Infection Control within the NHS
It was just last week, during a speech to Trafford general hospital concerning the history and future of the NHS, that David Cameron announced his party’s ideas for a more effective means of controlling the spread of infections.
The premise, at its most fundamental, is to financially penalise hospitals for every patient who contracts a superbug during the length of their admission. In direct response to this declaration the British Medical Association warned that such a punitive system would discourage hospitals from treating vulnerable patients.
“How are you going to manage people on chemotherapy, who often get infections during the course of their treatment? Are you just not going to have them in the hospital?”
In one sense the BMA has a point. Some illnesses and pharmaceuticals can weaken the immune systems of many patients in hospital, rendering them much more susceptible to infection. Diseases such as leukaemia can invade bone marrow, the site of most white blood cell production, inhibiting immune response, whilst similar symptoms are experienced every day by those persons suffering from HIV and AIDS. In some circumstances the latter can completely eliminate the efficacy of a patient’s immune system.
Further, given that Britain’s elderly population is expected to expand at an ever-increasing rate over the coming decades, currently accounting for around 72 per cent of all social care clients, it is imperative that recognition is given to the growing burden that older people place on health and social care services. Not only does the human immune system deteriorate with age, but some of the more basic physical symptoms empirically attributable to infectious diseases are simply absent in older people making it very difficult for medical practitioners to establish the presence of an illness.
Accordingly, Conservative proposals may prove very difficult to implement and monitor in practice. Firstly, it would mean penalising important hospital departments, such as Sexual Health and Oncology, when a patient contracts an infectious illness as a result of their health complaint. Second, I imagine that distinguishing hospital-contracted infections from those contracted elsewhere would be a problematical task. It will be obvious that those patients who are long-term bed users will have likely contracted an infection during their admission, but for those patients who stay for a shorter period or perhaps only visit as part of regular consultation, the picture is not so clear.
Take for example a patient with AIDS who has been visiting a sexual health consultant on a weekly basis for over five years ago. During one consultation it becomes apparent that the patient’s health has deteriorated due to the Clostridium difficile toxin.
Given that such bacteria are found in the intestine of three per cent of adults and two thirds of infants, how much time and money is to be spent in proving whether or not the infection occurred within the confines of the hospital? Is it even feasible? Clostridium difficile can cause health complications due to a wide range of uncontrollable externalities.
However, the BMA’s statement does not get my complete approval. It implies that poor-performing hospitals with high infection rates will consciously avoid admitting those persons who are or may suffer an immuno-compromising condition during their stay. This simply would not happen.
The NHS Hospital Trust is directly responsible for the actions of hospitals and is in turn accountable to the government, an institution answerable to society. This hierarchical transparency, an obligation under law and the Hippocratic Oath are such that discrimination on the grounds of illness ought to be avoidable.
Regardless, I stand by my view that while financial penalties might in some circumstances incentivise and hasten a drive toward efficiency and cost-cutting, it does not necessarily harbour a culture of best practice. Instead it can breed contempt and disaffection amongst professionals toward managers, the Operational Framework and ‘the system’ in general. A quick read of Random Acts of Reality, a website written by an employee of the London Ambulance Service, will tell you that. To reduce a hospital’s budget for being unable to attain a number of performance targets only makes it more difficult for a hospital to achieve success in the following year.
Within the field of social care there exist solid publications documenting the standards that need to be met in order to ensure a safe and clean environment for service users. There exists also a methodology behind effective infection control within health and social care settings (see Essential Steps to safe clean care: reducing healthcare-associated infections, and National Minimum Standards).
By my interpretation, these documents are comprehensive and practical, with the Essential Steps framework and monitoring tools due to be rolled out shortly. What is great about the Essential Steps document is how flexible the framework is, allowing departments to adopt and adjust certain aspects of the framework based on local needs, existing financial pressures and structural impediments.
It is my opinion that such simple yet constructive documents as Essential Steps should certainly be made obligatory, but with time-scales set just as locally and realistically as the procedures contained within them. Setting a national time frame will not suit all hospitals, forcing some to redistribute funding from more vital areas, rushing the implementation of policies to avoid incurring a hefty fine.
As such, consideration must always be given to the fact that delays in the adoption of new and effective practices can occur for an assortment of reasons: from poor communication and mismanagement through to a hospital simply lacking the funds with which to implement them. These are the issues that need to be examined and highlighted all throughout the period of a policy’s locally set implementation in order to weed out poor practice and inefficient structures. I don’t believe that standardised, per head financial penalties can do this as effectively.
The Conservatives criticise the government for its apparent fanatical proclivity toward statistics and performance targets, which, they argue, do little to cut costs and improve the quality of care. While this is perhaps true, patients may receive no better deal under Conservative proposals. Both parties are eager to communicate to the public that their idea is the better, but both proposals centre around tight performance figures with little consideration to the quality and efficacy of care and infection control practices.
So, rather than taking money from a hospital when something goes wrong, perhaps the local Primary Care Trust should concentrate on ascertaining exactly why the infection happened on a ward in the first place - be it that a policy wasn’t properly implemented or that the policy itself is flawed - and then work with the hospital on fixing the problem. In so doing, these problems require assessment through a locally established partnership between the PCT, hospital management and the ward, and not punished through a system of centrally set capitation.
Title photograph taken by The Lewisham Hospital NHS Trust
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2 Responses to “Infection Control within the NHS”
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I enjoy your posts about social policy a great deal. Yet in recent months I have noticed they tend to devote their time to criticising those that are trying to introduce new ideas (i.e. the Tories), while promoting the tried, tested and failed ideas of socialist Brown.
Therefore i ask, if the Tories are so bad - then what would CK do?
If it’s any consolation, the post was originally noted in my work’s folder to be a pro-Tory article. It was actually chosen in the first instance because David’s announcement piqued my interest in a positive way. It even begun:
“I hope you’re sitting down: I’m about to show support for David Cameron and lambast the dogmatic institution that is the British Medical Association”.
Oddly, while writing the piece, additional issues came into my head. Primarily that I am sceptical of the view that financial punishment can bring improvement, especially not for the right reasons and while instilling the right attitudes in professional staff. Apart from this and the implications surrounding the policy’s inception, it’s by no means his worst suggestion.
Similarly, the fact that the Labour party proposed an almost identical agenda (before the Tory announcement, I should add), makes Labour’s policy on infection control equally as flawed.
The post has been amended to take this into consideration.