HL Deb 04 June 1986 vol 475 cc1019-25

5.55 p.m.

Baroness Trumpington

My Lords, with the leave of the House, I shall now repeat a Statement which is being made in another place by my right honourable friend the Minister for Health. The Statement reads as follows:

"With permission, Mr. Speaker, I will make a Statement about the first report of the Badenoch Committee of Inquiry into the outbreak of legionnaires' disease in Stafford.

"The outbreak at Stafford District General Hospital occurred in April 1985. One hundred and one patients caught the disease, and there were 28 deaths. This was the second most serious incident ever recorded, surpassed only by the outbreak in Pennsylvania in 1976 from which the disease was first recognised. The source of infection was traced to the air conditioning system. My right honourable friend the Secretary of State for Social Services appointed a statutory public inquiry on 7th June 1985, chaired by Sir John Badenoch.

"The inquiry has produced a first report covering the Stafford outbreak and has also made recommendations more generally about hospital air conditioning systems. The inquiry will now consider and make recommendations on action to reduce the possibility of future outbreaks whether in hospitals, other buildings or elsewhere, and the Government expect to receive this second report around the turn of the year.

"The first report concludes that, on present knowledge, the outbreak at Stafford cannot be attributed to any single factor, nor does it hold any individual or group directly responsible. It points out that legionnaires' disease has only recently been identified and is not well understood. The report refers to a combination of circumstances which appear to have contributed to this outbreak.

"These circumstances include defects in the design and construction of engineering services, problems during the commissioning of the air conditioning plant, lack of knowledge and understanding of the sophisticated engineering plant, shortcomings in maintenance including chlorination, and the weather conditions. The report also points to the inherent difficulty on present knowledge of eliminating the legionella bacillus in water spray cooling towers used for air conditioning.

"The report praises those who cared for the infected patients and I gladly endorse this tribute. The report makes recommendations specific to the circumstances surrounding the outbreak and requiring local action. In particular, it calls for a review of the health authority's microbiological services in Stafford. I am asking the West Midlands RHA and the Mid-Staffordshire DHA to report within three months on the follow-up action they have taken or intend to take.

"Revised guidance on the maintenance of cooling towers was issued to health authorities in January 1986 following consultation with Sir John Badenoch. This reflects the lessons learned at that stage from the inquiry. In the light of the completed report, the department has today issued a further circular to health authorities asking them to check for features similar to those found at Stafford and to take appropriate action. They are also being asked to ensure that existing guidance on maintenance is being followed and that operational engineering staff have access to detailed guidance on the operation of individual water spray cooling systems.

"The recommended code of practice for hospital engineers should be available by about the end of the year. In the meantime, discussions are in hand with the Public Health Laboratory Service to establish a register of engineers so that relevant expertise can be available if needed by the Communicable Disease Surveillance Centre and health authorities.

"The inquiry recommended that a committee of experts should be convened urgently to consider all aspects of the use of biocides as a means of minimising build-up of legionella. This committee will be chaired by Dr. A. E. Wright, director of the Public Health Laboratory Service, Newcastle laboratory, and will begin its work shortly.

"Other recommendations dealt with reducing reliance on air conditioning in general and water spray cooling towers in particular. Current hospital building policy with its emphasis on smaller hospitals means that new hospitals generally use less air conditioning than before. Preliminary inquiries indicate that no new water spray cooling towers will be incorporated in hospitals currently being planned. The inquiry's conclusions will reinforce the commitment to air-cooled systems for new hospital building.

"As regards existing hospitals, health authorities have been asked to give details about the type and number of water spray systems now in use, as a first step to carrying out the recommendation that urgent consideration should be given to their replacement. Only a minority of hospitals are thought to have such systems but the inquiry will establish an accurate national picture. I understand that the inquiry team did not envisage immediate replacement of such systems; they were concerned to ensure that existing systems operate as safely as possible and those which have reached the end of their natural life or present particular maintenance problems should have priority for replacement.

"Mr. Speaker, early action was taken with the two health notices in July 1985 and January 1986 and further instructions, based upon this first report, have now been issued to health authorities. These steps will reduce the risk of any repetition of the outbreak. Production of a code of practice and setting up the register of engineers experienced in this field will also contribute to that end. In the longer term the new committee on biocides should help to clarify how these chemicals can best be used to reduce risks further. Information is being collected about existing hospital water spray cooling systems as a first step in the consideration of their longer term future.

"We owe a great deal to Sir John Badenoch and his fellow inquiry members for the energy and application they have brought to producing this report. For the broader questions about what may need to be done to reduce any risk from the disease in other circumstances in hospitals, other buildings and elsewhere, the Government look forward to the second report, which is expected around the turn of the year."

My Lords, that concludes the Statement.

6 p.m.

