Deaths from listeria and streptococcus: a wake-up call for public health
As medical students in Newcastle upon Tyne in the late 1960s and early 1970s, we were in fear and awe of a senior surgeon who had seen military service in the Second World War. His teaching on ward rounds was clear and precise: using a pen, ink and a clipboard he would draw diagrams of Billroth 1 and 2 surgical operations and, if you were late to the ward or unable to answer his questions, the same tools would create a hangman illustration with your head in the noose. He regaled us with clinical war stories of how just he and a trained nurse had triaged casualties from a sunk warship off the Italian coast with minimal loss of life. On a Saturday morning he would conduct a military and forensic hygiene examination of the ward and the ablutions (his wound infection rates were a fraction of those of the new Professor of surgery who placed great faith in antibiotics).
I was reminded of all this during this summer, when there were two serious failures of the public health system in England. Firstly, there was the incident involving a Listeria infection from contaminated hospital sandwiches in hospitals across the country that killed six elderly patients, which was closely followed by 12 group ‘A ‘ streptococcal deaths among patients in care homes and in their own homes in mid-Essex. For me it was a deja vu moment, a re-run of two serious clinical service failures in the mid-1980s that brought urgent action. First, in August 1984, an outbreak of salmonella food poisoning at the Stanley Royds Psychiatric Hospital in Yorkshire led to the deaths of 19 elderly patients, while an outbreak of Legionella at Stafford District General Hospital in April 1985 affected 68 patients, of whom 22 died. As a result of these two major clinical incidents, Chief Medical Officer, Sir Donald Acheson, carried out an enquiry into public health in England that led to steps being taken to rectify serious weaknesses in effective local environmental and communicable disease control. It is to be hoped that the latest incidents will lead to a similar level of scrutiny of Public Health England, which has been responsible for providing leadership and ensuring a robust and effective public health system since the Lansley reforms to the NHS in 2012.
If a review was to be carried out today it is likely to find that the arrangements that have been in place since 2013 have led to a centralisation of public health into London and the south-east, with a weakening of the local and regional levels that have been an essential part of the NHS since 1948. It would also most likely find a weakening of the public health support for the NHS at all levels, including local hospitals and care homes. I would hope that steps would then be taken to rectify these unacceptable vulnerabilities in the system, but it shouldn’t stop there. One lesson down the decades from Newcastle is the fundamental role of clinicians as guardians of the public health. That we now have hospitals without kitchens to provide safe, nourishing food to vulnerable patients is an indictment of all of us who have allowed this to happen. Sound nutrition is as important as pharmaceuticals and other evidence based interventions in total patient care, and a general hospital without a fully functioning kitchen is like one without an operating theatre. It is time to reclaim a clinical role in public health.
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