Shutterstock/monkey business images
Show Hide image

Patient care is key to a thriving health system

Investment in cutting-edge care will reap long-term benefits for patients and healthcare budgets alike.

The NHS is one of the finest healthcare systems in the world, and an integral part of the United Kingdom’s post-war identity. That is why I am so proud to run the UK operations of BD (Becton, Dickinson and Company), a world leader in patient safety, which is the standard benchmark of modern, high-quality healthcare.

We are a global medical technology company leading the world in innovations to improve health outcomes. Health systems today need a collaborative approach to deliver higher quality care for less. We want to share the responsibility to improve health outcomes – ensuring safer, more efficient care delivered to patients – and to do it sustainably. We work across the continuum, from discovery of new markers for disease to diagnostics to the delivery of care and have end-to-end, interconnected solutions. We have the resources and global network to gather the finest minds to make it happen.

The NHS’s basic formula is built on the Hippocratic Oath of “First, Do No Harm” to patients and maximising patient safety is key to that. In order for the NHS to provide quality affordable care we need to provide joined up solutions and deliver improvements on patient safety.

The crucial patient safety challenge, and one which some NHS leaders across the past few decades have occasionally struggled with, is infection prevention and control. Most people understand this as Healthcare Acquired Infections (HAIs) such as MRSA (methicillin-resistant Staphylococcus aureus), and there have been many examples in the press of the severe effect these infections have on patients.

There is good news. Infection rates have fallen, and improvements have certainly been made. MRSA Action have reported that there has been a 37 per cent drop in the number of MRSA bloodstream infections reported in the primary care setting between 2011 and 2016, with 1,116 cases reported in 2011/12 down to 820 cases in 2015/16. However, the trend in reductions halted in 2014/15 and a 3 per cent increase was seen in 2015/16. Clostridium difficile (C. diff) reduced significantly between 2011 and 2016, with a 48 per cent reduction in hospital cases and 27 per cent reduction in primary care. However, the reducing trend has stalled since then and it is vital we continue to monitor and highlight the importance of managing both MRSA and C. diff, along with other infections.

This is still a problem. In certain areas MRSA and C. diff are too high and sepsis still kills about 14,000 people unnecessarily every year in the UK, even though basic interventions could prevent these complications.

Antimicrobial resistance (AMR) is the new challenge on the horizon, and this problem is potentially more challenging than any in healthcare. Current trends project that AMR could cause up to 10 million deaths annually by 2050, surpassing deaths currently caused by cancer. If we fail to tackle it at the root, surgical and commonplace medical procedures, which are now routine, will come with huge risks to the patient, and antibiotics that have been used for decades will become useless. Preventing this catastrophe will involve rethinking our approach to surveillance, diagnostics and treatment. Diagnostic operations will have to become far more effective, and appropriately targeted antibiotics must only be given out where a set of conditions are met.

Medication errors also present a significant and avoidable burden of harm and cost to patients and the efficient running of health services. There is a 45 per cent chance for error in the medication administration process. Campaigns to reduce errors were launched in 2017 by both the UK Department of Health and the World Health Organization. Through our research, we have shown medication errors can be reduced through the better use of technology, including automated dispensing systems in pharmacies and digital checks at every step of the process.

BD has solutions to some of the key pillars underpinning safer patient care, be it medication errors or HAIs and its related problem, AMR, and we are ready to partner with the NHS to implement these solutions. Industry needs to take shared responsibility for failures in patient safety and must deliver improvements, not just through the technologies we provide but by working alongside healthcare providers to ensure the necessary practices and procedures, supported by the most appropriate proven technologies, are used to ensure we put patient safety at the heart of everything we do.

We work tirelessly to educate clinicians in using these tools effectively. We are here as a resource for clinicians, managers and politicians to draw on in tackling some of the biggest challenges facing the NHS – challenges which needlessly costs thousands of lives and many millions of pounds.

In April, BD announced our intent to acquire C. R. Bard, Inc., a company with similarly international operations and complementary safety platforms that broadens our offering right across this landscape. After the acquisition is completed, it will enable us to provide even more comprehensive solutions.

In an austerity economy, we must find ways to save money and improve outcomes wherever possible. This is easier said than done, of course, but it is possible. Companies such as ours must be realistic about the reality of budgetary pressures and pose solutions to both clinical and economical challenges. But there is no false dichotomy.

