Oct 2007 12

Hospital infections at Maidstone & Tunbridge Wells NHS Trust8

The news from Kent is truly shocking.  In the face of financial problems and in an effort to meet government targets a clearly incompetent management presided over hospital infections that the Healthcare Commission say directly killed at least 90 patients and may have contributed to the deaths of 331 people.  Some of the anecdotal evidence is, perhaps, even more shocking:

"Nurses did not have time to wash their hands properly, and left patients to lie in their own excrement because they had not been able to assist them to a commode.  The report found that shortages were so dire that nurses told patients to "go in their beds"."

An undercover reporter found:

Hosp_2_2

"On my first day as I emptied bins, swept and mopped I noticed old blood stains ingrained on the floor.

I also saw unlocked sharps bins containing used needles lying in corridors – I was never told where to store them or how to handle them.

Clinical waste skips, which contain bags full of old dressings and bodily fluids, were left open in corridors used by visitors and patients, even though the hospital’s own policy says they should always be locked.

The clinical waste skip I had to use also filled up quickly so rubbish bags had to be left on the floor – when I asked a supervisor what to do with them I was told to leave them beside the skip.

In A&E’s operating theatre, a blood-stained gown was left on a trolley for 24 hours and used medical instruments were discarded in a sink for a day."

There are two things we need to understand when considering the meaning of this shocking story.  First, when the Health Secretary, Alan Johnson, says this:

"Mr Johnson told BBC Radio 4′s Today programme this morning that the Kent outbreak was an isolated incident."

He is either fudging the issue or outright lying.  While the scale of the outbreak in Maidstone & Tunbridge Wells is exceptional the scandal of hospital infections is not confined to that NHS Trust.  In 2000 the National Audit Office estimated that 9 per cent of hospital inpatients have a hospital acquired infection at any one time.  That number is probably even higher today.  In recent years, the number of deaths from C. difficile infection has spiralled, as this graph from the Office of National Statistics shows:

Cdiffdeaths
Even these shocking numbers, way above the 540 who die each year from – for example – drink driving, may well be an underestimate of the true scale of the problem.  In the case of Maidstone & Tunbridge Wells the Trust was clearly either genuinely clueless or outright dishonest about how it presented the statistics.  The Trust told the Healthcare Commission that no deaths had definitely been caused by C. difficile between April 2004 and March 2006.  The Healthcare Commission did a quick sample of 50 patients who had died and had contracted C. difficile and found that in 26 per cent of cases it was definitely or probably the cause of death and in 78 per cent of cases definitely or probably contributed to the patients’ deaths.

With 55,364 per year being infected by C. difficile the true number of deaths caused by the disease could easily be higher than that shown in the graph above.  The graph also only shows C. difficile and not other, sometimes lethal, hospital infections such as MRSA.

Broader questions should also be asked about the implications of such a massive a disincentive to go to hospital when a large part of Britain’s poor cancer survival rate, for example, is blamed upon late diagnosis.  Is part of that due to an unwillingness to go to hospital and run a big risk of contracting a new illness while you are there?  If they are contributing to people delaying a visit to hospital when they feel ill the true number of deaths caused by hospital infections could be even higher.

Hosp_6

Second, we need to understand that these problems stem from the way the NHS is organised.  The health service has had huge increases in its budget – the problem is not a basic lack of money.  Political management contributes to the problem of hospital infection in two key ways:

There have been five Health Secretaries since 1997 (Frank Dobson, Alan Milburn, John Reid, Patricia Hewitt, Alan Johnson).  This lack of long-term leadership, which leads inexorably to a myopic management culture, explains how Rose Gibb, chief executive of Maidstone & Tunbridge Wells NHS Trust was able to get away with repeated public assurances that she had the problem under control over a period of four years.  Instead of insisting that rapid progress be made in reducing the number of patients killed by their hospitals each Health Secretary since at least 2000 (when the National Audit Office found hospital infection on a massive scale) has passed the issue on to their successors.

In order to measure and understand progress in overgrown, bureaucratic public services politicians have to use simplistic statistics.  These are the targets which form the basis of politicians’ demands for results.  Too many weak-willed managers bow to the pressure for certain targets, such as the reduction of waiting lists, to be prioritised and this leads to the exclusion of basic measures like ensuring proper hygiene.  No manager wants to risk the ire of politicians who see them failing to make progress on key targets.  The Healthcare Commission describe how the target that no patient should be in A & E for more than four hours had taken priority over controlling infection even during outbreaks of C. difficile.

While politicians might be able to improve the NHS’ record on hospital infections if they make that the new obsession for the target culture only fundamental reform of the NHS will lead to the balanced management priorities that the service needs.  While it might be possible to stop Rose Gibb’s generous severance package without accountability at the top the NHS will remain slow to respond to new problems.  Only when politicians get out of management and the health service is put back under the control of patients will we see real improvement in British healthcare.

