Services
CPT – Cornwall Partnerships Trust
DEFRA – Department for Food and Rural Affairs
DETR – Department for the Environment, Transport and the Regions
EnRep – Environmental Representative
EU – European Union
HDPE – High Density Polyethylene kg - Kilograms
LDD – Learning Disability
MH – Mental Health
NHS – National Health Service
NHS PASA – NHS Purchasing and Supplies Agency
PCT – Primary Care Trust
PET – Polyethylene Terephthalate
RCH – Royal Cornwall Hospital
Remade Kernow – Recycling Market Development in Cornwall
WIN – Waste It Not vol. - Volume
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Executive summary
The quantity of waste being produced in the UK from all sectors continues to rise each year. The UK Government has sought to implement a number of policies and measures to encourage greater efficiency and better manage that produced.
This report details a local initiative in the form of a waste minimisation project in the Cornwall NHS called the ‘WIN (Waste It Not) Project’. The WIN Project ran between the period of December 2002 and December 2005 and was developed in response to growing national, county and organisational drivers for a more sustainable approach to the management of waste. Through a holistic, collaborative and strategic approach the project set out to undertake research and conceptualise strategies to manage the waste in a more sustainable manner. The report highlights a number successes achieved by the project including:
(1) The development of baseline data on all of the major waste streams
(2) Improved logistics (e.g. implementation of standardised containment systems for domestic, clinical and recycling waste, and collection of bulky waste)
(3) Addressing social concerns (e.g. increased staff training, awareness of waste issues through amongst both internal and external publics, and participation in recycling and segregation schemes)
(4) Up-stream management (e.g. increased use of sustainable procurement and recyclables)
(5) Greater compliance with health and safety and legislation
It also highlights some limitations, including staff turn over and the inability to extend the length of the project beyond its initial time boundaries. However, despite these limitations, overall it can be deemed that the project was successful and can serve as a useful model for others in that it was able to meet and indeed in some cases surpass several of its initial goals and objectives.
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CHAPTER 1
Introduction
Whilst the quantity of waste being produced in the UK is steadily increasing, the availability of landfill space is decreasing (DETR, 2000; DEFRA, 2005). In response, Government has sought to implement a number of policies and initiatives to encourage a more sustainable approach to the management of waste from all sectors
(DETR, 2000; DEFRA, 2003; 2005 a
; 2006), including:
(1) The development of several strategic governing policies including the integrated ‘Environmental Protection Act 1990’ (DOE, 1990),
‘Making Waste Work’ (DETR, 1995), ‘Less Waste: More Value’
(DETR, 1998), ‘A Way With Waste’ (DETR, 1999), the ‘Waste
Strategy 2000’ (DETR, 2000 1 ) and the ‘UK Government
Sustainable Development Strategy – securing the future’ (DEFRA,
2005 a
)
(2) A more integrated management approach and consultation between stakeholders
(3) The implementation of a range of market-based drivers such as increased Landfill Tax, Tradable Permits for packaging waste and
Producer Responsibility
In addition, there has also been the imposition of recycling and recovery targets and baselines for most sectors including Local Authorities following the implementation of the EU (European Union) Landfill Directive (EU, 1999) and promotions such as the national waste minimisation campaign ‘Are you doing your bit?’ All of these efforts have been aimed at reducing the quantity of waste going to landfill.
Specifically for organisations Government states that through a reduction in environmental impacts such as a reduction in waste to landfill, they can significantly
1 Under review in 2006
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reduce costs and better manage their environmental risks and liabilities (DEFRA,
2006). Indeed, a number of initiatives have been put in place to encourage organisations to increase the efficiency of their processes, save money and manage their resource use (BREW, 2005). Amongst these programmes have included the development of various support agencies such as BREW (Business Resource
Efficiency and Waste Programme), WRAP (Waste Resources and Action
Programme), NISP (National Industry Symbiosis Programme) and the MTP (Market
Transformation Programme). These initiatives have focused on encouraging organisations to target raw material use, reduce waste, water and energy use, as well as transport and packaging (DEFRA, 2006).
This report examines sustainable waste management initiatives in the healthcare sector, with a focus on the NHS (National Health Service) within which a number of initiatives have been put in place. Specifically, the study details the results of one such sustainability initiative, a waste minimisation project called the WIN
(Waste It Not) Project within the Cornwall NHS, which ran from December 2002 until December 2005.
Structure of the report
The report is set out in five chapters. Chapter 1 has provided a brief overview of Government’s focus for a more sustainable approach to waste management, and the systems that have been put in place at the national level to support this drive. Chapter
2 will outline background information on the County of Cornwall and key issues surrounding waste management in the County. In Chapter 3 the key factors surrounding waste management in the NHS nationally, as well as in the Cornwall
NHS are examined. Chapter 4 will outline the structure and approach employed for the WIN Project, and detail its major achievements and limitations. Finally, concluding remarks are discussed in Chapter 5.
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CHAPTER 2
The county of Cornwall
Waste management in the Southwest of the UK has a number of features that make it unique. The environment of the South West is characterised by three key issues:
(1) Historical disposal of significant quantities of sewage and bioorganic discharges to sea
(2) A shortfall of landfill space (resulting in protracted licensing and planning consents)
(3) Significant localised sites with high metal contaminated soils and acidic mine water discharge to surface waters, particularly in
Cornwall
In addition, a heavy reliance on surface water extraction, coupled with limited reservoir capacity, has lead to the region being very drought sensitive. This has therefore lead to charges above the national average for solid waste management, liquid effluent treatment and the supply of water. Coupled with these factors is the remoteness of the region from the major recycling and hazardous treatment facilities and significant seasonally fluctuations in the environment. Compounding these environmental concerns is the fact that the population in the South West is thought to be growing at twice the national average, which will require increased provision of services.
A somewhat now dated study commissioned by the waste management company Biffa (1995), found that even though 75% of companies in the South West,
(against a national average of 56%) knew how much they spent on wastes, the South
West was slow to translate this knowledge into action, by putting appropriate waste management plans in place. Following on from this, the South West Regional
Assembly (which has overall responsibility for implementing Government policy at the local level) has stated its objective of making the South West a minimum waste
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producer by 2030. This would be achieved through measures such as green procurement, the development of markets for recyclables, greater household access to convenient segregated collection schemes, increased public education about waste management, product redesigning and having the infrastructure in place to increase and encourage recycling and reuse (SWRA, 2002).
As illustrated in Fig. 2.1 Cornwall is the most South Westerly county in the
UK. It covers an area of 876,650 acres (354,920 hectares) and from Lands End to
Bude measures 132 km (82.5 miles) in length, with the distance between the north and south coasts varying between 72 km (45 miles), at the eastern end, to 8 km (5 miles) at the western end of the county (Cornwall County Council, 2001). According to the
2001 population census, the population of Cornwall and the Isles of Scilly is 501,267 people ( www.statistics.gov.uk/census2001 ), with an annual visitor total of about 3 million people, contributing an estimated 23% to the local gross domestic product
(Cornwall County Council, 2001). In addition to the Cornwall County Council there are six district councils: North Cornwall, Caradon, Restromel, Carrick, Kerrier and
Penwith.
Fig. 2.1 Map indicating the geographical location of Cornwall in relation to the UK
Source: www.cornishlight.co.uk
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The rural state of the county compounded by its peninsular nature and heavy historical reliance on industry (particularly the mining and farming industry), have played a large part in the type and management of waste in Cornwall. In 2001 the
County Council estimated that the county was producing approximately 7.28 million tonnes of waste each year. The largest percentage of this waste was thought to be agricultural in nature. As is the case across the UK, traditionally the majority of the county’s waste has gone to landfill. There are currently seventeen landfill sites for inert wastes and two for special/hazardous wastes in the county. These two sites are at
United Mines, in Redruth, near St. Day (which is scheduled to close in 2010) and
Connon Bridge in Liskeard (scheduled to close in 2006/7) ( www.cornwall.gov.uk
).
The United Mines site has planning permission until 31 st
October 2010, hence replacement landfill capacity will have to be found for the west and central areas of the county after this date. Its geographical nature therefore means that it is crucial for
Cornwall to come up with sustainable solutions for managing its waste.
Hence, it can be seen that there are a number of challenges facing waste management in the county. However, at the same time, there are also opportunities for diversion away from landfill. In terms of the municipal waste in the county, a study by the research company SWAP (2002), showed that waste generation rates varied widely across the county, from 7.56 kgs/household/week, to 17.79 kgs/household/week, with an average of 12.93 kgs/household/week. The study concluded that between 54% and 63% of the domestic waste could be recycled or composted, with an average of 21.3% from all areas being compostable (kitchen and garden waste). General waste was comprised primarily of putrescible waste (kitchen waste) (40%), followed by paper (17%) and glass (9%). The main recyclables in the general waste were magazines and PAMS (Printed Advertising Material), noncorrugated cardboard packaging, clear and green bottles and jars, PET (Polyethylene
Terephthalate) bottles and coloured HDPE (High Density Polyethylene) bottles. Dry recyclables were comprised mostly of paper (78%), (particularly in the more affluent areas, i.e. the regions of higher ACORN categories), in addition to corrugated cardboard, packaging, glass jars and bottles, plastic bottles and ferrous food and beverage cans. As illustrated in Fig 2.2 the study showed that household waste composition for the county was primarily comprised of putrescible (28%), paper
