The Healthcare Commission’s report last month into Clostridium difficile outbreaks at Maidstone and Tunbridge Wells NHS Trust was undeniably shocking. It revealed that, over an 18-month period, 91 people had almost certainly died as a result of the healthcare-associated infection and hundreds had been infected.
In the immediate aftermath, nurses at the trust kept silent, even though they were often the target of blame by both the media and trust management. But they have finally spoken out. Their accounts reveal how management lost sight of patient care in favour of meeting government targets.
Speaking to NT last week, Alison Coppin, a senior staff nurse on an escalation ward at Maidstone Hospital, agrees the report doesn’t make easy reading. ‘I was shocked, stunned and disappointed,’ she says.
Even the nurses were surprised by the extent of the problem. Hilary Bulmer, Ms Coppin’s ward manager and a nurse at the trust for 22 years, adds: ‘I was shocked as to how many patients had been affected. I hadn’t worked in areas where C. diff was prevalent and we didn’t know of many people who had died.’
The report’s fallout has been difficult for all at the trust. ‘One of the problems is that we were perceived to be the only trust in the country that has had this problem and that to me is a misrepresentation – it’s UK-wide,’ explains Ms Bulmer. ‘We’ve had a lot of bad publicity and it’s still continuing.’
The impact on staff is ongoing. ‘People were very upset because a lot of nurses feel they work very, very hard, they put in an awful lot of work and they just felt it was yet another damning indictment of nurses,’ says Louise Todd (pictured), acting ward manager on an elective surgical ward at Kent and Sussex Hospital in Tunbridge Wells.
As a ward manager Ms Bulmer said it was up to her to try to raise morale: ‘We run a very good ward and we give very good basic care. I just told my nurses this was not a reflection on us personally but these are problems that were in the trust.
‘Of course as nurses we have to accept responsibility along the way but when you don’t have enough staff and you’re not given the support, you’re in a catch-22 situation. I do think everybody tried their best given the resources they had.’
The report has taken its toll on relationships between the public and the trust, admits Ms Bulmer. ‘We’ve recently been hit by the norovirus and I think relatives feel that we’re covering up and that it’s actually C. diff. We need to explain it’s not the same bug and build up public confidence again.’
Ms Todd has also had to reassure patients who lost their nerve about coming in for elective surgery.
But the nurses agree that once on the wards, patients have been very supportive. Ms Coppin says: ‘Obviously new admissions have been a little bit wary but once they’re here and see what goes on the shop floor they realise that they are experiencing good care.’
Events have also affected relationships between nurses and the trust’s former management. In his resignation letter, former trust chairman James Lee wrote: ‘On the whole our nurses are first class but not all. Our nursing director would advise us that NHS employment practices make it difficult to take action even against transparent incompetence. I would strongly recommend that the NHS needs to have a root and branch review of all aspects of nursing.’
These comments and others that were quoted in the press were met with anger from nurses at the trust. ‘It was a blame culture and Mr Lee decided to blame nurses. We were an easy target because we don’t stand up or speak out,’ says Ms Bulmer.
Also, nurses feel the former management should accept some responsibility. Those who spoke to NT agreed government targets were prioritised over and above basic care, to the detriment of patients.
‘This report was a wake-up call,’ says Ms Todd. ‘I think you also have to remember there’s a person at the end of the equation – not a commodity.’
Trust management may also have taken more notice of the impact that a lack of nursing staff was having on the wards, she says. Indeed, one of the commission’s criticisms was that a lack of registered nurses contributed to the number of deaths. The problem is one that nurses at the trust say they are still facing. ‘We do our best with what we have but it’s not always perfect. We don’t have unlimited money and we’re understaffed. The report said we should be running at Healthcare Commission-recommended levels that are a lot higher than what we’re running at right now.’
On the plus side, the trust is undertaking a major recruitment drive. Since Ms Todd has been acting ward manager, she has recruited five new nurses. On Ms Bulmer’s ward, nurse numbers have increased from five whole-time equivalents to 20. And there have been other positive developments. The nurses say the culture within the trust has changed and they now have a much greater voice in the organisation.
Other changes include a more stringent antibiotic prescribing policy, greater use of disposables, improvements to ward layouts and a more strictly enforced uniform policy. The housekeeping team has been given more staff and money to do their jobs and the infection control team has been given much greater power. There are very clear pathways for nursing patients with HCAIs. What’s more, latest figures from the Health Protection Agency show that the trust’s rate of cases per 1,000 bed days has dropped from 3.49 to 2.23, and is below the current average rate across England of 2.39.
Now the focus is on moving forwards, says Ms Coppin. ‘We have accepted there were problems and that’s not something to be proud of but now we are working towards improving patient care.’
And the nurses say there is a lesson for everyone involved. ‘Don’t lose sight of the fact that the patient comes first at all times,’ says Ms Todd. ‘We didn’t go into nursing to be nagged by the government to meet targets. So that’s what I would say to nurses: just hold on to what’s important.’