§ The Minister for Health (Mr. Kenneth Clarke)
I will, with permission, Mr. Speaker, make a statement about the outbreak of Legionnaire's disease in the Stafford area.
From mid-April onwards the Mid-Staffordshire health authority has had a series of admissions to its hospitals of mainly male and mainly elderly patients with acute respiratory illness. The combination of pneumonic and other symptoms suggested that one of the organisms responsible could be legionnella pneumophila. Investigations also showed cases of influenza B. Legionnaire's disease is difficult to diagnose with certainty at the beginning of an outbreak because blood tests on living patients do not provide confirmatory evidence until two to four weeks after the onset of the illness. It was not until 3 May that the first positive evidence of Legionnaire's disease was obtained and a positive diagnosis of the disease was then made in 12 cases.
On 29 April the health authority contacted the communicable disease surveillance centre at Colindale which is the national centre of expertise in this field. The following day two doctors from Colindale began their investigation in Stafford. They were asked to support the health authority in the efforts that it was already making to diagnose and trace the source of the disease. After 3 May, the team from Colindale was increased and intensified its efforts to identify possible sources of the outbreak in the community. These investigations are still continuing. One probable source that has been identified is the water in the cooling towers of the Stafford district general hospital's own air conditioning system. This and all water supplies at the hospital have therefore been tested and heavily chlorinated. The hospital has now been declared safe by the Colindale team and the Health and Safety Executive.
By 10 am this morning, a total of 30 people showing the symptoms of acute respiratory illness have died since the beginning of the outbreak. Of these, six are confirmed cases of Legionnaire's disease. A total of 130 people have been admitted to hospital with the symptoms. Seventy-four are still in hospital, of whom two are in intensive care. The indications are, however, that the outbreak is now under control. Seven patients have been admitted or transferred to Stafford general hospital during the last 24 hours. Sixteen patients have recovered sufficiently to have been discharged.
I have spoken to the chairman of the Mid-Staffordshire health authority and I am confident that the authority is doing everything necessary. I should like to pay tribute to all the authority's employees, and in particular to the nursing and medical staff, who have worked throughout the period to treat the patients and keep the Stafford hospital open.
The first priority so far has been to deal efficiently with the outbreak and positively to identify the source of the infection. Once we are completely satisfied that this has been done, we will need to inquire into the outbreak in detail, and to consider what lessons can be learnt from it. The exact form, composition and terms of reference of the inquiry can most sensibly be settled when the immediate task is complete. The patients, their families and the public 648 will wish to have the full history of the outbreak. We and health authorities will want to know what further steps might be taken to minimise the risk of any similar occurrence anywhere in the future. I expect, therefore, to make a further detailed announcement about the inquiry as soon as possible.
I am sure that the whole House will join me in expressing sympathy with the families of the victims of this tragic outbreak of disease in Stafford.
§ Mr. Frank Dobson (Holborn and St. Pancras)
I am sure that all hon. Members will wish to join the Minister in expressing sympathy for the victims of the outbreak, and their families, and in paying tribute to the NHS staff who have worked so hard to try to save the lives of those affected.
It is also right that people should concentrate for the moment on combating the outbreak. However, people in the Staffordshire area, and perhaps further afield, will not be really reassured until there has been a thorough-going and independent inquiry into the outbreak. People will not be satisfied with a local internal inquiry conducted by the health authority or an inquiry conducted by the regional health authority.
I should like to ask a number of specific questions. The Minister may not be able to answer all of them today, but the inquiry will need to consider them. What was the cause of the outbreak, and how did it spread? When did the health authority first suspect that the outbreak was not influenza? If the health authority had suspicions before 29 April, when it first contacted the communicable disease surveillance centre, why was there delay in contacting the centre? Have the tests on the cooling tower water provided positive proof of an infection in the water system? Is the health authority's own pathology laboratory sufficiently well equipped and staffed to cope with the outbreak? Did the Stafford general hospital follow the DHSS guidelines for keeping the cooling towers clean? In any case, are those guidelines adequate? Have checks been made at other hospitals of a similar design, of which there are a substantial number? Are checks to be made on other forms of cooling towers and cooling systems, whether commercial or industrial?
Until those questions have been answered, people in Stafford and others interested in the outbreak are not likely to be satisfied.
§ Mr. Clarke
The hon. Gentleman accepted that a number of his questions anticipate the outcome of the inquiry, so I shall not go into detail on those matters. I have discussed the issue with my hon. Friend the Member for Stafford (Mr. Cash) and we have talked about the form of any inquiry. It turns out that the hon. Member for Holborn and St. Pancras (Mr. Dobson) agrees with me and my hon. Friend that the inquiry must be independent, which almost certainly means that members will not be drawn from the regional or the district health authority.