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  • Graeme Pirie

    There’s a lot to learn from incidences like this, and not only the target culture. We are of course debating this with only information from the media but the basic principles are the same.
    The main thing of course is that this seems no less than corporate manslaughter, as such it MUST be properly investigated and individual charges brought where appropriate. There is a habit of ignoring things like this in the public sector, or issuing company fines. Public services must be treated exactly the same as private companies except that fines must be limited, after only it’s “only” taxpayers money that pays the fines. Individual responsibility and the consequences that go with that must be brought in.
    Secondly there is a tendency to blame the target setting culture, targets are a valuable management tool, the real issue (and this is the case with all public services), is the interpretation and implementation that the management of that service put on targets, targets must not be the only measure and action should be taken against managers “fiddling targets” – for example my GP only allows appointments to be made on the day they have a vacancy – clearly abuse of the system. Targets must be taken in the spirit they are set – i.e. to improve services.
    Management of public services must be investigated. From what we read of this case, the CEO should have been dismissed for gross misconduct – not allowed to “quietly go” with a sack full of taxpayers money. Therefore those responsible for the management of senior employees, in this case the trust, must be brought to book for poor management.
    Finally lets recognise that the blame is shared by every single person working in these hospitals. Hundreds of doctors, nurses, managers KNEW that patients were lying in filth etc. There’s no excuse and they should all be hanging their heads in shame. Stop blaming everyone else and take responsibility for your own workplaces.

  • http://profile.typekey.com/HenryMorgan./ Sir Henry Morgan

    In answer to an issue you raised in the main post:
    My GP recently referred me twice to a local hospital for two separate problems. I didn’t turn up for three reasons, one of which is this issue of hospital acquired infections.
    As a man in my middle-fifties I really should be keeping closer track on my condition – but I will not take the chance. This is not negotiable in present hospital circumstances. No doubt I will be described somewhere in writing as being in “morbid fear of hospitals” (i.e. psychiatrising a perfectefly reasonable attitude. Getting more like the old Soviet Union by the day).
    One of the remaining two reasons is the steady absorption of the NHS into the emerging surveillance society. I’m even reluctant to see my GP.

  • http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/10/12/nbugs212.xml Sick as a Parrot

    Interesting how the Chief Exec of this NHS Trust appears to have a history re poor trust performance and cleanliness:
    http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/10/12/nbugs212.xml
    NHS “safe in our hands” – who is the Government kidding this time?

  • Alred of Wessex

    Medical negligence on this scale is almost unbelievable! It is the medical hygiene equivalent of ‘clogs to clogs in three generations’. Have our medical ‘profession’ forgotten everything that Florence Nightingale and subsequent generations of nursing pioneers learned the hard way?
    The Nazis used gas chambers to eliminate people they had no use for, Stalin mass executions, mass deportations and the Gulags, Mao the Cultural Revolution, and Pol Pot the Killing Fields.
    New Labour allows the sheer incompetence, greed and mendacity of Chief Executives of NHS Trusts to cut short the lives of those who have contributed most and longest to this country!
    We are back to people being frightened of going into hospital for fear of what they might catch and die of. My wife’s grandmother feared hospitals for the same reason: hospitals were places you went to die.
    Have we forgotten everything the last two generations learned?

  • CHRISTOPHER LUKE

    As a citizen of Tunbridge Wells – if not, contrary to popular opinion, the original “Disgusted” – one feels that the latest scandal from the Maidstone and Tunbridge Wells NHS Trust confirms why we should cease calling the NHS a “National Health Service” but, instead, refer to it as the “Nationalised Health Shambles”.
    The NHS remains the largest public sector employer in the whole of Europe. For all that the Thatcher Government very commendably privatised many hitherto nationalised industries and rolled back the frontiers of the state in other spheres, contrary to popular belief the Thatcher Administration actually increased public spending on the NHS and continued to feed this, the most sacred cow of socialism.
    Surely to God, after all this time, it is clear that the state – as a “provider” of health care – has failed to provide what it purports to supply, and we need a fundamental shift away from state provision towards greater private sector provision of medical treatment and self-help to radically the size and influence of the state in the provision of primary and secondary health care.

  • http://www.henrynorthlondon.blogspot.com Henry North London

    Chief executives are well skilled at lying and covering up.
    It seems to be a common theme.

  • http://www.drrant.net Dr Blue

    One of an NHS chief execs main functions is to fall on their sword at appropriate times. The blow is cushioned by an escape clause and payoff in their contract.
    NHS chief execs are usually recycled to some other agency or consultantcy work. There is no equivalent of the GMC or nurses UKCC that can remove for ever their right to practise.
    The NHS operates on Central credit local blame. Hewitt was quick to claim the plaudits for NHS trusts balancing their budgets. She won’t be seen at all commenting on cases of C.Difficile that result from time stress, target stress, overcrowding of beds, over occupancy, excessive managers, and too few real nurses on duty.

  • Pete B

    Even before this government lost my data this time round, my NHS records had gone missing (about 10yrs ago).No-one but me is too bothered, I wanted to know if my anti-tetanus was up to date. “Don’t know, we’ve lost your records!” Nice.
    Recently, I went to see my GP (mid 50′s concerns) and asked about stopping smoking. Now my daily habit is on his database, without my permission. I wonder who’ll get that info? The insurance companies? Just like the gentlemen above, I am really reticent about any visits to my health practioners. Abuse of my personal data, in-house infections? No thanks.
    Anyway, what do I know? I’m just another cash cow.