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House of Commons Hansard
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Listeria: Contaminated Sandwiches
17 June 2019
Volume 662

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To ask the Secretary of State for Health and Social Care to make a statement on the listeria outbreak related to contaminated sandwiches in hospital trusts.

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I would like to update the House on the actions the Government are taking to protect the public following cases of listeria in hospitals linked to contaminated food. The NHS has identified nine confirmed cases of listeria in seven different hospitals between 14 April and 28 May this year, all linked to contaminated sandwiches from a single supplier. All the known cases involve in-patients. Very sadly, five people have died. I would like to express my condolences to the families of those who have lost a loved one. I promise that there will be a full and thorough investigation, with severe consequences if there is any evidence of wrongdoing.

Lab testing indicated a link between two cases in Manchester Royal Infirmary and one case in Liverpool. Contaminated sandwiches were identified as the likely cause by Public Health England. The manufacturer—The Good Food Chain—and its supplier, North Country Cooked Meats, have withdrawn the sandwiches, and voluntarily ceased supply of all products on 7 June. They are both complying with the Food Standards Agency on a full product withdrawal. The other cases have been identified at these hospitals: Royal Derby, Worthing, William Harvey in Ashford, Wexham Park, Leicester Royal Infirmary, and St Richards in Chichester.

The risk to the public is very low, but any patients or members of the public with concerns should contact NHS 111 or, of course, 999 if they experience severe symptoms. Listeria infection in healthy people may cause mild illness but is rarely fatal. However, for certain groups it can be much more serious, as we have tragically seen. The NHS, Public Health England and the Food Standards Agency have acted swiftly to identify, contain and investigate the cause of this listeria outbreak. These deaths should never have happened. People rightly expect to be safe and looked after in hospitals, and we must ensure that we take the necessary steps to restore that trust that the public deserve to be able to hold.

This is not just about ensuring that the food we serve in hospitals is safe—the NHS served 140 million main meals to in-patients last year—but, importantly, is also about ensuring that food given to patients is healthy, nutritious, and aids their recovery. So I can inform the House that we are launching a root-and-branch review of all the food in our hospitals—both the food served and the food sold. The Government will work with the NHS to build on progress in three vital areas. First, there is eliminating junk food from hospitals. Since the introduction of the NHS action on sugar scheme, we have halved the sale of high-sugar soft drinks, and trusts are taking action to remove unhealthy food and drink items and replace them with healthier alternatives. After all, hospitals are places for good health. Secondly, on improving nutrition, new national standards for all healthcare food will be published this year. All patient menus will have to ensure that minimum patient nutrition standards are met. Thirdly, on healthier choices, we will work closely with the Hospital Caterers Association and others to ensure that healthier food choices are available across the NHS.

The review will identify where we need to do more, where we need to do better to improve the quality of food in our hospitals, and how we help people to make healthier choices. I know that this is an issue that many colleagues in the House feel strongly about, as do the public. We will do everything we can to ensure that the food we eat in hospitals is both safe and healthy.

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Let me say at the outset that despite our often sharp political differences across the Dispatch Box, the Secretary of State has my commiserations over his entirely noble ambition to want to be the Prime Minister of this country—but perhaps, given Brexit, he has had a lucky escape.

Moving on to the substance of what we have to discuss today, our thoughts really must be with the families of those who have lost their lives. This is, first and foremost, an issue of patient safety and standards of care. Every patient deserves the very safest possible care and absolute confidence about the quality and safety of the food that they are offered. I am pleased that there is an investigation, and I welcome what he said about serious consequences if wrongdoing is found. I am also pleased that he talked about a root-and-branch review, which we have been calling for. As I understand it, NHS Improvement was already reviewing the hospital food plan, which was delayed from April. Is this a new review or an existing review that now has new obligations? Can he explain to the House how the review he has announced interacts with the existing NHS Improvement review?

I know that the investigation will want to get to the bottom of what went wrong and why, and it will no doubt make recommendations for the future, but we would be grateful if the Secretary of State offered some clarification. The first case showing symptoms of listeria was on 25 April, and sandwiches and salads were withdrawn on 25 May. When were Ministers informed, and what action was taken?

I am grateful that the Secretary of State listed the other hospital trusts affected, which include the one in my Leicester constituency. As I understand it, the Good Food Chain was supplying sandwiches to 43 trusts. Can he tell us the status of investigations or what investigations have gone on in the other trusts that he has not listed today? Does he expect cases to emerge in more trusts, and what action is currently under way to contain the spread?

