Examining the NHS plan

4 June 2002



The broad effects of NHS plan proved a central theme at the Linen Managers conference, Janet Taylor reports from Scarborough


Conferences must deliver practical value to their audience. Networking and socialising continue to have a role, but delegates also demand that the business sessions provide practical value.

This year's conference of the Society of Hospital Linen Services and Laundry Managers gave further evidence of this trend. Right from the start, conference papers attracted good attendance, even the Tuesday afternoon opening session when many are still travelling.

The wide implications of the NHS plan, unveiled last year, are now becoming apparent, particularly the emphasis it places on actively seeking patient views.

June Lancaster of NHS Estates explained the ward housekeeping service. The aim behind the NHS plan is to improve the quality of both clinical and non-clinical patient care. There is now increasing recognition that patients' views of the quality of care are influenced by the whole environment including the cleanliness of the ward and of the linen.

Multi-skilled housekeepers

Ward sisters will be responsible for managing that environment, supported by housekeepers who must be multi-skilled, adaptable and clear communicators. Their duties will include liaising with service providers.

The service will have to meet clear standards, for example there must be enough clean linen to meet patients' needs. One of the tasks of the NHS Executive will be to map out how services are working and how they should work.

The benefits of the service include increased patient satisfaction and this is already being seen. June Lancaster reported that the introduction of a housekeeping service in one trust had reduced complaints from around six a week to zero.

Monitoring will also be important to ensure standards are kept, agreed levels of service maintained and that action is taken, if things go wrong.

Andy Collingwood, head of Facilities Management at NHS Estates proved controversial, but provoked debate. Looking directly at laundry strategy he reported on a recent survey carried out by his department. Findings included:

• in total the NHS handles 8.8 million pieces linen a week

• this splits roughly 50/50 public and private sector, but…

• … one company handles 26% of the total.

The majority of in-house laundries have an output of less than 100,000 pieces a week, the private sector handles 390,000 to 700,000.

The quality of work, scored on a traffic light system, showed little difference between public and private sectors, but put the majority still stuck on yellow - that is, needing improvement.

The number of in-house laundries is reducing. The trend within trusts is to sweat out the assets of an in-house operation and then put the service to tender.

The NHS has to manage its market and establish national standards - patient care, service, and operational - with standardised arrangements and contingency plans.

But as the NHS, he said, we have no contingency plan for facilities. The profile of linen needs to be raised, it's a direct patient concern. But "who bears the cost?"

He pointed to the need for the NHS, in managing its market, to set realistic performance criteria. There would also be a need for more working together among the trusts. There was an opportunity with the 28 authorities to look at sharing facilities to maximise the assets. He also saw a trend to longer and larger contracts.

"Should the NHS be in the laundry business?" he wondered. The message from the patients is that cleanliness is important (and linen is a factor). But, he warned, Government policy is now focussed on public private partnership and he couldn't see public money being used for laundry services.

Comment from the floor

Comment from the floor followed. "We'll not get the money until we're seen as a priority," said one delegate. Another said: "You were right to say the 'bean counters' were closing laundries. When is it going to stop?" And another: "You say there's no money, but there are ways of investment other than capital investment - such as leasing? Why can't we compete on that basis?"

The NHS plan will provide for project leaders to manage contracts. These managers must go through accreditation which involves formal training. Terry Finch of the NHS Executive in Leeds gave a personal view of his course which delivered wider management lessons.

Working in teams, the first exercise was to put together tenders to provide a combined community building for a primary care trust, with a choice of two sites, both difficult. Much planning and research went into his group's final tender but another team decided the exercise was impossible and aborted the tender. That group ended up with higher marks as the chief executive marking the task had a different set of priorities. The lesson: know what your stake holders want.

Mr Finch's team had six directors, each used to being in charge which led to problems. The lesson: pick the right team.

He analysed his group members in terms of how they worked, identifying types such as "Sir Galahad" and "Storming Norman".

He put forward ideas on group working. Establishing compatibility is crucial. The group needs to mature together with shared goals. The leader must understand how people want to work. He pointed out that, in practice, team members will not necessarily be based in the same place. Virtual or dispersed teams present extra problems.

The audience could also learn much from the descriptions of the projects attempted and the problems they solved.

The NHS plan was a topical theme, but the conference programme catered for an audience with diverse responsibilities.

Keeping operating costs down is crucial for all laundries, particularly so here. Richard Neale's talk on resource management therefore fitted well with his audience. Taking steps to improve management of resources should be considered before investment.

He gave his audience targets to measure their own performance. For example, in energy, leading commercial laundries are now achieving 2kWh per kg of work. The average is around 3kWh.

Many of the measures are relatively simple - such as, do not believe a digital meter implicitly. Check it. Often just challenging the authority concerned will bring a reduction.

Most laundries could comfortable save around 30% across the operation, said Dr Neale. He outlined an action plan for improving management. The ingredients included: the right team with representative from production, engineering or works, " bean counters", plus two enthusiasts; performance monitoring, with weekly figures; and setting progressive targets and noting achievements.

Compensation culture

Mike Clark titled his talk "the compensation culture". Claims against employers for failure to prevent accidents and illness have been startling. The knock-on effect of settling claims can be devastating. Several major claims could put an operation out of business.

