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 Waste Management & Research
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Utilizing a `systems' approach to improve the management of waste from healthcare facilities: best
practice case studies from England and Wales
Terry L. Tudor, Anne C. Woolridge, Margaret P. Bates, Paul S. Phillips, Sharon Butler and Keith Jones
Waste Manag Res 2008; 26; 233
DOI: 10.1177/0734242X07081482

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Los Angeles, London, New Delhi
and Singapore
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Copyright © ISWA 2008
ISSN 0734–242X
Waste Management & Research
2008: 26: 233–240

Utilizing a ‘systems’ approach to improve the

management of waste from healthcare facilities:
best practice case studies from England and Wales
Terry L. Tudor, Anne C. Woolridge, Margaret P. Bates, Paul S. Phillips
SITA Centre for Sustainable Wastes Management, University of Northampton, Northampton, UK

Sharon Butler
Cornwall NHS Trust, The Utilities Department, St Lawrence’s Hospital, Bodmin, Cornwall, UK

Keith Jones
Cardiff and Vale NHS Trust, University Hospital of Wales, Heath Park, Cardiff, UK

Changes in environmental legislation and standards governing healthcare waste, such as the Hazardous Waste Regulations
are expected to have a significant impact on healthcare waste quantities and costs in England and Wales. This paper presents
findings from two award winning case study organizations, the Cardiff and Vale NHS Trust and the Cornwall NHS Trust on
‘systems’ they have employed for minimizing waste. The results suggest the need for the development and implementation
of a holistic range of systems in order to develop best practice, including waste minimization strategies, key performance indi-
cators, and staff training and awareness. The implications for the sharing of best practice from the two case studies are also
discussed.

Keywords: hazardous waste regulations, healthcare waste segregation, medical waste minimization, best practice, Cornwall,
Cardiff, National Health Service (NHS), wmr 1207–9

Introduction
Changes in environmental legislation and standards govern-
ing healthcare waste are expected to have a significant
impact on waste quantities and costs in England and Wales.
Key pieces of legislation include the EU Landfill Directive
(EU 1999), the Hazardous Waste Directive (EU 1994), and
the recent Hazardous Waste (England and Wales) Regula-
tions (DEFRA 2005a), which was introduced in July 2005
under Department of Health (DoH) guidance. The imple-
mentation of these pieces of legislation have resulted in a
number of changes for waste management including a reduc-
tion in the quantity of biodegradable waste that can be sent
to landfill, fewer landfills being authorized to accept hazard-
ous waste, and changes to the classification of waste that has
resulted in increased quantities of hazardous waste.
In England and Wales hazardous waste is defined as
(DEFRA 2006a):
Waste that contains hazardous properties that may
render it harmful to human health or the environment
Under the Hazardous Waste Directive (EU 1994), hazard-
ous waste is defined on the basis of the European Waste Cat-
alogue (EWC), which were drawn up under the Directive. On
16th July 2005 the Hazardous Waste Directive was transposed
by the Hazardous Waste (England and Wales) Regulations
2005 (DEFRA 2005a) and the List of Waste (England) Regu-
lations 2005 (DEFRA 2005b) into law in England and Wales.
The Regulations place a duty of care on producers to segre-
gate hazardous wastes from non-hazardous waste. Table 1
lists the 14 characteristics that are used to define hazardous
waste
This reclassification of waste types is expected to have
major implications for the quantities and resulting treat-

Corresponding author: Terry L. Tudor, SITA Centre for Sustainable Wastes Management. School of Applied Sciences, University of Northampton,
Northampton, NN2 7AL, UK. Tel.: +44 01604 892398; fax: +44 01604 720636; e-mail: terry.tudor@northampton.ac.uk
DOI: 10.1177/0734242X07081482
Received 14 March 2007; accepted in revised form 21 May 2007
Figures 1, 4 appear in colour online: http://wmr.sagepub.com

233
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T.L. Tudor, A.C. Woolridge, M.P. Bates, P.S. Phillips, S. Butler, K. Jones

