Britain: Privatisation of hospital cleaning is costing lives

By Josie Jones
27 January 2001

At the end of last year, a damning report linked the incidence of life-threatening diseases in several British hospitals with poor hygiene practices. Just two months earlier in August, St Thomas's Hospital in London was forced to close its operating theatres for heart surgery after two patients died from the "super-bug" MRSA (Methicillin-Resistant Staphylococcus aureus).

According to the Health Service Journal, an ongoing National Health Service (NHS) survey had found many examples of poor hygiene practices in hospitals. This included rubbish, dirty linen and food trays being left uncollected and even instances of pigeons—known carriers of disease—being left to fly around in hospital canteens. Such conditions are blamed for the rise of MRSA and other diseases.

One official report estimated that 5,000 patients died annually from infections they caught while in hospital. The Public Health Laboratory Service (PHLS) and the London School of Hygiene and Tropical Medicine analysed the social and economic burden of hospital-acquired infections (HAIs), and found that these cost the health sector in England almost £1bn each year.

On average, a patient with an HAI spends 2.5 times longer in hospital; costs almost £3,000 more to treat and can often require additional treatment for their infection after leaving hospital.

Hospitals are particularly vulnerable to MRSA because of the clinical characteristic of the infection. It has potential pathogens (micro organisms that can cause disease) capable of colonising healthy people without causing them any harm, but in those compromised by illness or recuperating following an operation or other course of treatment it can initiate infections that may prove fatal. The number of patients diagnosed with MRSA has shot up in recent years. The reasons are complex, involving a number of different factors, but effective hygiene control is vital because of the infection's ability to spread and the difficulties involved in treatment once it has taken hold.

Nigel Edwards, director of policy at the NHS Confederation, which represents local health authorities, said he accepted the findings and blamed the problem on the "cost-cutting culture" imposed on the health service by successive governments over the last two decades. He told BCC Radio 4's Today programme, “There has been a 20-year history of asking the NHS to produce efficiency savings each year and what NHS managers have tended to do is look at areas which didn't affect the care of patients. Over the course of years, I am afraid what has happened is that cleaning and catering and some of the hostel services have suffered the brunt of the major cuts in provision”.

A major factor involved in the declining levels of hospital hygiene is that, in an effort to save money, many Health Trusts have "outsourced" cleaning to private contractors tendering the lowest quotes. In contrast to official claims, this has had a detrimental effect on patient care. A ministerial statement last year had to admit that during the preceding three years, private companies contracted to provide pharmacy, information technology and ancillary services to the NHS had incurred more than £2m in fines for failing to meet performance standards. An additional ten contracts for support services—mainly involving cleaning and laundry—were terminated due to a "failure to perform". This included returning supposedly "clean" laundry to the hospital with blood and faeces still on it.

Worsening conditions for mental health patients

The results of a national survey conducted by the leading mental health charity Mind revealed that many patients regarded NHS psychiatric wards as “bleak”, “depressing” and “un-therapeutic”. The conditions are blamed on severe under-investment in mental health facilities.

Amongst the findings, 45 percent of those surveyed said they could not get enough food to eat during their stay on psychiatric wards; one-third of the 343 former patients questioned reported that illegal drugs had been used by other patients on their wards. More than half said they did not have enough contact with staff.

Dr Salter, a consultant psychiatrist for 15 years currently working at Homerton hospital in London, told BBC's Radio 4 Today programme that health services were "bumping along the bottom" after many decades of under investment. Despite Homerton being a brand new facility, patients regularly had to sleep on the floor because there were not enough beds, he said. “At the moment we have 19 patients and 16 beds. The atmosphere in the wards is dreadful—we have three or four nurses if you are lucky, and 16 psychotically disorganised and distressed patients. We have patients who will smear their faeces on the floor and then it takes months to get the carpet replaced.”

"It all comes down to money", Dr Salter continued. "We have a society that doesn't give a damn about the mentally ill”.

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