The independent NHS watchdog, the Healthcare Commission, has pledged to crack down on dirty hospitals after official figures showed one in four trusts had failed to meet minimum hygiene standards.
Annual performance ratings for every NHS trust, published today, show 44 hospital trusts out of 172 (25 per cent) failed at least one of three core standards on infection control. Overall, hygiene was the area where compliance with the core standards set by the Commission for the NHS was lowest.
The finding is the first official confirmation of the poor state of hygiene in the NHS. It follows an investigation by the Commission published last week which revealed that at least 90 people died at Maidstone and Tunbridge Wells NHS Trust between 2004 and 2006 from the C. Difficile bug as a result of failures in infection control.
Today's report, the second annual health check by the Commission, shows the situation is worse than the trusts themselves admitted in June. Then, 99 trusts overall – including primary care trusts, mental health trusts and ambulance trusts, as well as hospital trusts – said they had failed at least one infection control standard. This has since been revised to 111 trusts, following spot checks by the Commission.
Anna Walker, chief executive of the Healthcare Commission, said: "Healthcare-associated infections really matter to patients. Trusts have got to meet the hygiene standards."
The Hygiene Code, introduced in October 2006, ushered in tougher standards for the NHS and 87 spot checks had so far been carried out by the Commission with 33 more planned by the end of the year, said Ms Walker. From next year every trust would be inspected for hygiene at least once every year.
But she dismissed suggestions that hospitals were unsafe even though at least 20 trusts had higher rates of infection with C. Diff than Maidstone. "The question is how well trusts deal with infection, not the infection rate itself," she said. "The issue in Maidstone related to deaths – there is a huge difference."
Overall, the performance ratings show the NHS is improving with one in three trusts recording a higher score on measures including waiting times, cancelled operations and financial standing than last year. Nineteen trusts were rated excellent for both quality of care and use of resources, up from two last year. But 33 trusts were rated weak on quality of services, and 20 were also weak on use of resources.
The results show a clear north-south divide with patients getting better care in the North than in the South. Three-quarters of trusts in the North-east were rated excellent or good, whereas three-quarters were rated fair or weak in the South-east. Suggested reasons for the difference include extra resources going into the the North, lower cost of living in the North, and difficulties faced by failing organisations in the South in attracting high-quality staff. Sir Ian Kennedy, the chairman of the Healthcare Commission, said: "One of the successes of a regulatory system is it helps us to get to grips with these issues."
The worst performer
The Royal Cornwall Hospitals NHS Trust has been rated the worst in the country – for the second year running. Based in one of England's most sought-after counties, it should be fighting off applications from top quality staff. Instead, it is blighted – scoring "weak" on quality of services and "weak" on use of resources.
It has had problems for a decade, and some have suggested its low turnover of staff could be the source of its downfall. Applicants have been put off for fear of becoming tarred by its image– and its position off the beaten track is less appealing to ambitious young doctors and managers who want to be at the cutting edge in a teaching institution.
A hospital that becomes a comfortable back water, where people are left to get on with their work, is in danger of losing its way. No institution in the NHS can afford to separate itself from the mainstream. The Royal Cornwall has become an outpost of the NHS, run according to its own rules. The safety of patients demands it is now brought in from the cold.