§ The Secretary of State for Social Services (Mr. Norman Fowler)
With permission, Mr. Speaker, I should like to make a statement on the Stanley Royd hospital inquiry report. I am this afternoon publishing the report of the committee of inquiry into the outbreak of food poisoning at Stanley Royd hospital, Wakefield.
Stanley Royd is a large hospital in Wakefield for mentally ill and psychogeriatric patients. In a major outbreak of salmonella food poisoning which began on 26 August 1984, 355 patients and 106 members of staff were affected. Food poisoning caused, or contributed to, the deaths of 19 patients. At the time of the outbreak and subsequently, a number of allegations were made of errors in the control of infection, of poor standards of hygiene in the hospital kitchen and of other shortcomings.
I announced in September 1984 that I was setting up a public inquiry into the outbreak under the chairmanship of Mr. John Hugill QC. The other members of the inquiry were Professor Rosalinde Hurley and Mr. Patrick Salmon. The committee heard oral evidence between February and May 1985. It submitted its report to me last month. I am most grateful to the chairman and members of the committee for all their work on this complex inquiry.
The report gives a detailed account of the background to the outbreak and its course and of the actions taken by National Health Service staff.
The committee concludes that the cause of the outbreak was salmonella which was probably brought into the kitchen in contaminated chickens, and that cold roast beef was the most likely vehicle of infection. The infection was able to multiply because the beef was not properly refrigerated. The committee found that a number of unhygienic and unsatisfactory practices had grown up in the hospital kitchen.
The report pays tribute to the work of the junior doctors on duty during the early days of the outbreak and the care given by nursing staff on the wards. Those staff were working under very difficult conditions and their efforts were in the highest traditions of their professions.
The committee makes criticisms on a number of matters. In particular, it comments on the failure to ensure satisfactory management of the kitchen at the hospital. It criticises medical and nursing management and in particular the failure to seek, or accept offers of, help from outside specialists, both in the investigation of the outbreak and in the treatment of the patients affected by it. The regional health authority and some officers at regional and district level are criticised for failing fully to inform themselves first-hand of the situation once the outbreak had occurred.
Since the outbreak, Wakefield health authority has made a number of improvements in the kitchen and its management. I am now instructing it and the Yorkshire regional health authority to consider all the points raised by the report and to report to me urgently on the action they have taken and propose to take in response to them. That response must cover the position of those people whose conduct may have contributed to these tragic events, and the steps taken to ensure that such events do not recur.
The report identifies serious failures of supervision and management. General managers have now been appointed by the Yorkshire regional health authority and Wakefield 191 health authority. As in all authorities, these managers carry clear and personal responsibility for securing effective action.
A number of comments were made on the position at Stanley Royd prior to and during the inquiry. One of these concerned finance. On this the report says that it was not itsview that the question of financial restraints or constraints above the level of the region were relevant to any of the issues which we had to consider and, in taking this view, we are supported by the evidence given by witnesses from the Yorkshire regional health authority".
Another suggestion was that Crown premises like hospitals should be subject to the general food legislation. However, the report states that in the case of Stanley Royd the evidence did not support the need for the abolition of Crown immunity. The report says:We find it impossible to recommend any change in the law on the vexed question of Crown immunity where the entirety of the evidence given to us by the professional environmental health officers was to the effect that the sanctions of the criminal law would not have been employed in respect of the kitchen at Stanley Royd, even if they had been available.
The Government will nevertheless continue the urgent review of Crown immunity for hospital kitchens, including the suggestion in the report that a "Crown notice" form of procedure should be initiated.
The majority of the report's formal recommendations are aimed at improving standards of hygiene in hospital kitchens and improving the investigation and control of any future outbreaks. The committee recognises that the departmental guidance on food hygiene in hospitals is basically sound and recommends that health authorities should be reminded of its terms. We had already done that before the report was received.