By procuring for the longer term, healthcare leaders can improve outcomes and save money. Effective, safe solutions are not always the cheapest but, often, provide efficiencies further down the line and avoid additional cost burdens by reducing errors. For example, by diagnosing the correct pathogen in a case of suspected sepsis, clinicians can halt the systemic infection and avoid life-changing injuries, which will take a patient out of work for decades, and lifelong care, which is costly. By investing in technological solutions, this can be avoided not just in one case, but thousands.

Patient safety is not simply a luxury – it makes complete financial sense to treat it as a long-term investment. BD supported Health First Europe’s Declaration for Patient Safety, which was launched in December, and urged Ministers of Health across Europe to agree a high level of understanding on patient safety practices and standards to make care consistently safe across Europe’s healthcare systems.

My message is this: we are here to help make the NHS the safest healthcare system in the world. Our experts are a resource for healthcare professionals to draw on. We want to contribute in any way we can to the UK’s national objectives of keeping patients safe and, by doing that, lowering the cost of healthcare delivery.

Mike Fairbourn is vice-president general manager at BD UK & Ireland.

Photo: Getty
Show Hide image

Arsène Wenger: The Innovator in Old Age

As the Arsenal manager announces his departure from the club after more than two decades, the New Statesman editor, Jason Cowley, appreciates English football’s first true cosmpolitan. 

How to account for the essence of a football club? The players and managers come and go, of course, and so do the owners. The fans lose interest or grow old and die. Clubs relocate to new grounds. Arsenal did so in the summer of 2006 when they moved from the intimate jewel of a stadium that was Highbury to embrace the soulless corporate gigantism of the Emirates. Clubs can even relocate to a new town or to a different part of a city, as indeed Arsenal also did when they moved from south of the Thames to north London in 1913 (a land-grab that has never been forgiven by their fiercest rivals, Tottenham). Yet something endures through all the change, something akin to the Aristotelian notion of substance.

Before Arsène Wenger arrived in London in late September 1996, Arsenal were one of England’s most traditional clubs: stately, conservative, even staid. Three generations of the Hill-Wood family had occupied the role of chairman. In 1983, an ambitious young London businessman and ardent fan named David Dein invested £290,000 in the club. “It’s dead money,” said Peter Hill-Wood, an Old Etonian who had succeeded his father a year earlier. In 2007, Dein sold his stake in the club to Red & White Holdings, co-owned by the Uzbek-born billionaire Alisher Usmanov, for £75m. Not so dead after all.

In the pre-Wenger years, unfairly or otherwise, the Gunners were known as “lucky Arsenal”, a pejorative nickname that went back to the 1930s. For better or worse, they were associated with a functional style of play. Under George Graham, manager from 1986 to 1995, they were exponents of a muscular, sometimes brutalist, long-ball game and often won important matches 1-0. Through long decades of middling success, Arsenal were respected but never loved, except by their fans, who could be passionless when compared to, say, those of Liverpool or Newcastle, or even the cockneys of West Ham.

Yet Wenger, who was born in October 1949, changed everything at Arsenal. This tall, thin, cerebral, polyglot son of an Alsatian bistro owner, who had an economics degree and was never much of a player in the French leagues, was English football’s first true cosmopolitan.

He was naturally received with suspicion by the British and Irish players he inherited (who called him Le Professeur), the fans (most of whom had never heard of him) and by journalists (who were used to clubbable British managers they could banter with over a drink). Wenger was different. He was reserved and self-contained. He refused to give personal interviews, though he was candid and courteous in press conferences during which he often revealed his sly sense of humour.

He joined from the Japanese J League side, Nagoya Grampus Eight, where he went to coach after seven seasons at Monaco, and was determined to globalise the Gunners. This he did swiftly, recruiting players from all over the world but most notably, in his early years, from France and francophone Africa. I was once told a story of how, not long after joining the club, Wenger instructed his chief scout, Steve Rowley, to watch a particular player. “You’ll need to travel,” Wenger said. “Up north?” “No – to Brazil,” came the reply. A new era had begun.

