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MRSA: the public private contrast Patrick Crozier writes about MRSA, which stands for Methicillin-resistant Staphylococcus Aureus:
Stephen Pollard mentions MRSA (seems that the government figures are rather dodgy), which got me wondering: is it any better in private hospitals? So, I did a bit of googling and uncovered this, this and this.
And the answer? Yes, it is.
Indeed. The second this gets you to this:
Evidence from a selection of hospitals in Sheffield reveals that a far smaller proportion of private hospitals are being blighted by the infection, which has led people to ask why this disparity exists.
I daresay readers of and writers for Samizdata could come up with the odd reason or two.
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The NHS Treatments rationed by beurocrats; funded by coercion
The worst healthcare funded in the worst possible way.
I want my money back?
One quote, from your first ‘this’, struck me. It is both on and off topic:
“…hospital workers – LIKE MANY EMPLOYEES OF STATE INDUSTRIES – are demoralized and their pay rates are unresponsive, thus causing the local shortages.” (emphasis mine)
One of the most powerful underpinnings of the State’s power and one of the most resistant constituencies to efforts limiting it, are government employees.
It is too bad that they can’t seem to see that they might be better off with private jobs.
I worked a corporate meeting this week (a pharma/medical company), and one of their major points of discussion was how their products could help fight things like MRSA, since it’s such a big problem with the NHS (and, indeed, a burgeoning problem everywhere). They also pointed out how it was easy to sell new and improved tech to private hospitals, but introducing new tech to the NHS was a hard fight, and how the best angle was to get the doctors to convince the accountants that it would save money.
Of course, one of the other things they brought up was that the NHS is the world’s second-largest employer, after the Indian Railway…
It might help that private patients are in rooms of their own. I assume this hinders the spread of infection.
AB
All they really need is more cleaners. This has been done to death and the conclusions are the same again and again: the care is ‘okay’ but the cleanliness standards are terrible. Problem is, cleaners don’t show up on the figures as ‘qualified healthcare workers’ etc so they don’t get hiring priority as hospitals are judged (among other things) by the doctor/nurse:patient ratio. Oops!
I’d have though that the reason is quite simple really: if an NHS hospital does anything, it costs the hospital money. But if a private or charitable hospital has patients, that (usually) brings in money.
The NHS Hospital will therefore view things from the perspective of cost control alone. As a result they will hire the cheapest contract cleaners rather than the most appropriate. By contrast a private hospital will lose its patients and income if it is found to be unclean. Which one is likely to be cleaner?
Harvey writes:
“All they really need is more cleaners.”
A few bottles of good old-fashioned disinfectant wouldn’t hurt, either.
There was an excellent letter published in the Telegraph a few weeks ago from the former head of a trade association which represents biocide manufacturers (“biocide” – such a lovely word).
He recounted how disinfectant products were shunned by the NHS on the grounds that people objected to the smell (!) and they were not environmentally sound, because they killed all bugs indiscriminately.
Clearly, there are many contributory factors to the MRSA story, including poor doctor training in hygiene, the over-professionalisation of nursing, the quality and number of cleaners and the appalling bureaucracy of the NHS itself. Still, it was interesting to hear that the absurd “Green” tendency has had its own dark role to play in this sphere, as in so many others.
The single most important factor in the spread of MRSA is medical care provider hand hygiene. Care providers ‘pick up’ bacteria from infected patients or contaminated surfaces and pass the infection on to their patients. Many studies have demonstrated relatively poor hand hygiene policy compliance in numerous facilities. Extended hospitalizations, overcrowding, increased proportion of hospital patients who are inmmunocompromised, and excessive use of antibiotics are also factors. Control requires stringent hand and surface hygiene practices. Screening & isolation of infected patients also decreases prevalence.
I thought the cleaning of hospitals was now via the ‘lowest bidder’ system beloved of the free market? The NHS is absorbing more and more free market practices such as a bloated managerial layer and lots of lovely paperwork.
Does anybody know what type of patient is likely to contract MRSA and whether that type of patient is also to be found in a private hospital? I don’t mean plebs, I mean the type of medical condition they have.
Don’t forget, the private hopitals cherry pick their customers. Get a complication or anything needing long term treatment and the private hospital will dump you straight back onto the NHS.
True story: Several years back I was stuck for several weeks in a hospital that had a bad reputation for infection. Twice I watched as the cleaning woman, wearing thick rubber gloves, scrubbed out the toilets and shower. Good idea, I thought, they take the spread of infection seriously. Then I noticed that when the cleaning was done, she replaced the paper towels above the sink while wearing those same, damp, rubber gloves. The doctors always washed and dried their hands with those paper towels before checking my wounds.