In addition, I am urgently reviewing departmental guidance to health authorities on the steps that they must take to ensure proper food hygiene in hospitals and to ensure that environmental health officers are encouraged to visit, and that proper regard is paid to their recommendations. In doing so, I shall take full account of the Stanley Royd committee's recommendations.
I am referring the recommendations about the arrangements for the control of infection and the handling of outbreaks to the hospital infection working group. This group was set up last summer to advise me on the revision of departmental guidance on control of infection and I am asking it to give me the highest priority on contingency plans for dealing with outbreaks of infection—plans that will ensure that specialist help is brought in as soon as it is needed.
There can be no doubt at all about the continuing need for proper provision of public health and community medicine advice within the management structure of the Health Service. The functions of the specialty of community medicine include not only the control of infectious diseases but the assessment of the needs of populations for health care, the planning and evaluation of health services and responsibility for prevention and health promotion.
I have therefore decided that it would be right to establish an inquiry into the future development of the public health function, including the control of communicable diseases, and the specialty of community medicine in England. The inquiry will be a broad and fundamental examination of the role of public health doctors, including how such a role could best be fulfilled. The inquiry will be chaired by the Government's Chief 192 Medical Officer, Dr. Donald Acheson, and I expect to receive its report before the end of the year. Details of membership will be finalised shortly. In the meantime, we shall take every step possible to prevent a recurrence of these tragic events.
§ Mr. Michael Meacher (Oldham, West)
Is the Secretary of State aware that this tragedy represents the culmination of a damning catalogue of manifest negligence in this case, and brings to a head the scandal of appalling insanitary and even lethal conditions in so many hospital kitchens throughout the country?
On this specific episode, will he confirm that the magnitude of the outbreak—27 deaths in all and two nurses on the critical list—was due to four serious failings that should never have happened? Does he agree that when the duty doctor advised the use of barrier precautions there was, astonishingly, no barrier equipment available to the staff? There were no gowns, masks. gloves or shoes for the purpose.
Will the Secretary of State confirm also that when staff asked that the nearby Snapethorpe hospital—an old isolation hospital which had been closed during the cuts—should be used to isolate infected patients, especially the elderly and frail, management rejected the request, and, as a result, only three of the 32 wards escaped infection? Does the right hon. Gentleman agree that in such a situation the normal instruction is that staff should return to work only after three consecutive negative tests? At Stanley Royd, however, because of staff shortages, which the reports fully recognise, the staff were told to return to work before they were over the illness and, in some cases, while they were still giving positive tests.
Will the Secretary of State also confirm that the health authority sought to minimise the situation at the time to the extent of restarting admissions halfway through the outbreak, although on the first night of readmissions three more patients died and admissions had to be stopped again? What specific action is the Secretary of State taking to prevent each of those four causes of disaster from recurring at Stanley Royd or elsewhere?
The Secretary of State said complacently that, since the outbreak, Wakefield health authority had made a number of improvements in the kitchens and in management. Is that not a wholly inadequate whitewash when previous salmonella outbreaks had occurred at Stanley Royd in 1974 and 1979, when a district medical officer had described the kitchens as "a culinary disaster area" seven years before the tragedy, when plans to upgrade the kitchens had been continuously postponed since 19'78 and when help specifically offered to the hospital by the communicable diseases surveillance centre had been categorically turned down?
Is the Secretary of State further aware that this episode, while particularly tragic, is far from unique? There are now about 40 outbreaks of food poisoning in hospitals every year and hospitals are now the third highest source of food poisoning in the country. Is the Secretary of State aware that illness from bacterial food poisoning in hospitals has increased fourfold since 1981 to more than 1,000 cases per year and that deaths from that cause have risen over the same period to more than 50 per year?
