This interview was recorded after Mike Jepson had been shown some of the clips from the Panorama. Mike Jepson is the managing director of Initial Hospital Services, who hold the contract for cleaning in the hospital where Panorama filmed undercover.
How many hospitals in total in the country do you provide cleaning for?
We have 50 sites throughout the UK.
How much does the trust (Heart of England NHS Foundation) pay you every year to clean their hospital?
The total now in terms of the overall contract which includes porters and domestic contracts is approximately something like 3.7 million pounds.
When you employ cleaners, what kind of security checks do you carry out on them?
We have a thorough process in terms of vetting people, in terms of working in the vulnerable sensitive areas such as children, maternity, are CRB checked, that is Criminal Records Bureau checked. We also then, before the vetting is completed, we would make sure that individuals are chaperoned before we get their full details, and in fact even with yourselves I think we were aware of the issues over the NI details, not stacking up, and also we were looking at the individual references.
Are you aware that no criminal record check or references were taken up for me when I was employed?
Yes, I'm aware of that. My understanding is that you were not put into a position where vulnerable people were working and therefore the CRB check had not been carried out.
It wasn't carried out in any of the time that I worked there, neither were references taken.
I know that we were checking the references and we had identified that we hadn't any response from the references. Obviously we take it very seriously in terms of vetting our staff and if we have to re-look at those and make sure that our vetting procedures are improved upon and looked at, I will certainly be looking at that.
In terms of the conditions, could you tell me a bit about the sick pay arrangements that you have for your staff?
Well in terms of currently the staff have SSP, which is the statutory sick pay, but I'm very pleased that we've been able to negotiate with the staff and through the Trust and from August of this year the staff will be enjoying a full sick pay in terms of comparability with the NHS.
But until now and in the time that I was working there, members of staff, if they were not well, sometimes came into work because they were afraid they wouldn't get paid for the day that they didn't come in? This means that they are more likely to come into work when they were infectious or unwell.
Obviously we're very careful in terms of making sure that sick people would not come back into work, but in terms of the actual sick scheme that we inherited when we took the staff over 18 months ago, then there was only the statutory sick pay scheme. We inherited the terms and conditions and we transferred the staff over under those terms and conditions which was part of our specification and part of our response to the tender.
I'm delighted that we've been able to negotiate that from August this year there will be a proper sick pay scheme for the staff at Birmingham Heartlands.
Do you think that you might have less of a problem with recruitment of staff or understaffing if your staff were paid better and had better conditions?
As regards the issue in terms of pay, we're also very pleased that following discussions with the Trust and the Unions last year in November we're able to negotiate a 30% pay award for our staff. Over the last 12 months which was from April 2004 to April 2005 they've enjoyed a 30% increase, and again I'm very pleased that over the next two years with discussions through the Trust with the Unions and ourselves, that we will by 2007 amalgamate the NHS terms and conditions for our staff.
How important do you think cleaning is in fighting the spread of infection in a hospital?
I think cleaning is a vital part of the complex subject of fighting infection within hospitals. The issues over MRSA and infections within hospitals, as you probably know, is a very, very complex subject, and I feel we have an important part to play in terms of the role that we can play in terms of the cleaning, and also very much in terms of the hygiene situation for our staff, the impact that has on the actual general hygiene for the hospital.
Do you think that you are reaching the standard that you want to?
Well in terms of the actual cleaning standards, I'm delighted that over the last 18 months we've developed our cleaning standards to the point where we're actually meeting the national standards of cleanliness. Our pass rate is high at 95%, we've been consistently achieving over that. We're monitored in-house, by ourselves. We're also monitored by a patient group every month and annually by the government NHS Direct audit. The last audit of this year was excellent for the cleanliness.
How do you train your staff, what kind of training do they receive, your cleaners?
We have a very thorough induction programme for our domestics. It's over a five day period and it contains over eighteen modules covering the basics like health and safety, controlled infection, isolation cleaning, barrier cleaning and then also goes into the actual basis of the tools that they would use, damp dusting, high dusting such as things like that. We've also been able to introduce here an MRSA clean your hands induction to make the staff aware that MRSA is such an important part and they need to be aware of that.
So it's a five day course?
