How Not to Fix the NHS
Recently, David Cameron made a worrying suggestion for the NHS. He argued that hospitals should be fined for every patient that catches MRSA while in their wards. Of course, this approach to dealing with the superbug is nothing new. For some time now, the government has said hospitals should be fined for not meeting infection targets. However, it remains in my view a poor way of dealing with healthcare problems.
Superficially, Cameron’s proposal may have some merits. Certainly, it appears a more logical way of fining hospitals than that currently in place. I have a distinct aversion to centrally set targets, especially on difficult problems like MSRA rates. There are so many possible problems. The government might overestimate the progress physically possible in a given time-period, and end up fining the majority of hospitals unjustly. A hospital might make significant progress in treating MRSA, but not enough to meet the targets, and so still be punished for improving. NHS staff, desperate to meet targets to keep funding, might take shortcuts to do so, skimping on individual care to speed things up. The list goes on. In this regard, Cameron’s method is superior - at least it only penalises hospitals in actual cases of infection.
However, the issue is not how a hospital should be fined, but whether it should be. I cannot see the logic behind depriving a failing hospital of funds. It will be a, “means of hard-wiring infection control into the system,” its advocates say.
Really? It strikes me that, far from causing people to think again, it will simply breed resentment among NHS staff for making a hard job harder. And even if it does turn minds to finding solutions, what good will it do? The funds needed by hospitals to enact those solutions will have gone. How, for example, would hospitals provide extra training for porters on the rigorous hygienic procedures needed to combat MRSA without the money to do so? As the Conservatives themselves have been fond of saying, you can’t spend money that’s not there. The NHS is no exception.
Instead, the government should be helping failing NHS trusts. If MRSA rates are rising in a hospital, it probably means that the staff don’t know how to tackle the infection effectively. They therefore either need to be trained to do so, or sacked and replaced with trained staff. Both of these would require time, energy, and above all, funding. A failing hospital needs more funding, not less.
Do I expect either of the two big parties to do that? No. Their policies here only mirror their regressively populist attitudes to crime - recriminatory punishment which solves nothing. Those show no sign of changing, and neither does this. But that’s no reason not to hope, I suppose.
Charging hospitals per MRSA case would only be a reasonable suggestion (although I would still disagree in principle) if hospitals were paid by the government per patient admitted in the first place.
The simple problem remains that stripping a failing hospital of funds can only make things worse. Better, sack all of the pen-pushers and employ more cleaners*. Oh, and the cleaners might do a better job if they were paid a decent wage**.
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*That sounds a bit Daily Mail for my liking
**That’s better
Alexander Ogston initially identified Staphyococcus aureus (Staph) in 1880, and published a paper linking staphylococcal disease and its role in sepsis and abscess formation. Staph Infections are initiated when a breach of the skin or mucosal barrier allows this bacterial access to adjoining tissue or the blood stream. Use of Peripheral vascualr device (cannula) among hospitalised patients significantly increased from 20% in 1992 to 51% in 2002, and consequently the use of cannula from 11 to 33% of inpatients. The number of both community acquired and hospital acquired staphylococcal infection have increased in the past 20 years. This trend parallels the increased use of canulae. 25 million cannulae are used in NHS and the banned ported cannula in USA is the most common one used here in NHS. Organisam is said to colonize in the port and said to enter blood circulation.
IV Cannula more often were inserted in the emergency department, had a shorter duration from insertion to bacteraemia and had Staphylococcus aureus more frequently as the causative pathogen. Majority of septicemia begin with colonization of the cannula-insertion tract by bacteria from patients own skin-flora (8).
Frequency of hand contamination was less in common areas than on the hands of healthcare workers exiting rooms of patients with organisam colonization. Unfortunately, because few clinical events have been observed in individual studies, it remains unclear which antiseptic solution is best, both statastically and clinically, for reducing the risk for catheter-related blood stream infection. Hand washing by hospital staff is said to be poor. One study found 40% of workers do not adequatly wash their hands well before performing a practical invasive procedure in patients. This coupled with 30% of health people colonising antibiotic resistant bacterias in their skin increases the chances of introducing bacteria into blood stream resulting in serious systemic infection and death within 48 hours.
Nurses are not adviced to clean the site of injection with chlorhexidine with alcohol. They have never heard of drying time and so do not follow the asterile precaustion. How can we expect things to change ? There are various factors than bug in dirty hospital. I feel the act has to change, better guidlines provided than fining hospitals. Doctors have moral & ethical obligation “Do No Harm”, if introduction of MRSA is linked to and now proved to be a major risk factor, how can they perform any practical procedure comfortably without the threat of legal action.
Wow. Erm… OK.