Yesterday the Healthcare Commission, the major inspectorate of the NHS came out with a report on the C difficile epidemic at Stoke Madeville Hospital. The report castigates the management of the hospital for focusing only on meeting government targets and losing sight of its responsibilities for infection control.
The Chief Executive of the period was fired and a new acting Chief Executive has responded to the Commission report by agreeing with its conclusions and promising to collaborate with the commission to make sure that such breaches no longer occur.
What is interesting to me is that the commission actually does recognise that the centre has put extreme pressure on individual organizations to meet government targets and that this resulted in reducing the priority given to infection control.
The report says
"In this investigation we found that the problems created for those attempting to reduce the incidence of hospital acquired infection was not just that the time and effort of managers were devoted to other priorities, but that the approach to achieving those other priorities can itself compromise the control of infection."
This included ring fencing surgical beds which reduced the possibility of isolating infected patients. High turnovers made it more difficult to keep wards clean. Little training about infection control made hand cleanliness harder to achieve.
The report stated that these and other operational problems arose out of the need to "juggle a number of 'must do' objectives."
This is a good time to rethink how the central targets of the NHS have had unexpected adverse consequences. Is this a normal occurence in complex systems? It may be time for the centre to think differently about how it intervenes.