‘Systematic failures’ in public health led to listeria outbreak, expert says

“Systematic failures” in public health led to the deaths of nearly 20 people including five linked to an outbreak of listeria, according to a former health chief.

Independent public health consultant Professor John Ashton described 17 deaths linked to separate outbreaks of listeria and streptococcus earlier this year as “serious failures” of the public health system.

The former north west regional director of public health from 1993 and 2006 said that since responsibility for public health moved to local government in 2013 public health establishments had been “whittled away” while budgets and salaries had been cut “dramatically”.

Writing in the Journal Of The Royal Society Of Medicine on Friday he warned that nearly a decade of austerity and “massive cuts” to local authority budgets had led to environmental health departments which were no longer able to “keep ahead of the threats to human health”.

He added: “It is now time to digest these latest failings of a public health system that was only put in place six years ago as part of (former health secretary) Andrew Lansley’s structural changes to the NHS and for public health.

“There is a schism in which the clinical perspective in local government has been disappearing and the links between local authorities and the NHS have become ever more dysfunctional.

“This has been reflected in the deterioration in performance in areas that include sexual health, immunisation and vaccination and screening programmes.

“To add to the agony, 10 years of austerity and massive cuts to local authority budgets have resulted in attrition of environmental health departments which no longer have the capacity to keep ahead of the threats to human health despite their best efforts.”

Between writing his report and its publication the number of deaths linked to the listeria outbreak has risen from five to six and those from streptococcus from 12 to 13.

Prof Ashton drew comparisons with two major incidents that caused 41 deaths in the mid-1980s involving outbreaks of salmonella food poisoning and legionella.

He said these outbreaks had followed “radical changes” to local government which “unravelled” the existing public health system.

According to a 1988 inquiry a lack of effective local environmental and communicable disease control was deemed to be central to both events, he said.

Prof Ashton warned the lesson from history was not to embark on another re-organisational “folly”.

He added: “So in 2019, just six years after the pack of cards was thrown up in the air and public health rearranged in an NHS-style top-down reorganisation we have a systemic problem resulting in the deaths of 17 elderly citizens who deserved better.

“The lesson from history is that we should not embark on another re-organisational folly but rather find ways to strengthen what we now have and support its evolution into something fit for purpose.”

Public Health England (PHE) said earlier this month that a sixth person had died after eating pre-packaged sandwiches and salads linked to a listeria outbreak.

The latest death was one of the nine cases previously confirmed and PHE said there have been no new cases linked to the outbreak.

The patient, whose age and gender were not given, acquired listeriosis from Good Food Chain products while at Western Sussex Hospitals NHS Foundation Trust, PHE said.

The Food Standards Agency has previously confirmed that the Good Food Chain, which went into liquidation in June, was not the source of the outbreak.

NHS Mid Essex Clinical Commissioning Group said last month that 13 people had died in an outbreak of invasive Group A streptococcus.

Health bosses had previously reported 12 deaths due to the spread of the rare bacterial infection, but an additional case has been added to the total after PHE reviewed how cases are defined.

Dr Nick Phin, deputy director, National Infections Service, PHE, said: “PHE rapidly identified the extent and source of the recent listeria outbreak, using whole genome sequencing, which undoubtedly saved lives. The public health system works 24/7 to keep the country safe from infectious disease and other hazards to health.”