THE outbreak of Legionnaires' disease in Edinburgh has come against a backdrop of severe cuts in the number of health inspectors and safety checks meant to prevent the life-threatening bug from spreading.

Experts are warning that cutbacks in the number of health and safety inspectors and the amount of inspections could have allowed the outbreak of Legionnaires' disease in Edinburgh to happen and may cause future outbreaks elsewhere in Scotland.

The Sunday Herald can reveal that City of Edinburgh Council has cut its environmental health officers by 18% in the last three years – double the country's average cut of 9%. The number of officials responsible for protecting public health in the city has dropped from 61 in 2009 to 50 in 2011.

The UK Government's Health & Safety Executive (HSE) has also suffered serious cuts. Its UK field operations division, which is responsible for inspections, has lost 18% of its staff – more than 250 jobs – between 2007 and 2011.

According to the trade union, Prospect, which represents HSE inspectors, the number of preventative workplace inspections was slashed by a third last year on the instructions of UK ministers, from 30,000 to 20,000 a year.

The cuts were described as "staggering, shocking and savage" by Professor Andrew Watterson, head of the occupational and environment research group at Stirling University.

He said: "The crippling impact of cuts in staff numbers and resources is now threatening public health.

"The Legionnaires' disease outbreak has happened against a backdrop of serious and continuing UK cuts, loss of staff and expertise and significant demoralisation in two crucial bodies involved – the HSE and environmental health services. These cuts must raise serious doubts about the capacity of such bodies to deal with similar future threats to public health."

A whole raft of businesses had been recategorised as "low risk" to enable the number of inspections to be reduced, Watterson argued. "The Legionnaires' outbreak should be a wake-up call because so-called 'low-risk' premises such as offices and large shopping premises have cooling towers that require continuing regular inspection as well as proper maintenance if public health is to be protected."

It was hard to imagine how the HSE could effectively enforce the regulations meant to control the risk of legionella with an ever-shrinking group of staff, he added. "Saving money by cuts in personnel and resources could cost lives in the future."

Prospect also said that the Legionnaires' outbreak highlighted the risks of cutting back on proactive inspections.

Simon Hester, chairman of the union's HSE branch, said: "It is a stark reminder of the danger of denigrating health and safety at work and the value of effective inspection by the HSE.

"Due to spending cuts, HSE's occupational health expertise is extremely thinly spread, which has led to a lack of sufficient advice in the field. It is always preferable to avoid incidents that harm people, rather than merely investigating after the event."

Hester added: "Prospect believes that decisions on proactive inspection should be based on professional expertise and that adequate resources are made available. HSE needs more inspectors, not less."

The cuts to Edinburgh's environmental health officers were disclosed to the Royal Environmental Health Institute of Scotland, a professional body, in response to a freedom of information request.

Across all of Scotland's 32 local authorities, the number of such officers has dropped from 556 in March 2009 to 506 in September 2011.

The institute's chief executive, Tom Bell, who previously worked as an environmental health officer for Edinburgh City Council, said the council had lost some very experienced staff.

Bell said that common sense would suggest there is "some kind of relationship" between cutbacks and the Legionnaires' outbreak.

He said: "Most people would feel that if you reduce the resource, there is the potential for problems to develop and not be remedied or identified, and operators not required to address them."

The number of Edinburgh council departments had also been reduced from about 16 to four, he said. "You're now a very small part of a very large department, so your voice is very hard to hear. It does make the job more difficult when it comes to arguing for resources."

Bell was worried about the "soft touch" regulatory agenda being promoted by the UK Government. "Inspections should be related to the actual risk, and not be about helping businesses," he said.

Labour MSP for Lothian, Sarah Boyack, said she was deeply concerned about the cutbacks. She added: "We also need answers from the HSE as to whether they have reduced the number of proactive inspections in any of the companies which have been investigated in this contamination.

