Thursday, August 09, 2007

Hygeine discipline everywhere except in the NHS

In the week that Bournemouth council banned the issuing of armbands at its swimming pools, for fear of spreading germs, we are told that 60,000 hospital patients this year will catch the superbug Clostridium difficile. While one part of the public sector is infected with a virulent strain of health and safety disease (let's call it HSD), another - the part that is supposed to look after our health - seems strangely immune.

No one has ever been knowingly infected by blowing up a rubber ring. But the head of the Institute of Sport and Recreation Management was unrepentant, stating: "I don't think it's health and safety gone mad to say that something should be clean and safe." He is surely the perfect candidate to run one of the quarter of hospitals that are not meeting even the basic requirements of the hygiene code.

Even though there is not much hand-washing going on in the NHS, there is plenty of hand-wringing. Cases of "C diff", as it is known in the trade, have risen by 22 per cent in the past year, affecting more than 15,500 people over 65. It is not always lethal: in 2005 it was mentioned on 3,697 English death certificates (MRSA was mentioned on 1,512). But those figures understate the problem, because hospital-acquired infections often go unmentioned as a factor in death. The campaign group MRSA Action UK believes that many deaths that are listed as organ failure will also have involved MRSA. It is generally agreed that the UK's performance in combating these bugs lags behind every other European country except - oh, here's a comfort - Romania. The good news this week was that MRSA rates have started to fall, by 6 per cent in three months. But even this must be seen in the context of a sixfold increase over the past decade.

When superbugs first invaded hospitals in the Netherlands in the early 1990s, the Dutch took a zero-tolerance approach. They used an age-old tactic of infection control: isolating patients in dedicated wards. Their relatively clean hospitals were spruced up even further, and staff who came into contact with infected patients were tested. Mark Enright, an epidemiologist at Imperial College, London, says that NHS managers thought the Dutch had overreacted. But 15 years on, their MRSA rates are 50 times lower than ours.

It is trickier to isolate patients in the NHS because it has far fewer empty beds than almost any other Western health service. That is a direct consequence of the determined reduction in hospital beds from almost 300,000 20 years ago to 175,000 last year. At Stoke Mandeville, where at least 33 and possibly 65 people died from C. difficile in 2004, staff claimed that they could not isolate patients because of budgets and waiting-time targets.

This lack of beds and conflict between targets is critical for ministers to address. But it has been largely obscured by the focus on hand-washing. The problem is that, while hospitals remain dirty, it is hard to see the bigger issue. Ministers must also realise that all these "Wipe Out!", "Saving Lives" and "clean your hands" initiatives, unusually self-explanatory for this acronym-laden bureaucracy, have been staggeringly ineffective.

It is quite clear that a package of measures is needed to combat these infections: it includes isolation of patients, much more careful use of antibiotics in the case of C. difficile, and proper hygiene. The Health Protection Agency this week produced figures showing that some hospital trusts are doing quite well. But they will not permit us humble patients to know the success or failure rates for individual hospitals. The discrepancies must be far too revealing.

The fact is that a clean hospital is a well-managed hospital. Infection control is not impossible. What it really boils down to, in the words of Georgina Duckworth, of the Health Protection Agency, is "running a tight ship". Only a well-managed hospital will get a grip on superbugs. And the fact is that there are still far too many poorly managed hospitals.

The superbugs are not only a problem in themselves - they are also a symptom of what is wrong with the NHS culture. When voters said that they wanted to bring back matron, they did not mean "appoint someone with the title of matron and ask her to build partnerships with team members towards a better future", which is pretty much what happened in 2001. They wanted someone with the authority and willingness to tell others what to do.

The Healthcare Commission report published this week contains some telling quotes from NHS employees. "It's difficult to enforce authority like it was in the past," says one. "Staff have so many rights, unions, human resources," says another. And the report concludes that "overly authoritarian or hierarchical styles of management" can now be perceived as "bullying".

On recent visits to hospitals I have watched as staff turn a blind eye to nurses who do not wash their hands and cleaners who do not clean. Two weeks ago, a postoperative colleague complained about a huge splotch of blood on the wall of the toilet. "Oh," said the nurse, "we hoped you wouldn't notice."

Talk to former members of the nursing profession, such as my great-aunt and my mother-in-law, and they will tell you how they quaked when the infection control man made his daily visit to the ward and ran his finger along the top of every bed curtain. They would not have made excuses about outsourced cleaning contracts. They just got on with saving lives.

Outside the NHS, health and safety is being enforced maniacally. There is no shortage of bossy enforcers to remove your rubber ring. I never thought I'd say it, but we need a bit more of that in the NHS.


This Must Be One of the Oddest Racism Accusations Yet

The Jewish and Leftist son of a prominent Marxist theoretician and the grandson of someone who fought in the original Red Army is accused of being an anti-Russian racist?? Western Marxists were always devoted defenders of Russian horrors! Most still are.

"A key adviser to President Vladimir Putin accused [British] Foreign Secretary David Miliband of 'anti-Russian racism' over his handling of the Alexander Litvinenko affair.

It was claimed Mr Miliband let his personal views cloud his judgment in the recent tit-for-tat diplomat expulsion row over the murder of ex-KGB operative Litvinenko.

Last month the Foreign Secretary expelled Russian diplomats from Britain after the Kremlin refused to sanction the extradition of the prime suspect in the murder case.


Australian wine success

AUSTRALIAN wine exports have topped $3 billion in a year for the first time, triggered by surges in demand from the US and China. About 805 million litres of wine - valued at $3.007 billion - was exported in the 12 months to July, figures from the Australian Wine and Brandy Corporation state. The value of the Chinese market has risen 125 per cent, and the US is poised to overtake the UK as the most lucrative market.

The corporation's chief executive Sam Tolley said increased bottled wine sales helped the industry surpass the $3 billion mark. China now buys $51 million worth of Australian wine, and will soon be the fifth largest market for Aussie wine exporters. "Clearly, China is developing in its sophistication through the growth of its cities, and coming with that is a desire for wine - and Australian wine is in that mix," Mr Tolley said. "The scale of the opportunity is enormous."

The UK remains Australia's most lucrative market, valued at $974 million -- ahead of the US ($972 million), Canada ($273 million), New Zealand ($102 million) and Ireland ($71 million). In volume terms, the UK remained top with 285 million litres, ahead of the US (222 million litres), Canada (51 million litres), Germany (41 million litres) and New Zealand (35 million litres).

Mr Tolley said water and drought remained challenges for the 2008 vintage, which is expected to be as small as the 2007 vintage of about 1.34 million tonnes -- the lowest this decade. "The drought has been managed well. The question intensifies for the next year, though, in view of the very small allocations of water," he said. "It's critical that we get adequate winter rains and that we have a careful approach to the use of that water for the next vintage. "Water is certainly one of the major issues facing the wine industry. Access to water in our productive regions is the most important production issue."


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