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Legionnaire's Disease (Badenoch Report)

Volume 98: debated on Wednesday 4 June 1986

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3.52 pm

With permission, Mr. Speaker, I will make a statement about the first report of the Badenoch committee of inquiry into the outbreak of legionnaire's disease in Stafford.

The outbreak at Stafford district general hospital occurred in April 1985: 101 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 hon. Friend the Secretary of State for Social Services appointed a statutory public inquiry on 7 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 legionnaire's 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 regional health authority and the Mid-Staffordshire district health authority 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; it was 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.

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.

I join the Minister in thanking Sir John Badenoch and his colleagues for the work that t hey have done in the inquiry. As the Minister has said, the findings of the committee have revealed a considerable number of shortcomings. There are many uncertainties surrounding even that which happened at Stafford, and there are even more uncertainties about the knowledge, development and spread of legionnaire's disease generally.

Even the first report has implications for other hospitals in other areas, and it is not entirely clear from the Minister's statement whether the Government fully accept all the recommendations within it. I should like the Minister to be specific about that. Will he tell us whether the Government intend to find the extra staff and money that will be necessary for the investigation of the cooling systems at other hospitals and for any adaptations and replacements that may be necessary?

Does the Minister accept the committee's recommendation that there should be further research into legionnaire's disease? If he does, is he satisfied that there are presently only two Government-funded research projects into legionnaire's disease? Given the tribute that has been paid to the Public Health Laboratory Service and the Communicable Disease Surveillance Centre in the report, will he reaffirm that the Government have abandoned any intention of interfering with the Public Health Laboratory Service, or to abolish it or the Communicable Disease Surveillance Centre, which were around at the time of the outbreak.

Although this is not covered by the report, I should like to know whether the final report will cover the action taken by the Minister's Department? To be fair to the Minister, that was action taken before he became the Minister for Health. Is the right hon. Gentleman satisfied that no fewer than five days elapsed between his office at the Elephant and Castle being informed that the Stafford hospital people believed that legionnaire's disease was caused by their water cooling system and the Department informing other health authorities with hospitals with identical cooling systems of what had happened at Stafford?

I am grateful for the hon. Gentleman's comments about Sir John and his colleagues. As a first step towards achieving urgent consideration about whether to replace existing spray systems, we have called for the establishment of the precise situation throughout the country. I understand that there are about 400 water spray cooling towers now in place, and we shall need to consider the details of the installations.

The assessment of where we stand can be undertaken notwithstanding resource implications within existing budgets. The immediate priority for health authorities must be to ensure that the existing equipment is correctly and safely maintained. These instructions have already gone out and they will be reinforced by the publication of the report and by the further health notice which is being issued.

Legionnaire's disease is affecting countries throughout the world and I am not aware of any research projects that are not being followed through. I would be prepared to give consideration to any suggestions that come forward and to pass them on to those responsible for medical research.

The hon. Gentleman made some rather exaggerated comments about the Public Health Laboratory Service and a report which was produced earlier this year. My right hon. Friend the Secretary of State made it clear quickly that he did not accept the proposals in the report and that he wished the service to continue in its existing form. My right hon. Friend's clear undertaking remains.

The content of Sir John's final report will be a matter for him and his colleagues and not for me.

I welcome my right hon. Friend's statement, the Badenoch report and the Government's immediate response last year to my call for a full independent inquiry, but will my right hon. Friend accept that some serious criticisms are contained in the report that show that the sort of action that is outlined in the report is necessary? Will he join me in extending sympathy to those who were bereaved during the course of the outbreak of legionnaire's disease in my constituency? Will he ensure that appropriate praise is given to the nursing staff for the wonderful work that it conducted in difficult and dangerous circumstances while the outbreak was continuing?

Yes, I join my hon. Friend in his expressions of sympathy, which have been made in the House before and which, I am sure, will be reiterated in all parts of it, to the relatives and friends of those who suffered. I endorse the tribute which was paid in the report and paid previously by my predecessor and by the hon. Member for Holborn and St. Pancras (Mr. Dobson) to the staff. Anyone who reads the report of the inquiry will see that tribute is paid in unstinted fashion to those who had the care of the patients who, alas, suffered from this serious infection. I congratulate my hon. Friend, whose assiduous attention to detail as the constituency Member has rightly won admiration and praise in all parts of the House.

