Signpost: Surgeons’ loss of confidence in Scottish hospitals

The story today of the level of carelessness in the crucial matter of the sterilisation of surgical equipment emanating from the pan-Glasgow decontamination unit at Cowlairs, is simply numbing.

To hear surgeons talk of often having to go through three packets of theatre equipment returned from this facility  as ready for use, before finding a safely usable one, is a matter than cannot be left there.

It is no use to hear a Director of Glasgow and Clyde NHS talk tonight of improvements already in place, and reassuring the sick and worried public that all will now be well.

This simply cannot be correct – cannot be correct.

The complaining surgeons, from Gartnavel Hospital – but they will  be everywhere,  seeing operations cancelled for lack of surgical instruments that are clean and safe to use on patients, have made it clear that their previous complaints achieved no improvement whatsoever in the performance of this critical unit.

Any unit with a culture SO disgracefully slack, in its practices and in its attitudes absolutely cannot be bettered over night by a pep talk and a PR attempt.

This situation needs a root and branch assault on fundamental matters like responsibility; training; constant supervision; clean premises, equipment and working practices.

The filthy, rusting gate at Cowlairs itself spoke volumes for what does not go on inside it.

This situation needs a ‘one-strike and you’re out’ philosophy for staff at all levels, in a service so centrally mission-critical for surviving hospitalisation.

By coincidence and on this very matter of surviving hospitalisation, we learned a couple of days ago of the experience of a patient from Argyll having major surgery in a Glasgow hospital

This patient was undergoing the removal of an organ one can survive without – and left hospital to go home the day after surgery.

This seemingly precipitate self-discharge was on the urgent advice of the consultant surgeon himself.

He told the patient the morning after surgery that the best advice he could give was, if it seemed at all feasible, to get out of hospital as soon as possible after the operation – to avoid post-operative hospital acquired infection.

The patient reported feeling that one more day in hospital would be helpful.

The surgeon again emphasised that if it was at all possible, the best thing would be to go without delay.

The end of this story was that the surgeon’s advice was taken and the patient is now feeling well on the way to recovery.

But what does this say about the real state of our NHS?

This is a cow that has been left sacred for far too long and the reality must be confronted without delay.

It is not a matter of funding. The NHS is well funded. It is a matter of a sick culture where the most basic standards and practices of hygiene and of care for patients are routinely ignored at all levels and in all places – and now we know this includes even the operating theatres.

The NHS is disorganised, complacent, unprofessional, uncaring, dirty and frankly, lazy. There is no evidence of consistent teamwork or of a sense of pride in delivering the best.

This must now stop. It has gone far too far already and people are literally dying because of it.

Why don’t we take a single hospital and drive – mercilessly – every attitude, routine, system, practice  and person to be the best – until it works as it should and can then serve as a template, put into effect with relentless and persistent  scrutiny at all levels and with no second chance after any failure, regardless of seniority?

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22 Responses to Signpost: Surgeons’ loss of confidence in Scottish hospitals

  1. We could always go back to the days when every hospital had an autoclave and a faithful retainer in a brown dustcoat administering to its needs.

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  2. Having seen at first hand my old mother’s treatment by the NHS over the past three years, I can well agree that this is an institution which is very sick indeed. And by many accounts, it is very well funded by international standards. But what you see is a reflection of the situation across the public sector; it’s just that with health, we see the consequences of any incompetence and ineptitude up close and very, very personal to the point of life-threateningly so.

    Last week, Alex Salmond said that public sector spending will increase in a independent Scotland. My heart sank. More is better? Good after bad? He misses the point.

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    • The anecdote about not staying in hospital any longer than you need to reflects a truth but not one that supports the NHS as: “disorganised, complacent, unprofessional, uncaring, dirty and frankly, lazy. There is no evidence of consistent teamwork or of a sense of pride in delivering the best.” Good to see Lynda Henderson continuing her drive to make friends and influence people.

      Hospital acquired infections are a big problem and the Scottish NHS has done a good job of improving infection rates by better screening of potential sources and improved approaches to cleanliness. However, the elephant in the room is antibiotic resistant bacteria. In the past, attention to cleanliness did dip because medics could always rely on antibiotics to mop up any hospital acquired infection. Not so now and hence a re-discovery of the need for rigorous cleaning techniques. Even when these are in place, it is still a good idea to spend as little time as possible in a hospital to minimise the chance of an infection.