(19%), miscellaneous (13%) and glass (8%).
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4%
13%
27%
4%
1%
19%
6%
1% 6%
5%
6%
8% paper cardboard glass plastic film dense plastic ferrous metals non-ferrous metals putrescible textiles miscellaneous hazardous household fines
Fig. 2.2. Estimated composition of household waste in Cornwall
Source: SWAP (2002)
In recent times therefore, there have been efforts to reduce the quantity of waste that is sent to landfill and to examine alternative options. The recycling rate in
Cornwall has moved from around 6% in 1998 to 10% in 2001, and currently stands around 23% (DEFRA, 2005 b
). Cornwall County Council in its drive towards zero waste has aimed to achieve recycling targets of 20% by 2006 and 40% by 2010, through initiatives such as the ‘Recycle Now’ campaign in 2004/5. ReMade Kernow, which is responsible for the development of the recyclates market in Cornwall, has also instituted a major waste minimisation programme on behalf of the county council and the six district councils called ‘Recycle for Cornwall’. ReZolve the partnership of
Cornish organisations that provides advice on waste management has proposed a target of 60% by 2015 (ReZolve, 2003). One aspect of this drive to 40% has been a
25-year PFI (Public Finance Initiative) contract for a 50,000 tonne capacity MRF
(Materials Recycling Facility) at Bodmin (which was built in 2003), to complement another at Redruth. This is in addition to the introduction of a biowaste collection scheme, with separate collection for kitchen waste and increased garden waste composting, the enhancement of existing CA (civic amenity) sites and the rebranding
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of additional sites as household recycling centres, in addition to an education and awareness programme (MRW, 2003 a
). There are presently around 900 recycling banks for paper, cans, glass, textiles and plastic bottles in the county and close to 90% of the domestic dwellings have access to fortnightly kerbside collections (MRW,
2003 b ). Currently there are also 12 CA sites in the county and the County Council uses three composting sites at Bake Farm in Saltash, Downs Farm in Camborne and
Splattenridden Farm in Hayle, whilst North Cornwall District Council also uses facilities at Tinten Farm in St Tudy.
These efforts have not been without limitations. For example, most of the recyclables are transported out of the County to the Midlands, south Wales or to the
North, primarily Yorkshire for processing, due to a lack of available facilities in the
South West of England. Approximately 90% of the special/hazardous waste is exported out of Cornwall for recycling, treatment or disposal, as there are limited facilities in the county. Total household waste stood at 263,000 tonnes in 1999/2000 and line with national figures has increased by around 3% per annum. This growth is predicted to fall to 2% per annum after 2004 up to 2009, and decrease further to 1% through to 2011. This decrease should occur due to the implementation of waste minimisation programmes, despite plans to build 45,500 new homes in the county between 1991 and 2011. Key sustainable waste management policy decisions have also changed rapidly over the years, for example the creation of a Resource Recovery
Centre at Roche in central Cornwall and ‘Greenpark Cornwall’ (CES, 2002) which have been proposed, have since been abandoned. Other plans for the use of pyrolysis, gasification and mechanical biological treatment (MBT) facilities, at the ‘back end’ of recycling and composting and an energy-from-waste plant have also been shelved.
Finally, even though there are many agencies that influence waste management in the county, there is limited coordination between them. For example, within the county, there are a number of waste management companies such as CES (County
Environmental Services), Biffa, Sid Knowles and Wyvern Waste. Additionally, there are also a number of organisations such as SKW, Rag and Bone and Cornwall Paper
Company who are concerned specifically with environmental (waste) issues, as well as others such as the NHS (National Health Service) which though not directly involved, have a significant role to play.
Hence, in addition to the geographical pressures, there are also several countywide issues (particularly the need for the building of capacity and an
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infrastructure), that are driving the need for a more collaborative approach towards waste minimisation efforts that can be of benefit to the organisations in Cornwall and to the county itself.
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CHAPTER 3
3.1 The NHS
The NHS (National Health Service) is the largest public sector organisation in the UK. It was established in 1948 and was the first health service in western society to offer free medical care to the entire population, i.e. based on need rather than the ability to pay (The NHS, 2005). The NHS is comprised of a range of professionals, support workers and organisations. At the top are the policy makers, comprised primarily of the Secretary of State for Health and the DOH (Department of Health), aided by the Modernisation Agency. Health Authorities, particularly the SHAs
(Strategic Health Authorities) play an important role in translating this policy at the local level, by acting as the main link between the DOH and the various NHS Trusts.
SHAs were set up in 2002 and there are currently 28 SHAs in England (The NHS,
2005). It is expected that they will play an especially significant role in the monitoring of all environmental targets including waste, as they begin to become more established.
Key NHS Trusts include PCTs (Primary Care Trusts) which provide routine healthcare and are based in the community and the larger Acute Care Trusts that provide acute care services and are found in the large towns and cities of the UK. The
NHS is the largest employer (an estimated 2 million people are employed in the health services in the UK), as well as being one of the largest food buyers and one of the highest producers of waste in the UK (Coote, 2002). Operating costs are also high, an estimated £69 billion annually, in 2005 (The NHS, 2005). This amounts to more than
50% of the annual public sector expenditure in the UK, which is approximately £125 billion (DEFRA, 2006).
As illustrated in Table 3.1 healthcare institutions in the UK are amongst the highest producers of healthcare waste, as compared to other countries in Europe and the USA. The system of classifying healthcare waste is also different between the UK and Europe and generally there is more effective segregation of waste in Europe.
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Table 3.1
Generation rates of healthcare/medical waste in selected countries
Country
UK
Ireland
USA
France
Portugal
Belgium
Greece
Italy
Spain
Netherlands
Taiwan
Germany kg/patient/day
5.5
2.6
2.2
1.9
1.5
1.4
1.4
1.0
0.6
0.6
0.5
0.4
Sources: Krisiunas et al. (2000), Chung and Lo (2003)
It has been stated that the NHS produces 600,000 tonnes of clinical, pharmaceutical, infectious and domestic waste per year, at a cost of £42 million
(Coote, 2002). Hence healthcare waste generation rates in the UK are very high.
The increases in the NHS waste has been linked to the increased use of disposables in healthcare. This growth in the use of disposables has been attributed to:
(1) Increased concern over infection control to reduce nosocomial
2
diseases
(2) The need to provide more expedient treatment has resulted in shifts in technology, including greater use of disposables such as sharps
(3) Increased costs of healthcare labour and handling and sterilisation of equipment
2 Nosocomial – hospital-acquired.
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(4) General acceptance of disposables as a part of the waste stream
However, Coote (2002) argues that if NHS resources were utilised in a more efficient manner, it would:
(1) Benefit the local communities
(2) Safeguard the environment
(3) Reduce the demand for healthcare, by tackling unemployment, boosting local businesses, reducing the amount of waste they produce and make their buildings more energy efficient
There are also a number of legislative drivers impacting on the NHS aimed at greater sustainable environmental performance, including the EPA 1990 (DOE,
1990), the Landfill Directive (EU, 1999), the Hazardous Waste Directive (EU, 2004 a
) and the WEEE (Waste Electrical and Electronic Equipment) Directive (EU, 2004 b
). In response, a number of sustainable development initiatives and guidance documents have been produced with the aim of saving costs and reducing the impact on the environment (NHS Estates, 2002 a ). These include the NHS’ own Waste Management
Prevention Guide and Screening Tool, which allows for an assessment of waste management options based on the main criteria of costs, performance, risk assessment and environmental impact (NHS Estates, 2000). Other documents and initiatives include ‘Developing an Estate Strategy’, ‘Sustainable Development in the NHS’, the
‘Healthcare Waste Minimisation - a Compendium of Good Practice, ‘Environmental
Issues in Purchasing’ and ‘The NHS Healthy Transport ToolKit’ (NHS Estates,
2002 a ).
This awareness of the potential benefits has meant that hospitals and other medical facilities in the UK are increasingly looking to improve the efficiency of their processes (NHS, 2000; NHS Estates, 1997; 2001 a
; 2002 a,b
). Several hospitals in the
UK including Derriford Hospital in Plymouth, University College London Hospital’s
NHS Trust, Queen’s Medical Centre and Nottingham University Hospital NHS Trust
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have all started to examine options for waste minimisation, waste segregation and alternatives to disposal. These measures include:
(1) Sending secondary packaging back to suppliers
(2) Use of electronic media for disseminating information
(3) Removal of recyclables such as HDPE, PET, cardboard, toner cartridges and office paper from the waste stream, and the use of either reusable or biodegradable nappies
(4) Use of composting, anaerobic digestion and CHP (Combined Heat and
Power) to treat their waste
In addition, hospitals such as Preston Acute NHS Trust have also implemented segregation schemes for their clinical waste to reduce costs (NHS Estates, 2000;
2001 b
). Specifically within the Cornwall NHS there have also been a range of sustainability initiatives, including the building of a centralised food production unit
(RCHT, 2002), the purchasing of fish and fresh produce from local suppliers (West
Briton, 2005) and the on-site EnRep (Environmental Representatives) Scheme where designated staff are responsible for championing environmental management at their site. This scheme was identified as good practice at the NHS Estates’ Building Better
Healthcare Awards in 1999.
3.2 The Cornwall NHS
The case study organisation, the Cornwall NHS is comprised of 5 NHS Trusts
(four PCTs and one Acute Care Trust) approximately 100 sites and employs some
9536 staff (Millership S. per. comm.). NHS Trusts are responsible for the strategic planning of healthcare service provision and are comprised primarily of PCTs, Acute
