While Scotland’s 35% lower fatality rate will be explained by multiple factors, the decision in 2008, to axe outsourced cleaning and to increase the number of cleaners, by Nicola Sturgeon, then Health Secretary, seems likely to have been a major factor.

What happened:

(May 2011) In the 1980s, the Thatcher government in the UK introduced compulsory tendering of all cleaning and catering work in hospitals throughout the UK. This was bitterly fought at the time, with a series of lengthy strikes, public campaigns and court cases. For the next 20 years the unions continued to organise cleaners, negotiate to improve their pay and conditions , and campaign to bring work back in-house. Now, three of the four countries in the UK have decided that there will be no more contracting-out of these services, and all cleaning in NHS hospitals will remain in-house. In Scotland, the decision was taken in 2008, against the background of major problems in British hospitals with infections resistant to treatment. The Scottish ministry of health banned any further contracting-out of these services, so that when existing contracts expire all work returns and remains in-house. It also financed the employment of 600 extra cleaners to raise standards of cleanliness.

Scientific evidence that it has worked:

The number of older people recorded as having contracted the Clostridium difficile hospital bug has dropped by 37% in a year, statistics showed today. Quarterly figures from Health Protection Scotland show that between October and December last year 425 new cases of C.diff were recorded in those over 65, compared with 672 in the same period of 2009. The number of new cases in under-65s has fallen by 45%, from 235 in the final quarter of 2009 to 129 in the final quarter of last year. Cases of MRSA-related illness among all age groups were also down, with 82 new infections recorded between October and December 2009, down from 119 cases in the same period of 2009.

SNP Health Secretary Nicola Sturgeon today praised Scotland’s NHS staff’s commitment to driving down the number of hospital infections. Commenting on the figures, she said: “The SNP Government has put 1,000 additional cleaners in our hospitals, brought an end to the privatisation of hospital cleaning contracts and introduced a tough new inspection regime by the Healthcare Environment Inspectorate.

New research shows that NHS hospitals that employ private cleaners are associated with a higher incidence of MRSA, a ‘superbug’ that causes life-threatening infection and has previously been linked with a lack of cleanliness…on average, the incidence of MRSA infection between 2005 and 2009 was 2.28 in every 100,000 bed days in trusts that outsourced their cleaning, compared with 1.46 bed days in trusts that used in-house cleaners –.a difference of almost 50 per cent. 

The research was conducted by the University of Oxford, with the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine.