THERE are calls for an inquiry to be held into risks to public health at Scottish hospitals over the handling of hazardous medical waste.

Both former Scottish health secretary Alex Neil, and the renowned scientist Professor Hugh Pennington - who led the inquiry into a deadly E Coli outbreak in Scotland - have called for an inquiry.

Public health fears centre on the way hazardous waste - such as needles, body fluids, and soiled or infected bandages - is being handled.

Concerns will increase pressure on the NHS following a number of deaths. Two patients died at Glasgow’s Queen Elizabeth University Hospital from an infection related to pigeon droppings. An undisclosed number of heart patients also died at NHS Lothian due to fungal infections.

Until recently, hazardous waste was secured in leak-proof large plastic bins when being moved through hospitals. Now, there is evidence that waste is being transported in open-sided metal ‘roll cages’, which could leak.

Previously, staff did not have to touch waste - now it is claimed porters have to pick waste from roll cages to put into skips. Needle stick injuries appear to have risen.

There are further concerns that roll cages are transporting food and linen around hospitals without being cleaned first. Previously this did not happen as dirty bins were swapped for clean ones every day.

Additionally, there are fears that food and linen companies, which deliver to hospitals, are unwittingly collecting roll cages and using them to deliver to schools, care homes, and hotels without being sterilised. This did not happen previously when bins were used.

The changes to the way dangerous waste is handled follows the collapse of Healthcare Environmental Services (HES) last December. The company managed all Scotland’s medical waste and 40% of the UK’s waste.

With the company gone, hospitals had to find new ways of managing waste, leading to fears that the systems in place are unsafe. There are concerns the Scottish NHS is struggling to cope with day to day waste.

Hugh Pennington, emeritus professor of bacteriology at Aberdeen University, said using open-sided roll cages ‘substantially increases the potential risk of needle stick injuries’.

Using bins ‘would really minimise the chance of needle stick injuries’. He said the current system sounded ‘dangerous’. Infections on needles could include Hepatitis, HIV, and ‘bugs that cause septicaemia and sepsis’.

In NHS Highland, there were no needle stick injuries in the four months before the HES collapsed, when the old waste management system was in place. However, from December 2018 there were between one and four injuries each month.

Between December and the end of February, NHS Lothian recorded three needle stick injuries. NHS Ayrshire and Arran recorded 21 ‘adverse events’ relating to needles over the same period. NHS Grampian recorded 44 needle stick injuries.

Pennington said he was concerned that members of the public could ‘brush up against’ roll cages and be injured.

On the issue of roll cages spreading infection in hospitals whilst moving waste, Pennington said ‘leakage’ was ‘theoretically possible’.

He added: ‘Take the hypothetical situation that there’s been a norovirus outbreak in a hospital. It’s the biggest form of infection problem that hospitals face on a routine basis … Decontamination means there will be lots of contaminated material containing the virus …So any possibility that you might be recontaminating or spreading contamination by leakages from one of these cages is just daft.’

Pennington said patients ‘don’t go into hospital expecting to pick up something there. The sort of people who go into hospital, a lot of them are elderly, they’ve all got something wrong with them or else they wouldn’t be there, and norovirus might be the straw that breaks the camel’s back’.

On using roll cages for both transporting waste, and transporting food and linen inside and outside hospitals, he said: ‘This is extremely unsatisfactory. It’s a no-no because there’s the possibility of contaminating materials which shouldn’t be contaminated.’

He said a bug such as MRSA ‘could be only on the inside of the cage and then get transferred to bed linen and bingo you’ve got someone in bed with ostensibly clean sheets but they’ve got bugs on them … and with food, you don’t want to be giving someone something to eat that’s got bugs on it.’

He added: ‘It’s not rocket science having a leakproof container properly designed, and proper protocols about how it comes in and where it goes - any decent hospital manager will want to see those protocols.’

Pennington said ‘it didn’t sound as if there was a contingency plan’ for how to manage waste after HES collapsed. The response ‘doesn’t sound adequate at all’.

Pennington said a ‘quick, independent’ inquiry, similar to the one he led into the E Coli outbreak in Wishaw which saw 21 people die in 1996, should be established. ‘That kind of inquiry can give you fairly rapid answers, and it could well be the one that the public needs for an explanation about what has happened, and a description of what is being done to stop it from happening again, to make sure the public is safe, and give the public confidence in the health service’.

He said this ‘could well be the way forward’ for health secretary Jeane Freeman. Former health secretary Alex Neil backed Pennington, saying: ‘There should be a short, sharp comprehensive inquiry into the allegations to establish their veracity because clearly we cannot take any risks with health and infection.’ He suggested Health Protection Scotland or Health Improvement Scotland take the lead on any inquiry.

Neil said an inquiry would ‘put people’s minds at rest and ensure there isn’t a risk of infection arising from the situation with medical waste management’.

The Scottish NHS kept a proportion of HES bins after the company’s collapse, but in an email to HES last month, NHS Scotland’s Waste Contingency Team, said it ‘does not have the facilities to sterilise’ bins.

