The dirty truth about London's hospitals

Last autumn, Government inspectors visited NHS hospitals and graded them for cleanliness and other features of patient comfort. Now they have returned unannounced to see if any progress has been made. We look at one hospital that is still graded among the worst, and one that has improved substantially.

Loos overflowing onto floors covered in vomit, paint peeling off walls and patients too weary from long waits for treatment to complain about it.

This is the scene which greeted volunteers carrying out regular spot-checks on West Middlesex Hospital, Isleworth. The sprawling west London institution has twice failed inspections aimed at driving up standards of cleanli-ness, infection control and tidiness in NHS hospitals, despite more than £100,000 of investment allocated to help it improve.

West Middlesex was one of 42 hospitals across the country given socalled red traffic light status - denoting unacceptable levels of cleanliness - in the first inspection last autumn.

Inspectors revisited in the New Year, but while nine other hospitals in the capital had been able to make improvements needed to elevate themselves from red status to green, West Middlesex had failed.

"Accident and emergency is a particular problem," said Anne Blanche of Hounslow Community Health Council. "It is not unusual to find vomit in the public loos.

They are regularly checked, but it can often be an hour before it is cleaned up - especially if nobody tells the receptionist.

"When you have got a casualty department which is dealing with double the patients it is designed to cope with and people are waiting up to 40 hours for a bed, then simple things like dusting do not even come into the equation.

"The problem is people have often waited so long, they are just grateful to be treated and are often too weary to complain about things like paint peeling off the walls."

The problems at West Middlesex are not unique, but common to hospitals where the buildings have been starved of investment for decades.

The Royal London Hospital, in Whitechapel, equally failed to improve on its red status between inspections and, like West Middlesex, is largely made up of dilapidated buildings due to be replaced.

At West Middlesex, many patients arrive at an accident and emergency department located in a "tempo-rary" building which has been its home for more than 40 years. Much of the rest of the hospital is made up of Victorian buildings unlikely ever to achieve green status.

Ironically, an acceptance that the buildings are badly in need of attention has worked against the hospital in the short term. A £50 million redevelopment programme has just begun, which will involve demolishing and replacing some of the oldest buildings, but means improving the environment in the meantime is fraught with difficulties.

According to hospital managers, there was a concerted effort to improve conditions following the initial inspection, but it was impossible to make changes fast enough.

Grace Gibbs, deputy chief executive and director of nursing and midwifery at the hospital, said: "The dilemma for us is that we are right in the middle of transforming the hospital. We had to ask, do we invest in areas which we know will no longer be there in two or three years' time?"

A hospital spokesman added: "We are well aware that some older parts of the hospital are unsatisfactory, but it would have been irresponsible to waste valuable public funds on improving areas due to be demolished in the next few months."

But Mrs Blanche said: "The hospital is being pulled down and re-built around the ears of staff and patients. That brings disruption, dust, people traipsing in and out. That does make things difficult, but it is no excuse for unacceptable levels of hygiene."

However money is now being invested in some of the older buildings despite their now-short life span. The outpatient department and Northside entrance have been decorated. Walls where paint was once peeling have had a lick of colour and new visitor lavatories are being installed and curtains and linen replaced.

A campaign has been launched to raise awareness of the importance of hygiene among staff and prevent the spread of infection. The hospital also hopes to receive specific funding to upgrade six wards.

Contract cleaners have been told to improve standards of general clean-liness, but experience problems recruiting and holding on to staff.

Ms Gibbs added: "I think if the inspectors came again today, they would see we have made huge improvements already. I would say we are least half way to putting things right."

Vandalism is one of the major hurdles to improving standards at Newham General. Signs are routinely pulled down from the low ceilings in the main corridor. Loos are blocked or smashed, litter dropped and flowers that were planted to brighten up the grounds are ripped from their pots.

Hugh Steward, general manager of sites and facilities, said: "We have suffered terribly from vandalism. All of the signposts were replaced four years ago and again two years ago. If you were running a hospital somewhere like Gloucester, you wouldn't expect to have to replace signs every two years because of vandalism."

The bill for replacing signs at Newham and sister hospital St Andrew's, was a staggering £50,000.

This, plus the absence of anything resembling a reception desk, inadequate levels of general cleaning and gardens left for years to fall into disrepair, conspired to place the hospital in the lowest category when inspectors visited unannounced last October.

However Newham is one of a handful of London hospitals to raise its status from red to green in a matter of months. Key to the turnaround was the establishment of a shadow inspection team made up of staff from Newham and St Andrew's. Using the same criteria as employed by the official inspectors they graded the hospitals and compiled a tough action plan for managers.

Improvements include heated trolleys to serve food to patients after the inspectors discovered it was cold by the time it got to the wards.

Each ward now has 11 hours extra cleaning a week, and accident and emergency has a 24-hour cleaning programme where previously there was an overnight gap. Cleaners have been given new uniforms and an effort has been made to make them feel "part" of the hospital.

Staff are encouraged to report problems with cleaning and breakages straight away on a 24-hour hotline.

Liz Killock, assistant hotel services manager at the hospital, said: "Patients have really noticed the difference and there are far fewer complaints about the cleaning."

A three-man "hit team" has also been established to improve the environment in the hospital grounds and gardens. Courtyards are being renovated to provide peaceful areas for staff and patients, flower beds have been created, litter is picked up daily and grass cut when necessary.

Like West Middlesex, Newham received £100,000 to drive up standards. However, Mr Steward added: "The advantage for the trust was that we had already identified many of the problems and we were able to show how we planned to make improvements."

A further £200,000 was spent on building a new reception and coffee bar area.

The new reception desk includes a computerised system which allows staff to track patients as they come through accident and emergency and are admitted to a ward - enabling them to direct relatives accurately.

Translators are also on call for patients who do not speak English. The hospital covers a population which speaks 64 different dialects, the core 12 of which are catered for by in-house patient advocates.

Kathy Watkins, trust chief executive said: "We are green, clean and delighted."