Is the right hon. Gentleman aware that the latest reports—a year ago—of the Institution of Environmental Health Officers revealed that 60 per cent. of hospital kitchens currently breach food hygiene regulations and 193 that 97 hospitals would be prosecuted were it not for Crown immunity? As the Department of Health and Social Security has the list, will the Secretary of State publish the names of the 97 hospitals, because the public are entitled to know? Will he accept that, where repeated surveys of hospital kitchens have found vermin infestation, open gutters, foul smelling grids, bird droppings and insecticide spraying during food preparation, the only effective way to protect patients, visitors and hospital workers is to abolish Crown immunity?
Is it not a medieval anachronism that a café with cockroaches is prosecuted but a hospital escapes, although frail, elderly patients are particularly vulnerable to lethal food poisoning? If 27 people can die in a hospital which the report claims would not be prosecuted, how many deaths are we risking in the 97 hospitals that would be prosecuted tomorrow if the Secretary of State fulfilled his responsibility to the nation by lifting the unjustified and unjustifiable immunity?
§ Mr. Fowler
There is absolutely no question of complacency on the Government's part. Neither is there any question, as anyone who has read the report would know, of any attempt to whitewash the seriousness of the outbreak. What the House should concern itself with—I recognise that the hon. Member for Oldham, West (Mr. Meacher) was seeking at least in part to do this—is to decide what action should be taken to prevent such tragedies from occurring again.
The causes of the outbreak are set out very succinctly on page 106 of the report. It states that the main problems were human errors compounded by failures of supervision and management. The report makes clear that all the rules and principles of good catering practice were known and the outbreak occurred because the rules were ignored. The failure to follow the rules arose partly through the failure of supervisory grades to supervise, and that failure stemmed from the failure of the management to manage and check. The hon. Gentleman will know, having read the report, that it sets out a number of illustrations and examples of where the management process had fallen down. At that stage, of course, general managers had not been appointed in the health authorities in question. That improvement has since taken place.
The hon. Gentleman asks what action will follow from the report. The people who are criticised in the report and the chairmen of the authorities have seen the report for the first time today. I shall be inviting the chairmen of the authorities to meet me this week and I shall discuss with them the action that must be taken. That talk will also cover individual responsibilities. As the hon. Gentleman will know, disciplinary action is a matter for the authority, and it would be wrong for me to comment on that as I have an appellate function in that respect.
The question of barrier nursing is dealt with in paragraph 76. The report sets out the grave difficulties that exist in a hospital of this kind and paragraph 76 ends by stating that:To speak of barrier nursing against such a background is absurd.Further study of the report will provide an answer to the hon. Gentleman.
The report states quite clearly that finance was available both to improve the kitchens and to replace them by 194 building new kitchens. That is now being done. It was a complete failure on management's part that that was not done before. I accept that that is the case. One of the reasons was that no one was ultimately responsible for the decision not being taken.
I accept the comments of the hon. Member for Oldham, West and I know the feelings of the Opposition and of many of my hon. Friends on the matter of Crown immunity. There is a serious issue to examine, but it is clearly fair to stress that the report repeats on three occasions that the existence of Crown immunity would have made no difference in the handling of this particular case. The reason for that is that it was not the physical conditions of the kitchen that were at fault but the procedures that were being used. For example, the pan wash was found to be blocked by cutlery. That has nothing to do with the physical conditions, but it has everything to do with the procedures being followed. We shall consider both Crown immunity and the new proposal in the report for Crown notice and we shall report to the House on our consideration of those matters.
§ Mr. William O'Brien (Normanton)
Will the Secretary of State join me in congratulating the staff of Stanley Royd hospital, which is in my constituency? I know the results of the work that the staff had to undertake, some times beyond their usual call of duty, in an attempt to combat the problem. The House ought to record its appreciation for the staff who worked under those conditions.
I hope that the Secretary of State will refer to another cause for concern—the delay in the presentation of the report. A number of people who live in the area and work in the hospital repeatedly asked me when the report would be published. There is genuine criticism about the length of time that the report took to be presented.