Table 1: The 14 characteristics of hazardous waste. as well as NHS Purchasing and Supplies Agency (PASA) have
specific responsibility for the implementation of sustainable
Category Code
waste management practices within the NHS.
Explosive H1
Oxidising H2 The case study organizations
Highly flammable H3A At the time of this study in 2004/5, the Cornwall NHS was
Flammable H3B comprised of five Trusts (three PCTs, one specialist Mental
Irritant H4 Health Trust and one Acute Care Trust), at approximately 100
sites and employed some 9536 staff (Cornwall NHS 2005).
Harmful H5
These sites included three acute hospitals, 15 community hos-
Toxic H6
pitals (including one with mental health facilities), eight men-
Carcinogenic H7
tal health/learning disability (MH/LDD) in-patient units/
Corrosive H8 homes, 23 health centres, four drop-in centres, as well as a
Infectious H9 number of offices and administrative facilities. There were
Toxic for reproduction H10 approximately 1800 NHS beds in the county. It provides
Mutagenic H11 acute, mental health and acute care services to approximately
Substances that release toxic gases H12 500 000 individuals in Cornwall, a county in the south-west of
Substances capable of yielding substances H13 England (Figure 1). Royal Cornwall Hospitals Trust is the
listed above largest NHS Trust with around 1000 beds, 5000 staff, and
Ecotoxic H14 operating expenses of approximately £249 million in the
Source: EU (1994).
financial year 2005/6 (RCHT 2007).
Cardiff and Vale NHS Trust is the largest NHS Trust in
Wales, and the third largest in the UK, employing over 13 500
ment costs of waste generated from all sectors (e.g. indus- staff at nine hospital sites and 18 health centres and clinics.
trial and commercial, agricultural and municipal), in Eng- The Trust has approximately 1658 beds. It provides a range of
land and Wales. It is therefore imperative that organizations acute, mental health, and community services to approxi-
such as the National Health Service (NHS), on which this mately 500 000 individuals in Cardiff (the capital city of
study was based, to develop policies and systems which bet- Wales), and the Vale of Glamorgan. In the financial year
ter manage their production of waste materials, through 2005/6 its annual turnover was £576 million (Cardiff and Vale
minimization and recovery. NHS Trust 2007).
Using two award-winning case study organizations, this
paper examines the site level ‘systems’ via which they have
sought to effectively segregate and minimize the hazardous
and non-hazardous wastes produced. The case studies are
taken from the NHS, which is the largest employer in Eng-
land and Wales. For the purposes of the paper, the term ‘sys-
tems’ should be taken in its broadest sense to mean strategies
and technologies have been employed for the effective man-
agement of waste.

The National Health Service (NHS)

In England and Wales, the DoH has overall responsibility for
the provision of healthcare. The NHS which is charged with
the delivery of healthcare is comprised of a range of profes-
sionals, support workers and constituent organizations. At
the top of the organizational hierarchy are policy makers,
comprised primarily of the Secretary of State for Health and
the DoH. These policy makers are aided by specialist agencies
such as the Institute for Innovation and Improvement. Health
Authorities, particularly the Strategic Health Authorities play
an important role in translating policies at the local level, by
acting as the main link between the DoH and the various
NHS Trusts. At the local level, NHS Trusts, such as Primary
Care Trusts (PCTs), Acute Care, Mental Health and Founda-
tion Trusts are charged with delivering NHS healthcare serv- Fig. 1: Map of the UK showing the geographical location of the NHS
ices. Agencies such as the estates departments of each Trust, Trusts surveyed.

