§ 4.29 p.m.
§ Baroness Trumpington
My Lords, with the leave of the House, I should like to repeat a Statement being made in another place by my right honourable friend the Secretary of State for Social Services. The Statement is as follows:
"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 26th August 1984, 355 patients and 106 members of staff were affected. Food poisoning caused, or contributed to, the deaths of 19 patients. 135 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. They submitted their 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 conclude 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. This 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. These staff were working under very difficult conditions and their efforts were in the highest traditions of their professions.
"The committee make criticisms on a number of matters. In particular, they comment on the failure to ensure satisfactory management of the kitchen at the hospital. They criticise 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 firsthand of the situation once the outbreak had occurred.
"Since the outbreak Wakefield Health Authority have made a number of improvements in the kitchen and its management. I am now instructing them 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 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 136 inquiry. One of these concerned finance. On this the report says that it was not their'view 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 the 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 recognise that the departmental guidance on food hygiene in hospitals is basically sound and recommend 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 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 on the revision of departmental guidance on control of infection and I am asking them to give 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 137 of public health doctors including how such a role could best be fulfilled. The inquiry will be chaired by the Government's Chief 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 will take every step possible to prevent a recurrence of these tragic events."
§ That concludes the Statement, my Lords.
§ Lord Ennals
My Lords, I thank the noble Baroness for repeating the Statement made by her right honourable friend, in spite of her cold which I hope gets better soon. May I also thank Mr. Hugill and his colleagues for the thoroughness of their report?
The facts of the case were appalling. It was a major outbreak of salmonella food poisoning affecting 355 patients and 106 members of staff, with the tragedy of 19 people dying. It is a frightening story of neglect leading to avoidable deaths. I suspect that this is the worst case of salmonella poisoning, with the highest number of deaths, in the history of the National Health Service. I wonder whether the noble Baroness can confirm that.
The Statement must be seen in the context of the report last year by environmental health officers stating that 97 hospital kitchens they had examined would have been closed and legal action instigated had it not been that hospitals are covered by Crown immunity. The Statement must also be considered in the light of last night's World in Action, which may have been seen by some noble Lords, which gave a picture of hospital kitchens being in an appalling state of dirtiness, with in some cases rats, mice and cockroaches. That is a lamentable situation. If one cannot expect good clean food in a hospital, to what sort of catering department should one turn?
May I put a number of questions to the noble Baroness? First, why has there been what seems to be a delay in publishing this report? The inquiry ended on 17th May last year, and The Times the following day said that the report was likely to be in the hands of the Minister of Health by August. Was it? If it was, why was it not published months ago?
Secondly, I warmly welcome the decision announced by the noble Baroness that there is to be established 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. I say that in the light of what is said in relation to the recommendation on page 110 of the report:We were told that 10 per cent. of patients admitted to hospital with no evidence of infection"—this was not to Stanley Royd Hospital but to hospitals in general—have their progress in hospital complicated by an infection contracted as a direct result of their stay there".This seems to be an utterly appalling fact. One must suppose that they thought it true; otherwise, they would not have published it. I quote it because it shows the urgency of the study that the Secretary of State is to set up.
138 Thirdly, will the noble Baroness say more about the question of Crown immunity? As she has said, the report states:We find it impossible to recommend any change in the law on the vexed question of Crown immunity".I should like to know whether she knows why they found it impossible to do so. Of course, it would be possible to do so if they had chosen to do so. If the noble Baroness cannot explain why they found it impossible to do so, perhaps she can say what is the Government's view on an issue that has been frequently aired with a degree of urgency in this House. The Statement read by the noble Baroness said: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".Why has this study not been completed? How urgent is "urgent" if, after all these many months, the Government cannot reach a conclusion on a situation that seems to most of us to be apparent and is now crucial, with all the mounting evidence of inadequately maintained hospital kitchens?
I should like, if I may, to put two more questions to the noble Baroness concerning the management of the situation in the Stanley Royd Hospital at the time. Will she confirm that when staff asked that a nearby hospital, the Snapethorpe Hospital, an old isolation hospital closed down during the cuts, should be used to isolate infected patients, especially the elderly and the frail, the management rejected this request, and that as a result only 3 out of 32 wards escaped infection?
