§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Nicholas Baker.]
2.30 pm§ Mr. Rhodri Morgan (Cardiff, West)It is always with much diffidence that an hon. Member who has no medical qualifications brings a medical matter to the attention of the House. When I think how little I know about medicine—I barely recognise the difference between a bacterium and a virus—and of what medically qualified people know, I am naturally hesitant to raise the topic. However, when constituents' lives have been shattered by a tragic and probably avoidable death and they bring the matter to the attention of a Member of Parliament, he or she has a duty to raise the matter in the House.
There are lessons to be learnt from the death of my constituent, three-year-old Anneka Brown, in the Wick Ferry holiday camp near Bournemouth on 23 August of this year. I raise the matter also on behalf of a constituent of my hon. Friend the Member for Coventry, South-East (Mr. Nellist), who is unable to be here today because of the ambulancemen's dispute. He has asked to be associated with my sentiments. Fifteen-year-old Stephen King died at the Pontin's Wall park, Brixham camp. That is probably where Stephen King contracted the meningococcal meningitis virus which also eventually tragically put an end to the life of Anneka Brown in another Pontins holiday camp four weeks later.
Stephen King died on 19 July 1989 at Wall park holiday camp outside Brixham. The family had to wait 13 hours for medical help. A resident camp nurse was supposed to be available, but one was not available. Non-medical staff administered aspirin on the ground of suspected sunstroke. Obviously, the expected 24-hour medical care was not available. The circumstances were remarkably similar in the tragedy which occurred four weeks later, in another Pontins holiday camp, where my constituent died. Although it is upsetting, I shall read the mother's letter to describe the circumstances in which her daughter died. She said:
On Tuesday 22 August, we went into Bournemouth for the whole day because I did not feel that the camp was safe enough for my children. On returning to our chalet mid afternoon some friends took my six-year-old son and three-year-old daughter to the swimming pool, but when I arrived and saw that the pool was extremely dirty I returned them to the chalet.On pages 14 and 15 of Pontin's brochure they offer a facility of resident nurse and chalet patrol. At 5.45 pm on this day I went to the reception office as I found the first-aid room was closed. When met by the receptionist I requested that a doctor be called for my daughter and after waiting 10 minutes she gave me the telephone so that I could speak to the doctor but he refused to come out. The receptionist asked if everything was all right and I said 'No'. The doctor had told me to give her Calpol. I asked her where the nurse was in case I needed her later, and she informed me that she finished at 3.30 pm but if I needed help to go to security and he would get me a doctor. Later that evening my husband went to the reception area to ask the security officer for help in getting a nurse or doctor, to his surprise there was a note on the door 'If security is required please go to the main building', this was the ballroom. My husband went to the ballroom and had to go through crowds of people drinking as the security officer is in an office behind the main bar. This same man patrols the area as well so it took my husband an hour to find him. The security officer who helped us was David Martin Campbell, he 1369 took my daughter's temperature himself then telephoned a doctor. The doctor arrived and diagnosed an ear infection without even examining her.At 4.00 am my daughter's condition had worsened so I went looking for the security officer in the main building but this was all locked up so I ran to a telephone box on the camp but found it was out of order and had to go outside the camp to use a telephone there where I managed to get help after ringing the emergency services. When the ambulance arrived it could not get through the gates as there were cars parked blocking its way. When my daughter eventually got on her way to hospital unfortunately it was too late.What lessons can we learn from that? I shall give the House the reply received from the Dorset Ambulance Service to the questions raised about the service being unable to enter Pontin's holiday camp. On 1 November, Mr. Jolliffe, the chief ambulance officer wrote to my constituent:We have had discussions with the manager, Mr. Rozier, who explained the difficulty they have with controlling parking during the peak season, due to the limited number of staff available to deal with the problem. Clearly this is an unsatisfactory situation for all concerned, not least the Ambulance Service but is an issue which is outside our jurisdiction. Any long-term solution to this problem will need to be addressed by the owners of the camp and the local authority.I return to the questions of the lessons that we must learn about the seriousness of the disease and the new strains of meningitis. I am told that it is the commonest cause of childhood deaths from any infectious disease. It recently passed the predicted levels and is now surpassing the incidence of the heavy 1974 outbreak. Children have far less natural immunity than adults. Indeed, the high incidence of the virus among adults is extremely important in building up antibodies to the disease, but that is not the case for children, and especially not for children aged nought to five. Unfortunately, adults can carry the disease in their nasal passages for long periods of time at no harm to themselves. They are innocent carriers, but in blowing their nose or sneezing they can pass the virus on to children who do not have that natural immunity because of their age.I refer to some of the serious statements made recently about meningitis so that the House can appreciate how seriously the Government should be taking it. The Royal College of Physicians of London stated in January 1982, when we were not in a period of serious infection:
Meningococcal infection is the cause of 2 per cent. of all deaths between one and four years".An author called Raman wrote in the British Medical Journal in 1988:early diagnosis and treatment are vital … delay may be catastrophic".How true that is of the two cases that I have mentioned. Another comment, from Abercrombie and McConaghey in "The Encyclopaedia of General Practice" also needs underlining. It states:Bacterial meningitis is one of the great emergencies of medicine".My last quotation comes from the report of the task force on diagnosis and management of meningitis, by Klein, Feigin and McCracken in1986, which states:Prompt diagnosis and aggressive management are the goals".We are certainly not getting prompt diagnosis and aggressive management of meningitis in the cases that I have raised this afternoon.1370 I turn now to what the Government should be doing to ensure that such cases are not repeated. We should look at the quality of the medical guidelines issued to GPs by the Department of Health and its territorial equivalent in Wales, Scotland and Northern Ireland. We should also consider the particular case of holiday camps.
