How hard is it to keep a hospital clean?
Populism and the audacious question that no one remembers
Last autumn, a cyst on my back that had turned into a painful abscess led me to one of London's biggest hospitals. I had been advised by my doctor to go to Accident and Emergency (known as the Emergency Room in the US) for urgent surgery to drain and remove the infected cyst. Within an hour or two a doctor was assessing the abscess in order to remove me to the surgical team. After she had seen it I sat back down, shirtless and distracted, as I asked her about the next steps. Within a few seconds I realised what I had done: The abscess on my naked back had touched the plastic seat back. For me that wasn't too big a deal - regardless of whatever was lurking on the seat back, I already had an infection and it was going to be removed - but it might be a big deal for whoever sat on the seat next. So I told the doctor that she should probably disinfect the seat before the next patient arrived.
It is through such myriad, tiny and careless actions that infections spread. A hospital is only unusual in that we are more likely to be alert in that space to the presence of our bodies, its ingresses, discharges and movements. But even then, attention can fade. It certainly did for me. I was asked to return for surgery at 7:30am the next day. In the end, it took over 11 hours for me to finally enter the operating theatre (mine was the least urgent urgent case). I was anxious, I wasn't allowed to eat or drink, and I was bored. I started off the day wearing a mask and frequently applying hand sanitiser. By the end of the day I had grown careless and apathetic. Who knows what my body passed on and what it received? Certainly, I developed a chest infection on return from hospital that has persisted long after the pain of the (successful) surgery has subsided.
I am sure many readers might think I am making an utterly banal point: Does it need to be said that a hospital is a place that is almost impossible to keep sterile, a place where infections can easily spread. Has anyone ever doubted that?
Well actually, yes they have. And I am not talking about fringe conspiracists who don't believe that germs exist or hold to bizarre alternate worldviews. I'm talking about a group of educated, 'mainstream' figures who, nearly 20 years ago, gathered in a room and approved this message to the general public:
It's safe to say that the 2005 UK general election does not resonate in the public memory and even the most fervent politics geeks will not remember it as dramatic or historically significant. This was Blair's third general election as Labour leader and, while the party took a hit from the Iraq war and lost seats, they were still left with an 80 seat majority. The Conservatives, led by Michael Howard, were never expected to win and the task for the party was to shore up the core vote and start making inroads into Labour's lead as part of a slow process of rebuilding.
The Tories turned to Australian strategist Lynton Crosby to manage the campaign. It was structured round a limited number of well-worn right-wing offers - more police, better discipline in schools, lower taxes - judged to chime with 'common sense' thinking. The slogan for the campaign was 'Are you thinking what we're thinking?'.
The question about how hard it is to keep a hospital clean appeared in the manifesto and was designed to draw attention to stories of 'superbug' infections and the like, allegedly the result of poor hygiene in hospitals caused by Labour's allegedly poor management of the NHS.
I don't remember the question being discussed much and it certainly didn't help or hinder the Tory's electoral chances. But I still think it represents something remarkable in its audacity, something that was definitely a harbinger of what was to come. Perhaps it was the beginning of the fall...
How hard is it to keep a hospital clean? You don't need to be a health expert, or to even have visited a hospital to know that the answer is 'extremely hard'. A public building that is full of sick people, their families and visitors, medical personnel and whoever else wants to walk in off the street, is by definition extremely difficult to keep clean. However many cleaners there are, there will always be middle aged men who, in their careless anxiety, transfer tiny amounts of highly infectious pus to the back of a plastic seat.Â
And yet in 2005, the Tory high command, and the party leader, signed off on a document that implied that keeping a hospital clean is an easy task.
This is one of those occasions where it is almost impossible to believe that those who created the campaign actually believed what they were saying. It is also hard to credit that any of their intended audience could possibly believe that it's easy to keep a hospital clean. Because, in this case, 'common sense' - whatever it is - can only lead to one conclusion; that it's hard to keep a hospital clean. No person's 'default' state is to assume a hospital is easy to keep clean. It is just not credible.