What advice has the Secretary of State received from officials that microbiological controls for listeria need to be improved with respect to pre-packaged sandwiches? Will he consider introducing mandatory testing on all batches of high-risk food? Of course, this is not the first time that there has been a listeria outbreak. There was an outbreak back in 2016, and in response, the Food Standards Agency investigated and issued a report warning Ministers of the dangers posed by pre-packed sandwiches. Can he outline what measures were taken by Ministers in response to that report in 2016?

I have been speaking to hospital catering staff in recent days, and they raised concerns that tight finances and years of capital cuts have left kitchens substandard, which has driven a move to greater outsourcing of catering, with sandwiches and soups steadily replacing hot meals. Recent data show some hospitals spending less than £3 per patient per day. Does the Secretary of State agree that the review he has announced today should be backed up by investment in hospital catering facilities and legally backed, clear minimum-quality standards for hospital food? Healthcare is not just about medicine, surgery, bandages and procedures; it is about nutrition and hydration too. Patients will need urgent reassurance. Can he provide that today?

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The shadow Secretary of State raises important questions, and I will try to address them all. Ultimately, I strongly agree with him that this is about standards of care. People deserve to be able to trust that the food they eat and are given in hospital is safe and, indeed, nutritious and good for their health—that is an important part of this too. Clearly, the most acute aspect of what we are discussing is safety and the lack of listeria in food, but it is part of a much bigger picture, which is why we are having a root-and-branch review.

The hon. Gentleman asked about the hospital food plan, which NHS Improvement has been leading. The review will be wider than, but will encompass, some of the existing work that is ongoing. It is about not only how food is procured by hospitals, but the quality of food. Work on the national standards in hospital food is important. It has been ongoing for several years and will come to fruition very soon. More broadly, dozens of hospital trusts have brought their catering in-house and found that they get better quality food that is more likely to be locally produced and is better value for money. We will be examining that model closely, because I am very attracted to it, and it has the potential to reduce the risk of safety concerns such as this.

The hon. Gentleman asked about timings. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for South Ribble (Seema Kennedy), was made aware of this outbreak on 4 June. I was informed on 6 June, and we published the details of the outbreak on 7 June.

Before that, Public Health England very swiftly identified that there was a link between these particular listeria outbreaks. It is only because of recent advances in genomic medicine and testing that we could work out—that Public Health England could work out—that the outbreak in Liverpool and the outbreak in Manchester were connected, and therefore identify that the source was outside those hospitals, rather than inside the hospitals, and that is what then identified that this was from the food source. The truth is that there are just over 150 listeria cases a year. It is a notifiable disease, so we are confident that we are properly notified of the various cases. Frankly, it was cutting-edge work by Public Health England that allowed us to connect these different cases and work out that a single source was causing these deaths.

The hon. Gentleman mentioned the 43 trusts that we know bought from the Good Food Chain. We have of course been in contact with all hospital trusts, whether or not they bought from this individual company, to try to make sure that we have confidence in their supplies. The Good Food Chain has confirmed that it has followed advice and has disposed of all products. That is what the Good Food Chain company has said to us, but we are of course reconfirming that with the trusts because we want to get this right.

Finally, the hon. Gentleman asked about investment in food and catering facilities. The truth is that it is important to have the best-quality food in hospitals. I am completely open to upgrading hospital equipment if that is what is necessary, and if it provides value for money. I have been struck by the number of hospital chief executives who have said that from the point of view of patient satisfaction, staff morale, and nutrition and the quality of food, bringing such food supplies in-house is the best thing they have done.

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The Secretary of State will be aware that in my constituency of Stone, where the Good Food Chain is situated, there is obviously very deep concern, not least because we had the horrendous Mid Staffs hospital crisis. I had to campaign on that against the Labour Government’s refusal to give a full public inquiry, which our Government did give.

Having said that, is it not the case that the Good Food Chain is only responsible for the products that the patients consumed, and that the bacteria came from another company, which I am given to understand is called North Country Cooked Meats in Salford? I do commend Public Health England and the Secretary of State for the rapid way in which they identified the connections between these different places. Whereas it is absolutely essential that we have the root and branch review the Secretary of State has provided, is it not also the case that while the companies concerned will have to accept responsibility as far as it falls on them, at the same time there are really important reasons to identify exactly what did happen—where the food was contaminated, how it was contaminated—and then to exonerate the Good Food Chain, if in fact that is the case, because it is very unfair for companies to be caught up in something when it was not entirely their fault?