The module will take place over a five day period to cover all those aspects.
Are you aware of the kind of training that I received?
Yes, I've seen your training records and I was again very pleased that you were able to in your feedback form say that it had been very informative, very comprehensive and communicated well to you.
I received two full days of training that were very, very good, and a day of food hygiene training. And the other two days were an hour and a half of very little and nothing on the final day, so do you think that you're actually delivering what you think you're delivering?
Well in terms of your own training, having looked at your records, I noticed that you'd ticked most of the check list in terms of the cleaning that you had, things like toilet cleaning etc that you'd ticked for. So I assume that you'd had a very thorough training. Obviously I hold great store by the training of the company. We're unable to deliver the quality of service that we have to deliver unless we train our staff. We're constantly looking at our training programme so if there are any gaps in those I will certainly look into those and make sure that we cover those aspects.
How long have you been providing this kind of training for your cleaners, this five day course?
We've been covering that, providing that over the last 12 months.
There are members of staff that I worked with who told me they only had half a day training and they started work within the last 12 months.
Well obviously I will look into those. I'm passionate about the training within our company. I'm passionate that I should set up the training programmes for our managers to conduct the training, and obviously if there are any gaps in that I will ensure that that is improved upon. But I have to say that the training that we do carry out is supported by the trust control infection team who come down and provide control infection training in addition to our training. I believe this has led to an extremely clean hospital here at Birmingham Heartlands.
Could you tell me about barrier room cleaning, what's the procedure?
Well to start with the staff have to collect the right equipment that they need for the barrier cleaning. That would include the mops, the cloths and the soapy water and any chemicals that they may require, depending on the control of the infection. And then they would put on their disposable apron, disposable gloves and go into the barrier room and clean that from the point of the cleanest to the dirtiest.
How strongly do you emphasise barrier control procedures and the need to follow them to your staff?
We put great emphasis on the barrier cleaning, the control of infection department work very closely with us in terms of educating our staff. It's a key component of the induction training and I feel that has resulted in the reduction of MRSA in this hospital by over 30% over the last 12 months, and also in us attaining the excellent mark in terms of cleaning from the external audits that we've been given.
However, I think it's a very important topic and I do feel that there are some issues. For example confusion about the methodology in terms of the actual cleaning of some of the barrier rooms and the confusion about whether it is or it isn't a barrier room. We're going to work with the Trust and see how we can improve the information that we give to our staff and work more closely with the nursing staff in order to make sure we improve the situation.
Do you think your staff know what to do when they come across a barrier room?
I feel that the majority of staff understand what is required. Obviously from the clips that we saw from your film, there are quite clearly some people who need further education, but I'm absolutely convinced that the majority of staff here provide an excellent service to the hospital and hence our contribution to the reduction of MRSA by over 30%.
One of your cleaners who is featured in the film is regularly getting, so he tells me, and so one of your supervisors told me, getting over 90% for his cleaning by your inspections. Now he is clearly not cleaning properly.
I think what we've got to do is differentiate the cleaning and the hygiene procedures. I think in terms of the cleaning we've quite clearly demonstrated over the last 12 months that this hospital is clean. The patient group that comes round every month checks that. However, I think that there are some issues in terms of the actual hygiene, which is different to the cleaning, where we need to refocus in terms of our staff working together with the Trust to actually improve staff understanding of what barrier cleaning is, when it should happen and how they (the staff) link into the fight against infections within the hospital.
Some of these cleaners who I saw, who are in the film, who are sometimes cutting corners or not carrying out procedures in the right way and sometimes working in ways that are dangerous; Why haven't they been spotted by their supervisors? What kind of supervision are you carrying out?
We have a ratio in terms of supervisors to operatives well within the norm for the industry and we have some excellent supervisors working within the hospital. However it's an extremely busy location. If there are some issues in terms of the supervision, again we've recently introduced, starting last January, a new supervisory training programme, and it gives supervisors the tools to do their job in terms of management and effective management.
So are you satisfied that your supervisors are managing and supervising their cleaners correctly and safely?