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 Utilizing a ‘systems’ approach to improve the management of waste from healthcare facilities
The two Trusts serve as excellent case studies for an exam-
ination of sustainable waste management practices as they
have both won national awards for their environmental man-
agement programmes. For example, the integrated environ-
mental management schemes of the Cornwall NHS were
awarded an honourable mention in the NHS Estate’s Build-
ing Better Healthcare Awards in 2004. In 2005 the Cardiff
and Vale NHS Trust was a winner and finalist in the prestig-
ious Arena Network Wales Environmental Awards, won for
Best Practice, and was a finalist in the Sustainability Waste
Management category in the Public Sector Awards. The Car-
diff and Vale NHS Trust was also accredited ISO 14001 status
in 2003 (Cardiff and Vale NHS Trust 2007).
Minimizing waste generated from healthcare
facilities
Realizing greater efficiency in the manner in which waste
from healthcare facilities is managed is one of the main prior-
ities of the various NHS estates departments in England and
Wales. These departments have lead responsibility for provid-
ing guidance on targets for energy, water, waste, transport
and procurement DoH (2003), in conjunction with NHS
PASA which has lead responsibility for procurement and pur-
chasing. For example, driven in large part by Government
(Welsh National Assembly (2002)), Welsh Strategy for
Healthcare Waste (NHS Wales 2006) requires that by 2010
each Welsh NHS Trust should reduce the total quantity of
waste it produces by 10% of 2002/3 baseline figures. In addi-
tion, it also argues that (NHS Wales 2006):
“All healthcare organisations should review with imme-
diate effect, the production of all hazardous waste pro-
duced on-site and should produce a hazardous waste
inventory.”
Table 2 lists examples of common hazardous and non-haz-
ardous waste produced by NHS Trusts in England and Wales.
The implementation of the Hazardous Waste Regulations
incorporates a wider range of waste from healthcare facilities
into the hazardous category. For example, the regulations
reclassify all clinical/medical waste in England and Wales as
hazardous waste. However, it should be noted that some dis-
crepancy does exist, as the technical guidance document
WM2 (EA 2006) produced by the regulating body, the Envi-
ronment Agency, differs in its classification scheme from the
DoH guidance. Strategies for the effective segregation of
hazardous and non-hazardous wastes from healthcare facili-
ties are therefore timely and important.
A number of studies have demonstrated that the percent-
age of non-hazardous waste disposed of in the hazardous/
clinical waste stream can often be 50–90% (Zafar & Butler
2000, AoDM 2003, Woolridge et al. 2005, Tudor et al. 2005,
Tudor 2007). Research has suggested mechanisms for mini-
mization and hence more sustainable management of waste
from healthcare facilities. These include improved waste seg-
regation, sending packaging back to the suppliers, use of bio-
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Table 2: Examples of hazardous and non-hazardous waste produced
in the NHS in England and Wales.
Hazardous waste Non-hazardous waste
Cytotoxic
Cytostatic
Clinical waste* Domestic waste
Fluorescent tubes Food waste
Laboratory chemicals Hygiene waste
Cleaning chemicals Packaging waste
Photo chemicals Recyclates (e.g. paper,
aluminum and glass)
Oils Furniture
Batteries Construction and demolition waste
Waste electronics Grounds waste
Asbestos
Solvents
Paints
Sources: NHS Wales (2006), DEFRA (2005a).
*Some exceptions exist.
degradable or reusable nappies and greater streamlining of
procurement with product/service usage (NHS Estates 2001,
Lee et al. 2004, Ozbek & Sanin 2004, Tudor et al. 2005). Lee
et al. (2004) demonstrated that the employment of an effec-
tive waste classification system and the utilization of different
treatment and disposal methods based on this classification
could reduce the quantities and treatment costs for clinical
waste requiring special handling and disposal by 78%. How-
ever, within the NHS a significant barrier is that the manage-
ment of waste has generally tended to be focused on disposal
procedures, the reduction of clinical waste and limited diver-
sion of items such as paper and plastics to recycling (Tudor
et al. 2005).
Woolridge et al. (2005) argue for the use of tactical and
strategic tools such as the Strategic Waste Achievement Pro-
gramme (SWAP) in order to enable NHS Trusts to effec-
tively manage the environmental, social and economic factors
associated with their waste. Indeed, in a limited study for one
general hospital Woolridge & Phillips (2004) were able to
identify approximately £28 000 in savings through the use of
systems analysis designed methods (SSADM). Similarly,
Tudor (2007) proposed a unit to improve the efficiency of
monitoring waste generation patterns across departments,
thus enabling better targeting of resources, and hence
achieve cost savings in the management of the waste.
Improving waste segregation and minimization
Waste generation patterns and costs
A study of healthcare arisings for NHS Trusts from England and
Wales by Barrett et al. (2004) estimated that 384 698 tonnes of
healthcare waste was generated. This total was comprised of
3063 tonnes of hazardous waste and 381 333 tonnes of non-
hazardous waste. However, the Department of Health (DoH)
reported that the NHS generates a lower figure of around
235
T.L. Tudor, A.C. Woolridge, M.P. Bates, P.S. Phillips, S. Butler, K. Jones

Fig. 2: Quantity of waste produced by NHS Trusts in Wales NHS Wales Fig. 3: Costs of waste disposal for NHS Trusts in Wales NHS Wales
(2006). (2006).