"I've asked the Scottish Government a series of questions about the health and safety regime because I'm concerned not just about getting to the bottom of this outbreak but about ensuring that it does not happen again."

Edinburgh City Council denied that staff numbers had an impact on inspections, as there was only one site with cooling towers that it was responsible for in the city.

A council spokesman said: "Responsibility for enforcement falls to either local authorities or the HSE, depending on the premises or work activity. Premises within the council's enforcement remit are inspected in accordance with an ongoing inspection programme.

"Work is ongoing to identify the source of the [Legionnaires'] outbreak."

The HSE insisted that the number of inspectors in Scotland has remained stable since 2008, though there had been a drop from 184 in 2010 to 174 in 2012.

A spokeswoman said: "HSE has maintained the broad number of inspectors and other staff based in Scotland over the last five years. It is wrong to claim that numbers have been significantly reduced."

National Museum visited as number of cases rises to 80

The search for the source. By Rob Edwards and Judith Duffy

THE number of cases of Legionnaires' disease in Edinburgh yesterday rose to 80, as the search for the source of the outbreak spread to the National Museum of Scotland.

A total of 80 confirmed and suspected cases of Legionnaires' disease have now been linked to the south-west of the city, according to the latest Scottish Government figures.

The number of confirmed cases rose by eight, while there was a decrease of two in suspected cases.

The Health and Safety Executive (HSE) told the Sunday Herald that its inspectors visited the museum in Chambers Street on Friday as part of its continuing efforts to pinpoint the source of the infection.

To date, some two million people have visited the museum since its £47 million upgrade 10 months ago, making it the most popular tourist attraction in Scotland.

The HSE also confirmed that it had paid a visit to an Italian defence electronics company, Selex Galileo, at Crewe Toll in the city. This brings to six the number of sites whose cooling towers have been checked for the deadly legionella bacteria.

A spokeswoman for the National Museum of Scotland confirmed that it had received a "precautionary visit" from HSE inspectors. "They checked our documentation and procedures and there were no immediate concerns raised," said a museum spokeswoman.

"We constantly test and monitor our water systems on an ongoing basis and undertook an extra chemical treatment earlier this week as a precaution."

Selex Galileo said that it had complied with HSE and environmental health agencies. "Both were satisfied with our control procedures for Legionnaires," said the company's head of operations in Edinburgh, Peter Dillon.

The Sunday Herald can also reveal that one of the other sites close to the centre of the outbreak visited by inspectors – the Macfarlan Smith pharmaceutical factory, run by the Johnson Matthey company – has a poor health and safety record. It has been served five improvement notices by HSE since 2008 for breaches of health and safety rules.

Four of the notices were in 2010, for exposing employees to risks from dangerous substances and for failing to keep proper records of exhaust ventilation plant tests. The fifth was issued in 2008 "for failure to limit the consequences to people from a major accident".

Debra Boni, Macfarlan Smith's human resources director, insisted the breaches were "totally unrelated" to the control of legionella. "We fully complied with the requirements of the notices," she said.

"There has never been any indication of legionella present," she added. "We continue to co-operate fully with the relevant authorities."

Another of the suspect sites, the North British Distillery, has been served with a legal improvement notice by the HSE. It has been given until June 29 to rectify alleged failings in the measures used to kill legionella in one of its cooling towers.

The distillery, which is 50% owned by the whisky giant Diageo, reacted by voluntarily closing all three of its cooling towers as a precaution, and shutting down production. It said, however, that the flaws alleged by the HSE did not mean that the company was responsible for the Legionnaires' disease outbreak.

The HSE also stressed that the action taken against the distillery did not mean it was to blame. "The source of the outbreak may never be conclusively identified, based on our experience from previous outbreaks," said an HSE spokeswoman.

The HSE has also inspected the Burtons Food factory at Sighthill. A sixth site, Aegon insurance company in South Gyle, has been inspected by environmental health officers from the City of Edinburgh Council.

