Hospitals need more beds, not more bare arms - Telegraph.co.uk

Yet while there has been a public outcry about the alleged suspension – and a flurry of outraged messages in my inbox – few people have grasped that the real scandal, and the focus of Nunn's anger, was about something far more important than politicians and their photo opportunities.

The "bare below the elbows" policy that Nunn was talking about came into force across NHS hospitals several years ago, in an attempt to reduce infection rates. The policy states that doctors and nurses are not allowed on to a ward wearing a coat or outer garment, must have their shirtsleeves rolled up to their elbows, and must not wear watches or other jewellery.

Of course, there is very good evidence that regular hand-washing combats the spread of infections in hospitals: no one would suggest otherwise. But even though we doctors are encouraged to practise evidence-based medicine, there is not a shred of evidence to show that the policy of "bare below the elbows" reduces the spread of infection in any way. In fact, I'd go so far as to say that it's actively dangerous, because it diverts attention from the real problems.

Nunn himself has been critical of the policy, not least on the letters page of this newspaper. Indeed, his outburst can be seen as an attempt to highlight the utter hypocrisy and lunacy surrounding infection control in the NHS.

Both the previous administration and the present one know that the public is concerned about hospital infection rates. They must be seen to be doing something. But all the research shows that the single biggest factor in the spread of hospital-acquired infections, such as MRSA and C. difficile, is bed occupancy rate. The quicker the turnaround in hospitals, and the more pressure on bed space, the more infections there are.

Scandalously, this link was emphasised six years ago, in a report funded by the Department of Health. Yet it was ignored by Labour because it did not fit in with its new NHS agenda of closing hospitals, introducing PFI hospitals (which typically have 30 per cent fewer beds) and "streamlining" services.

These policies have left us with some of the highest bed occupancy rates in the developed world, with hospitals often running at over 100 per cent capacity. It's this that is causing the spread of hospital-acquired infections, not shirtsleeves or watches. MRSA rates are more than 40 per cent higher in hospitals with 90 per cent bed occupancy than in those with less than 85 per cent. On the Continent, where bed-occupancy rates are lower still, they have far fewer outbreaks. Then there's the issue of the contracting-out of cleaning services to companies that often seem to be more interested in their own profits than the state of the floors.

Rather than act on these problems, we instead rolled out "bare below the elbows" – a policy with no scientific basis or tangible benefit, which was just as much of a PR stunt as Cameron and Clegg's trip to Guy's. If ministers really cared about hospital infection rates, they wouldn't be rolling up their shirtsleeves: they'd be demanding an increase in the number of hospital beds. So well done to David Nunn for speaking out. I hope that wherever he is and whatever he's doing, he's back at work soon, because we need more doctors like him in the health service. All power to his bare elbow.