Ad description

A national press ad for UNISON stated "SHOULDN'T YOUR SAFETY COME BEFORE PROFITS? ... The government plans to allow more private firms to profit from vital public services, like policing, the NHS and social care … This could put you and your family at risk … And where hospital cleaning has been outsourced, we have seen jobs cut and a rise in hospital infections".

Issue

The complainant challenged whether the claim "And where hospital cleaning has been outsourced, we have seen … a rise in hospital infections", was misleading and could be substantiated.

Response

Unison told us the ad was paid for, as required by their rulebook and the law, by their General Political Fund which funded political activity, political campaigning and advertising. They said the law required trade unions to use only dedicated funds to pay for political campaigning. They said that because they used advertising as part of their political campaigning work, to influence opinions and voting intentions, the ad did not fall within the remit of the CAP Code or the ASA.

The advertiser said they did not claim that hospital cleaning was the sole cause of a rise or subsequent fall in infection rates, merely that where it had been outsourced they had seen a rise in infection rates. They said the statement was included as one example of concerns raised and widely discussed around the impact of contracting out and privatisation during the course of various governments' outsourcing and privatisation regimes. It was used as an example to show that further privatisation of other public services may put service-users at risk.

In order to substantiate the claim Unison supplied several web-links. They explained that the previously anecdotal evidence of a rise in hospital acquired infections since the introduction of compulsory competitive tendering for hospital cleaning services in the early 2000s, was confirmed by the introduction of comprehensive infection rate monitoring. They said the rise of two super infections, Methicillin-Resistant Staphylococcus Aureus (MRSA) and C-Difficile which peaked in 2004 and 2006 respectively, was confirmed by two official government reports.

Unison explained that the link between the peaks and outsourced hospital cleaning could be substantiated with additional government reports, parliamentary question and answers and independent publications. They said data from an NHS Freedom of Information request identified that 75% of the worst cleaning services were outsourced and the House of Commons Public Accounts Committee had raised concerns about cleanliness standards in hospitals. They said this was further supported by a review of management services in hospitals that found concerns about the quality of contract cleaning and this was hampered by an over-reliance on poorly paid contract cleaners who were unlikely to have an allegiance with the NHS.

Unison said they had seen evidence of the wider impact on the NHS in terms of a rise in hospital infections due to the contracting culture and there was a large degree of political consensus about falling cleaning standards as a result of contracting out.

They explained that in 2001, the previous Labour government ended compulsory competitive tendering of cleaning services in the NHS because of falling standards. This, they said, was supported by a government minister who said competitive tendering had reduced costs rather than improved quality.

Assessment

Upheld

The ASA noted Unison's assertion that the ad fell outside the remit of the CAP Code. However, because its principal function was not to influence voters in a local, regional, national or international election, we concluded it was subject to the CAP Code.

The various documents supplied by the advertiser included detail about cleaning services and the concerns raised within and outside government and the Department of Health. We noted the documents provided information about the quality of cleaning in hospitals that contracted this service out which also cited statistics about MRSA, C-Difficile and infections in general but did not directly compare actual infection rates between hospitals who contracted out cleaning services with those who did not.

We understood that cleaning could be one element used to combat hospital infections. However, several of the documents discussed cleaning in general but also took into consideration overall tidiness of the physical environment as well as how engaged contracted staff were in the overall maintenance of the care setting. The documents also highlighted policies that successive governments had introduced to address the various issues around the increase in infections. We noted they included additional variables which could contribute to the increase in nosocomial infections such as antibiotic resistance, staff hand washing, patient movement, bed occupancy and the role of infection control teams. Therefore, we concluded that cleaning services were only one variable likely to influence infection rates.

We noted Unison's assertion that the ad did not claim hospital cleaning was the sole factor that influenced hospital infections. However, we disagreed and considered that the claim implied a direct link between outsourced cleaning and an increase in hospital infections. We also noted the dates of the documents ranged from 2001 to 2010 but considered consumers were likely to expect the claim to be based on up-to-date statistics relevant to the time the ad was published.

We understood infection rates were officially collated and published online and were collected from a range of healthcare providers. However, we understood the statistics showed a fall in specific hospital infections over the past reporting year, but were not separated by hospitals that contracted out cleaning services and those that did not.

Because Unison had not provided evidence that directly attributed a rise in hospital infections to the use of outsourced cleaning services, we concluded the ad was misleading.

The ad breached CAP Code (Edition 12) rules  3.1 3.1 Marketing communications must not materially mislead or be likely to do so.  (Misleading advertising),  3.7 3.7 Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove claims that consumers are likely to regard as objective and that are capable of objective substantiation. The ASA may regard claims as misleading in the absence of adequate substantiation.  (Substantiation) and  12.1 12.1 Objective claims must be backed by evidence, if relevant consisting of trials conducted on people. Substantiation will be assessed on the basis of the available scientific knowledge.
Medicinal or medical claims and indications may be made for a medicinal product that is licensed by the MHRA, VMD or under the auspices of the EMA, or for a CE-marked medical device. A medicinal claim is a claim that a product or its constituent(s) can be used with a view to making a medical diagnosis or can treat or prevent disease, including an injury, ailment or adverse condition, whether of body or mind, in human beings.
Secondary medicinal claims made for cosmetic products as defined in the appropriate European legislation must be backed by evidence. These are limited to any preventative action of the product and may not include claims to treat disease.
 (Medicines, medical devices, health related products and beauty products).

Action

The ad must not appear again in its current form. We told Unison to hold robust and specific evidence before making claims related to contracted-out cleaning services and hospital infections.

CAP Code (Edition 12)

12.1     3.1     3.7    


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