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From The Times

December 26, 2007

Nurses ‘should cook and clean in hospitals to beat threat of superbug’

David Rose

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.”

As a student nurse, it's depressing to read many of the above comments. My current placement is a 15 bedded elderly ward. On a typical day, it will be staffed by one nurse and two health care assistants. Each of those 15 patients requires a full wash once a day, plus most also need additional washes and changes of clothes in a typical shift. Many of our patients have complex medical needs and of course there are drug rounds ,doctors rounds, dressings and 1000s of other essential care tasks that have to be done on a regular basis.
All of the nurses working on this ward are deeply caring, dedicated people. The ward is chronically understaffed - it is common for nurses to take on double shifts because they have no staff available and unpaid overtime is a norm.
In my experience, most nurses are exhausted and morale is appalling. The simple fact is that we need far more nurses - we are not superhuman and one qualified nurse for 15 patients is simly dangerous.

jo, hove, uk

I am a nurse with more than 20 years experience. If you read this article correctly Dame Betty is not saying that nurses should do it, just take responsibility for the cooking and cleaning. Having experienced patient care as an inpatient myself I can say with confidence that the level of nursing care today is no where as comprehensive as it once was. The level of cleanliness is far worse than ever before.
The main issue in the NHS today is related to managers. Most managers in the NHS do not know how to effectively manage, then there are managers who are not nurses, so can not lead by example. The most pressing issue is that nurses are not being accountable and not holding their co-workers accountable for the level of care they provide.
As a manager myself, it was a personal challenge to observe and teach my staff daily in all aspects of patient care, I can say that this rarely happens on wards today.

Lyne, High Wycombe, Bucks

Often in the NHS one Registered Nurse will have 16 acutely ill patients to look after on a ward. The reason patients are not fed, washed etc is not because we are lazy. It is because we are chronically understaffed. I worked on a surgical ward for 4 years, and ran myself ragged trying to do 3 peoples work. Forget meal breaks, loo breaks and getting off on time if you work for the NHS. I have now left that ward. ~The straw that broke the camels back was getting a parking ticket on my car for parking on a yellow line in the hospital car park. This was after trying to get a parking spot for 30 mins. I did not want to be late for my shift.
And forget single/double rooms in the NHS. That would require more staff to nurse patients, so it will definitely be a no no for the politicians.
The reason hospitals are dirty is simple, there are too many managers and not enough cleaning staff.

Annette, Cheshire, UK

As a nurse myself I think its a ridiculous sugguestion that nurses should do the cooking and cleaing in hospitals, if that was to happen who would do nurse and treat the patients (cleaners) I don' think so, I think Dame Betty should maybe come into hosptials and see what the role of nurses and the ward sister is. I think its an insult to expect nurses to go back to cleaning and catering. It is an insult, we don't do 3 years degree training to do that. I can only comment on my hospital where the standards of hygiene are very good, and the incidence of MRSA and C-Diff are low. Sir Roy should get his facts right there are not geriatric wards anymore they are now called care of the elderly wards.

JC, Dorset, UK

I am a registered nurse who works in a rehab hospital in the U.S. I have noticed that the patients rooms and hallways always look sparkling, but the bathrooms throughout the facility are appalling. The wastebaskets are overflowing and the floors appear dirty and there is a strong urine odor . I have notified administration about the unsanitary conditions , but I have only worked at this facility for 1 week. I believe signs should be posted in every bathroom reminding everyone not only to wash their hands, but also on the proper steps of handwashing. Proper handwashing is the single most important way to prevent transmission of germs.

Mari RN, Modesto, California

AS A nurse I am insulted that someone would think we do not have better things to do then cook and clean that being said I would like a argue a specific point of logic here -
"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,â€
This is kind of silly logic is it not? So you treated your nurses poorly- then they unionized to improve working conditons for themselves and their patients and now the complaint is because of " lack of discipline" and strong unions you can't dismiss a nurse who is a danger to the patients? What a joke! If you had proper safe staffing, proper investing in your infrastucture you would have a safer patients and less issues with mrsa and other bugs see JAMA articlehttp://jama.ama-assn.org/cgi/content/full/288/16/1987

J.A. Hull, Oregon, USA

TO Dr Kadiyali M Srivatsa, Guildford, UK,
MRSA is not found only in dirty hospitals, it is out in the community, and is just a likely to be found in the cleanest of health care facilities.

