As part of her work on 'Undercover hospital cleaner' Shabnam Grewal kept a diary throughout her time undercover at Birmingham Heartlands Hospital as a cleaner. These are edited extracts:
7 March to 14 March 2005
First week - working with Vicky
First week at work in Birmingham Heartlands. I spend most of the week working with a conscientious cleaner called Vicky on a cystic fibrosis ward. Vicky introduced me to the protocol in the hospital; she regularly changed gloves, using alcohol gel on her hands in between to make sure hands were clean and everything was safe. She gets through around 20 sets of gloves a day. I am impressed.
14 March to 17 March 2004
Georgina was responsible for Shabnam's training
This was training week. It started pretty well on Monday - indeed the trainer, Georgina, emphasised the dangers of spreading infection so strongly, that one of the trainees decided to quit because she didn't want to risk her own health by working in a hospital.
Nevertheless I questioned the practicality of some of the training we received - especially because it seems to go beyond what I have seen already on the ward. For example, I was told that for every toilet I clean, I should use 5 J-cloths. The ward I have been working in with Vicki has 20 rooms each with an en suite toilet. 20 toilets means 100 J-cloths to be used on one ward, in one day. Sounds a lot to me. Still I checked with our trainer, Georgina and her response was that there were lots of J-cloths in the cupboard.
I spoke to other trainees about this and they all thought it was crazy and completely impractical. People seemed to just take it in their stride that this was another daft thing that companies say, that no one was actually expected to do.
We were also taught how to wash our hands properly. We had to put our hands into a machine which looked a bit like a toaster on its side. It shone a light on our hands and all the dirt on them glowed white. It was amazing. We then washed out hands again, more thoroughly, and the difference was clear. Washing your hands properly really does make a difference.
Training seemed to be quite thorough, but it fizzled out towards the end of the week and was, I realise, almost all theoretical.
18 March to 25 March 2005
Working with Stephen
I have been put to work on the Cystic Fibrosis ward again, but this time with a different partner. Stephen is hugely friendly but not at all as diligent as Vicky had been. He tends to wash only areas which look dirty and leave everything else. His motto seems to be "if it looks clean it is clean." When he caught me trying to be more thorough, he told me to stop as we would be there all day.
He has instructed me to wash under the beds because that is where supervisors look when they inspect. The bucket water we use is not being regularly changed - which would have helped prevent the spread of germs.
Stephen rarely changes his gloves, except when dealing with barrier rooms, which require extra care. People receiving 'Barrier' nursing in a side room or a specially designed 'Isolation room'need to have minimum physical contact with other people. This is because they are either vulnerable to infection or themselves have an infection, which could be a problem for other patients. Anyone going into a 'Barrier room' needs to take precautions. But when Steve is cleaning barrier rooms he isn't keen to change the bucket of water, which he uses to mop the floor, in between them. I am worried this could just spread infections from one room to another. I am relieved that at the moment there aren't any infected patients in those rooms.
Stephen also takes frequent breaks. In total out of a five hour shift, you could spend over an hour and a half not working if you followed his pattern. To be fair I think this might be the product of his long working hours. He has told me he is working fifty-two hours a week, seven days a week, starting at 8 am every morning, and has done so since last August. He earns less than five pounds an hour, is trying to support his family and doesn't want to 'sign on', so he feels he must put in the hours. It isn't surprising that he is looking for rest at work.
I am beginning to realise that there are problems with the way cleaning is managed in this hospital. I feel there needs to be more and better supervision, to make sure that the provision of cleaning is not as patchy as it seems to me. Of course there are good cleaners, but there are bad cleaners too and for patients it is pot luck which kind they get.
28 March to 31 March 2005
More problems with barrier rooms
During this period I became increasingly confused at how barrier rooms should be treated. Barrier rooms are for people who either have an infection or are vulnerable to infection and are therefore isolated from contact with other patients.
On one ward where I worked there were three barrier rooms, so I carefully changed gloves and aprons before cleaning each. However, two of the rooms had doors which were wide open, which I thought completely defeated the purpose of isolating these patients. I noticed that despite the gloves and aprons provided outside the room, nurses just went in or out without using them
On another occasion I witnessed a nurse carrying out a procedure on a patient in a barrier room. The nurse was not wearing an apron or gloves. I waited till the nurse came out and asked what the barrier sign meant. The nurse explained to me, as she would to any cleaner, that it meant wearing gloves and apron and throwing them out afterwards. This meant she knew what the rules were but wasn't following them.
Cleaners I am working with seemed reluctant to follow the barrier room cleaning procedures we were taught - like changing the water used to mop the floor of a barrier room, every time you come to one
My colleagues use a separate bucket for the barrier rooms which they do not use on the main ward, but they don't change the water or mop head between the barrier rooms. As I understood it, each barrier room patient might have a different infection from the patient in the room next door, so the cleaning materials need to be changed for each room.
Other cleaners tell me not to bother when I try and comply with rules like this. It seems to me that this is mostly because it takes time to comply with the rules and they want to work fast. I keep being told by colleagues that I am too slow - when I feel that that is because I am doing a thorough job and actually cleaning properly.
30 March to 7 April 2004
Working with Habib
I have started doing overtime, which involves a second shift in the afternoon.
Habib manages to look busy by always having a packet of paper towels under each arm
The supervisor of the late shift introduced me to Habib, who I am now working with. She told me that because of a vacancy Habib was single-handedly managing to clean an area, which would normally be cleaned by three people
Over the course of the past few days I have seen just how Habib managed to do this. He barely does any work amounting to serious cleaning at all. He spends a lot of time hanging round talking to friends in other parts of the hospital, a lot of time eating hospital food and a lot of time pretending to work.
He keeps telling me to look busy, which he accomplishes by always having a packet of paper towels under each arm when walking around or going off to visit friends. This way, he assures me people think he is about to take them somewhere to replenish supplies when in reality he is bunking off.
He claims he manages the work that three people would do in a full shift, within his first hour, working alone.
I actually find the effort of skiving and trying to look busy, harder and more exhausting than doing the work. Time goes slowly when you are doing nothing. It is hard to pester him for work and he is very brazen about not working.
I try to make up for not doing anything by intensely busying myself with cleaning when he leaves me to myself. In the day room, which is part of our area, I started to clean the chairs and sinks when Habib disappeared somewhere else. He came back to catch me actually at work. He asked why I was cleaning the chairs when people sit on them, and that cleans them well enough. His 'clean' is no visible dust!
I am amazed that there is no supervisor to notice that Habib is doing so little. In fact, he seems to be extremely popular amongst the staff and our bosses are full of praise for him. I think that they are just happy to have someone doing the job, who won't say no to overtime and who always shows up for work. Habib has been getting away with doing scarcely any cleaning, for about eight months at Birmingham Heartlands and it is not clear to me that anyone is likely to notice, except as a result of my filming
15 April 2004
Today I spoke to Georgina who hired and trained me as a cleaner for the trust. I raised my concerns about cleaners who were not cleaning the way we were taught to. She asked for a specific example. So I told her that we do not change the water in the mop bucket between barrier rooms. Georgina looked visibly shocked and burst out that it is no wonder that patients keep getting infections.
Georgina passed my concerns onto a senior supervisor, who in turn spoke to me. Everyone has basically told me that I have to stick to what I was taught in the initial training. They have said they will protect me against pressure to work faster where that means cutting corners and compromising the safety of patients.
I don't have time to find out whether these discussions would have any affect on my day to day work as a cleaner.
Soon I will quit my job at Birmingham and return to Panorama, to make a film about the problems I have uncovered here.