Remember the joke about Skoda cars: what do you call a Skoda convertible? Answer: a skip!

Well, I don’t know if you’ve looked at Skodas recently, but they are now made to high standards and have won a design award. They are also backed by extensive warranties as the manufacturer is extremely confident of the vehicles’ quality – even though their price range is still cheap when compared to that for competitors’ cars with similar features. I mention this to emphasise that you can have good quality at reasonable prices, if you know your market and pitch your product correctly.

The NHS is moving away (slowly, I hasten to add) from buying the cheapest of everything to looking for “best value”. Sometimes best value equates with the cheapest, but often it does not.

In textile services, the strategy means ensuring that the product meets relevant standards (EN/ISO/Controls Assurance), is accepted by the customer and doesn’t fall apart after 10 washes.

Ensuring patient safety

This move to “best value” is being partly driven by the need to ensure patient safety and prevent complications arising, and partly by a recognition by the NHS that “you get what you pay for”.

The shift towards new fabrics and disposables has been influenced, I am sure, by research into post-operative and other hospital-acquired infections and the cost of these to the NHS (approximately £1billion a year).

So from using the cheapest cotton or cotton/polyester cloth, we are moving towards barrier fabrics/disposables, which are more expensive, yet give better protection to the patient and nursing/medical staff.

Is this best value? I believe that if such a change reduced infections by as little as 1%, the savings to the NHS in both money and patient suffering would make this a positive move.

Cheaper textile products often require more frequent replacement or repairs, customers may not find them easy to use and they may offer only poor protection from blood and other body fluids. If one member of theatre staff contracted an infection from using poor quality drapes, how could you quantify the cost? If they sued their employer on the basis that the risk was known about but that the hospital trust decided to save money, how much could that cost the NHS?

Press reports of recent awards for personal injury and stress show the huge sums involved in litigation. So buying cheaply is not always the best way to do business. However, coming back to my point about Skodas, you can get good value and quality, but only by careful evaluation of products.

Value for money

My experience of obtaining value for money has been gained by running trials of differing materials and speaking to colleagues who had either used, or were still using, the services of potential suppliers of a theatre “textile” service (this includes disposables).

The suppliers were invited to supply a range of packs for use over a set period and each of the products was assessed on:

• compliance with standards

• ease of use

• customer satisfaction

• availability

• flexibility (that is, pack contents)

• performance in use

• price.

The trials looked at the cost of linen replacement as well as at the recommended maximum number of uses before disposal. For disposables, clinical waste disposal was considered because of the environmental issues. The question of clinical disposal was raised by customers. Indeed customers today are very much concerned with environmental matters.

We had to look at price of course and, on the surface, disposable products seemed to be more expensive every time, making textile products look good on paper.

One of the senior managers in theatres in my trust has recently put together a business case for changing our drapes to a different system, so responding to changing standards. Guidelines published by the British Orthopaedic Association mean that orthopaedic consultants are pressing for a change to disposable products despite the cost.

The association has looked at the effects of post-operative complications in major joint surgery. Obtaining best value for such patients relates not so much to cost as to quality of product, so helping to prevent infection, which can cause joint surgery to fail and patients to become unwell. In this case, the cost of drug therapy and an extended stay in hospital could far outweigh any savings made by having a “cheap” draping system.


It may well be that to obtain best value in our case we will need to have a mix of quality reusable fabric drapes for some types of surgery and disposables for higher risk procedures. This combination could then provide us with the quality we require, but, at the same time, prove cost effective.

For, despite the move away from a “pile ’em high and sell ’em cheap” policy, we still have to face the reality that there is a limited amount of money to draw on in the NHS and we have to consider cost, carefully balancing that against the quality we require – not always an easy balance to achieve.

I know of one hospital which has made a complete changeover to a disposable system of drapes and gowns, with a subsequent loss of business to the in-house laundry. The decision was made on the basis that the linen stock was old, the standards were changing and the laundry was not accredited to ISO9002 or CE standards. Such changes to disposables may well become more common, especially with the advent of Controls Assurance standards.

Evaluation process

I am aware that several of my colleagues in other trusts are getting involved in the evaluation process when it comes to looking at linen versus disposable products.

Infection control staff are being asked for advice too. It may well be that in the future, users of textile services will be much more fussy about where they buy their service, and a CE-marked product will be the minimum requirement for drapes/gowns, with price being the next consideration.

In a previous article for LCN I explained how I thought textile service companies should respond and observed that those who weren’t prepared, could well lose business. In future, being the cheapest in future will not necessarily guarantee winning contracts as customers focus more on quality and less on money.

This change in customer priorities could mean that some textile rental companies will need to make a significant investment in upgrading facilities. They need to recognise that staff must be well trained in order to achieve the standards expected. The investment needed to upgrade could also include a review of the staff pay structure in order to attract the right people, for it must be said that staff are generally poorly paid.

The textile rental sector could well find itself faced with the same kind of problems as those faced by some sterile services over the last few years.

The standards have changed rapidly but some departments have lagged behind, and failed to meet the expectations of customers or to follow best practice. The situation was highlighted during a recent national audit of all departments in the public sector. The audit used a traffic light system to indicate how well or how badly trusts were doing.

Red light

Several trusts were given a red light, and then had a short period to rectify urgent problems and reach at least a standard that merited an amber light.

If laundries were to be judged in a similar manner, how do you think you would be rated? Every aspect of patient care is now subject to audit, from cleaning to catering to pathology services. Why should textile services be exempt?

I suspect that the private sector has a lead in some respects because it has more money to invest in facilities than the average NHS laundry and therefore may have a market advantage.

Outsourcing downside

However, the downside of outsourcing linen contracts (and I speak from experience) is that you lose a large element of control, and communication over a telephone is not as reassuring as face-to-face contact when you have a problem. If your service is on site, acute problems are sometimes more easily resolved, though not always.

How do I think the quality versus price argument will develop? It is difficult to answer at present, but one thing I am sure of is that textile services will come under much closer scrutiny in the near future and competition for business will become fierce. This is especially so if older facilities close, as trusts look to make savings on real estate and overheads.

Controls Assurance/ISO/EN standards will also impact on the service as customers seek to ensure that they are using compliant products.

The main issues will then be the unit price and customer satisfaction with the product. I am convinced that if the quality of textile products is good and if they repeatedly perform well in use, textiles have a price advantage over disposables in many instances.

The key is ensuring that the quality is consistent and that frequent checks are made to monitor quality. If you can get this right, you are in a strong position to compete with suppliers of disposables. If not, maybe now is the time to think about that villa in Spain and early retirement.

Shaun Deneen, is hospital sterilisation and disinfection unit manager with Portsmouth Hospitals NHS Trust