This week in the UK the Health Care Commission have published a report into what was described in the media as ‘a serious outbreak’ of Clostridium Difficile at a Hospital in the southeast of England. Between April 2004 and September 2006 over 1100 people developed the infection and some 90 people died. The Commission found evidence of poor infection control practices, poor cleanliness within the NHS Trust hospitals and evidence of poor care of the patients who suffered from this awful condition. They also identify that the buildings which made up the hospital were old and in a poor state of repair, that beds were placed too closely together and that high bed occupancy and a shortage of nurses had contributed to the situation.

In a world where blame needs to be laid at someones door it would be easy to accuse nurses of not caring, cleaners not cleaning and managers failing at allocate money to the right areas of the health system. However, like most things just blaming one or two groups of people for individual failings would mean that people missed the point. In my very humble opinion what we have here is a whole system failure, many years of under investment (or at least in the right areas) and an obsession with counting the number of people with one infection while failing to notice that people were in fact dying from something else under their noses.

If the hospital was in a poor state of repair, then one wonders why that might be. Is this because for years there seemed to be no investment in the upkeep of hospital buildings at all. I worked in a hospital myself where no walls were painted or fixtures and fittings replaced for a good 10 years. In addition, each re-organisation is going to close this place and open this one, and I guess if you always think yours is the hospital to be closed and moved to or merged with some where else you might not bother with the decorating.

If the cleaning is poor, maybe it has something to do with the way in which in house cleaning services were contracted out to the cheapest provider. Maybe it has something to do with the poor wages paid to staff and the fact that they just get treated as mop machines. Maybe they are poorly trained and don’t understand about infection control.

If insufficient money has been spent then maybe it is due to the poor financial management that has taken place across the system, maybe it has something to do with the target driven way in which they are asked to manage. Maybe the fact that at the time of these problems the local health economy was one of the most over spent in the country and was being forced to pay this money back.

Maybe the shortage of nurses is directly related the poor financial position of the trust and the health authority, which led to vacancy freezes, to poorly staffed wards, to nurses who couldn’t cope and to poor care.

If staff failed to treat Clostridium Difficile as an illness on its own perhaps this is because they didn’t understand what they were coping with, maybe they were overwhelmed with having to care for ill people who were suddenly developing diarrhoea. Maybe they didn’t know how serious it was because the government asked them to count MRSA not C Diff.

I am not working in clinical practice, so do not have recent experience (thank goodness) of looking after someone with C Diff. However, I have heard a few local horror stories of patients being discharged and the district nurse discovering that actually far from being well and ready for discharge their patients are in fact very ill with something quite unexpected and unassociated with the problem they were admitted with. It has taken far too long for people to sit up and listen and notice. Mangers have been trying to save money, to save the jobs of politicians and mean while the health care system has been collapsing around their ears.

My hope is that this report will be read by everyone around the country who provides care to people, who cleans wards, who manages wards, units or services. Most of all I hope it is read by those in charge of NHS trusts and by those who work at the department of health. I hope that the person at the bottom of the pile (i.e. the nurse cleaning up the patient and the cleaner cleaning the floor) is not the one to take the blame because in my opinion the responsibility lies with all of us. Last of all, I hope that people who need hospital care and their friends and family will take notice of the instructions for hand washing, for sitting on beds, and for other general precautions and not imagine that this has nothing to do with them!