Every year, over 1,600 people die from MRSA in England and Wales and over 3,800 people die from clostridium difficile. An investigation into two outbreaks of clostridium difficile at Stoke Mandeville Hospital in 2004 and 2005 that killed 30 people determined that the deaths were avoidable. The report found a lack of side rooms, a shortage of nurses, poor infection control practice and a poor ward environment. It concluded that the Trust compromised the care and safety of the patients due to the priority it gave to controlling finance, reconfiguring services and meeting targets.
Prime Minister Brown has promised to rid all hospitals of MRSA and clostridium difficile over the next twelve months by restoring their original state of cleanliness. His idea of a ‘deep clean’ does not address understaffing, reduced bed capacity and bed over-occupancy, staff education or clinical practice, all critical to attaining the objective.
Almost 4,000 babies were stillborn in 2006 in Britain and many of them were avoidable. In the last ten years the stillbirth rate has remained unchanged: 5.4 per 1,000 births in 2006 with regional variations showing London to have the highest rate at 6.3. Only four countries in Western Europe have a worse rate. The Perinatal Institute has recently revealed that women in the most deprived areas are twice as likely to have a stillbirth as those living in the least deprived areas.
Births have risen by 12.5 per cent since 2001 but midwife numbers have risen just 4.5 per cent since 1997. Almost half of all midwives are due to retire in the next ten years and the Royal College of Midwives predicts that an extra 5,000 will be needed by 2012 in order to reach government targets. Meanwhile the government has just announced that it is ending bursaries for trainee midwives.
The Homerton hospital in east London, guilty of closing ten maternity beds in the past year and with a shortage of qualified midwives has proudly announced the introduction of volunteer labour support workers – women who give their time for free to support women in labour. Cheap and cheerful, but no substitute for qualified midwives.
Private Finance Initiative
‘The NHS is now a tenant in hospitals it once owned, leasing back buildings and services from private sector landlords at astronomical rents that are currently consuming £500 million a year and will increase exponentially.’ Allyson Pollock, head of the Centre for International Health Policy.
For almost every hospital built under the Private Finance Initiative (PFI), three hospitals will close and bed closures and cuts in staff are par for the course. The government says the NHS has had unprecedented funding but whereas administrative costs of the NHS used to be 5-6% of total spending, now they are 15-20% of the NHS budget (over £12 billion per year). These funds are squandered on the transaction costs of the market: invoicing, accounting, auditing, setting up and monitoring projects, management consultants, financial rescue teams, marketing and advertising, lawyers and communications and so on.
Chaos when money drives a health system
The icon on the Electronic Patient Record (EPR) screen to complete the computerised check out of a person when they leave the A&E department at the Homerton hospital is a little sack labelled ‘moneybag’. A crude reminder that generating income is a priority.
For financial reasons, the children’s ward at the Homerton no longer has a ward clerk. The work a ward clerk does allows nurses to devote more time to patient care. Now nurses’ duties include answering the telephone and door entry-phone, and many other tasks unrelated to their clinical work. Ironically, the ward clerk had ensured that entries on EPR were up-to-date and accurate so that the hospital received the money it was owed.