Faster,Higher,Stronger

Writing the editorial for each issue of JIP requires a bit of crystal ball gazing at times, and I am going to take a leap of faith that the weather finally cottoned on to the fact that it is summer in July, that the London 2012 Olympics has been the greatest show on earth and that everyone in the country is proud of the performances of Team GB. Each one of the team trained day in and day out, giving up friends and family to focus on the challenge of competing at the very highest level and performing at their absolute best at a set moment in time. The British Olympic team is a highly trained ‘workforce’ and each person is individually and collectively part of a great ideal. Each of the component parts of Team GB enjoyed increased funding over the past seven years to ensure that they were properly prepared for London 2012. My crystal ball gazing suggests that the near future will see a reduction in funding, with no reduction in our expectations that in 2016 Team GB will be ‘faster, higher, stronger.’ So what does any of this have to do with infection prevention and patient safety?

The healthcare workforce is very similar to Team GB – highly trained and individually and collectively focused on ensuring that the NHS delivers high quality care at the point of need. The past ten years have seen NHS funding increase year on year, but so has demand and the cost of new technologies and treatments. Since 2005, infection prevention and control (IPC) has been a medal winning team, rising to the challenges set by the government of the day and by healthcare infections. This medal winning team now faces the harsh reality of ‘the post games’ reduction in financial and human resources while bed occupancy and patient dependency increases. In these circumstances, professional development and networking are important elements of continuing to drive innovation and improvement.

The Infection Prevention Society (IPS) exists to provide professional development opportunities for all disciplines of staff with a role in preventing infection, and the programme for Infection Prevention 2012 in Liverpool promises to build on its success in recent years with a high quality scientific programme focused on improving infection prevention from a professional and service user perspective. Over the past six months the Society has been involved in work focused on two issues: identifying the size of the infection prevention workforce in England through a Freedom of Information (FOI) request and working with the Patients’ Association (PA) and other professional organisations to gauge the impact of NHS reform and budget constraint on infection prevention teams and activity.

The FOI request was made to all NHS acute, mental health and primary care trusts/ organisations in England and asked, “How many whole time equivalent staff are employed specifically in infection prevention in your trust? To date we have had an 86% response rate identifying a predicted whole time equivalent workforce of 1438 staff working in infection prevention, including doctors, antimicrobial pharmacists, laboratory and information scientists and specialist nurses. Of this total 72% are specialist nursing staff, 7% medical staff, and 10% antimicrobial pharmacists, with the remaining 11% being spread across scientific and administrative support roles.

The UK-wide Patients’ Association survey aimed to identify changes in the resource and organisational priority given to infection prevention and control over the past 12 months, with a response rate of 84% in England, and between 6% and 1% from the devolved administrations and the Republic of Ireland. Over half of the responses were from secondary care organisations. While just over half of respondents reported that the focus on various aspects of IPC remained stable or in some cases had increased, 45% of respondents indicated that the capacity within the IPC team to meet organisational needs had reduced over the past year. The outlook for the next 12 months, based on what is known about the situation of individual organisations, is that 47% expect the financial and human resources available for IPC to be reduced, with 46% expecting them to remain at the same level. Interestingly approximately a quarter of those responding to the survey expected IPC to be less of an organisational and national priority in the next 12 months.

The top three challenges for improving patient experience in relation to IPC were seen as financial pressures and staff reductions (77%), antimicrobial resistance (62%) and emerging infections (47%). Interestingly the fragmentation of care providers as a result of NHS reform (in England) was the fourth most anticipated challenge (41%). When asked what could be done to influence the IPC agenda and drive further improvement over the next five years respondents indicated that there needed to be a wider recognition of IPC issues beyond the current focus on meticillin resistant Staphylococcus aureus (MRSA) and Clostridum difficile (C. diff.) (85%). There was also an indication that respondents felt that professional societies and patient organisations had an important role to play in influencing the future agenda (61% and 40% respectively).

None of these responses are particularly surprising. It has been clear over the past year that colleagues, within the IPS in both practice and education, are facing reductions in the size and experience within their teams. Perhaps the most frightening element of these conversations is the focus on reducing the number of band 8 posts, not just in IPC, but also in a wide range of clinical specialties where the greatest experience and organisational memory resides. So how should we as IPC professionals respond to the information in these two separate but connected pieces of work?

Firstly, we need to ensure that we do not become isolated from colleagues and that we encourage others to become active members of IPS. The Society provides access to a national competency framework, which supports a programme of high quality professional development to members that in the current financial climate across the UK and Republic of Ireland will not be the key priority of employers. Make it a priority to attend the IPS branch study days to keep abreast of IPC innovation and maintain contact with colleagues. The Infection Prevention Society is also an important networking and influencing organisation that recognises the importance of working collaboratively with other professional societies and groups. The work of the Commissioning Network is one example of where IPS has been at the forefront of supporting colleagues who are involved in the upheaval of commissioning and primary care.

Secondly, we need to use our influence locally and nationally to ensure that the success of the past five years is not squandered under the assumption that the reductions in MRSA bacteraemias and C. diff. are an endpoint rather than a starting point for improvement. This means retaining highly experienced practitioners, collecting and using local data to identify where improvement is needed and ensuring that new practitioners are supported. Acceptance of infection as an inevitable consequence of complex treatment was an underlying feature of the escalating MRSA bacteraemias and C. diff infections. Do not allow acceptance of a deskilled IPC team, as part of fiscal constraint, to undermine patient safety.

Finally, improved patient outcomes are at the centre of the NHS across the UK and the patient ‘voice’ is an important weapon in sustaining services and driving quality initiatives. The work that Julie Hughes has undertaken in Five Boroughs Partnership (Hughes et al, 2011) demonstrates that IPC teams, in meaningful partnership with patients and service users, can shape services and improve quality. Patient experience and professional knowledge and insight are a powerful combination that politicians, service commissioners and chief executives find it difficult to ignore with impunity. Overall the situation is very similar to the Olympic analogy I used earlier – continued success and gold medals require investment, high quality data and commitment, without these you start peddling backwards very swiftly. Politicians take note!