Sep 25 2007
How difficult is it to have cleaner hospitals?
One of the Conservatives more memorable lines from 2005 has now been answered. The answer is "very" for some NHS hospitals.
Today we will learn that the problem is so worrying the government willl spend more of our money on a new regulator to supervise hospital cleanliness, and on a deep clean for every NHS hospital in the land.
Once again we have top down solutions imposed from outside a large organisation that are unlikely to work.
The Regulator is unlikely to improve hospital staff morale and motivation, will issue countless bits of guidance on how to wield the mop, and encourage a box ticking mentality. Doubtless hospitals will appoint Cleanliness compliance officers to talk to the Regulator’s officials. It will all get dearer and more complicated but not better.
A single deep clean may help a little, but it does not tackle the day by day attention to detail needed to create a bug free environment. It also leaves open the question what are we paying the in house cleaners and the contract cleaners for at the moment, if there needs to be additional super cleans from time time time? Have they set the wrong standards for the current contracts? If so, why not amend them?
Cleaning buildings more may not be enough - it may require a different approach from all people entering a hospital.
John Redwood has been the Member of Parliament for Wokingham since 1987. First attending Kent College, Canterbury, he graduated from Magdalen College...
“It also leaves open the question what are we paying the in house cleaners and the contract cleaners for at the moment” (JR)
That is actually a key part of the question. The appointment of yet another Regulator is just another naive response to a key service and quality management question. For many cleaning contracts (e.g. those in office and IT environments) the criteria of clean is specified in terms of visible dust on horizontal surfaces, removal of “litter”, removal of smears on glass, handling of spills, etc. Within the NHS a much tighter definition ought to be enforced, e.g. addressing cleanliness at a “bacterial” rather than purely visible level.
However at a practical level, how many contractors would be prepared to sign up to the required standards, when so much of the environment is not under their control - e.g. the bacteria brought into wards by hospital staff, visitors and patients themselves.
Rather than the window dressing of yet another Regulator, we need hospital managers to do their job and manage their cleaning contracts effectively, rather than fill in yet more Whitehall inspired forms and set up more league tables.
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The cleaning of hospital wards was carried out by NHS employed cleaners/domestics. These people were part of the ward team and had pride in the cleanliness of “their” ward.
Now the wards are cleaned by contractors, many of them not having English as a first language, but will work for the national minimum wage. Often it is difficult for ward staff to communicate with these contractors due to language barriers. These contractors will often “clean” several wards during their shift. In order to comply with “elf n safety” many of the cleaning chemicals such as bleach and hibbiscrub that were used on wards are no longer permitted. Many of these “cleaners” also have other duties to perform during their shift such as serving food that is also reheated by them.
Reply: I am told there is no evidence that contract cleaning is either worse or better overall than in house cleaning. In each case it depends how it is managed and who is running it. The NHS are responsible for managing outside contractors as well as for managing in house teams of cleaners. Every cleaning organisation has to train its staff to suitable level to ensure good results.
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The BBC / Nu Labour alliance is reporting Johnson as saying;
‘Mr Johnson said Labour had a “proud record” of increasing investment, staff and survival rates in the NHS - but now wanted to move away from “top-down structural change” to concentrate on better patient care.’
Perhaps the prime minister wasn’t aware of this when handing out cleaning dictates from above?
Reply: Good one!
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Well said. Alan Johnson clearly has no control over the health service and completely skipped over the core issues such as private sector involvement and the GP and dentist contracts.
http://lettersfromatory.wordpress.com/2007/09/26/weak-and-insulting/
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The ‘Invitation to Tender for Cleaning of Hospital Wards and Ancillary Rooms’ culture must be removed from the hospital manager’s ‘jobs to do’ list.
Simply screwing down an outside contractor to the lowest possible price is tantamount to a licence to infect. The winning bid, in order to make any profit whatsoever will use the cheapest materials and the most uneducated labour they can find.
Uneducated labour and a ‘don’t care attitude’ are a lethal combination - and it is the patients who reap the infections. If they are to be given out at all, tenders must, simply must be based upon a scientific approach to cleaning. The contractor most fit for purpose - and not the cheapest should be awarded the contract.
And if the hospital they clean is free of infections for example, for a 6 month period - then they should be awarded a bonus - similarly, if infection breaks out - and it can be proved to have originated from a site that had not been cleaned properly then they should be heavily fined. It could all be put into the initial contract. That way, you would get shot of the cowboys and the Del boys with their mop and Domestos quicker than you could say “MRSA”.
My last stay in a hospital was a particularly unpleasant one. By the side of my bed, on the wall, was an arc of dried blood spatterings. I complained about it but was told it was the cleaners job to do it. And since I never actually saw a cleaner, it remained there for as long as I was there.
Reply: I was sorry to learn of your unpleasant experience in hospital. I do not agree that going to the lowest bidder is the wrong approach. The idea of competitive tender is to set out a required standard that the contractor must achieve, and to award the job to the lowest priced - the most efficient - contractor. Of course there should be incentives and penalties in the contract designed around the required standard. It may not be the cleaning company that has caused MRSA - that may have come in on the hands or clothes of someone - but if there are stains and marks these should be sorted out under any sensibly designed contract. A good cleaning company might need good quality staff, but also have plenty of machine power to back them up to achieve better efficiencies. The NHS should be a good client, superviisng the standard of work well and motivating the contractor to do a good job.
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