Care Trust, Ambulance Trusts and Mental Health Trusts. PCTs provide primary care such as dentists and general practitioners and are found in the community. Acute Care
Trusts (which are found in the larger towns and cites of the UK) provide acute and specialised care, such as surgeries. Mental Health Trusts provide mental health
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services, whilst ambulance Trusts are responsible for patient transport (The NHS,
2005). These sites include three acute hospitals, 15 community hospitals (including one with mental health facilities), eight MH/LDD (Mental Health/Learning Disability) in-patient units/homes, 23 health centres, four drop-in centres, as well as a number of offices and administrative facilities. There are approximately 1800 NHS beds in the county.
Waste management, as well as broader environmental management across the entire Cornwall NHS is handled by the CHESS (Cornwall Healthcare Estates and
Support Services), which is a shared service amongst all of the Trusts (Tudor et al.
,
2005 a
). As shown in Fig. 3.1 there is one waste manager for the county with two main assistants. Direct responsibility for on-site waste management is that of individual site managers through EnReps (Environmental Representatives), who voluntarily carry out the role in addition to their full time jobs (Tudor et al., 2005 a
).
Government/NHS Estates nationally
(produces waste management guidance and policies)
Waste Manager
(interpretation to
Trust/local needs)
Trust management
(ratification of policies)
On-site EnReps
(50% of the sites)
Individual staff members Individual staff members
Fig. 3.1. The organisational structure of waste management in the Cornwall NHS
Adapted from Tudor et al. (2005:610)
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There is only one specific training session for staff in waste management, which is held during induction. The organisation produces in excess of 7,000 tonnes of waste per annum, costing in excess of £300,000 (Butler S., per. comm.). Hence, due to limited landfill space and a number of pressures including increasingly stricter environmental management legislation and rising waste quantities and costs, options for a more sustainable approach to managing the Cornwall NHS waste were therefore vital.
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CHAPTER 4
The previous chapter indicated the drivers for action towards a more sustainable approach to the management of the waste from the NHS, as well as background information on the Cornwall NHS and waste management in the organisation. This chapter is primarily concerned with highlighting the main achievements as well as the limitations of the waste minimisation project, the ‘WIN
Project’. It begins by providing information on the background to the project, its structure and the overall approach taken.
4.1 The WIN Project
4.1.1 Background
As outlined in the previous chapters there were a number of national, countywide and NHS issues that acted as drivers for the project, most notably stricter EU and UK environmental legislation, limited capacity, infrastructure and landfill space in
Cornwall and high quantities of waste being generated in the NHS. In addition, there were also a number of specific factors within the Cornwall NHS that drove the need for the project. As noted in the site recommendations report (CPT, 2003) these included:
(1) An increasing quantity and variety of waste being produced from the Cornwall NHS ranging from domestic and clinical bag waste, to redundant equipment and hazardous substances
(2) Increasing treatment and disposal costs, from approximately
£288,000.00 in 2002, to a projected £500,000.00 in 2005
(3) Storage and collection issues for a range of waste, particularly redundant equipment
(4) Increased quantities of packaging waste
(5) A general lack of facilities for recycling and segregation
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(6) A general lack of awareness of key issues such as allocation of costs and payments and how best to dispose of unwanted materials
(7) Increasing patient numbers and countywide service needs
(8) Duty of Care issues related to the discarding, storage and collection of waste
(9) In some cases non-compliance with health and safety requirements
(related to correct disposal of sharps) and confidentially rules
(related to shredding of documents)
(10) Provision of meals for patients and visitors 24 hours a day
(11) Provision of data to meet a range of NHS and Government targets
It is against this background of local and national drivers for greater resource efficiency that the WIN Project was formulated. Based in part on the findings of a final year degree project (Vanhorn, 2001), the WIN Project ran from December 2002 until December 2005. The project was budgeted to cost £428,000.00 over its threeyear life span. The majority of the funding for the project was contributed by CET
(County Environmental Trust), match funding was also attained, as well as funding from each of NHS Trusts in Cornwall: Cornwall Partnerships Trust, Central Cornwall
Primary Care Trust, North and East Primary Care Trust, West of Cornwall Primary
Care Trust and Royal Cornwall Hospitals Trust.
The key aims of the project were to:
(1) Measure the existing waste quantities across the county’s NHS sites
(2) Determine how these waste streams were being dealt with
(3) Research and pilot improved procedures for waste management
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(4) Establish a 10-year plan for handling NHS waste in the county
4.1.2 Project approach
In order to realise the key project aims a holistic approach was taken in two main respects: First, as shown in Appendix 1 a multi stakeholder approach was utilised in the delivery of the project. The study was project managed by the Cornwall
NHS, with decision-making by a Steering Group comprised of individuals from the
Cornwall NHS, academia (the University of Exeter in Cornwall), the recyclates industry (Remade Kernow) and the main funding agency (CET). During the course of the project in-put was also had from other key agencies in the NHS (including NHS
PASA) and the community (including Cornwall County Council and the district councils). Second, the project sought to examine a range of issues related to waste management in the organisation, including:
(1) An analysis of all of the key waste stream
(2) Logistical factors (e.g. containment and collection)
(3) Social issues (e.g. staff awareness, behaviour and training)
(4) Up-stream management (e.g. procurement)
(5) Compliance (e.g. health and safety)
Each of these factors will be expanded upon later in this chapter.
4.1.3 Overall WIN Project achievements
Overall the WIN Project could be divided into two main phases: First, the gathering of data on all of the main waste streams in the Cornwall NHS and second the implementation of mechanisms to manage these streams in a more sustainable and efficient manner.
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4.1.3.1 Phase one
4.1.3.1.1 Analysis of waste streams
One of the key initial accomplishments of the project was the gathering of baseline data on the waste arisings of all of the major waste streams, from all of the
Cornwall NHS sites. This was important, as prior to the start of the project there had been limited detailed information on the various waste streams. In addition, this information also provided the basis for the development of strategies on the areas that should be focused on, in order to better manage the waste, as will be outlined later in this chapter.
The gathering of the baseline data was undertaken in two main phases: First, through site visits to make observations and the gathering of information on containment from all sites, during the period of March to July 2004. Second, through detailed waste audits of representative samples of both clinical and domestic/municipal waste bags from NHS sites across the county, to determine arisings on a site and departmental basis. These audits were conducted during the period of June to September 2004. In conjunction with these waste bag audits, analysis of post-production food waste was also undertaken. Details of waste arisings have been outlined in a number of previous reports including (CET Report 1, 2003),
(CET Report 2, 2003), (CET Report 3, 2003) and academic fora (Tudor et al ., 2005 a
;
Tudor, 2006; Tudor et al., 2006).
As shown in Fig 4.1 on average both Acute Care Trust and PCT (Primary Care
Trust) sites produced similar quantities and compositions of waste. For example, both produced high quantities of mixed paper, cardboard and food/organic waste in the domestic bagged waste.
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Cardboard 5.8%
Plastics 16.7%
Mixed Paper 37.4%
Food/Organics 19.6%
Other 20.5%
RCH Average
Domestic Waste Bag
Composition
Non Clinical 39.9%
Clinical Incontinence
12.5%
Clinical 47.5%
RCH Average
Clinical Waste Bag
Composition
Cardboard 5.7%
Plastics 12.5%
Non Clinical 20.0%
Mixed Paper 44.6%
Clinical Incontinence
37.0%
Food/Organics 20.3%
Clinical 43.0%
Other 16.7%
Community Average
Domestic Waste Bag
Composition
Community Average
Clinical Waste Bag
Composition
Fig. 4.1. Average composition of domestic (municipal) and clinical bag waste from acute and community sites
Source: CET Report 4 (2004)
However, there were some differences, for example, on average the quantity of gloves, PET and PS (Polystyrene) was greater at the acute care sites compared to
PCT sites, whilst office paper was less. Table 4.1 outlines some of the key findings from the bag waste audits. With respect to food waste, the cook-serve method of food preparation produced a lower quantity of post-production food waste as compared to the cook-freeze method of food preparation (Tudor et al ., 2005 b
).
The general countywide visits and the waste audits indicated that three key areas should be given priority in the second phase:
(1) Logistical issues – including improved segregation and containment and the collection of bulky waste
(2) Social issues – including staff awareness and behaviour and training
(3) Up-stream management – including addressing the high quantities of packaging and the need for greater sustainable procurement and use of recyclables.
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Table 4.1
A summary of the key results indicating how and why site and department type and size (activity levels) affect waste generation rates in the Cornwall NHS
Key differences at the site level
(1) Quantities of the plastics (PP, PET) and gloves from acute sites were double those from the community sites
(2) An average clinical bag was 2.1 kg from the community sites, compared to 1.37 kg from acute sites
(3) The quantity of clinical incontinence waste from an acute site was less at
16% (wt.) and 13% (vol.), compared to 37% (wt.) and 24% (vol.) from a community site
Key differences at the
(2) department level
The top 3 clinical waste producers were:
(1) General wards – 4.0 kg
(2) MH/LDD units – 3.8 kg
(3) Maternity wards – 1.73 kg
The top 3 domestic waste producers were:
(1) Offices – 5.6 kg
MH/LDD wards – 4.9 kg
(3) Canteens/restaurants – 3.6 kg
Top waste items
(across all departments)
Domestic –
(1) Mixed paper
(17.6% – 57.6%)
(2) Food/organics
(2.3% – 34.6%)
Clinical –
(1) Clinical nonincontinence (11.5%
- 79.7%)
Highest and lowest per capita generating departments
Acute care wards –
32.1 kg/person/mnth
(domestic)
22.7 kg/person/mnth
(clinical)
MIU –
0.01 kg/person/mnth
(domestic)
0.1 kg/person/mnth
(clinical)
Source: Tudor (2006)
25

