The deaths of six people from Listeria infections linked to hospital food earlier this year resulted from serious failures in England’s public health system, according to a report published in the Journal of the Royal Society of Medicine.

Professor John Ashton says in the report that there was a confused picture of what was happening when patients with Listeria infections were first reported in June. Ashton is the former North West England regional director of public health. He criticized communications by Public Health England.

The outbreak saw six people die and nine listeriosis infections recorded with links to chicken sandwiches supplied to hospital trusts across England by the Good Food Chain. All patients developed Listeria infections between April 20 and June 2.

Sandwich producer the Good Food Chain was told it could restart business by the Food Standards Agency (FSA) as it was not confirmed to be the outbreak source, but had to go into liquidation.

The outbreak strain was found in meat produced by North Country Cooked Meats. The firm and their distributor North Country Quality Foods went into liquidation in late July and both companies ceased trading.

Lessons from history
In the Journal of the Royal Society of Medicine, Ashton also cited reports that 12 people in Essex receiving community treatment for wounds had died from the spread of group ‘A’ streptococcus and 20 more had been infected in care homes and their own houses.

He drew comparisons with two incidents that caused 41 deaths in the mid-1980s involving outbreaks of Salmonella and Legionella. According to a 1988 enquiry, a lack of effective local environmental and communicable disease control was central to both events.

In August 1984, an outbreak of Salmonella at the Stanley Royds psychiatric hospital in Yorkshire led to the deaths of 19 elderly patients, and in April 1985 there was an outbreak of Legionella at Stafford District General Hospital affecting 68 patients, of whom 22 died.

Ashton said lessons from history show another reorganization is not needed but ways to strengthen what is currently in place and support its evolution into something fit for purpose are required.

Reflect on failures of public health system
“It is now time to digest these latest failings of a public health system that was only put in place six years ago as part of Andrew Lansley’s structural changes to the NHS and for public health,” Ashton wrote.

“The return of the public health function to local government in 2013 meant many directors of public health were placed in structures in which they are line managed by directors of adult social care, with restrictions placed on their scope for action and freedom of expression. There is a schism in which the clinical perspective in local government has been disappearing and the links between local authorities and the NHS have become ever more dysfunctional.”

Ashton said since 2013 local authority public health establishments have been whittled away and budgets cut dramatically.

“To add to the agony, 10 years of austerity and massive cuts to local authority budgets have resulted in attrition of environmental health departments which no longer have the capacity to keep ahead of the threats to human health despite their best efforts.

“Nevertheless some local public health teams have been achieving remarkable results, often at a personal price with deteriorating morale and coordinated anticipatory partnership work has suffered.”