Wednesday, 17 October 2007

Clostridium difficile - whose fault?

I know of no one who has not been appalled by the story emerging from Kent of the outbreak of Clostridium difficile infection which has affected so many mainly elderly patients, and killed a substantial number.

But it emerges that the situation in many NHS Trusts is not so different.According to the official figures from the Health Protection Agency ( during the period January 2006 to March 2007, there were the following number of cases of C difficile infection:

Maidstone : 542
Kettering Hospital : 757
Luton and Dunstable : 477
Bedford Hospital : 485

I quote these hospitals just because they are local, but it is clear that there is a huge national problem in the English NHS. I say English, because curiously Wales has not been similarly affected. Why is this? As far as I am aware Offa’s Dyke and the River Severn have no magical antibacterial properties, and indeed in parts of the West Midlands it is routine for English patients to be admitted to Welsh hospitals and vice versa.

There is only one obvious difference between hospital medical practice in England and in Wales, and that is that in England there has been a rigid application by hospital managers of waiting list targets.The impact of this obsession with targets is that there has been an insistence on admitting non urgent patients even when there is a bed shortage, and even when wards are contaminated by infected patients. Wards were not designed for occupancy rates close to 100%, and the reason for this is that when occupancy rates rise, so does the risk of hospital acquired infection.

The real tragedy is that all this misery could and should have been avoided; contrast the sorry situation relating to C diff with how the recent outbreak of Foot and Mouth Disease has been handled. Infected animals were immediately isolated, movement of animals was stopped, and the situation resolved itself. Obviously we can’t cull patients, but it seems obvious that when there is an outbreak of hospital acquired infection, the first thing to do is to stop admitting non-urgent cases.

So who is to blame? I appreciate what appalling pressures managers were placed under by their political masters; they were told, as I understand it, that if they didn’t achieve their targets that they would be fired. Equally, ministers were probably too stupid to understand the consequence of their actions. The people who I blame, were, firstly, the Chief Medical Officer, whose duty it is to explain the potential implications of policy to politicians, and secondly the Medical Directors of hospital trusts, whose duty it was to explain the dangers to hospital managers. Perhaps it is time for a few of them to be sent to the GMC for failing in their duties

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