The Secretary of State referred to the regional health authority's role and I hope that he will take cognisance of that. Paragraph 180 refers to the kitchen and paragraph 190 refers to the under-staffing of the kitchen. Paragraphs 251 and 252 refer to the health authorities' attitudes to the need for a new kitchen or for reorganisation of the kitchen. Paragraph 252 states that the area health authority wished to take over the responsibility for providing a new kitchen but was not permitted to do so by the regional health authority.
Paragragh 288 states:We also find it quite incredible that, apart from expressing regret and sympathy about the outbreak, the Region did not discuss the problem, the causes, or the action being planned or taken, at any meeting thereafter. It was as if it had nothing to do with the RHA. If it had not, then the usefulness and relevance of this body would seem dubious.In the light of that, will the Secretary of State consider whether it is not time for the regional health authorities to be abolished and for responsibility for running area health authorities to reside at local level?
§ Mr. Fowler
On the last point, I should not wish to go on record as supporting that, but I share the hon. Gentleman's concern about the statements made in paragraph 288 of the report and the fact that the management, control and effective leadership that the public had a right to expect were not provided at that time. I believe that the solution is to consider the responsibilities of the regional health authority and to make it clear, as we did prior to the report, that we expect the regional health authority not to act in the way described in paragraph 288. 195 On the other points, I gladly repeat what I said in my statement. I believe that the public generally and the whole House wish to pay tribute to the nursing staff, junior doctors and other staff who worked extremely long and hard to ensure that the outbreak was contained.
As for delay, the report was received only last month. It has been printed and the Government clearly wanted to make an initial response, so I do not think that there has been any undue delay in bringing it before the House.
The finance for a new kitchen was available—there is no question about that—but the regional health authority did not process it as it should have been processed. The new kitchen should have been built long ago.
§ Mr. Teddy Taylor (Southend, East)
Despite what my right hon. Friend has correctly said about the availability of capital expenditure, does he agree that paragraph 190 states specifically that the cleaning schedule for the kitchen fell behind due to shortage of staff? Although the report makes it clear that there would not have been prosecution if Crown immunity had not applied, does he agree that that does not affect the principle of the matter? Will he therefore give a clear assurance that he will support the excellent Bill proposed by my hon. Friend the Member for Aldridge-Brownhills (Mr. Shepherd)?
§ Mr. Fowler
I can certainly give a full assurance that the Government will continue urgently to review the whole issue of Crown immunity and the proposal for Crown notice put forward in the report. I believe that it would be wise for the House to pause and consider the proposal for Crown notice as well as the issue of Crown immunity. Nevertheless, my hon. Friend the Member for Southend, East (Mr. Taylor) and the Government are at one in wishing to have the causes of this type of outbreak contained. The Government are therefore considering the matter urgently and with determination to ensure that no future outbreak takes place. The other part of the report also deserves study as it makes it clear that lack of management and supervision contributed substantially to the outbreak. I accept that a shortage of catering staff is also noted, and that is one of the points that I shall wish to take up in my discussions with the chairmen.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
Does the Minister accept that, instead of pausing to consider Crown notice, the House should condemn one of the most disgracefully complacent ministerial statements ever to be made in this Chamber? The Secretary of State is directly responsible for the deaths of those people in Wakefield, and his suave easy-going manner will convince no one to the contrary. In the past six years there have been 211 outbreaks of food poisoning in hospitals, in which 3,969 people have been poisoned by salmonella bacteria and 279 people have died. The Secretary of State cannot dispute that because those are his own figures given in reply to questions from me. The Government are in the dock on this and they are to blame because they have refused to abolish Crown immunity and health authorities hide behind the fact that they cannot be prosecuted. Will the Secretary of State admit that he is responsible and that, regardless of what the report says, the only way to solve the problem is to abolish Crown immunity, prosecute negligent authorities and provide the funds needed to end this scandal once and for all.
§ Mr. Fowler
First, I regret very much the tone adopted by the right hon. Gentleman, which did not live up to the high standards that we expect of him. The Government are not refusing to abolish Crown immunity, but we believe that it is sensible to have regard to an independently commissioned report. In this case, the report states that the abolition of Crown immunity would not have tackled the fundamental cause. With great respect, the right hon. Gentleman should address his mind to those issues as well.
