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How long will it take the health service to clean up its act?
Wearied by events, readers may by now have forgotten the first fine frenzy of the New Labour imperium. How exciting it all was. New, cool ways of doing things in new, Cool Britannia burst upon us, day after new young day.
For instance, in the early June of 1997, only a few weeks after Tony Blair's tremendous triumph, the new minister for public health, Tessa Jowell, and the new minister for food safety, Jeff Rooker, in a dazzlingly new sort of initiative, took themselves off to the young, happening area of Covent Garden in London, the fashionable haunt of clowns, hucksters and mountebanks.
There they proceeded to communicate with the people, in a very thoughtful and inclusive piece of performance art. Their theme was the need for improvement in standards of personal hygiene; what they did, carefully rolling up their sleeves for the purpose, was to act out, and thereby to demonstrate, the most effective way of washing one's hands.
At the time I was duly amazed. It had not occurred to me that any government could ever be so shamelessly, flamboyantly patronising, though Virginia Bottomley, in the previous one, had gone a surprisingly long way in that direction.
I wondered then, and I wonder now, why it has never struck any of the bossy brigade that their attempts to bully us are almost always counter-productive. Years of state sex education have produced nothing but an increase in pre-teen sex, schoolgirl pregnancies, single mothers and an exponential leap in sexually transmitted diseases. Years of trying to impose equality on education have resulted in much greater educational inequality. Years of nagging health education initiatives have coincided with an enormous growth of food poisoning, eating disorders, obesity and affluent malnutrition.
In just the same way, despite the sterling buffoonery of Ms Jowell and Mr Rooker, and all the apparatchiks who put them up to it, the handwashing situation has not improved. On the contrary: we don't do enough of it. Or, to be more precise, our doctors and nurses don't do enough of it. Hospital hygiene in this country is all too often abysmal. Deadly new superbugs stalk the wards; they kill about 5,000 patients a year, they make at least 100,000 others needlessly, miserably sick; and all this costs the NHS pounds 1 billion a year in wasted effort.
And one of the most important reasons is that all too many doctors and nurses don't wash their hands often enough; they don't observe the most elementary rules of hygiene and cross-infection. This week, the Commons Public Accounts Committee made the usual shocked and horrified noises, but there is nothing new about all this. It is merely getting worse.
"Hospital-acquired infection endangers patients' lives and is a major drain on NHS resources," the committee's conclusions were reported. How true. I have several times made the same point, with much the same figures, on this very page. "We find it inexcusable that compliance with guidance on handwashing is so poor."
Well, yes. It is particularly inexcusable because it is so easy to put right. As well as being absolutely essential at certain times, it is very cheap, quick and easy to wash your hands. One can ask only why so many doctors and nurses don't do it. This problem, and its solution, have almost nothing to do with money. Like most of the really intractable problems of the NHS, it has to do with culture, or, in this case, perhaps, with a lack of culture.
I am often tempted to hold forth about the culture, or lack of culture, among NHS nurses. I can hardly believe my eyes when I see them out in the street in their working uniforms, trailing germs and the filth from the pavements into and out of the wards, and from the hospital into and out of home, no doubt. I am astonished by determinedly untidy hair, falling forward on to patients, and their revolting food, not to mention their wounds. However, as far as handwashing goes, it is doctors who are more to blame, according to the parliamentary committee.
I have heard horror stories from nurses about doctors. One is the poison pen routine. Doctor with clean hands examines patient, takes pen from breast pocket, makes note, puts now contaminated pen back in pocket, washes hands and proceeds to next patient. Takes out contaminated pen. Touches patient. Finally takes pen home and uses it there.
Nurses often dare not speak out; very often, doctors won't be told. Nurses dare not criticise one another either. One who regularly cleans equipment sloppily will not be reported by another, more vigilant nurse; the entire culture is against it.
Part of this may be due to a general decline of standards in most things, from personal hygiene to grammar to manners. More specifically, one must conclude that the NHS hospital culture, all too often now, devalues the patient. For where anything is really felt to be of value, as (say) in the food industry, where bad hygiene means bad business, there is an excellent culture of hygiene: successful food factories insist on hairnets, hats, sterile clothing and footwear and superstrict discipline.
The average supermarket ham sandwich has more tender loving hygiene lavished on it, with scrupulously washed hands, than the average hospital patient. Twenty-four hours to save the NHS? It takes more than a few empty promises, and a couple of prancing politicos in the piazza, to change a decadent culture.
The Daily Telegraph | Saturday, November 25, 2000