By yesterday there were 36 confirmed cases and 44 suspected cases linked to the outbreak. One man has died, who has been named as 56-year-old Robert Air, from Seafield in Edinburgh.

Of those patients being treated in hospital, 15 are in intensive care and 27 are in general wards. The rest are being treated in the community or have been discharged from hospital.

Five cases are being treated outwith the NHS Lothian area, including one patient in the north of England, two in NHS Tayside, one in NHS Lanarkshire and one patient from NHS Highland, who is now being treated in Glasgow.

The ages of the confirmed cases ranges between 33 and 76, with more males than females affected.

Health Secretary Nicola Sturgeon said: "Although there has been a rise in the number of confirmed cases, it is reassuring to see that the number of suspected cases is decreasing and that 16 people have now been discharged from hospital."


By Judith Duffy

THE true scale of the outbreak of Legionnaires' disease in Edinburgh could involve hundreds of people, according to an expert.

Bacteriologist Professor Hugh Pennington said many more people could have been infected by the bacteria than the cases which have so far been officially reported suggest. They may be "under the radar" as they might be suffering only mild symptoms which could be mistaken for a cold.

The Sunday Herald can also reveal the number of cases of the potentially fatal lung infection almost doubled last year in Scotland.

Newly published figures show 34 cases of Legionnaires' disease were reported to Health Protection Scotland in 2011, against just 16 the previous year. It is the highest since 2007, when 43 cases were notified to health authorities.

The disease is caused by breathing in small droplets of water contaminated by legionella bacteria, which is commonly found in low numbers in water sources such as rivers and lakes. It typically causes a problem when it is able to multiply quickly in poorly maintained water systems, such as showers, air conditioning systems and spas.

Seven out of 10 cases recorded over the past 15 years have been in people who have spent time abroad. Around one in five victims picked up the infection in the community, while 3% of cases were acquired in hospital. In around one in 10 cases, the source is never identified.

Those most at risk are men and the most common age group affected is between 60 and 69. Cases in those aged under 40 are considered uncommon.

In around 8% of reported cases, the patient has died from their infection or complications arising from their infection.

Pennington said it was still essentially a rare disease and unusual to have an outbreak originating in Scotland. He said the public health teams in Edinburgh were likely to be "aggressively" searching for cases which may otherwise not have been picked up by laboratory tests.

He said: "Quite a few people will have had mild illnesses, they don't even go and see a doctor and if they do they don't need particular treatment. They don't have a sample taken so they go 'under the radar' and only by doing special surveys can you find out."

The UK's most serious outbreak of Legionnaires' disease happened in Barrow-in-Furness, Cumbria, in 2002. It was traced to an air conditioning system at the Barrow Borough Council-run Forum 28 arts complex. Seven people died and there were 180 confirmed cases, but it was estimated 2500 people might have been affected.

Pennington said it was possible that hundreds of people could have been infected in Edinburgh.

Health officials have yet to pinpoint the source, but industrial cooling towers in one area of the city are being investigated as a possible origin.

Pennington added: "There is probably quite a substantial number of cases, much larger than the actual number of [diagnosed] cases itself. That could well be a very large number. It depends on exactly what has happened.

"Was it one big puff coming out of a cooling tower, or was it a cooling tower that had been leaking over several days? They may be able to come to some conclusion on that, although possibly not."

The type of bacterium involved in the outbreak is legionella pneumophila, which causes the majority of cases of Legionnaires' disease in Europe. Tests are still being carried out to establish the exact strain.

Meanwhile, an alert has been issued to health staff south of the Border asking them to watch out for anyone with the symptoms of the disease who has recently visited Edinburgh. One case has already emerged in the north of England, linked to the Edinburgh outbreak.

UK Health Minister, Simon Burns, said: "We have asked doctors to pay extra attention to any patient who has been to Edinburgh in the last two weeks and develops flu-like symptoms or breathing problems.

"Anyone who thinks they may be at risk should seek advice from their GP."