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:
"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:
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.
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.