4.1.3.2 Phase two
4.1.3.2.1 Logistical factors (waste trials, containment and collection systems)
There were three key logistical issues that had to be dealt with, including mechanisms for greater segregation and diversion from landfill, the identification and implementation of appropriate and standardised containment systems and collection of bulky materials such as redundant equipment and IT (Information Technology) waste.
Nappy trials
Successful trials of reusable nappies were undertaken during September 2003 in the Penrice Maternity Unit at St Austell Community Hospital, in conjunction with the company Lollipop from the ‘Cornish Real Nappy Project’. During the project new mums were provided with Real Nappies, rather than disposable nappies, as a means of seeking to reduce the quantity of disposable nappies that were sent to landfill. The
Real Nappy Project have continued to work with the midwifery department at St
Austell Community Hospital.
Containment systems trials
During 2004, trials of a number of new clinical, domestic and recycling bins were conducted in selected departments, at various sites. Bins were sourced from various manufacturers to examine the effect of bin type and size on segregation and recycling activities of both staff and the general public. These trials, which incorporated domestic services and the Waste Operatives at RCH, were undertaken during January and February 2004 in the following departments:

Oncology

Clinical Decision Unit

Estates Offices
26


General Theatres

Laboratories – Haematology

Mullions Kitchen and Restaurant

Public Entrances (Trelawney, Tower, Maternity)
Using the new bins, in conjunction with materials for staff awareness
(Appendix 2), the trials were able to significantly reduce the quantities entering the domestic/municipal waste streams (Fig. 4.2).
70
60
50
40
30
20
10
0
G en
D er al
w ar ds
w tie nt
inpa ar
O ut ds
pat ie nt s
M
H
/LD
M
IU
O ff ic es tre s ra tor ie s re war ds
Thea
Labo
A cu te
ca
Departments
Before trials
After trials
Projected target
Fig. 4.2. A comparison of potentially recyclable fraction, before and after the trial and projected reduction potentials for domestic/municipal bag waste
Source: Tudor et al. (2006)
27

Following these trials, new standardised domestic, clinical and recycling bins were ordered and put in place in a number of departments across the county, throughout 2004 and 2005.
Green cones
In addition to the trials of bins for domestic/municipal and clinical waste, trials were also undertaken to reduce the quantity of food waste. These involved the use of
Green Cones at Helston Community Hospital. Whilst the trials were not as successful as had been hoped for (due to issues related to the quantity and types of food waste being disposed of and health and safety concerns), efforts, in conjunction with the
Environment Agency, will be continued to find a suitable solution(s).
Collection schemes for bulky waste
A countywide collection scheme for redundant equipment was successfully implemented during 2004. This service utilised a small private contractor to collect redundant equipment on a quarterly basis, thereby reducing the quantity redundant materials that was stored at many sites and that which had to be disposed of. Hence the removal of this equipment meant that many sites had more storage space available and fewer health and safety risks.
Initial research by the Cornwall NHS and Remade Kernow into setting up an exchange system for equipment between sites and indeed between NHS and non-NHS sites was also examined, but not pursued due to lack of resources.
In addition to redundant equipment the project was also able to reduce the quantity of IT waste going to landfill through the identification of alternative routes.
This reduction was achieved through the fostering of collaboration between the IT department and a local IT recyclables contractor. Site issues related to the need to store unwanted computer and communication systems, as well as the costs of disposal were therefore reduced. The new collection system also ensured compliance with the
EU WEEE (Waste Electrical and Electronic Equipment) Directive (EU, 2004), which calls for greater reduction and recycling of electrical and electronic waste.
28

Hence, through the implementation of various containment schemes for domestic, clinical and recyclable waste and the formulation of collection systems for bulky waste items such as redundant equipment and IT waste, the project was able to realise significant reductions in waste quantities and alleviate storage constraints at several sites.
4.1.3.2.2 Social issues (building awareness and changing attitudes)
As stated earlier one of the priority factors that had to be addressed was that of staff awareness of and behaviour towards waste. To meet these issues a number of successful mechanisms were put in place, both for the internal publics (i.e. employees), as well as external publics. These initiatives included a ‘Waste
Awareness Week’, the creation of a new website by the project team on the Cornwall
NHS intranet, information sheets, flyers and posters, articles and reports for academic and trade journals, as well as a number of meetings and presentations. The strategies employed for each public will now be discussed in turn.
Internal publics
A ‘Waste Awareness Week’ was held during the week of May 10 th
– 14 th
,
2004, with events held at sites across the county including at RCH and St. Austell
Community Hospital. This week was used to sensitise employees to the work that was being undertaken by the project and to enable them to speak directly to members of the project team. Significant events during the week included the launching of the enquiry service, the implementation of new recycling bins, the televising of videos during lunch times and the use of competitions and stickers to involve employees and increase awareness. Patients were also involved, in that children from the children’s ward at RCH had the opportunity to design and make products using recycled materials. These items were displayed at various sites, most notably in the staff cafeteria of RCH during the week of activities.
Generally, there was a good response from staff to the Week. However, support from some of the senior managers was limited.
29

A key issue within increased awareness was deemed to be that of the need for increased staff training. To this end a ‘Waste Management and Training Toolkit’ was produced during the project. This toolkit was developed through work with trial departments and included:

Room plans to help in the siting of bins

Standard bins for purchase on EROS (the national NHS purchasing system)