250 000 tonnes of waste per year (Brayford 2006). These dis-
crepancies may have arisen due to differences in measure-
ment or in the types of waste included.
According to NHS Wales (2006), between 2003 and 2005
the quantity of non-hazardous waste from Welsh NHS sites
increased by approximately 25% and the hazardous/clinical
waste increased by 20% (Figure 2). As shown in Figure 3 the
costs of treating the non-hazardous waste remained relatively
constant, but there was a slight decrease in the treatment
costs for hazardous/clinical waste, due in part to increased
conservation and recycling. Recycling rates for all Trusts were
nearly double between 2004 and 2005, moving from 2.5% to
almost 5%. However, at the time of the study five of the seven
NHS Trusts in Wales did not recycle any waste, whereas three
trusts recycled on average 15% of their non-hazardous waste.
Research undertaken in a similar setting, the Republic of Ire-
land (Table 3) illustrates the differences in quantities and
costs of hazardous and non-hazardous waste generated by the
main types of hospitals. It can be seen that both the quantity
as well as the source of the waste are important considera-
tions in its management.
The Cornwall NHS
In 2004/5 the Cornwall NHS Trust generated in excess of
7000 tonnes of non-hazardous and hazardous waste at an
approximate cost of £300 000 (Cornwall NHS 2005). Table 4

Table 3: A comparison of handling and disposal costs for waste from selected hospital types in the Republic of Ireland.

Handling and disposal costs (£000s)

Hospital type Risk waste Non-risk waste All waste

Acute 4715 2788 7503
Maternity 316 127 444
Community 20 249 269
Psychiatric 20 619 639
Total 5071 (57%) 3785 (43%) 8857 (100%)
Adapted from DoHC (2005).

Table 4: Estimated waste arisings and their associated costs from the Cornwall NHS for 2004/5.

Waste stream Estimated weight/year (tonnes) Estimated collection/disposal costs (£/year)

Clinical 477.4 20571
Domestic (includes mixed paper, plastics, office paper, 681.6 21455
newspaper/magazines)
Recyclables (includes office paper, card, plastics, glass) 327.4 8069 (collection charges)
Printer cartridges 3500 0
Cytotoxics 4.5 1791
Food 110.5 Macerated and included in water
and sewage charges
Bulk/redundant 180.6 2080
Radioactive 0.1 1468
Adapted from Tudor et al. (2005).

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 Utilizing a ‘systems’ approach to improve the management of waste from healthcare facilities

Table 5: Estimated waste arisings and their associated costs for the Cardiff and Vale NHS Trust for 2005/6.

Estimated waste arisings Costs

Waste type Arisings per month Arisings per year (tonnes) Waste treatment costs Waste treatment costs
(tonnes) per month (£) per year (£)
Clinical 95 1137 66966 803603
Domestic 84 1003 19264 231171
Hazardous 5 60 3013 36166
Recyclables 5 61 0 0
Source: Cardiff and Vale NHS Trust (2006).

Table 6: Estimated average annual waste arisings per bed for the Table 7: Examples of hazardous waste produced by the Cardiff and
Cardiff and Vale NHS Trust for 2005/6. Vale NHS Trust.

Average annual waste arisings Human and animal tissue

Waste type
per bed (tonnes) Blood and other body fluids
Clinical (non-hazardous) 0.681 Excretions
Domestic (non-hazardous) 0.60 Drugs or other pharmaceutical products
Hazardous 0.036 Swabs or dressings
Recycled 0.037 Syringes, needles or sharp instruments
Source: Cardiff and Vale NHS Trust (2006). Source: Cardiff and Vale NHS Trust (2005).

provides an estimate of the quantities and costs of waste gen-
eration in the Cornwall NHS. It can be seen that even though
the quantities of non-hazardous waste were approximately
43% higher than for hazardous/clinical waste, treatment
costs were similar. Costs for food waste were included in
sewage charges as food was macerated on-site and disposed
of via the waste water systems. There was no charge for
printer cartridges as they were collected from a central site
by the manufacturers.
Cardiff and Vale NHS Trust
In 2005/6 total waste disposal costs for the Trust were
approximately £1.3 million per annum, with a projected sig-
nificant rise due to the need to meet changes in compliance
and legislation, as well as stricter environmental standards
(Cardiff and Vale NHS Trust 2007). Tables 5 and 6 provide a
break down of the quantities and costs for the overall and
main waste categories for 2005/6 from the Cardiff and Vale
NHS Trust. The costs of the recyclables equates to zero as
these incurred no disposal charges.
cling, composting and energy from waste. Within this overall
approach it set up new recycling and reuse schemes and intro-
duced a more integrated resource use programme. This
involved working more closely with its waste contractors and
implementing strategies to encourage staff (for example in
facilities and procurement/purchasing), to participate in recy-
cling schemes and reduce their waste. Figure 4 demonstrates
the reduction in the clinical/hazardous waste streams achieved
by the Cardiff and Vale NHS Trust as a result of the waste min-
imization and recycling initiatives undertaken. Over the period
the total quantities of waste remained relatively constant, but
there was some increase in the domestic waste, as well as
waste from the cardiac ITU/HDU unit.
Both organizations have developed a system of perform-
ance management indicators. Table 8 illustrates the key per-
formance indicators used by the Trusts, which have been
based primarily on waste arisings, as well as staff training and
legislative compliance. The indicators serve to manage the
effective development and implementation of segregation
and reduction schemes. By July 2006 some 460 staff in the

