Of all the many lessons to be learned from Lord MacLean’s inquiry into why 143 patients at the Vale of Leven hospital in Dunbartonshire were infected with Clostridium difficile (C. diff) between 2007 and 2008, causing the deaths of at least 34 people, the biggest is that good buildings and good management of medical services are as important as good doctoring.
Excellence in all three aspects of hospital care is essential to ensure sick people get well. But Lord MacLean found that all three were defective, enabling the C. diff infection to take hold, causing severe pain and suffering that no patient or their relatives should have to endure.
Newly appointed health secretary Shona Robison accepted there had been a lack of investment at the hospital, which meant it was not fit for the purpose of hospital care. That was partly because there was uncertainty over whether the hospital had a future, which also affected its management.
Lord MacLean identified poor leadership amongst the managers at NHS Greater Glasgow and Clyde health board as contributing to poor nursing care and the hospital having not enough doctors. That meant the consultants were stretched too far and junior doctors had too much responsibility. This caused medical mistakes to be made, most particularly in the prescribing of antibiotics. Wrongly applied, they can make C. diff infections worse.
Any one of these faults occurring in any one hospital would be bad enough. But for all three to happen is simply appalling. It is the kind of picture you might fear to find in a less developed country, but not surely in a developed nation such as Scotland. Even with the benefit of Lord MacLean’s report, it is still hard to understand how it came to be.
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An inspection regime such as the one which now operates would certainly have helped identify problems earlier. But even with that, the report still leaves the troubling thought that current financial pressures on the NHS are such that some gaps in infection control may be opening up.
Ms Robison must therefore make sure that Lord MacLean’s 75 recommendations, all of which she has accepted, are indeed as fully implemented as she intends they should be. She still, however, has one question to answer.
This report has been published some six to seven years after the original outbreak. The families of those who died had to campaign for the inquiry which led to it, which is the principal reason for the delay. Now they have had some justice, but as it is justice delayed, they may feel it is justice denied.
This, too, is highly unsatisfactory. When things go wrong, especially in the medical environment, knowledge of exactly what went wrong is vital to prevent it happening again. Ms Robison should look at whether it is possible to put in place procedures so lessons can be learned sooner to be more effective.
Murder mystery may yet be solved
ON A chilly November evening ten years ago, Veronica Wilson answered a ring on her doorbell in Nairn and a man asked to speak to her husband, Alistair, a bank manager. He went to the door and was shot dead. Apart from the unusual, German-made, pre-1945 handgun used in the killing, which was later recovered, little more than that is known.
That brief instant of violence, the terrible outcome and the empty desert of understanding surrounding it ever since is chilling. It is also extraordinary to learn that, in times when forensic science has advanced to remarkable levels, and cameras in the streets of most towns are customary, there is apparently no forensic trail nor any useful CCTV recordings.
The pain of Mrs Wilson and her two sons will never leave them and must be especially acute on every anniversary of the murder. Finding the culprit would help a little, but that prospect seems as remote as ever.
The police are, however, reviewing the thousands of pieces of evidence and statements that were taken in the hope of spotting a pattern or seeing something in a different light that may allow them to make progress.
Detectives are convinced that someone, somewhere, and maybe not just the killer, knows why the shooting happened. The family believes that too and fears that, as long as he goes undetected, he may kill again, just as callously, leaving another grieving family.
Between advances in forensic science, new eyes seeing evidence or a statement in a novel way, or just the pricking of a troubled conscience, it is possible that the case could yet be drawn to a conclusion. For the Wilson family, we hope so.
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