Lord Ennals

My Lords, once again I must thank the noble Baroness for repeating the Statement given in another place by her right honourable friend. One recognises that this is in a sense an interim report and that there is more to come. However, having had the opportunity of only glancing through this very substantial interim report, I think that we have every justification to thank Sir John Badenoch and his committee for the thoroughness of the work that they have done so far. We have to recognise—and I am certain that the noble Baroness does—that this was a very serious outbreak indeed. That a disease should be caught in one of our hospitals—not elsewhere, but in that hospital—and that there were 28 deaths is a very serious matter. Equally, there are very serious conclusions and recommendations that are made.

I note the reference to the defects in the design and construction of engineering services, problems during the commissioning of the air conditioning plant, lack of knowledge and understanding of the sophisticated engineering plant, shortcomings in maintenance including chlorination, and the weather conditions. This is a very serious indictment of those who were responsible for fitting this equipment in the hospital. I find it surprising that the noble Baroness says that it is not possible to pin some blame on some people because there are a number of commercial firms who were responsible for establishing this equipment in which there were defects and problems during the commissioning, as well as a lack of knowledge and understanding. This was a very serious, one might almost say crime that was committed by those involved, which led to such a serious consequence.

I welcome the Government's circular that has been issued today and the code of practice for hospital engineers. But the Statement of the noble Baroness leaves one or two questions unanswered. I should like to know when the system was installed in the hospital. This may be in the report. Has it been in too long? Is it too old, rotten or rusty, or was it installed five years ago? When trying to pin responsibility, as we must, for the death of 28 people, we need to know who was responsible and when they were responsible for it.

Secondly, what kind of system exists as of now—not in the future—for inspecting water systems and air conditioning systems within our hospitals? I am sure that it will improve as a result of the inquiry, but I want to know what our present system is.

The third, last, and I believe most important question is this. Will these issues be dealt with in the Crown immunity legislation which is now before another place, and which will eventually come to your Lordships' House? That deals with very important health and safety requirements. There is no earthly reason why people responsible for such a situation, because they are within a hospital, should be in any way held less responsible to society than those making similar mistakes in a commercial enterprise. I need to know—I ask the noble Baroness, and hope that she can tell me—whether this issue will be dealt with in the Bill that deals with Crown immunity which will shortly come before your Lordships' House.

Lord Winstanley

My Lords, on behalf of my noble friends on these Benches, I would wish to join at once with the noble Lord, Lord Ennals, in thanking the noble Baroness for repeating this extremely important Statement. At the outset I should like to join the noble Lord and the noble Baroness in conveying our thanks from these Benches to Sir John Badenoch and his colleagues for the very thorough way in which they have done their very important work, and for the expeditious manner in which they have produced their first report.

As a doctor I know enough about the matters contained in this report to know that it would be extremely unwise to make any detailed comments until I have studied this lengthy report with more care. I have no objection whatever to making instant comment on Statements concerning matters about which I know nothing, but on matters of this kind I think that I should be unwise.

Having glanced at the report, with my noble friends on these Benches I should like to join at once with Sir John Badenoch and his colleagues in thanking all the staff at Stafford and the other medical and environmental personnel in that district for the way in which they carried out their very difficult and worrying duties at what was a very worrying time. In my experience, visiting Stafford at that time, it seemed to me that many of the staff to whom I have referred, and to whom Sir John refers in his report, carried out duties with a total disregard of any considerations for their own safety.

I note that this is a first report. As one of those in your Lordships' House who asked for a statutory public inquiry when we discussed this matter briefly during a Statement on Stafford, I welcome the appearance of this first report. However, I note that the inquiry will now proceed to consider and make recommendations on action to reduce the possibility of future outbreaks, whether in hospitals, other buildings or elsewhere. The word "elsewhere" appears in the Statement which the noble Baroness has given us. It seems to me that places to be looked at urgently are establishments where people are kept in perhaps crowded conditions, and sometimes old buildings. I would particularise prisons, some schools and barracks, and other military establishments. I make the prediction that sooner or later there will be another outbreak of legionnaires' disease. When there is another outbreak we shall be much better able to combat it as a result of the work already performed by this committee of inquiry.

I notice in the Statement also that a committee of experts is being convened urgently to consider all aspects of the use of biocides as a means of minimising the buildup of legionella. I express the hope, as a doctor, that when that committee of experts has conducted its inquiries and comes forward with its recommendations that expert advice on biocides will be accepted rather than being rejected, as very often expert advice on matters of that kind has been. I am not going to mention fluoride and such things, but we do not always make great haste to accept the advice of experts, and on this matter I think that is important.