I associate my right hon. and hon. Friends with the comments that have been made about the sympathy that we should extend to the relatives of those who died in this tragic incident and the tribute that we should pay to the heroic efforts of the staff who put it right. We owe a debt to Sir John Badenoch for the expedition with which he has produced the report.

Can the Minister confirm that DHSS maintenance standards for the cooling towers are upheld and that the proper recommended procedures are followed? I understand from his statement that he found that there were maintenance defects. Has he considered the use of biocides such as Hatacide LP5 as a replacement for chlorination, as chlorination has been found to be defective, and certainly in the conditions found in modern water spray cooling systems?

Secondly, the Minister will know from the expert advice that he has been receiving that old people are especially vulnerable to legionnaire's disease. He has said that 400 institutions have water spray cooling systems, and I ask him to give especial attention and priority to those that accommodate elderly people, who are particularly at risk. If he finds that there are still suspect systems, will he ensure that no expense is spared in replacing equipment?

I am grateful to the hon. Gentleman for what he has said about extending sympathy to the relatives of those who died. He has addressed himself to the maintenance of the air conditioning plant at Stafford and, as I said earlier, the report reveals a number of defects in design, installation, maintenance and chlorination which appear to have contributed to the outbreak of the disease. The inquiry was not able to point the finger precisely at any one specific failure or cause. The infection appeared to start on 9 April and appeared to cease on 19 April. The cessation may have been contributed to by a change in weather conditions, but there is still no absolutely clear reason why the outbreak started and why it ended.

The way in which infections of this particular organism have been found to operate in different parts of the world at different times makes it extremely difficult to be precise and specific about the causes. The hon. Gentleman has referred to the use of biocides and he will have heard me say that we have accepted the recommendation that an expert committee should consider the issue. I have said that Dr. Wright, who is a distinguished expert in this area, will be chairing the committee. I hope that the membership of it will be established pretty soon and that it will get to work without delay.

The hon. Member for Holborn and St. Pancras (Mr. Dobson) was right to draw attention to the vulnerability of old people to infection. People who have suffered from chronic infections and, indeed, those who have been heavy smokers also appear to be vulnerable. They all appear to be more liable to be adversely affected by the infection. The hon. Gentleman's point about the water spray cooling towers, and their relationship to institutions where there are people with particular vulnerability, such as the old, will be taken into account.

May I associate myself with my right hon. Friend's kind and generous remarks about the care bestowed by the staff at Stafford hospital, particularly the care for my constituents, who are just five miles away from Stafford hospital? Will my right hon. Friend confirm that also about five miles away is Meaford power station? Have he and the inquiry completely eliminated the possibility of a correlation between the water cooling system of Meaford power station and legionnaire's disease? Has my right hon. Friend satisfied himself that the committee has ensured, through any consultations that it may have had with the Central Electricity Generating Board and others, that there was no connection? Will he confirm that the most rigorous inquiry has taken place as to the efficacy of the water cooling system at Stafford general hospital and, indeed, the quality of maintenance of the water cooling system?

I am grateful to my hon. Friend for his comments and his endorsement of the tribute to the staff concerned. He will have personal knowledge of that because some of his constituents were affected. A connection with the water cooling systems in nearby power stations has not been established, nor, I suggest—although I do so subject to correction—has it been totally eliminated. As far as I can judge from the scientific and engineering evidence that is coming forward, it is extremely difficult to be absolutely positive either for or against any proposition in this area. It has become clear that the organism that led to the deaths and illness of those affected in the outbreak was identified as being in the air conditioning system. Cooling tower No. 4 had a connection with the outpatients' department where, as far as one can judge, the majority of those who were affected picked up the infection.

What steps will be taken to ensure that employees of the National Health Service are made aware of the contents of the Badenoch report, and what steps will be taken to ensure that sufficient training is given to staff in the NHS to overcome any problems arising from the changes that will be necessary as a result of the recommendations in the report?

Secondly, will the right hon. Gentleman assure the House that any changes that have to be made to NHS equipment in any hospital as a result of the report will be paid for out of central funds, not out of local district health authority funds, so that they will not be set against the costs of existing services and staff?