I feel that we're constantly reviewing our training and reviewing the methods in terms of how we manage the contract. Obviously looking at some of the aspects of the clips that we saw, then there may be an issue in terms of the supervision. However we've got some excellent staff working at Birmingham Heartlands. Some staff have been here over 20 years. We've got some extremely loyal staff and we want to work with them and with the Trust to ensure that those individuals that aren't doing their jobs properly will either get the right training or be reviewed in terms of their performance.
Do you think your cleaners have the right resources to do their job properly in terms of chemicals and equipment, Jay clothes etc?
One of the things that I'm absolutely passionate about is making sure that all our managers have the right equipment to provide to their staff so the staff can do their jobs properly, from the actual machinery to the right cleaning cloths.
I was sometimes given a bucket of water with nothing in it to mop a floor. I overheard other cleaners and supervisors complaining about there not being enough cleaning fluid available to them.
I can't talk about specifics but what I can say is that I would never ever condone any of our managers cutting corners in terms of not providing the right equipment and the right chemicals to do the job.
Without the right training, without the right tools and the right equipment we can't expect that our staff will do the right job.
Therefore there are no issues from the company in terms of trying to cut corners in terms of cleaning materials or equipment. In fact over the last 18 months we've invested something like £150,000 in brand new cleaning equipment. We're constantly looking at new innovations to bring into the hospital. We recently brought in a steam cleaning machine which is very effective in killing bacteria, so we're constantly looking at how we can help our staff to improve in terms of their tools to do the job.
Are you aware that you have members of staff working 7 days a week, and sometimes 72 hours 7 days a week, on an ongoing basis, not a one off?
No, I'm not aware of that. My understanding is that we had a number of staff that we inherited from the previous contractor whose contracts allowed them to work five days a week, 12 hours a day which is not something that we would condone as a company but they had these contractual rights when they transferred over. We also understand that there are some who transferred over working weekends. Now I will investigate that because it's not something which as a company we would condone.
Is there a limit? How many hours you would allow a cleaner to work, or can they take as much overtime as the like?
I think we would limit the overtime to ensure that the rest periods in between comply with the working time directive. Obviously when we have periods of shortages in the hospital people will work overtime, but we will work very hard to ensure that people do not work that level of overtime. This is because of the possible an impact on performance but again I feel that what we've achieved in the last 18 months in Birmingham Heartlands (Now Heart of England) demonstrates that overall we are providing an excellent standard of cleanliness to the hospital.
But that's not what I saw. While working there I saw that alongside the cleaners who, as you say, are doing an excellent job, there were many cleaners cutting corners. I saw them using the wrong equipment. I was told by other cleaners and by supervisors to do things that are not correct as far as infection control procedures go.
Having seen the clips that we saw yesterday, quite clearly there are some individuals who, having had the right training, knowing what they should do, are actually cutting those corners and we are investigating that as we speak. We have in fact suspended two of our members of staff. We're reviewing those, but overall I believe that the right resources are going in, in order to achieve the standards. How else would we be achieving such high standards, not just internally marked but actually externally managed and marked, if we were cutting corners across the board. I don't believe that to be the case.
I suppose the thing that concerns me is that I worked with cleaners who were definitely cutting corners and were definitely doing things that I'm sure you would agree were not the correct thing to do. At least one of those was regularly getting very, very high marks at internal inspection. A supervisor told me he was an excellent worker. Now I don't quite understand how you can have the two things. I mean is it a case of it looks clean so it is clean?
I think the fact that the Trust has reduced MRSA over the last 12 months by 30%, the fact that we are achieving the standards internally in terms of the 96% that we're achieving on a regular basis now, means that we are achieving a clean hospital. Now again, I go back to the issues that we talked about in terms of hygiene, now in terms of hygiene and training there may be more development that we have to do but I'm 100% sure that we are providing a clean hospital.
My supervisor told me that I did not need to change my gloves, my rubber disposable gloves between cleaning toilets. So I would go into a toilet, I would clean a sink and then the bowl itself, the toilet itself, the lid, the inside, everything, and I thought I was supposed to throw my gloves away before I went to the next toilet. I was told not to. Now who is right, her or me?
You signed to say that the training you had was very informative and well communicated and I believe that the information that you were given is the correct training.
So why is my supervisor telling me something different?