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My right hon. Friend—[Interruption.] Not yet. My hon. Friend rightly raises the question of the supply chain, and it is true that the food in question came from North Country Cooked Meats. In turn, we are trying to identify the suppliers to North Country Cooked Meats to get to the real root of this outbreak. He is quite right to identify that this is a supply chain issue, and that there is a complex supply chain in operation.

I join my hon. Friend in commending the work of Public Health England. Within days, it spotted the links between individual cases and, from a local incident, made this into a national incident. At the appropriate moment, it raised the issue with the chief medical officer and with Ministers in the Department, and we could then explain the problem to the public. Its work has identified the problem, and undoubtedly it has potentially saved lives.

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I hope the hon. Member for Stone (Sir William Cash) will not be saddened by the fact that he is not yet a member of the Privy Council. After all, he is a Staffordshire knight, he has served his constituency without interruption in this House for 35 years, and I remind the House that the hon. Gentleman has a whole chapter named after him in the late Hugo Young’s estimable tome on Britain’s relationship with Europe. There is a chapter in the name of Mr Bill Cash.

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I, too, would like to express our sympathies with the families of the five patients who lost their lives, but also the four who remain critically ill. Obviously, we do not know what outcome they face.

As the shadow health spokesperson highlighted, these sandwiches were sold to 43 trusts, and while there have been no cases since 25 May, the incubation period of listeriosis is 70 days, so will surveillance of those 43 trusts continue alongside the Health Secretary’s investigation?

The Food Standards Agency published a report in 2014 about the dangers of hospital food. It cited 32 failures, including sandwiches spending hours outside fridges, and fridges often not being cold enough. Indeed, it has been highlighted that hospital sandwiches have been the commonest source of listeria outbreaks over the past two decades.

As the Health Secretary says, simple cases are often a matter of people being unwell for a few days, but listeria poses a major threat to pregnant women, who may lose their child, and is life-threatening for people who are already ill. Will the Health Secretary therefore pay particular attention in his review to why on earth people who were seriously ill or frail were being fed sandwiches? Someone who has no appetite and is recovering from illness is simply not going to be tempted by a pack of sandwiches. That really makes the case for bringing food preparation in-hospital and producing tempting meals, because nutrition is critical to recovery.

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I entirely agree with and endorse what the hon. Lady has said. She is quite right to point out that a meal has to be appetising as well as nutritious. The best hospitals deliver that, and I would like that practice to be much more widespread.

I reassure the hon. Lady that the 2014 report by the Food Standards Agency was, as I understand it, looked into in great detail and assurances have been made that what it raised has, correctly, been followed through. Obviously, that was before my time as Health Secretary but I have taken advice on precisely the point she raises and I have been assured that what was necessary happened. I am open-minded, however, on what may have happened and what more needs to be done, and the review will absolutely look into that question.

Finally, the hon. Lady is absolutely right about the incubation period. We remain vigilant. Because listeria is a notifiable disease, Public Health England is told of every case and is able to analyse the links from every new case to existing cases. Notification of most cases takes place after the fact, given the nature of the disease, but we are then able to find genetic links, where they exist, and find out whether different cases have the same source.

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As my right hon. Friend said in his opening remarks, one of the cases took place at the William Harvey Hospital in my constituency, and my constituent Tanya Marston, who is, happily, recovering from listeria, says that there should be a very urgent inquiry, so I welcome the announcement that my right hon. Friend has made today. On the specific safety aspect, however, rather than the wider inquiry on nutrition, what is the timescale for coming to some kind of conclusion so that people can be reassured that hospital food is safe?

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I am grateful to my right hon. Friend and erstwhile campaign manager for his question. I am glad to hear that the patient who is his constituent is recovering. I am informed that all patients are either stable or have recovered, but for the five who tragically died. On the timescale, the urgent task at hand is to ensure that there are no further cases and that there is no more of the food that we know has the potential to cause problems in the food supply chain. That is what is going on right now. The timescale for the review will be a matter of months.