The lack of control regarding the spread of MRSA is due to colonized patients being discharged back into the community and than readmitted. Screening, isolation, and attempting eradication prior to discharge has proven effective in the Netherlands.

To prevent the spread of staph or MRSA in the workplace, employers should ensure the availability of adequate facilities and supplies that encourage workers to practice good hygiene; that routine housekeeping in the workplace is followed; and that contaminated equipment and surfaces are cleaned with detergent-based cleaners or Environmental Protection Agency (EPA)-registered disinfectants.

D. Clinansmith, Windsor, Ontario

I guess what ticks me off regarding the tone of the article is the implication that nurses were to blame for these services being contracted out in the first place and therefore the decline in their effective implementation. I guess no matter where a nurse practices some things never change, it's just easier to blame the nurses instead of NHS, or any health care structure for that matter, taking ownership for their own inept decisions.

I worked as a housekeeper in a hospital, just before MRSA and VRE hit the news. When I was hired all surfaces in the room were disinfected once a day, all floors washed once a day, all sinks and BRs cleaned & restocked once a day, etc, etc. Minimally all patient care areas were cleaned and disinfected once a day. Flash forward a few years, I'm now working at this same facility as a nurse, after MRSA and VRE are well known throughout the medical community, and patients are being screened for them. Some company sold a "program," at the cost of thousands no less, that told the Environmental department HOW to clean a hospital. According to this bill of goods, patient rooms didn't need to be cleaned and disinfected once a day, neither did the floors, nor the BRs/sinks, etc, etc. They certainly didn't need all that staff, so let's get rid of them. Things that were once cleaned daily were lucky to be done once a week. Boy, did this new "cleaning program" help hinder the spread of resistant strains of bacteria----NOT!!!

D. Clinansmith, Windsor, Ontario

I have had 2 stays in different hospitals as an in patient over the past 12 months due to treatment for breast cancer. I found some of the nurses thought they were absolute "know it alls" who seemed to believe they had more knowledge of medicine than all the surgical consultants, oncologists and haematologists put together. At one point I was kept in for 6 days duse to a severe skin reaction resulting from a chemotherapy drug which had punctured my vein; it was not known that this was the case at first so all avenues had to be investigated. When the consultants got to the bottom of it, one snooty ward sister who had ideas of grandeur said to me "I could have told them that 5 days ago". This is the problem with nurses now, because they have degrees they think they are now doctors. I found the older nurses who were nearing retirement to be much better in their standards of care.

Linda, Fife,

Earlier thsi month I was admitted to the Chelsea and Westminster Hospital with pneumonia. Thie hosptial has recently had a hand-hyguine awareness campaign.

Within minutes of reaching the ward, a nurse sneezed into her fingers and without hesitation whisked an oxygen mask onto my face. I remonstrated with her and she tittered. The wash-hand-basin was two paces away.

She did the same thing next day but after the sneeze she disappeared down the corridor for a minute. When I asked, she said sheâ€™d washed her hands in the sluice. Hmmm.

Also that day, another staff nurse asked me if I wanted my tablets broken up. I didnâ€™t but she broke them up anyway, using bare fingernails.

If the ward sister did a ward round I could have raised the matter and it could have been dealt with promptly.

It's sloppy nurses that spread infection, not fluff under the beds.

Caroline, Chelsea, London

I think what has been said in this article is being misinterpreted what is being suggested is that ward staff have the responsibility for ensuring cleaning and catering is up to standard not that nurses actually do the work. I think this makes alot of sense this means you can do away with the current top heavy managment that are costing the NHS ridiculous amounts of money for very poor results.
I was an inpatient in the late 60's the wards had a cleaner in them all day they were employed by the NHS reported to the ward sister, they took a pride in their ward and it was spotless. In the 90's and 00's my mother was a inpatient it was immediately obvious how things had changed the wards were poorly cleaned and maintained cleaners were round once a day if you were lucky. There was dried blood on the bed mum was in on one occasion and dried urine on the floor in another, the beds were not moved to clean underneath mum died of infection similar to mrsa and c diff in 2005.

