5. Contracts out
Resolution submitted by the RCN Greater Glasgow and Clyde Branch
That this meeting of RCN Congress demands that RCN Council lobbies government to end contract cleaning in the NHS
Report on this debate
Members want an end to contract cleaning
The resolution to end contract cleaning in the NHS was backed wholeheartedly by members yesterday.
May McCreaddie from Glasgow spoke passionately about the decline in hospital cleanliness and the clear link to rising infection levels. She called for the return of ward domestics and to once again make them an integral part of the nursing team.
The use of contract cleaners can lead to poor standards of hygiene, inadequate staffing levels and management of cleaning staff is not in nurse's hands. Claire Picton felt that the contract companies did not understand what their cleaning staff would be asked to do in a hospital environment.
Speakers highlighted that it is essential that nurses manage cleaning staff, are able to instil basic standards and precautions and have control over cleaning rotas. Many said that cleaners need to be recognised for the important role they play and their contribution to providing a good patient environment. Nurse experiences show that once cleaners felt part of the team there was an increased sense of pride on the ward.
Delegates spoke of the lack of cleaning staff available on night shifts, nurses often having to clean up, taking their attention away from more vital tasks.
BJ Waltho said that nurses need to value their cleaners and to recognise that they are often on low wages. The work of cleaning staff must be recognised as important and valuable within the NHS.
The resolution was carried by an overwhelming majority of 98.88%.
| For | 353 | 98.88% |
|---|---|---|
| Against | 4 | 1.12% |
| Abstain | 0 |
| Yes |
99 |
9% |
|---|---|---|
| No |
1 |
1% |
Background
The provision of a clean health care environment is recognised as an important aspect of the efforts to reduce health care associated infections (HCAIs). The introduction of compulsory competitive tendering in 1983 led to concerns that standards of cleanliness were falling as financial efficiency, not quality, became the main driving force for contract awards ― regardless of whether the successful bid came from the NHS or a private company. Compulsory tendering in England ended in 2001, and in 2004 revised guidance for cleaning contracts was published to ensure that quality, not price, was the driving parameter in the award of cleaning contracts. The focus on the importance of standards of cleaning and cleanliness was also raised by the introduction of the Department of Health’s A matron’s charter (England) (Jones, 2004), which placed responsibility for standards of cleanliness firmly in the hands of matrons.
Current government targets aim to reduce HCAIs, yet recent Healthcare Commission investigation reports on individual hospitals continue to raise concerns relating to the overall management and cleanliness of hospital environments. The drive for financial efficiency by NHS trusts means that estates and facilities services now have to meet annual savings targets ― which threatens the ability of these services to deliver consistently high standards of cleanliness.
While the recent announcement to undertake a ‘deep clean’ of all hospitals in England is to be welcomed, it further fuels concerns that NHS trusts are unable to maintain everyday standards and will rely on ad hoc ‘deep cleans’ to make up for an inability to solve practical issues around the provision of regular cleaning staff, and the integration of cleaning staff into ward teams. This controversial issue has been further highlighted by a recent BBC news report (2008) on how cleaning contractors are struggling to provide the additional staff required to undertake ‘deep cleans’, and the practical issues around transferring patients whilst cleaning is undertaken.
The recent ‘deep clean’ announcement is an ‘England only’ issue, highlighting that a full review of contracting services and a return to in-house cleaning has not been addressed at a national level. Scotland, Northern Ireland and Wales, however, have undertaken reviews and are in various stages of a return to in-house cleaning.
The RCN’s Wipe it out campaign has been lobbying for 24-hour cleaning teams to be available in all acute facilities, and rapidly deployable by senior nursing staff in high-risk areas such as ICU and emergency care settings. In addition, the RCN is currently developing a strategy for infection control and revising its 10 minimum standards for infection control to reflect changes and improvements in health care provision across all four countries.
The need to maintain high standards of cleanliness in hospital environments is essential. In order to ensure the provision of service quality in this area, nurses should continue to argue for a local and established (regular) cleaning staff, managed by ward sisters and working as an integral part of the ward team.
References and further reading
British Broadcasting Corporation (2008) Hospital deep cleaning under fire, London: BBC (BBC Online News, 14 January 2008). Available from: http://news.bbc.co.uk/2/hi/health/7181837.stm (Accessed 18 January 2008) (Internet).
Jones E (2004) A matron’s charter: an action plan for cleaner hospitals, London: Department of Health. Available from: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4091506 (Accessed 1 February 2008) (Internet).