If the purpose of a hospital cleaning contract is to reduce infection, why not let a contract to reduce infection? Photograph: Nigel Hillier/UNPThe specification for Merseyside Waste and Recycling Authority's (MWRA) proposed £1bn contract, which could see Merseyside waste transported to the north-east of England for processing, may have been what MWRA believed was needed, but failed to reflect what local people, those who pay MWRA's bills, wanted.
Had the contract been let to the losing bidder, energy-from-waste company Covanta, which was hoping to develop the country's biggest eco-waste plant in a joint initiative with Peel Environmental, it would have resulted in £500m of investment in the north west and the creation of 600 construction and 100 operational jobs.
What has this to do with hospital cleaning? All hospitals let cleaning contracts, and specifications usually require so many cleans per day of toilets and floors. But such contacts are expensive, so why let them? 12 cleans per day of the toilets (only two cleans at one hospital I visited recently) does not guarantee cleanliness and hygiene. At two relevant conferences, delegates agreed that the purpose was to reduce infection and to make the environment more pleasant.
If the purpose of the contracts is to reduce infection – which at worst can kill people and can cause wards to be shut down, delay operations, create much inconvenience and huge expense – then why not let contracts to minimise infection? This would allow for innovation and all-round attempts to improve hygiene. People might be compelled to wash after using the toilets, to use the alcohol cleansers regularly, to disinfect shoes on entry to the hospital, as happened near farms to prevent the spread of foot and mouth disease in 2000. Nurses might have to change into hospital-sterilised outfits rather than use them travelling between home and hospital. A key contract performance measure could be the number of infections.
So why doesn't it happen? Residents and hospital chief executives would no doubt have infection control high on their list of objectives, but this does not seem to have been passed down to operational staff – budget holders and on to procurement personnel. In an example of Chinese whispers, the outcome is cleaning contracts.
Virgin won its appeal against the award of the West Coast rail franchise. However, much of the concern in the North West was the suspicion that the proposed contract was more about trying to raise income for the Treasury rather than about customer service and supporting economic development. The existing contractor, Virgin, was perceived to be providing a good service. I don't recall any consultation with people who live along the route and use the line about what they expected from the service. Let us hope for effective consultation before the specification and evaluation criteria for the re-tendering are determined.
What is the lesson in all this? Those letting public sector contracts need to be clear about the purpose of the contract and make sure the specification is aligned to that purpose. Repeating an old formula may not deliver what is needed. They also need to be clear about who are the stakeholders and ensure that their views are properly reflected in the specifications and evaluation criteria. There are no prizes for buying the wrong things well.
Colin Cram is contributing editor to the Public Leaders Network
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