My fifth and last question is this. Will the noble Baroness confirm that in such a situation normal instructions are that staff should only go back to work after three consecutive negative tests, but that at Stanley Royd, because of a staff shortage, which this report fully recognises, they were told to go back to work before they were over the illness, some even while giving positive tests? This seems a really appalling situation. I hope that the noble Baroness will forgive me if I say that the Statement that she read—not drafted, but read—did really seem to be rather complacent in view not just of the situation itself but of a situation that has become apparently a national one subsequent to the Stanley Royd disaster.
§ 4.45 p.m.
My Lords, on behalf of my noble friends on these Benches I should like to join the noble Lord, Lord Ennals, in thanking the noble Baroness for repeating this very important and indeed alarming Statement, particularly as I understand she has some difficulties at the moment. I hope that the length of the Statement—it is unusually long—indicates the seriousness with which the Government regard the contents of the report. I should like, too, to join with the noble Lord, Lord Ennals, in thanking the chairman, Mr. John Hugill, and his colleagues, for the expedition and the very thorough way in which they have inquired into these extremely complex and difficult matters. They have done that with greater expedition than the Government have perhaps shown in bringing the report to us. It was, of course, a very small committee. In that connection, I can perhaps say that the nature of the report points in part to the 139 wisdom of appointing a very small committee in order to inquire into a matter of this degree of importance and seriousness.
As to the action to be taken, I certainly welcome the news in the Statement that new guidance is to be given to area health authorities regarding hygiene practices and standards in hospitals. It seems to me that there was nothing much wrong with the old guidance, save that no notice was taken of it. If more notice is taken of the new guidance, that is surely a good thing. We know from the report that the environmental health officer for Wakefield had warned the Stanley Royd Hospital over and over again regarding the deficiencies in hygiene practices and standards within the hospital. But no action was taken at all save the action taken by the bacterium, salmonella typhimurium, with the disastrous results that the noble Lord, Lord Ennals, has described.
I note that we are also to have a further inquiry. I welcome that, particularly as the further inquiry is to look into the future development of the public health function, including the control of communicable diseases and the specialty of community medicine in England. Here, there has clearly been a breakdown in communication, and at a very important stage. This further inquiry rather reminds me of the days before 1948, at the time of the old municipal hospitals, when we then had medical officers of health who were responsible to the same authorities. I worked in three of those old municipal hospitals in which the buildings, frankly, were deplorable, were antiquated and were in need of much work. But the medical officer of health for the area was very closely related to the hospital. There was no way, in those days, that any recommendation that he made would have been ignored in the way that the recommendations of the environmental health officer for Wakefield were ignored in the case of the Stanley Royd Hospital. I hope, therefore, that the further inquiry into that matter will see to it that communication between public health services and those who actually provide health care is very much closer.
I am also very interested in what has been said about Crown immunity. That must certainly be looked into further. I can perhaps ask the noble Baroness whether much thought has been given to the position of Crown immunity or otherwise with regard to hospitals in which catering and cleaning services have been privatised. Is it a fact that the privatised workers in those particular capacities, who are very important from a hygienic point of view, enjoy the same kind of immunity as apparently do those in this particular hospital? I should like an answer to that.
But, my Lords, what we need is not all these inquiries: we need action. I am very sorry, but clearly there have been deficiencies by the employees in this hospital. It should be understood, however, that in this hospital they were working in appalling conditions. To me, it seems a little disturbing and contradictory that only yesterday we were discussing spending billions of pounds on two tunnels under the English Channel—about the merits of which I say nothing—but apparently we cannot put hospital kitchens in order so that people do not die from salmonella.
§ Baroness Trumpington
My Lords, may I first say to both the noble Lord, Lord Ennals, and the noble Lord, Lord Winstanley, that the Government thoroughly share the revulsion of, I imagine, all noble Lords at this report. In no way are the Government complacent about the findings, or about the future.
The first question that the noble Lord, Lord Ennals, asked concerned Crown immunity. The conclusion of the committee, as it says in paragraph 232, is:… 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".In answer to the noble Lord, Lord Winstanley, it is true that poor buildings did not help. But, as the report says, one can get bad hygiene in modern buildings. This was a case of bad hygiene.
