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I was interested to see the problems of Maidstone laid at the door of the Exec team for chasing targets/Ft status. Of course they, including the Medical Director have to take ultimate responsibility , but the levels of CDiff and MRSA , which was one of the key issues here must be the responsibility of clinical teams to identify and action and it has been a mystery to me that the consultants in this Trust seemed to be able to completly abdicate their responsibilities for good patient care. Admittedly what really is going on in the Trust is different to what we see in the public domain and I trruly hope that there was more humility and soul searching than appeared to be the case. If appraisals include a rigorous review of outcomes including infection rates we will make progress, if they continue to contain the smoke screeens that I know many currently do then forget it.