Oooh Matron!!! (Democracy isn’t working, part CCCLXIV)

1. Though a lot of nurses are men, the word ‘nurse’ itself has connotations rooted in the feminine, does it not? If women can adjust to finding themselves chairmen, surely a man can reconcile himself to being a matron. This was not, I think, the most powerful point you made here. (I believe, BTW, that the American equivalent of matron would be ‘charge nurse’; suitably gender-neutral, but altogether too martial and/or electrical for my taste.)

2. The notion of a senior professional like a matron having responsibility for ward hygiene isn’t really so offensive if understood as a sort of shorthand. The officer in charge of a transport unit may fairly be said to be responsible for seeing that the trucks etc. run properly, but this does not mean we expect him to spend his time tuning the motors. Hospital hygiene is in fact an extremely serious matter (and, see point 3, comprises much more than mere ‘cleanliness’) — I would be worried if senior professionals of both the nursing and the physician staff were not expected to keep a close eye on it.

3. Here’s your really good point, though. Clean floors etc. are certainly an important part of hospital hygiene, but by no means the only important part and in some cases, as the one you mention, very far from the most important part. Nosocomial infection is a real problem. A clean ward is a good start in preventing it, but there needs to be so much more (and primary responsibility for a lot of it, esp. proper antibiotic discipline, cannot be offloaded onto even very senior nursing staff). To suggest that all will be made right with a bit of Lysol and a mop is, as you say, either ignorant or irresponsible.

Whether the ignorance and/or irresponsibility of the two major UK parties means that democracy isn’t working, I cannot say. Looks to me like it’s working pretty much the way it has always worked.

There should be a measure of domestic-ness of fame.

Thus, John Wayne, recognised equally in the US and (for example) the UK, would rate a 1.000.

While Katie Couric and Julian Clary, known well, but only in their own countries, would be down around the 0.003s.

(Inspired by the ‘Oooh matron’ gag – how many Yanks have heard of Kenneth Williams, I wonder?)

It isn’t likely that the Daily Mail will start running scare stories about members of the public demanding inappropriate anti-biotics on every excuse, and consequently contributing to the evolution of resistance, as well as indirectly raising the cost of drugs by increasing research requirements.

That would be anti-democratic, wouldn’t it? Freedom of choice and that would be jeopardised. So what is to be done?

I can’t remember the last time I read of a new policy initiative announced by either the Tories or (‘New’) Labour when they weren’t playing to the Daily Mail in their continual race for the bottom.

I suspect the primary reason for cleanliness problems, to the extent that there are some, is that they are caused by privatisation of cleaning services. I say this as I used to be a hospital cleaner for a short time. The hospital had recently put their cleaning services up for tender.

What this means, generally, is that companies all produce incredible fantasy-land projections of what will be cleaned and how often. They all compete to offer the most comprehensive service at the lowest price.

“We will hand bleach every square inch of tile thrice daily. Toilets will be cleaned every hour on the hour and floors mopped every 12.5 minutes between the hours of midnight and 4am, etc.”

This whole process takes place totally divorced from any understanding of whether this level of cleaning is possible on the projected budget.

Then all of the existing hospital-employed cleaning staff get fired and 50 or 60% get rehired by the new private contractor on the same or lower wages and asked to do the same job they were doing before only with less people and even less realistic targets.

Corner cutting is endemic in that kind of environment.

I’ve been through the same process in a number of other ‘tendering’ processes and it seems the same in every case.

I can’t remember the last time I read of a new policy initiative announced by either the Tories or (‘New’) Labour when they weren’t playing to the Daily Mail in their continual race for the bottom.

I suspect the primary reason for cleanliness problems, to the extent that there are some, is that they are caused by privatisation of cleaning services. I say this as I used to be a hospital cleaner for a short time. The hospital had recently put their cleaning services up for tender.

What this means, generally, is that companies all produce incredible fantasy-land projections of what will be cleaned and how often. They all compete to offer the most comprehensive service at the lowest price.

“We will hand bleach every square inch of tile thrice daily. Toilets will be cleaned every hour on the hour and floors mopped every 12.5 minutes between the hours of midnight and 4am, etc.”

This whole process takes place totally divorced from any understanding of whether this level of cleaning is possible on the projected budget.

Then all of the existing hospital-employed cleaning staff get fired and 50 or 60% get rehired by the new private contractor on the same or lower wages and asked to do the same job they were doing before only with less people and even less realistic targets.

Corner cutting is endemic in that kind of environment.

I’ve been through the same process in a number of other ‘tendering’ processes and it seems the same in every case.

