Sunday, 11 April 2010

The NHS and Hygiene

Figures released last Thursday showed rates of MRSA and C.diff are declining in Scottish hospitals. Not before time, because the source of these infections is down to one thing and that is hygiene. Hand washing has become an after-thought rather than a necessity in the lives of many. Publicity about these hospital-acquired infections, which have killed or played a part in the deaths of almost 3000 people in the past five years, may have helped jog the consciences of some, but not all.

Experts claim the bugs are often spread by doctors, nurses and other hospital staff who fail to wash their hands before contact with individual patients. Last year Nicola Sturgeon said that those staff who did not comply with hand hygiene guidance would face action, but only one worker has been taken to task for flouting the rules.

An investigation revealed several health boards, including Ayrshire, Arran, Fife and Tayside don't treat breaches of hygiene rules as a disciplinary issue. Two others, Grampian and Greater Glasgow and Clyde, claim they've no idea how many people they have disciplined because they do not routinely collect information. Unbelievable!

Margaret Kennedy, the hand hygiene co-ordinator at NHS Tayside, said any breaches of hygiene picked up during a hospital audit are used as a training opportunity.

A training opportunity?

Last month Scotland first hospital inspector said she was disappointed by the poor standard of cleaning on wards. We have yet to hear what action is being taken.

But wait, maybe it's because managers are not being well enough paid. Nicola Sturgeon has the answer: 'Managers in the NHS should be paid more.' They should start on higher salaries and progress up the pay scale more swiftly, according to an official report.

They should also receive some form of performance-related bonus - even though the current scheme, which cost more than £1.2 million over 4 years, is found to have done little to motivate staff.

Earlier this month Nicola Sturgeon said she had scrapped bonuses for senior NHS managers in their latest pay settlement because of the financial climate. However, the next day the Scottish Government sent health board chairs the review of executive and senior management pay arrangements, which says they should earn more.

In a covering note, Dr Kevin Woods, chief executive of NHS Scotland, said he had told the chairman of the review group that it had done its job "well". Indeed they have. NHS managers must be feeling much the same a GPs did when they were told their their salaries would rise dramatically for less working time.

Claire Pullar, Scottish officer for Managers in Partnership which represents NHS executives, said she was aware some health boards had found it difficult to recruit and retrain managers.
She added: "The salary is not exactly ideal. but it is also about how you treat people in the NHS, where they can see their career going and if they think they are being treated fairly and equally. We need to look at pay, but also our attitude to how we value managers".

Any person interested in the politics of the NHS knows there is a surplus of managers with the organisation, yet we have the Scottish government agreeing they should be paid higher salaries.

Have I missed something here? If managers aren't performing even after receiving performance-related bonuses in the past, the answer is sack them and replace them with someone who can do the job efficiently. Another idea would be to delay replacing them as it could well be found the post wasn't necessary.

Getting rid of just one manager in each hospital in Scotland could pay for a years supply of bleach to clean the wards thoroughly. There's a thought!

A Sunday Telegraph article discusses hygiene in English hospitals - 'Muslim staff escape NHS hygiene rule'. I make no apology for saying I would refuse to be touched by any staff member who did not comply with the basic hygiene rule of 'bare below the elbow', whether they be Muslim or agnostic. We must have one standard for all. If that doesn't suit certain people for various reasons, then a job in the health service isn't for them.


Joe Public said...

If they really want to improve hospital hygiene, all political visits (with or without huge media entourage) should immediately be banned.

subrosa said...

There is that Joe. I wonder how many entourages wash their hands when arriving and leaving?

Macheath said...

For what it's worth, a relative who contracted a nasty post-op infection in a Scottish hospital repeatedly saw visiting children sent to take unsupervised showers and baths in the patients' washrooms while the adults chatted.

Since cleaning staff only worked early in the morning, the resulting mess and constant lack of clean towels was a perpetual problem for the patients on the ward.

Mr. Mxyzptlk said...

My prediction

Budget cuts

The cleaners will be gone...The Managers will not

I wonder what conclusions the Cleaners might come to if they carried out a a review of managerial pay...

In the Olden Olden days Nurses would clean up if they saw some mess.

In these more modern days they are far to 'Hoity-toity' for such common tasks.

They would rather wait all day long for a Cleaner than roll up their sleeves and get stuck in.

subrosa said...

That doesn't surprise me Macheath. I was a victim of c.diff, picked up in a local hospital. The shower was shared among 6 of us and was never cleaned from the Friday lunchtime until the Monday. Only on the Monday was it discovered had c.diff and I was moved to a single room.

Fortunately I had the facility to get detailed information about the infection and I made sure I was back in my own home within 48 hours. Back with own standards of cleanliness, where I slowly recovered.

subrosa said...

The cleaners vanished years ago Niko. A cleaner comes into a ward once a day if you're lucky. They spend more time pushing a floor polisher around rather than washing it with bleach.

There are some nurses who will roll up their sleeves and clean Niko, but not many. The ones who do are usually those older ones, trained properly in the risk of infection.

Apogee said...

Nurses only can do what they are told to do.It should be remembered that there is a chain of command which stretches to the top of the NHS and then to the politicians in government who have overall control, including of the money and priorities.
If box ticking to cut costs is the main priority the service to the patients will go downhill rapidly.
Also there should be more nurses and doctors than managers, last I checked there were far more managers than beds.
Can any one please explain why this is so???
And why one religious grouping is allowed to flout reasonable and sensible cleanliness rules???

Macheath said...

Apogee, good point about top-down control.

Incidentally, you see a whole new side to hospital treatment when you're on a drugs trial. Since infections complicate the statistical analysis and interfere with results, suddenly everything surrounding you is scrupulously clean and the nurses are attentive to the point of obsession.

It's amazing how much better the care is when the staff have a vested interest in your continued survival.

subrosa said...

While I see your point Apogee, every nurse and medical should know that hand washing is the best control of infection.

Box ticking has been in vogue for some years now - thanks to Labour. There are all these promises to answer an inquiry within xx days yet few do it. The eventual response just apologises with no explanation.

I've no idea why we permit one religious group to flout the rules. It's a disgrace to basic hygiene and one which should be rectified immediately.

subrosa said...

Macheath, you've jogged my memory about drugs trials. I remember a young lad saying exactly that some years ago.

Can't upset big pharma can they? Plus of course the additional funds which will drip into the hands of management.

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