Stronger links between environmental health and public health services would save lives, argued an independent expert.
Professor John Ashton said in the journal of the Royal Society of Medicine that the status, scope and funding of public health has been diminished.
The former president of the Faculty of Public Health argued that 20 deaths so far this year – six fatalities among hospital patients due to an outbreak of listeria from pre-packed sandwiches, and 14 deaths from ‘A’ streptococcus infections – were avoidable.
“You should not have people dying from listeria in a hospital or healthcare setting – it should be a ‘never event’ in the same way as they have ‘never events’ for surgery,” Ashton told EHN Extra.
“It’s an indication of a situation that’s vulnerable and we can expect more of the same unless a review is carried out. And it isn’t just about money although more does need to be put back.”
Fragmentation and erosion of a formidable public health service from the 1970s, where local authority governments such as Liverpool had around 6,000 public health related staff on their books – has accelerated rapidly in the last decade under austerity, Ashton argued. He also argued that the service is still reeling from the then health secretary Andrew Lansley’s shake-up six years ago.
Ashton said there are weaknesses in the links between national, regional and local bodies such as the FSA, Public Health England, the Department of Health and Social Care (DHSC), local clinical bodies and local government. This is resulting in decisions being made without the wider picture, or their consequences, being considered.
“What are we doing giving patients in hospitals sandwiches? Having a fully functioning hospital kitchen is as important as having a fully functioning theatre for surgery, or having a fully stocked pharmacy – nutrition is as important especially for those who are ill.”
Ashton also argued that the importance of public health work – alongside environmental health services – was not being recognised by local or national government.
“Historically, environmental health and public health were Siamese twins, joined at the hip – and they need to be,” he said.
“You have got to have the troops in environmental health because if you don’t, you have got a contract culture where if something isn’t in the contract, it’s outside of the contract and if there is a major incident you have got to scrabble around to put it together.”
Austerity cuts to local government budgets, he argued, have added to 'the agony' and made it more difficult for environmental health teams to keep ahead of the threats to human health, despite their best efforts.
Ashton has called for the incoming chief medical officer Chris Whitty to undertake an urgent review into public health provision to find ways to strengthen the weakened ‘horizontal’ and ‘vertical’ links across public health services, and related provision such as environmental health.
He added: “We need a fundamental review by someone who knows what they’re talking about and what we need is to find ways of strengthening the situation rather than throwing everything up in the air again because in doing that you lose people, and collective memory”.
He was critical of national policy in England from Public Health England and DHSC such as support for e-cigarettes and described the statement that vaping is 95% safer than traditional cigarettes as ‘crazy’. Many across public health have strong reservations about e-cigarettes as there are no long-term studies into their safety and a paper from the University of Birmingham actually raised serious health concerns.
Ashton was also critical of the public health support for fracking, and the ‘slowness’ to embrace the sugar reduction agenda, as well as the introduction of a voluntary instead of mandatory scheme to address the health impacts of junk food in the form of the responsibility deal.
PHE released a statement when the journal article was originally published attributed to Nick Phin, deputy director, national infections service, saying: “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.”
However, it refused to comment on the claims that these deaths could have been prevented, and instead referred EHN Extra to the DHSC’s ‘root and branch’ review into hospital food. DHSC declined to comment.