When the final report is ready, and if any changes are required in building control regulations for any other building or installation, will the right hon. Gentleman ensure that the Department of the Environment introduces the necessary building control regulations for any new central heating or water cooling systems rather than awaiting another disaster such as the one that we have already had in the NHS?

The general tenor of the hon. Gentleman's remarks is much less than fair to the very careful preparation that has been done in the past to give guidance on the dangers and difficulties associated with the disease. I checked the experience in other countries, and I found that the guidance that was issued by the NHS in this country was in advance of that issued anywhere else in the world. We should take pride in the fact that NHS staff have been out in the front and leading internationally in dealing with this difficult infection.

With regard to passing on information, the report is going to all health authorities. No doubt, in their own circumstances, they will let all those concerned know. There are recommendations in the report about the wed for further training and, of course, it will be carried through.

Order. I must have regard to subsequent business on the Order Paper. This statement is about the inquiry into legionnaire's disease in Stafford. Will hon. Members direct their questions to that and not widen the issue?

As I have two hospitals in my constituency—Leicester general and the Towers hospital — will my right hon. Friend assure constituents and the elderly——

Will my right hon. Friend ensure that there is wide circulation of the Badenoch report so that elderly people in the country, including Stafford, realise that when they go into hospital they will be properly cared for and that health and safety will be maintained throughout? Will he further ensure that the report will be distributed not just to the health authorities but to those who are particularly concerned—the elderly?

I can assure my hon. Friend that the report will go to all the health authorities, and indeed it has been circulated among Government colleagues and, I am pretty sure, to the professional institutions and others involved. I imagine that within the scientific and engineering community with particular concern for those systems the report's recommendations will be studied with care. The guidance that my Department will issue to all health authorities will also be made available to anyone else outside who has an interest and who asks for it.

Is not the Minister aware that it was precisely because it was impossible to isolate the true origin of the epidemic at Stafford that there was considerable disquiet in the area? Will he please understand that what is required now is urgent action in relation to the other hospitals with comparable systems? That requires central funding. It is not enough to send out a circular. Those hospitals must be given money immediately so that they can do something about their existing systems.

The hon. Lady slightly misunderstands the position. Guidance about existing systems has been available since 1980, and it was reinforced in July 1985 and January 1986. The hon. Lady does a grave disservice if she is trying to show that a shortage of finance is connected with the difficulties. If she reads the report, she will see that lack of finance was in no way involved.

The Minister has talked about specific recommendations for hospitals, but I suggest that an outbreak could occur in air conditioning systems in other public buildings, unless proper maintenance of the systems is carried out. The remit of any committee that the right hon. Gentleman sets up should include aspects of air pollution through air conditioning systems and its effect on health. More people are recognising the link between air conditioning systems and absenteeism from work, with more infections — [Interruption.] But it is important that any committee——

Order. I am sure that it is important, but will the hon. Lady please concentrate on the statement?

I am attempting to do so, Mr. Speaker, by showing that legionnaire's disease could occur in any public building unless there is proper control of air conditioning systems. Any committee that the Minister intends to set up should have a much wider remit than what he has suggested so far.

The hon. Lady must have misunderstood what I said. She will understand when she reads the report. Sir John Badenock's committee has produced a first report dealing with the Stafford incident in particular. I said that there would be a second report, which would look at what could be done to reduce any risk from the disease in other circumstances, in hospitals or other buildings, whether in the public or private sector, and elsewhere. Even the possibility of the infection on ships has already been identified. Sir John and his colleagues are going ahead with that wider work and their report can be expected towards the end of the year.

Has the Minister considered paragraph 52 of the report? It says that one of the ways in which the dissemination of this disease is known to occur is

"via shower heads or spray taps (which are used intermittently, and where the organism may multiply if the water is warm) …"
Bearing in mind that the Select Committee on Employment, on which I have the privilege to serve, looked into the problems of this disease and considered evidence to the effect that it also arises from whirlpools and Jacuzzis and in other precise systems where water goes into the air, will the Minister direct the inquiry specifically to those problems? Apparently no prosecutions are to arise from the current disasters. Can the Minister tell the House whether as a result of this inquiry and the miseries which gave rise to it steps will be taken to remove Crown immunity in respect of any such further incidents which may involve liability by hospitals or prisons or any other public institution? That immunity should have been removed long ago.