The Government and the House must consider why the outbreak occurred. The reasons are set out in the report. The main problems were human error compounded by failure of supervision and management. Whatever we do about Crown immunity, we must tackle that problem, otherwise the right hon. Gentleman's words will mean precisely nothing.
§ Mr. Richard Shepherd (Aldridge-Brownhills)
Will my right hon. Friend publish the list of more than 90 hospitals which would be liable to prosecution but for Crown immunity so that the public at large may have at least the protection of that warning as to the kind of institution they will be entering? As environmental health officers have been pressing for 14 years for this specific relief from Crown immunity, could the urgency with which the Government are reviewing this particular area be advanced to the extent of allowing us to know by 7 February where the Government stand?
§ Mr. Fowler
I cannot promise the latter. However, I do not intend that the review should be an extended one. I shall let the House know of the outcome as soon as I can. I shall provide as much information as we have available to the House and to the public.
§ Mr. Geoffrey Lofthouse (Pontefract and Castleford)
Does the Secretary of State agree that this devastating report is an absolute disgrace in 1986? I speak with some emotion, because the 19 deaths arising out of the salmonella outbreak at Wakefield included my brother-in-law. I visited the hospital in the early days of the outbreak. I join my hon. Friend the Member for Normanton (Mr. O'Brien) in paying tribute to the hardworking staff who worked, at considerable risk to themselves, to put an end to the unfortunate incident. However, it is no good looking back and having sympathy. Those unfortunate people are gone.
Does the Secretary of State agree that the report clearly shows that there was neglect in some quarters? The report suggests that if Crown immunity had not been operating, that may have made no difference. It would, however, have been an added safeguard. There is no reason why Crown immunity should not be lifted. There should be a statutory obligation by which local health inspectors are allowed into hospitals to carry out additional inspections. If not, why not? If there is nothing to cover up, there is nothing to fear.
Does the Secretary of State agree that the cause of one of the biggest problems, which should be abolished, is that of housing people in Victorian workhouses such as the Stanley Royd hospital. I plead with the Minister not to wait for further inquiries. There is sufficient evidence. He should abolish Crown immunity immediately and allow independent health inspectors into those hospitals so that they can make a further check on the disgraceful conditions that existed in that hospital.
§ Mr. Fowler
I share the hon. Gentleman's concern about the outbreak. I agree with him that the report tells a story of neglect at several levels. No one who has read the report could be satisfied or happy about the position. However, the hon. Gentleman will accept that it is wise for the Government to consider the report's proposals, even though the proposal on Crown immunity is contrary to what the hon. Gentleman wishes.
Environmental health officers have, and will continue to have, absolute and free access to hospitals. That is essential. It is equally important that the catering procedures and practices are such that, irrespective of the inspectorates, catering establishments and kitchens are run in a proper way. The hon. Gentleman will agree that that is a function of good supervision and good management, all of which broke down in this case.
§ Mr. Anthony Beaumont-Dark (Birmingham, Selly Oak)
Does my right hon. Friend accept that it is hysterical nonsense for the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) to suggest that the Government are in the dock, as though they had invented Crown immunity?
Would it not be a great success for the Government to realise that it is nonsense to hide behind Crown immunity, when they should be protecting people? The Government may not be hiding behind it in this case. But is it not proper justice in this modern age that people should be protected, whether it be from the Crown or from villains?
§ Mr. Fowler
I am grateful for what my hon. Friend has said. We are discussing how that protection should be provided. Apart from the matter of Crown immunity or Crown notice we must tackle the cause of the problem, which, in this case, has been the failure of supervision and management.
