Other Questions. - Health Care Risk Waste.

Máire Geoghegan-Quinn

Question:

15 Mrs. Geoghegan-Quinn asked the Minister for Health the reason for the delay in addressing the medical waste crisis in hospitals and the cost to the Exchequer in terms of additional transport costs to Holland; and the action, if any, he plans to take in relation to the disposal of medical waste by the James Connolly Memorial Hospital and by the Mid-Western Health Board. [20487/96]

(Limerick East): My Department has acted promptly in making arrangements for the safe disposal of health care risk waste, both in progressing the long-term solution to tender stage and in dealing with a temporary situation which arose recently.

The long-term solution is being addressed by a joint waste management body, representative of my Department and the Department of Health and Social Services in Northern Ireland, which is currently seeking tenders for the collection, transportation, treatment and disposal of health care risk waste within Ireland. The programme envisages the appointment of a contractor by the end of this year and the commencement of the service before the end of 1997. This solution will cater for the health care risk waste from all health agencies including James Connolly Memorial Hospital and the Mid-Western Health Board.

In the meantime, health boards and voluntary hospitals have made arrangements with waste management contractors to collect their health care risk waste and export it for treatment in the United Kingdom. I am aware that, on 10 October, the contractor dealing with the majority of these exports wrote to his customer hospitals informing them that collections would cease immediately. My Department wrote to the health agencies advising them to provide refrigerated storage until exports could resume. In addition, my Department sought disposal routes to other countries and, on 24 October, confirmed its acceptance of the proposals made by an Irish waste management company to have this waste exported to the Netherlands for incineration. Although exports to the UK have now resumed and the waste stored on hospital sites has been substantially cleared, it is necessary to keep the Netherlands route open in the interest of ensuring continuity of service.

There will be additional costs associated with export to the Netherlands. These are currently being assessed by the health agencies, and it is not possible at this stage to give a precise figure for the costs involved.

Will the Minister indicate the total tonnage of medical or clinical waste generated here, the amount held in storage, where it is held and how?

(Limerick East): Public hospitals generate about 4,000 tonnes of health care risk waste annually. Until recently this waste was disposed of in small hospital based incinerators. When the EU introduced the current standards on incineration it was not technically feasible to bring these small incinerators up to EU standards. The Deputy will be aware that when she was Minister in 1992-3 the building of a large modern incinerator in the grounds of St. James's Hospital was considered but the Government of the day did not proceed with this option due to public opposition. Unfortunately the Government, as in many other cases, allowed the matter to rest and no solution was put in place. We were then in a position where it was contrary to EU standards to keep the small incinerators, with which we were all familiar in hospitals all over the country, in operation. The only alternative was to get private contractors to export to the United Kingdom. The UK was quite happy to take this waste on a temporary basis. In negotiations with my colleague Malcolm Moss in Northern Ireland, we have agreed an all-Ireland initiative on the disposal of hospital waste as there are similar problems in the North. Initially we invited submissions from over 30 companies. This has been reduced to a tender list of eight who expressed an interest and showed particular expertise. Those eight companies have tendered and we hope to have a contractor selected before Christmas. We hope to have a system in place which would allow for the disposal of hospital waste in this country without recourse to export.

In the meantime, because decisions were not taken in time by the Government, of which Deputy Geoghegan-Quinn was a member, we have to export waste. We had an agreement with the United Kingdom that on its Protocol for the disposal of waste it would include hospital waste from Ireland supplied by private contractors. The pressure on its incineration system increased dramatically with the BSE cull. The incineration of cattle arising from the culling of herds, because of BSE, has put such pressure on its system that it reorganised its Protocols in terms of prioritising what would be dealt with in its incineration. We received notice from some private contractors involved in this business that the UK authorities would no longer take Irish waste. Then the Minister for the Environment who has primary responsibility in this area contacted his equivalent in the United Kingdom. I had previously made a submission to Mr. Stephen Dorrell and within a short period the United Kingdom reversed positions and, thankfully, it is now obliging us by taking the waste.

In the meantime some of the contractors sought alternative countries who would take our hospital waste and succeeded in reaching an agreement with authorities in the Netherlands. Since that agreement the UK authorities have again agreed — and I thank them — to take our hospital waste. The export of waste which was stored has recommenced to the United Kingdom. No waste has yet been exported to the Netherlands but an arrangement was made to do so and it is prudent to keep that alternative open. One of the health boards has also entered negotiations with Denmark and that is another alternative. We must look at this in the overall context. We are talking about 4,000 tonnes a year, which is a very small amount of waste compared to the amount of waste generated by any reasonably sized town. We can solve that problem domestically and, because the amount is so small, we can solve it more economically on an all Ireland basis than with separate North and South initiatives. That is what we are proceeding to do.

In this, as in other matters, I reject the criticism being levelled at me. I would not have this problem if those who came before me had taken this action several years ago.

It is a bit like the hepatitis C issue in that, unfortunately for the Minister, he has to accept political responsibility for it in his capacity as the current Minister.

(Limerick East): But not personal abuse.

I am not giving the Minister any personal abuse.

Let us hear the Member in possession without interruption.

The Minister is terribly sensitive. The only abuse he received recently was on the "Questions and Answers" programme from the Minister for Agriculture, Food and Forestry, Deputy Yates, who failed to defend him.

(Interruptions.)

I did not hear any interruption when the previous speaker was speaking.

We know how the Minister feels about the Minister for Agriculture, Food and Forestry.

Where did the Minister get the figure of 4,000 tonnes? In a written reply to six questions which I tabled on this matter some weeks ago the Minister said he had not received an audit for quantities of medical waste from the Eastern Health Board, where would one assume the vast majority of clinical waste is located.