Jet,

I worked in a hospital for a number of years and my mother is a “charge nurse” at one. Rest assured that a very significant number (don’t recall the exact percentage, but over 30, I believe) of people who come to the hospital get ill w/ some other infection they catch while there. There are many reasons to sue hospitals, but this isn’t one, since little can be done over it. Sometimes the infections are quite bad, even life-threatening. But, the big problem is 1) weakend immune systems, 2) all the damned sick people around. There’s no negligence involved, so no suits. Despite what’s often thought, one still does need negligence to have any chance at a malpractice suit.

I suppose you can’t sue a UK hospital if you pick up some disease in the waiting room. But I would hazard a guess that a class action would soon be in the making if US hospitals were providing these life threatening infections.

I don’t think you would be able to sue any hospital over a disease picked up in the waiting room other than in quite strange circumstances. If you can prove that a UK hospital gave you a serious illness or injury through negligence, though, you can sue ’em for sure, and the cost of these lawsuits has been steadily rising over the last few years.

As Scott points out above, the same is true of the USA; it’s one of the forms of “malpractice” torts that apparently need to be reformed. I doubt it would be a class action suit though, because I don’t see how you’d successfully get all the individual cases of MRSA certified as a class.

Matt – you say –

“I can’t remember the last time I read of a new policy initiative announced by either the Tories or (‘New’) Labour when they weren’t playing to the Daily Mail in their continual race for the bottom.”

I’m asking for trouble, I know, but here goes.
Might the following two things be true:
1. If the government doesn’t make a sufficient splash with a particular policy initiative, that presents the opposition with the chance to announce the very same policy (or, more likely, a coarsened or half-baked version of it) a few days later: the media will let them get away with doing so, and will give airtime to their claim to be ‘the only party taking X seriously’; the public (not just the Mail-reading public) will probably react by thinking – why should we believe the opposition, they’re politicians too, they’re all as bad as each other – but still will come away with their pre-existing view reinforced, that hospitals/schools/the country are going to the dogs and ‘nothing is being done’.

2. The way to make a sufficient splash with a policy initiative is to tap into popular imagery – like matrons.

Might it be true that some of those working in government don’t like (2) any more than you do – but that their distaste for it is overcome by their frustration at witnessing too many instances of (1)? Do you genuinely believe that if the Government ‘rose above’ this depressing little game, that would actually result in a better quality of debate? I don’t – not on issues like ‘superbugs’ or immigration, not in the short to medium term, at any rate.

Anytime I run into a British pop-cultural reference with which I’m unfamiliar, there’s a 75% chance that it will prove to be somehow related to the “Carry On” films.

Yeh, but my point was that these bacteria aren’t in general spread by contact with dirty hospital walls or floors. The precautions against MRSA have to do with hand-washing and using alcohol rub. (It’s also possible for the patient himself to be the source of the infection as it is perfectly possible to carry an MRSA colony around on your skin without being aware of it until you become a burns patient). In general, hospital cleaners aren’t responsible for washing the staff and visitors’ hands, and senior nurses are already responsible for making sure that their staff follow procedures.

The failure to make a distinction between “this is a serious problem” and “this, however, is not actually a solution to it” is the hallmark of Daily Mail policymaking. (I’d also note that there is a big, big Freudian issue here with respect to people wanting to tackle the grimy corners that they can see and ignoring the actual contaminant that they’re possibly carrying on them).

I hear what you’re saying, Neil, but I think that in turn, you’er operating on a rather old fashioned view of politics. Look at the words they used; they’re not just “shorthand”, they’re chosen carefully.

First up, “Matron”. This is not a neutral term for a senior nurse; it’s overloaded with cultural references, which is why I used the hyperlinks above.

Second, “Bring Back Matron”. This is saying precisely that there used to be these people called Matrons, we got rid of them (for some reason?) and now we need to bring them back. This isn’t a neutral shorthand for a policy; it’s grounding that policy in a framework of saying that a previous era, when nursing was carried out by matronly matrons, was better, and that people who have attempted to modernise the nursing profession were wrong.

Moving on …

“to deliver clean and infection-free wards” (alternatively “hospital cleanliness”).

Two points here:

first, “clean” does not mean the same as “infection-free”. The two usually go together, and it’s difficult to keep something infection-free without also keeping it clean over the long term, but they’re not synonyms, and it’s very easy to have something that’s clean but not infection-free. This is the Freudian point I was alluding to earlier. The obsession is with dirt, rather than with what is actually dangerous. I have actually seen an article in the Mail whereby someone (I think, actually a former Matron!) suggested that hospital cleaners should not be using disinfectant, because it made them less concerned with their real job of removing visible dirt!

And second, note that what is to be delivered is clean wards (or clean “hospitals”). This is what really gave it away to me that this is not neutral shorthand.

As I say, MRSA is carried for the most part by people, not walls. The infection control procedure which would do most to control its spread would be to insist that hospital visitors adhered to the same hand-washing procedures as staff. But the politicians have, presumably correctly, decided that there are fewer votes in telling the population “invisible superbugs are living on your skin and you need to be reminded to wash”. It’s much easier to claim that the problem is “dirty wards”.

anyway, my name’s Jacques Derrida goodnight. try the shrimp folks it’s really great, I’ll be here all week.

