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Vale of Leven C. diff inquiry criticises health board Vale of Leven C. diff inquiry criticises health board
(35 minutes later)
Scotland's largest health board has been heavily criticised by an inquiry into the country's worst Clostridium difficile (C. diff) outbreak.Scotland's largest health board has been heavily criticised by an inquiry into the country's worst Clostridium difficile (C. diff) outbreak.
The probe, led by Lord MacLean, looked at the treatment of patients at Vale of Leven Hospital in Dunbartonshire between December 2007 and June 2008.The probe, led by Lord MacLean, looked at the treatment of patients at Vale of Leven Hospital in Dunbartonshire between December 2007 and June 2008.
Of the 143 patients with C. diff, it was a contributory factor in 34 deaths.Of the 143 patients with C. diff, it was a contributory factor in 34 deaths.
Lord MacLean said patients at the hospital had been "badly let down" by NHS Greater Glasgow and Clyde (GGC).Lord MacLean said patients at the hospital had been "badly let down" by NHS Greater Glasgow and Clyde (GGC).
The judge identified "deficiencies in nursing and medical care" at the Vale of Leven and said many patients had been exposed "unnecessarily" to infection. The judge said: "The inquiry has discovered serious personal and systemic failures.
Poor facilities "Patients at the Vale of Leven Hospital were badly let down by people at different levels of NHS Greater Glasgow and Clyde who were supposed to care for them."
He said management failures at NHS GGC resulted in care failures on the ground and that "overall responsibility" had to rest with the health board. 'Overall responsibility'
Lord MacLean said an "effective inspection regime" at the hospital would have identified failures and helped avoid more cases of infection. He added: "There were failures by individuals but the overall responsibility has to rest with the health board."
He cited poor facilities, such as a lack of wash hand basins and a lack of commodes, as well as issues with the fabric of the building as evidence of a poor management. Lord MacLean said "systems were simply not adequate to tackle effectively a healthcare associated infection" like C. diff.
He added: "The major lesson to be learned is that what happened at Vale of Leven Hospital to cause such personal suffering should never be allowed to happen again."
Lord MacLean also expressed his view that the figure of 34 deaths was probably an underestimate as medical records were not available for all of the patients during the period in question.
He cited poor facilities, such as a lack of wash hand basins and a lack of commodes, as well as issues with the fabric of the building as evidence of poor management.
The judge said that prolonged uncertainty over the future of the Vale of Leven hospital contributed to poor morale and recruitment.The judge said that prolonged uncertainty over the future of the Vale of Leven hospital contributed to poor morale and recruitment.
Management failures
Poor leadership among NHS GGC managers, the judge said, contributed to substandard nursing care and deficiencies in medical staffing.Poor leadership among NHS GGC managers, the judge said, contributed to substandard nursing care and deficiencies in medical staffing.
He said inexperienced junior doctors had too much responsibility and consultants were stretched.He said inexperienced junior doctors had too much responsibility and consultants were stretched.
Lord MacLean also said antibiotics were prescribed in cases where it was inappropriate.Lord MacLean also said antibiotics were prescribed in cases where it was inappropriate.
His report identified a number of failings:
There are 75 recommendations in his report, including recommendations on infection prevention and control, nursing and medical care, antibiotic prescribing, communication with patients and relatives, and death certification.
'Repeated warnings'
Lord MacLean added: "An effective inspection regime, I am convinced, would have been able to identify the dysfunctional nature of infection prevention and control at the hospital.
"There must be an effective line of reporting, accountability and assurance.
"This was lacking for the Vale of Leven Hospital. In addition, repeated warnings over a number of years about the importance of prudent antibiotic prescribing had no impact."
Lord MacLean acknowledged that improvements had been made since the C. diff outbreak.
He said: "NHS Greater Glasgow and Clyde did introduce more effective reporting systems for CDI (C. diff) after June 2008 but the message should be reinforced that systems must ensure that important information is relayed from ward to board (NHS GGC).
"I am convinced that the adoption of the recommendations proposed will result in a significantly improved focus on patient care, and in particular, care of patients who contract an infection such as CDI.
"Although it was the failures in how CDI was managed at the hospital that governed the work of the inquiry, the recommendations should, I hope, have a more far-reaching impact."