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As the Secretary of State knows, two of the tragic deaths occurred at Manchester Royal Infirmary. Our hearts go out to the families. Nothing could be worse that going to hospital poorly and trying to get better, and then dying because of a sandwich provided by the hospital to aid recovery. Like the Secretary of State, I want to pay tribute to Public Health England and the Manchester Royal Infirmary for acting so quickly in identifying the source and closing it down. As others have said, however, there are some wider questions. First, we need a bit more transparency. It is only today that we have learnt which other trusts have been affected. The what, the why and the how—there are still many questions we do not know the answer to. On food outsourcing, I welcome the review he identifies today, but surely we have to be a lot firmer in identifying that the growth in outsourcing food supplies is leading to some real safety issues and, potentially, to deaths.

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I agree with the hon. Lady on the need for food to be produced in-house whenever possible, especially as the evidence from some of the best hospitals in the country is that it is also very good value for money. There really is not a case against doing that and I look forward to best practice spreading across the NHS. I will, like her, do what I can to make that happen. She asks about transparency. I made it clear that there are hospitals trusts where further information needs to be published. There is a need to tell patients first, which is why the information has come out at the pace that is has. That duty of candour is important, but of course the review will lead to full transparency. All that everybody wants to do is get to the bottom of this situation and learn lessons for the future.

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May I join those who have praised Public Health England? Not every hospital involved has necessarily had fatalities or major problems, but it was very important that Public Health England notified all those who might have been supplied by the same people. May I put it to the Secretary of State that we should not just think that there was one cause of listeriosis? It can come from processed vegetables, processed meats, ice cream and other things. May I ask him to recommend to everyone that people try to ensure there is safe handling, safe cooking and safe consumption to reduce the risk of cross-contamination? When an outbreak happens, that is the way, as well as through the work of Public Health England, that people can help to ensure it does not affect them.

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I agree wholeheartedly with the wise words of my hon. Friend.

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What is happening in hospitals? Surely we should be role-modelling fresh and healthy produce? Giving people packaged produce, including sandwiches, to eat gives them the wrong message about health and rehabilitation. Surely we should be role-modelling correct behavioural choices at every opportunity when somebody goes into hospital? Will the Secretary of State speak to the Government’s behavioural insights team to consider taking that forward? In my experience, kitchens in hospitals do exist. If he looks deeply into the issue, he will find that staff and visitors often have restaurants in hospitals. However, fresh food from those restaurants is not always made available to patients. We need to tackle and stop that inequality, particularly when patients are fragile, frail and elderly.

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I will happily look into the last point for the hon. Lady. She is absolutely right that a hospital should be a role model of fresh and healthy food, because after all, what is hospital but a place to try to make us all healthy?

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Although there is no evidence that cost is behind the tragic cases that we have heard about, will the Secretary of State look in his root-and-branch review at the price that the hospital is paying for food? Spending £1 per meal is not enough for a healthy, nutritious meal for patients. Some trusts are spending less than £5 a day on a patient’s food. Will he also look at legislating for safe staffing levels, so that there are enough nurses on wards to feed patients? About a third of patients are eating less than half the food that is served to them and are suffering from malnutrition. Will he look at both those issues to improve patient safety?

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Making sure that there are enough nurses on wards is incredibly important for delivering good patient care not just in relation to food, but more broadly. My hon. Friend raises the question of price per meal. It is interesting that the hospitals that have brought food production in-house and source not necessarily locally distributed food but locally produced food have often found that that reduces costs rather than raises them. This is a question not of resources, but of good practice.

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I welcome the announcement of the root-and-branch review and I know that patient safety continues to be a top priority for the Secretary of State, but can he reassure me and my constituents that the overall risk of listeriosis remains low?

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Yes, of course. Millions of meals are served in NHS hospitals each year. While we regret any death, especially a death that could have been avoided, the overall food in hospitals absolutely is safe.

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The NHS is a pioneer of and, increasingly, an international authority on the new science of genomics. Will the Minister confirm that without this NHS expertise, the source of the outbreak would not have been identified nearly as quickly and that we could well have been looking at far more deaths than in fact occurred?

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My hon. Friend makes an incredibly important point—even more than he says. Without genomics, which the UK is the world leader in, it would have been impossible to link the different listeria deaths. They would have looked like individual cases in separate, individual hospitals. It is only because through genomics it could be worked out that the exact strain of listeria was the same in cases in different hospitals that we could then work out that there must have been a factor at work that was not internal to the hospital. When it was then identified that the food provider provided food to many different hospitals, that link could be made, too. Science and scientific progress are saving lives here.