3.83 The National Health Service Hospital Advisory Service in November, 1971, referred to the substantial criticism it received of the shortage in the amount of linen supplied to the wards, particularly on geriatric wards where the demand is greatest. In March, 1973, the Regional Advisory Team of the South East Metropolitan Regional Hospital Board received similar complaints from all grades of staff, and many wards which were visited by that Team at varying times of the day and night had bare shelves in the linen stores.
3.84 We also received many criticisms about the inadequate supply of linen, especially at weekends, and it seemed that many of the nurses and, indeed, the laundry manager believed the problem would only be overcome if the hospital implemented the recommendation of the Hospital Advisory Service to introduce a 'topping-up' system backed up by an additional supply of linen. Under a 'topping-up' system each ward is supplied on weekdays with enough linen (i.e. sheets, pillow-cases, towels etc.) to bring ward stocks up to a pre-determined level calculated to provide the ward with sufficient linen to last until the next delivery
3.85 The Group Secretary disagreed with the advice of the Advisory Service. He alleged there was sufficient linen in circulation and that shortages were caused by hoarding on wards. He further claimed that the Regional Board's work study officers had supported his view that a 'topping-up' system could not be used successfully on all wards because of the problems of access, and that the 'standard-pack' system was, therefore, the best one for St. Augustine' s Hospital. With a 'standard-pack', system each ward receives a fixed quantity of linen each weekday, the actual amount supplied being based on the average consumption of the individual wards. Mr. CX, the former Principal Nursing Officer, and the Group Laundry Manager in fact commenced to carry out a successful trial of the 'topping- up' system on selected wards but this experiment was stopped by Mr. B who told us that this was because he had not been consulted in advance. A study of the documents submitted to us, however, showed that Mr. B had attended a meeting at which approval had been given to this trial being carried out and it was difficult for us not to conclude that the experiment had been stopped because it seemed likely to succeed.
3.86 There were serious personality clashes between the Group Secretary and the Group Laundry Manager, and the Hospital Management Committee set up a sub- committee to investigate the problem, but it failed to find a solution acceptable to these officers. The Laundry Manager resented having to report to the Hospital Management Committee through the Group Secretary and asked for direct access to the Committee in the same way as some of the other group officers. This request had not been accepted, and at one stage the difficulties became so acute that members of that Committee were called into the hospital to carry out on-the-spot enquiries into complaints about the laundry service.
3.87 The members of the Management Committee were undoubtedly aware of the views of nurses about the general shortage of linen in the hospital and of the statements made by the Group Secretary that the shortage had been the result of stockpiling on wards or linen being held up in the laundry. However, a comparison of actual costs per in-patient week between St. Augustine's Hospital and two other psychiatric hospitals in the same region would have shown that during this period (1970/73) substantially less had been spent on bedding and linen at St. Augustine's than at the other hospitals and it is surprising that this basic information does not appear to have been made available or to have been called for by members of the Committee.
3.88 Whatever the explanation, the indisputable fact remains that wards had been deprived of an adequate supply of linen and that nurses were, therefore, unable to provide a satisfactory service to their patients because of the inability of management to solve a basic laundry supply problem. If the test of an organisation is a test of performance and results, then the Group Secretary as the Chief Administrative Officer and the Hospital Management Committee failed to deal with this long-standing problem of laundry. Laundry problems are endemic in the hospital service, but it is rare to find a state of affairs as bad as we found at St. Augustine's during the periods covered by both parts of the Critique.
3.89 The District Management Team has made great efforts to improve the position and there was general agreement among nursing staff in the Autumn of 1975 that, although not ideal, the situation had improved, and that emergency issues of linen could then be obtained if shortages occurred during the weekends and public holidays. In the last few years some wards have been supplied with their own automatic washing machines, and this has also made a major contribution to solving the laundry problems, although it has meant that in some cases quite senior nursing staff have been involved in operating the washing machines or carrying out other duties inappropriate to their training and experience. The hospital also experienced considerable difficulties with the marking of patients' clothing, but again a great deal of progress had been made in the 12 months preceding our arrival at the hospital, and the washing machines on the wards are often used for personal clothing which might otherwise get mislaid in the laundry.
3.90 We are pleased to report that towards the end of the Enquiry a working committee composed of all those principally concerned with the laundry and linen services was set up to make a start on solving the outstanding problems, and that as a result a topping up system has already been introduced in some wards. The District Management Team will have to watch the laundry situation carefully and take resolute action if this further attempt to provide an acceptable service founders on personality problems.
6 April 2025