Wenger was an innovator and disrupter long before such concepts became fashionable. A pioneer in using data analysis to monitor and improve performance, he ended the culture of heavy drinking at Arsenal and introduced dietary controls and a strict fitness regime. He was idealistic but also pragmatic. Retaining Graham’s all-English back five, as well as the hard-running Ray Parlour in midfield, Wenger over several seasons added French flair to the team – Nicolas Anelka (who was bought for £500,000 and sold at a £22m profit after only two seasons), Thierry Henry, Patrick Vieira, Robert Pirès. It would be a period of glorious transformation – Arsenal won the Premier League and FA Cup “double” in his first full season and went through the entire 2003-2004 League season unbeaten, the season of the so-called Invincibles.

The second decade of Wenger’s long tenure at Arsenal, during which the club stopped winning titles after moving to the bespoke 60,000-capacity Emirates Stadium, was much more troubled. Beginning with the arrival of the Russian oligarch Roman Abramovich in 2003, the international plutocracy began to take over the Premier League, and clubs such as Chelsea and Manchester City, much richer than Arsenal, spent their way to the top table of the European game. What were once competitive advantages for Wenger – knowledge of other leagues and markets, a worldwide scouting network, sports science – became routine, replicated even, in the lower leagues.

Wenger has spoken of his fear of death and of his desire to lose himself in work, always work. “The only possible moment of happiness is the present,” he told L’Équipe in a 2016 interview. “The past gives you regrets. And the future uncertainties. Man understood this very fast and created religion.” In the same interview – perhaps his most fascinating – Wenger described himself as a facilitator who enables “others to express what they have within them”. He yearns for his teams to play beautifully. “My never-ending struggle in this business is to release what is beautiful in man.”

Arsène Wenger is in the last year of his contract and fans are divided over whether he should stay on. To manage a super-club such as Arsenal for 20 years is remarkable and, even if he chooses to say farewell at the end of the season, it is most unlikely that any one manager will ever again stay so long or achieve so much at such a club – indeed, at any club. We should savour his cool intelligence and subtle humour while we can. Wenger changed football in England. More than a facilitator, he was a pathfinder: he created space for all those foreign coaches who followed him and adopted his methods as the Premier League became the richest and most watched in the world: one of the purest expressions of let it rip, winner-takes-all free-market globalisation, a symbol of deracinated cosmopolitanism, the global game’s truly global league. 

(2017)

Postscript

Arsène Wenger has announced he is stepping down, less than a year after signing a new two-year contract in the summer of 2017. A run to the Europa League finals turned out not to be enough to put off the announcement to the end of the season.

Late-period Wenger was defined by struggle and unrest. And the mood at the Emirates stadium on match day was often sour: fans in open revolt against Wenger, against the club’s absentee American owner Stan Kroenke, against the chief executive Ivan Gazidis, and sometimes even against one another, with clashes between pro and anti-Wenger factions. As Arsenal’s form became ever more erratic, Wenger spoke often of how much he suffered. “There is no possibility not to suffer,” he said in March 2018. “You have to suffer.”

Arsenal once had special values, we were told, and decision-making was informed by the accumulated wisdom of past generations. But the club seems to have lost any coherent sense of purpose or strategic long-term plan, beyond striving to enhance the profitability of the “franchise”.

The younger Wenger excelled at discovering and nurturing outstanding young players, especially in his early seasons in north London. But that was a long time ago. Under his leadership, Arsenal became predictable in their vulnerability and inflexibility, doomed to keep repeating the same mistakes, especially defensive mistakes. They invariably faltered when confronted by the strongest opponents, the Manchester clubs, say, or one of the European super-clubs such as Bayern Munich or Barcelona.

Wenger’s late struggles were a symbol of all that had gone wrong at the club. The vitriol and abuse directed at this proud man was, however, often painful to behold.

How had it come to this? There seems to be something rotten in the culture of Arsenal football club. And Wenger suffered from wilful blindness. He could not see, or stubbornly refused to see, what others could: that he had become a man out of a time who had been surpassed by a new generation of innovators such as Pep Guardiola and Tottenham’s Mauricio Pochettino. “In Arsene we trust”? Not anymore. He had stayed too long. Sometimes the thing you love most ends up killing you.

 

Jason Cowley is editor of the New Statesman. He has been the editor of Granta, a senior editor at the Observer and a staff writer at the Times.