§ Mr. Walter Harrison (Wakefield)
In his statement the Secretary of State congratulated the chairman. Will the Secretary of State identify to which chairman he was referring? He can read his statement to see that he has congratulated a chåirman, but there are three chairmen involved—the chairman of the inquiry, the chairman of the health authority and the chairman of the regional health authority. The Secretary of State should identify the chairman who merits congratulations.
The statement uses the words "human error" and "prosecution". The words "lack of occur about five times, but what is never mentioned in all the references to the lack of administration, of supervision and of everything else, is the lack of adequate finance to run a proper Health Service. I refer you to paragraph 266—[HON. MEMBERS: "You?"]
§ Mr. Speaker
The right hon. Member is being questioned because he is drawing me into this matter. He should address his remarks to the Minister.
§ Mr. Harrison
I thought that I saw the Minister mumbling and I am rather sensitive about such things. Paragraph 266 of the report states:There can be no doubt but that neither the Wakefield Health Authority nor the Regional Health Authority have sufficient funds available to bring everything within their jurisdiction up to the best possible standard immediately.The Secretary of State and his Department have had reports about inadequacies in the hospital. It was drawn to their attention that funds were required. What happened? The regional health authority and the Wakefield health authority received global sums, but it is like the chap who 198 gambles with the three eggcups and must decide which one hides the money. Priorities have been discussed. The regional health authority chairman got a flap on and turned down the proposals not because of the facilities that were required. I have met four or five Ministers about this. Ministers tried to spread out the money in Wakefield, but it was completely inadequate and hospitals were closed. Snapethorpe could have treated patients with infectious diseases, but it was closed because funds were cut.
§ Mr. Speaker
I know that the right hon. Gentleman has a deep and personal interest in this matter, which is quite right, but I ask him to put his question.
§ Mr. Harrison
I thought that I had qualified my question by asking why the Secretary of State had not taken these matters into consideration, Mr. Speaker.
Snapethorpe was closed through lack of funds, and I am still fighting that battle.
Regarding human error, the Secretary of State is responsible. If there is a prosecution, the first person to be prosecuted should be the Secretary of State. The "lack of which is mentioned five times in the report, should refer to lack of funds, funds that his Department has failed to allocate to Wakefield. Since you wish me to wind up, Mr. Speaker, I conclude by saying that the Department should conduct another reappraisal of the moneys that it has allocated to the Yorkshire region so that the problems can be dealt with.
§ Mr. Fowler
May I answer the right hon. Gentleman's first question, which he asked some time ago. In my statement, I said that the inquiry was chaired by Mr. John Hugill, and that the other members of the inquiry were Professor Rosalinde Hurley and Mr. Patrick Salmon. I said:I am most grateful to the chairman and members of the committee for all their work on this complex inquiry."I am not sure whether I could have made it much clearer, but I am grateful for the opportunity of repeating it.
As to lack of finance, I draw the right hon. Gentleman's attention to paragraph 284 of the report, which states clearly that the committee did not believe that financial restraints or constraints above regional level were relevant to any of the issues that it considered. As to the regional health authority and the delay in the building of the new hospital, I have made it clear that I deplore the delay. The report makes it clear that the delay has been caused by people failing to take decisions. We hope—this is our aim—that the position will be improved after the introduction of a general management process.
§ Mr. Speaker
Order. I shall call those hon. Members who have been standing, but I ask for brief questions.
§ Mr. Merlyn Rees (Morley and Leeds, South)
Is the Secretary of State aware that although Stanley Royd hospital is in Wakefield and in the constituency of my hon. Friend the Member for Normanton (Mr. O'Brien), it serves a much wider area and there is great concern about what happened 18 months ago? My constituents want more information about what happened. I welcome the right hon. Gentleman's statement and the report, although I have not yet had an opportunity to read it. After we have digested the report, we shall want another debate on the Floor of the House so that we may ask the Secretary of State more questions. Before then will he undertake that 199 when he receives replies to the questions that he says he has asked, he will give that information to the House? If he does not, the report by itself will not be enough.
