The NHS Reforms- Lansley’s wonderful plan, by Clostridium difficile
Good day! May I introduce myself? I am a Clostridium difficile, and I live in soil and in intestines. I like to set up home inside hospitals, as there I can spread to new people, especially when there’s a lot of antibiotics used.
I’m really looking forward to the NHS reforms. After six years of being hammered by disease control measures run by primary care trusts, it looks as though good times are coming for me, because the PCTs are being dismantled.
PCTs were amongst the NHS bodies required to have Directors of Infection Prevention and Control (the terrifying Dipcies): nurses, directors of quality, directors or consultants in public health. Their joint infection prevention and control committees attacked us on all fronts. They stopped us moving through nursing homes to hospitals to GP surgeries and round again. They imposed nursing, community pharmacy, and health protection measures. They cut the rich supply of antibiotics that were killing our competitors and giving us space to thrive. They stopped the prescribing of loperamide against diarrhoea which stopped us being flushed out of those lovely warm guts, and instead we could breed and breed. They encouraged spotless wards and clean hands so we couldn’t spread so easily. In some parts of the country ruthless senior management and medical staff championed hand washing, good antibiotic prescribing and “serious untoward incident” exercises, which really hit me and my family. They double tested. In Sandwell, my kill rate fell by half and my hit rate by even more. It was a massacre.
All those measures will be going under the new arrangements. Thankfully this government has no respect for high quality medical advice –our national enemy Tzar Duerden has already gone, and the government listens only to the economists and the big investors. No-one at national level takes nosocomial infection seriously, and even those in the front line who want to don’t have the expertise or troops on the ground to control us. Financial competition between hospitals will mean that nursing staff productivity will be expected to go up, regulation will decrease, and cleaning will be done as fast and as cheaply as humanly possible. Andrew Lansley is our greatest friend ever! He’s even better than Mrs Thatcher who started the outsourcing of hospital cleaning and helped MRSA to spread in the hospitals.
The new public health provisions don’t include Dipcy roles. The individual Directors of PH that I used to fear will now assure (sic) a system but will have to battle local authorities and Public Health England for any weapons to keep fighting me. Some military strategists have called it ‘responsibility without power’; I say they’ll be up shit creek without a paddle. And that’s fantastic – shit creek is my home ground.
And not only will we run riot, but the free marketeers will even safeguard our privacy through commercial confidentiality: there’s no sign that private hospitals will be required to report hospital-acquired infections, and they won’t voluntarily do it, because that would put patients off and reduce their income. Maybe those hospitals won’t even trouble to collect information to monitor our growth and spread, because doing that costs money, and they are allowed to conduct their business as they see fit under Clause 4 so as to meet their profit goals. All the NHS hospitals are to be converted to Foundation Trusts, which also don’t have to report any data at all, and those too will be constantly pushed to save money.
Even under the present system, I have crept into Foundation Trusts. I have escaped detection in those FTs who took a ‘business decision’ not to do two stage testing because they thought they would be more likely to miss their financial targets if they spent money on robust infection control. Some have resisted the pressure to operate the double test against us because they don’t want to know we’re there! Afraid their masters will punish them for finding us! Their outsourced cleaning contractors haven’t helped them much either, with their everlasting wrangling over how much time their cleaners will do on what. Blood stains congealing on the lino in this day and age….
The CCGs won’t know enough about us to understand how to find us let alone fight us, and they will try to push what hospitals charge them downward so as to stretch their shrinking referral budgets. So if hospitals can’t charge for this through patient referrals, and all central budgets have been abolished in the reform, where are hospitals supposed to get money from to fight us? We can see from marketisation of healthcare systems such as China’s that prevention measures cease because the market doesn’t fund them: ill people pay for their own care, but no-one wants to pay for prevention measures.
The marketised NHS will encourage more antibiotic use, because that’s what the consumers (formerly known as patients) want. So not only our pathogen competitors will be killed off but also the normal gut flora that keep us out, at least those that can’t come up with some kind of antibiotic resistance. And from those that have or can develop this resistance, we Clostridia can often acquire the resistance genes, so that protects us from being killed off by antibiotics ourselves.
Public health surveillance will be moved into local authorities, and Public Health England will be so remote from where I and my offspring live. I expect to run riot in nursing homes once again because the local authorities won’t have the troops to fight me.
I just can’t thank Mr Lansley enough for his brilliant reform.
Translators note: Clostridium difficile, aka C.diff, is a bacterium which lives in the guts of about 3% of the population. Generally harmless, if allowed to get out of hand it can cause severe diarrhoea, and a fulminating enterocolitis leading to death. It has been subject of English government health policy because of its place as a healthcare-associated infection spread by poor hygiene, excessive antibiotic prescribing and use of antidiarrhoeal medications. Until now C. diff has been silent on the reforms, but now speaks through the medium of Dr John Middleton, Director of Public Health Sandwell and Dr Lucy Reynolds ,Public health military strategist at London School of Hygiene. C diff holds the honour of being Andrew Lansley’s greatest fan (outside the City of London, of course).
A Better NHS 
I don’t see what your problem is with FTs. We have to have DIPCs. C. diff and MRSA rates are falling.
Anyone who thinks that, in a competitive world, a provider will attract patients by negelecting infection control is just nuts.
All NHS Trusts will soon fail HCAI targets inevitably, because B Duerden did not point out to his masters that achieving year on year % reductions in anything is impossible. Some trusts failed there target in the first month because they had a target of zero. This is madness.
Thanks john – C diff is saddened to hear that there is still such resolve in foundation trusts such as yours. FTs are obliged to operate in increasingly competitive times as if they are private operators – you may be diligent in your fight against me – other FTs may find it easier not to test for me and change their definition of a C Diff infection – faced with seven figure fines for exceeding targets – what better way to reduce your infection rate that simply not to test for C Diff ….
Yes and while DIPCies still fight me in hospitals, the notion of the PCT ‘commissioning DIPC’ able to fight me in nursing homes, through primary care, community pharmacy and health protection services is being broken up as we speak.
Under the Bill, would the entire field of preventative medicine essentially disappear? If people only pay for their own healthcare, would things like QoF and other monitoring/research measures go without funding?
Their target sorry – fundamental error.