As one might expect, if twenty ‘experts’ were assembled and asked to advise on a linen stock requirement for a 1000 bed acute hospital, there would be twenty responses and none would be near the same. Why?… because every laundry operates to different criteria, every trust has its own idea of what constitutes a linen service and every nurse has his, or her, own idea of when a bed should be changed.

The ideal is a National Health Service which incorporates best practices, and where established systems of work, previously found to be effective, efficient and reliable, would be adopted by all. Instead, competitive tendering has created mistrust between laundries, and a reluctance to share financial and performance information.

Trusts have also been reluctant to share information. With the absence of any centralised data collection system, ‘good practice’ has not always been identified.

Weekly output

Most linen service managers know their plant’s weekly output, but not all of them know their circulating stock. Many are aware of the number of beds served, but to have any degree of accuracy in stock control, optimisation of beds needs to be taken into account.

The value of linen circulating in any one trust will depend upon the size of the trust and the number of various linen items per bed. In this regard, a conservative figure of £150 (US$240) of stock per bed is not considered unreasonable.

In 1993, a team of management consultants undertook a project involving 15 trusts (then health authorities) as part of a value-for-money exercise. Out of the 15 surveyed, four had declared losses of less than 1%, another four admitted that they never undertook linen counts and, of the remaining seven, the average loss was 5.7% of circulating stock at an estimated value of £210,000 (US$336,000) No one knows the true value of stock within the NHS but, taking account of the number of available beds, estimates of £60 million (US$96 million) would not be unrealistic.

Core items

Using the previously noted 5.7% average loss, then this would indicate that the NHS is losing an estimated £3.4 million (US$ 5.4m) each year through unrecorded losses of core items, and this does not include theatre drapes, theatre gowns or uniforms.

Of course, a significant part of this loss is not down to theft.

Worn out linen, that should have been withdrawn by a quality assurance system but instead escapes from the laundry, may be ‘condemned’ at ward level by nursing staff and as such is never recorded as being removed from the system.

Similarly, frayed towels are often seen as ‘fair game’ for cleaning windows and are invaluable for painting and decorating jobs, as well as the care of pets. Curtains and counterpanes make excellent dust sheets.

A major problem that my laundry suffers from is nightwear. Freshly laundered and crease-free night dresses are popular as shrouds. How do I know? Ask the undertakers.

Since the introduction of clinical waste and the dreaded ‘yellow bag’, linen losses have increased. Routine audits on yellow bags often find ‘soiled’ items of textiles, which, under normal circumstances, would be laundered and recycled but are instead destined for the incinerator by an overcautious user.

Northern Ireland has gained a reputation due to the exploits of its legendary ‘Billy the Blanket Kid’. Yet despite being widely publicised, blankets continue to disappear at an alarmingly high rate from trusts all over the UK as well as Ireland, possibly via the ambulance network and into nursing homes.

Who can blame them for ‘borrowing’ a blanket to keep the chill off some poorly patient’s shoulders, but anything borrowed should be returned.

Theft does occur and whilst linen managers apply security marking to items in as discrete and attractive way as possible, this in itself has been known to create a problem. Attractive, multicoloured logos are often seen as a memento or souvenir of when an accident occurred, the day an appendix was removed or the birth of a child.

So how can we reduce the problem?

Security experts advise us of basic steps which should be built into our culture to help alleviate the problem. These may not work against the determined thief but they should act as a deterrent from the opportunist one.

• Issue guidelines on the condemnation and disposal of time-served linen to all users.

• Keep all linen room doors locked, control the issue of keys or rotate the frequency of change if using digital locks.

• Ensure that soiled items are stored under secure conditions.

• Always lock vehicles when left unattended.

• Be prepared to challenge anyone seen leaving the hospital with trust-owned items.

The Society of Hospital and Linen Services & Laundry Managers is keen to establish a database where items such as losses can be compared and analysed.