Hospital and community deaths from listeria and streptococcus reveal weaknesses in public health

So far this year there have been two more serious failures of the public health system in England. In June, Public Health England announced that listeria had appeared in six seriously ill in-patients, three of whom had since died and later the same month it transpired that 12 people had died and 20 more had been infected from the spread of group ‘A’ streptococcus in care homes and in their own homes in mid-Essex. Initially there was a confused picture of what was happening with Public Health England apparently reluctant to divulge the full story. Not for the first time the communications function at Public Health England seemed to be not up to the job. As the full picture emerged about listeria, the finger was pointed at sandwiches supplied to NHS Hospital Trusts across England by the Good Food Chain from Staffordshire which soon went into liquidation. By the time the incident subsided, 5 patients had died with others affected across the country. Public Health England saw fit to claim that the risk to the public was low. The affair had quickly become political with questions being asked in the House of Commons and the Secretary for Health, Matt Hancock announcing a root and branch review of hospital food. The Health Select Committee announced that they would call Public Health England Chief Executive, Duncan Selbie to ‘explain how dozens of NHS hospitals were supplied with sandwiches potentially contaminated with lethal listeria’ and former health minister MP Ben Bradshaw criticised Mr Selbie for leaving the crisis in the hands of his deputies. With the row over listeria still bubbling away it emerged that there had been a number of streptococcal-related deaths among patients in Essex involving 32 elderly people receiving community treatment for wounds where most care was being delivered by a ‘Community Interest Company’. The director of nursing quality at the clinical commissioning group responsible for overseeing the provision of care in mid-Essex is quoted as saying that ‘‘Our thoughts are with the families of those patients who have died . . . The risk of contracting (Invasive Group A streptococcus) is very low for the vast majority of people and treatment with antibiotics is very effective if started early . . . ’’. It is now time to digest these latest failings of a public health system that was only put in place 6 years ago as part of Andrew Lansley’s structural changes to the NHS and for public health. In doing so we should reflect that we have been here before. In 1974, radical changes to local government unravelled a public health system that had evolved over 130 years. In this the NHS had consisted of three complementary parts – the hospital services, the family practitioner and related community health services, and the public health services under the direction of the Medical Officer of Health. Environmental health, food hygiene, water, housing, maternal and child health clinics, social work and health visiting, were all parts of an integrated approach to public health. At a stroke this was taken apart with the position of Medical Officer of Health disappearing and being replaced by the short lived ‘community physician’ based in the local health authority. This new role was largely an administrative one and a shadow of the one it replaced. Its weaknesses soon showed. Two serious clinical service failures occurred 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, and then in April 1985 there was an outbreak of legionella at Stafford District General Hospital affecting 68 patients, of whom 22 died. As a result of these two major clinical incidents, Chief Medical Officer, Sir Donald Acheson, carried Journal of the Royal Society of Medicine; 2019, Vol. 112(9) 401–403