Fire / Infection control precautions

Publicity materials
Hence the toolkit served as a ‘framework’ to enable sites to improve their waste management practices. The kit included a number of pieces of materials including information on awareness building, improving containment, increasing knowledge of compliance and health and safety and legislative issues and training manuals. As noted in Report 4 (CET Report 4, 2004), the toolkit has the potential to become a useful tool to allow other organisations outside of the Cornwall NHS to develop more sustainable waste management policies.
The project also produced several information sheets, such as guidance on setting up a recycling collection at the site (Appendix 3) and the registering of bulky waste
(redundant equipment) for collection. Leaflets of ‘Win Updates’ were also provided for all staff to maintain awareness of the project and information supplied for publication in site newsletters (Fig. 4.3).
30

To everyone who supported this year’s
Hospital Football Cup.
Another great night was had by all!
The Porters got revenge for last year by winning
6-2, in a match played in excellent spirit.
Former Exeter City striker Mark Rapsey scored
all 6 for the Porters, with Rob Lawson and
Dermot Dalton replying for the Doctors.
Appreciation to the three officials -
Gerald Searle, John Reid and Paul Minns.
Special thanks to Trevor Thomas & Truro City AFC for their facilities, especially Caroline Hawke for the superb buffet. Also to managers Brian Agbull and Mike Counter for organising the two teams.
Last but not least, Mr Kit Kitaruth for his excellent job of presenting the trophies.
See you all next year!!!
On Monday 28th April a car, belonging to a member of staff, was damaged in the car park behind the megashed. The damage to the car was extensive and, as the driver did not report the incident or leave details, the owner of the car is left feeling extremely distressed, having to pay for the repair work.
We are currently following up CCTV footage, but would be grateful if witnesses to this accident contact the Hospital Police on Ext 3399.
Please remember that all road traffic accidents, whether accidental or not, should be reported and it is a crime not to do so.
HAVE YOU SEEN THIS WOMAN?
You may have spotted a team of people removing black and yellow bags from wheelie bins around the site last month. In case you’re wondering, these are members of the
WASTE MINIMISATION
& RECYLCING RESEARCH
PROJECT team.
Sample black and yellow bags are currently being analysed to determine exactly what we are throwing away. Even before any detailed analysis is carried out on the findings, we can tell you that we have found large quantities of plastic, mixed paper, food and newspapers & magazines within the black bags many of which could be recycled if everyone had the right storage and collection facilities. Within the yellow bags we found many items, particularly packaging, which could go down a much cheaper disposal route.
It’s our job now to analyse the data, carry out some more sampling, before putting forward some recommendations to reduce the amount of waste going to landfill and incineration, and increase that going for recycling.
We plan to spend considerable time in each department to develop some practical solutions. It is clear that confidential and paper recycling is working - most black bags (with some exceptions) contained very little paper. Thank you for your co-operation to date.
We look forward to meeting with many more of you as the project develops. Look out for the updates and the WASTE IT NOT logo!
Any queries contact Judith Van Horn, Claire Noonan or Sharon Butler on ext 3813.
Photo: Judith and a wheelie bin.
Fig. 4.3 Royal Cornwall Hospital’s newsletter featuring the WIN Project
31

An enquiry service was launched in 2004 consisting of an intranet website and dedicated email and phone services for enquiries. All enquiries via email were dealt with within 36 hours. The intranet website was developed to inform staff about the
WIN Project and waste management issues within the Cornwall NHS in general. In addition, the service provided staff with a centralised facility through which they could order new waste resources such as bins and bin liners via the NHS purchasing system EROS. The website also contained downloadable information for employees.
This site was updated on a regular basis to ensure staff were kept up to date and also as a means of maintaining interest.
EnReps (Environmental Representatives) provide a vital function driving sustainable waste management at the site level, by acting as a link between the waste department and their site. During the latter half of 2003 a number of briefing and training sessions were held with EnReps as a means of providing further support to the EnRep Scheme, and encouraging greater self-sufficiency at the various sites.
In addition to these initiatives for general staff, a number of presentations were also made and meetings held with all categories of staff within the organisation
(including senior managers and directors), to inform them about the project. These events included:

Risk Management meetings at RCH

Finance directors meetings

Operational directors and managers meetings

Site meetings at the various Trusts

Health and safety meetings
External publics
One academic paper has thus far been published (Tudor et al ., 2005), with others pending.
32

Articles were also written for the ‘Lets Recycle Campaign’ in January 2005. The report ‘Good Corporate Citizenship and the NHS’ written by the King’s Fund for the
Health Development Agency (HDA, 2004), also included a write up on the WIN
Project within the waste section for the South West.
In addition, as stated in Report four (CET Report 4, 2004) a number of presentations were made to a range of external publics about the project, including to:

Various National NHS Performance and Advisory Group meetings – Waste

NHS Trusts in Exeter

NHS PASA (Purchasing and Supplies Agency) and local supplies meetings

The CET Projects conference at the Hall for Cornwall (18/2/2003)

Various CET Board meetings

Cornwall Waste Forum

Eden

CIWM Special Interest Group – Healthcare waste
A range of mechanisms was therefore put in place to increase the level of awareness amongst both the internal and the external publics about the project and to seek to change their attitudes towards waste. Initiatives included the development of a training toolkit, an enquiry service, posters and leaflets, as well as several presentations and meetings.
4.1.3.2.3 Up-stream management (sustainable procurement and use of recyclables)
The third category of factors that was examined was that of improved upstream management of resources. As noted by various authors a key aspect of a more sustainable approach to managing waste has to involve an examination of its entire life-cycle (DEFRA, 2003; 2005 a
; Lisney et al., 2003). Within this context, two aspects were studied:
33

(1) A more in-depth analysis of packaging waste
(2) Mechanisms for more sustainable procurement, including the increased use of recyclables
These studies relied heavily on the recyclate market expertise of Remade Kernow.
Packaging audits
Packaging audits were undertaken during 2004, primarily at RCH in conjunction with the company Fresanius (which is a large supplier of bulk fluids).
These audits sought to better map the flows of packaging waste from delivery of the products to final use in the departments. A case study of the renal fluid containers revealed that use of a bulk tank system would reduce storage issues and improve both health and safety and manual handling concerns. However, due to the immediate financial implications and possible disruption in service during the change over it was decided not to pursue this route. It was also found that the most commonly used products were single use primarily due to contamination concerns, hence smaller containers (which produced more packaging waste) were widely used. One skin preparation company expressed an interest in reducing their container sizes, whilst the major catering companies were keen to reduce their packaging by using reusables but the lack of on-site available storage space at the hospital made this difficult.
Therefore, whilst there were possible packaging reductions to be made, various limitations made pursuing these options difficult. This option is still seen as the best long-term solution for the department not only to reduce packaging, but also to address issues related to handling and health and safety.
Recyclables
Prior to the implementation of the project the Cornwall NHS had an active toner cartridge recycling programme in place. Spent toner cartridges were sent from the organisation to Scotland for recycling. In order to improve on these efforts and under the guidance of Remade Kernow, trials of remanufactured toner cartridges were undertaken between October 2003 and January 2004. The key results of these trials
34

were that the trial cartridges lasted 30% longer, produced costs savings of between
26-33%, with no negative effects on the machine and at comparable quality to the regular cartridges. In addition, the box used was also reusable. As a result of these trials, the project was able to encourage a number of sites to purchase both recycled and recyclable cartridges for use, thus in effect serving to close the product loop.
Constructing compounds using recyclable materials
Considerable efforts were made to encourage the Cornwall NHS Capital
Works Department to make greater use of recyclables in the construction projects. A significant achievement for the project team was the utilisation of recyclable materials for the construction of new waste compounds at Falmouth Community Hospital and
Helston Community Hospital (Fig. 4.4). This therefore represented a positive behavioural change, which arguers well for the future incorporation of recyclables
(e.g. toner cartridges) and for construction purposes.
Fig. 4.4. The new waste compound at Falmouth Community Hospital
35

4.1.3.2.4 Compliance and health and safety
As outlined in Box 4.1 improved awareness, participation in segregation and recycling activities and training, as well as the provision of new containment systems also generally served to reduce risks related to non-compliance with legislation, confidentiality standards and health and safety requirements.
BOX 4.1
Improved training, awareness and containment led to several health and safety and compliance benefits including reduced incidents of:

Confidential paper items being found in both clinical and domestic bags

Sharps bins being regularly used for non-sharp items such as non-clinical waste that should enter the domestic waste stream

Clinical waste bags not being labelled and therefore not being compliant with Duty of Care according to the Environmental Protection Act 1990

Departments being unaware of the correct procedures for storage and collection of waste streams to ensure safety and compliance

Contamination of recyclables (e.g. of confidential paper for shredding by
 food waste)
Needle stick injuries due to sharps being placed in waste bags rather than sharps boxes
Hence the project was able to divert significant quantities of waste away from landfill through various measures including:
(1) The encouragement of greater segregation
(2) Recycling of materials through the implementation of new standardised containment systems
(3) Greater awareness
36

(4) Staff training.
Box 4.2 summarises some of the key achievements of the project, ranging from the formulation of baseline data, to increased awareness, improved containment, the setting up of collection schemes, increased training opportunities, increased use of recyclables and costs savings.
BOX 4.2
Key achievements of the WIN Project

Successful determination of baseline quantities for all of the major waste streams from the Cornwall NHS

Development of a new toolkit was developed to assist in training and waste management procedures

Increased participation in segregation and recycling at all of the major
NHS sites across the county

Increased use of recyclables (e.g. toner cartridges and construction materials)

Increased training for EnReps and general staff in waste management

Increased awareness of waste management issues amongst Cornwall
NHS employees and external publics through the development of a new intranet website and several presentations and publications (articles, flyers, information sheets, posters, etc.)

