The £10bn Covid PPE scandal is just the tip of the iceberg

By Chris Naylor, Policy Lead for the Centre for Sustainable Healthcare and Senior Fellow at The King’s Fund

Recent revelations about the cost of personal protective equipment (PPE) wasted during the Covid-19 pandemic are almost hard to comprehend. The Covid inquiry estimates that two thirds of the £14.9 billion spent by the UK Government on PPE between 2020 and 2022 went on supplies that were either unusable or out of date. Waste on this scale is appalling but the truth is that this was not a one-off mistake unique to the pandemic – rather, it was a symptom of an ongoing failure to procure and use medical supplies in a way that makes best use of public money.

The chaotic global scramble for PPE in 2020 has its roots in a shift in clinical norms driven by wider transformations in manufacturing processes over several decades. In the past, medical tools, textiles and equipment were routinely sterilized and reused. Today, the same products are often designed to be disposed of after a single use. This has left the NHS dependent on a continuous flow of vast quantities of products manufactured in other parts of the world. The PPE shortages during the pandemic were a wake-up call and more recent geopolitical crises have reinforced the conclusion that global supply chains cannot be relied upon in the way once taken for granted.

The trend for disposables is not limited to gloves, masks and gowns. Sophisticated surgical instruments worth hundreds of pounds are used once, then destroyed. Curtains around hospital beds are sent to landfill or incinerators after a few weeks. A single maternity unit can dispose of tens of thousands of infant feeding bottles in a year. The throwaway economy has become so pervasive that it can be hard to find an aspect of medical practice that remains untouched.

The case for disposables often rests on two arguments: they are safer, and they are cheaper. On examination of the evidence, both of these claims turn out to be misleading or false.

There can be a perception that disposables help to reduce infection risk but this is often untrue. To take one example, overuse of disposable gloves has been found to increase infection risk in some circumstances – for routine tasks such as checking pulse and blood pressure, or changing bed linen, handwashing is more important. Some trusts have demonstrated that it is possible to safely reduce glove use by at least 10–30%. Trusts such as Great Ormond Street Hospital and Northamptonshire Healthcare have saved tens of thousands of pounds through educational campaigns to reduce overuse of gloves and aprons.

The second argument – that disposables are cheaper – falls apart once we consider the true costs to the system. If the goal is to minimise the upfront price for each item purchased, disposables can look attractive. But when value is assessed more comprehensively, including ongoing purchasing and disposal costs, products that can be used multiple times are often a more economical choice. We have worked with dozens of trusts that have saved thousands by shifting to reusable products. For example:

Sheffield Teaching Hospital switched to reusable tourniquets in some services and estimated this could lead to savings of over £35,000 if implemented across the trust. As well as saving money, staff found the reusable tourniquets easier to use and reported that they caused less bruising and skin damage.

Hampshire Hospitals replaced 10 disposable instruments used in labour wards with reusables, saving over £27,000 per year in one maternity unit alone.

Disposables are of course also a disaster for the environment: oil-based plastics, manufactured and transported around the world, and then burned in huge quantities – sometimes without being used. The PPE procured in the UK during the first six months of the pandemic had a carbon footprint of more than 100,000 tonnes of CO2e. It would take a forest the size of the Isle of Wight more than a year to absorb this much carbon.

While the pandemic gave us a particularly striking example of how money and resources are wasted through overreliance on disposable products, we are dealing with a chronic issue. A nationally-led shift to reusables for many product types would save the NHS money and be better for patients. It would also create UK-based jobs in high-quality manufacturing, logistics and local re-processing.

The Depart of Health and Social Care has taken encouraging steps in the right direction through its Design for Life programme, which aims to shift to a circular economy for medtech supplies. This work now needs to be turbo-charged, including by acting on the recommendations of a recent review of the transition to reusable medical products in the NHS.

More broadly, by helping clinicians and procurement teams take a sustainability lens to their work – using well-established quality improvement tools – we can reveal countless opportunities to improve care, save money, and strengthen the resilience of health services during uncertain times ahead.

The right response to the staggering waste revealed by the Covid inquiry is to put an end to the ongoing dependence on disposable products in healthcare. Reusable alternatives already exist – what we need now is concerted national leadership to drive adoption at scale.