Footballers versus regulation

The politics of regulatory services are not likely to trouble the front pages of the newspapers, as long as there is a story about a premiership footballer’s amatory exploits. So most people outside the worlds of environmental health and trading standards will be unconcerned that a promised white paper on regulation failed to appear ‘after Easter’.

In May, something caused the white paper to be downgraded to a consultation. It was due to appear in early June. The fact that it did not will not disappoint news editors. But for those interested in the future of the primary authority scheme and of earned recognition, the delay is more than academic. Once the consultation is launched, the CIEH will seek views from its members before responding.

The CIEH believes high standards are best sustained by ensuring organisations accept the need for them; in other words, that they accept the concept rather than have it imposed externally although, in a minority of cases, this may be necessary.

It believes regulatory activity may develop so that it is defined less by a fixed number of inspections and more by a collaboration between regulators and those they regulate. This view is underlined by our feature on health and safety enforcement in Birmingham (see page 10). Far from pestering compliant, low-risk premises with needless visits, which resources do not permit, Birmingham EHOs use intelligence gathering to target the most problematic businesses, backed by workplace interventions including self-assessment questionnaires, spot-checks and, where necessary, formal enforcement.

The CIEH argues that those who can demonstrate regulatory compliance may be entitled to recognition in terms of risk assessment and regulatory oversight. However, essential to earned recognition would be safety assurance schemes audited by third parties. Also, earned recognition should not prejudice the ability of local authorities to use the law where necessary. These matters are of more than academic interest. Sometimes, as shown by the outbreak of E. coli in Germany (page 6), the effectiveness of regulation can be about life and death.

Death by a thousand cuts

Your local library may be closing. Waits of more than four hours in accident and emergency departments, or 48 hours to see your doctor may be routine. And you might have to wait more than four months before you receive hospital treatment. If you have lost your job, legal aid won’t be available for your industrial tribunal or, for private-sector tenants, your housing disrepair case. Oh, and Consumer Focus, set up in 2008, has been chopped.

It is indisputable that from next year, because of major cuts in public spending, quality of life for those on low incomes — the people who use, disproportionately, accident and emergency departments for their first-line health service, live in the private rented sector and who tend to suffer from late diagnosis of chronic illness — will markedly decline. Some, consequently, will die earlier than they would have done.

Health secretary Andrew Lansley, announcing the dropping of NHS targets for casualty waiting times, seeing a family doctor and hospital referral in June, said: ‘I want to free the NHS from bureaucracy and targets that have no clinical justification.’

In an ironic statement, which should be hung up on hospital walls all over the country, health minster Simon Burns said: ‘Changing the way we manage waiting times will empower both patients and clinicians.’

Ah, empowerment, local accountability. Is that the reason that the government has decided to take the funding of schools in England into national control?

Other disjunctions between the philosophical principles of the coalition government and its actual policies have become apparent. For example, Mr Lansley has also said repeatedly that health policies should be based on outcomes rather than input-driven targets. As a statement, this is unimpeachable. So why doesn’t it apply, across the board, to environmental health services?

Liverpool City Council admitted this month, following an FSA audit, that it does not have enough EHOs to fulfil its food safety service plan. It is the FSA’s which it does admirably, to oversee food inspection. It is a numbers game. No outcomes here.
Shouldn’t environmental health services be measured more on how much they improve quality of life and prevent illness rather than the number of boxes and protocols they tick?

Dance of the quangos

So many questions, so few answers. Delegates meet at last week’s Best of the Best conference in Telford at a time when there is much uncertainty around environmental health.

The intriguing, Salome-like dance of the quangos is not yet played out. Will the Local Better Regulation Office survive as an autonomous body or be merged into its parent department? The LBRO has gained allies in environmental health as a government-level champion. Will the Food Standards Agency
and the Health and Safety Executive be merged into a new food and safety agency.

This option may not appear probable, but could be a runner if next month’s comprehensive spending review prefigures seismic changes in who regulates what.
Lord Young’s report on health and safety is now complete, EHN understands, and will be strongly backed by the prime minister at its launch. Reducing ‘risk aversion’ and unnecessary bureaucracy are at the heart of Mr Cameron’s vision of a go-ahead Big Society. There’s a lot of rhetoric here, but the report may recommend changes to Riddor and a much-needed system of safety consultants’ accreditation, which the CIEH has been working on.