This is part of the investigation. If there are individual supervisors who need to be retrained and re-looked at, then we have to investigate. I'm doing that as we speak. But across the board, I believe the vast majority of staff here are following the right procedures and are carrying those out because if they weren't, we would not be getting the marks that we're achieving.
The supervisor is possibly telling all her other cleaners the same thing. So it may well be much wider than just me.
I take personal responsibility for the overall cleaning standards. We employ our managers to provide that and to provide the training. I will provide the correct level of information for our managers for the training, and obviously if there are some gaps in that we will review it. But again, I would say that overall this hospital is a very clean hospital and the results show that.
We've had over 172 of our domestics going through NVQ level one. They've all signed up to go on to NVQ level two. So we're pushing and pushing in terms of further developments in terms of the training, and as I said, we also will look at the issues around hygiene and control of infection, working with the Trust.
One of your cleaners seemed completely unaware of infection control procedures, this is Habib who you will have seen in the clips. Why do you think it is that he doesn't seem to know anything about infection control?
Having looked at his training programme he has been through the proper training programme. In terms of the vast majority of staff I feel they have adapted and understood the training programmes. However, there will always be some people within the organisation that do not follow the correct procedure and we are dealing with that as we speak.
Do you worry that the way your cleaners are working may be putting patients in jeopardy?
MRSA and infection control is a huge issue within the NHS. What we know is that by having the right hygiene standards, providing the right equipment, we can contribute to infection control, and I do believe we have contributed over the last 12 months by the 30% reduction in the Trust in MRSA. However, as I said, we're looking all the time to see how we can improve on that. One of the areas we're looking at is new technology. Our research and development department is looking at a new intelligent door handle system, which actually allows you to ensure that people going through doors, have actually sanitised their hands.
But isn't the issue really ongoing supervision and the fact that that doesn't seem to be working properly? You're training your staff but are they going out and carrying through what they learnt?
This is an issue we are looking at. We're constantly looking at our training and development of that training but the supervision across the board at this hospital is very good or we would not be achieving the results. We need to look at your particular experience and we need to retrain those people involved. We've recently brought in a new general manager who has got a tremendous amount of experience in terms of hospital cleaning, and we're going to look at those systems again to see if we can help develop those supervisors and give them further tools if they require it.
Do you have a recruitment problem?
We occasionally have pockets of shortages which we cover with overtime and agency staff. Ongoing recruitment is something we're working on and obviously as we develop the terms and conditions of our staff, working closely with the Trust and with the Unions, we feel that recruitment will get easier. By providing the right atmosphere in which the staff can work we believe that we will retain and we do in fact retain many staff her over a number of years.
Working closely with nursing staff to amalgamate cleaners more closely with the hospital team will also help. We believe that the Matron's Charter is the right way to go forward and in fact we're hosting a conference with a number of our southern clients next week to talk about the actual relationship between nursing staff, ourselves and how we can work together in order to impact on cleanliness and infection control. I have in fact had meetings with Mark Goldman, the Chief Executive of this Trust 4-6 weeks ago and we talked about how we were going to work more closely together.
What did you think when you saw the clips that we provided you of the kind of things that I saw?
I was extremely saddened by what I saw in the clips, particularly saddened by the fact that the people who you identified, had been trained, had gone through the proper procedures and that a number of them had chosen to disregard the procedures. I'm particularly saddened because overall I believe our staff here at Birmingham Heartlands are excellent and do an excellent job.
Do you think you failed at all?
I'm disappointed that a minority of staff have not followed the procedures and we are dealing with those people. But we have achieved a tremendous amount over the last 12 months and that we are working with the Trust to go further in terms of making this a clean hospital.
But how do you know they're a minority of staff, how do you know there aren't lots more Habibs in this hospital?
I believe that in terms of the results, both in terms of MRSA reduction, the biggest reduction in any acute hospital within the country, and also in terms of meeting the stringent national standards of cleanliness targets that we do not have that problem across the country.
What action will you be taking, based on what you've seen?
We've already implemented a full investigation into terms of the processes not being followed, and we will be reviewing our training programmes. We'll be reviewing the support we have for our supervisors and ensuring that we maintain the standards which we have across the country in terms of cleaning and the environment that we work in.