Finally, I note with satisfaction what was said in the report and particularly in the Statement by the noble Baroness about the design of new hospitals. It is important that the design of new hospitals should be entirely in keeping with what we know about legionella, though it is right to say that there is much that we do not know at the moment. Surely that points to the urgent need to get rid of some very old hospitals. I hope that the noble Baroness will agree with me when I say that it will be impossible at any acceptable cost to make some of the very old buildings that are still in use wholly safe in the way in which all noble Lords would wish.

Baroness Trumpington

My Lords, with regard to the remarks of the noble Lord, Lord Ennals, of course, we realise the seriousness of the outbreak. I hope that the Statement expresses that seriousness. The report did not find any single cause of the outbreak. Although it is critical of the actions of some individuals, it does not point to any one person or group of people who, by their acts or omissions, either caused or failed to prevent the outbreak. The actions by any local staff are of course up to the health authorities that employ them. It is for them to take any necessary action. The date when the system was installed was 1983. The systems are inspected as a matter of priority by the health authority engineers and the Health and Safety Executive.

With regard to the question of Crown immunity, the current Bill does not deal with that except so far as food poisoning is concerned, and there is no reason to think that further legal sanctions are needed in this case.

The noble Lord, Lord Winstanley, asked about other buildings. The inquiry's recommendations are specific to hospital air conditioning systems. We must await the second report to learn its views on the recommendations that should apply to other kinds of building and what additional advice it offers. The risks to health are clearly greater in hospital because of the greater vulnerablility of sick people to disease, which of course the noble Lord appreciates. Obviously some of the recommendations in the first report are relevant in other buildings with water-spray-cooled air conditioning, and I am sure that the inquiry report should and will be carefully studied by professional and other bodies. The guidance to the National Health Service issued by my department is publicly available on request. The report is of course a published document and my department stands ready to deal with inquiries arising from it.

The question of finance was raised by the noble Lord, Lord Winstanley. The immediate priority for health authorites is to ensure that existing equipment is correctly and safely maintained. I would hope that the vast majority are already doing this. I see no reason why any extra cost should not be met from any existing budgets. Replacing cooling towers will have a cost. As I said in the Statement, however, the inquiry team did not recommend immediate replacement of such systems, and replacement of towers at the end of their useful life will have a cost in any case.

I am grateful to the noble Lord, Lord Winstanley, for not making instant statements. Some of us are of course used to doing just that; equally we are used to listening to them.

6.15 p.m.

Baroness Gardner of Parkes

My Lords, I should like to take this opportunity to ask the noble Baroness about the situation in the new hospitals that have been referred to, and in particular in the new Brompton National Heart Hospital, which is under construction. I attended a meeting this week to see the plans. It is imminently ready for construction, and I understand that there has been much concern about this matter of the water-sprayed cooling towers and that a great deal of research has been done. It has been discovered that air-cooled cooling towers can be provided, and that would certainly be desirable in view of the findings in the report.

However, there is a definite financial difference in the cost, and I hope that the noble Baroness's department will look at the matter very carefully and authorise it as soon as possible. Without doubt it would be more expensive in a new hospital now to go ahead with what is considered an unsatisfactory system and then have to replace it very soon thereafter. Having heard that the present system was put in only in 1983, I shall certainly support the view that no one intentionally or deliberately would have done anything to injure people in hospital. It was simply that these facts were not known at that time. Now that they are known, I am convinced that the department will confirm that it will be willing for a proper air-cooled system to be put into this new hospital.

I am sorry to say that the cost arises because the only country producing a system of air cooling of adequate size is Japan. I hope that we shall soon start producing something in this country to give us what we want and provide additional employment in Briain.

Baroness Trumpington

My Lords, I thank my noble friend for her helpful remarks. With regard to Brompton National Heart Hospital, I hope that she will understand if I reply in writing. With regard to the dependence on air conditioning in future hospitals, current hospital building policy with its emphasis on smaller hospitals has already much reduced the reliance on air conditioning. We shall have regard to the risk of infection identified by the report along with other considerations.

Lord Ennals

My Lords, the noble Baroness having established herself as the listening Baroness or Minister, may I pursue two points briefly?

The noble Baroness, Lady Gardner of Parkes, was as surprised and disturbed as I was that this equipment was put in in 1983. It is very new—it is not as if it was a piece of old equipment. If this were to happen in some situation other than a hospital and 28 people were to die as a result, I should have thought that cases of civil liability would be brought in the courts by the families of some of those killed as their deaths appeared to be a direct result of faulty equipment. I therefore very much hope that the noble Baroness, Lady Trumpington, will reconsider the answer she gave me on whether Crown immunity should not cover health and safety in a hospital as well as simply heating. Heating is very important, but dying is even worse—it has a kind of permanency about it.

Baroness Trumpington

My Lords, the noble Lord, Lord Ennals, will know that I shall bring his remarks to the attention of my noble friend.