Joseph Lister and the plastic dog turd

Joseph Lister

James Bartholomew has blogged recently about the appalling state of cleanliness in the NHS. It is a national disgrace. It is hard to believe that it does not contribute to post-operative infections and the increase of MRSA.

How has it happened?

When Dr Crippen started work in his family health centre, there were two cleaners, Doris and Emily. They had been working at the Health Centre longer than any one could remember, and they had old fashioned ideas about cleanliness. If a patient had vomited on the carpet it was cleaned up without a discussion about the dangers of “clinical waste”.

“Dirt is dirt” said Doris as she marched down the corridor with her bucket, mop and disinfectant.

They arrived in the Health Centre several hours before the doctors and staff, and left mid-morning. Their final task was to bring a cup of tea into all the doctors. They had never been asked to do that. They just started doing it and, well, no one complained.

The doctors paid Doris and Emily out of their own pockets and were then reimbursed by the Health Authority.

Then came Thatcher. And cost-efficiency. And the “internal economy”. And out-sourcing. And civil-servants. You cannot build a national cleaning service on Doris and Emily. That is not efficient.

The civil servants found out that Doris and Emily were both over sixty-five. That was the last straw. They might have been well-known, well-liked and genuinely part of the team. But they had to go. Too old.

Kevin, the chief executive of the contract cleaning company appointed by the Health Authority came to see us. He drove a 5-series BMW. Smart suit and a white shirt with a tide mark around the collar. Talked like an East End barrow-boy which is what he used to be, he proudly told us.

What exactly did we want him to do?

“Clean the Health Centre?”

“Ah! Indeed yes, but it is not as simple as that”

“Isn’t it?”

“Oh! No! I mean, you have to see it from my point of view. There are certain things my staff cannot clean. They are not medically trained. Clinical waste. I mean, bedrolls that patients have been on. That sort of thing.”

“Doris and Emily just cleaned everything.”

Kevin was not having this. His company was not insured to do “everything”. He gave us a list of all the things his staff could not clean. A long and comprehensive list. Broadly speaking, this seemed to be anything that might be dirty.

The years have passed. We have not seen Kevin since, but his staff arrive for an hour or so every evening. They wander round with a vacuum cleaner and empty the bins. Then they go home.

Two years ago, I did a controlled experiment. I bought a plastic dog turd from the joke shop. I put it on the floor in my consulting room at the back of the foot-well of my desk. It is still there.

Maybe Kevin's cleaners think it is “clinical waste”. Maybe they just have not noticed it. I suspect the latter because it is filthy under the desk

Kevin costs more than Doris and Emily. Well, he would do, wouldn’t he? His contract is much more complicated and Doris and Emily did not drive BMWs.

The Health Centre is filthy. The doctors and nurses are ashamed to work in such an environment. It saps morale.

It is the same story throughout the Health Service, both in primary care and hospitals.

Lister must be turning in his grave.


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Joseph Lister photograph from : "General anaesthesia"