The views of Adam Read, Suez external affairs director, in the piece, Cut backs and staffing concerns leave recycling in the shadows at UK hospitals, made for interesting reading. Interesting, but not surprising according to Graham Flynn, managing director of Anenta, an independent environmental services contract management partner.
In fact the only real surprise is that our hospitals have managed to provide the quality of care that Adam Read enjoyed, for as long as they have, given the millions of pounds which is effectively thrown away as a result of inneficient waste management practices.
Reflecting on what’s not working in the hospitals he had visited across England, Adam noted how tight staffing levels were, and specifically, the obvious lack of bins. But is it cuts and staffing concerns that are creating the waste management issue, or poor waste management that is resulting, in part at least, in those same cuts?
It would perhaps be a step too far to suggest that improving waste management in the NHS is the panacea to all ailments, but the reality is that in just 18 months, working as NHS England’s managing agent for North London Primary Care waste, Anenta has delivered savings of £1.8m, using its unique proprietary platform to standardise pricing schedules, match customer requirements to contracts and optimise service provision. In fact in the last four years, this way of working has enabled Anenta to save the NHS over £3.2m on existing contracts across 19 CCGs. When extrapolated across England, potential savings of £8.75m annually become apparent. It is clear therefore that improving the efficiency of waste management is a real alternative to cuts which negatively impact frontline services.
It was also interesting to note that Adam needed to ask nurses and other staff to direct him to the appropriate bins for different types of waste, which were not readily visible. More significant perhaps is the fact that while nurses and other front line staff do of course need to dispose of waste, it should following the provision of training to give an understanding of the different waste types. In many cases, this training is simply not being provided.
Meanwhile, it is falling to administrative staff from nursing backgrounds to manage the waste management contracts and the reality is that despite the skilled and proffessional attitude demonstrated every day by NHS staff across the country, contract management is something these people have neither the time or expertise to deliver effectively.
Indeed Anenta’s analysis of NHS contracts has highlighted that in the majority of cases, once the waste management service has been procured, it is not managed effectively and in a significant number of cases, it is not managed at all by the customer. A lack of contract management expertise combined with a lack of ownership within the NHS, ultimately means more than simply a lack of the necessary types of bins or unclear signage as Adam saw. It means low levels of efficiency at best and high levels of waste and quite possibly front line cuts which could have been avoided, at worst. Of course I share Adam’s frustration and he is right, a great deal has been done over the years to identify cost saving opportunities throughout the NHS and one has only to look to Lord Carter’s 2016 report which estimated a saving of £1bn on running costs every year if each NHS trust performed as well as the best, to see the scale of the opportunity. And he is also absolutely right that Warwick Hospital, like so many others, would benefit from an audit.
However, the insight to be gained from such a process will only prove to be of use if other key issues are tackled, specifically within the procurement process. The current disconnect between those procuring waste management contracts and their understanding of the NHS’s waste management requirements is perhaps the first of these. The procurement framework and the limitations it imposes particularly for higher value contracts is another and once a service has been procured, it has to be managed by those with the right expertise and appropriate motivation. Adam also calls for stakeholders to share good and bad practice – again he is right. But clear ownership is required first – this will drive more effective collaboration between departments and Trusts.
But let’s look beyond the hospitals for moment – aside from an unnecessarily complicated procurement and a lack of contract management processes within the NHS, change is needed in the waste management industry too. Trusts are faced with ambiguous pricing from service providers which is subject to change over time, a lack of clarity concerning contract deliverables and poor monitoring and communications.
To tackle these issues, Anenta has already invested more than £1m in its proprietary online waste management platform with the objective of providing every customer with an easy to use system which delivered a bespoke service and provided best value.
The ability, and capacity to analyse data effectively which this platform has provided has also enabled Anenta to highlight charges for services that have not been provided by waste management suppliers for numerous customers. Innapropriate miscellaneous charges totalling over £2m have been identified by Anenta across its customer base and in the last three years waste contractors have refunded more than £500,000.
Resources are important and hospital expenditure huge, as Adam noted, making the point that a relatively small percentage saving could be significant in terms of nursing care and patient access. Quite right – cutting waste through more effective contract management will help to stop cuts in other critical areas. But the percentage saving could be a great deal more than many realise. Indeed, with a step change in procurement and waste management process, the percentage saving could make a significant contribution to the 2020 overall efficiency savings target of £22bn.
And it will help Adam and millions of other patients to continue receiving the care they require from the front line staff who work so hard to deliver it.