'Go in the bed.’ Just four words – spoken by a nurse in response to a patient’s request for a bedpan – summed up the scale of the poor hygiene standards, and ultimately poor management, at Maidstone & Tunbridge Wells NHS Trust. The culture of apathy caused 90 deaths from Clostridium difficile (C difficile) in the trust’s three hospitals between 2004 and 2006.
That visceral quote appears alongside eye-watering images and moving testimony from relatives in the October 2007 report by the Healthcare Commission (now the Care Quality Commission). Its shock value, together with the volume of casualties, would always have sparked heavy media coverage.
But there were other angles that gave the story legs for months. The trust had been lobbying the Government for years to replace the dilapidated Pembury Hospital in Tunbridge Wells. This allegedly had distracted it from patient care.
Former Bucks Fizz singer Cheryl Baker’s mother-in-law was one of the patients killed by C difficile, giving the story a celebrity angle.
And Tunbridge Wells MP Greg Clark, an up-and-coming member of the shadow cabinet, was keen to be quoted putting pressure on the trust.
Aided by colleagues drafted in from other NHS bodies, the trust’s acting head of communications Darren Yates fielded an avalanche of interview requests from as far afield as Los Angeles.
Accusations of a cover-up
But his position was tricky. The report accused the trust of covering up the true extent of the problem – by issuing press statements implying patients had mainly acquired the infection before entering hospital, and by under-reporting the number of related deaths.
‘It’s a fair point,’ says Yates. ‘We’ve changed the policies on reporting now, both to the media and within wards.’
What he may be too modest to add is filled in by his colleague Paul Brydon, who joined the trust in the week after the report: ‘It was never within Darren’s gift to issue those figures. It was strictly a top-down communications culture.’
But the pair were aided by the fact that, in the week preceding the report’s publication, several members of the trust’s top management, including chief executive Rose Gibb, resigned.
Yates recalls: ‘Our biggest issue was just accepting the detail of the report and coming to terms with that internally. For months the old management had been in denial about the problem and so we’d been in fighting mode. Once the report was out, we needed to move into acceptance and apology.’
A key new recruit was the director of infection control, microbiologist Dr Sara Mumford, who proved to be ‘really good on TV’, says Brydon. She was fielded on everything from GMTV to Radio 4’s You & Yours programme to talk about the new isolation ward, the new focus on hygiene and the key message that C difficile, although transferred by poor hygiene, is primarily caused by overprescription of antibiotics.
Yates says: ‘When all the TV satellite trucks are camped outside, it’s easy to feel like winding up the drawbridge. But we decided to keep seeking publicity to show how we intended to move on.’
So, after establishing that producers were keen to examine the effect of government targets on infection rates, the BBC’s Panorama team was given free rein to film.
A chance to apologise
As well as showing the public that the trust had already implemented a comprehensive plan to reduce C difficile infections, the coverage also gave staff the chance to apologise on camera.
‘It was an opportunity for atonement,’ says Yates. ‘Most of us live in this area and there was a stigma attached to being accused of not caring for people in their weakest moments.’
Creating a culture of openness was key to educating staff, patients and visitors about hand hygiene. The new chief executive began weekly emails to staff, providing updates on new policies and falling infection rates.
Yates commissioned huge signage on the glass-fronted main entrance to Maidstone Hospital, with the slogan ‘Clean your hands – for all our sakes’. Large Alcogel dispensers were installed in the main reception of all three of the trust’s hospitals (including Kent & Sussex in Tunbridge Wells and Pembury) .
The National Patient Safety Agency (NPSA) has focused on improving hygiene at the ‘point of care’. But Katherine Wilson, head of the NP SA’s Clean Your Hands campaign, says highly visible signage at hospital entrances can be ‘important in giving the public confidence of raised standards’.
The trust has also worked to cultivate local people and groups. The Healthcare Commission report found relatives of C difficile patients who wanted to complain to the old management were often ignored or given wrong information. This meant they were eager to talk to the media after the report’s publication and began litigation against the trust.
The new regime has invited some relatives to attend trust board meetings and see the changes for themselves. One woman, whose mother died of C difficile, was given a tour of the new isolation ward and the Kent Messenger printed an article on her positive reaction.
Mary Harris, community editor at the Kent & Sussex Courier, believes local people now have more confidence in the trust. She says the fact that all visitors now clean their hands on entering the hospitals reflects a shared seriousness about hand hygiene. ‘We don’t describe the trust as scandal-hit any more,’ she adds. ‘We think it has moved on.’ Harris also believes visible evidence of the new state-of-the-art Pembury Hospital, now under construction, is focusing people’s minds on the future.
Yates has been promoting media updates on the new hospital, the trust’s growing reputation for keyhole surgery and sharply falling C difficile rates (see graph). But he is under no illusion that people have forgotten its darkest days. Only last month, the story resurfaced when Gibb lost an appeal against the removal of her £175,000 severance payment. ‘It’s a scar that won’t go away easily,’ concludes Yates.
Case Study: Rolling up their sleeves
Director of communications, Barnet & Chase NHS Trust
McKnight wishes journalists would stop adding the line ‘Barnet & Chase was the first NHS trust to be served with a Healthcare Commission improvement notice’ in stories about the trust or MRSA.
‘Our infection rates have plummeted in the two years since it happened, but this keeps coming up.’
The improvement notice, issued in July 2007, was the first use of a new legal power to force superbuginfested hospitals to clean up. It put the trust at the centre of a swarm of media coverage and prompted a rigorous campaign to communicate anti-infection policies internally. ‘The Big Deal’ campaign, launched last year, aimed to communicate the message that the trust needed patients’ and visitors’ help to reduce infection at its two hospitals, encouraging them to ask staff if they had washed their hands. McKnight says it was a challenge to get doctors to roll up their sleeves and take off their watches. ‘We’ve empowered the matrons to tell them to do that now.’
The trust also put up a notice in the hospital restaurants informing staff they would not be served unless they changed out of their theatre ‘blues’.
But McKnight’s attempts to convince local media and residents that positive change has been implemented have been complicated by a proposal to reduce the A&E services at the trust’s Chase Farm Hospital. This has been vehemently opposed by local people via the ‘Save Chase Farm’ campaign.
‘Our challenge now is to harness that strength of feeling and show the local community how we can serve their needs,’ says McKnight.