Alistair Seymour, Peterborough, England

A lifetime ago, when I was a student Nurse in Chelsea, things were so much different.
The word Vocation springs to mind.
All Hospitals were litteraly run by dedicated Matrons, and Ward Sisters... .
These Women lived "on site"...Our Matron Miss Colthorpe had her own private appartment attatched to the Nurses home, always "On call".
There were two cleaners attatched to each Ward, who, looked after the cleanliness of the Ward.( with pride)
Daily Sister would do her own round with a retinue of student nurses,staff nurses and cleaners in her wake. Whenever she found something that was not "up to standard" she knew exactly who to berate..........and did so in the most convincing manner.
That was then...........Today this would of course not be accepted as PC, so we are doomed to accept what we have, until someone has the Political courage to radically rethink how the Hospital bugets are spent. I feel the Ward Manager should have her own buget, along with the accountabiliy

barbara, manchester, UK

The problem is largely lack of staff, if you want clean, safe wards then staff them properly. I am a nurse I work on medical wards, sometimes there are as little as 3 nurses to 28 elderly patients. The work load is terrible, morale is zero, I often feel gateful just for getting through the day. Also we definitely do not need any more matrons. The hospital where I work has between 15 and 20 matrons, also head matrons. we are a small general hospital how can a system like this be justified?

Bobbie, Milton Keynes, Bucks

Wholeheartedly agree with Peter Entwistle from Canada - it is the layout and design of wards that contribute to hospital aquired infections. Single and double rooms would reduce cross infection by the using of a physical and psychological barrier between patients. This would also solve the problem of mixed sexed wards, dignity and privacy. Better planning of ward space would reduce the 'clutter' that if prevalent in our hospitals - bits of equipment all over the corridors for all to touch. None of this will happen because single and double bedded wards would appear to be on a par with 'private' hospitals which this government dislikes.

Sarah, Ashburton, UK

The trouble is that nurses are now graduates and partially trained in practicing medicine. The better idea would be to reinstate the old role of the nurse, thus opening up the career once more to young people who want to help the sick but may not be academically talented. Then, if we need Assistant Doctors, introduce that job as a new role. The current nurses can be invited to apply rather than waste their medical training.

Inge Jones, London, UK

That'll resolve the crisis of nursing shortages in the UK, won't it? Thank god I left it all behind six years ago.

Nigel Linklater RN, Sydney, Australia

In the late 1990's I asked a Health Minister: "what proportion of hospital beds will be in single wards in 20 years time?" I got the firm impression the issue had never even been thought about as answer was there none. It did seem to me at the time to be a question of privacy and dignity as these were part of the driving force behind people going private.

The problem of hospital acquired infections then becomes another dimension in the equation. Cleanliness is surely a matter of methodology and discipline rather than who does what. Failure to ensure it is to a high standard is itself a failure of local management.

However, a failure to plan for the right infra-structure at the end of whatever "n" year plan we are currently in is the responsibilty of those at the top of the organisation. This is especially true of the long line of Health (and other) ministers who appear not to have been up to the job.

Richard, west midlands,

...and whilst the nurses are at it, they could take in sewing too.
For crying out loud, which moran thought up this latest intiative?

I have just left nursing because it is poorly paid and poorly regarded. I was sick and tired of spending my days off improving my education for the benefit of those in my care and working long shifts that often went way over what I was being paid for. It was taken for granted I would just stay until they got cover...sometimes an hour after I was rostered to finish.
I have been through so many changes in systems and management styles via the various government initiatives, I really do have 'change fatigue' Everyone has an opinion as to how things can be improved, everyone that is who doesn't work in nursing. As for the patients...some are very grateful but the reality is most are not and some can be pretty disgusting and so confident that what ever they say or do you are supposed to put up with; you being just a nurse, which takes its toll believe me

Mags, Devon, England, UK

I'm not sure if the writer of this article knows anything about what he is writting about. It appears he is so out of touch that he is probably unaware that nurses go to university for three years to study nursing not cookery or cleaning. Journalists are quick to criticise politicians and government policy but some of the journalists make some of the most absurd and nonsensical suggestions I have ever come across. I'm a nurse and I get paid Â£17.84 per hour and there is far better use of my skills than cleaning floors.

mike jones, london, uk

Peter entwistle, you said it! I completely agree with his opinion regarding the attitude of the authorities that they consider NHS as charity rather than a service the patients entitled for.

Manoj K, Liberton, Soctland

The roots of this go back to the 80s with meddling polticians and DOH beaurocrats insisting on a more "business like" approach to running the NHS. Against advice from clinicians (mainly nurses) they tendered out cleaning and catering services. What are the results of this? Disease ridden hospitals serving enedible slop for food. I hope those jokers are honest enough to admit their mistakes today.

