Dangerous Waste and Body Parts Disposal: NHS

Steve Barclay Excerpts

Tuesday 9th October 2018 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the accumulation of hundreds of tonnes of dangerous waste.

[The Minister for Health (Stephen Barclay)]

As I set out in the written statement published this morning, on 31 July the Environment Agency notified central Government of an issue concerning clinical waste disposal. The primary concern was that too much waste was being held by a contractor, Healthcare Environment Services, in a number of waste storage and treatment sites. This included waste collected from hospitals and other public services. Although the waste was stored securely, it was not being disposed of within the correct regulatory timescales.

The Department of Health and Social Care, the NHS, the Department for Environment, Food and Rural Affairs, the Environment Agency and the Cabinet Office have worked together to resolve the issues. Our priority throughout has been to ensure that proper measures were put in place to enable trusts to continue to operate as normal. A major part of the contingency plans concerned commercially sensitive contractual discussions with HES and other providers.

Following the Environment Agency’s partial suspension of HES’s Normanton site, which came into force on 3 October 2018, NHS Improvement wrote to HES to raise its concerns. NHSI gave HES an opportunity to set out how it was complying with its legal and contractual obligations; HES failed to provide that assurance. As a result, 15 NHS trusts served contract termination notices on Sunday 7 October. As part of our contingency arrangements, we ran a tender process with the clinical waste sector before awarding a new contract to Mitie. As contracts with HES were terminated over the weekend, Mitie stepped in and, from Monday morning, provided continuing waste collection and incineration across all of these organisations.

In September, officials from the Department of Health and Social Care visited each of the major trauma centres affected and confirmed that waste was being stored correctly and that contingency plans were in place.

In addition, visits have been undertaken to each of the sites by the Environment Agency this weekend and this week, alongside earlier visits. The Environment Agency is continuing its enforcement action against HES. This includes ensuring that excess waste is cleared from non-compliant sites. The Government are working with the Environment Agency and the NHS to ensure that lessons are learned, and we are reviewing how contracts will be awarded in the future. I have updated the House on this situation today as new contracts were implemented on Sunday following the conclusion of this commercially sensitive process. Our priority throughout has been to ensure that measures were put in place so that the NHS could continue operating as normal. No gap in service provision has been reported and we are working to ensure that that remains the case.

[Jonathan Ashworth]

This is an absolutely horrific scandal. A private contractor has failed in its responsibilities to a quite staggering degree. Three hundred and fifty tonnes of waste, including human body parts, amputated limbs, infectious fluid and substances of cancer, was left effectively stockpiled and not safely disposed of; it is an absolute scandal. How on earth did we get to this? If the Environment Agency first raised concerns in March, if Ministers were formally informed in July, and if Cobra was convened and chaired by the Health Secretary last month—by the way, I really think that the Health Secretary should be answering questions at the Dispatch Box today—why was the decision taken not to inform Parliament and the public sooner? Given that concerns were raised in March, why did the NHS not intervene earlier? In fact, concerns were raised with NHS England last year, so can the Minister tell us what monitoring, if any, of the HES contract was put in place by the Department and Ministers?

The Minister referred to 15 trusts having terminated their contracts. The Health Service Journal reported that up to 50 trusts were affected. Will he clarify what the status is of the contracts with the remaining 35 trusts? Where Mitie has taken over the contracts, what regulation and oversight of Mitie and its subcontractors is now in place? Is he confident that there are enough incinerators across the country to dispose of waste in a timely manner?

Let me turn now to the public health implications. At the Normanton site, we were told that waste is now in refrigerators, but where was it before if not in refrigerators? Hospitals are now using temporary containers, but questions have been raised about the public safety implications of those containers. Can the Minister give us an absolute guarantee that those containers are safe and that there is no public health risk?

We are picking up the pieces, yet again, of another disastrous procurement of an outsourced contract by a private firm going wrong. What plans are now in place to ensure that something like this never happens again?

[Stephen Barclay]

Let me pick up on the various points that the hon. Gentleman has raised. On when Parliament was told, as I said in my statement, the partial suspension notice was served on the company on 3 October and new contracts were put in place over the weekend. This is, therefore, the first opportunity, following what had been commercially sensitive negotiations, to notify the House. It is also right to remind Members that the key strategic objective throughout has been to maintain operations at NHS hospitals to ensure that clinical waste is being collected. That strategic objective has been maintained at all times.

