National Health Service hospitals have been a disaster not only waiting to happen, but actually happening, for many years. I have received hundreds of bitter readers’ letters in evidence. However, it is a rule of public life that something quite exceptionally dreadful has to occur before anything is done.
Everyone has known for years that serious hospital-acquired infections have been winning their germ wars against the feeble hygiene of many NHS hospitals and have been killing more and more patients. But little has been done about it apart from the usual witterings about wake-up calls.
Now something terrible has happened: 90 people, according to last week’s report by the Commission for Healthcare Audit and Inspection, have died, quite unnecessarily, in three filthy NHS hospitals in Kent, as a result of being infected by clostridium difficile (C diff). The infection may also have contributed to the deaths of a couple of hundred more. And this because of the toxic filth, appalling care and abysmal management in three hospitals in one of the richest countries in the world.
The stories of patients lying for hours in their own excrement, of filthy wards stinking of diarrhoea, of unwashed nurses and unwashed equipment, would shame a Third World country. But this was Maidstone and Tunbridge Wells! Now, you might think, something will be done.
wouldn’t count on it. The response of Alan Johnson, the health secretary, last week was to wash his hands – forgive the tasteless irony – of government responsibility. He put the blame exclusively on the NHS trust – largely for failing to follow government guidelines about hygiene and antibiotics. He emphatically denied what happened in Kent reflects what is occurring across the country.
I wonder what he really believes. He must know that his government has been running, and indeed intrusively micromanaging, the NHS for the past 10 years, precisely so as to change its culture, precisely so as to ensure “delivery” of a “world class” health service.
He must know that his government has almost overwhelmed the NHS with money, protocols, guidelines, employment procedures, information technology – much of it clearly disastrous and with perverse consequences. The whole point of this tyranny of inspection, infection control teams, recording, box-ticking and, above all, the imposition of targets, was to make things better in the health service.
How on earth, then, can a Labour minister insist that it’s absolutely wrong to suggest the Kent failings reflect what is happening across the entire NHS?
In saying so he is flatly contradicting the findings of last week’s damning Health Commission report. This states quite clearly that the Maidstone and Tunbridge Wells NHS Trust was obsessed with government waiting time targets and financial targets, to the neglect of infection control. The report also remarked on a number of similarities between this case and its investigation of a C diff outbreak at Stoke Mandeville – “it seems unlikely these similarities are coincidental”, it commented tersely.
Perhaps Johnson hasn’t read that bit. Whatever the case, he could not offer any suggestion that the government should and would change anything after this report. Nor did he speak of lessons learnt: I do believe this government is incapable of learning them.
What strikes me most of all in this horrible story of stupidity, laziness, filth, incompetence, deception and revolting personal habits is the loss of something that used to be widely felt in hospitals – fear. What’s needed is more fear, except among the patients, of course; it’s among them only that fear now prevails.
When I was once anxious about some work I was doing, my kind employer tried to console me by saying that fear of failure is an excellent thing; it is the essence of professionalism. I don’t think I would go so far as to call journalists professionals, but I agree with his point. Fear is a spur. The fear of doing badly drives people to do well. At least it used to.
In these three hospitals it seems some nurses and doctors were not afraid to skip washing their hands, not afraid to tell patients to relieve themselves in their beds, not afraid of prescribing antibiotics without proper care. Managers were not afraid to ignore or fib about infections, to overlook evidence and to pull the wool over the eyes of their nonexecutive board members. Nonexecutives were not fearful enough of such possibilities, nor anxious enough for their reputations, to seek them out. Even after this emerged, managers were not scared of giving the chief executive a glowing reference and a huge pay-off.
All these people ought to have been afraid. But they weren’t, because there are few unpleasant consequences these days of doing one’s job badly. Except in the commercial sector, criticising people’s efforts is frowned on and it’s extremely difficult to dismiss them; the fear of being sacked for incompetence is a thing of the long-distant past in the state sector.
I imagine that’s why nurses often look so slaggy, with untidy hair falling over their faces, wearing hospital clothes in the street. Women doctors’ hair is often just as unhygienic and unprofessional and consultants of both sexes are notoriously bad about washing their hands.
High standards, like hygiene, are a state of mind – a kind of anxious professional perfectionism which insists on doing things well, whether it’s sweeping a room, washing a commode or tying one’s hair back neatly. I know that nurses are often too busy to keep up standards, but I also know that all too often they don’t care about them anyway.
The culture of fear, in which matron would insist on spotless fingernails, perfectly made beds and every hair in place, disappeared long ago, along with a sense of authority and hierarchy in the wards. The same is true in schools and in public places and institutions generally.
The kind of fear that I mean goes with unpleasant things such as blame, guilt and even punishment. It can be repressive. I used to think it was a good thing that the cultural pendulum had swung against an excess of this kind of fear. But now I think it has swung too far. True professionalism and true accountability mean fear, as well as pride and pleasure in doing well.