Pests, Uncleanliness and Starvation
One British newspaper went so far as to rebrand the National Health Service (NHS) the “National Filth Service” [link]. Two thirds to three quarters of NHS hospitals reportedly have pest problems that include plagues of rats, maggot infestations, flies, wasp nests, flying ants, bed bugs, fleas, and cockroaches in wards, kitchens, sterile areas, and operating rooms [link]. In the past, the NHS has also “put patient lives at risk” [link] with poor clinical waste management that breaches UK health and safety regulation, fire regulations, and hazardous waste regulations [link].
NHS hospitals also have problems with relatively straightforward tasks like food service. Rats infect hospital kitchens, even in relatively new buildings. Environmental health officer reports from a quarter of English local hospital authorities suggest that 46 percent had poor cleanliness in their food service operations and 18 percent did not fulfill the legal requirements for storing food. Other problems include no soap or hot water at sinks, dirty or moldy equipment, and failure to follow safety procedures. [link]
A detailed listing of hospital food service problems notes that “no hospital kitchen has been shut down by health inspectors – although catering establishments in the private sector are regularly taken to court.” [link]
For some patients, a bigger problem is getting fed at all. At least 30,000 patients were starving in NHS wards in 2007 [link]. Cases of starvation rose 88 percent between 2005 and 2007. Cases of nurses handing out meals who put food out of reach of bedridden patients, come back 15 minutes later and take it away have been documented. So have cases of food arriving in wrappings that patients cannot undo. [link]
To take care of this problem, in 2002 the Royal Infirmary of Edinburgh pioneered the position of Ward Hostess, an addition to the multidisciplinary ward teams that have replaced nurses in patient care [link]. The Ward Hostess, who will assist patients in choosing their menus, liaise with the catering department, monitor food charges, document nutrition intake, do oral hygiene, and “participate in the care of patients unable to eat independently.” In 2004 Hickson et al. reported the results of a randomized study of the effect of “health care assistants…trained to provide additional support with feeding.” While the assistants reduced the use of intravenous antibiotics, they did not improve nutritional status or cut lengths of stay. [link; gated but with abstract]
“Participating in the care of patients unable to eat” does not, it appears, mean feeding them. In at least one hospital, it means only ensuring that they receive “identified help.”
Unlike private health care providers subject to government inspections and fines, the NHS is a creature of government. In effect, it inspects itself. Third parties have very limited power to make it obey the rules necessary for good patient care.
Remember, this is the very same health service that British politicians told British voters was “the envy of the world” for years and years and years.
Socialized medicine is clearly not next to cleanliness. So it must not be next to Godliness either.
The important point is that British hospitals are not competing for patients the way, say, Indian hospitals compete for patients. (See “Same Quality at One-tenth the Cost” posted below.)
So, there is no incentive to make patient-pleasing adjustments. Or even health-improving adjustments.
Cases of nurses handing out meals who put food out of reach of bedridden patients, come back 15 minutes later and take it away have been documented. So have cases of food arriving in wrappings that patients cannot undo.