With regard to the programme on Granada television last night, my right honourable friend the Secretary of State has asked for an urgent report from the health authorities concerned, and has made it clear that whatever action needs to be taken should be taken without delay. Furthermore, there is a meeting of all regional health authority chairmen next week with my right honourable friend and this whole matter will be fully discussed by my right honourable friend and his team of Ministers.
I believe that this is the worst outbreak but I cannot totally confirm that. There was no delay in publication. The report reached Ministers last month.
With regard to the 10 per cent. infection rate in hospitals, the best available information about the position in this country is based on a survey carried out by the public health laboratory service in 1981. This showed that 9.2 per cent. of patients were suffering from hospital-acquired infections. A slightly larger proportion, 9.9 per cent., of patients were suffering from community-acquired infections; in other words, they had them before they went into hospital. It is important to bear in mind that not all hospital-acquired infection is preventable. It would be impossible to reduce it to zero. The problem exists worldwide. The use of comparative information is unreliable but it would suggest that this country's performance is about average for advanced countries.
Apart from issuing a great deal of technical advice on specific issues the department has set up the Hospital Infection Working Group to revise our guidance to management on day-to-day infection control and handling serious outbreaks.
With regard to the question of moving the patients to Snapethorpe, I think I can do no better than quote from the report, at paragraph 160, which says:In our opinion the suggestion that Snapethorpe Hospital should have been re-opened is wholly devoid of merit. The diversion and redeployment of nursing, domestic and ancillary staff from Stanley Royd at this time, and on the scale required, solely in order to provide an isolation or admission unit of 12 beds, would have been a gross error of judgment and added an enormous burden to a staff already stretched to the limit".That perhaps wraps that question up.
I think that I have covered the various points made by the two noble Lords.
My Lords, the question was with regard to the position of Crown immunity in relation to those cleaning and catering services in hospitals which have been privatised.
§ Baroness Trumpington
My Lords, that position did not apply in this hospital. We would have to find out the general situation in order to see how that applies.
§ Baroness Bacon
My Lords, is the noble Baroness aware that, as I have lived the whole of my life within two or three miles of Stanley Royd Hospital, I realise only too well the appalling tragedy which happened in our area and the suffering not only of the patients but of the relatives of patients who were in the hospital at the time? Is the noble Baroness also aware that I am personally acquainted with the doctors, nurses, patients and others at the hospital, and, in spite of this tragedy, I feel that the patients are receiving all the medical care and attention from doctors and nurses which they would receive in other hospitals?
Is the noble Baroness further aware that I was interested to hear that the report—which I have not yet read—says that finance did not enter into this? I find that rather hard to believe because this happens to be one of the old Victorian hospitals—like so many others in the country—that need either demolishing and rebuilding or a great deal of money being spent on them.
§ Baroness Trumpington
My Lords, may I thank the noble Baroness, Lady Bacon, for her remarks about the care of patients in the hospital. I think that she will see that the report bears out what she said about the excellent nursing and care which the staff and the junior doctors always give to patients there. On behalf of the department I should like to add warmly to the praise of those people who, at a time of great difficulty, worked magnificently and always cared for the patients.
§ Lord Auckland
My Lords, may I add to the tributes expressed to the noble Baroness the Minister on the report itself, which I have not seen because it has only just been published. Will the noble Baroness accept that those who watched last night's "World in Action" programme—and particularly those of us who are concerned with long-stay hospitals—will have been very disturbed by much of what was contained in the programme?
May I put one question to my noble friend? As I say, I have not seen the report. The programme concentrated very largely on the problems of ventilation particularly in the catering departments. Can the noble Baroness say what emphasis the Government will put on making sure that kitchens and other places where food is stored are properly ventilated or air conditioned so that contamination is much less of a risk than at the present time?
§ Baroness Trumpington
My Lords, I am grateful for the point made by my noble friend Lord Auckland. Of course, the Government are taking into consideration all the issues arising from the report which include ventilation, refrigeration, making sure that cooked and uncooked food is not kept together, making sure that raw poultry is not kept near meat, and a great many other recommendations in the report.
