Maintaining a clean regime amid austerity

After spending 13 long years out of government, the run up to the 2010 general election saw the Conservative party invest a great deal of time and energy hosting public focus groups, as it searched far and wide for the policies that would propel it back power. One of the themes which emerged from this research was the need to ‘detoxify’ the Conservative brand and for it to become more appealing to independent voters, particularly outside of the south-east of England, where anti-Thatcher sentiments remain and a deep suspicion of Conservative motives is common.

Armed with their market research, the Tories entered the general election campaign season with their manifesto anchored by their cast-iron pledge that they would protect the NHS’s budget whatever the weather, through maintaining healthcare spending in ‘real-terms’ – that is, above the rate of inflation – which meant that the popular national institution was the only part of the public sector that would be protected in this way.

But 18 months after a hung parliament forced the Conservatives into a five year coalition partnership with the Liberal Democrats, the NHS pledge is coming under the twin pressures of anaemic economic growth which is curtailing the Treasury’s tax receipts, while keeping up with the rate of inflation which, at its current five per cent, is the highest it’s been for 14 years.

Early in the parliament health secretary Andrew Lansley announced that the NHS would need to make £20bn of efficiency savings in England by 2015, adding a promise to voters that these savings would not cause the NHS to limit the services it provides.

Instead, he claimed, the money would be saved through reducing bureaucracy, ending waste and adopting innovative ways of working and restructuring services. The key question for the cleaning industry is how much of an effect will these changes have on cleaning budgets, and will this mean that ward hygiene and patient safety is put at risk?

Driving down infection
In the past few years, cleaning has played a increasingly prominent role in patient safety, operating on the frontline in the battle against hospital acquired infections (HAI’s) during the previous Labour government’s £50million deep clean in 2008, and benefitting from the extra resources which were dedicated to drive down infection rates further in the years that followed.

The additional investment in cleaning has undoubtedly driven down HAI rates; figures from the Office for National Statistics revealed that in 2009 MRSA infection rates fell by 35 per cent, with C.diff falling by 29 per cent. Then, in 2010, the number of deaths involving superbugs dropped again in England and Wales, with the mentions of C.diff on death certificates down by 31 per cent to 2,704.

In a period of transition for the NHS, the next set of data on HAI rates will be interesting. But across the country, there are worrying portents that the progress on this issue may stall as budgets tighten.

Earlier this year, the Daily Mirror reported that the NHS is spending £134million less than the minimum required to ensure that wards are kept clear of the MRSA and Clostridium difficile superbugs. Keith Sammonds, of the Health Facilities Consortium, a body which oversees hospital cleaning, publicly warned that the £897million allocated for 2011-12 is 15 per cent below the necessary amount required to keep wards safe.

And up in Scotland, the Labour party has claimed that over 100 cleaning posts have been lost in hospitals during 2011, despite a promise from Scottish National Party health secretary Nicola Sturgeon that they would recruit an extra 600 cleaners in the same period. The figures, acquired after a freedom of information request was submitted six months after the SNP pledge, were disputed by some health authorities, although the SNP has not yet produced any evidence to decisively counter the claim.

Meanwhile, away from the hospital wards, back office staff are also feeling the cuts bite. In Wales, early November 2011 saw media reports that Cardiff and Vale University Health Board told their staff to start cleaning their own offices in an attempt to save money, as offices within the board area are no longer cleaned daily, with bins emptied just once a week as part of the cost-saving measures.

In an email which was leaked to WalesOnline, non-clinical staff working at the health board were told that offices and administrative areas will no longer be cleaned at all, while toilets will be cleaned ‘according to how often they are used’.

The health board justified the change by stating that all cleaning services spending should be concentrated on clinical and patient areas across Cardiff and Vale. But it is a clear indication of how much they value cleaning when they have stopped offering a professional service in the staff workplace. And the move becomes even less unsurprising when Cardiff and Vale health board announced shortly afterwards that it needed to make massive savings of £87.8m – more than five per cent of their total turnover – in 2011.

Managing Austerity
But what is the view from those with a close working relationship with the NHS? Andrew Large, Chief Executive of the Cleaning and Support Services Association (CSSA), says that his member’s experience of working with the NHS under the coalition in the age of austerity has been relatively good: “CSSA members would strongly resist the suggestion that austerity should mean less hospital cleaning. High levels of cleaning pay for themselves through reduced incidence of healthcare associated infections. As it stands, the figures published by the Health Protection Agency show a steady decline in the level of both MRSA and C Diff infections in hospitals. The CSSA is monitoring those figures closely and if there is any evidence of cuts putting in jeopardy the progress that has been made then we will intervene ”.

Large concedes that the level of service provided in the non-clinical, ‘low risk’ areas has come under review and, and, in some instances, service levels have been reduced: “In an office for example, maybe the bins won’t be emptied every night, they will be emptied once a week. However, patient safety must always be maintained. It makes sense to manage cleaning on the basis of a scientific risk assessment, but the fact is that patients, medical staff, visitors and office workers all have expectations about the cleanliness of their immediate environment and these expectations need to be met or complaints begin to flood in.”

Large strongly refutes the suggestion that outsourcing can only create greater efficiencies by doing things more cheaply, despite concern that the term is just a smokescreen for cutting key healthcare services: “Outsourced service providers can deliver savings of 10-15 per cent through better management, transfer of knowledge from other sites and economies of scale. Experienced outsourced service providers understand how to motivate and lead cleaning staff to improve performance.”

He believes that some of the issues that have arisen throughout 2011 may be evidence of managerial self-preservation at work: “In terms of middle-management, there can be a bit of a barrier being put up because they can see themselves being a target of cuts. Finance directors are fully engaged and understand the need to work smarter and more efficiently with the resources available, but there can be resistance at the contract management level from people who are directly employed by the NHS.”

Large concludes that in an era of reducing bureaucracy, ending waste and adopting innovative working practices for the NHS, outsourcing is the best way to manage costs and overtly demonstrate best value: “It’s often forgotten that it’s still only about a third of cleaning services that are contracted out in the NHS. If the NHS is serious about improving the value it gets from public expenditure, it is going to have to grasp that nettle and engage the private sector in a much bigger way”.

The NHS is the third largest employer in the world, operating with a budget of 106bn and employing one in 23 workers in Britain. With any complicated and temperamental organism of this size, the picture around funding will always be contentious, with different groups crying foul when they believe their interests might be threatened.

The true effect of the government’s efficiencies will only be known when the HAI statistics for 2011 are released by the ONS in august 2012. While judgement should be reserved until then, it is a matter of grave importance for the patients being treated in Britain’s hospitals that safer and cleaner wards remain a sacred goal.

For more information
www.britishcleaningcouncil.org