- FOOD
POISON DEATHS PROBE
- MAY
REVEAL NHS FLAWS
The
Sunday Times (London) 24 February 1985
By
Brian Deer
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
- SCRAPHEAP
HOSPITAL
The
Sunday Times (London) May 19 1985
The
Stanley Royd hospital food poisoning scandal has
far-reaching implications, writes BRIAN DEER
IT IS
TRAGIC that 19 frail and mentally ill old people died
in something as preventable as the food poisoning
epidemic which last summer swept the Stanley Royd
hospital in Wakefield. But as the public inquiry into
that event reached its conclusion this weekend, a yet
greater tragedy emerged - that more than 700 similar
patients should have been expected to go on living
there under so appalling a regime.
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.
Copyright,
Times Newspapers Ltd. All rights reserved. No portion
of this article on the Stanley Royd hospital scandal
of 1984 may be copied, retransmitted, reposted,
duplicated or otherwise used without the express
written approval of the copyright owner. Responses,
information and other feedback are appreciated - via
Brian Deer's homepage.
