Daily Insight: An elusive threat

There’s a lot of learning from the outbreak of carbapenemase-producing enterobacterales at Frimley Health Foundation Trust. This nasty little organism can spread through hospital drainage systems, potentially infecting vulnerable patients through washbasins and shower drains.

As HSJ reports, the trust had 94 cases last year and has launched a mortality and morbidity review. CPE has become more common in recent years, with growing concern about its resistance to many antibiotics.

But with water systems being one of the ways in which it can be spread, is it time for a wider rethink about them? The risk of legionella is well known — it’s more than a decade since Basildon Hospital was prosecuted following two fatal cases. But CPE is a newer risk and may be a greater challenge to “design out”.

One of the reasons is that removing handbasins from areas like ITU and oncology — as recommended at Frimley — is inconvenient and goes against the “now wash your hands” mantra. And greater testing of patients on admission could play havoc with flow out of accident and emergency.

As always, the NHS may have to balance risks. But CPE should be on boards’ minds and possibly in their risk registers.

Hello, goodbye

The NHS has treated overseas workers pretty shabbily in many regards.

Most recently, it was revealed two ambulance trusts had sacked paramedics recruited from Nigeria after discovering that they did not, in fact, have the equivalent qualifications to their English counterparts.

But as North West Ambulance Service Trust pointed out, the staff were on the Health and Care Professions Council register, and the HCPC had assessed their skills, right?

Wrong.

Or if it had, it hadn’t assessed them very well.

Should trusts still take the HCPC’s word for it that overseas registrants have the equivalent skills? It’s not clear.

The trusts were keen to stress the paramedics without the relevant skills were not a danger to the public. But imagine you had been offered a job in good faith, thousands of miles way, relocated with your family, then being given jobs outside of your capabilities. That’s terrifying stuff for a clinician.

The trusts would have been delighted to get staff with five years’ experience at newly qualified paramedic rates. It would have helped with the ambulance sector’s broader diversity problem.

The trusts did not have to just sack the staff though. Five dismissed at NWAS, five at South East Coast Ambulance Service Trust — about a third of the cohort.

The trusts could have trained them to the appropriate level, instead of sacking the staff and referring them back to the same HCPC that hadn’t assessed them properly in the first place, to be potentially struck off in the fitness to practise process.

SECAmb offered staff flights home to be rid of the problem, but no one took up the offer.

London Ambulance Service had the same issue but paid for staff to be trained.

This debacle is symptomatic of this whole period of NHS history, of the human costs to funding vital services on the cheap, leading to shoddy processes and a desire to get the cheapest possible workforce.