Systemic failures in public health system led to deaths in elderly patients

The deaths of 17 elderly people earlier this summer were the result of systemic failures in the public health system in England, according to a leading public health expert.

Writing in the Journal of the Royal Society of Medicine, Professor John Ashton describes a confused picture of what was happening when cases of listeria were first reported in June, with Public Health England apparently reluctant to divulge the full story. Five patients died with others affected across the country. Only a few weeks later it was reported that 12 people in Essex receiving community treatment for wounds had died from the spread of group 'A' streptococcus.

Professor Ashton draws comparisons with two major incidents that caused 41 deaths in the mid-1980s involving outbreaks of salmonella food poisoning and legionella. According to a 1988 enquiry, a lack of effective local environmental and communicable disease control was deemed to be central to both events.

"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 Andrew Lansley's structural changes to the NHS and for public health," he writes.

"The return of the public health function to local government in 2013 meant many directors of public health were placed in structures in which they are line managed by directors of adult social care, with restrictions placed on their scope for action and freedom of expression.

"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."

The lesson from history, he suggests, 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.