I complained about the situation but I doubt anything was ever done about it.
zmollusc writes:
“I thought the cleaning of hospitals was now via the ‘lowest bidder’ system beloved of the free market?”
The problem here lies with the lack of adequate standards being set and maintained by the management and medical staff.
“Does anybody know what type of patient is likely to contract MRSA and whether that type of patient is also to be found in a private hospital?”
Any invasive procedure. And private hospitals perform a great amount of routine, elective surgery – just where one might expect MRSA to strike.
The simple fact is that many NHS wards are, not to put too fine a point on it, filthy. Private wards tend not to be because paying customers complain and have to be listened to.
I would have thought that elective surgery would give you a lower risk as you are likely to be comparitively fit and not spend too long in the hospital.
You can’t maintain cleaning standards by setting goals from the comfort of your office. The fricken Matron should have the authority to hire and fire the cleaners, sadly anyone in a position to monitor standards properly is too lowly to be allowed to ‘interfere’ with who gets the contracts. That is the job of suits far away from the reality. Never mind, the suits can always shift the blame.
Obviously, the historic under-investment in the NHS is a major contributor, as it means more open wards and fewer cleaners. The solution seems to be to increase investment to increase capacity to allow more patient separation and to hire more cleaners. I notice that the Telegraph story mentioned that MRSA is much lower in countries with much higher levels of public expenditure on health.
Interesting quote from this story: “Speaking to the Star, John Lofthouse, executive director at Thornbury, said that patient screening on arrival was helping to reduce the rates of infection in his hospital.”
I’d be interested to know exactly what he means here. What do they do with a patient if the screening reveals MRSA infection? Do they admit them but in isolation or do they send them to another hospital?
“The solution seems to be to increase investment to increase capacity to allow more patient separation and to hire more cleaners.”
Complete rot – in fact, the usual socialist remedy: ‘it isn’t working – let’s do more of it!’
The answer is to educate doctors and nurses in basic hygiene (you’d be surprised how poorly a generation raised under an antibiotic shield understands it) and to re-instate nursing authority over basic ward hygiene.
It isn’t about money. It’s about replacing bogus “sophisticated” ideas with old-fashioned common sense.
” What do they do with a patient if the screening reveals MRSA infection? Do they admit them but in isolation or do they send them to another hospital?”
Usually, they are isolated. Which is a worthless procedure if the attending medical staff are careless of basic procedures and unable to enforce standards even if they are not.
“Don’t forget, the private hopitals cherry pick their customers. Get a complication or anything needing long term treatment and the private hospital will dump you straight back onto the NHS.”
Why on Earth would they do that? “Long term-treatment” or “complication” is just medical speak for “repeat business”, which every self-respecting private vendor drools over.
It’s the public agencies that start looking for excuses to get rid of you or to shove you in a room and forget about you. You’re costing them money, not buying anything from them…
Ken, unless you are of vast personal wealth it will be your medical insurance cover that will be paying out for your ‘repeat business’ should the worst happen. Since the insurance COMPANY is interested in making money, not paying it out they will wriggle like blimey to avoid paying for your long term care. What will the private hospital do when nobody is paying for your expensive treatment? Three guesses?
……and another thing……
Do all these private hospitals that do lucrative elective surgery have full Intensive care facilities ( or whatever the trendy name is for them this week)? Or will they call an NHS ambulance ?
Clue: Having ITU beds and staff standing by just in case they are needed will greatly affect profitability in a downward direction.
“I thought the cleaning of hospitals was now via the ‘lowest bidder’ system beloved of the free market?”
That is the most retarded description of free market economics I have ever read.
Wow! I am bowled over by the insight and devastating explaination of how free market economics really works. Thanks for the education, I am still reeling from the eloquence.
The private and public sectors both, in anything, seek the lowest-cost options that meet their needs. The difference is in the nature of those needs.
The private sector wants to make a profit, and the shortest distance to profit is to attract and retain customers who feel that you deliver good value for the money. This results in the private sector providing goods and services — or at least attempting to provide goods and services — at as low a cost as possible for the quality demanded. This means, for instance, not killing your patients with nosocomial infections.
It’s hard to figure out just what the public sector wants to do, and I mean that quite seriously.
Imagine a state where the public servants are perfectly honest and are interested solely in serving the people as best they can, rather than in getting re-elected by catering to the interests of specific groups.
Further imagine that this state has a comprehensive system of social welfare programs: the public pays high taxes, and should one of the public get sick, he is taken care of at the public’s expense. Should one of the public become unemployed, he recieves some kind of benefit (i.e. dole) to keep him from starving or freezing to death, and the state assists him in finding new employment. Et cetera. Something like this system is in place in most Western countries.
