Towards more sustainable use of plastics in healthcare

Plastic is everywhere

Plastics play a huge role across modern society, providing convenience in our daily lives and enabling many innovations which we now take for granted. However, whether it’s from the BBC’s Blue Planet coverage of ocean plastic pollution, or from our daily experience of plastic waste in our work and home lives, there’s increasing awareness of the negative impact that plastics are having on the world around us, and on us directly.

Globally, the plastics challenge is enormous. Many of the figures are hard to put into context but, since the 1950s when industrial production took off, it’s estimated that 9 billion tonnes of plastic have been manufactured. And of that output, only around 9% has ever been recycled. So a huge volume of plastics has followed a linear economy model into disuse and we’ve missed out on opportunities for better use of resources.

The problem is growing year on year. Plastics production has quadrupled in the last 30yrs, with more than 380 million tonnes of plastic produced worldwide in 2020. Although recycling rates are improving, still only 16% of plastic waste is recycled to make new plastics, while 40% is sent to landfill, 25% to incineration and 19% is dumped. Other studies estimate that as much as 22% of all plastics evade waste management altogether and enter the environment in a completely uncontrolled way, with disastrous consequences.

Plastics in healthcare

In healthcare, over recent decades there’s been a move away from reusable metal instruments and washable items to single-use disposables. This trend has been driven by the many benefits which plastic products can offer, including infection control and lower cost. Revenue models have developed to depend upon consumable plastic items. Plastics have become ubiquitous in healthcare, to the point where delivery of medical care might seem impossible without them.

Globally, annual use of plastics in healthcare was recently estimated at 15 million tonnes. This represents a small but still significant part of overall plastics consumption. It also comes with some challenges which are particular to healthcare, in particular the management of contaminated waste.

Across Europe, it’s estimated that 36% of healthcare waste is plastics. And critically, 42% of healthcare plastic waste is incinerated, with associated climate change and environmental impacts.

The picture in the NHS and other healthcare systems

In the UK, the NHS is not only one of the biggest producers of healthcare waste in Europe, but also the biggest user of single-use plastics. A recent report by Healthcare Without Harm identified that, prior to the pandemic, the NHS produced 11,300 tonnes of waste daily. Of this, 22.7% was plastic – that’s around 2,500 tonnes of plastic waste every day.

Healthcare plastic waste is usually a mix of clinical and non-clinical items. In a hospital setting, major product categories for clinical items are diverse and include the likes of gloves, protective clothing, surgical drapes, syringes, incontinence products and IV bags & administration kits. Non-clinical waste includes food-contacting materials, hygiene products and bags.

In one hospital study from the Netherlands, 50% of total plastic waste examined was plastic packaging – and roughly half of that didn’t have labels identifying the polymer(s) used. Another study in Denmark identified at least 15 polymer types used in packaging – with LDPE being most common – but again half of the polymer types were unknown. The results are likely to be similar in the NHS and the challenges in managing these complex waste streams are significant.

In addition to the environmental impacts, we’re all becoming more aware of the human health impacts of plastics – whether that’s from micro- and nano-plastics in the air, food and water; toxic chemicals associated with extraction, production and disposal of plastics; or from plastic additives used to improve material performance. So there are plenty of clear reasons to act.

What’s being done?

From a UK domestic market perspective, the NHS is starting to get to grips with the problem. The NHS Long Term Plan in 2019 identified the need for reductions in single-use plastics. Following on from this, the NHS Sustainable Development Unit (now succeeded by the Greener NHS programme) supported the NHS to reduce the amount of avoidable single-use plastics used in clinical activity, and to reduce the amount of plastic packaging throughout the supply chain. The NHS instituted a Single-Use Plastics Reduction Pledge, focusing on consumer and food & drink waste.

More broadly, NHS sustainability commitments under “Delivering a Net Zero NHS” include references to reducing & reusing plastics in the supply chain, and to the need for PPE with improved sustainability profiles. It’s important to note that there are many overlaps between sustainability goals and plastics use, particularly given that plastics accounted for 4.5% of global greenhouse gas emissions in 2015.

For manufacturers, the high-level challenges are starting to translate into real commercial considerations. Specifically for plastics, the Plastics Packaging Tax will be implemented in the UK from April 2022. For sustainability more generally, from April 2022 NHS procurement will include a minimum of 10% social value weighting in their tender scoring, covering issues such as environmental impact; and from April 2023 NHS suppliers will need to start complying with carbon emission reporting and reduction requirements.

It’s not just NHS practice which is changing. Other healthcare systems around the world will be watching progress in the UK. At COP26 last year 45 countries committed to more sustainable and low-carbon healthcare, of which 14 aim to reach net zero by 2050. So changes in UK domestic market requirements have the potential to translate into global market opportunities.

How can I get involved?

As a framework for action, it’s important to consider the waste hierarchy and how it applies to plastics. The waste hierarchy highlights that waste prevention is preferred and should be the starting point – through redesign, reduction, reuse, reprocessing and repair. After this you can consider interventions which address end of product life – around recycling, recovery and disposal.

The UK Circular Plastics Network (UKCPN), supported by Innovate UK KTN and UK Research and Innovation (UKRI), can help you to implement this approach. It brings together diverse users of plastic products and helps realise the best means for reducing plastic waste, through a programme of networking & knowledge-sharing events and related support activities. Its resources include an interactive landscape map which can help you to identify sources of expertise and potential collaborators across the UK.

In healthcare, there are already some great examples of more circular approaches to plastics use. They include prevention of waste by changing clinical practice; redesigning plastic components to reduce weight or to be reusable; implementing take-back schemes for devices; and thermal compaction of used PPE and lateral flow tests into construction materials.

If you want to find out more, from 15-17 March 2022 UKCPN and KTN will be delivering the Global Research & Innovation in Plastics Sustainability (GRIPS) conference. GRIPS is an online conference, exhibition and showcase which highlights the best of the UK and select international activities in more sustainable plastics use. It will feature a session on medical plastics – so please join us to hear about the latest innovations across multiple sectors including healthcare, to see how you can make a difference!