This sort of thing matters, because as you know, the NHS is measured by targets these days, and those targets are set by civil servants who are not always 100% aware of the clinical issues, but who are more or less always 100% aware of the political priorities being assigned to things. If we get policy made on the basis of these manifestoes, then there is a real danger that we’ll get an NHS which delivers well-mopped floors and scrubbed walls, but which doesn’t have any coherent policy for addressing the real dangers of infection.

OK dsquared, I doubt you or anyone else is still on this thread, but just in case: yesterday I didn’t have time to check all the news coverage of this stuff, so I granted your implied accusation (echoed by some commenters) that both parties were equally to blame for dragging in crude/sinister imagery (matron) and rank irrationalism (linking MRSA to dirt) of this story. I therefore confined myself to defending the government (of which, it will already be pretty clear, I am a supporter, though not I hope a blinkered one) for sometimes deciding to engage with the debate at the level or on the terms where it finds it, rather than ‘rising above it’.

However, a bit of checking up today doesn’t seem to bear out the implication that both parties are equally responsible, or even partially responsible, for this particular bout of ‘daily mail’ politics. A few examples:

1. The Conservatives’ website’s top story today, under the heading ‘Matrons to lead battle against hospital superbugs’, runs as follows: “Michael Howard has unveiled dynamic plans to restore hospital matrons – armed with new powers to crackdown on the deadly MRSA “superbug” scandal. Launching his party’s health manifesto, the Opposition Leader condemned Labour’s failure to eliminate MRSA – “a scandal unique in Europe” – and promised that under a Conservative administration matrons would be able to overrule NHS bureaucrats and shutdown dirty wards and operating theatres.”

(And in a fine piece of impartial, sceptical reporting, the Sun’s chief political correspondent Trevor Kavanagh started his big piece on this as follows:

“TONY Blair was last night accused of “sitting idly by” while thousands die from hospital superbugs. Tory leader Michael Howard lashed the PM for presiding over 40,000 unnecessary deaths from MRSA. And he attacked ministers for promising only to halve the 5,000-a-year death toll by 2009. Mr Howard whose mother-in-law died from MRSA, vowed to put powerful new matrons back on the wards to enforce strict hygiene standards.”)

By contrast the Labour website has only one mention of the word ‘matron’, and it is nothing to do with clean wards or MRSA (it is about more senior community nurses). In fact there is only one mention of ‘MRSA’ on the Labour website; this refers to alcohol rubs (cf most of the informed comment on the thread above, including yours) and does not refer to dirty wards.

2. Googling on “mrsa dirty ward” etc, pretty much all the links are to Conservative quotes. All I could find googling on “john reid mrsa dirty” was this kind of thing from july 04:
“Two days before the NAO report was released,
health secretary John Reid announced that
trusts will be given targets to reduce MRSA,
and that every hospital should publish and
display its infection rates. ‘I want NHS patients
to demand the highest standards of hygiene
and – since human contact is a major way
that infection spreads in hospital – to feel
happy to ask staff if they have washed their
hands,’ said Mr Reid. He said matrons should to be put in charge
of cleaners, alcohol rubs would be provided
at every staff-patient contact point and advice
sought from overseas infection control experts.”

From all this it seems to me that, on this particular issue at least, it is the Conservatives who are mainly or even entirely responsible for dragging in the crude/sinister imagery and the rank irrationalism. This isn’t always the case, of course – but here it seems to be. Tell me if I’m wrong (I confess to not having closely followed the story on the day). If I’m not, then I think you should have been more careful in your accusations. If you want to have a general go at the political class, it would have more force if you saved it for an issue where the government is equally/partially responsible.

OK, fair point, on matrons. I which case, I retreat (in lawyerly fashion) to my second line of defence on that (see my earlier post, above).

As for the other charge – pretty clear, if implicit, in most of the posts above – i.e., that politicians are either ignorant about MRSA being more to do with dirty hands than dirty wards, or deliberately suppressing that fact – do you accept that this charge is much less fair when directed at Labour than at the Conservatives?

What bugs me is there’d be no damn reason for all this useless privatization if the British people could just learn to live with really crappy perpetually declining health care and teeth like an Egyptian mummy.

It’s a delight to at least look forward to Sharia law finally settling on Britain and a prudent Islamic hand gently guiding this troubled medical system back to the good old days of leeches and prompt amputations. No more namby pamby complaining about health costs – it’s just as easy for the doctor, who’s also a Koran scholar, to take that head off as well as the leg in the one hour clinic. So don’t tell me about your way overpriced vasectomy pal, that axe cuts both ways when it’s getting wielded by Abdul The Unlicensed Dentist.