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Outsourcing is a public health hazard 

It is clear that the shoddy employment practices of the management companies operating in the NHS are putting us all at risk. We need to take all workers back in house today, writes HELEN O'CONNOR

IT should be obvious that hospitals have the potential to harbour far more germs and disease than most other public buildings. People are admitted to hospital when they are suffering from contagious disease themselves. Hospital patients are susceptible to contracting infections and they can go on to develop additional health complications as a result of increased physical vulnerability. 

Preventing cross-infection in hospitals is not only key to patient recovery, it is key to protecting the workforce, so rigorous infection control should be an integral part of the running of a hospital. No-one wants hospital staff to be off sick unnecessarily or for patients or hospital staff to die from hospital-acquired infections. No patient should ever be discharged from a hospital in a worse state than when they were admitted. 

The result of years of outsourcing of hospital cleaning means that staff, patients and the public can no longer feel confident that hospitals are cleaned as thoroughly as they should be. When some cleaning staff took up voluntary redundancy at St Georges hospital in 2019, GMB Union was shown pictures of the accumulating dirt and filth including rolls of dust building up underneath hospital beds on wards. 

Dirty hospital wards are a risk factor in patients developing infection and filthy workplace conditions can also cause hospital staff to become unwell. The deaths of NHS workers during the coronavirus pandemic has exposed the ease at which infections are transmitted and contracted within modern day hospital environments.

As well as cutting terms and conditions, private companies force hospital cleaners to take on impossible workloads so that they can run the contract cheaply. In Lewisham Hospital cleaners are so overrun by their workloads they can no longer empty bins regularly and one cleaner reported that her NHS colleagues are now pitching in to help her.

Here is one cleaners account of her working day in Lewisham hospital.

“I was working in my area since Dec 2018. For the first time I was told my area was dirty. ISS have expanded our areas and gave us more jobs in [the] same working hours and we have NO TIME to clean them properly…This is unbelievable. They expect us to kill ourselves over this job. Supervisors are pushing us to do more than we can handle to clean perfectly or ISS will get [a] financial penalty from the trust…I have six toilets, nine rooms, one large theatre, four waiting areas and corridors to do in four hours…and they keep asking why I can’t do dusting and why I can’t remove chewing gum under chairs…plus get our trolleys ready before work and then empty them!!”

Occupational sick pay was another infection control safeguard that used to be in place for every hospital employee. The contractual right to sick pay ensured that if hospital staff became unwell they could have time off on full pay in order to stay well away from patients and not infect them with their germs. No colleague or patient wanted to see a hospital worker coughing and sneezing all over the place or experience the consequences of a worker signing on duty with a bout of gastric flu.

Outsourced hospital workers do not get the contractual right to full occupational sick pay (OSP) unless they were transferred over to a private provider on an NHS contract. If an outsourced worker on a company contract takes a sick day they quickly find out that they won’t get paid so taking sick leave is not an option when the pay is low, there are no guarantees that wages will be paid in full for hours worked and living hand to mouth is the norm. 

Marianne (not her real name) is a hostess and she works for a multinational company in a Large South London hospital. 

It is 4.30am and Marianne wakes up shivering and with stomach cramps. She is due on shift at 6am to start to set up for the patients’ breakfasts. She has been sick several times already during the night and she feels very weak. Luckily she has managed to keep some  paracetamol down which helps with the pain but she is still getting waves of nausea followed by vomiting. 

The ward feels hot and the lights are making her head spin but Marianne continues to set up her trolley. She is trying to make sure that no-one notices she is unwell because she knows that if she is sent home she won’t get paid for that day. Her pay was short again last week by almost £200 and she has filled in the pay query form and she is waiting to see if she can get some of the money back. Her rent is now in arrears and she is getting red letters through for the bills. The last time she was sick the ward manager shouted at her and told her she was selfish for infecting the patients with her germs. The ward manager made Marianne feel so ashamed that she cried in front of the patients.

Porters ,catering staff and cleaners end up on Statutory Sick Pay (SSP) which is the minimum sick pay that the law allows. Anyone who is subjected to SSP has no income at all for the first three days and if they are lucky they might be paid under £20 a day thereafter if the private company supervisor can be bothered to process their sick certificate on time. It is not uncommon for supervisors to refuse to accept a self sick certificate so the employee ends up with absolutely nothing for the period of sickness.

 It is difficult to imagine that any policy maker or employer could ever seriously think that SSP meets even the very basic costs of living anywhere in the country. To rent one room in a cheap London borough costs a minimum of £130 a week. With SSP ringing in at £96 a week, starvation and homelessness are very real prospects for any outsourced hospital worker who is unfortunate enough to be struck by illness or injury. Many of the migrant hospital workers employed on the cheap by the big NHS contractors have no savings, no family to fall back on and no opportunity to ever escape from a lifetime of this low-paid drudgery that is now commonplace in our hospitals.

Prior to the pandemic the lack of full occupational sick pay for outsourced NHS workers was raised by GMB Union as a risk factor for cross contamination in hospital environments.  GMB Union first started campaigning on this issue in Kingston hospital in 2018. During this lively campaign we heard that a member who was off sick for weeks following a stroke needed his colleagues to do a whip round for him so that he could survive.

We found that the public and NHS staff do not even know that people who work in a hospital are forced to come into work when they are sick because SSP is so woefully inadequate to sustain them. The Kingston hospital campaign took us to the heart of government and we eventually secured a meeting with Matt Hancock himself to carefully explain the seriousness of the issue to him. It was disappointing but not surprising that Hancock did absolutely nothing to remedy the situation.

As part of the Kingston hospital campaign GMB union even took a giant inflatable rat up to ISS HQ in Canary Wharf to expose the plight GMB hospital workers faced and to show how occupational sick pay (OSP) is vital for public health. One freezing cold Saturday more than 100 GMB members marched through Kingston to tell the public about the shocking employment practices going on right under their noses in their own local hospital that were putting them at risk.

Some contractors have reluctantly agreed to pay wages while workers are off sick with Covid-19 but even getting this tiny concession to keep our hospitals safe during a deadly pandemic has been a contract by contract battle. The obvious problem with this time-limited deal is that it fails to acknowledge that Covid-19 is not the only infection that has the potential to spread like wildfire in hospitals and become deadly for patients.

It is ironic that the workers who are most vital to preventing cross-infection in our hospitals are the very people that may be inadvertently putting the patients at risk of cross-infection because they have little choice but to go into work in our hospitals when they are sick.

No outsourced hospital worker wants to face the brutal choice between slipping into a financial black hole or spreading infection to vulnerable hospital patients. They find they are  placed in an impossible situation by contractors and their plight is ignored by NHS managers who have washed their hands of the problem. 

What patients are left with is a cleaner, porter or hostess who is cleaning around their bed, serving their food or wheeling them around the hospital when they are sick and possibly carrying infection themselves.

Dirty hospital wards and workers who have no choice but to come into work unwell spread germs which make everyone around them sick, including patients.

The issues of manageable work loads and sick pay from day one in hospitals is not going away as outsourced NHS workers start to slowly realise that pay, terms and conditions fall far short of what their NHS colleagues get.

Equally outsourced hospital workers are starting to slowly recognise that if they stick together and become active in a  trade union they can make demands and win.

It is even better if the local community get behind hospital workers’ campaigns because the right to occupational sick pay and manageable workloads are vital to health and safety and infection control in any hospital.

It is important to recognise that basic workplace rights in any hospital are not just about justice for workers – they are vital safeguards that protect anyone using the NHS. Outsourcing is a public health hazard and this is why we must all fight together to stop it for good.

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