Implementation of standardised containment systems at the majority of
NHS sites across the county

Development of a countywide collection scheme for redundant waste and diversion of IT waste

Delivery of significant costs savings for each of the NHS Trusts involved
37

4.1.4 Limitations
Whilst the project was able to achieve many successes, there were perhaps two main limitations: First, staffing issues and second, limitation of resources, primarily in terms of longer-term continuity and finance.
Indeed, as noted by the Project Manager at the end of 2004 (CET Report 6,
2005), the WIN Project “was continually dogged with (the) retention of staff”. Only one person, the Research Assistant from the Camborne School of Mines was employed full time on the project, and this was only for the first two years. Before the end of the scheduled two years in December 2004, the project had suffered the lost of key team members including the Waste Minimisation and Supplies Assistants (Nick
Waters and James Drinkwater), the Remade Kernow officer – Julie Hoare (who was later replaced by Clive Hoskins) the graphic artist Zoe Brunt and finally the Project
Coordinator Claire Noonan, in September 2004. This loss and changing of personnel therefore resulted in shifting of work to other staff and some lack continuity.
The second key limitation related to the inability to access further funding despite various bids (see CET Report 6, 2005), which meant that many of the initiatives started could not be extended beyond the initial life of the WIN Project.
Despite the fact that long-term measures were examined with respect to the overall organisational structure of waste management (Fig. 4.5), and the treatment of waste
(Appendix 4), the constraints of time and lack of finance made it difficult to implement these initiatives.
38

Fig. 4.5. An improved waste management infrastructure for the Cornwall NHS
In summary therefore, the WIN Project had several achievements including:
(1) The gathering of data
(2) Improved awareness and training
(3) The implementation of standardised containment systems
(4) Diversion of waste from landfill
39

In addition to these successes there were also some limitations, related primarily to staff turnover and the inability to extend the goals of the project beyond its 3-year existence.
However, it can be said that despite these limitations, generally, the project was able to achieve much for the Cornwall NHS and for the county as a whole. It is particularly important to highlight these achievements as the project was essentially formulated to be a research driven only. Hence, the approach taken and structure can serve as a use model for others to follow in an effort to attain greater sustainable waste management.
40

CHAPTER 5
With increasing quantities of waste, decreasing landfill space and rising treatment costs, initiatives that encourage a more sustainable approach to the management of waste have become crucial in the UK. This report has outlined such an initiative, a collaborative waste minimisation project within the Cornwall NHS called the WIN
(Waste It Not) Project, which ran from December 2002 until December 2005.
Through a multi-stakeholder and holistic approach the project sought to undertake a comprehensive examination of waste management within the Cornwall NHS, by determining the quantities and flows of the main waste streams in the organisation and devising strategies to manage these streams in a more sustainable manner. The project was able to realise a number of significant achievements including:
(1) The formulation of base line data on waste arisings
(2) Address many of issues which had previously limited waste management in the organisation, such as:
(a) Logistical issues (e.g. improved containment and collection systems)
(b) Social issues (e.g. increased awareness and training)
(c) Up-stream concerns (sustainable procurement and use of recyclables)
(d) Financial issues (costs savings)
In so doing, the WIN Project demonstrated a number of issues that are important considerations for the success of such projects, with respect to:
(1) The overall approach taken to delivering the project
(2) The strategies employed during the project.
41

The structure of the WIN Project was very much a collaborative one, involving stakeholders from a range of areas, including expertise from the recyclables industry, academia, various agencies within the organisation itself (such as purchasing), as well as the community. The achievements of the project demonstrated the need for and the benefits of such a holistic approach, and the necessity for partnerships at all levels.
These levels should include at the departmental, site, community and national levels, to ensure a degree of success. These results would not have been possible without such an approach being adopted. In addition, the project also sought to examine all of the major waste streams in the organisation and then to utilise these results for a more in-depth examination of the full life cycle of the waste from down-stream (arisings) to up-stream (procurement). Hence the study of the actual waste streams employed both a holistic (all of the key waste streams) and strategic (from an overall base-line to a focus on the priorities) approach, thereby allowing for a focus to the project.
Within these priorities the study also sought to incorporate both the technical (i.e. logistical issues of containment and collection) with the social, within a holistic approach (up-stream and down-stream management). This strategy and approach also proved vital since it enabled both the technical and behavioural factors required for a more sustainable approach to waste management to be addressed. Too often there is an emphasis on one or the other, however, this research project as with others, demonstrated the importance of addressing both areas in order to achieve success.
Whilst having the facilities (i.e. the containment systems) in place is important, consideration also has to be given to the users and their behaviour. There is a vital need to have all staff, from directors and senior managers to general staff on board, if they are going to support project initiatives. There is also a need to keep them informed, aware (using a range of media, which is continually updated and tailored towards the specific public) and involved in the process, if they are to accept and embrace any changes.
The achievements of the WIN project have been widely acknowledged. One of the most notable was the recognition attained from NHS Estates at the national ‘Building
Better Healthcare Awards’ in 2004, where CHESS won the ‘Highly Commended
Award’ in the category of Best Sustainable Development. This award was for its
‘Integrated Sustainable Decision-making Programme’ which involved a holistic and sustainable approach to the issues of waste, food procurement, utilities and new builds.
42

However, whilst there were many achievements, there were also limitations in the project, particularly with respect to staffing and continuity. Many of the accomplishments of the WIN Project whilst good were in some cases quick wins or short-term only. Hence, whilst the project achieved much, other projects with a similar focus should be planned on a much longer-term basis, if real sustainable success is to be achieved. It is imperative that for such projects to succeed and bring about real change, that consideration be given to a more long-term approach. Within this long-term approach there should be adequate provision for both finance and incentives for the retention of staff. Failure to do so will result only in a focus on quick wins, lack of continuity due to project staff turnover and unrealised project potential.
In summary, the WIN Project has demonstrated that through a holistic approach and with the necessary support, local projects can indeed make a significant contribution towards a more sustainable approach to waste management in the UK.
Indeed, this study was able to do so for the Cornwall NHS, the County of Cornwall and for the NHS generally. Certainly with more and more NHS Trusts going into debt and with increasing quantities of waste from the UK healthcare sector and the costs of treating this waste rising, this project has demonstrated the high potential for diversion away from landfill and the utilisation of more sustainable options. However, whilst Government has committed itself to the issue of improved sustainability, there is a need for greater actual provision of support, particularly at the local as well as the national level, if such efforts are to achieve their true potential.
43

Contacts about the WIN Project
Mr Mark Summers
Cornwall NHS Head of Utilities
The Utilities Department
Royal Cornwall Hospital mark.summers@cpt.cornwall.nhs.uk
(01872) 253813
Mrs Sharon Butler
Cornwall NHS Waste Manager
The Utilities Department
St. Lawrence’s Hospital
Bodmin
Cornwall
TR1 3LJ
Sharon.Butler@cpt.cornwall.nhs.uk
(01208) 251491
Ms Claire Neal
Cornwall NHS Funding Project Officer claireneal@hotmail.co.uk
(01726) 65884
Useful websites www.ces.co.uk
(County Environmental Services) www.exeter.ac.uk
(The University of Exeter) www.remadekernow.co.uk
(Remade Kernow) www.cornwall.nhs.uk
(Cornwall NHS) www.thenhsexplained.gov.uk
(The National Health Service) www.nhsestates.gov.uk
(NHS Estates) www.cornwall.gov.uk
(Cornwall County Council) www.southwestrda.org.uk
(The South West Regional Assembly) http://www.mtprog.com
MTP (Market Transformation Programme) http://www.nisp.org.uk
NISP (National Industry Symbiosis Programme) http://www.wrap.org.uk
WRAP (Waste and Resources Action Programme) http://www.brew.org.uk
BREW (Business Resource Efficiency and Waste
Programme)
44

