Learning to manage costs more effectively

This April the Society of Hospital Linen Service and Laundry Managers’ conference and exhibition returned to Buxton after a long absence.

The venue stirred memories of the past that contrasted greatly with the present. For when the conference was last held there in 1982, the NHS had over 300 hospital-based plants and managers had few of the stresses of modern day living.

In 2010 the theme was Surviving the Downturn and the importance of cost-efficiency for those serving the NHS was the keynote.

Society president John Gallagher of Greenvale Linen Services, Wales, welcomed delegates, promising that the programme would satisfy their thirst for knowledge. He assured them of a relaxed and friendly atmosphere in which they could network and share their experiences.

Keynote speaker, Chris Hodgson, is director of estates and facilities at East Lancashire NHS Trust and regional chairman of the North West branch of HEFMA (Health Estates and Facilities Management Associations). He drew upon both roles in describing the challenges his audience will face – finance, quality, regulation and sustainability.

Spending cuts

The NHS is facing a reduction of £15billion – £20billion in spending over the next five years. This means zero growth in the acute sector but it must also meet higher standards and deliver higher quality without any extra funding to help achieve these targets. Key performance indicators will be introduced to measure success or otherwise.

Hodgson said that the Care Quality Commission (CQC) had already started rigorous inspections to ensure that trusts conform to government policy and this would mean more work for managers already trying to cope with fewer resources.

Trusts will have to implement cost improvement policies (CIPs) that reduce spending over the next three years by about 3 – 4%.

The policies will need to focus on competition, shared services and joint ventures to reduce overall expenditure.

Procurement policies and investment appraisals will ensure value for money on all purchasing.

Hodgson stressed that managers must fully understand the business they are handling. In particular they should know their business’s carbon emissions and actively look for ways of reducing the level.

This year will be extremely challenging for the NHS, its external providers, suppliers and contractors. The public sector will follow the private sector’s recession, creating significant funding problems for 2011 and beyond.

Linen managers will need to get their service to the ward right first time. They will need to know linen usage by ward type and speciality and be able to benchmark them with other similar providers.

The future will look back on the innovators, those with the vision to change the way in which they work to improve the quality while still managing costs efficiently.

Wayne Spencer, of healthcare facilities consultant Spencer Nickson, spoke about the changes required with Health Technical Memorandum 01-04 (HTM01-04).

Spencer said that this was by far the most searching guidance document relating to healthcare linen in the history of the NHS. Previous guidelines and the most recent, HSG95(18) which still applies, advised on the handling, processing and transport of soiled and infected linen and put the main emphasis was on thermal disinfection and the segregation of soiled and potentially infectious linen.

However, in 2007 a working group was formed to re-evaluate the guidelines. It consisted of representatives from both NHS and private linen service providers, the Society of Hospital Linen Services and Laundry Managers, TSA, microbiologists, infection control nurses and a representative from the care home association.

While the group’s research had shown that the correlation between time/temperature and bacteria count was still valid, it also produced several grounds for updating the current guidance.

Care home guidance

The recently published Code of Practice on Healthcare Associated Infections (HCAIs) gave new guidance for care homes. What will be the implications for them?

Energy efficient, chemical processes such as ozone, peracetic and phthalimidoperoxyhexanoic acid have been developed and are capable of disinfection at low temperature, provided the parameters are maintained.

The new guidance will shift the emphasis away from thermal disinfection and instead focus on a defined level of reduction in micro-organism contamination by whatever method.

Those establishments that rely on a washer-extractor operating at 71C for 3 minutes plus mixing time will still have this option but those that want to implement low temperature washing and use chemical disinfection will be able to do so, provided the process meets strict criteria and is subject to validation at defined intervals.

Probably the greatest single change will be the relaxation of the rules to allow use of tunnel washers for the processing of infected linen, subject to risk assessment.

Tunnel washers have improved greatly over recent years and provided they are operated and maintained in accordance with the manufacturer’s instructions, provide a reliable and trouble-free solution while saving valuable resources.

The guidance will encourage the use of best practice and adoption of BS/EN14065, but will not be prescriptive.

Services review

Paul Gibson’s paper, Shifting the Laundry Paradigm, was perhaps the most controversial and thought-provoking address of the conference.

Faced with an ageing plant and the need to make large savings to retain an in-house service, Gibson had undertaken a complete review of the way linen services were provided to Bolton NHS Trust. The results were quite startling.

First, like many managers in other trusts, Gibson had implemented the “sleep knit” principle, developed by MIP.

He had introduced a non-iron bed-linen assembly, which had allowed him to move away from the traditional ironer line with feeders and folders. This had increased staff productivity and reduced his overall labour costs.

Lean techniques

Then, using techniques based on the “lean principles”, first developed by the Toyota manufacturing group, he removed many of the unnecessary procedures involved in the linen supply cycle.

Post-wash sorting replaced the traditional method, improving hygiene control throughout the area. At this stage Gibson introduced a big departure from the traditional approach.

For years the industry has been focused upon larger processing units and therefore reduced operating costs but Gibson was recommending small cellular production and still achieving savings.

Equally controversial was his decision to adopt a return-to-sender system, with each ward having a dedicated stock.

By operating seven days per week he had removed the need for large stock holdings and prevented wards from hoarding excessive linen stocks as the laundry only returned the linen that the ward had used.

Nurses now took a greater interest in the linen as it belonged to their wards and any items that they mistreated would be returned to them.

Areas of linen loss were now easily identified and those responsible could now be held accountable.

Gibson said that this redesigned system was still in its early stages; however, productivity had now risen to over 170PPOH (pieces per operator hour).

Two papers by Grant Bailey, Thermal Energy International and Knut Gimmi, Luwa Air Engineering gave delegates an insight into how they could reduce their carbon footprints and in turn, reduce their energy costs.

Bailey explained the GEM condensate return system, which offered a redesigned steam-trap that needed minimum maintenance and on one site had reduced energy consumption by 19%.

Recycling energy

Gimmi’s presentation concentrated on recycling energy, that is usually either lost into the atmosphere or discharged to the drain as hot effluent.

By passing hot effluent through a heat-exchanger, it was possible to save up to 80% of its energy by redirecting the heat back into the washer or boiler make-up tank.

When heat-exchangers are connected to the exhaust from tumbler dryers or installed in the boiler flue savings of between 20 – 50% are possible.

Handling microfibres

Increasingly, launderers are being asked to process microfibre items and an expert’s views on why microfibre is so popular and how it should be processed were of great interest.

Lee Readman and Julie McNichol of Vileda explained the manufacturing process involved and the numerous applications for microfibre.

Microfibre mops not only improve cleaning but are also claimed to reduce costs by 61% compared with a conventional system. However Readman said suppliers often omitted to give advice on laundering parameters and his talk filled that gap. He advised loading the machine at about 80% of capacity and giving the mops a cold water pre-wash.

The main wash should be carried out at 95C as a maximum and the detergent should have a pH value of 10.5maximum.

Do not use fabric conditioner. It is equally important to limit tumbler temperature to 50 – 60C and to avoid overdrying.

Other speakers included Irene Dee, of the University of Wales, who spoke on the use of patient dignity gowns.

Reg Ramsden of North Tees NHS?Trust had researched pros and cons of both traditional cotton bed drapes and disposable types in a ward environment. Interestingly for launderers, Ramsden had found that recyclable curtains had a considerable cost advantage.

An exhibition organised by the Allied Traders accompanied the conference.