The answer is to carry out an extensive survey of the risks for each process (with documentation), look to see where improvements can be made, take action and then re-assess the risk. Mr Clark described, with recorded examples of course, how the task should be approached. His message was that everything must be rigourously recorded - the HSE may not always require it, but the lawyers will.

Decontamination has been subject to relatively little official scrutiny in the past but the situation is changing. Ros Jackson, hospital sterilisation and disinfection manager at the Royal Hallamshire Hospital in Sheffield, delivered a view of the critical issues with a look at the future. She started with a definition of decontamination: "A combination of processes that if not undertaken individually or collectively may increase the likelihood of micro-organisms being transferred to patients or staff." The decontamination cycle involves all aspects from purchasing to delivery, inspection and return for cleaning. She detailed requirements in terms of both validation and monitoring of decontamination processes. Traceability, and training would be critical in the future.

  Ms Jackson's talk touched on a constant audience concern - reusables versus disposables - and the topic emerged again in Richard Lamb's talk on performance fabrics. Too often confused with linen, these high-tech textiles are designed as "medical devices" and offer fluid repellence and other qualities such as anti-static which will be required by European standards. The market for these fabrics is now 10 to 15 years old, but the growth has been increasing in the light of future standards.

EN13795 (yet to be published) will cover the performance standards required for gowns, drapes and scrubs, in each case dividing the them into areas according to the risk: basic, less critical, critical standard (microfibres), and critical high risk (laminate fabrics).

Mr Lamb covered the characteristics for each and looked at processing requirements. All fabrics would be provided with laundering recommendations but working with suppliers is vital. Process validation is essential and required by the standard.

Some pointers: Do follow guidelines and discuss specifics with supplier. Do sour and rinse thoroughly - it adds to the cost but prolongs fabric life. Do retreat if required. Do use self-material repair fabrics and apply by heat transfer. Do use non-solvents for stain removal and seek advice of chemical supplier on this.

Do not dryclean. Do not use chlorine bleach. Do not leave alkali in the fabric.

Mr Lamb concluded by reinforcing the strengths of the performance reusable fabrics and the opportunities they presented, but also warned of the weaknesses.

Mike Palin, technical director of the TSA, updated the conference on EU standards. Three standards, expected to be published this year, would affect his audience specifically. However, ENV14237 - healthcare sector textiles (as denoted by the V in its title) is "experimental" and wouldn't override the others.

He began though by talking about EN13596 published last year. Although it relates specifically to cabinet towels, it was seen a landmark as it defined hygienic cleanliness - a reduction in the bug count by a factor of 100,000. It also introduced the concepts of process validation and monitoring and he reminded his audience of the difference between these.

He then looked at EN14065 covering biocontamination in laundering, which is aimed at the food, healthcare, pharmaceuticals and cosmetics industry.

There has as yet been no specific biocontamination. The standard would combine the principles of hazard and risk analysis introducing RABC (risk analysis and bicontamination control). This system is a "fined down" version of HACCP (hazard analysis at critical control points). Mr Palin detailed the prerequisites for putting this in place.

Some aspects aspects of EN13795, covering surgeon gowns and drapes had already been discussed in Mr Lamb's talk, but Mr Palin gave more technical detail of the standard and also reminded his audience that it applied not only to reusables but also to single-use items. A point on standards - they are mandated (required to be there) but not mandatory.

What the delegates thought

John Duffy, operations manager, East Kent Linen Service: My first impression was: “Where are the younger members?” followed by the realisation that there are no fledglings coming through the system. My concern is that 13 years have elapsed without investment in time and resource for management trainees. Link this to the thought-provoking paper delivered by Andy Collingwood, NHS Estates, on “Laundry Strategies” where it seems as if laundries and the way forward are now much on the agenda. We need to take the opportunity to put forward the case for increased management training resources. The papers were of a high standard and sufficiently diverse to include something for everyone. A pleasing aspect of the conference was the optimism about putting the patient at the heart of the service we, as linen managers, provide. There were some brave comments about quality of service being the first priority, and being placed above the accountants’ bottom line. I believe the NHS is becoming increasingly concerned about poor quality within the non-clinical services and ministers are accepting urgent that action is required to raise the quality of these basic services. Laundry strategy involves 28 strategic health authorities deciding the best way forward to allow for healthy competition between public and private laundries. Unfortunately this initiative has come too late for some health authorities, disadvantaged because of the lack of laundry capacity in their area. Peter Roberts, assistant Facilities manager: Salford NHS Trust: This is my first conference, my boss suggested I come. What amazed me was the complexity and depth of what I learned. I actually monitor the finished product. The majority of papers have been on how the job gets done. That’s not important to me. However, the conference has given me ideas on how we can work with contractors. Richard Neale’s talk (on resource management) was heavy to take in but vital because we can use it to work with contractors. The wider view has helped because I see the finished product but I don’t see what’s gone on or what needs to go on. Gerry Foley, Midland Health Board, Ireland. This is my 12th society forum. It’s the only forum where you can find out what’s going on in the industry. Papers such as Richard Lamb’s (performance fabrics) and Richard Neale (resource management) were excellent. The others, too were relevant. If you only learn one new thing it’s worthwhile. I would have liked to see more from CSSD (the people that deal with theatre linen). It would be good to bring more of them here. I’m a believer in making sure infection control is adhered to. In 28 years, I’ve never had a cross infection. lt’s good to meet the allied traders and hear their views.




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