Good2Have a View

It is hard to imagine a link between Sir Isaac Newton (the father of physics whom Einstein admired) and David Brent of the office, who is probably only admired by the management at The Carphone Warehouse. They rung me four times in the space of 24 hours to sell me broadband. This is despite being told on each occasion that I knew their service was rubbish and that there was no way on this earth I would have it. Being perfectly happy with Pipex.
There is the obvious if forced observation that both knew of gravity, David Brent constantly falling on his face. There is a second (tenuous?) link that both observed the fact that to every action there is an equal and opposite reaction. Where they part company is that Newton was able to rationalise this into a law of physics Brent is simply dumbstruck and flounders to handle the experience.
A better similarity is between David Brent and Good Hope Hospital, or at least the management. Now, this isn’t just a cheap shot. Brent isn’t a bad person he is simply incompetent. And in fact it isn’t really Brent who is the true incompetent but the company he works for. When Brent finally gets the push, he is replaced as office manager by the only person he seemed to have a rapport with – the ‘Team Leader’, Gareth Keenan. David Brent MKI is replaced by David Brent MKII. The company, rather than the office, is in serious trouble,
So with Good Hope, its failings (which occur even when successful) are endemic to the system not the building. Let me explain.
In February 2007 Good Hope announced it was full. Having managed to fill the car park the management had now managed to fill every bed (but not trolleys) in every nook and cranny of the building. Not perfect, but let the hosannas reign as targets were met or passed or nearly or something.
Yeah, I know, more cynical carping. Look they’re doing better, not perfect, but hey get real.
But like Brent this action is likely to have an opposite reaction that, as far as can be seen, the management of Good Hope and the NHS in general struggle with comprehending. Infection is likely, very likely, to spread.
In Norway and Holland less than 1% of all bloodstream infections are drug resistant, while in Britain the figure is 44%. Figures compiled by the European Antimicrobial Resistance Surveillance System, which Dutch doctor Hajo Grundmann co-ordinates, show that Britain has higher rates of MRSA than all comparable European countries, including Germany, France and Spain, and is ranked  with Cyprus, Malta and Portugal.
As a doctor who has worked in Britain and Holland, Hajo Grundmann is well placed to offer an insight as to why the two countries are so far apart in the battle against MRSA.
Grundmann, a consultant microbiologist, cites the differing levels of cleanliness between Britain and Holland, apparent to anyone entering the hospitals. Dutch hospitals, are generally  modern and the design of the wards translates into the ability to isolate patients in single rooms, There is certainly a greater availability of beds.
However, cleanliness explains only a proportion of the transmission of MRSA but it is important because it is a marker for diligence and commitment and shows that staff are taking their work seriously.
Overcrowded British hospitals are a big contributor to infection. British hospitals have fewer single rooms and so isolating all infected patients is impossible. As a result, patients with MRSA need to be cared for on communal wards and risk passing on the bug.
The proximity of beds, the high percentage of beds occupied at any given time and the rapid turnover of patients fuelled the high rates of MRSA in British hospitals. So by squeezing in more patients, especially by squeezing in more beds in ward, what do you think might happen. More to the point what does management think might happen?
The inability to isolate patients due to lack of space and pressure to have wards open to keep waiting times down contrasts starkly with the drastic action taken to control MRSA outbreaks in Holland.
Grundmann recalls an outbreak in a large Dutch hospital in 2003, affecting 28 patients. Managers reacted by closing two wards, including an intensive care unit, and spent 2m Euros (£1.3m) screening all staff and patients. Staff found to be carrying MRSA were sent home.
Ironically, the process of screening patients for MRSA and isolating those found to be carrying the bug, a technique known as ’search and destroy’, was devised in Britain. But, in the mid-1990s when the MRSA rates began to soar, managers found it impossible to isolate all infected patients -  there simply was not enough space.
Yet this is against a backdrop of record levels of spending, sorry ‘investment’, in the NHS. The simple truth is that this money has been badly managed – but that should not be a surprise quite frankly.
The NHS was founded on three assumptions of human nature that were profoundly false. That the American taxpayer would GIVE Britain money to establish a socialist state. That patients would not pursue their own interests at the expense of others. That health workers would not pursue their interests at the expense of others. It soon became obvious that these assumptions were false. The American government loaned Britain the money, at a low interest rate but still a loan. Prescription charges were introduced because, in the words of Nye Bevan the father of the NHS, ‘they (patients) weren’t even bringing the bottles back’. So very early on it ceased to be a universal health system free at the point of delivery but became an affordable health system that the electorate would support. Political, rather than medical, interests became the order of the day.
