Safety first as government gets tough on causes of superbugs

The prime minister and health secretary Alan Johnson used their speeches at this week’s Labour Party conference to pledge stronger action against hospital-acquired infections.

The drive to improve patient safety will not focus only on cleanliness. It is understood the quality of services, for example maternity services, will also come under scrutiny, with trusts pushed to make better use of data to prompt improvements.

The clinical groups set up to feed into junior health minister Lord Darzi’s review of the NHS are expected to compare services with international best practice to see whether they can be improved.

Mr Brown promised a ‘deep clean’ of all hospitals and said the number of hospital matrons, with powers to speak out on infection, would be increased to 5,000. ‘Matrons will have the power to order additional cleaning and send out a message - meet the highest standards of cleanliness or lose your contract,’ he said.

Number 10 is understood to be looking at how failing long-term cleaning contracts, such as those under the private finance initiative, could be terminated.

Asked about cleaning contractors, Mr Johnson told delegates the views of clinical staff would take precedence over managers’. ‘There is an issue about these contracts, which is why Gordon said yesterday that we need to put matrons in charge, not people in managerial positions on the trust.’

The health secretary promised that Ofcare would be given tough powers to ‘investigate and intervene where hospitals are failing to meet hygiene standards’.

‘The new regulator will have power to impose fines and additional powers to inspect and issue warnings, as well as halting new admissions or even cancelling a provider’s registration entirely,’ he said after his speech.

Matrons and ward sisters will be given whistleblower protection to report any concerns on hygiene.

Healthcare Commission chief executive Anna Walker said that under the existing hygiene code the regulator could close wards if it chose to. But the new regulator’s powers would ultimately give it the power to take away a trust’s power to operate if it failed on standards for quality or safety.

‘The significance of the announcements is that the government is signalling how really serious it is about infection control,’ she told HSJ.

‘The value of those powers will lie as much in the fact that they are there as in the exercise of them.’

‘What we are beginning to see happen on infection control is trusts beginning to take the hygiene code seriously and some of that has got to do with us all recognising that infection control is a very serious issue.’

She welcomed the announcement of new clinical guidance to increase the use of isolation for patients infected in hospitals.

Health Foundation chief executive Stephen Thornton praised the focus on quality and safety. But he criticised the emphasis on ‘punishment rather than inspiration’.

There should be more talk of the importance of training and sharing best practice, he said. ‘What a dreadful admission of failure if we ever get to the point where an external body has to come in and shut down a ward.’ he added.

But he said he would welcome more consistent collection and use of patient-related outcome measures to assess quality.

The appointment of the Department of Health’s new medical director Professor Sir Bruce Keogh, whose work led to the publication of heart surgery survival rates by the Healthcare Commission, would help, he said.

NHS Confederation chief executive Dr Gill Morgan echoed Mr Thornton’s views on Sir Bruce’s appointment but said she did not see the announcements on cleanliness and infection as a significant change of direction. ‘This goes exactly with the grain,’ she said.

Academy of Royal Medical Colleges chair Dame Carol Black said rules and regulations on safety were important but that clinical staff should be involved in drawing them up. ‘If you involve staff, you are much more likely to get sensible rules and regulations which people will observe,’ she said.

However, King’s Fund chief executive Niall Dickson warned ministers not to be lured into trying to control too much centrally.

‘We need to free local systems to find their own solutions and then we need to hold them to account,’ he said. ‘It’s important that we do not go back to bombarding the system with initiatives or ideas, however tempting or tough they might seem.’

To read the editor’s comment on the conference, click here