‘System’ approaches to reducing the waste

The types of hazardous wastes produced by both organiza-
tions are similar. Table 7 lists examples of hazardous wastes
produced by the Cardiff and Vale NHS Trust.
An important approach for both Trusts has been the setting
of resource management targets using evidence-based data.
Both organizations undertook major baseline studies to bet-
ter understand how waste was being managed at all their sites,
with targets then being set. For example, in 2004 the Cardiff
and Vale NHS Trust set out to recover value from 10% of its Fig. 4: Solid waste quantities from the Cardiff and Vale NHS Trust
domestic waste by 2005 through initiatives for re-use, recy- between April 2006 and November 2006.

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T.L. Tudor, A.C. Woolridge, M.P. Bates, P.S. Phillips, S. Butler, K. Jones

Table 8: A comparison of the key waste management performance incineration such as the use of hot oil); a domestic waste bag
indicators used by both the Cardiff and Vale NHS Trust and the stream; a ‘Tiger bag’ stream (low-risk clinical waste e.g. swabs
Cornwall NHS Trust.
and dressings); and a yellow bag waste steam (for high-risk
Cardiff and Vale Cornwall NHS clinical waste) that is incinerated. The use of this system has
Performance indicator
NHS Trust Trust enabled the organization to implement effective segregation
Welsh Risk Management Y N mechanisms for its overall bagged waste.
Score Both Cardiff and Vale and Cornwall NHS Trusts sought
Number of ‘incident’ reports Y Y to raise awareness and knowledge of waste management
Number of waste audits Y N through staff training, audits, and promotional material. In
undertaken addition, the Cornwall NHS also set up an internal website
Number of staff undertaking Y Y through which staff could gain information on waste man-
mandatory training agement at their site and could seek information or assist-
Number of staff attending Y N ance from the waste management department (Tudor et al.
training 2005).
Clinical/hazardous waste Y Y
produced Discussion
Non-hazardous waste Y Y An increasingly stringent legislative and regulatory frame-
produced work for the management of waste in England and Wales will
Percentage of overall waste Y N result in increased quantities of and therefore costs for haz-
to landfill ardous and non-hazardous healthcare waste generated. Sys-
Percentage of overall Y Y tems (approaches and technologies) via which these waste
waste recycled
can be more cost effectively managed are therefore impor-
Cost of waste disposal Y Y tant. Indeed, Woolridge et al. (2005) argue that the need for
Number of environmental/ N Y formal systems to accurately monitor and manage waste
waste representatives
streams is crucial within the NHS.
Y, yes; N, no. This study has examined a number of ‘systems’ imple-
mented by the Cardiff and Vale and Cornwall NHS Trusts
through which they have sought to achieve sustainable man-
organization had received waste management training, its agement of their waste streams. These ‘systems’ included: (1)
Welsh risk management score was 87% against a bench mark the development and implementation of key performance
of 75% and there were no ‘incidents reports’. Departments indicators (which enable the monitoring of waste arisings and
that performed well were used as best practice examples staff training within an overall environmental management
throughout the Trust. Those that failed to meet agreed stand- systems framework); (2) a formal auditing and reporting sys-
ards were reported to the Trust Directorate, but also pro- tem; (3) a comprehensive recycling and reuse system for sev-
vided with support primarily in the form of advice to eral waste streams; and (4) mechanisms to raise the levels of
improve their performance. Training schemes and waste awareness and knowledge of staff. The findings suggest that
management pilots have also been introduced at ward and development and implementation of the systems should first
departmental levels to minimize waste production and be grounded in sound evidence-based data, incorporating
improve segregation rates (Cardiff and Vale NHS Trust information on waste generation and monitoring, as well as
2005). These indicators form an integral role in the mainte- staff training and awareness for the employees. To effect long-
nance of the organization’s ISO 14001 environmental man- term change, the systems should employ both quantitative
agement accreditation scheme. (e.g. questionnaires and waste bin analyses), as well as quali-
The Cardiff and Vale NHS Trust has also implemented a tative (e.g. interviews) mechanisms (NHS Estates 2001;
bar-coding system as a means of more accurately auditing its AoDM 2003; Woolridge and Philips 2004; Tudor et al., 2007).
waste (Cardiff and Vale NHS Trust 2006). Waste management This would enable examination of both the waste arisings, as
toolkits have also been developed and employed by both well as the socio-psychological and socio-demographic char-
organizations in order to enable staff to better track and man- acteristics of the waste producers, i.e. the staff.
age the waste that is being produced. The results of the research suggest the need for the utiliza-
Both organizations recycle and reuse a number of materi- tion of a range of systems in order to reduce the growing
als. For example, the Cardiff and Vale NHS Trust recycles and quantities of waste being produced. These should, however,
reprocesses materials such as paper, and cardboard, as well as be undertaken within a structured and holistic ‘framework’.
various items that are hazardous by definition, such as waste An important ‘support’ construct within this framework should
oils and some flammable substances and electrical equipment be the development of staff training and awareness building
(Cardiff and Vale NHS Trust 2006). A four-bin system has programmes in order to ensure successful system implemen-
also been implemented by the organization, comprised of an tation and long-term success. Within this, the mechanisms for
orange bag waste stream (to be treated using alternatives to behavioural change should play a key role (Tudor et al. 2007).

