Dublin Castle - 24 June 2005

Press Release: VFM Report on Waste Management in Hospitals

The Comptroller and Auditor General, Mr John Purcell, has today published a report on a value for money examination of waste management in hospitals.

Background to the Examination

Healthcare risk waste is any potentially hazardous waste material arising from healthcare-related activities.  Such waste requires special management and the use of costly handling and disposal arrangements to avoid causing infection or injury to those who come in contact with it, and to minimise negative impacts on the environment.  Because of the scale and nature of the services they provide, hospitals also produce large volumes of non-risk waste e.g. from kitchens, cleaning services, offices, etc. 

The examination was carried out to identify

  • the level of output of waste in publicly-funded hospitals in Ireland, and the type of waste produced
  • the costs associated with the collection, handling, treatment and disposal of such waste
  • good practice in the management of waste in publicly-funded hospitals.  

Main Findings

The direct costs incurred by hospitals in handling and disposing of waste in 2002 is estimated at ?13.2 million (or ?15.5 million in 2004 prices).   While this is a small expenditure in the context of the overall public provision for hospital services, it still represents a significant cost element for hospitals, and one that may escalate rapidly if not properly managed.   

The total quantity of waste produced by publicly-funded hospitals in 2002 is estimated at around 27,500 tonnes.  A comparison with waste output levels for hospitals in other jurisdictions showed that output levels were similar for large hospitals but that many small and medium-sized Irish hospitals had significantly higher waste output levels than their equivalents elsewhere.  This suggests there is scope for such hospitals to reduce the amounts of waste they produce.    

A high proportion of the materials in non-risk hospital waste could be recycled but the reported level of recycling by hospitals was low.  Hospitals reported having had difficulties in finding contractors willing to take recyclable materials, but a number stated that they have more recently started to recycle or increased the level of recycling.  Recycling is usually not cost free, but it is generally cheaper than disposing of waste at landfill, and some hospitals reported recycling initiatives that resulted in worthwhile savings. 

Risk waste accounted for almost one fifth of the total waste output ? just under 5,300 tonnes ? and nearly all of this was produced in the acute and maternity hospitals.

The cost to hospitals for handling and disposal of risk waste (estimated to average ?1,430 per tonne) was almost six times the cost of handling and disposal of non-risk waste (estimated at an average of around ?250 per tonne).  The very wide difference in cost underlines the importance of ensuring there is good segregation of waste, so that only waste that needs to be treated as risk waste gets into that disposal stream.

On the basis of a comparison of costs across the hospital sector, there appears to be scope for savings in the procurement and use of the special colour-coded containers and bags used when risk waste is being handled. 

Most publicly-funded hospitals use the same service provider to remove and treat risk waste, under a joint contract arrangement.  Almost all the risk waste collected from those hospitals is treated by disinfection at the service provider?s plant, and subsequently sent for landfill.  A very small percentage of risk waste (around 2% in 2002) is considered to require incineration, and this is carried out in Belgium. 

Individual hospitals reported that they pay prices ranging from around ?140 to just over ?450 per tonne to the waste contractors that collect their non-risk waste.  This variation in cost reflects many factors, including local landfill costs, distance to landfill and the degree of competition between waste contractors locally. 

Some good practice ideas already in use in individual hospitals are highlighted in this report to assist hospital and other health sector managers in developing and improving their strategies for dealing with waste.  

None of the hospitals or health boards visited during this examination had adopted a clear set of relevant and comprehensive targets for waste management performance.  In general, their waste management plans contain little information about hospitals? and health boards? performance in managing waste e.g. the incidence of waste-related health and safety incidents, the amount of waste produced, the costs incurred, the proportion of waste recycled, etc. 

A set of about twelve key measures could be used by larger hospitals in assessing, monitoring and setting targets for waste management performance.  Developing plans that focus primarily on performance objectives and targets to be achieved by stated dates would provide hospital managers with a much stronger focus and incentive for improving waste management in hospitals.

Notes for Editors

The Comptroller and Auditor General is an independent constitutional officer with responsibility for the audit of public funds.  He reports to Dáil ?reann. 

The full text of the report is available on the website of the Office of the Comptroller and Auditor General (go to www.gov.ie/audgen/)

For further information about the report, please contact:

Seamus McCarthy at (087) 907 8262 or at Seamus_McCarthy@audgen.irlgov.ie