The biggest object on the horizon for environmental health is the promise of a public health white paper, prefiguring a national public health service. Services commissioned locally, around health and lifestyle, overseen by old-fashioned boards, with elected council representative on them. Surely, the reasoning goes, this has to be good for environmental health? And it could be — very good — at all levels of local government.

EHPs deliver cost-effective and well-targeted and measured interventions and have been embedded in local communities for more than a century. Optimists see a return to a golden age of district-based environmental health, liberated from purely bureaucratic targets and empowered to help people. But then, of course, we have the prospect of huge cuts, in the next budget round, to a local authority service that is already extremely lean. How much of environmental health will survive, to benefit from the new public health service? Next year’s annual conference should give a clearer idea of the way ahead.

Paradigm shift for government

At first, it was just pruning — a leaf here, a twig there. But a bush fire is now raging across Whitehall. Last week, environment secretary Caroline Spelman consigned 30 arm’s length bodies attached to the Department for Environment Food and Rural Affairs (Defra) to the flames, including the Royal Commission on Environmental Pollution, a well-respected body which, in the the last three decades, had produced influential reports on topics ranging from lead in the environment to climate change.

Her announcement followed the down-sizing of the Food Standards Agency, now stripped back to a food safety role, with nutritional and health matters transferred to the Department of Health and agricultural matters to Defra. This week there was a dramatic cull at the Department of Health, in which 18 arm’s length bodies were reduced to between eight and ten, and the functions of the Health Protection Agency were absorbed into the department.

More cuts are inevitable and quangos and arm’s length bodies of all shapes and sizes are now planting friendly questions in Parliament and commissioning research to show they are indispensable. Meanwhile, across local government, business, the environment, edu–cation and health, a coherent political paradigm is emerging — a radical shift, unlike the almost seemless transition from John Major to Tony Blair.

The government’s executive branch is being reduced through the loss of intermediate bodies that advised on policy, measured things, or set strategies. This model will lead us inexorably to low taxation, more inequality and vestigial public services — in other words, we are moving to an American system.

There was a reason why the UK set up Royal Commissions, subjected bills to full Parliamentary scrutiny and, latterly, made sure that it was advised by agencies separated from the ‘producer’ concerns of big business. It is naïve to assume, as the health secretary appears to, that business will regulate itself.

Would lead have been banned from petrol or smoking banished from enclosed public places under the coalition? And what of the battles ahead on unhealthy fast food (see page 6) and the continued devastation caused by smoking and binge drinking? The most important role of government is to ensure the health and wellbeing of the public. They should not be left to the whims of the market.

Invisible departments

Anyone perusing the newspapers after the general election would have found scant evidence that local government exists in the UK. Each paper devoted pages to incoming secretaries of state, ministerial portfolios and their in-trays of issues.

But Eric Pickles, the new communities and local government chief and a hard man to miss, was almost absent. Eric’s in-tray is bulging. He must hack £6bn from ‘non-frontline’ services, dismantle the regional development agencies, take shears to the Audit Commission, review senior officers’ salaries and decide how the public sector pension bill is to be pruned. However, the public was deemed not to be interested.

The days when the nationals employed well-informed local government correspondents are long gone, reflecting the fact that most councils now merely deliver centrally-imposed diktats. They raise a negligible amount of revenue locally, are micro-managed and subject to ministerial control if, heaven forbid, errors are made in high-profile services.

Environmental health is not, generally, a high-profile service and neither, these days, is housing. The new housing minister Grant Shapps does not have a place in cabinet. Council housing is old hat. The housing revenue account has gone the way of the dodo and the Rubik’s cube (it officially vanished just before the election). Proposals to register private landlords are now unlikely to see the light of day.

Looking for crumbs of comfort, councils have welcomed promises of a ‘power of general competence’, devolved budgets, fewer targets and less ring-fencing. And, yes, there is going to be a ‘full review of local government finance’.

Councillors of all parties would love to have their hands on more levers. But we have been here before. Incoming governments never relinquish power to lower tiers — they merely set up quangos.

