Jeremy Laurance: Managers must always act in interests of patient care

Patients going into hospital put their trust in medical staff to make them better. They know that there are no guarantees, that treatment carries risks and that there are limits to what medicine can achieve. What they do not expect is to be made worse.

Anyone reading the Healthcare Commission's latest report may now reconsider. One in 10 patients catches an infection while in hospital that they would have avoided had they stayed away. They claim thousands of lives and cost billions of pounds but remain at the bottom of concerns for doctors, nurses and managers.

The Health Commission's investigation into the outbreaks of Clostridium difficile at the Maidstone and Tunbridge Wells NHS Trust between 2004 and 2006 underlines the depth of the scandal. Despite a doubling in the rate of infection in the autumn of 2005, doctors and managers failed to act. While hundreds of patients fell ill and scores died, they continued to push patients through the wards, dangerously overburdening the nurses in order to hit government targets on waiting times and balance their books. The bacterium is a nasty one that can cause a lingering, painful and distressing death. Virtually unknown in Britain until an outbreak at Stoke Mandeville Hospital, exposed by The Independent in June 2005, it has since regularly made the headlines. The annual toll of cases has risen from a few hundred in the early 1990s to more than 50,000 in 2006 andcontinues to rise.

The Government must share some of the blame. The pressure to hit targets and clear financial deficits has led to tunnel vision among some managers. Maidstone has cut £40m from its budget over three years in an effort to clear a £17.6m deficit and the report makes clear that this financial pressure was a contributor to the disaster.

But at bottom this is a about a change in the culture of medicine.

There was still a sense yesterday, from the way members of the trust queried the number of deaths cited by the commission, that they struggled to accept the seriousness of what happened. They cited human error as a cause of the problems, rather than a failure by the trust to make infection control a priority.

Infections acquired in hospitals now account for more days spent in hospitals in Europe than all other causes of infectious disease – influenza, pneumonia, tuberculosis, Aids – combined, according to the Orgainisation for Economic Co-operation and Development. Until doctors and managers acknowledge this, patients will continue to be at risk.