Tim, Romford,

It must be said again,and repeated often. The NHS is run for the benifit of the NHS.Too many administrators and managers are only interested in keeping their own budgets high and pursuing the least troublesome course.Patient care in a world of numbers and targets is always the last consideration.

With most doctors and pretty well every senior manager having private health insurance, for them and their families,the answer might lie in making them chance death with the rest of us.

The workhouse is a reality once again.The less sophisticated people in working class areas recive no consideration from many GPs and are shovelled into wards where nursing care,especially at night can be appalling.

Unfortunately this is not invention.Their are tales from patient care and management ignorance in this part of the country that would make you weep.Every day real people suffer and die,their stories untold in newspapers.

There is no shortage of money,only care which does not have a pay grade yet.

robert everitt, wolverhampton,

It's sad to see the comments. Nurses in UK are treated in high esteem. They are given so much importance, I wish I was one insted of qualifying to be a doctor. The Govt thought they could get a nurse trained to be nurse practitioners and made them prescribe medication. They are not capable of understanding the difference between flucloxacilline and amoxicalline yet they manage and treat patients in hospitals and walk-in centres. It will be very interesting to see how they will manage CA-MRSA infection in the community. I have heard them tell me that MRSA is a bug in dirty hospitals. If the Govt is listening to their view and acting, GOD SAVE US ALL.

Dr Kadiyali M Srivatsa, Guildford, UK

No one has said that Nurses should cook and clean. What has been said is that Nurses should take back the responsibilty for those who do. When Senior Nurses were responsible for Cooks and Cleaners we had the best hospitals in the world. When the responsibility for running the hospital was removed from Nurses, in the early 70's, everything fell apart, including it seems, a Nurses ability to read beyond misleading headlines.

Paul, Rochester, UK

England has long had an attitude problem: aisde from notable exceptions most people in public service see themselves as victims: they hate their jobs, moan constantly about their pay and feel they're doing us, sad recipients of their so-called efforts, a favour by turning up in the morning or for their shift. So why should NHS workers be different? Just 'listen' to the nurses who have posted their comments to an article which in no sense attacks them. Get real! University degrees mean you don't need to clean (why wash your face either, come to think of it, since you're so bloody grand)! And never mind the patient: not your fault he or she is ill and in hospital! Beside which we all have to die one day. Tax payers do stop winging!

Paola, Milan, Italy

The problem with the UK and some other countries is that nursing has been pulled in so many directions. Why should nurses be forced to take a three year Nursing Degree? only to find out later that there are no nursing positions in their local hospital but there are nursing assistant positions available that pay little more than the minimum wage!

What a slap in the face for investing three years of hard work/study.

UK nurses study for 3 years to find that they will be competing against nurses from places like Malawi, one of the poorest countries in the world, where I'm sure the medical training is 2nd to none!

If nurses are to cook and clean, scrap the nursing degree and bring back some COMMON SENSE to NHS training that IS DESPERATELY NEEDED.

We have dirty hospitals so uk MPs, stop blocking the new and very welcome EU law that will allow us to use clean, well run hospitals in Europe with no waiting lists!

MPs also use pritvate health care, what a bunch of hypocrites.

Graham Wharton, St. Albans, uk

As well as nurse? Here's another drop in standards on the way.

Judy , Liverpool, england

Nurses cook and clean!! Are you serious? Next you will expect them to look after patients rather than reading and eating at the nurses station. Get real, this is the UK.

john, Lincoln,

Rigidly segmenting roles is not the best way to organise a workforce.
I can understand why a nurse would turn round and ask why a doctor should not clean & cook either, and the answer is, probably, they have more important things to do: like having to treat patients who have suffered a decline in health due to unclean wards and poor nourishment. Justify that division of labour!
The real answer is to have a multi-disciplinary team with a range of skills and a hierarchy, but without rigid demarkation and a common understanding of what the team seeks to achieve.

MarkS, Leeds,

Unfortunately nowadays there are too many 'wanna-be doctor' nurses in practice. Lets get back to the days when nurses knew they place and duties within the NHS. Let doctors be doctors and nurses...get rid of that huge chip on your shoulders and get back to your nursing duties

zoe, london, UK

Paul Ingleton Registered Nurse; if with your brilliant university training you are unable to ensure your patients are getting a safe hygienic and clean environment what are doing getting a university training. If that is not the first and foremost thing that nurses are supposed to learn what are you doing in the profession. Like doctors I believe the worst place to be sick is in a hospital, especially in Australia.