(Limerick East): I have given the House the information which was supplied to me. Quite clearly, I cannot count and weigh the refrigerated containers myself. If the Deputy has done an audit herself I would like to hear her figure.

I have a very large file here because, as the Minister knows, his Department referred my parliamentary questions to every local authority in connection with permits. I received very interesting replies from a number of those local authorities, including ones in the mid west. How has an audit been received in relation to quantities of clinical waste? I presume that is how the information was provided by his officials to the Minister. A number of weeks ago in answer to six parliamentary questions I was told no audit was available of quantities of medical waste.

In relation to the second part of my earlier supplementary question, where is the waste held in storage and how is it stored? Is it still in refrigerated trucks?

(Limerick East): When the United Kingdom authorities unexpectedly told the private contractors engaged by the different health boards and hospitals they would no longer take Irish medical waste, the problem landed back in the Department of Health. We said that until we negotiated alternative outlets it should be stored in refrigerated units. It was stored on health board and hospital property at that stage.

(Limerick East): Sometimes at the individual hospital which generated the waste and sometimes at a central location. It was stored under refrigerated conditions. I understand from my brief that that has been almost cleared now. Some of it may now be stored by private contractors.

I have been informed that the United Kingdom, which has changed its Protocol once more, is now receiving the medical waste and that the private contractors which deal with this matter have commenced export to the United Kingdom. I do not know whether they have succeeded in clearing the backlog but there is not a problem about clearing it.

However, because of the difficulty which arose, and for fear difficulties would arise again, from a policy point of view the arrangements with the Netherlands should be kept open. We should encourage health boards and private contractors to use the Netherlands outlet because it gives us a prudent alternative.

The ultimate solution is what I have already put in place — a joint initiative between ourselves and the health authorities in Northern Ireland to deal with this problem in a satisfactory way within Ireland. We are jointly examining the tenders to select a contractor.

We are making very slow progress. We should be reaching questions tabled by other Deputies.

In relation to what the Minister said about dealing with the situation within Ireland, does he have any plans for an initiative to reduce the amount of clinical waste? My consultation with hospital staff suggests that a considerable amount of material which is not clinical waste is categorised as clinical waste because of the lax practice of bundling it all together. Will the Minister take an initiative to greatly improve that situation?

Has the Minister considered the technologies, other than incineration, now in place for dealing with actual clinical waste? Is he open to consultation on some of these technologies which do not inform the present waste strategy? The waste legislation deals with very large scale solutions which are not always appropriate, particularly where the technology exists to deal with them locally andin situ.

(Limerick East): That is a very fair comment. If the Deputy had asked that of my predecessor several years ago there would have been a much higher tonnage of hospital waste but it would not have been clinical waste. Everything was bundled together. Cartons in which new equipment was packed were included with waste from the operating theatres and canteens. New strategies have been put in place and we have succeeded — in my predecessor, Deputy Howlin's, time and mine — to introduce Protocols to the health boards. Normal domestic waste is now separated from clinical hospital waste which is why the tonnage is now substantially less than it was heretofore.

A range of technologies is available. However, the option I am considering of appointing a contractor to deal with the problem within the country, in consultation with my friends in Northern Ireland, does not involve an incineration option.

While the Minister rightly stated the overall amount of waste produced is relatively small, it faces a premium charge for its disposal. Are there figures in the Department on how much the disposal of waste outside the country costs on an overall basis?

(Limerick East): I do not have that figure in my brief. The disposal is done by private contractors on behalf of health boards, in the first instance, and then on behalf of large voluntary hospitals. I can communicate the figure to the Deputy. We are not totally devoid of facilities. There is a very good, modern, high tech facility at University College Hospital, Cork.

Does the Minister know if any clinical or medical waste was stored, either by a hospital or health board, anywhere in the country without the required permit for such storage or disposal under the Waste Regulations Act, 1979?

(Limerick East): I do not have that information readily available. If I can get anything on it I will communicate with the Deputy. The primary responsibility for the disposal of waste rests with the Department of the Environment which might have that information. If I have the information I will provide it to the Deputy; if I do not have it I suggest she table a question to my colleague.

Was any waste stored in the Mid Western Health Board area?

(Limerick East): My only knowledge of the Mid Western Health Board storage is that it had a refrigerated unit at the regional hospital in Limerick. A second refrigerated unit was put in place which became a constituency problem for me because the sound of the refrigeration kept local residents awake at night. That was my route to the information. Some of those refrigerated units were subsequently put together near Croom Hospital which has extensive grounds. I have not heard of any unauthorised storage. Once the waste is sent to the contractor it is a matter for him, while the controls are exercised by the Department of the Environment. I cannot, therefore, give a categorical assurance that there was not storage.

The Minister's reply is interesting. I have two replies, one from Limerick County Council and the other from Limerick Corporation. The county council is an involved in Croom Hospital while the corporation is involved in the health board property in the city. Both replies state clearly that no application was requested or received in respect of a permit to dispose of or to store clinical waste. It is important to establish how the health board was able to operate — as it would seem from these replies to have done — outside the law.

(Limerick East): There is a misinterpretation in that the storage is by third parties. A person who forgets to put out a rubbish bin one week and puts out two loads of waste the following week does not commit an offence. He simply generates waste without disposing of it.

If the waste is in a refrigerated unit one commits an offence.

Let us hear the Minister's reply.

(Limerick East): I do not wish to give legal advice at Question Time but if a hospital generates waste and takes the precaution of storing it in a refrigerated unit it does not break the law.

It is required to obtain a permit for that.

(Limerick East): If the waste is taken out of the hospital grounds and stored elsewhere then an offence could arise. We all store waste, at least for a week.

Not clinical waste, that is unless the Minister's home is different from every other home.

(Limerick East): What does the Deputy expect people to do?

Will the Deputy give suggestions as to what they should do with it?