Thursday, October 11, 2007

NHS Hospital Killings

Spiralling deaths from Clostridium difficile (E&W: see here)



The most appalling thing about this morning's news from Maidstone is that it will not be a shock to the customers of many NHS hospitals:

"Appalling standards of care and a catalogue of failures contributed to the deaths of 331 patients in the worst outbreak of a hospital superbug ever recorded in the NHS, a report has found.

Crowded wards, a shortage of nurses and financial problems led to 1,176 people contracting Clostridium difficile over two and half years at three hospitals in Kent.

Though the superbug was rife on the wards, managers failed to act. Isolation units were not set up, nurses were so rushed they did not have time to wash their hands and patients were left in soiled beds. Bedpans were not decontaminated properly and beds were not cleaned as well as they should have been."


Harrowing, disgusting and entirely avoidable. According to clinicians, C Diff is wholly preventable, but only if hospitals are properly run.

The vacuous Johnson has just been on BBC R4 Today claiming it's nothing to do with him guv, or the government, or their top down targets on A&E waiting times etc. After all, they've set out all necessary procedures in a 15,000 page manual, which all hospital staff should have read, memorised, and implemented. The Commissars have clearly discharged their responsibilities, and their hands are clean.

Except of course, the real world isn't anything like that pie in the sky. Rewind the tape and read it slowly:

"Though the superbug was rife on the wards, managers failed to act. Isolation units were not set up, nurses were so rushed they did not have time to wash their hands and patients were left in soiled beds. Bedpans were not decontaminated properly and beds were not cleaned as well as they should have been."

Just as we saw during Gerry Robinson's hospital visit, NHS hospital managers don't actually manage. Sure, they do loads of stuff- ticking boxes, establishing protocols and pathways, slashing budgets, closing wards, and imposing all kinds of irrelevant bureaucratic burdens. But they don't actually manage, in the sense of making sure their operations are working properly in terms of looking after sick people.

We've mentioned before that Mrs T's 92 year old father is currently in an NHS hospital. It is a very large teaching hospital, and it describes itself as "a flagship". The trust boasts (literally) 10,000 staff and an annual £500m turnover. It will have seen a rough doubling in its budget since 2000.

Yet the conditions on the wards are disgraceful. Yes, there a lumps of shiny new kit, but they're bobbing around in a shambolic third world setting.

Long gone is that traditional hospital smell of antiseptic, replaced by the overpowering smell of bodily functions. The wards are untidy and dirty: you notice your feet sticking to the floor and indeed Mrs T has taken to going equipped with anti-bacterial wipes to swap down the surfaces around her Dad.

Staff? Yes, there are loads of them, and overall, they seem to be caring types. But their time is largely taken up with pressing affairs that have little bearing on old-fashioned patient care. Reams of paperwork, lengthy shift "handovers", general milling around the "nursing station", timetabled breaks, and other tractor production duties we outsiders can only guess at.

Patients who can't get out of bed and are dependent on their call buttons are routinely left shouting for help. Tyler spends much of each visit tracking down nurses for those who need them.

There's one Big Conclusion that screams out of the shambles- nobody's actually in charge. The photo organogram on the wall vaguely hints that the three people at the top might be in charge, although even that's unclear. Anyway, didn't the Roman Empire prove some time ago that organisations need one boss?

Much more fundamentally, our guargantuan top-down NHS still suffers from its terminal mismatch between power and responsibility. The real power- the money power- is still kept firmly at the top, which is why the top is still able to operate its hopeless dysfunctional command and control system (eg Bottler's headline grabbing "deep clean" order).

In Tyler's experience, management by "protocol"- of which there seem to be hundreds on the wards- always betrays a lack of trust at the top in the judgement of those at the coalface.

The trouble is, once you remove power from the coalface, you can't then insist a la Johnson that the coalface still bears responsibility (Tyler's Second Law- head honchos can delegate power, but they can never delegate responsibility).

With power and responsibility out of whack, our hospital wards are much more dangerous than they were when Sister ruled with a rod of iron, and Tyler's Mum nursed in the clean, disinfected, orderly wards pre-Bevan.

And these terrible deaths are part of the price we're paying.

PS Camilla Cavendish has an excellent article on the NHS "maw" in today's Times. Highlighting the way the sacred NHS is gobbling up a bigger and bigger share of public spending, she points out that our politicos are still scared to tell the truth- ie that choice and competition is the only way forward, and that means breaking up the entire tax-funded nationalised free-at-the-point-of-use Soviet system. Precisely echoing our experiences, she also says : "Far too many patients, particularly the elderly, are treated with a callousness bordering on brutality. Almost everyone I know who has had a baby recently has been told by the nurses to bring their own Jif, and not to set foot in an NHS shower without scrubbing it. World-class that isn’t." (htp HJ)

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