Len, Perth, Western Australia

Why do people think nurses should pay good money for a university degree so they can end up cooking and cleaning? Perhaps we should get the doctors to do the cleaning ,that way the wards should be really clean!
Paul Ingleton Registered Nurse

paul ingleton, brisbane, australia

Until recently I worked in the NHS and was aware of the huge problem of hospital aquired infection ,now working in Canada this feels to be significantly less of problem despite high bed occupancy rates .

Perhaps the most noticable difference is the lay out of the wards with only single or double bedded wards ,this in a health care system that is free at the point of delivery just as in the UK .

In the UK when I was involved in planning a new hospital and suggsted single rooms I was given a series of fatuous reasons why this wasn't possible .It seems to me that the NHS is run by those who feel that patients are receiving charity ( rather than a service they have contibuted to ) and a little bit of communal suffering binds us together in the way that rationing and the blitz did .

Perhaps if there had been a little less inverted social and political orthodoxy and we would be reaping less in the way of hospital acquired infection now .

peter entwistle, Oliver , British Columbia ,Canada

About thirty years ago I was a cleaner at a large hospital in Scotland. The work which I and all other cleaners did was hard, but we all took great pride in keeping the areas we were responsible for in an imaculate state of cleanliness. After our shift, we were then responsible for washing out all our mops , brushes, buckets, dusters etc. in a disinfectant solution, and cleaning our D.S.R. before locking it up and leaving it for the next shift to come on duty. Every one of us were paid a pittance for this work, but we still did it to the best of our ability, and our hospital was always thoroughly clean.
Recently I visited a friend in hospital, and was appalled to see a D.S.R. lying open, with the dirtiest mops I have ever in my life seen, sitting in full view of all the visitors and patients, and all the colour coded mops were sitting on top of the same filthy bucket, in the filthy D.S.R. It speaks volumes, this is how infections are being spread, no cleaning standards.

Margaret, Glasgow, Scotland

Leaving aside the pay issue, we do however need to return to the matron system. Thankfully I have not been a patient at a hospital in the recent years, but I did visit my brother who was a heart patient at on the leading London hospital and I was appalled to see two members of staff looking after 10 emergency patients. All of whom were waiting to see a doctor as to whether they would be admitted or released. What amazed me more than anything was the lack of hygiene the two members of staff were displaying and how slow they were. One of them was literally shuffling and it occurred to me that probably, he had been on duty for ages and was too tired to walk properly. We need the matrons back!! Do the nurses whom we hire understand what real hygiene and sanitation is about?? It seems to be a hotch potch of hight turnover of patients, few nurses, poor cleaning, poor hygiene, poor sanitation,long visiting hours, all in sundry allowed to visit when ever wherever. Surely, It has to end.

salma nasser, gerrards cross,

And who is going to look after the patients while the nurses are cleaning and cooking? These fantasists, publishing rubbish reports need to get out into the real world and see what is going on?. Nursing is supposed to be a profession. Why not ask the doctors, radiographers etc to cook and clean.

Michael Riley, London, London

Giving nurses the responsibiity and control of the tasks refers to their allocation and supervision, not their execution. It dispenses with the lunacy of external tiers of management who currently have no direct contact with the care environment, and are answerable to their company shareholders before their clients.

Don Murray, Bournemouth,

and what ever happened to the discovery that simple copper kills super bugs and all we had to do was replace all door handles in hospitals with copper ones and the problem would be gone, well almost????? Heard nothing more about this after it's 'discovery' around 6 months ago.

Who cares

whocares, Beijing, China

1966 Report "Relieving Nurses of Non-Nursing Duties". Are we again going full circle?

One doesn't need nurses to cook and clean but hospitals do need to take and keep control of catering and housekeeping services. Contracting-out in the 1980s changed significantly the organisational dynamics within hospitals with disasterous results.

Phil Constable, Jakarta,

What lunacy! Okay I have no idea the hourly rate of nurses pay but its probably around Â£11 per hour? If a cleaner is Â£6 an hour it make no sense whatsoever to pay nurses to clean. They are supposed to nurse! Pay cleaners to clean and nurses to nurse! Its no wonder the NHS is so badly managed when such simple business decisions are beyond its capability.

Paul Davis, York, uk