Now imagine that Joe Bloggs, a citizen of this wonderful country, falls ill and enters a state hospital. The responsibility of the hospital to Mr. Bloggs is clear: to make him well again. But the hospital is just one arm of the vast apparatus of the state, which has a lot of goals.
One of the goals might be to prevent incompetent cleaners from becoming unemployed and requiring benefits. In this imaginary state, hiring competent cleaners for the hospital wouldn’t just require paying a bit more for the mop squad, but also paying unemployment benefits to the incompetents, and finding new work for them to do. If there’s no useful work that they can perform nearby, then the state could find itself responsible for paying for their people and their families to move somewhere else. And, remember, these people were judged to be incompetent cleaners; it is reasonable to assume that their skills and work ethic are not all one might want them to be.
Another goal might be to keep down the entire expenditure on health care; if Mr. Bloggs has a complicated complaint and is taking up a hospital bed that could be filled by someone with a disease that’s easier and cheaper to cure. Maybe the country is overpopulated and the death of Mr. Bloggs and a few million of his compatriots would improve the society’s chances of success overall. Maybe Mr. Bloggs is a troublemaker, and has been annoying his neighbors. (Some of these things may be unlikely in the UK, but there are plenty of other countries where they’re applicable.)
So in this perfectly fair, competently-run state, the best alternative may well be to let Mr. Bloggs contract an infection and die, rather than to clean the hospital properly. This is, I believe, what some people refer to as ‘bearing the full cost’, as in ‘CORPORATIONS don’t bear the FULL COST of their PREDATORY policies!!!1’
As it happens, that’s usually true. Within a given society or economy, though, the ‘full cost’ is always borne somehow: in a more laissez-faire society, some of the cost is borne by unemployed incompetents, while under state socialism the cost is borne by the dying Mr. Bloggs.
There’s your difference between public-sector and private-sector health care right there. On the one hand, I am ‘interested in mankind’, and so I would like to see those incompetent cleaners happy and well-fed; but on the other hand *my* death affects me more than any other, so when I’m in the hospital bed, I prioritize my health over their happiness.
(This is admittedly a hyperbolic example, and the situation at hand isn’t nearly as simple as I make it here: I have been given to understand that zeal can actually make the problem worse, as overuse of antibiotics and disinfectants winds up killing off everything except the very hardiest bugs.)
In medicine, whether you find yourself in a private or a public hospital, when you are afflicted with cancer of the toe, the doctors will recommend amputation before it metastasizes. The toe might not like this very much, but as it is the brain that pays the bills, the toe’s immediate needs take a back seat to the brain’s desire to survive. In the public sector, you as an individual are the Toe of the State, whose needs are subsidiary to those of the public at large. Doubtless there are people in the world who would gladly die (or who believe they would gladly die) as Toes if in so dying they knew that they were being Socially Just. I am not one of them.
The simple use of individual beltclip mounted alcohol based hand disinfectant dispensers would almost completely eliminate this problem. Cost? Approx. $1 per worker with patient contact per day.
I’ve been in several hospitals over the past year – visiting and as a patient. In all cases alcohol gel hand cleaners were provided at ward entrances and at other strategic locations. The number of visitors using them was miniscule. If patients’ own families can’t be bothered to observe elementary precautions what chance do medical staff have?
I also must cast doubt on the descriptions of NHS wards as filthy. Since part of my own admission was a post op infection (not MRSA than God) I am pretty highly tuned to matters of cleanliness.
I think someone else has already pointed out that MRSA rates in places like Sweden are much lower than in the UK. The problem is clearly much more complex than the private good – public bad sloganising allows for. We have for example to accept the rather unappetising fact that as a nation our general standards of cleanliness are pretty poor in all areas – as a trip around any town centre on a Sunday monring will demonstrate.
ian writes:
“I also must cast doubt on the descriptions of NHS wards as filthy.”
You can cast as much doubt on it as you like, but I’m afraid, in many cases, you would be quite wrong.
I’m glad to hear that your own experience of NHS wards has been good. I shan’t ruin your dinner by telling you some of the things I have seen during the past couple of years.
Just count your blessings.
For hygiene, have alcohol gel/foam dispensers at every bedside – not just at the ward doors. And have alcohol wipes for stethoscopes. If it’s not trivially easy, it won’t be used.
Nurses are generally worse than doctors for spreading, not because doctors are more careful (they’re not) but because nurses have so much more contact with the patients, and because it is so difficult for them to make sure they’re completely cleaned every time they touch someone.