Written by Rory Way, Senior Design Consultant and Oliver Jelley, Engineering Consultant at 42 Technology
The NHS in England faces a waste crisis. Every year, it generates a staggering 156,000 tonnes of clinical waste – equivalent to more than 400 fully-loaded jumbo jets [1]. And among the biggest culprits are single-use medical devices, discarded by the millions. For example, the NHS purchased so many pairs of single-use scissors in 2022-23 that hundreds were used and thrown away every hour [2].
This ‘take-make-waste’ culture is unsustainable but the circular economy offers a lifeline.
By rethinking waste as a resource and prioritising reuse, repair and recycling, the UK healthcare sector can drastically cut its environmental impact and save costs too. The UK government’s Design for Life Roadmap sees a future where avoidable single-use medical technologies are phased out by 2045, which aligns with the NHS commitment to achieve net-zero emissions by the same year [3,4].
This shift isn’t just a necessity, it’s a huge opportunity for medtech innovators. By designing smarter, reusable technologies, medtech developers can help build a more sustainable healthcare system, reduce waste, and support the NHS in achieving its ambitious environmental goals.
Addressing healthcare challenges through circularity
The benefits and challenges of a shift to circularity was a key theme discussed in a recent webinar, ‘Driving Innovation: Paving the Path to a Net Zero NHS’, hosted by 42 Technology and Health Innovation East.
Climate change is a health emergency, directly linked to poor health outcomes through environmental degradation, severe weather events, and increased air pollution. Circular practices can address these interconnected issues by promoting sustainability, reducing waste, and supporting local economies.
Supply chain resilience and cost savings
Procurement faces increasing disruption from volatile supply chains, a vulnerability that became evident during the Covid-19 pandemic. Circular practices help reduce reliance on global supply chains too: by keeping production and reuse local while mitigating risks from environmental or geopolitical events.
Additionally, circular solutions are often significantly lower cost with case studies showing savings of over 50% compared to single-use alternatives, while retaining funds within the UK [5]. The Waste and Resources Action Programme (WRAP) projects a £75 billion boost to the UK economy by 2030 through national adoption of circular practices [6].
Cultural barriers
There is significant cultural resistance to reusables, particularly post-pandemic as clinicians and patients perceive single-use items as being safer and more convenient. Education and awareness will be crucial in helping shift this mindset, particularly as public demand for disposable PPE increases.
Overcoming barriers to circular healthcare
The Driving Innovation webinar underlined three core challenges in implementing circular practices within the NHS for medtech companies to be aware of:
- Legislative and stakeholder alignment: Success hinges on buy-in from policymakers, procurement teams and clinicians to ensure circular solutions can be integrated into existing workflows.
- Understanding NHS procurement: Innovators often struggle to navigate NHS procurement processes, hindering the adoption of sustainable solutions.
- Embedding sustainability as standard: Sustainability should become the default standard for excellent healthcare delivery, not an optional consideration.
The importance of stakeholder collaboration and leveraging collective expertise within the healthcare system cannot be overstated as developing products for circularity isn’t enough. It’s vital to address cleaning, sterilisation, disposal and the logistics of reuse because without robust systems in place, circular innovations risk falling short.
Lifecycle Assessments (LCA) and data-driven evaluations of cost implications, outcomes, and environmental impact are also vital in securing buy-in and ensuring long-term success.
A case study in circularity
Revolution-ZERO, a certified B-Corp, is embracing circular principles with a commitment to replace single-use medical textiles with more effective, sustainable and economic reusable alternatives [7].
In the UK, over 53,000 tonnes of regulated single-use medical textiles are used annually, costing 436 million GBP and producing significant supply chain and disposal emissions. If Revolution-ZERO’s proven system was implemented across the NHS, it could reduce CO2 emissions by more than 100,000 tonnes, waste by 25,000 tonnes, and save 50 million GBP per year.
The company’s total system solution provides not only reusable products but also the necessary infrastructure to support reuse. Their three-tier model – Reuse, Repurpose, Recycle – ensures minimal waste:
Reuse – items such as surgical drapes, aprons and face masks are cleaned, sterilised and reused up to 70 times. In a trial with 10 orthopaedic surgical teams in a Cornish hospital, Revolution-ZERO was able to eliminate almost all single-use medical textiles and packaging, showcasing the benefits of reuse.