Alex Neil has also called for an inquiry into the collapse of HES. Company director, Garry Pettigrew, claims HES was effectively killed off by the UK government.

HES ceased trading in December, with the loss of 150 Scottish jobs, following claims it was stockpiling clinical waste. The case was dubbed the ‘body parts scandal’ after media reports that limbs were being stored in an English waste facility. However, that has been disputed by Pettigrew. ‘Less than one percent of the waste we brought in was body parts,’ he said.

Pettigrew insists he warned the UK government months previously that he was having to store waste due to capacity problems at incinerators used to burn medical material - but no assistance was given.

Pettigrew says he approached the UK’s Environment Agency (EA) in January 2018 to say that an HES site in Yorkshire was nearing its legal storage limit of 70 tonnes. HES had traded for 23 years with no problems.

The EA, Pettigrew said, would give ‘no dispensation’ to store more waste, despite there being space in warehouses to keep sealed material safely. By March, the company went over its storage permit limit. In March, Pettigrew says he asked again to be allowed to increase his storage limit. He was refused. ‘It wasn’t as if we were piling [clinical waste] on the roof,’ he said.

By June, Pettigrew said there was a drop in UK incineration capacity of more than 60 per cent. The EA then issued HES with a legal demand to clear the waste by September. ‘We said, ‘what’s the point?’,’ said Pettigrew. ‘We’ve been asking for help since January and you’ve not given any. We asked again in March and you didn’t give any, and here we are in June and you’re telling us you’re now going to down a legal route. If there’s no [incinerator] capacity now, there might not be any capacity in September. There’s no room at the inn.’

Officially, the UK government has denied any problems. Former health Minister Stephen Barclay, now Brexit Secretary, dismissed claims that any clinical waste backlog was caused by a reduction in incineration capacity.

However, an email from a senior EA advisor in May states the agency is ‘aware of the unprecedented challenges we have with hazardous waste incinerators’.

An NHS document marked ‘official-sensitive’ recording a meeting on disposing medical waste in August shows officials ‘acknowledged that there appeared to be a national market capacity issue’, and that as far back as ‘October 2015, HES highlighted the issue that there was a shortage of incinerator capacity, affecting the destruction of NHS waste’. The meeting, including senior representatives of the NHS and EA, noted ‘all agreed that there was longer term issues to address around waste management. These include further investment to increase national capacity … It was acknowledged that HES have continued to collect waste, with no faults in service delivery’.

Pettigrew maintains the ‘rush to be zero waste to landfill’ put pressure on incinerator capacity. HES had built a multi-million pound state of the art incinerator in Scotland to deal with the problem. It was opened by Princess Anne in April 2018 and awaiting final approval at the time the crisis hit. Pettigrew says he allocated £400,000 to deal with the backlog.

It’s believed that other companies began profiteering from the problem, increasing the cost of dealing with a tonne of waste from £420 to £1500.

Pettigrew says he received a call from from the UK Cabinet Office and he says they told him she dealt with companies critical to UK infrastructure, such as Carillion which was liquidated in 2018, and HES was now on her ‘radar’. The phone call was combative. Pettigrew said as soon as he was allowed to use his new incinerator he would deal with the backlog.

At a Cabinet Office meeting, sites were identified to take excess HES waste and store it for up to two years. However, Pettigrew claims one wasn’t licensed and others didn’t have capacity. Pettigrew said he would not take waste to unlicensed sites.

‘I said, ‘if I take [waste] to an unlicensed site you’re telling me that’s going to be okay? Do I get a get-out-of-jail-free card?’,’ said Pettigrew. ‘I’ve been asking for a full year for dispensation just to change our permit to keep it on a site that’s already licensed. You’re going to take it out of my site and hide it in someone else’s site for up to two years? This proves there was no incinerator capacity.’

Pettigrew swore during the meeting and the atmosphere became tense. He was told the cost to him could reach £1.4m. He refused to co-operate. ‘I said if you think I’m going to pay that kind of money for someone else to store waste I’m storing safety in a building under 24-7 supervision, and it’s now going to go to unlicensed sites that are going to store it out in the rain - and charge me £1.4m for the privilege, that ain’t going to happen. "

A Cobra meeting was apparently held, and Pettigrew was told that shipping containers to store waste were arriving at hospitals as he was set to lose his contracts. In early October, HES lost millions in contracts - Scotland was worth £18m a year, and the rest of the UK around £15m.

Today, clinical waste is building up outside hospitals across Britain. Costs are hitting hospitals with bills in the hundreds of thousands, and an attempt to export NHS waste to Holland was abandoned. There are also claims hazardous waste is being put through municipal incinerators.

Suppliers began demanding to be paid up front by HES. Pettigrew claims the company’s bank, HSBC, froze an account of £400,000, meaning wages couldn’t be paid.

He claims he received no help from the Scottish government, which told him the matter was a Cabinet Office issue. The company ceased trading on December 27.

