CLEANLINESS IN HOSPITALS – 13 January 2004
Dr Julian Lewis: My short contribution to the debate dovetails well with the contribution that we have just heard from the hon. Member for Weston-super-Mare (Brian Cotter). Much of what he had to say was anecdotal, but that does not mean that it was not true. The more true anecdotes we hear, the more we realise that something is wrong with the system. I do not have the expertise of the hon. Member for Norwich, North (Dr Ian Gibson), but we are all in his debt for pursuing not only the subject under discussion, but many other causes on behalf of NHS patients since he has become an hon. Member.
I know that my right hon. Friend the Member for Hitchin and Harpenden (Peter Lilley) has made such a vital cause one of his own. However, it was the contribution of the hon. Member for Stevenage (Barbara Follett) that reached the nub of the problem. She referred to the system that is operating in wards now, and compared it with the system that used to operate when there was a sort of quasi-military discipline in the administration of the management of patients.
Both my right hon. Friend and the hon. Lady referred to Florence Nightingale. It is surely astonishing that, so many years after her basic lessons of hygiene were put into effect with such dramatic results, we are having to learn them all over again. The problem lies in the fact that people who accepted her philosophy had the ability to put it into effect. This meant having a serious hierarchy of power on a ward, a serious chain of responsibility and serious consequences for people in that power structure if they did not deliver the goods – clean wards being part of the package. But that ethos is no longer available to people who manage wards today.
I was struck by an article published in the the Daily Telegraph on 29 November 2003, which was based on a Centre for Policy Studies pamphlet by Harriet Sargeant. I shall enter a number of quotations from her article into the record of this debate.
"It is a revelation to anyone spending time in a hospital to discover how little of hospital activity is actually managed. The closer you get to the patient, the less management there is. No single person appears to have the authority to oversee all the elements of a patient's care, pull them together and take responsibility for that person's wellbeing. Whether you enjoy attentive nurses, a proper diet and clean wards is simply pot luck."
She goes on to examine in some detail how, since nursing has largely become a graduate profession, there has been a movement away from the fundamental duties on which patients rely if they are to be kept in a clean and safe environment. Here is another anecdote, which is true. She records:
"At a London A&E department, a staff nurse who had recently qualified complained to me that her training had not prepared her at all. In 18 months of study, she had spent only one-and-a-half hours learning how to take blood pressure and a patient's temperature. On the other hand, a whole afternoon had been devoted to poverty in Russia."
[Interruption.] The hon. Member for Norwich, North (Dr Gibson) laughs – I am sure that it is bleak laughter. I know how he feels.
"For assignments, her tutors had set her work on social issues and ethics – including patient rights."
Someone who had been through the courses stated:
" 'I learnt more in the first three months on the job than in three years at college’.”
The article is shot through with anecdotes. However, as a constituency Member of Parliament, I have my own to report on the Southampton General Hospital, which is a mighty establishment that does much good work. My experience with that hospital is similar to the experience of the hon. Member for Weston-super-Mare (Brian Cotter) in correspondence with the chief executive of his main hospital.
I shall give three examples, which refer to three cases about which people sent me letters in a 24-hour period. That is not typical, but it is extremely worrying. In my letter to the chief executive in February 2003 I raised the case of a person I shall call patient C, whose wife wrote to me listing in detail
"the dirty state of the ward in September 2002 and the administering of injections to successive patients on repeated occasions by nurses who did not wash their hands before moving from one patient to another."
While patient D was in Southampton General Hospital,
"his wife observed dirty swabs left on the floor for two or three days at a time, as well as excrement left on the floor after sheets were changed. Once again, nurses were observed not washing their hands or changing gloves"
before administering injections.
In the case of patient A, while in the D-Level wards his family observed blood and pus on the table alongside his bed and on the window-sill, as well as blood spots on a ceiling tile. On some occasions, he was attended by staff members who were not wearing the relevant gloves and aprons, and on others such gloves and aprons were left for long periods in an overflowing bin in his room after they had been discarded. Soiled bedding was also left in the room for several days.
To balance the picture, I am happy to acknowledge that the son of patient A told me that the attention given to him in F1 Ward after he had to have part of his leg amputated was first-class, and that the standards of hygiene and cleanliness were very good. The attention given by consultants was also warmly praised.
However, what is the point of having high standards in one part of the hospital when the patient has already been made seriously ill by low standards in another part? I do not know whether the difference is the result of changes in cleaning practices, the disappearance of matrons, the politically correct reduction in standards of discipline and training, or a lack of practical experience by trainee nurses; but I do know that things cannot be allowed to go on as they are.
I had a good response from the chief executive of the Southampton University Hospitals NHS Trust. He faced up to the criticisms in a straightforward way. He said that my comments would be raised at the next trust cleanliness group meeting, and that
“areas identified as not reaching the required standard in your letter will be the subject of further audit to ensure that the correct standard of cleanliness is achieved."
I am sure that when Members of Parliament bring such concerns to the attention of chief executives of hospitals, those chief executives do everything in their power to rectify them. It should not be the case, however, that things can go wrong in this way so that people have to complain to get remedial action on a piecemeal basis.
The systems in place should include the sort of rigorous discipline that existed in my days as a youngster, which meant that when I had to be admitted to a hospital for a scrape or a minor operation, cleanliness shone out at patient and visitors alike. That is what we have lost, and what we look to the Government to help us recover.