Transforming healthcare waste management across the NHS

Introducing circular economy principles into healthcare waste management

Healthcare contributes almost 5% of the UK’s carbon footprint with waste management representing a significant opportunity to reduce emissions and improve resource efficiency. To support its net zero ambitions, NHS England commissioned Mott MacDonald to undertake a comprehensive update of Health Technical Memorandum (HTM) 07-01, the primary guidance document for healthcare waste management, which was first published in 2013.

Mott MacDonald worked in partnership with healthcare design specialist Arcus and NHS England to publish the overhaul of the document in 2023. Mott MacDonald’s brief was to use its healthcare knowledge and sustainability expertise to deliver a new document that better supported decarbonisation in the NHS, as well as circular economy principles and more sustainable waste treatment methods.

"There was a need to update HTM 07-01 because a decade of regulatory change, combined with increasing sustainability ambitions, meant the existing guidance no longer fully reflected the realities of healthcare waste management," explains Mott MacDonald principal waste and resource management consultant Grace Peel. "Expectations around decarbonisation, resource efficiency and environmental accountability had evolved significantly, as it become a key part of the NHS’s wider sustainability agenda."

"This wasn't simply a matter of updating sections or refining language. The guidance required a fundamental overhaul to ensure it remained practical, relevant and aligned with current policy objectives"

To deliver the programme, Mott MacDonald assembled a small but highly experienced group of healthcare waste and resource management specialists, drawing on expertise across waste management, sustainability, circular economy and healthcare operations.

The programme involved multiple stages of drafting, consultation and review with Mott MacDonald working in partnership with Arcus, NHS England and other stakeholders from across the healthcare sector to ensure the revised guidance reflected both the latest policy requirements and the practical realities of managing waste within in healthcare settings.

Extensive collaboration with NHS England and stakeholders from across the healthcare sector helped ensure the revised HTM 07-01 was technically robust, practical to implement and aligned with both policy objectives and operational realities.

Designing for usability

While the technical content of the updated HTM is extensive, one of its most significant innovations is its focus on practical application. The project team recognised that previous guidance, although comprehensive, could be difficult to navigate in busy healthcare environments where users need clear, accessible information to make decisions quickly and confidently.

To address this, Mott MacDonald introduced a range of features intended to improve usability, including visual waste classification tools, process flow diagrams and a more structured layout that guides users to the sections most relevant to their role and responsibilities.

"Technical guidance can often be dense and difficult to interpret," Grace explains. "Alongside updating the technical content, a key priority was ensuring the document could be used as a practical day-to-day reference by a wide range of users across the NHS."

This approach reflects a broader recognition that effective guidance must be both technically robust but also easy to use. By improving accessibility and navigation, the revised HTM 07-01 helps support consistent decision-making, improve compliance and embed best practice across the NHS estate.

Focusing on segregation

At the heart of the revised HTM 07-01 is a strengthened focus on waste segregation, particularly the diversion of offensive waste from high-temperature clinical waste treatment routes. This represents one of the most significant technical changes within the updated guidance, reflecting growing recognition that appropriate waste classification and segregation are critical to reducing both environmental impacts and waste management costs.

By promoting segregation at the point of production, the guidance supports the use of lower-carbon treatment options for suitable waste streams, helping healthcare organisations reduce reliance on carbon-intensive disposal methods while maintaining compliance and patient safety standards.

"Improving segregation was the biggest technical shift," says Grace. "By ensuring waste is correctly classified and segregated, healthcare organisations can significantly reduce the amount sent for high-temperature treatment, delivering substantial carbon and cost savings at scale"

The revised approach demonstrates how relatively simple operational changes can deliver significant environmental benefits, helping the NHS reduce emissions, improve resource efficiency and make better use of existing waste management infrastructure. This emphasis on segregation aligns closely with the NHS’s wider decarbonisation ambitions and highlights how practical changes at site level can contribute to system-wide sustainability outcomes.

Once a material becomes waste, the options available can be limited

Sustainability at every stage

Beyond waste segregation, the revised HTM 07-01 adopts a more systemic view of sustainability, extending its focus upstream to procurement and product selection, as well as downstream to treatment and disposal. While opportunities to apply circular economy principles in healthcare can be constrained by infection prevention and control requirements, the guidance encourages organisations to consider how waste can be prevented before it is created.

"Once a material becomes waste, the options available can be limited," Grace notes. "Opportunities often lie earlier in the product lifecycle by considering what is purchased, how it is packaged and whether materials can be reduced, reused or avoided altogether." This reflects the NHS's growing focus on whole-life sustainability, with waste prevention and resource efficiency sitting alongside safe and compliant waste management.

Wider impact

The revised HTM 07-01 was published in 2023, providing NHS organisations with a modernised framework for managing healthcare waste. This has contributed to measurable progress in reducing emissions and improving waste management performance across recent years, supported by both updated guidance and broader system-wide initiatives.

The revised HTM 07-01 played an important role in supporting NHS England's Clinical Waste Strategy, which was also developed by Mott MacDonald. By translating strategic ambitions into practical requirements for healthcare organisations, the guidance provided a framework for improving segregation, reducing reliance on high-carbon treatment routes and embedding sustainability across the waste lifecycle.

The influence of the revised HTM is already extending beyond its original scope. NHS Wales has subsequently worked with Mott MacDonald to draw on the guidance as a foundation for developing its own equivalent framework. This demonstrates both the robustness of the approach and its relevance across healthcare systems facing similar environmental and operational challenges.