238
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 Utilizing a ‘systems’ approach to improve the management of waste from healthcare facilities
It is only through staff involvement in and ‘ownership’ of the
systems that they will realize a degree of acceptance and suc-
cess among employees.
This research was undertaken on a case study basis, and
hence would be subject to the specific nature of the case study
Trusts. However, the award winning nature of the two organ-
izations studied, and the results obtained from the use of the
systems suggest that they can serve as examples of best prac-
tice for other healthcare providers in the UK and beyond.
Evidently the development and implementation of structured
systems can serve to minimize the quantities of both hazard-
ous and non-hazardous waste that is produced, as well as the
associated treatment costs.
The adoption of these systems enabled both of the case
study organizations to realize economic, environmental and
social benefits. For example, both Trusts have been able to
achieve cost savings, raise staff awareness of and attitudes
towards sustainable waste management, and meet their legis-
lative and compliance requirements.
However, an important point to note is that despite their
many benefits, systems are not without limitations. For
example, Woolridge et al. (2005) note the length of time that
it takes for large organizations to adopt new methodologies.
Therefore a number of factors should be taken into consid-
eration before implementation. These factors include: (1)
collection of evidence-based data of current practice; (2) an
understanding of the specific requirements for the organiza-
tion; (3) fitness for purpose, to ensure that they achieve the
required objectives; and (4) mechanisms to monitor and
respond to change.
References
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There is a need for further evidence-based research into
healthcare waste to be conducted in order to build upon this
study. This research would also enable the development of
effective policies and best practice and the sharing of this best
practice. This should ideally take the form of a network or col-
laborative partnerships between NHS Trusts as the main pro-
ducers of the waste, industry as providers of technology and
academia, to provide the research capacity. Such a network, the
‘Healthcare Waste and Resources Research Group’ has been
formed. The group is coordinated by the University of North-
ampton, UK, and involves representatives from academia, the
NHS, industry and consultants. There are three working groups
that are concerned with undertaking ‘fundamental research’,
‘operational research’ and ‘policy research’. The formation of
this group has enabled holistic strategies to be developed for
the effective management of the increasing quantities of haz-
ardous waste being produced by the healthcare sector.
Conclusion
This study has examined strategies for improving the man-
agement of waste from healthcare facilities using a ‘systems’
approach. The more effective management of waste has a
significant role to play in the drive towards enhanced sustain-
ability practices in England and Wales. Driven in large meas-
ure by increasingly stricter EU environmental legislation there
is therefore a need for measures to be put in place to manage
the waste arisings in a more sustainable manner. As demon-
strated by this paper, the implementation of improved sys-
tems offers one way through which the goal of enhanced
sustainable management of waste could be achieved.
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