A clean sheet for contract cleaning?

March 2012 saw the NHS Health and Social Care Bill being passed by the House of Lords into law. The many critics of the act can console themselves with the fact that they managed to force more than 1,000 amendments to the original proposals during what was often a tense and emotional debate, changes that were mostly added during the two-month pause last summer when the legislation underwent extensive reconstruction work.

So what are the fundamentals of this heavily amended act? And how might these changes affect the cleaning, housekeeping and facilities management arms relationship with the NHS?

Starting at the top, the act spells the end for Primary care trusts (PCTs). These will be replaced by clinical commissioning groups (CCGs) - mainly made up from Doctors - who will be handed responsibility for £60bn of NHS funds in the coming years.

This dramatic extension of doctors power will mean that they will assume ultimate responsibility for allocating the services provided to patients. As doctors tend to have a more patient and outcome focused approach to care, this may mean that new medicines and treatments receive priority over other areas, such as the healthcare environment, or cleaning.

Driving up quality
Also near to the top, the newly minted NHS Commissioning Board will manage the CCGs, with the overall responsibility to try to drive up the quality of care. The CCG’s will be handed much of ministers’ day-to-day control of the NHS - the aim of this is to reduce current levels of political involvement. The aim of this component of the reform is that government officials who are outside of the political fray will be able to take a more consistent and less impulsive approach to policy-making and planning.

Responsibility for public health campaigns – addressing societal problems such as obesity, smoking and alcohol abuse – will transfer from the NHS to local councils. They will have a specific remit to narrow widening health inequalities between rich and poor, and allow the NHS to shift their resources from focusing on prevention onto cure.

All hospitals which are not already semi-independent foundation trusts will have to take this status within the next two years. They will compete for treatment contracts from CCGs, and some experts predict that CCGs could over time force the closure of units, departments, or even entire hospitals, if they think the care being given is inadequate. This could also mean that regions of the UK are underserved for particular treatments, or that hospitals tend to move towards more specialisation in the future. In theory this means better management and less potential for malpractice, with specialised hospitals able to focus and consolidate their strengths.

The most controversial measure in the act was perhaps the ‘cap’ on how much hospitals can earn from private patients, which will rise from just 1.5 per cent to 49 per cent. The move prompted criticism from some quarters that this is privatisation by stealth and will lead to a two-tier service in which disadvantaged NHS patients have to wait longer than those who can pay, with less resources and poorer quality care going to hospitals which offer less paid-for services. The ‘privatisation’ of some elements of the NHS undoubtedly opens up huge potential opportunities for any companies involved in the NHS, and could change the fundaments of the 64 year old institution. In addition, competition will be extended throughout the NHS, and groups such as charities and private healthcare firms will be able to bid for increasing amounts of work currently done by NHS staff. This means greater opportunity for outsourcing specialists, and may lead to contract cleaners and private facilities management firms eventually having a greater contribution to provision in the NHS.

Campaigners have criticised this move will lead to a ‘rush to the bottom’ on quality, as new providers put in unrealistically low bids to win contracts, which leads to a drop in the level of service provided to patients. Supporters of the act claim that the shift towards a market-based system, with different providers competing against each other, will drive up standards and encourage innovation.


Economists have predicted the savings will slice between 4 to 5 per cent of the NHS’ total budget, with managers instructed to find these through productivity savings, not through cutting frontline services. Critics have added that many of the savings that have been made so far have been through cutting or freezing staff pay, and this overreliance on pay is unsustainable in the longer term. Pay cuts tend to have an effect of disincentivising the workforce, and in the case of hospitals, the cuts could see them deliver services less well and reduce their attractiveness as a potential employer. With rising inflation and the increasing cost of living, the NHS may well face a difficult job in continuing to make savings gains in this way in the long-term, as long-term pay-freezes are unlikely to be accepted by the workforce.

The Health and Social Care Act represents a both a challenge and an opportunity for all healthcare providers, and removes layers of management from many of the budgeting decisions while increasing the threshold for private providers within the service. The healthcare minister, Andrew Lansley, has long asserted that the act will reduce bureaucracy and open up the NHS to competition, which will help drive up standards and help guarantee the NHS’s relevance and importance for another generation. One way or the other, the cleaning industry will continue to play a vital role in keeping healthcare environments clean and safe for patients, regardless of the managerial or financial structure sitting above it.

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