APPENDICES
Appendix 1 – The initial WIN Project Team
Following agreement of the funding in November 2002 a Project Steering Group was established as follows:
Project Leader
CSM (Camborne School of Mines)
Remade Kernow
County Environmental Trust
Project Manager
Mark Summers
Loveday Jenkin
Michael Poole
Voirrey Costain
Sharon Butler
Efficiency Improvement Team Matthew Dunkerley
The project began in earnest in January 2003 once all staff were in post
Project Manager
Waste Minimisation Co-ordinator
Research Assistant (Waste Minimisation)
Sharon Butler Part time
Research Assistant (CSM)
Waste logistics – Royal Cornwall Hospitals
Claire Noonan Part time
James Drinkwater Part time
Market Development Officer (Procurement) Julie Hoare Part time
Research Assistant (Procurement) Nick Waters Part time
Terry Tudor full time
* Judith Van Horn (short term only)
* Funded by NHS
45

Appendix 2 - Promotional material used during the WIN Project
EXAMPLES OF GOOD PRACTICE FROM ACROSS THE COUNTY
Site (s) Example
Measure taken
Waste quantities
Annual
Savings based on current landfill or incineration rates
£2352 / yr
Annual
Savings based on future landfill or incineration rates
£11 400
Community
Hospitals
(Falmouth,
SACH,
Stratton,
Helston)
MAU Dept
RCH
Excellent recycling facilities
57 T waste diverted from landfill every yr
£1800 / yr from one department
£3150 / yr from one department
Haematology
Labs, RCH
Introduction of domestic bins to help segregation
(clinical)
Introduction of domestic bins to help segregation
(clinical)
6.3 T non- clinical waste removed from clinical every yr
2.6 T non- clinical waste removed from clinical every yr
£780 / yr from one department
£1300 / yr from one department
Source: CPT (2004)
46

Appendix 3 – An example of an Information sheet used during the WIN Project
Information Sheet 1 setting up a recycling collection from your site
Is there a county-wide contract for the collection of recycleable items from NHS sites?
Yes. Almost all sites are covered by the current contract for collection and recycling of items by Cornwall Paper Company. This was established in July 2002. Since then, each site in the contract has been paying £13 a quarter but not all sites have been fully utilising this service.
The contract is due to be reviewed in the Autumn when charging structure (and even collection company) could change.
What items can be collected for recycling?
Within the contract, the following items can be collected; office paper (shredded or nonconfidential), newspapers/magazines, plastic bottles (milk and other – washed and squashed), cans (aluminium and steel), textiles, cardboard
How do I set up a collection?
Phone Sue Martin at Cornwall Paper Company (tel:01209 212294)
Tell her approximate quantities needing collecting, where they will be stored and a contact name for the driver to speak to when they arrive at your site. She will give you a delivery day
(same day per week/fortnight). If you have very low quantities, she may suggest that you phone for collection as necessary.
How do I store the items for collection?
Items need to be stored in a safe, secure place (eg external wheelie bin, outdoor shed).
Cornwall Paper Company staff will need access to this store on their collection days. Items should be segregated as much as possible into the following bags:
Clear plastic bags – paper, plastics, cans, vending cups, textiles
Hessian sacks – newspapers & magazines, confidential waste
Where do I order the bags for storage of items?
Clear plastic bags should be ordered from EROS (code: MVN045)
Hessian sacks are re-usable and are provided by Cornwall Paper Co. on request.
How do I send confidential paper for shredding?
If you are able to shred confidential paper on site, this can be sent in the clear plastic bags with the office paper within the above contract. If however you have large volumes for shredding, this should be arranged with Cornwall Paper Co. at a contract cost of £80 per tonne. They will provide hessian sacks (red writing) which can be filled and tied, ties are obtained from the Waste Department on 01208 251491 ,full details of the procedure can be found in the Waste Management Policy and Procedures document. your site will be invoiced directly.
Any transfer documents should be returned to the waste Manager to ensure compliance.
What if I have a clear out and have larger quantities than usual?
For all items within the recycling contract, notification should be given to Sue Martin on the number above. Depending on the volume collected this should be removed at no extra cost however this arrangement may change in the future. If the large quantities arise because of an office move, please refer to Information Sheet 2.
THE WIN TEAM CAN ARRANGE A SITE VISIT TO HELP YOU SET UP
THIS SERVICE & ADVISE ON STORAGE AND SEGREGATION IF
REQUIRED.
CONTACT: 01208 251491 / 1409 or email: claire.noonan@cornwall.nhs.uk
47

PR
IO
RI
TY
1.
2.
Appendix 4 – Long-term waste management plans for waste from the Cornwall
NHS
WASTE PRIORITISATION TABLE
WASTE
STREAM
Clinical
(yellow bag waste)
Bulk
Waste
Office
Paper
(high quality)
Confidenti al paper
(for shredding)
Key Issues
High quantity, mix paper & packaging in waste stream
No formal procedures or resources for collection from outlying sites, poorly segregated, little space for storage
Variations in current recycling rates, high quantities
Variations in current recycling rates, high quantities
Recommend ed solutions
(short term)
1. segregation
& staff awareness
1. Formalise procedures for collections & begin to segregate for re-use & recycling
(focus on clearouts)
1. segregation for recycling and staff awareness
2.Buy recycled
3.Limit use
1. segregation for recycling
& staff awareness
Implication s
(technol or other)
Training
Coordinatio n, procedural
Training,
PASA liaison,
Policy change
Training
Recommended solutions
(long term)
2. Thermal treatment
2. Develop waste exchange system
N/A
2.Move to shredding our own paper – research whether this is ec. viable
Implications
(technological or other)
In house treatment plant with potential partners (Las)
Space & coordination
N/A shredders
Recommended
Actions Yr 2
1.Trial segregation systems (NHS)
2.Business case development – thermal treatment
(CSM)
1.Improve current arrangements
(NHS)
2.Business case development – waste exchange
(RMD)
Card Variation in current recycling rates, excessive packaging, contaminatio n by other waste streams
1.segregation for recycling
& staff awareness
2. reduce packaging of incoming products
Training
Supplier liaison
3. continue with recycling or utilise for biological treatment
Biological treatment plant
(shared with other organisations)
1.Trial segregation systems (NHS)
2.Policy & specification work (NHS,
RMD)
1.Trial segregation systems (NHS)
2.Assess potential for increase in inhouse shredding
(NHS)
1.trial segregation systems (NHS)
2.reduce packaging through supplier liaison
(RMD)
3.Bus Case
Devlpt -
Biolog.
Treatment
(CSM)
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News / magazines
Green
Garden waste
Textiles
Aluminiu m
Variation in recycling rates
Lack of shredding facilities
Produced from small no. of areas
Rel. small amount spread across county
1.segregation for recycling and staff awareness
2.minimisatio
n of quantity received into
NHS
1. purchase small shredder & additional large shredder
1.segregation for recycling
& staff awareness
1. segregation for recycling
& staff awareness
Training
Shredder with training
& certification
Training
Training
3.continue with recycling or utilise for biological treatment
N/A
N/A
2.Potential for income
IT
Food
(waste disposal unit)
Increasingly strict legislation, centralised responsibility needed as individual purchases of items currently occuring
Free disposal at present,
High quantities of wastage
1.continue utilising current collector
2.formalise contract to ensure the equipment is still useable
(ie not rubbish)
1. reduce waste at source (in conjunction with Patient
Power) procedures
Patient
Power
3.IT collector to develop business by extracting valuables and establishing refurbishments
2.enclosed biological treatment
3.SMALL
Outlying areas utilise green cone digestors for food and paper mix
Biological treatment plant
(shared with other organisations
1.trial segregation systems (NHS)
3.Bus Case
Devlpt – biolog.
Treatment(CSM
)
N/a
N/A
1. assist grounds dept with bus case
(NHS)
1.trial segregation systems (NHS)
2.Link to other metal waste streams (eg IT, steel) facilities for shredding of equipment
NHS to segregate into specific waste streams before passing on
Partnerships with other IT producers
CPU
Treatment plant (in partnership)
1.trial segregation systems (NHS)
2.Bus Case
Dvlpt – incomes from metals (CSM)
1&2.Formalise procedures with current contractor
(NHS)
3.Bus Case
Dvlpt for an
External contractor
(current or other) This would be a countywide project, not just
NHS. (RMD &
Resolve?)
1.improve procedures for waste minimisation
(NHS)
2&3.Bus Case
Dvlpt (CSM&
Resolve)
- include trials of green cones in conjuction with
Wider biological treatment research(CSM&
NHS)
49