Repurpose – when reuse is no longer viable, textiles are fully repurposed for new applications. For example, surgical gowns can be converted into endoscopy gowns then into patient gowns.
Recycle – finally, textiles are recycled via predominantly mechanical methods to produce raw materials for manufacturing.
In a project with Cardiff and Vale Health Board in Wales, Revolution-ZERO’s reusable surgical drapes reduced CO2 emissions by 83% in a colorectal surgery use case while also simplifying use. As part of its ongoing commitment to data-driven innovation, the company uses RFID tags to track wash cycles, carbon and waste metrics in real-time.
Company founder Tom Dawson argues that despite showing clear benefits, implementing circular principles within the NHS can be challenging with issues such as siloed procurement systems. He stresses the importance of taking a systems approach because ‘collaboration between cost stream owners is vital in getting any new product or process adopted into existing workflows’.
Circular design strategies for medtech
The six R’s of circular product design – Reduce, Reuse, Repair, Refurbish, Remanufacture and Recycle – provide a hierarchy for maximising value and minimising emissions. As product design consultants, we always recommend medtech clients adopt several strategies to stay at the top of this hierarchy:
Design for durability: Ensure products can withstand repeated use, using stress analysis to mitigate weak points and by learning from failures in returned products.
Design for repair: Use standardised fixings, modular components and avoid permanent bonds. If failures occur, ensure additional product longevity by providing clear repair documentation, maintain stocks of replacement parts and offer a repair service.
Design for modularity: Enable product adaptability with interchangeable parts and compatibility across product generations to help extend product lifespan.
Not only do these design recommendations aid repairability, they also consider the disassembly process for easier refurbishment, remanufacture and recycling. Integrating these principles into product design and team practices – through serviceable models or takeback schemes – will encourage the creation of products with longer primary lifespans, minimal complexity for repair and refurbishment, and ultimately maximum impact within the six R hierarchy.
The way forward
The NHS’s reliance on single-use medical devices is causing significant environmental, financial and systemic challenges and cannot continue. Transitioning to circular practices offers a practical solution, while presenting medtech innovators with the perfect opportunity to create more sustainable systems aligned to the NHS’s sustainability goals.
Case studies like Revolution-ZERO highlight the potential for reusables to cut emissions, reduce waste and save costs. But there are still significant cultural, logistical and legislative barriers to overcome.
In our experience, circular design practices, data-driven evaluation, LCAs and encouraging collaboration across all stakeholders will be essential in bringing the latest innovations to life.
Sustainability is not just an environmental imperative, it will be critical in delivering tomorrow’s healthcare system and better patient outcomes. But one thing is clear: to accelerate this shift, innovators, suppliers, clinicians, and policymakers need to work closely together.
If one partnership between the NHS and a medtech innovator can cut emissions by 83%, just think what could be achieved with a fully circular NHS? And what role your innovations could have in driving this transformation?
References
- https://www.england.nhs.uk/long-read/nhs-clinical-waste-strategy/
- https://www.gov.uk/government/news/major-crackdown-on-nhs-waste
- https://www.gov.uk/government/publications/design-for-life-roadmap
- https://www.england.nhs.uk/greenernhs/get-involved/suppliers/
- https://s41874.pcdn.co/wp-content/uploads/Green-Surgery-Report-v1.1.pdf , page 56
- https://resource.co/article/circular-economy-could-boost-uk-economy-75bn-says-wrap
- https://www.revolution-zero.com/
Author biographies
Rory Way is a senior design consultant at 42 Technology (42T), focused on the circular economy and helping to create sustainable products designed for longevity, repair and recyclability. His specialist skills include designing at a systems level, for example by looking at areas such as product reuse and remanufacture.
Oliver Jelley (Oli) is a mechanical engineering consultant at 42T with experience in the healthcare industry, developing drug delivery technology across concept and design verification stages. His expertise includes life-cycle testing, design for manufacture and risk management.