The only matters about which I wish to delay are the composition and terms of the reference of the inquiry. Only after the whole thing has been dealt with at Stafford shall we be certain of the sort of expertise that we shall require on the inquiry team. We shall then know to what extent they will be considering health matters or engineering matters and so on, and we shall be able to get the right people together.
Questions about the cause of the outbreak and steps taken to identify and diagnose the disease will have to be 649 addressed by the inquiry. The hon. Member for Holborn and St. Pancras will appreciate that the people of Stafford were taking steps from the moment they began to realise that there was an upsurge in numbers, and he will appreciate the difficulties in positively identifying and diagnosing Legionnaire's disease and distinguishing it from other forms of apparent pneumonia. The details mentioned by the hon. Gentleman will be addressed by the inquiry.
We do not yet have the results of the tests on the water in the cooling towers, but no doubt we shall receive the results soon and find out whether they are positive and whether they confirm the identification of the cooling towers as the probable source of the infection. The epidemiological evidence is compelling and makes it almost certain that the cooling towers were the source.
There are departmental guidelines, and they were circulated to all authorities after an outbreak in Kingston upon Thames in 1980. As far as I am aware, the guidelines have been complied with, but, again, the inquiry will look into that. One result of the tragic outbreak may be that we shall have another opportunity to assess the adequacy of the guidelines and to update, strengthen or adapt them, as proves necessary.
Purely as a precaution—and one that the hon. Member seemed to be urging—we intend in the next day or two to write to the managers of every district health authority drawing attention yet again to the guidelines and making sure that the necessary inspections, tests and chlorination are being carried out on cooling towers of the type at Stafford.
Whether it will be necessary to look again at the design of new hospitals, cooling towers and air conditioning systems in a wide range of modern buildings will be discovered only in the fullness of time when there has been the most exhaustive inquiry into the outbreak.
§ Mr. William Cash (Stafford)
I am grateful to my right hon. and learned Friend for making a statement and for agreeing to the independent inquiry for which I have called over the past week. I am also grateful for the effective and immediate advice tendered to the district health authority by the Government and their officials. Has my right hon. and learned Friend any idea when the inquiry is likely to take place?
§ Mr. Clarke
I am grateful to my hon. Friend, particularly for his tribute to the assistance given by the people from Colindale in the most valuable scientific and medical support that the Department was able to give to the people struggling with problems in Stafford.
We do not want a great delay before the inquiry is held, because we do not want memories to fade or details to be lost. I expect to be able to make the further announcement to which I referred—about the form and terms of reference of the inquiry—within the next week or two, assuming that we are able to clear up the remaining doubts about the outbreak and its resolution over the next day or two. After that, it will be a matter of logistics to get the inquiry under way as soon as possible.
§ Mr. Michael Meadowcroft (Leeds, West)
I associate my right hon. and hon. Friends with the Minister's expressions of sympathy.
The institution of an inquiry must be sensitively timed, though I accept what the Minister said about the need for some speed. Will he consider making the inquiry's terms 650 of reference sufficiently wide to take into account the possibility that this disease, like others, may have originated in non-industrialised countries? Increased mobility, let alone altruism, perhaps necessitates preventive measures and effective health care being looked at globally rather than in our country alone. Might not some of the new health problems that we are experiencing be coming from abroad and should we not consider carefully whether action needs to be taken beyond our shores?
§ Mr. Clarke
The disease has been positively identified only in fairly recent times, but it appears to be a particular problem in modern buildings, with modern air conditioning systems and showers. I have no doubt that everything learnt from such outbreaks in this country and in other countries has to be used on a worldwide basis. It is only from such occurrences that we learn how to protect ourselves against them. My hon. Friend the Parliamentary Under-Secretary of State for Health and Social Security is attending the World Health Assembly in Geneva this week, and no doubt he will take the opportunity at the margins of the meeting to discuss experience of Legionnaire's disease throughout the world.
§ Mr. Patrick Cormack (Staffordshire, South)
I associate myself with the expressions of sympathy that my right hon. and learned Friend has properly uttered. Is he aware that for many years my constituents and others in Staffordshire were waiting for the hospital, that many thousands of them are grateful for the extraordinarily fine care that they have received as inpatients and outpatients since it opened, but that they are deeply worried about what appears to be a terrible problem emanating from the most modern of buildings?
I thank my right hon. and learned Friend for saying that the inquiry will be independent, but I urge him to ensure that it is thoroughly independent and that someone such as a High Court judge is asked to preside over it.
