SurplusMed sent a Freedom of Information (FOI) request to a total of 146 NHS Trusts in England to ascertain the current level of drug wastage in the NHS.  This is wastage caused by drugs expiring and needing to be disposed of.  This creates both a cost of the wasted drugs themselves as well as the disposal costs and cost to the environment.

Summary

The purpose of this report is to provide an up-to-date review of the cost of medicine waste in NHS trusts today. This survey was conducted by SurplusMed to emphasise the need for a comprehensive stock of pharmaceutical products across hospital trusts.

On the 2nd February 2021, we sent Freedom of Information (FOI) requests to 146 NHS trusts in England. By the 18th March 2021, we had received and collated responses from 72 of these trusts. Therefore we have obtained primary data regarding medical wastage from over a third of hospitals in England.

Figure 1. Total Number of Responses

 

Through utilisation of primary data analysis and secondary data research – we can pinpoint two interrelated points that require attention and will be explored further below.

 

  1. The amount of medical waste the NHS produces annually greatly exceeds recommended figures.
  2. Swift action is urgently needed to minimise this.

Introduction

The NHS is one the largest global employers. With approximately one million patient contacts every 36 hours, its sheer scale directly impacts our immediate environment socially, financially and environmentally. Currently, it is the largest public sector emitter of greenhouse gases and wastes approximately £40.6 million pharmaceutical resources in landfills and incineration processes alone. (RCP, 2018)

Presently, the NHS is facing extreme pressure to reduce this. These come from multiple sources, all with the same goal of decreasing waste and encouraging sustainability.

Ranging from national legislation such as The Climate Change Act (2008) that was introduced to ensure the UK cuts its carbon emissions by 80% by 2050, to senior healthcare professionals drawing up Sustainable Development Management Plans (SDMP) and even nonprofit organisations such as the Centre for Sustainable Healthcare that offers consultancy on sustainable healthcare research, optimising healthcare services with an shared goal of lowering CO2 emissions has been a long-term goal for the NHS. However, as research shows, we are far from our overall target.

As recently as 2019, carbon footprint assessments highlighted that NHS emissions totalled 25 megatonnes of carbon dioxide. Of this figure, 24% was from the direct delivery of care, 10% from staff commute and patient and visitor travel, 4% from private health and care services commissioned by the NHS and crucially, an astounding 62% came from procurement. (Tennison et al, 2021)

These figures clearly show that our present methods of using and disposing of medicine have been inefficient and are a major factor in contributing to CO2 emissions. Due to the direct negative effects of ongoing procurement practices, we need to reconfigure and optimise our current supply chain, with the primary intention of waste prevention.

Results

This section presents an overview of the responses we received from the 72 FOI requests we collected. We then formatted them statistically, using bar graphs and pie charts as visual aids.

Below are the questions we sent to 146 NHS trusts.

  1. For each of the hospitals in your Trust what is the value of the medication you have had to waste in the last 2 financial years. This the value of medication that was the property of the hospital at the point it was wasted, ie, the cost of medication that expired before it could be used:
  2. For each hospital in your trust, what has been your total drug spend over the past two financial years?
  3. For the last two financial years combined, what is the drug that you have wasted the most of and what was the total cost?
  4. Please name and indicate for the hospitals in your Trust if they possess a Wholesaler Dealers Licence – WDA(H)

Figure 2. Total Value of Medication Wasted in 2018/19 per Trust

The trust with the highest figure is one of the NHS Trust general district hospitals with £​​542,761 wasted in 2018/19. Comparatively, the lowest reported £0 for one of the smaller specialised hospital. On average, each trust wasted £91,863 worth of medication in 2018/19.

Figure 3. Total Value of Medication Wasted in 2019/20 per Trust

The highest value of wasted medicine we reported was £630,383.66 wasted in 2019/20. Comparatively, the lowest value reported was £93.94. On average, each trust wasted £89,453 worth of medication in 2018/2019.

Figure 4. Total Drug Spend 2018/19 per Trust

These figures vary drastically, from the highest spend of £156,800,000 in the financial year of 2018/19 to the lowest spend of £2,977. Averagely, the trusts surveyed spent a total of £32,414,629 in the financial year of 2018/2019.

Figure 5. Total Drug Spend 2019/20 per Trust

 

Once again, there is a huge disparity in figures – from the highest spend of £167,274,660 to the lowest spend being £2,775. Averagely, the trusts surveyed spent a total of £34,785,71 in the financial year of 2019/20.

Figure 6. High Cost Drugs Wasted per Trust

78 hospitals reported a high cost drug (Pbr excluded drug) as their most wasted drug.The most expensive drug was ‘Pembrolizumab’, costing £126,526.76 across 2018/19 and 2019/20.

Figure 7. Wholesalers Dealers Licenses Possession per Trust

 

68 hospitals surveyed did not possess Wholesaler Dealers Licences, whereas 52 did possess this license. Only three trusts did not respond to this question; and for two of them – this question was not applicable.

Discussion

This section presents the main takeaways from this report. It includes a reflection of our research methods and techniques, as well as three key points that demonstrate the importance of this research.

We found that in two financial years (2018/19 and 2019/20) these trusts had a combined total drug spend of approximately £7.6 billion.

From 2018-2020, these hospitals wasted a combined figure of approximately £590 million. In 2018/2019, hospitals wasted on average 0.34% of their budget.
In 2019/2020, Hospitals wasted on average 0.37% of their budget.

We deduced that ‘social desirability response bias’ may have influenced the responses to our questionnaire. Defined as the “tendency to under-report socially undesirable attitudes and behaviours and over-report more desirable attributes”, (Latkin et al, 2018) this leads to inaccurate figures as respondents may have provided answers that align to what they believe is socially acceptable, rather than providing truthful answers.

In this report, this is most likely to reveal itself in underestimating / underreporting the value of medication wasted. For example, as Figure 2 highlights, one trust reported that the value of medicine wasted in the financial year of 2018/2019 was £0. This figure is unlikely to be accurate, and could have been the result of social desirability response bias. To be perceived as economically conscious is very important to healthcare professionals, so this could easily impact how respondents answer questions on behalf of their trust.

Additionally, due to our research method of self-reported questionnaires and our use of close-ended questions, social desirability response bias is more likely to take place. There are two reasons why this might happen. Firstly, because it is self-reported, they can provide socially desirable answers without being challenged by an interviewer. Respondents can easily give inaccurate figures without it being checked for validity.

Secondly, because the questions are close-ended, they can provide responses without having to explain their answers or detail how they managed to obtain such low figures. For example, for the trust that reported £0 as the value of medicine wasted in 2018/2019, an additional question could be “What measures did you put in place to achieve this low figure?”. As there is no scope for this, it provides more opportunity for respondents to answer how they see fit. Ultimately, these factors limit the validity of the report.

Despite this, this report has given significant insight into the extent of medicine wastage in the NHS in 2021. From this, we can provide three essential tenets that exemplifies the need for SurplusMed in order to:

  1. Minimise the disposal of unused medicine before its expiry.
  2. Optimise NHS expenditure that could be put towards other aspects of healthcare e.g. patient care.
  3. Reduce the negative environmental impact that is greatly affecting the NHS carbon footprint.