Crown immunity has absolutely nothing to do with this. If compensation is paid as a result of this inquiry and this incident, it will be a matter for the Mid Staffordshire health authority operating under our regulations, and in the final analysis it will be a matter for the courts to determine. I can give the hon. and learned Member the assurance that Crown immunity will not come into that.

The hon. and learned Gentleman directed my attention to a paragraph in the report and seemed to be suggesting that I should draw Sir John's attention to that paragraph so that he and his colleagues could carry out further work. Sir John and his colleagues hardly need me to draw their attention to what they have written so that they can decide upon their further work. As I have said, that work will be wide ranging and Sir John and his colleagues will look at the action that will be required to reduce the possibility of this infection arising in hospitals, in other buildings or elsewhere. Sir John and his colleagues have taken a fairly wide remit.

This important report demonstrates the difficulty of explaining why legionnella bacilli multiply. In following up the report, will the Minister ensure that a careful look is taken at the extent to which the problem could arise because of products being used in the manufacture of drainage systems, air cooling towers and so on that do not comply with the BSI standard, especially if such products are imported?

I am sure that Sir John and his colleagues will wish to look at that matter.

The hon. and learned Member for Leicester, West (Mr. Janner) spoke about other buildings. I have checked and found that the air conditioning system in the Houses of Parliament does not have a water spray system.

May I refer the Minister to the recommendations of the report and especially to recommendation 8(a) on page 64? It says:

"urgent consideration should be given to replacing any wet cooling tower with an air-cooled system".
That will involve finance. Can the Minister say whether finance will be provided and, if so, whether it will come from central funds?

The report says that urgent consideration should be given to those matters and as a first step towards giving that consideration we have called for information about the systems in use. That information will need to be considered. As I have said, the immediate priority must be to ensure tha the existing equipment is correctly and safely maintained. Of course it will cost money to replace water spray cooling towers. It is clear that the inquiry did not recommend immediate replacement of such systems, and in any case the replacement of towers that are at the end of their lives will cost money.

In planned hospital building for the future we have, fortunately, turned to air cooling rather than water spray cooling and we will look into the problems identified by the survey that has been initiated about dealing with existing water spray cooling towers. If that involves significant cost, then, of course, the matter will be looked at. Changing circumstances are always looked at in the context of the ways in which we fund the National Health Service.

On a point of order, Mr. Speaker. Earlier today we had a statement about the resignation of Mr. Victor Paige. I asked the Secretary of State a question. I am not suggesting that his reply was a lie, but I am suggesting that we should have fairness and I know that you, Mr. Speaker, try to ensure that. The Secretary of State said that the Committee which considered the Social Security Bill sat for three months. That is correct, and I never missed a sitting. He said that I suggested things in the Committee with which he totally disagreed. The Secretary of State was hardly ever there. May I suggest that you, Mr. Speaker, have a word with the Secretary of State to sort things out?

I thought that the hon. Gentleman had asked for the Minister's resignation.

On a point of order, Mr. Speaker. We have had an important statement about legionnaire's disease at Stafford hospital, and implications for local health authorities clearly arise from the statement. The Minister has not answered the serious question about how the local authorities are to fund the cost of implementing the recommendations in the report. Can you advise me, Mr. Speaker, by what means we can get a clear answer from the Government about this important matter that is causing many health authorities a great deal of worry?

I called the hon. Gentleman to ask a question, but I do not know whether it was fully answered. There are other ways in which the hon. Gentleman can deal with the matter. He can deal with it at Question Time or even by way of an Adjournment debate if he is fortunate enough to get one.

Bill Presented

Tobacco Products (Health Warnings)

Mr. Archy Kirkwood, supported by Mr. Roger Sims and Mr. Laurie Pavitt, presented a Bill to provide for the presentation of health warnings on packaging of tobacco products, and related advertising and promotional materials: And the same was read the First time; and ordered to be read a Second time on Friday 4 July and to be printed. [Bill 170.]