It is probably worthwhile noting that the recent large sums of money are just that – recent. They didn’t materialise until after the 2001 election. During the election campaign a lady cornered Tony Blair in front of the cameras at the Queen Elizabeth and wanted to know why her partner wasn’t receiving adequate treatment for his cancer. Whilst it may be too simplistic to say that Mr. Blair is all presentation it is certainly true that he is very, very, very, very media savvy. Having won the election the good times rolled. It is worth noting that a similar complaint over GPs refusing appointments more than 24 hours in advance in order to fiddle their targets and get dosh has not been met with any response. Taxpayers are obviously a softer touch than doctors.
In fact taxpayers are a softer touch than doctors, nurses, members of Unison, NHS managers, IT consultants and drug companies. All of whom have benefited enormously from this money. Problem is that bricks and mortar and patients can’t talk. Pay may have had to improve but the supply of beds needed to improve more. But we all know it’s the squeaky brake that gets the oil. Of course some building has goneon. But that’s via PFI where effectively the private sector lends the government the money – it builds, the government leases.
It would be wrong to blame the management of Good Hope for this sort of thing. The wages are centrally negotiated – or rather surrendered. An example of this ‘negotiation’ is that before the 2005 election Alan Johnson surrendered retirement benefits to public-sector workers that are unknown in the private sector (where the money comes from). But as education secretary he has given in over conditions on public-money for faith schools. He makes Neville Chamberlain look like Winston Churchill.
This results in a situation Charles Darwin would have recognised. Those managers that have political rather than organisational and negotiating skills thrive.
Having calmed one source of bad headlines with pay rises, in the case of doctors very large pay rises, the electorate were calmed by targets of getting waiting lists down. The fact that the resources didn’t exist to do this safely is meaningless.
Any health-care system is imperfect. One where management can’t do the basics of wage control and quality is fatally flawed – you only have to look at British Leyland to see that. The NHS lurches from famine to feast and then back to famine. Governments pump money in as electoral pressure becomes unbearable. Rather than one-off spending on capital projects, the bulk of the money goes into wages. Once a building is built the flow of money can recede, with wages the only way to turn the tap off is to reduce headcount – just as has been seen in the NHS recently. The flow has to recede as government has over-allocated funds due to electoral pressure and, with time, that pressure moves elsewhere and the funds with it. Famine resumes with little or nothing to be shown from the feast.
Without competition management has no need to address fundamental problems. With politicians as their masters, the NHS managers address the agenda politicians set
The government’s PFI initiative (the private sector builds infrastructure and the government leases it) would, at first sight, seem a good way around this. The investment (rather than consumption in the form of wages) takes place and is ring-fenced from employees as the rent the lease demands has to be paid first. However, as the government (or civil servants) are so poor at negotiating with public-sector workers and private-sector consultants why should they be any better with builders? It is likely to be an expensive solution. But at least the patient may be better served.
But it would be a funny world if a wry smile couldn’t be found somewhere. The seriously concerned members of SCRAM got themselves in a bit of a lather over wi-fi networks at Good Hope. I guess scrambled by name and scrambled by nature (see my blog on mast huggers).
Of all the risks a patient faces in hospital, any imagined risk from wi-fi is completely, totally, utterly, incredibly negligible. Hope I got that over. What with medical mistakes, lost records (never know, a wi-fi network may help alleviate both of those – see Dr Larry Weed of Harvard on this), poor nutrition and, of course, infections – anyone concerned over wi-fi is worrying up a gum tree.
I shouldn’t be so dismissive of wi-fi concerns; anything that causes people to lead their lives in such a way as to stay clear of hospital is good. The NHS is not the National Health Service it is the National Delivery of Drugs and Medical Procedures Society. All the NHS horses and all the NHS men frequently can’t put Humpty together again.
We all know the answer, the real NHS service is provided by the likes of the fruit shops in Erdington and walking (driver, leave that car alone) . Because, whilst Newtonian physics got man to the moon and David Brent seemed constantly over the moon, I’m afraid expecting the NHS to get a grip on hospital-acquired infections is wishing for the moon.

This entry was posted on Friday, February 23rd, 2007 at 8:09 pm and is filed under Sutton Coldfield. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.