While I am on my feet, may I say to the noble Lord, Lord Winstanley, regarding a reference to my difficulties that I simply have 'flu. I am not having any difficulty in answering these questions.
§ Lord Boothby
My Lords, in view of the growing public anxiety over the state of hygiene in the kitchens of our national hospitals, may I ask the noble Baroness whether there is any valid reason why, even if Crown immunity—the exemption from criminal penalties—should be preserved, such immunity should preserve these kitchens from periodic inspections and reports on the state of hygiene, similar to those which are made in private hospitals?
§ Baroness Trumpington
My Lords, at the moment Crown immunity operates not only for hospitals but for prisons—and indeed your Lordships' House. All such places which come under Crown immunity have been told to welcome environmental health officers whenever they wish to come; and that their reports should be published. The fact is that the Stanley Royd report has only just come out. No district health authorities have as yet seen it. I am sure it is the hope of my department that this report is studied very carefully by the districts and the regions, and that the lessons will be well and thoroughly learnt.
§ 5 p.m.
§ Lord Dean of Beswick
My Lords, I too join the other speakers in supporting the facts that have been made public today. Briefly, I should like to put two matters to the Minister. I believe that the report criticised quite directly both the district health authority and the Yorkshire Regional Health Authority. Is the Minister aware that, within days of this tragedy happening, the Yorkshire Evening Post produced an extensive report showing that the Yorkshire region as a whole has a far higher incidence of salmonella poisoning than any other regional health authority? Will the noble Baroness bring that to the notice of the committee which is being set up to hold the general inquiry in order to discover why that is the case?
Finally, the Minister made a point about environmental health officers for the local authority district involved offering their help and being refused access. It is about time that the Government reviewed the appointment of local councillors as chairmen of health authorities, irrespective of their political affiliations. There will be times like this—there have been in the past and there will be again—when the interests of the two are on a collision course. I submit that it is impossible for a prominent councillor of any particular political colour also to be the chairman of the local health authority and to carry out that task impartially.
§ Baroness Trumpington
My Lords, perhaps I may clear up one matter. I said that the findings of environ- 143 mental health officers are published. I am not totally correct on that. Consideration is being given to publishing their findings.
The noble Lord, Lord Dean, asked me some questions and I am doing my best to answer them. With regard to the staff who were criticised in the report, which concerns his first question—
§ Baroness Trumpington
My Lords, as I said previously, the authority will not have seen this report until today. Ministers will see the members of the authority this week to discuss the action to be taken on the report, and this will cover individual responsibility. Any disciplinary action is a matter for the authority and an appeal can be entered. Is the noble Lord anxious to hear my answers, because if he is not I will sit down and we can get on with the Shops Bill.
I do not think that it would be right for me to express any opinion on local councillors serving on health authorities, but I am quite sure that the noble Lord's remarks will be noted.
§ Lord Ennals
My Lords, I should like briefly to return to two points made by the noble Baroness. The first is on the question of Crown immunity, and the noble Baroness quoted from the report. Inevitably she was selective, and that is no criticism of her. Paragraph 232, to which the noble Baroness referred, states that it would be wrong:for us to base any such recommendations on hearsay, second-hand or outdated information, or belief as to the position outside Stanley Royd".Therefore, part of the reason that the report makes no recommendation on this matter is that the members of the committee were studying Stanley Royd and not the whole question.
Secondly, I referred to complacency and the noble Baroness said that there was no complacency. However, is she aware that illness from bacterial food poisoning in hospitals has increased fourfold since 1981 to over 1,000 cases a year? Is not this a very serious issue?
§ Baroness Trumpington
My Lords, I take the point that the committee was looking at Stanley Royd with regard to Crown immunity, but that is the object of this Statement. With regard to bacterial food poisoning in hospitals, I hear what the noble Lord says.
§ Lord McCarthy
My Lords, will the noble Baroness not agree that although we know that Crown immunity has existed for a very long time, we do not know why it continues to exist? What is the justification for it?
§ Baroness Trumpington
My Lords, I have already said that Ministers are very seriously examining the question of the continuance of Crown immunity. I certainly do not know its origin any more than I know why no noble Lord may die in the House of Lords.