We should understand the question, then, as something else; not as a truth claim but an audacious invitation to a particular kind of thinking. The Tory 'offer' was to redefine common sense not as a surrender to empirical reality but as a defiance of it. It was an offer to part company with the world as it is, in favour of the voluptuous pleasures of a world of simplicity; a world where infection could be banished without effort provided we dispense with those who think too much.
Notice that I resist the term 'stupidity' here. Certainly the team of people who made this offer were not stupid. In fact, it took money, coordination, deliberation and research to come up with the offer to redefine common sense. As I have argued elsewhere in my book on Denial, turning against knowledge and supplanting it with one's preferred truths is not a stupid act; it is a bold choice to embark on an arduous path. One chooses to believe that a hospital is easy to keep clean; it doesn't just happen. Keeping the inconvenient reality at bay is not an easy task.
This one short message in the 2005 has obsessed me for years. One of the things it tells us is that the post-truth tendencies that dominate today's Conservative Party and that supercharged Brexit, did not spring from nowhere. While the 2005 manifesto clearly did not 'work' at the time, one might see it as a kind of experiment, in which smart people like Crosby tried to work out how far one might be able to tempt voters to depart from common sense under the guise of common sense itself.
As far as I can tell, the belief that hospitals are easy to keep clean does not seem to widely shared even now. My suspicion is that the reason it did not resonate in 2005 and doesn't resonate now is that, however nonsensical it is, it is ultimately not nonsensical enough. To believe that vaccines kill or secretly contain microchips, that germs do not exist or to believe in any number of other conspiracy theories, is exciting, transgressive and involving. To believe that hospitals are easy to keep clean doesn't turn the world on its axis, it doesn't reveal the secret rulers of the world, it doesn't build a community of true believers. The Tory claim didn't even imply a juicy conspiracy; it only sought to draw attention to neglect and incompetence. Why bother with believing it at all?Â
Michael Howard wasn't really a populist post-truther. He still inhabited the actually existing world. In some ways that makes his signing off of this statement even more contemptible. But really his heart wasn't in it. When it comes to post-truth politics, you have to live it, you have to go big or go home. That's also why Donald Trump was much more successful in building a movement than Boris Johnson has been; the latter is cursed by a lingering inability to leave the world entirely behind.
As Michael Howard discovered, the future doesn't belong to those who who claim that hospitals are easy to keep clean. Rather, it belongs to those who make wilder claims - perhaps that cleanliness itself is a conspiracy, or that hospitals don't exist - that strike at the very fabric of reality itself.
For the 'big lie' to work, it seems as though certain conditions have to be satisfied. Denying reality is hard work, as you say, so it requires a traumatised and reasonably united population, willing to risk self-destruction in pursuit of a delusional fantasy. Are those conditions satisfied anywhere at the moment? In the US? Britain? Russia? China? Only one place seems to fit the bill. Israel.
I don't remember the hospital-cleaning aspect of 2005, since the dog whistling about immigration deafened everyone. Tory positioning on that issue started back in the William Hague years, as he was convinced it would eventually move up the polls and become a plus for the Tories - it did, but not fast enough to save his leadership.
I do remember a general concern about the idea of a "deep clean" of all hospitals, which Gordon Brown agreed with soon after he took over, though I don't remember if it happened.
However I was in hospital quite a bit in 2008-9, with leukaemia. I can report that the wards full of people with suppressed or damaged immune systems were always subject to a regime of keeping down infections: visitors told to wear masks and gowns, not allowed to bring flowers (full of bacteria), cleaners in your room every other day. So it certainly is possible to keep specific *parts* of a hospital extremely clean... but they have to be limited, semi-isolated places, with a limited number of special patients, with no hanging around as soon as you have enough neutrophils in your bloodstream to survive in the fresh air.
Last year a friend of mine died of lung cancer, after 18 months of first chemotherapy then immunotherapy and then trying a few alternative things as additional palliative care along with the morphine. My experience, as someone who responded to treatment and survived for over a decade, became less relevant and helpful as the months went by. The only observation I had left that I would share with other visitors was: as long as they want you in a hospital bed, that's a positive sign. Because a hospital isn't a hotel and they won't keep you in a day longer if they don't think it'll do any more good than being at home, and there's always a big queue of other people who need that bed.