Hospital chiefs cannot wash their hands of blame

Published on Thursday 7 August 2008 21:28

BETWEEN December 2007 and June 2008, there was a serious outbreak of infection from Clostridium difficile bacteria at the Vale of Leven hospital in Dunbartonshire. As a result, 55 patients were infected and 18 subsequently died. This was the worst single outbreak to date of C diff inside NHS hospitals in Scotland, though some 285 deaths have been linked to the infection during the same period as the outbreak at Vale of Leven.

Yesterday, an independent report into the C diff infestation at Vale of Leven concluded what has long been suspected – the scale of the infection and the tragic loss of life were largely the result of poor hospital management. In other words, this catalogue of misery could have been avoided.

Many of the errors were elementary: the report criticises inadequate hand-washing facilities, a lack of toilets, inappropriate spacing between beds and insufficient storage space to allow effective infection control. Some of this can be attributed to the fact that Vale of Leven had been slated for closure for a decade, and (in the words of the report) "uncertainties over the longer- term future had led to lack of investment in the upgrading and maintenance of the hospital". That was bad enough, but it does not excuse an apparent lack of professionalism by the hospital's administration.

For instance, and most crucially, "local systems did not allow the detection of the increased numbers of (C diff] cases over the period". In other words, though the hospital's lab had identified the individual infections, the monitoring procedures did not alert staff to the fact a major outbreak had occurred. That has now been rectified, but it suggests a singular managerial failure at Vale of Leven which is hardly justified by the doubling of NHS spending in the past decade, much of it on salaries.

But there is more. How did the outbreak occur? C diff is passed through poor hygiene and through the over-use of antibiotics. But at Vale of Leven, instructions for visitors regarding hand-washing or touching patients "were unclear and vague"; while there was "no active monitoring of the implementation of antibiotic policies or feedback on usage to clinical staff". Again, this seems to reflect a weakness in local management.

No-one wishes to turn the NHS into an American-style arena for medical litigation, where staff are afraid to do their jobs. But equally, the spread of C diff and other hospital infections is avoidable. In the case of Vale of Leven, some of the most elementary precautions against disease were not taken. Those responsible for such errors should resign.

It is imperative that the human failure at Vale of Leven does not recur. Procedures governing hospital infection control must be standardised throughout Scotland and subject to certification. As for Vale of Leven hospital itself, a further report is required to assure the public that infection control has been improved on a permanent basis.

Who'll save us from LIT?

WHO wants a local income tax (LIT)? Especially the SNP's idea for a centralised levy of 3p on the standard rate of income tax just as the economy is heading for recession? If the Scottish Government's public consultation on its LIT proposal is anything to go by, the answer is: "Hardly anyone". The idea was shot down in flames by the business community and academic experts.

But the SNP feels it has a mandate to get rid of council tax, and so it is now hoping to do a deal with the Liberal Democrats, who are also (in theory) in favour of some sort of LIT. The Lib Dem objection to the SNP model is that it is levied by Holyrood and so is anything but local. Which means the SNP might have to adopt the Lib Dem idea for a LIT if it is to rescue the idea. Unfortunately, the Lib Dem concept is even more unworkable than the SNP's. This would see each of Scotland's 32 local authorities setting its own LIT. Would such a tax be levied by where you work or where you live? What would HM Revenue charge to manage this complex system? And will the Lib Dems insist the LIT is applied to investment income, thus hurting savings?

Whatever the problems with the council tax, a LIT has even more anomalies – which is why most experts want to keep some sort of local property tax. The new Lib Dem leader in Scotland must save us from LIT, be it the SNP's or something cobbled together in an SNP-Lib Dem committee.

Research that puts us to shame

A ST Andrews University graduate made history by appearing on Who Wants To Be A Millionaire? without winning a penny. Michelle Simmonds, who has a business degree, could not answer the ludicrously easy questions at the start of the quiz. For 1,000, she was asked which word links a mammal with an archbishop: a) carnivore, b) rodent, c) primate, or d) marsupial? Ms Simmonds chose marsupial rather than primate. Her comment on making a fool of herself on national television was revealing: "I'm gutted – because of the embarrassment, not the money."

Now, at long last, St Andrews University is coming to the rescue of all of us who, at one time or another, have found ourselves blushing in public. Scientists are conducting a major research project on the social mechanics of embarrassment. The study will involve volunteers doing silly things in public to monitor the physiological results of acute embarrassment, including blushing. In particular, the researchers want to know if we feel more embarrassed by making a faux pas in front of strangers than with friends.

The answer to the latter question depends, of course, on the particular incident. Telling the boss what you think of him while drunk at the office party is very different from throwing up at your own birthday party. Unless, of course, your friends post your picture on YouTube.