I commend the work of the Meningitis Trust. Next Tuesday it is bringing out a new information pack designed for the medical profession and for interested lay people such as those living in areas where there have been epidemics—for instance, Stroud, Plymouth, south and mid-Glamorgan, the area in south Wales from which I come. Where there is such a concentration of infection the information published by the trust will be of interest not just to the medical profession and to school nurses, but to parents. I greatly commend the work of the Meningitis Trust and I am glad that its efforts are receiving some attention.
I am not completely happy, however, that the Department of Health has pushed the guidelines that it issued, through Sir Donald Acheson, on 3 February 1988. It should act to ensure that those guidelines have been read and are acted upon in the areas most prone to the disease. It is particularly important for those guidelines to be studied by those who deal with a lot of children in the nought to five age group or the 15 to 24 age group. The tragic deaths to which I have referred occurred in those age groups. Those age groups are particularly prone to attacks from the group B meningococcal meningitis virus.
One can issue as many guidelines as one likes, pile the paper into the post and assume that those guidelines are read by doctors and others who are supposed to receive that information. One can assume that they act on that information, but doctors receive an enormous quantity of paper through the post from drug companies and so forth. How does one ensure that they read information that is absolutely essential to them and which they may have missed out on at medical school 20 years ago when outbreaks of meningitis did not represent a particular crisis?
Efforts should be made to ensure that medical advice on the new strains of infection is absorbed by those doctors who are likely to be faced with a decision—sometimes in the middle of the night—on whether to treat something as sunstroke or ear ache instead of recognising it, as it should have been recognised in the two cases to which I have referred, as suspected meningococcal meningitis. One cannot afford to withhold the requisite penicillin treatment in such cases. Perhaps the most important medical fact to emerge from the study of the recent meningitis outbreaks is that penicillin should be administered on suspicion of the disease, rather than on certain diagnosis. If the symptoms turn out to be meningitis, delay often means it is too late to administer the treatment to small children or teenagers.
Which areas of the medical profession should be targeted for the specific instructions currently issued regarding new strains of this highly infectious disease? Obviously those instructions should go to the members of the profession who deal with closed or semi-closed communities—residential schools, military camps and holiday camps. As a criticism of Government health guidelines it is fair to say that they generally think of closed communities as residential schools or military camps. The Government have paid insufficient attention to holiday camps. Such camps do not always have even a minimum 1371 standard of medical care. Frequently such camps, as with Pontin's this summer, advertise a resident nurse. In the case to which I have already referred there was no resident nurse, nor was there a non-resident nurse available after 3.30 in the afternoon. To leave an untrained security guard to look after children who may be subject to the meningitis infection is well below the minimum standards that we should expect in such large communities. Generally 1,200 people stay in holiday camps, many of them children who play together in the swimming pool, and are therefore likely to pass infection between them.
In the case I have described the security guard acted heroically, but security guards are unable to match up to the demands of such a situation. The Government must ensure that holiday camps receive the same specific medical advice about the new strains of infection as is sent to military camps or residential schools, both of which contains many teenagers. The nought to five age group is less likely to be in either of them, but will be likely to be in holiday camps. That is an essential factor to which I hope that the Minister will be able to respond today. Clearly, there is a deficiency in holiday camps, which should provide a minimum standard of medical cover. Such camps are still a popular form of holiday for families. Minimum guidelines should be sent out to holiday camps to ensure that they have GPs with specific training so that if infectious diseases such as meningococcal meningitis break out in the camps, as happened this summer, the GPs will know how to recognise the suspicion of the presence of an extremely serious and potentially fatal disease which has a particular tendency to emerge where large numbers of children live together briefly for a week here or a fortnight there.