§ Mr. Clarke
There is a tragic irony here. We have a magnificent new hospital and there is a strong probability that one feature of it has proved to be a cause of disease. I reassure my hon. Friend's constituents that the water systems for the tanks have been drained, refilled and heavily chlorinated; the whole water system has been chlorinated; and the temperature in the hot water system was raised to a level that killed off the organisms that cause the disease. The system has been declared safe by everybody, including the national experts from Colindale. There is no continuing risk to health.
I entirely agree with what my hon. Friend said about the independence of the inquiry, and I shall comply with his request.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
I associate myself with the Minister's expressions of sympathy.
Is it not ironic that people going into hospital for a cure contract a disease instead? Is the Minister aware that that is happening frequently and that, according to a letter sent to me by the Secretary of State 18 months ago, 10 per cent. of patients in British hospitals acquire infection on entering hospital? Will the Minister take the advantage of this opportunity to deal with the major problem of hospital-induced disease and try to make hospitals safer for patients?
§ Mr. Clarke
The right hon. Gentleman is correct in saying that there is a problem of infection in hospitals. 651 Everybody in the NHS is aware of that and devotes considerable attention to reducing the infection incurred by patients.
I know that the right hon. Gentleman does not wish to cause needless alarm. He knows, though some members of the public may not, that some of the infection that makes up the near 10 per cent. figure is trivial and minor. Nevertheless, I would not minimise any of it. As Legionnaire's disease is a newly discovered and particularly difficult infection, we must make sure, in the light of the Stafford tragedy, that we reduce the risk to a minimum in future.
§ Mr. John Heddle (Mid-Staffordshire)
On behalf of my constituents in Stone and Rugeley in particular, many of whom work in the hospital and a number of whom have been bereaved, I should like to associate myself with my right hon. and learned Friend's remarks.
According to national press reports, the problem may have arisen from the air conditioning system, as my right hon. and learned Friend said, but that system was investigated and serviced as recently as January this year. Will the inquiry therefore establish that that investigation was thorough and proper rather than simply cursory and of a general nature? Secondly, will he take account of the fact that within easy reach of the hospital there are two power stations, Rugeley and Meaford, both in my constituency, and therefore that there might still be a possible risk of some atmospheric conditions emanating from the cooling towers there, and will he ensure that this wide-ranging inquiry considers that aspect also?
§ Mr. Clarke
On the available statistics, there is a strong probability that the cooling towers at the hospital were the source of the infection. Until we have the results of the tests, we cannot be absolutely certain. But, of course, we will not eliminate the continuing search for other possible sources of infection.
There are guidelines about the inspection and chlorination of water systems in hospitals. We will want to make sure, first, that they were complied with, and, secondly, that they are adequate, although, of course, one can never guarantee that an infection will not arise a day after a thorough inspection has been carried out. Any lessons that are drawn from this incident may well have wider application to buildings other than hospitals, because the problems with most air conditioning systems and large accumulations of water, as in cooling towers at power stations, can all give rise to Legionnaire's disease in some circumstances.
§ Mr. Mark Fisher (Stoke-on-Trent, Central)
Is the Minister able to say over what period of time the cooling ponds and towers may have been defective? Is he able to identify the number of people visiting the hospital who may have been at risk in that period, and so reassure people, certainly in my constituency and in neighbouring health authorities, that the problem will not spread?
§ Mr. Clarke
I am not able to give absolutely positive answers to those questions, because they are no doubt matters that the inquiry will examine.
The health authority became aware of this upsurge of people with pneumonic symptoms in mid-April. It peaked towards the end of April, and it is now falling. away again. 652 None of the staff appears to have contacted any problems of this kind, and many other people who obviously went to the outpatients' department have had no problem.
One of the features of Legionnaire's disease is that only particular sections of the population appear to be at risk. The young and the fit by and large are often quite unaware of the fact that they have had anything other than a mild dose of flu. Therefore, it may well be that no one will ever be able to give completely positive answers to the questions that the hon. Gentleman has asked.
§ Mr. Gerald Howarth (Cannock and Burntwood)
A number of my constituents in Cannock have been affected by this terrible disease. I have been asked by some of them to express to the staff involved the tremendous appreciation of those who have been bereaved at the efforts made by the hospital staff in difficult circumstances.
I very much welcome what I took to be an indication by my right hon. and learned Friend that there will be an independent inquiry. I am sure that bringing minds to bear on this problem from outside the Health Service could well be advantageous and help to root out the cause of this baffling disease. Will my right hon. and learned Friend look particularly at the air conditioning systems not only in the public sector but in the private sector? Lastly, once the causes have been discovered, could we perhaps have an action programme circulated to every hospital and general practitioner in the country, so that the disease can be identified at an early stage?