      As to the surgical instrument sterilisation unit – which is a completely different matter – then clearly the performance has been unacceptable. But to extrapolate from this to a situation where the NHS is: “The NHS is disorganised, complacent, unprofessional, uncaring, dirty and frankly, lazy. There is no evidence of consistent teamwork or of a sense of pride in delivering the best” is frankly very lazy and unprofessional journalism.

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  3. My experiences of the NHS have been consistently bad, and occasionally appalling.

    The repeated assurances that the NHS is getting better are completely at odds with my experiences and those of friends and family.

    I could provide you a few examples of disorganised, unprofessional behaviour. Very very easily.

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    • My experiences recently have been good – and what in any case are we comparing it to?

      Not to say that it cannot or indeed should not be improved. I think there is much scope for improvement but this constant rubbishing of the NHS (in Scotland at least) smacks of political opportunism rather than a genuine desire to improve the service.

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      • Do public sector workers and their managers who fail to do their job properly ever get fired? Or are they just given ‘lessons to learn’?

        A 75% failure rate in any job is complete incompetence. The workforce (including management) in this facility is demonstrably not fit for purpose Are those people still in their jobs? Have they been fired? If not, why not?

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      • My instincts are distinctly non-Thatcherite and there’s no opportunism or any political agenda on my part as far as this goes. But the words “health” and “service” have seemed like a sick joke to me when used in relation to this institution this while back.

        How to fix it? I don’t really know. One of the problems in this country is the “not invented here” syndrome. There are better run health systems elsewhere in Europe which, according to WHO and other rankings, clearly and consistently outperform our setup. France has often been held up to me as having a superior model by some medic acquaintances but I suspect that to learn from them would never do, would it?

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      • What indeed would you compare a surgeon who was about to cut out the non-cancerous part of a thyroid rather than the cancerous part to? Who had to order new scans to confirm that the patient was right, and several healthcare professionals had misread such key pieces of info.
        What would you compare the hospital who neglected a 86yr old who, very unexpectedly became one of the high-weekend mortality figures to?
        Or the NHS hospital who kept someone with a suspected detached retina in A&E until 3am after waiting 5 hours to tell them to go home, come back in the morning!
        It`s not about comparison, it`s about doing a good job regardless. The individuals are almost always dedicated, attentive and caring, but let down by the organisation, or lack of.

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  4. “As to the surgical instrument sterilisation unit – which is a completely different matter – …”

    How is this ‘a different matter’? Surely your previous statement suggests that hospital dirt has increased on a par with an increase in use of antibiotics; therefore the poor standards of the sterilization unit must surely fall into this same topic.

    As someone who has worked in operating theatres and surgical units across the UK this is extremely depressing news. The return of an instrument tray due to finding a dirty instrument used to be a rare event and so too were severe hospital acquired infections. I completely agree with db above.

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    • The cultural problem in the two elements of this ate clearly similar.
      The difference is between the general cleaning regime that is part of a hospital’s domestic services and a specialist unit that is nowhere other than the frontline of patient survival.
      As you and others are saying, the fact that there have been regular problems with instruments returned from the Cowlairs unit as sterile and ready for use – where such incidents used to be close to unheard of – is another measure of how low this service has fallen in acceptable standards of practice.
      While the over-prescription of antibiotics has created the problem of untreatable infections, it is not the root cause.
      Before we had antibiotics, hospitals were not places where, as a rule, one acquired infections; and patients used to be kept in for extensive post-operative periods without fatal consequences.
      The failure in antibiotics through their misuse does not impact on the acquisition of infection; but on the possibility of successful treatment.

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      • Both you and Lowry are barking up the wrong tree here. The instruments were not used because they were “dirty” . It was because either the instrument packs had the wrong instruments in them (a packing problem) or the packaging was damaged – meaning that they could not be considered sterile. This was a quality control problem not a hygiene problem because the pre-op quality control prevented the instruments being used in the first place.

        I also suggest that your grasp of medical history is, to say the least, shaky. The idea that: “Before we had antibiotics, hospitals were not places where, as a rule, one acquired infections; and patients used to be kept in for extensive post-operative periods without fatal consequences.” I suggest you look up puerperal fever and typhus. Over 80% of surgery resulted in infection prior to the introduction of antiseptics. The introduction of aseptic techniques and better cleanliness reduced post-operative infections down to about 10% prior to the introduction of antibiotics. The modern “gold standard” is 2%. However, this is being compromised by two factors: one is the increasing age of patients who often have chronic and multiple health problems requiring frequent stays in hospital and the other is drug resistant pathogens. These are not new – resistant strains started appearing in the 1950′s but the problem is now the prevalence of these organisms and the fact that they are now resistant to multiple antibiotics.