Whatever the problems with Crown immunity—they have arisen in previous Administrations and they affect the entire Government service—are not hospitals a special case? If this incident had occurred in a BUPA hospital, criminal proceedings could have been brought and Crown privilege would not have applied. Should we not change the system so that what is good enough for BUPA patients is good enough for Health Service patients?
§ Mr. Fowler
I agree that the case against Crown immunity is much stronger when it comes to hospitals than in almost any other area. For that reason, my right hon. Friend and I are reviewing the matter urgently. I also agree that this is a serious matter, and I do not wish to leave the House in any doubt about the Government's determination to tackle it. I and my right hon. Friend will do everything that we can to keep the House informed of all developments.
§ Mr. Alec Woodall (Hemsworth)
This is one of the most depressing reports that I have ever read. I agree wholeheartedly with my right hon. Friend the Member for Morley and Leeds, South (Mr. Rees) that we need a further debate on a 140-page report. Does the Secretary of State accept that I am disappointed that he did not refer to paragraphs 307, 308 and 309 under the heading, "The Press and Media"? Does he agree that it was disgraceful that a reporter and a photographer, one wearing and one carrying a white coat to disguise themselves, smuggled their way into the hospital, and that other reporters badgered patients and staff in an attempt to trivialise and dramatise the affair?
Paragraph 190 of the report states that the kitchen was understaffed. Does the Secretary of State accept that if the kitchen is understaffed before privatisation, it is likely that the position will become even worse if privatisation is forced on local health authorities? The paragraph states that there was 35 per cent. absence due to sickness and accidents. Is that not unacceptable in a hospital of that sort with so many patients?
§ Mr. Fowler
I do not accept what the hon. Gentleman says about the future policy of contracting out. It has nothing to do with this case. I shall discuss with the health authority chairman staffing in the kitchen, I must tell the hon. Gentleman that the basic problem was not staffing, but that laid-down and well-understood procedures were simply not followed. That was largely responsible for the outbreak.
I agree with what the hon. Gentleman said about the press and the media. I hope that the newspapers concerned will study paragraphs 307, 308 and 309. Hon. Members on both sides of the House will find it objectionable that patients at that hospital should have been so approached. The report makes some criticisms, and the press should study them.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
Does the Secretary of State accept that the entire National Health Service community will attach much importance to what the Government do about this report? Therefore, it is doubly important that he takes the appropriate action now. I have not had the advantage of reading the report, but it seems from the right hon. Gentleman's statement 200 that there was a management and supervisory malfunction. Does he accept that that will not be the case in the vast majority of the 40 to 50 outbreaks that we suffer each year, but that they will have been caused by a lack of resources? Far from giving guidance and reiterating his guidance, will he now insist that health authorities appoint hospital kitchen inspectors with authority to ensure that those supervisory functions are correct, and will he give the health authorities the resources to carry them out? May I also ask him—
§ Mr. Kirkwood
The Secretary of State said that the inquiry into the control of communicable diseases would be restricted to England. Can it not be extended to Scotland?
§ Mr. Fowler
The public health inquiry will be carried out by the Chief Medical Officer, but it will have lessons for Scotland, too. The report makes it clear that a lack of general finance did not cause this outbreak, and I know of no evidence on which the hon. Gentleman could base his argument. A management and supervision failure led to the problems that we are discussing.
§ Mr. Willie W. Hamilton (Fife, Central)
Is it not interesting that the report should have been published the day after a televison programme exposed the danger and the filth in many hospital kitchens? Despite what the Secretary of State said today, is it not true that this terrifying disaster could be repeated at any time in any hospital? All the authorities represented on the programme last night said that the prime causes of the outbreak were a lack of funds and the continuation of Crown immunity. In those circumstances, will he give a categorical undertaking that the Government will introduce legislation' this Session to abolish Crown immunity?