There are concerns the new waste regime is creaking. ‘Scotland’s waste is hidden all over the country in haulage yards,’ Pettigrew said. He has collated a dossier of photographs showing what he describes as the mishandling of dangerous waste.

‘Until December, we collected the waste from every Scottish hospital 24-7 in wheelie bin collections. We took dirty bins away, and we gave clean empty washed bins in return.’

After HES’s collapse, hospitals, he said, ‘are now using roll cages - with mesh sides. These roll cages come in for food or linen deliveries. They’re using these roll cages to take clinical waste through hospitals, and porters are putting the waste into containers by hand. Porters then leave the empty roll cage at the back of the hospital, where food or linen delivery drivers can pick them up, and they can then go to schools or restaurants. The delivery drivers have no idea the cage was just used for medical waste. Nor do roll cages go through any washing process like our bins did.’

Estimates of the total cost of the crisis run anywhere up to £100m. For example, the company Mitie is charging trusts in Yorkshire and Humber £10.4m. HES said its annual charge was £3.3m.

Pettigrew says he welcomes any inquiry, and is happy to be subjected to scrutiny.

Alex Neil, MSP for Shotts where HES operated, has spoken to another waste company which confirmed Pettigrew’s claims of ‘dire shortage’ in incineration and storage capacity. Neil questioned the role of the Cabinet Office.

‘There’s a possibility HES became the scapegoat for the inadequacy of policy down south about the management of medical waste,’ he said. Neil believes there may have been an attempt to ‘cover up’ shortage in capacity. He feels ‘the Cabinet Office set out to destroy this business’.

‘I think there should be an inquiry into the role of the Cabinet Office and the Environment Agency into the demise of this company,’ he said. Neil said Pettigrew could have handled the affair ‘a lot better’, however, adding: ‘I’m not saying one party was entirely to blame, what I’m saying is that the circumstances surrounding the demise of this company, including the company itself, should be the subject of an independent inquiry.’

Neil said it was important any inquiry investigated ‘why workers paid a heavy price in lost wages’. He also said allegations of other companies ‘profiteering’ should be investigated. Neil added: ‘Something has gone badly wrong that didn’t go wrong for the 23 years HES was trading.’ Neil says he has been waiting since November for information from the EA on storage and incinerator capacity.

‘It’s a very sorry saga,’ he said. ‘We need to get to the bottom of why this was allowed to happen.’

A SCOTTISH Government spokesperson said: 'National Services Scotland continues to work closely with NHS Health Boards, contractors, SEPA and the Scottish Government to deliver robust contingency plans to ensure NHS Scotland services to the public are maintained and patient services are not impacted.

‘Procedures followed for clinical waste collection in hospitals are unchanged since HES ceased operating. All agreed contingency measures ensure that the environment and human health are appropriately protected. SEPA is continuing to monitor the operation of these arrangements and to date their inspections have not identified any risk to human health or the environment.

‘The Scottish Government provided £1.4 million towards initial planning and once the contingency period ends the exact cost of these arrangements can be finalised. As Ms Freeman has told Parliament, we will then be able to confirm the exact cost of contingency arrangements in full and say how that is balanced against what our boards would normally have paid to HES and whether there is a deficit between those figures.

‘The Scottish Government offered PACE support to the company as early as November in the unfortunate event that employees may be made redundant. Scottish Enterprise also offered support to the company. The company refused this and subsequent offers of support. Support was provided for employees in Shotts in January and subsequently in Dundee.’

According to the Scottish government, the company Tradebe will commence responsibility for full service delivery of healthcare waste management services for all NHS boards in Scotland from August 2 2019. There will be a 20 week period until December 20 2019 which will allow Tradebe to develop their Scottish sites. During this period, waste will be treated and disposed of at sites in England and Wales.

A UK Government spokesperson said: ‘Since HES ceased to deliver services to the NHS, our focus has been on ensuring there is no disruption to services, and the contingency plans we helped the NHS to implement have ensured that waste continued to be removed and disposed of appropriately.

‘Despite the numerous incorrect claims made by HES over recent months, we would like to emphasise that the new contractor is in full operation and there continues to be no risk to the public or health, on storage sites or any NHS sites. Environment Agency officers are routinely inspecting all HES sites to ensure they are secure and they continue with a criminal investigation into the failures of the company.’

A SEPA spokesperson said: ‘SEPA is clear that our work with Scottish Government, NHS National Services Scotland and health boards on contingency arrangements for the storage and disposal of clinical waste, are a result of Healthcare Environmental Services no longer providing collection services to NHS Boards across Scotland. HES are subject to a live regulatory investigation to establish whether criminal offences have been committed.

‘All agreed contingency measures ensure that the environment and human health are appropriately protected. SEPA is continuing to monitor the operation of these arrangements and to date our inspections have not identified any risk to human health or the environment.’

HSBC said: ‘We sympathise with former employees of HES who are going through this difficult situation. We have requested authority from the Directors to release information to allow us to discuss this matter with the Scottish government and other elected representatives, but authority has not been granted therefore we are unable to comment on the specific financial affairs of the company.’