- THE first-ever public inquiry into the running of a hospital opens this week in Wakefield. It will investigate last August's outbreak of food poisoning at the Stanley Royd hospital, where 19 elderly patients died and another 300 patients and staff were taken ill.
Norman Fowler, the social services secretary, announced the inquiry in September following an investigation at the 900-bed psychiatric hospital by The Sunday Times and widespread disquiet over Wakefield health authority's handling of the crisis.
The inquiry will bring the conditions at one of Britain's main centres for old, mentally ill people under independent scrutiny for the first time. Previous investigations at mental hospitals, particularly following scandals in the 1960s and 1970s, were conducted in private.
Fowler's choice to head the three-person inquiry team is John Hugill, a senior crown court judge. At a preliminary hearing in London last month, Hugill said his main concern would be to prevent a similar occurrence elsewhere. The hearing is expected to last about a month and its formal report to Fowler will be published.
Among the evidence called for by the inquiry team are statements from The Sunday Times and photographs taken by Jeremy Nicholl five days after the epidemic began. Our investigation revealed the hospital's kitchen to be in a poor state of repair and cleanliness, despite urgent calls for improvements from environmental health officers.
We noted dirty cooking equipment and cockroach poison scattered on the floor. "The general impression was of facilities that were being given a thorough clean, but were taking a long time to reach the required standards," we have told inquiry officers. Salmonella bacteria were subsequently found in the kitchen drains.
Our inspection of the kitchen was condemned by the health authority, whose officials initially denied our claims that salmonella had been found in beef served to patients. Managers also rejected allegations that staff and equipment shortages contributed to the spread of infection on the hospital's wards.
This has surprised many observers, since psychogeriatrics - the care of old, mentally-ill people - is the least popular speciality for nurses and is regarded as poorly provided-for throughout the NHS.
An important aspect of the hearings will concern the response to the outbreak by the hospital management. But staff organisations also believe that the inquiry could "take the temperature" of the health service as a whole.
The Confederation of Health Service Employees is expected to tell the inquiry that nursing shortages were an important factor in the difficulties of the staff in containing the outbreak. The National Union of Public Employees is planning to blame government policy for risking patients' lives. Most of the hospital's kitchen staff are Nupe members.
"It's obviously not right just to blame government cuts for these deaths, but it will be very difficult for the inquiry to overlook the general problems a hospital faces when dealing with a disaster like this," said Trevor Clay, general secretary of the Royal College of Nursing.
But a senior health service official commented: "A lot of salmonella infections begin with poor handling of food. If Nupe can head off criticism of its members by blaming Mrs Thatcher, it will certainly try."
All the main parties are to be represented by barristers, with separate teams of lawyers representing the Yorkshire regional health authority, the Wakefield district authority and health service managers. The managers are anxious to rebut any charges that they failed to run the hospital properly, just as the unions are at pains to protect their members from criticism.
The stark lessons of a
The Sunday Times, May 19 1985
The Stanley Royd hospital food poisoning scandal has far-reaching implications, writes BRIAN DEER
The full extent of the hospital's horrors has unfolded only slowly and by painstaking cross-examination. In a cramped first-floor room at Wakefield's 18th century Church House, the inquiry has taken evidence from almost anyone who could help. The low-key modesty of the setting, however, has obscured the gravity of the evidence.
In its Victorian heyday as the West Riding Pauper Lunatic Asylum, Stanley Royd was a haven for those threatened by public hostility. But as the number of its inmates burgeoned - from 150 in 1818 to over 2,000 in the 1950s - it became a place of very little hope and barbarically simple solutions.
Modern behaviour-controlling drugs began the so-called "community care" policy begun by consecutive governments in the 1960s and started an exodus of the less severe cases from hospitals, Stanley Royd among them. Numbers fell sharply, the public spotlight shifted to medical miracles and social services, and the Stanley Royd population became older, frailer and forgotten by the world at large.
As the inquiry heard in seven weeks of evidence, it was in this setting that a new barbarism was born. Rats and cockroaches thrived in the hospital's cavernous kitchen. Food was sent to patients mouldy and open drains were left to fester. On wards, patients were left at night with no nursing supervision. And such was the record-keeping that doubts were raised last week over how many inmates there were.
For years, environmental health officers had been warning the hospital that its kitchen and staff practices posed a threat to patients. But managers either took no notice or felt that they were unable to act. Nobody appeared to accept responsibility and, during 32 days of hearings, the phalanx of lawyers representing them each contrived to blame someone else.
The Wakefield health district blamed the Yorkshire region for stalling modernisation plans. And yet the district's budgets, including catering, were consistently underspent. "Those who have come to administer should learn to manage," said Timothy Hartley, counsel for the inquiry. "Who was managing this hospital is a question which remains unanswered."
Management, however, did assert itself on the night of August 26 last year, when the first cases of severe vomiting and diarrhoea broke out on the hospital's wards. As some 400 patients and staff gradually succumbed to the salmonella infection, top administrators and doctors rushed an ad hoc plan into action.
Oddly, however, at this point they did not ask for help. Most cases of food poisoning are spread from person to person, and the Public Health Laboratory Service has gathered a mass of experience in dealing with them. But despite frantic calls and offers of help, all such approaches were shunned in Wakefield. And when outside experts finally gained admittance, valuable clues had been swept away.
When the inquiry findings are presented to health ministers in a few months' time, it is this key failing that is most certain to be tackled at once. The inquiry team, led by John Hugill QC, is under pressure to call for permanent crisis teams to be available in every health service region. Rules would demand that every infectious outbreak be notified at once and investigations begun immediately by independent experts. This could hinder the spread of infection, reinforce standards and prevent cover-ups.
Hugill will also take a view on the long-running row over hospitals' "crown immunity". Under this quaint principle, NHS authorities are theoretically servants of the Queen and cannot be criminally liable for actions or failings connected with their work. Worse, in view of what happened at Stanley Royd, crown immunity means exemption from enforcement of public health standards, meaning that while private hospitals can be forced to clean up their kitchens, NHS hospitals cannot.
Whatever Hugill's team recommends, there's every possibility that the government will act swiftly. Norman Fowler, the social services secretary, has nothing to lose and everything to gain from a hard-hitting attack on the hospital, and preventing a repetition at little cost to the government. Although money would have helped Stanley Royd, there is little evidence that financial savings were to blame.
Instead, culpability lies squarely on management at all levels, who were stringently and repeatedly criticised throughout the inquiry. There have been few more powerful examples of why the government is right to introduce a new tier of general managers into the health service, who can take command and be brought to account. Wakefield, more than anywhere, could do with new blood.
There is no doubt that the inquiry report will touch on these matters - but one hopes it could go beyond. For it could be that Hugill has spotted the flaw in the community care doctrine itself. Because it is this policy which is taking new ideas and the best staff away from our long-stay institutions - with last year's tragic result.
Much attention has been given recently to how community care can mean discharging the more independent, but still vulnerable elderly, the mentally ill, delinquent youth and the handicapped to an uncertain future on the streets. In the wake of the Stanley Royd affair, it would be a pity indeed if our social policy makers don't pause for a moment with the rest of us to remember those left behind.