Legionnaires’ outbreak exposes potential problems in HSE inspections

Legionnaires' disease: The HSE have served two Edinburgh sites with improvement notices.Centres for Disease Control/James Gathany

Experts have warned that “plummeting” numbers of inspections carried out by the Health and Safety Executive are putting public health at risk.

The HSE has issued three improvement notices to two sites in south west Edinburgh which have been investigated following the Legionnaires’ outbreak which began two weeks ago.

As a result of the outbreak one man has died and a total of 88 people have been affected either as confirmed or suspected cases.

The source of the disease has not been identified and due to various contributing factors it may never be known where the Legionella bacteria came from.

The HSE has been unable to pin point a source of the Legionnaires’ outbreak in south west Edinburgh last month but there are six possible locations.

This has raised concerns in relation to the way that the HSE operates and the implications on public health.

There is no requirement for the HSE to carry out regular scheduled inspections and the average gap between general HSE inspections is 12 to 14 years according Prospect, the union who represents HSE inspectors.

Mike MacDonald also confirmed that across the UK and in Edinburgh there had been a decrease in the number of inspectors available to do the work.

He said: “There is more of a focus on safety rather than health. The HSE is severely run down with less capacity to deal with health issues.

“General inspectors are experts in health and safety but focus on safety. For something like legionella you would need occupational health specialists to advise employers on what steps to take and what improvements are needed.”

Mr MacDonald explained that the number of doctors who work in this area is now three for the whole of the UK when it used to be 30. The number of nurses has also decreased from 30 to 20.

These cuts, Mr MacDonald explained came from Government level and dictate the HSE work on a tight budget.

Mr MacDonald said: “There two type of investigation, proactive and reactive. Over the last 18months proactive investigations have been run down, some sectors only get investigated if something goes wrong including power stations such as Cockenzie and Longannet

“The process are targeted by industry sector and does not take into account specifics such as legionella meaning that some places that are just as likely to have it won’t get investigated.”

Mr MacDonald also explained that carrying out proactive investigations was costly to the HSE but that research has show this investment to have wider benefit to the population. He said: “ Each pound that the HSE spends saves £2.50 elsewhere to the public including the NHS.”

Professor Andrew Watterson head of the occupational and environmental health research group at the University of Stirling said: “I think the HSE ought to be able to explain why there are no regular inspections. We are at a point where we do not know who is responsible [for the Legionnaires’ outbreak] and the HSE should be able to explain their rationale and they cannot do that at this time.

“There is no requirement for the HSE to inspect regularly but what we do know is that the number of inspections is plummeting.

“The role of the HSE is to inspect them and make sure the law is carried out. Inspections are an opportunity to provide information and advice and where the laws are being breached provide advice or prosecute.

“This has a human cost and an enormous economic cost including the burden on the NHS for the number of people in intensive care and of course there was one fatality.

“There is a need to inspect and keep checking on buildings and companies because the cost can be considerable in human and economic terms.”

A spokesman for the HSE said: “The dutyholder has the legal responsibility to manage the risks created by their work activity. Guidance on how to manage those risks is freely available on our website.

“How often a dutyholder checks their cooling towers varies according to a number of factors, not a prescriptive schedule.

“Companies are inspected by HSE in accordance with the risks their activities create and information about standards and performance which can include information about incidents and complaints. These inspections can be unannounced.”

On Tuesday the Scottish Government announced that the number of reported cases remained the same, the first time since the outbreak there has been no increase.

As of noon there 14 people in intensive care, 23 on general wards, 18 being treated in the community and 25 have been discharged.

There are seven case being treated outside the NHS Lothian area and the age range of confirmed cases stretches from 33 to 76-years-old with more men than women affected.

Dr Duncan McCormick, Chair of the IMT and Consultant in Public Health Medicine at NHS Lothian, said: "The number of confirmed and suspected cases remain the same as before, which is encouraging and in line with our predictions.

"We do expect some fluctuation, but overall we anticipate the numbers will soon begin to fall."I am also pleased to note that the numbers of patients who have recovered and been discharged from hospital has risen today which is also a welcome trend."

Any member of the public with health concerns can contact NHS 24 on 0800 0858 531, or their GP.

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