NHS told to return to the past

Nurses should take back responsibility for cooking and cleaning in hospitals instead of letting private contractors do the work, a medical expert says. Many doctors are afraid of being treated in their own hospitals, while a lack of support from the Government has left elderly patients at risk from hospital-acquired infections and malnourishment, according to academics writing in the British Journal of Hospital Medicine. Dame Betty Kershaw, the Emeritus Dean of Sheffield University School of Nursing and Midwifery, says that the NHS is offering an extremely poor service to older people in clinical settings and those being cared for in their homes. Recent attempts by ministers to lower rates of MRSA and Clostridium difficile infections through a “deep clean” of hospitals will not have any significant impact, she writes.

Dame Betty, a former president of the Royal College of Nursing, recommends giving responsibility back to nurses for tasks such as cleaning and catering. “We must return the power and control of nursing care to the ward sister (or the equivalent senior nursing post in the community) if we are to improve standards, address the serious loss of patients’ dignity and deal with the growing number of hospital-acquired infections,” she says. “The proposed ‘deep clean’ will be merely papering over the cracks. Cleaning staff need to be employed by the NHS, not contracted out.”

Gordon Brown announced the “deep clean” at the Labour Party conference, insisting that “a ward at a time, walls, ceilings, fittings and ventilation shafts, will be disinfected and scrubbed clean”. Health workers believe that the high volume of bed turnover in wards is a more serious issue. But the latest official report from the Department of Health suggests that dirty wards and high bed-occupancy rates no longer contribute significantly to the spread of MRSA.

Dame Betty is joining a debate prompted by Sir Roy Calne’ Emeritus Professor of Surgery at the University of Cambridge, who in a previous editorial for the journal declared that attitudes and standards in the NHS had changed so much that many doctors were afraid of being treated in their own hospitals. “As a consequence of bad treatment of nurses, the unions have become very strong and discipline has deteriorated, so that it is almost impossible to dismiss an unsafe nurse whose poor practice endangers patients,” he said.

Like Dame Betty, Sir Roy wants to see ward sisters in control of ancillary activity. He believes that a two-tier system of NHS treatment now exists, putting elderly patients at particular risk. He compared the high standards of flagship units with the “dismal” environment of geriatric wards, which were so dangerous they had become “a lottery for euthanasia from infection and malnourishment”.

The health workers’ union Unison says that the number of cleaners in the NHS has halved in the past 20 years. There have been concerns that hospitals are hiring the cheapest cleaning contracts and cutting corners. The standard of hospital food has also been recently criticised by the Healthcare Commission and the Royal College of Nursing.

Sir Roy said that boosting pay and morale among nurses would help to restore standards. “The shortage of nurses as a result of poor pay and perceived poor status has forced us to rely on the services of nurses from abroad, often from countries which can ill afford to lose their nurses,” he wrote.

Ministers argue that the increased focus on tackling hospital-acquired infections has contributed to a 27 per cent fall in the probability that a patient will acquire MRSA compared with 2001. But the Government is still expected to miss a three-year target to halve rates of MRSA by April.

A report published by the Department of Health concludes that high bed occupancy, greater use of temporary nursing staff and low cleanliness scores were correlated with higher MRSA rates up to 2003-04, but that in recent years these links have weakened to the point where they are not statistically significant. “One possibility is that trusts have become significantly better in recent years at understanding and meeting these challenges,” the report adds. Ann Keen, the Health Minister, said: “We have given the NHS comprehensive guidance on infection control and this report is consistent with our interventions and support beginning to bear fruit.”

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