It seems that the Department of Health has not yet got the measure of this disease. More must be done and higher standards must be set for residential establishments in which children congregate in the summer. Ten or 20 years ago we used to be able to say that when it came to health we were lucky to be born British. After all the events of this summer, I am not convinced that that is still true today.
§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)The House owes a debt of gratitude to the hon. Member for Cardiff, West (Mr. Morgan) for bringing this matter to its attention. It is an important issue and the hon. Gentleman has set out the concerns not only of himself and his constituents, but many other members of the public. I wish to try to reassure him, his constituents and other hon. Members.
I was extremely sorry to learn of the death of Anneka Brown. Death is never an easy thing to come to terms with, but the death of a young child is perhaps all the more sad. I have a three-year-old daughter who is almost the same age as Anneka would have been today. If my wife and I had been placed in the same circumstances as Anneka's parents, we would have suffered a grievous and devastating blow. I feel very much for Anneka's parents and I hope that the hon. Gentleman will convey to them my condolences and those of other hon. Members.
The hon. Member has raised a number of important questions in his speech which reflect the concern he expressed in a letter of 24 October to my right hon. and 1372 learned Friend the Secretary of State for Health. I shall try to deal with his various points and I hope that he will accept my reply today as a full answer to his letter.
First, I shall turn to the issue of what guidelines are issued to doctors about the recognition and treatment of meningitis. Following a noted increase in the prevalence of meningitis, Sir Donald Acheson, the chief medical officer, issued—as the hon. Gentleman has explained—two letters in February 1988. He issued one to all doctors and copies to regions, districts, family practitioner committees and environmental health officers and another to regional medical officers, also with copies to regions and districts. I have sent the hon. Gentleman copies and placed further copies in the Library.
The hon. Gentleman may know that the Meningitis Trust pack, to which he referred and which I also commend, contains the chief medical officer's letters with his support and approval. I shall not of course read from those letters, since they contain a lot of detailed medical information, but I should like to draw attention to certain points. Meningitis is the inflammation of the lining of the brain and can be caused by viruses or bacteria. The former are usually less serious and self-limiting; the latter need urgent treatment with antibiotics and may lead to death or handicap. The chief medical officer's letters mention that infections can occur at all ages, but the highest rates of the commonest group are seen at ages nought to four years. Anneka was three when she died. The classical features of meningitis are neck stiffness, sickness, headache and intolerance to light, but they may not always be prevalent, particularly in children under one year old.
I am advised by the medical officers in the Department of Health that it is difficult to diagnose meningitis in its early stages and that rapid deterioration is unfortunately common.
Guidance is given about the treatment that is recommended if diagnosis of meningitis is suspected. The letters stress that it is a statutory requirement to notify cases of meningitis to the proper authorities, usually the medical officer for environmental health. They also draw attention to a leaflet, attached to both letters, prepared by the Gloucester health authority. The leaflet, which is extremely well written, is a step-by-step guide and explains what meningitis is, what the signs and symptoms are, what can be done to prevent it, and how it is spread. On that last point, it is interesting to note that the leaflet says that the germ
cannot live long outside the human body so it cannot be picked up from buildings or factories, water supplies or swimming pools".The bacterial infection can be spread only by personal contact. The hon. Gentleman underlined that fact.In addition to the two letters I have mentioned, in December 1988 my Department issued a circular on the management of communicable diseases following the Government's acceptance of the main recommendations of the chief medical officer's report "Public Health in England". The circular is also in the Library.
The circular reminded health authorities that effective arrangements for the surveillance, prevention and control of communicable disease and infection were an important part of their responsibility to improve the health of the population. Health authorities were also advised, in that circular and in later guidance, as to the action that should be taken to ensure that those responsibilities were discharged. That includes the appointment of a consultant 1373 in communicable disease control, eventually, in every district to take executive responsibility for the surveillance, prevention and control of communicable disease and infection, whether notifiable or non-notifiable, in the local population.
Of course, at present every district has a medical officer of environmental health whose duties we have redefined for the new consultants. We have also just issued a consultation document on the review of the law on infectious disease control seeking views from all health and local authorities, a variety of professional bodies and anyone else who wishes to reply, about how we might go about providing a more modern and effective legislative backing to the control of these diseases.
I know that the matter that the hon. Gentleman has raised relates to two specific cases. If he has not had time to look at the consultative document, I shall write to him and send him a copy. I should welcome his views on the wider issue. Indeed, in the light of the sad experience of his constituent and the constituent of his hon. Friend the Member for Coventry, South-East (Mr. Nellist), his views would be particularly appropriate.