The hon. Gentleman asked a number of other questions, including whether there is enough incinerator capacity in the system. The answer to that is, yes there is. There are 24 incinerators. The Department for Environment, Food and Rural Affairs estimates that there is more than 30,000 tonnes of spare capacity in the system, and that there is significant capacity over and above that required by HES to perform its contract, so I can be very clear to the House that, moving forward, there is sufficient incinerator capacity.

The hon. Gentleman used some inflammatory language. It is worth reminding the House that just 1.1% of this clinical waste is anatomical, so some of the media headlines are slightly out of step with reality. The partial suspension that has been served on Normanton is solely in respect of the incinerator; it does not apply to the other sites under HES contractual arrangements with the trust.

The hon. Gentleman asked whether the waste was being secured safely. The answer is yes; the Environment Agency has been inspecting the situation. The issue is the overstorage of waste, not that the waste is not being stored in a safe manner. [Interruption.] Well, that is the legal remit of the Environment Agency, which is an independent body. It is right that the law is applied; the hon. Gentleman may not like to apply the law, but this is the legal process. Officials from the Department of Health have been to the major trauma sites to see the contingency plans at first hand, and the storage and capacity is in place at those sites.

The reality is that there was a contractual arrangement with a supplier that stored the waste correctly, but stored too much of it. The Environment Agency is enforcing against that. We have put in place contingency plans within the trusts and set up alternative provision in the form of a contract with Mitie. The key strategic objective of ensuring that NHS operations continue has been secured.

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the Minister for the prompt action that he has taken since being notified of this situation. Will he reassure people in the community and in community settings that this issue will not affect their safety?

[Stephen Barclay]

The Chair of the Health Committee raises an important point regarding residents in the areas where the sites are located, and I see the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) in her place. The Environment Agency has confirmed that the waste is being stored safely; it is the amount of waste that is the issue. Many of our constituents are waiting for operations on these sites and will want reassurance that those operations can continue in a timely fashion. That has been a key focus of the Department, and I pay tribute to the work of officials in the NHS, the Department of Health, DEFRA and the Environment Agency, who have ensured that that strategic objective has been maintained.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

This situation does indeed sound graphic and horrific. Equally, I recognise that much of this waste will be cytotoxic, including drugs and syringes. We are talking about materials that are contaminated with faeces, infectious material and blood. We are discussing five sites across England. HES also has two sites in Scotland, both of which have been checked and do not have overstorage.

We hear that HES was served with 13 warning notices and two compliance notices over the past year. If that information was not accelerated up to the Department of Health, should it have been? HES says that it has been reporting its issue with incineration to regulators for quite a long time, yet the Minister says that there is no issue of capacity, so could not the Department have responded by directing HES to all this extra incineration capacity that apparently exists? As more local authorities are going towards zero-waste and incinerating material that would have been in landfill, the pressure will increase. There is probably ageing infrastructure and a need to expand, so do the Government plan a waste incineration strategy?

--- Later in debate ---

[Stephen Barclay]

The hon. Lady is absolutely right that HES has sites in Scotland; I think there are four. The Scottish Environment Protection Agency has been conducting regular site inspections and we are looking closely at the situation there—not least regarding the movement of waste from one site to another. However, she is correct that we are not aware of any specific issues at those sites.

The primary purpose of enforcement notices has been to encourage the company back into compliance. That has been the focus of the Environment Agency. The reason for the partial suspension in Normanton has been the unwillingness of the company to respond. Some notices are for what might be seen as relatively minor issues such as documentation, but obviously some relate to the overstorage on these sites.

[Rebecca Pow (Taunton Deane) (Con)]

I am pleased that new contracts have been signed and enforcement action has been taken—and quickly—but what is really important are the lessons learned, so will the Minister expand on that? While this is a sensitive matter—understandably, it evokes all kinds of concerns for the public—will the Minister assure us that there has been no risk to patients at any time or indeed to the wider public from this most concerning of issues?

[Stephen Barclay]

I am grateful to my hon. Friend for her question, and I am happy to give her constituents an assurance that there has been no risk to patients at any point during this time. As for lessons learned, clearly we will need to look at some of the lessons, particularly what triggers a breach of contract. A series of contracts were held by a wide number of trusts with the supplier, and it is important that we look at what the notification periods are, what the monitoring and enforcement processes are, and what powers there are under the terms of the contract to ensure that the company is acting as it should.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

We still do not have the basic facts about what medical waste is being held at the Normanton site, how far over the environmental limits it currently is, and what the timetable is for compliance. Perhaps the Minister would share that information with us. Does he not accept that it is a basic principle that, when dealing with any kind of public health or environmental health risk or incident, proper, full, factual information is provided to the public and the community at the earliest possible opportunity? You do not hide behind contractual negotiations. Does he accept that there is nothing in the contract negotiations that would have prevented him or the Health Secretary from providing some basic facts about those risks much, much earlier than today?

