The departing chairman of a hospital trust at the centre of an infection scandal has called for a “root and branch” review of all aspects of nursing across the NHS, in an astonishing letter of resignation.

James Lee, the chairman of Maidstone and Tunbridge Wells NHS Trust, yesterday became the latest victim of the scandal following the damning report released last week which found that Clostridium difficile infections had caused the deaths of 90 patients at the trust over a two-year period.

Mr Lee offered his resignation by letter to the Health Secretary, which Alan Johnson, in a statement to the House of Commons, later announced had been accepted.

But in a separate letter detailing his reasons for stepping down, the senior manager openly condemned a culture of “command-and-control” in the NHS.

The comments made by Mr Lee come after the Healthcare Commission found a “litany” of errors in infection control at all levels in the trust’s three hospitals.

He said that the pressure of government targets, the desperate financial position of the trust and failings in nursing care contributed to the spate of infections at Maidstone, Kent & Sussex, and Pembury hospitals.

The target to reduce waiting times was “never really achievable at the trust” while it was “struggling with a state that is pretty close to bankruptcy”, he stated.

He added: “I would strongly recommend that the NHS needs to have a root and branch review of all aspects of nursing. I am convinced that something has gone badly wrong.”

His letter started: “Dear Secretary of State, by now you will have received my letter of October 14th, offering you my resignation.

“The events described in a report by the Healthcare Commission were nothing short of a tragedy . . . I am writing to you now to help you to understand some aspects of the background to this story.

“I am very conscious of the fact that this may seem like an excuse. It is not. There is no excuse for what happened. 90 people died. I simply want to place recent events in their proper context and for us all to learn the lessons.”

Mr Lee went on to explain that the trust’s board had to “devote an inordinate amount of time” to targets and finances, at the expense of managing infections.

He concluded: “In my opinion, it was never practical to apply the same uniform target to all trusts, regardless of their starting position, their capability, or the ability of local commissioners to fund the necessary growth in capacity. I strongly urge you to consider making these targets more flexible.” He also recommended that the Department of Health reviews the financial position of health authorities in West Kent.

“We knew that the Treasury was pumping money into the NHS, but quite frankly none of this seemed to be getting to the coal-face,” he added. “I am personally convinced that the formula, which is used to allocate funds to local health economies, is very badly flawed.

“I describe these pressures, not to justify or excuse the awful tragedy, which befell our patients, but to help you and the public understand the back story to these terrible events.”

Kent County Council has offered the trust a £5 million loan to help to restore public confidence in the hospitals where 1,176 patients were infected with C. difficile during two outbreaks of the infection between April 2004 and September 2006. Of those, at least 345 patients later died.

Mr Johnson described the Healthcare Commission report into the outbreaks at the trust as “a truly shocking document” and apologised to affected patients and relatives on behalf of the Government and the NHS.

Rose Gibb, the chief executive of the trust, resigned just days before the publication of the damning report.

Mr Johson insisted that “the awful failures” were unrepresentative of the standards of care expected and delivered in hospitals across the country.

But in response, Andrew Lansley, the Shadow Health Secretary, said that the outbreaks in Kent were not an isolated occurrence.

“We have had other cases and the common link between them is that managers in the NHS have been more focused on the Government’s targets and the Government’s imperatives, than they have on patient safety,” he said.

“Alan Johnson must accept the reality that the target culture is compromising patient safety.”

Glenn Douglas, the new acting chief executive for the trust, has promised “zero tolerance” of C. difficile.

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