Sustainability
Care to issue a rejection notice for the gowns in December 2020 over concerns they could compromise the clinical safety of NHS patients and staff. At the time of writing, this lawsuit is still ongoing, and the company in question is the subject of a potential fraud investigation by the National Crime Agency (NCA). Another concern raised was the fact that
the gowns’ packaging did not comply with sterility requirements as, rather than being double-wrapped, they were single-wrapped inside a polythene bag. This echoes a similar case in which the use of 10 million surgical gowns purchased from a US company was suspended for NHS frontline workers for the same reason.8
The company in question was
a jewellery and fashion accessories business and there was found to be no evidence that it had any experience trading in PPE prior to the pandemic.9 Together, these batches of stock formed
part of the £4 billion worth of single-use PPE which could not be used because it was not fit for purpose and did not meet NHS standards. According to reports,10
two commercial waste
companies were appointed to dispose 15,000 pallets of unusable items per month through a combination of recycling and burning to generate energy. As highlighted by the House of Commons Public Accounts Committee report on the Department of Health and Social Care’s accounts for 2020-21,1
the costs and environmental impacts of this are ‘unclear’.
The PPE Transition strategy The remaining PPE items sourced during the pandemic continue to be supplied free of charge to NHS Trusts. These include single-use surgical gowns, or ‘push’ gowns as they have been termed. Under the PPE Transition strategy,11
this
arrangement will continue until 31 March 2024 or until stocks are depleted. This is simply too late, and feels like an attempt
to justify the procurement decisions that were made to acquire the stock in the first place. In particular, it does not seem to be in keeping with what the NHS is trying to achieve in terms of becoming more sustainable and meeting 2045 Net Zero targets. Trusts should think carefully about the choices they are making and the long- term impact these will have. Disposable surgical textiles can cost more per use than reusable counterparts when all associated costs are factored in, and those at lower face value may be poor quality. In the case of ‘push’ gowns, although these are being supplied at no cost to Trusts, it is important to remember that, while they may be free at the point of use, they still come at a price in the form of clinical waste, associated disposal costs
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and the subsequent impact on the environment. As one of the largest producers of waste in the country, each year NHS providers produce approximately 156,000 tonnes of clinical waste, which is equivalent to over 400 loaded jumbo jets.12
Operating theatres are estimated to account for one quarter of all hospital waste and in the UK, research has shown that a typical surgical operation has a carbon footprint of 173kgCO2
e,13 which is the equivalent of driving
from London to Edinburgh in a petrol car. A major contributor to this is the vast amount of equipment disposed of after each procedure, which includes single- use items such as surgical textiles. While the NHS clinical waste strategy,
published earlier this year, set out plans to tackle this issue, one of the most effective ways to reduce clinical waste and associated carbon emissions remains prevention. However, the ongoing use and incineration of free disposable gowns – which could potentially be otherwise repurposed – under the PPE Transition strategy continues to undermine this and is incongruous with the clinical waste strategy. Unless the use of these disposable stocks will be offset by other means, which does not currently appear to be the case, then this is a step
backwards for the NHS on its ambitious journey to zero carbon by 2045.
The impact of reusable vs disposable surgical gowns Last year, the first ever independent UK- based surgical gowns Life Cycle Analysis (LCA)14
into reusable versus disposable gowns
was conducted by the Grantham Centre for Sustainable Futures - a collaboration between The Grantham Foundation for the Protection of the Environment and The University of Sheffield. The comprehensive research analysed 19 impact categories, with reusable gowns performing better than their disposable counterparts, showing that they have significant potential to reduce environmental emissions, minimise waste and deliver carbon savings in comparison to disposable alternatives. In terms of clinical
waste, the LCA showed that choosing reusable gowns over disposable alternatives could result in an 84%
reduction. Based on customers using 1,000 surgical gowns per week, this could equate to annual cost savings of up to £7,000, depending on regional clinical waste disposal costs. Due to economic structures within the NHS, in most instances it is the responsibility
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