[Stephen Barclay]

On the split to which the right hon. Lady referred between clinical waste and other waste at the Normanton site—she rightly focused on that for her constituents—just under a third of the flow of waste to the site is clinical. Just over two thirds, in my understanding, is non-clinical. It is not the case that all the waste on the Normanton site is clinical waste. As I have mentioned, some media reports about what the term “clinical waste” constitutes are slightly different from the reality.

As for notification, I set that out in my written ministerial statement and in my comments today. The key focus is on maintaining the continuity of operations and service within the NHS trusts so that we are not in a position where clinical waste cannot be cleared from them. That is the focus, and that is why, given the commercial negotiations and the contingency arrangements that have been put in place, we came to the House today, and not at an earlier point.

[Mr Philip Hollobone (Kettering) (Con)]

In the end, the system has worked. There has been no back-up of clinical waste in hospitals—it has just been overstored in these sites. However, it is worrying, if it is true, that 13 warning notices and two compliance notices were issued to the company. Does the Minister think that he should be alerted earlier by the Environment Agency if this sort of thing happens in future?

[Stephen Barclay]

My hon. Friend makes a valid point about the lessons to be learned from this. Part of what I would expect to look at as we move forward are questions about when the NHS was first made aware of this and what powers are available to enforce at an earlier stage. As I have mentioned, enforcement notices cover a spectrum of risk. Some of those risks are more technical in nature than others, so while there have been 13 notices, their enforcement encompasses a range of severity.

[Liz Kendall (Leicester West) (Lab)]

According to its most recent accounts, HES made a gross profit of over £15 million last year. What financial penalty will it suffer because of its gross incompetence?

[Stephen Barclay]

The first financial penalty it has suffered is the prompt action we took over the weekend, with 15 NHS trusts cancelling those contracts and moving across. There is a clear financial penalty in that loss of business. As for fines, that is a matter of legal process, through the Environment Agency, in the normal way. That is not an NHS matter. The focus for the NHS is on maintaining continuity of service.

[Rachel Maclean (Redditch) (Con)]

The Minister will be aware that my constituents want to be assured that their operations in Redditch and Worcester will be able to continue as normal. Can he give them that assurance?

[Stephen Barclay]

Yes, I can.

[Mary Creagh (Wakefield) (Lab)]

The Government like to talk tough on waste criminals, but here we have waste criminals storing 350 tonnes of clinical waste illegally—five times the amount to be compliant—at their site in Normanton, and despite the Minister being told about this on 31 July, neither the local MP nor constituents were informed. Cobra was informed. A criminal investigation is now under way into the company. Can he ensure that not a single acute hospital trust will lose one penny piece as a result of this criminal negligence?

[Stephen Barclay]

The hon. Lady raises several points. On the 350 tonnes of waste, I clarified the flow of that waste in my comments to the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) and I said that not all of it is clinical. I was not personally told on 31 July. I set out in my written statement when the NHS and then Ministers were told.

The question about whether there is any cost to NHS trusts is a very valid one for all constituency MPs who wish to understand the situation. The contingency cost—for example, from the additional capacity being put in place at trusts—will be borne centrally by the NHS family, and the cost of processing clinical waste will be borne by NHS trusts, as it has been to date.

[Kevin Foster (Torbay) (Con)]

I welcome the action the Minister has taken to terminate the contracts with this company, given its clear breaches and failure to deliver what it said it would. In his statement, he referred to the capacity for clinical waste incineration. Can he give us further detail about how he satisfied himself that there is capacity in each region? Clearly, these are specialist facilities, and having to transport waste could have a knock-on effect.

[Stephen Barclay]

I should clarify that it is not me personally who has terminated these contracts. These contracts with HES are held by the trusts themselves, and therefore it is a decision taken by those trusts.

As I said earlier, there is significant additional capacity within the incinerator landscape to process the waste generated by this contract, and therefore the suggestion in some quarters that this is an issue of a lack of capacity is simply not valid. To be clear, HES produces 595 tonnes of waste a month that goes to incineration, and the NHS identified 2,269 tonnes of incineration capacity, so reports that there is a lack of capacity in the market are not valid.