With the recent issue and broad circulation of both the chief medical officer's letters, the circular, the leaflet and the consultation document, we have widely informed professional people and authorities about the guidelines and services available for the recognition and treatment of infectious diseases such as meningitis. The hon. Gentleman rightly said that it is one thing to write and to distribute, but another to ensure that people read and understand. I shall return to that point in my closing remarks.
Another of the hon. Member's points was the question of guidelines to holiday camps for the provision of medical cover. We would expect holiday camps to adopt a commonsense approach by having trained medical staff available; should they be in any doubt as to what service to provide, they should either contact a local medical practitioner or seek advice from the district health authority or the proper officer, usually the medical officer for environmental health, who has the local lead responsibility when cases of communicable diseases occur. Such bodies are best placed to give advice based on local circumstances and the needs of patients.
Similarly, should the nursing staff become aware of an outbreak, whether it be meningitis, food poisoning or something else, we would expect them to contact an appropriate doctor. We expect those running holiday camps, like any other facility or organisation where people, especially the young, gather together—and holiday camps are not the only location where young children gather—to have clear guidelines for their staff such that, if they are approached about an individual incident or group of incidents, they should use their common sense and promptly call a general practitioner or the hospital. Indeed, despite the catalogue of organisational and procedural disasters to which the hon. Gentleman referred, the procedures were properly followed, a general practitioner was called and did take action, but, sadly, too late.
I should like to take this opportunity to clear up one or two points in relation to the cases of meningitis where Anneka Brown was concerned. Cases of meningitis 1374 occurred at the Brixham holiday camp at the time that Anneka and her family were there. However, it has been established that the organisms were all of different strains and therefore were not connected with each other, but had occurred by chance. I know that the hon. Gentleman did not imply that there was an epidemic of similarly related cases at that camp, but it is worth putting that on the record.
About four weeks after visiting that camp, Anneka and her family went to another holiday camp at Christchurch. The period between the family's stay in the two holiday camps makes it highly unlikely that there was any direct connection between the incidents as that period is way beyond the incubation period of infection which is only two to three days.
While it is possible that some member of the Brown family unwittingly became a carrier after the stay in the first holiday camp, it is also important to appreciate that up to 25 per cent. of young adults may be carriers at any one time and that the carriage rate in the normal population is about 10 per cent. The hon. Gentleman quite properly referred to that. Doubts have been expressed about how widely the treatment should be given among possible contacts of confirmed infectious cases, but the advice of experts in the field is that antibiotic medication should be given only to the close family contact. That is brought out in the chief medical officer's letters.
Finally, the hon. Gentleman mentioned the role of the local general practitioner in the diagnosis and treatment of Anneka. Hon. Members may like to know that, under his terms of service, a general practitioner is obliged to render to his patients all necessary and appropriate personal medical services of the type usually provided by general practitioners. Such services include arrangements for referring patients as necessary to any other service provided under the Health Service.
As for the doctor's obligation to make a visit, all I can say is that it is for the doctor himself to decide in each case whether such a visit is necessary, in the light of his professional knowledge and judgment. I cannot say more than that because I understand that the family is in the process of making a complaint or has already complained to the local family practitioner committee and, given the role of my right hon. and learned Friend the Secretary of State in these matters, it would be injudicious for me to say anything more.
I hope that I have been able to give some reassurance to the hon. Gentleman and to the Brown family. We recognise the distressing nature of the disease and have taken steps to advise health professionals about the diagnosis and treatment of meningitis. I am advised that meningitis notifications are now subsiding. Peak levels were reached last year. Periodically since the war, there have been increases in the number of incidents, but as I say, notifications are now subsiding.
I have reflected on the hon. Gentleman's suggestions about how to make sure that more people, and especially those in holiday camps, are aware of the affliction and its early signs and what steps they should take to ensure that medical advice is promptly called. I assure the hon. Gentleman that I shall take steps to see that districts with large seaside holiday camps pass to those camps copies of the meningitis leaflet for the better awareness specifically of holiday camp staff.
I think that we have prepared and circulated the correct advice to professionals. The hon. Gentleman wondered 1375 how far that chain of information has gone. I assure him that, because of the circumstances of the case that he raises, I will take specific steps to ensure that districts have passed on the excellent Gloucester health leaflet to the staff of the larger camps.
I appreciate how difficult it is to accept the occurrence of such a sad event, but it should not cause parents to cancel or to postpone their arrangements for staying at holiday camps next summer. Holiday camps are no less 1376 safe than school playgrounds, and the sad truth is that that distressing affliction can in too many cases prove fatal, particularly among very young children. We are determined, through steps taken not only by the Department but in the regions and districts, and among general practitioners, to ensure that proper information is available and that the correct action is taken.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Three o'clock.