§ Mr. Fowler
I cannot give the undertaking for which the hon. Gentleman asks. I have asked for an urgent report from the health authorities featured on yesterday's Granada programme, and I have made it clear to the health authority chairmen that whatever action is needed should be taken without delay. I shall talk to all the regional health authority chairmen next week at a meeting in Birmingham. The evidence in the programme is challenged by some district health authority chairmen, and I think that we should delay making a final decision on the matter until we consider more closely the points that were raised.
§ Mr. Frank Haynes (Ashfield)
Is the Secretary of State aware that the Stanley Royd incident has highlighted the real problem within the National Health Service? He is charged with the full responsibility of making sure that everything is put right. I warn the Secretary of State not to block any private Bill in this House proposing the abolition of Crown immunity.
§ Mr. Fowler
I hear what the hon. Gentleman says. He has raised the general responsibility issue. I hope that in his turn he will support the introduction of general managers at regional, district and hospital level so that we may get better and more effective decision taking.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
Despite the comments that the Secretary of State quite rightly made about the report highlighting general management problems at various levels, is he aware that the report also refers to the nurses in paragraph 292 and says: 201Furthermore, we heard how the nurse staffing position at Stanley Royd was one of the least favourable in the country and had been so for years.When that statement is read in conjunction with the statement quoted by the hon. Member for Southend, East (Mr. Taylor) and others about the lack of supervisory staff in the kitchens, do they not suggest to the Secretary of State that funding problems have a part to play in the explanation, despite his protestations this afternoon?
§ Mr. Fowler
No, I do not think that that is the case. When the hon. Gentleman looks at the report he will see, for example, that the district was underspending on its Stanley Royd nursing budget. As for the nurse-patient ratio, that has improved overall since 1979 in terms of both trained and untrained nurses.
§ Mr. Frank Dobson (Holborn and St. Pancras)
To help the House to get this hospital into perspective, will the Secretary of State confirm that it was built in 1818 when Napoleon was alive and that it was called the West Riding paupers lunatic asylum? Does he have some sympathy for the staff who are trying to provide services for patients in those circumstances? Will he confirm that when it was last calculated for hospitals of this type, the average spending was £40 per patient per day, but that at Stanley Royd it was only £25 per patient per day? Will he also confirm that in paragraph 274 the report says that the committee had alreadyidentified two areas in which additional expenditure was required, first in the level of nursing staff, and second in the catering facilities and staff.The catering manager is also reported as having said that she understood from her predecessor that it was no good asking for extra equipment because no money was available.
Will the Secretary of State also confirm that after the previous salmonella outbreak in 1979 at Stanley Royd 202 there were four years of bumbling incompetence, including, if he reads the report carefully, that of his own officials, not just the regional and district officials? Will he confirm that that continued for four years and that they argued not just about design and necessity but about availability of finance? Will he also confirm that the report contains no fewer than four pages of criticism by the environmental health officers of the standard of the kitchens? Will he further confirm that there are two pages in the report where the committee says that although it does not believe, on the strength of the evidence available to it, that Crown immunity should be abolished, it accepts that it leads to a difference of approach by the officers to inspections of hospital premises and other premises? Does not the Secretary of State agree with most sensible people that the source of this problem springs from that difference of attitude?
§ Mr. Fowler
I do not think that the hon. Gentleman can claim the support of the inquiry's report on everything that he has said and then come to that conclusion. The inquiry's report suggests not that Crown immunity should be abolished, but that there should be a new system of Crown notice. This means that where there is Crown immunity a notice is served on the health authority by the environmental health officer. That is the proposal that is contained in this report. The hon. Gentleman's description of this hospital was right. It was built in the 19th century. But again the report of the inquiry makes it quite clear that it was not the inherent physical defects in the hospital that were responsible for the outbreak but other factors. The conclusions are set out on page 106 of the report. It says:All the rules and principles of good catering practicewere known. The fact is that those rules were not followed. I hope that, whatever differences there are between the Opposition Front Bench and the Government, we can get more effective management into hospitals because it is in everybody's interest that these kinds of outbreaks should never occur.