Good communication became a recurring theme in this 50th anniversary conference of the Society of Hospital Linen Services and Laundry Managers. Speakers on widely varying topics made the same point. Better communication means a better service for both customer and supplier, particularly in an industry that is often sidelined in government thinking and last in line when spending on healthcare.

Too often linen and laundry services are left to work out the implications of legislation in which they had little input. Its members need to support each other by sharing experiences and one visitor in particular brought this point home.

As sole provider of a total linen management service for Malta and neighbouring island of Gozo, Peter Morales works without local contact and knows of others in similar roles. He said the conference gave him a point of reference.

Three angles

Contracts were the first subject under discussion, viewed from three angles, customer expectations, monitoring and quality. Liz Parker, director of Nursing and Ann Mayman, assistant director of facilities for the Scarborough and North East Yorkshire Trust gave the customer view.

An effective linen and laundry service is a two-way process. User and provider need to work together said Liz Parker. Customers need 24-hour, year-round availability and a service that can adapt to special requirements and provide compliance with infection control and health service legislation. Ann Mayman stressed the need for adherence to turnround times and good communication, particularly if there are any problems. Customers could help by full and accurate record keeping, good communications with wards and departments, particularly on procedure changes and special initiatives.

Service quality is clearly contentious, but not always easy to assess by those involved on a daily basis. Chris Tebbs delivered a view “from the outside, looking in.”

As a working definition, he suggested that quality is a standard agreed by the supplier, customer and the consumer. He saw three stages, the first and third being a specification and its implementation. But the most important element was good communication. This goes beyond talking, it means reaching an agreement, writing it down, distributing it and above all making sure it is understood.

The agreed quality must be maintained through regular monitoring, a complaints procedures, and a constructive evaluation. Here, an external assessment has advantages: giving a fresh view; a lack of self interest; the ability to arbitrate and freedom from internal pressures.

Communication becomes more urgent when changes are planned. Compulsory competitive tendering is finished, but the industry still awaits new tendering rules. Best value has been the buzzword for some time, but no-one knows when or how it will be put in place.

Bernard Flannigan, chairman of the SHLSLM (North West Region) has headed a working party into how benchmarks might be established. NHS managers already complete an annual report that includes performance indicators for laundries. However, these are too simple to be used as accurate benchmarks.

The Government’s eventual benchmarks will be influenced by the NHS plan and in a recent press release Alan Milburn has talked of contracts that put value ahead of cost. Mr Flannigan’s working party has looked at cost versus value, and he presented the elements of each to the conference. As an example, the cost side started with contract status,(eg launder only), specific costs, from which would come a scoring, which would then be compared with quality scoring and then result in an action plan.


Hospital hygiene has been much in the news, though with little direct reference to laundries. In this light, microbiologist Peter Hoffman looked at the topic of how infection occurred, the risks of linen becoming infectious and whether the current guidelines on sterilisation, HSG 95(18), should be upgraded.

Though reaching no clear-cut conclusion on the last, he viewed heat sterilisation as far more effective than chemical.

He also gave a useful reference for the current guidelines, 710C for 3min or 650C for at least 10, by pointing out that for milk pasteurisation the standard is 740C for 15 sec.

He then talked about the infected (more accurately infectious) linen classification. Laundries need to retain this category, but remember its main purpose is to allow procedures that minimise staff contact, rather than increase the degree of sterilisation in the machine.

Although inevitably highly technical at times, this talk was notable for a clear approach and for the effort made to relate to the audience.

Andy Collinwood’s address on the NHS plan contrasted sharply. Once a direct part of the laundry industry, Mr Collinwood is now a civil servant, heading facilities management at NHS Estates. He gave a slick and amusing presentation on the proposals for investing in and reforming NHS facilities. But it was largely PR with detailed accounts of the money being invested, stressing that the plan was a response to patients’ views. “Hospitals should be hotels for healthcare” he said. The plan promises £7billion new capital investment by 2010 and 100 new hospitals by the same date.

Within in the NHS, a clean-up campaign had already started and national standards would be established. But the detail had little to do with launderers. His brief message to them was that clean linen was essential to a clean hospital and they were in the best position to suggest the content of national standards.

Fortunately, other speakers redressed the balance. Alastair Campbell, laundry advisor to the CSA looked at the pros and cons of inhouse and contract laundry services. He said that the role of hygiene in healthcare has been undervalued, with the prevailing attitude that cleaning and clean linen are not part of the NHS. But Mr Campbell argued that “hospital laundries have made as much contribution to health as penicillin.”

Looking at how a largely contracted out service had worked, he said that competitive tendering had been misused as a substitute for proper management.

Outsourcing in itself does not solve problems if management is poor. Good management got good service from both in-house and contracted services. For outsourcing to work, a good relationship must be established. Trusts have to adopt a “change accepting” culture.

In Alastair Campbell’s experience, contracts proved most successful with high volumes and largely standard items where high levels of automation could be employed. There are dangers in placing too much concentration on productivity, without attention to the total service.

By inference, his message was that both inhouse and contracted services had a role to play, but the lessons of price-focussed tendering had to be learnt. It might be time for a change and more use of inhouse services.

The replacement of the NHS Supplies by the Purchasing and Supplies Agency (PASA) has meant big changes. Duncan Eaton, PASA’s chief executive and Stuart Sly (senior buyer textiles) explained. The new agency was more than a replacement said Mr Eaton. It was part of the Department of Health, centrally funded and reporting directly to the minister.

Key functions included

• setting up national contracts,

• acting as an advice centre,

• giving guidance, and

• monitoring performance.

In the context of the corporate plan, it had specific goals for savings, but also had a mandate to modernise and become a more professional service.

Purchasing was now subdivided into textiles and domestic with specific teams for each, explained Stuart Sly. He outlined key achievements and illustrated them by contracts that had been negotiated. New methods for quality assurance are being adopted.


The reusables versus disposables argument continues in the limelight, Don Proud gave a detailed outline of the pros and cons, and examined studies that had been carried out.

He also explained how textile developments and the introduction of ‘technical fabrics’ might influence the debate. Alastair Maclaren of the Medical Devices Agency took a broader view by looking at the likely effects of proposals for the new standard En13795, for theatre gowns and drapes.

It would be a European Harmonised standard and vertical (ie referred to a specific product). The standard is still much in the future, with even part 1 (of 5) unlikely to be implemented before 2003.

Its scope would be to assist communication between users and manufacturers with third party verification of both materials and products and to ensure the safety of both single-use and reusables.

He also tried to dispel some fears. Cotton fabrics would not be banned. Hospitals could continue to buy and use gowns and drapes to meet local needs.

He said that not all surgical gowns would qualify as medical devices, though most would. Some manufacturers simply sell such products as clean sterilisable workwear rather than as a barrier to prevent disease.