§ Mr. Clarke
I am sure that my hon. Friend's praise for the staff of the hospital will be much appreciated.
There is no doubt that we will have an independent inquiry. All that I am reserving today are the names of the members, the exact form of the inquiry and its terms of reference. I appreciate my hon. Friend's concern. As I said a moment ago, anything that we discover as a result of this outbreak almost certainly will have some relevance and application to those responsible for modern hotels or office blocks, and probably other premises.
§ Mr. Laurie Pavitt (Brent, South)
In the light of the increased knowledge that we now have of the whole question of pathology and respiratory diseases and the extra work at Colindale that the Minister has mentioned, can we rest assured that, in the cuts being applied to the Medical Research Council, research in this sector will not be cut back? Secondly, in the light of an answer that the Minister gave to one of his hon. Friends, as the family practitioner committee is no longer part of the district health authority and as more people die from respiratory disease not in but outside institutions, can we be reassured that the same kind of coverage and information will be made available to general practitioners as will be made available to hospital doctors?
§ Mr. Clarke
This is not the occasion on which to enter into arguments about whether cuts are taking place in the budget of the Medical Research Council. Since 1981 research has been commissioned into aspects of this disease. The results of the studies carried out are now being analysed. We hope to have the results of valuable work following that research by the autumn this year.
On the last point, we have obviously had to make sure that no division of responsibility leads to any division of knowledge or access to knowledge. In fact, the Stafford 653 district health authority took steps to notify its general practitioners, warning them to watch out for certain symptoms and to inform the health authority the moment that Legionnaire's disease was positively diagnosed. I quite accept that people in the community will be affected as much as those who have been admitted to hospital.
§ Mr. Edwina Currie (Derbyshire, South)
Does my right hon. and learned Friend agree that this outbreak is a tragedy not only for the people who died and for their families but for the dedicated staff of the hospital who must be deeply upset at the thought that the hospital itself could be the culprit? Perhaps all that it shows is that we know precious little yet about the epidemiology of this disease. Does he further agree that one of the lessons that are bound to be drawn is that spending on the maintenance of hospitals, new and old, is not optional but of the utmost importance, and that maintenance budgets at which no one ever looks and about which no one ever boasts are not in conflict with acute care but an essential part of it?
§ Mr. Clarke
I agree with both parts of my h on. Friend's question. First, I think that the staff would share her views entirely. Secondly, certain elements of maintenance are essential for safety. All authorities should resist the temptation to make cuts in maintenance which are easier to make than changes elsewhere. As far as I am aware, in this case there is no background of cuts in maintenance or anything else in Stafford. Indeed, Stafford is an authority with a brand new hospital, the hospital which we are discussing, and it has £500,000 more revenue spend this year than it had last year.
§ Mr. Tim Smith (Beaconsfield)
Is my right hon. and learned Friend aware that a company in my constituency, Housemans Burnham Limited, claims to have a product, Hatacide LP5, which is highly successful in controlling the legionella pneumophila bacteria in industrial cooling sytems? Will he see whether this could be used to prevent outbreaks elsewhere?
§ Mr. Clarke
I hate to say anything for good or ill about my hon. Friend's constituents, but the fact is that none of these biocides has the approval of my Department, although we have considered a number of them. All the advice that I have is that chlorine is the most effective way of dealing with Legionnaire's disease and the organism that causes it, and chlorine is the only product at present recommended by my Department.
§ Mr. Peter Bruinvels (Leicester, East)
Will my right hon. and learned Friend do everything in his power to speed up the decision and judgment of the inquiry because of the fear felt, perhaps unnaturally in certain other parts of the country, by people who may be deterred from going into a new hospital? We all know that hospitals are there to cure. We need the report of the inquiry as soon as possible.
§ Mr. Clarke
As I said earlier, as a precaution we will write to the general managers of all districts reminding them of the existence of the circular which sets out the frequency with which water systems should be tested and chlorine added. I am sure that we will find that every district is already following those recommendations. Any that are not will be doing so in double quick time and will not wait for the inquiry.
§ Mr. Dobson
Assuming, as we must for the time being, that the water system and the water towers are the source of the infection, will the Minister give us a clear commitment that he will get in touch immediately with those authorities which have hospitals of a design similar to that of this hospital to make sure that this does not occur in other places?
§ Mr. Clarke
I will. All that the letter to which I have referred awaits is the necessary typing and postal distribution. We will, as soon as possible, be writing to all health authorities pointing out that they should be examining their sytems every six months and chlorinating them to the recommended level.