3.
PET
Mixed paper
Mixed unidentifi ed plastics
(non
PVC)
Not segregated & will be collected with other plastic bottles
1. segregation for recycling
& staff awareness training
High quantities, low grade, often appears as clinical waste
High quantities,
Can’t identify types
N/A
Nonsegregated food
Contaminates other items, makes up a large proportion of the waste stream
1.divert as much as possible from clinical waste stream
1. keep food waste away from dry recycleables
Training & work with
Infection
Control
N/A training
2.continue with recycling for
PET or energy recovery or send for other products
(eg plaswood)
2.Biological treatment
3.Replace towels with dryers if economical
Energy recovery or send for other products
(eg plaswood)
2.Biological treatment
3.SMALL
Outlying areas utilise green cone digestors for food & paper mix
Separated plastics -
PS
Very low value recyclate
1. recycle cups training 2.energy recovery or send for other products
(eg plaswood)
Production of intermediate
(pellets) that could be sent to EFW plant or plaswood factory
Key to actions
NHS : will be led by team members in NHS (SB, CN)
CSM : will be led by partner organisation CSM (LJ, TT)
RMD : will be led by partner organisation ReMade (MP, CH)
Priority 4 items: all other waste streams – continue to landfill at present, no long term research required within the project.
Production of intermediate
(pellets) that could be sent to EFW plant or plaswood factory
Biolog treatment plant with partners
Hand dryers
Production of intermediate
(pellets) that could be sent to EFW plant or plaswood factory
Biolog treatment plant with partners
Staff training
1.training
2.identification of possible partners
(RMD)
1.Training
(NHS)
2.Bus Case
Devlpt –Biolog
(CSM)
3.Cost analysis of purchase / maint
Dryers
(RMD&NHS)
1.identification of possible partners
(RMD)
1.Training
(NHS)
2&3.Bus Case
Dvlpt (CSM)
Trial green cones in conjuction with
Wider biological treatment research(CSM&
NHS)
1.training
(NHS)
2.identification of possible partners
(RMD)
Source: Tudor et al. (2005)
50

REFERENCES
Biffa (1995). Waste: A game of snakes and ladders? http://www.biffa.co.uk
BREW (Business Resource Efficiency and Waste Programme). (2005). http://www.brew.org.uk
CES (County Environmental Services) (2002). Ten years of change. Cornwall.UK.
CET Report 1 (2003). Waste minimisation and recycling research project report. CPT.
Bodmin. Cornwall.
CET Report 2 (2003). Waste minimisation and recycling research project report. CPT.
Bodmin. Cornwall.
CET Report 3 (2003). Waste minimisation and recycling research project report. CPT.
Bodmin. Cornwall.
CET Report 4 (2004). Waste minimisation and recycling research project report. CPT.
Bodmin. Cornwall.
CET Report 6 (2005). Waste minimisation and recycling research project report.
Bodmin. Cornwall.
Chung S., Lo CWL. (2003). Evaluating sustainability in waste management: the case of construction and demolition, chemical and clinical wastes in Hong Kong.
Resources, Conservation and Recycling. 37 (2), 119-145
Coote A. (2002). Claiming the health dividend. King’s Fund. London.
Cornwall County Council (2001). Waste arisings in Cornwall: An assessment of future needs.
CPT (Cornwall Partnership Trust) (2003). Site recommendations. Bodmin. Cornwall.
51

CPT (Cornwall Partnership Trust) (2004). Briefing paper – community. July. Bodmin.
Cornwall.
DEFRA (Department of Environment, Food and Rural Affairs). (2006). Key environmental performance indicators: reporting guidelines for UK business. HMSO.
London
DEFRA (Department of Environment, Food and Rural Affairs) and DTI (Department for Trade and Industry). (2003). Changing patterns: UK Government Framework for sustainable consumption and production. HMSO. London
DEFRA (Department of Environment, Food and Rural Affairs). (2005 a
). The UK
Government Sustainable Development Strategy – securing the future. HMSO. London
DEFRA (Department of Environment, Food and Rural Affairs). (2005 b
). Recycling:
England Achieves A Personal Best. http:// www.defra.gov.uk/news/2005/050118.
DETR (Department for the Environment, Transport and the Regions). (1995). Making
Waste Work: A national strategy for waste. HMSO. London
DETR (Department for the Environment, Transport and the Regions). (1998). Less
Waste: More Value. HMSO. London
DETR (Department for the Environment, Transport and the Regions). (1999). A Way
With Waste: A draft waste strategy for England and Wales. HMSO. London
DETR (Department for the Environment, Transport and the Regions) (2000). Waste
Strategy 2000 for England and Wales. HMSO. London.
DOE (Department of the Environment). (1990). The Environmental Protection Act.
HMSO. London.
52

EU (European Union) (1999). EU Landfill Directive 99/31/EC. Official Journal of the
European Communities. L182/1 1999
EU (European Union). (2004 a
). EU Hazardous Waste Directive 91/689/EC. Official
Journal of the European Communities
EU (European Union). (2004 b ). EU Waste Electrical and Electronic Equipment
Directive 2004/249/EC. Official Journal of the European Communities
HDA (Health Development Agency) (2004). Good Corporate Citizenship and the
NHS. http://www.had.nhs.uk/documents/corp_citizenship
Krisiunas E., Seto HW., Ching P, Law R., Salkin IF. (2000). Hong Kong Hospital
Authority Clinical Waste Management Program: A model for success. In: Poon C.S.,
Seto H.W., Ching P., Law R., Salkin I.F. (eds.). Waste Management: The challenge for Asian cities – Search for a Sustainable Future. vol. 1. Proceedings of ISWA
International Symposium and Exhibition on Waste Management in Asian Cities.
Hong Kong. 23 rd
– 26 th
October, 2000. pp 84-89.
Lisney B., Riley K., Banks C. (2003). From waste to resource management: a discussion paper. Hampshire Natural Resources Initiative. Hampshire County
Council. Winchester. UK.
MRW (Materials Recycling Week) (2003 a
). Long-term PFI projects aim to boost recycling targets. 13/06/2003. pp 10-11.
MRW (Materials Recycling Week) (2003 b ). Lead-free goods. The count down to compliance. 7/02/2003. p 18.
NHS. (2000). The NHS Plan: A plan for investment, a plan for reform. HMSO.
London
NHS Estates. (1997). Healthcare waste management: segregation of waste streams in clinical areas. Healthcare Technical Memorandum 2065. HMSO. London
53

NHS Estates. (2000). Healthcare waste minimisation: a compendium of good practice.
HMSO. Leeds
NHS Estates. (2001 a
). Sustainable development in the NHS. HMSO. London
NHS Estates. (2001 b
). Waste prevention. HMSO. London
NHS Estates. (2002 a ). New environmental strategy for the NHS. HMSO. London
NHS Estates. (2002 b
). Waste prevention. HMSO. London
Rezolve (2003). The green book. Towards Zero Waste. Cornwall. UK
RCHT (Royal Cornwall Hospitals Trust) (2002). Catering Development Study
Report. Catering Services Department. Royal Cornwall Hospital.
SWRA (South West Regional Assembly) (2002). Minimum waste: Maximum benefit.
A vision for sustainable waste management in the South West. Somerset. UK
SWAP (Save Paper and Prosper) (2002). Waste analysis in the County of Cornwall.
Leeds. UK.
The NHS (National Health Service) (2005). http:// www.thenhsexplained.gov.uk
Tudor TL., Noonan CL., Jenkin LET. (2005 a ). Healthcare waste management: a case study from the Cornwall NHS, UK. Waste Management. 25 (6):606-615
Tudor TL. (2006). An examination of the influencing factors and policies for sustainable waste management: a case study of the Cornwall NHS. Unpublished PhD
Thesis. Department of Geography, Archaeology and Earth Resources. University of
Exeter. Exeter. UK
Tudor TL., Noonan CL., Vanhorn JH., Jenkin LET. (2005 b
). An analysis of food waste from the Cornwall NHS. Unpublished article.
54

Tudor TL., Marsh CL., Vanhorn JH., Jenkin LET. (2006). Realising resource efficiency in the management of healthcare waste from the Cornwall NHS.
(forthcoming).
VanHorn JA. (2001). A survey of domestic waste produced at two local hospitals and a local health office and the potential for waste management. Unpublished final year
Bsc. project. Camborne School of Mines. University of Exeter in Cornwall.
Personal communication
Sharon Butler – Cornwall NHS Waste Manager
Steven Millership – Cornwall NHS Workforce Assistant
55