Chris Lancelot on... Hospital infections increase

Following the 90 deaths from C difficile at Maidstone Hospital, two things were inevitable: the CEO would resign, and the secretary of state for health would wring his hands. He also announced that ward sisters would be making quarterly reports to the board of their NHS trusts. Everyone gets blamed except the politicians: and the solution to all ills is a management one.

Yet I can't help thinking that the continuing rise of hospital infections is related to the crazy targets and management systems currently imposed on the NHS. Take away professionals' responsibility and authority. Give managers impossible targets and tight financial constraints - and then blame them when it all goes wrong. There was nothing like the current rate of hospital infections 30 or 40 years ago, when Matron and Sister ruled the roost and management by target hadn't been thought of.

When draconian financial penalties follow the infringement of relatively minor organisational rules then corners will get cut. No sooner has a patient left a bed than another one is put in it - a sure-fire recipe for cross-infection. There's no money to employ the nurses we need - it's all gone on managers. The lack of front-line staff in our hospitals is a disgrace; and who can blame overworked nurses if they fail to observe all the rules of cleanliness? They haven't the time.

How typical that the secretary of state has waded in to suspend the severance pay of Maidstone's chief executive and to blame the local workforce for the outbreak. This emphasises that politicians can do no wrong - it's managers, doctors and nurses who make the mistakes.

Yet when the boot is on the other foot, the rules change. Will Mr Johnson curtail Patricia Hewitt's pension, seeing that the debacle of MTAS happened on her watch? Will he conduct an inquiry to establish whether tight central targets force hospitals to cut too many corners? Are the politicians really providing the right structure for a high-quality NHS, or is C difficile what happens when you run the NHS by management rather than through the professions?

For all Mr Johnson's hand-wringing the truth remains: the government has created a climate in which hospital infections are an almost inevitable outcome. If you want a symbol of the present-day NHS, then it's C difficile.

Dr Lancelot is a GP from Lancashire. Email him at

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