[Wes Streeting (Ilford North) (Lab)]

I learned from the Health Service Journal that Barking, Havering and Redbridge University Hospitals NHS Trust was one of those affected. It is totally unacceptable that clearly one of Ministers’ objectives was to cover things up for as long as possible to save their own blushes because of the failure of a Government contractor. Members of this House should not learn of such events from the media. We should hear it from Ministers via the Dispatch Box or the relevant Select Committee—or there is such a thing as email.

Ministers have announced that £1 million of contingency funding is to be made available to support trusts affected. Will that be met from existing departmental budgets, or will money be allocated by the Treasury? Further to the point made by my hon. Friend the Member for Leicester West (Liz Kendall), surely it should be the failing contractor that coughs up £1 million, if not more. It should not come from taxpayers.

[Stephen Barclay]

We all learn things on a regular basis from the HSJ, but it seems misplaced to suggest that the hon. Gentleman should have been told about this when we were ensuring continuity of service and putting in place alternative arrangements to ensure that operations could continue at Barking and other hospitals. I have already addressed that point.

As I said, some of the cost—the contingency cost—will be absorbed centrally. The normal cost of clearing clinical waste was borne by the trusts before and will continue to be borne by the trusts.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I welcome the fact that there has been no gap in service provision and no public health risk and that the Minister has confirmed that nobody’s operation has been delayed because of this build-up of clinical waste, but it is still concerning that the contract was not properly delivered. How long has he given the site to return to compliance and what action is he taking to supervise the remaining contracts?

[Stephen Barclay]

The key issue for performance under the contracts is what, contractually, the legal requirements on HES are and whether those contractual terms have been breached. Part of the lessons learned is to look at whether contractual enforcement powers are sufficient. In terms of moving forward in respect of the other HES sites, that will depend on the contracts that the supplier has and whether it is in breach of those contracts or of enforcement action from the Environment Agency. To date, the Environment Agency has served one partial suspension, on the Normanton site. As I referred to, the Environment Agency was at the other site over the weekend. This is an area of significant scrutiny, but it will be for the Environment Agency to determine whether the company is not in compliance with its permits.

[Maria Eagle (Garston and Halewood) (Lab)]

So far, the Minister appears to have been far more interested in contractual arrangements than in public accountability. Can he explain how come Cobra has met and this House has not been informed of it? This House should be informed about Cobra meetings as soon as possible after they are finished.

[Stephen Barclay]

I am not sure about the exact protocols for when Cobra should and should not be reported, but given that it usually deals with highly confidential matters, I would have thought that not every issue should necessarily be reported in the first instance. We have been focused not on contractual niceties, but on ensuring that the NHS continues to deliver first-class services. As I referred to earlier, this is the first opportunity we have had following the conference recess to notify the House, following the contractual arrangements being made.

[Tom Pursglove (Corby) (Con)]

Will my hon. Friend confirm that the backlog of waste will be dealt with speedily, in accordance with the requirements of the law and with appropriate supervision?

[Stephen Barclay]

I very much share my hon. Friend’s desire for the backlog to be cleared as speedily as possible. As I referred to a moment ago, this is an area of scrutiny for the Environment Agency, and it is important that the company complies with its legal requirements and ensures that the level of waste is in line with its permits as soon as possible.

[Nic Dakin (Scunthorpe) (Lab)]

Hospitals such as Scunthorpe general cannot run effectively without the safe and secure disposal of clinical waste, which is exactly why it is important that the Minister has made the comments that he has today. Northern Lincolnshire and Goole trust quite properly put in place local contingencies, because obviously it could not rely on things being sorted out. It now looks as though contingencies are sorted nationally, so can he be very clear that local trusts will not face a penny more of extra costs as a result?

[Stephen Barclay]

The hon. Gentleman raises a fair point, and I want to be clear about the distinction. Additional cost arising from the contingency arrangement—for example, putting in place extra storage on the trust’s sites—will not be an additional cost on the trust. I hope that that will reassure him, although I do not want to suggest to him that there will be no financial impact on trusts, because the requirement to clear clinical waste sits with the trust. That is why the trusts themselves had contracts with the supplier. The ongoing arrangements are likely to mean some increased cost, as the new supplier comes on board. That will fall to the trust, but not the contingency element.