As you probably know, between 2003 and 2005 there was an outbreak of C.Diff. at Stoke Mandeville Hospital in my constituency. More than 30 people died and more than 300 were infected. The source was a particularly virulent strain of C. Diff. known as 027. It cannot be eradicated by hand gels. Prevention requires hand washing. Patients need to be nursed in isolation and wards and rooms vacated and cleansed to get rid of the 027 spores.
The Healthcare Commission published a report into Stoke Mandeville. It was very critical of the local management and both the Chairman and Chief Executive stepped down shortly before the report was published. However, when I read the report what stuck out a mile was that the hospital managers were working on the assumption that the Department's financial and waiting time targets had to be put before everything else and pressure on beds (to meet those targets) meant that it was not possible to isolate patients or vacate infected rooms as should have been routinely done.
The Government knows that this tension existed. In April 2005, the Public Accounts Committee reported that :
10. There is evidence that wider factors such as bed management policies and the
need to meet waiting times targets can compromise infection prevention and
control. Seven out of ten trusts are still operating with bed occupancy levels higher than the 82% that the Department told our predecessors it hoped to achieve by 2003–04. Trusts need to reduce bed occupancy levels and to adopt more effective bed management practices which avoid patients moving too
11. In 2001 the Department assured our predecessors that the need for isolation
facilities was being addressed, yet only a quarter of the 56% of trusts that had
undertaken a risk assessment to determine the number and quality of isolation
7 facilities had obtained the required facilities. Strategic health authorities should
ensure that all NHS Trusts have carried out a risk assessment of their isolation
facilities, in line with Health and Safety legislation, and work with them to determine a timetable and resourcing strategy to address identified shortfalls in requirements.
12. The Comptroller and Auditor General’s Report noted that 12% of infection
control teams reported that their recommendation to close a ward or hospital
to admissions for the purpose of infection control had been refused or discouraged by their Chief Executive. NHS trusts should inform their strategic health authorities when a recommendation to close a ward is refused. Strategic health authorities should ensure that these incidents are recorded and should work with trusts to identify ways of minimising the impact of such closures.
(PAC 24th Report of 2004/2005 Session, HC 554, "Improving Patient Care by Reducing the Risk of Hospital Acquired Infection: A Progress Report")
Soon after the Stoke Mandeville outbreak was made public, I was tipped off by senior NHS staff that Stoke's case was far from unique and that C. Diff. was a growing problem throughout the Health Service. In June 2005, I asked Patricia Hewitt to extend the scope of the inquiry into Stoke Mandeville to cover every hospital in England where the 027 strain had been found. The Government declined to do so but said it "hopes best practice would be shared across the NHS".
We now know that C. Diff. is a serious threat to patient safety in many NHS hospitals. Even after many years in politics, I have been shocked by the Government's complacency about this crisis, and its sloth in taking effective action.
In 2006, there was still only one laboratory in the country, the Anaerobe Reference Laboratory in Cardiff, that was able to analyse C. Diff. samples and identify particular strains. There only a random selection of patient samples were being analysed. There was no comprehensive analysis of samples from patients who displayed C. Diff. symptoms. I would like to believe that things have now improved, but I fear that it takes a scandal as great as that at Maidstone to shake the Department of Health out of its obsession with targets.