The media is often full of stories about the need for the NHS to save money. Usually, this is seen in pejorative terms – the detrimental effects such savings have on frontline services. But one trust, Barts in Central London, has saved £700,000 by implementing an imaginative waste and recycling strategy that has gone further than any previous programme in the NHS. The figures are certainly impressive. Since the trust entered into a partnership with Skanska in 2011, Barts has managed to divert over 4,000 tonnes of waste from landfill, reduced clinical waste by 20 per cent and improved recycling rates by 400 per cent. Those changes have not gone unrecognised either – in 2013, Barts became the first health care trust to win the Carbon Trust Waste Standard. As Environmental Manager Fiona Daly explains, putting an increased emphasis on recycling and resource use made financial, as well as environmental, sense: “We spend a lot – about £2.5 million – getting rid of stuff, so it seems sensible to try and reduce that.” Skanska was chosen because of its “alignment in terms of values”. Plus “they came back with a smashing system that really looked at improving compliancing, engaging with people and trying to change behaviours”. Being the largest trust in the country, Barts faces greater waste challenges than other hospitals. It deals with 18 different waste streams (many of them clinical), which all have to be segregated. Plus there are the space constraints of getting those bins in place and then educating a large workforce on using them properly. But Barts has faced these challenges head on. Food waste has been segregated into its own waste stream, and Big Belly Solar compacting bins have been put in place. The hospital has started commoditising its waste by baling cardboard on site and developed a furniture reuse scheme that has in itself saved £10,000. Barts has also become the first hospital to install ‘reverse’ vending machines where, in return for putting waste in a bin, workers are given a token to spend at the canteen. Central to the programme has been an emphasis on behaviour change. “This means more than just a few posters or bin signs, but proper behaviour change”, explains Daly. Staff have been trained to segregate properly, and a specialised team audited, monitored, measured and then fed back on each of the different areas the hospital was trying to improve. Targets were introduced for segregation, waste reduction and avoidance, cost and carbon reduction and the eventual elimination of waste to landfill. Barts achieved the latter by October 2013, becoming the first trust to do so in the UK. Not surprisingly, other hospitals have shown an interest in what’s been happening at Barts. “We’ve had loads of enquiries from other trusts”, says Daly. “We ran a waste awareness day earlier this year, to showcase what we’ve done. You often hear what people are doing and think, ‘That’s excellent, but I want to know how you do it’, so we’re really keen to share ideas with other hospitals. “I think the key message would be to choose a trustworthy partner. Then trust them. It’s also really important to balance the immediate needs of the NHS in terms of costs with the long-term benefits. Would you rather save £10 this year or £100 over the next three years? There’s often a focus on money out today in healthcare. But you actually achieve a lot more with a longer-term plan.” The contract with Skanska runs out next year and will, of course, be put out to tender, but with plans afoot to introduce onsite processing for clinical waste and a scheme to part-recycle used inhalers, the focus on waste reduction and recycling looks likely to remain. “Ultimately, we are looking to transform attitudes to waste here”, Daly suggests. “We want it seen as not just something we get rid of, but something that has value to us."