        There was definitely a problem in UK hospitals where sterile technique and general cleanliness was not being pursued sufficiently rigorously. This has been tackled. However, even with improved sterility measures we can expect HAIs to increase due to the ageing population and the spread of drug resistant bacteria. Staying out of hospitals if you can remains as good advice today as it was in all the time before the introduction of antibiotics.

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        • Maybe there’ll come a day when sterilising re-usable instruments will be superseded by custom manufacturing non-metallic instruments for each procedure, by way of local 3D printers, with the waste material recycled for non-medical purposes.

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        • Me thinks that Fletcher tries to defend the indefensible. As one who has used the health service on a number of occasions over the past 6 years and who regularly visits a number of people in three different hospitals, it has to be said that our health service is clearly going down the drain.

          The Scottish Government continues to throw money at the NHS while depriving our Council’s of adequate funding. They throw money at the freebies (prescriptions, eye tests, bus passes, free personal care etc etc) that are enjoyed by the rich and very rich while doing nothing for the most vulnerable within our communities.

          If folk were honest, they would admit that our NHS is one of the most inefficient organisations in the country. Time somebody sorted them out instead of trying to say how wonderful they are.

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          • It’s all very well having a good old gripe, but you imply that the 3 hospitals you visit are inadequate.
            How about giving us the facts to support your contention?

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          • Er, its actually cheaper to not charge for prescriptions, as the costs involved in the administration of collecting prescription charges outweighs the monies collected -DOH!

            Also they are not “freebies” as they are paid for via taxes

            You have the wrong date in your “name” as you obviously separated yourself from reality a long time ago

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    • lowry for someone who says they have worked in operating theatres and surgical units across the country you do not have the slightest clue do you??? first things first. your conclusion of fletcher of saltuons comment say that hospital dirt has increased with the increased use of antibiotics. this is not what he’s saying at all. hospital dirt has not increased with the increased use of antibiotics some bacteria has become resistent to the antibiotics therefore “the poor standards of the sterilization unit” do not fall into this topic. after the investigation into the non conformance trays that gartnavel claimed to be coming from cowlairs cdu the outcome was that gartnavel had been negligent with the trays themselves. im not saying that every tray that leaves the unit is fit for purpose but what i will say is your agreement with db over the autoclave in every hospital shows your lack off experience, knowledge, understanding and proper training and to quote yourself is very depressing news coming from someone who has worked all across the uk in theatres and surgical units. if you knew anything about the sterilization process then you would know that every set that was sterilized by hospitals themselves back in the days and i mean every single last one came out of the autoclave sterile and by the time it had been carried back through the hospital to its destination was contaminated again. the cdu was put in place for a reason and if you would have bothered to do some proper research rather than have a bhlazay approach to your commenting then you might have had something worthwhile to say. and if you knew anything about science then you would know that HCAIs happen every day throughout the nhs and always will unless they stop family members visiting their loved ones whilst in hospital just as it will always happen in the workplace and in your local community its just that the risk is higher in a hospital environment because the hospitals are full of sick people. the only plus side to the autoclave being in hospitals was the time it took to get your trays back other than that every single set that ever came out of a hospital autoclave and was used on a patient was deemed fine back then but now every last tray would be a non conformance so good on you for agreeing with db. have a good wan!!!

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  5. The central decontamination unit seems to be suffering from a serious infection , and surely the only answer that will restore confidence is to have a thorough clean-out.
    Maybe a return to individual hospital-based sterilisation units, more manageable and directly answerable to the end-users, would be sensible – even if the bean-counters’ view ordained this to be less efficient.
    What price masses of aborted surgery – or, heaven forbid, serious infections and deaths?

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  6. I’m afraid to say that numbers relating to aborted operations may have a greater impact on the powers that be than the others mentioned due to the impact on waiting times.

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    • I recall reading that even minor operations cost thousands per hour of theatre time; what is the effective financial cost here of losing 200+ operations?

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  7. Hospitals can use single-use-instruments, sure they cost quite a bit, but certainly prevent problems associated with non-sterile instruments. I would be happy to pay a contribution of £20 towards the cost of single-use-instruments for an operation that I would have to have in a NHS hospital…

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