Responsibility and waste; a waste of time?

Where do our responsibilities as clinicians begin and end? We all agree that, as clinicians, we are responsible for providing high quality assessments and management plans for our patients. I think we all probably also agree that, as clinical leaders, we have a responsibility to set an example of professionalism in our teams and across the organisation. But do our responsibilities end there?

Are we as clinicians responsible for the impacts our organisation is having on the community or the environment? Certainly, I have felt in the past that as long as I provide a good service and work hard then surely that is enough. Right? Aren’t there enough burdens already being placed on us as it is, without putting more responsibility on our shoulders?

The interesting thing is, that we all feel responsible for the waste being produced in our homes. Most of us now acknowledge the importance of recycling and are beginning to accept the responsibility for the waste we produce. As a result, recycling rates are encouragingly on the up.

But, something happens when we get to work. We change. We all know the amount of paper that is needlessly printed out and then thrown away. We know we could be more careful about which bins we are using; clinical, domestic or recycling that is. But that is just us operating as individuals. How about the waste occurring at Trust level? Heating units blazing away while windows are left open or lights, computers, you name it, left on over night.

The NHS produces an astounding 600,000 tonnes of waste per year, at a cost of £42 million.  The UK produces on average ten times the waste that Germany produces (5.5 kg/pt/day versus 0.4 respectively). Across the UK, recycling activity was found to vary from 0% to as high as about 60%. At Bart’s hospital in London, they found that simple behavior change (Operation TLC; Turn off, Lights out, Close door saved 3% on energy bills across the Trust, equating to £105,000 per annum, which is 800 tonnes of CO₂e. With the resultant effect on patients that one-third reported fewer sleep disruptions due to noise and one-quarter reported fewer privacy intrusions.

How about a wider understanding of waste? What about national DNA rates of 8-9% for the past few years? The average cost of a first outpatient appointment is £156, second appointments are £76. In 2007/8, 6.5 million appointments were missed in the UK, with hospitals losing around £100 per patient in revenue, this equates to £600 million.

What about purchasing equipment or investigations? Data from the Department of Health in 2012 shows that average costs of blood tests vary from 24p to £13.28 depending on where you are in the country. Histology tests cost from £1.44 to £229.81 between hospitals and immunology from 65p to £31.91. Lord Warner said the NHS could save up to £750m by changing how pathology services were commissioned.

The NHS and the Trusts we work in are the economic and environmental equivalent of a leaky bucket. If we clinicians could broaden our sense of responsibility to minimizing waste in the services we work in, we could find money to spend on desperately needed staff shortages or services. Waste is surely everyone’s business.

I am speaking to the Academy of Medical Royal Colleges about this issue this month, as I believe the way to tackle this waste issue is to realize the importance of thinking sustainably. If you would like to know more, join the mental health sustainability network