The reality in local government, particularly for environmental health services, which are fragmented and less ‘front-line’ than education and social services, is going to be extremely painful, as Mr Pickles hands down emasculated budgets to chief executives.

There is bound to be more outsourcing and service sharing in environmental health — the latter is already happening. It’s going to be an extremely bumpy ride.

Adapt and survive

An important debate on the future of the profession is conducted in this EHN and it will be relevant long beyond the life of the new Conservative, Liberal Democrat government.

Barney Heywood (page 18) defends the traditional ‘holistic’ environmental health practitioner working for a service that ensures wholesome food, healthy workplaces, salubrious housing and clean skies and watercourses. He regrets the wider adoption of a degree that will create more specialist practitioners.

Countering his arguments, Tony Lewis, CIEH principal education officer, says that the specialist syllabus, now offered in the 2010 curriculum, reflects changes in delivery structures that are now openly being discussed by the government and its agencies.

The specialist, he argues, will find a natural home in organisations like the Health Protection Agency and also in the expert roles demanded by companies. Specialisation also appears to offer a solution to the apparently intractable problem of the severe shortage of paid local authority placements for generalists. For the profession to oppose change, says Tony, risks it looking like King Canute.

At the moment, however, local government is a scary place to be and one can understand Barney’s fears. Massive budgetary cuts, inevitable from 2011, will cause what is left of environmental health services to contract even further. And what about those ‘tick-box inspectors’ who threaten to usurp the role of the well-qualified EHP? For that matter, it is not inconceivable that whole professional areas — like food safety, health and safety or trading standards — could be transferred entirely from local government and placed in other hands, perhaps at a regional level.

The professional strategy advocated by the CIEH is, in fact, geared to a longer term than the next parliament and the one after that. It is part of a vision of a profession that has evolved far beyond its history of nuisance control in local government.

Complementing that vision, a simplified procedure is now available, through interview and portfolio assessment, for members to join from other disciplines. Many new members will be specialists. And they will come from many backgrounds. The future may be scary, but it’s also full of opportunities.

Change and opportunity

Last week’s Year Ahead for Regulatory services conference was a joint enterprise of the CIEH, the Trading Standards Institute, Lacors and the Local Better Regulation Office. The conference’s strapline was ‘working together for better outcomes’. At the lively conference, synergies between environmental health and trading standards were highlighted demonstrating the considerable community benefit and business confidence which can result in closer working arrangements and joint action.

Both services involve using investigatory skills and are backed by detailed legislation. Both are aimed, ultimately, at public protection. Both remain key services to ensure that health and public protection infrastructure are maintained and provide foundations that underpin confidence in our economy. They are both at the forefront of the better regulation agenda and acutely aware of the balance that needs to be struck between creating a favourable climate for wealth creation and ensuring public health.

Plate tectonics are shifting under local government. Central government’s total place initiative and its multi area agreements, bringing together many funding streams and different innovative ways of working, may not have affected environmental health and trading standards, yet. But they will. Westminster Council proposes putting health, police and council services all under one roof, saving £20m a year. The Barnet ‘easyCouncil’ model of local government would outsource virtually everything. And traditional district councils, driven by extreme budget cuts, are moving to the shared service model.

The nine new English unitary authorities, show the value of the skills and competencies of environmental health practitioners – as risk assessors, educators, enforcers, wealth enablers and as health protectors. In new-style services staff may have lost their old job titles but they are performing vital roles – in proactive and reactive enforcement, in investigatory teams, in public health services and in health promotion.

The conference showed that, with trading standards officers, EHPs are extremely valuable to the new authorities because of their broad base of knowledge and their wide skill-set and competencies. It’s clear that where the unitaries have led more traditional local authorities are likely to follow.

Freedom or danger

Earned autonomy, or earned recognition as it is also called, is probably coming soon. It will mean that businesses with high standards in food safety and health and safety would be exempted from routine inspection by EHPs.

Government policy, with its constant emphasis on ‘better regulation’, is moving inexorably in this direction. Potential cuts in local authority budgets and the growth of the primary authority scheme are providing further fillips.

Typically for an opposition party, the Conservatives promise a ‘bonfire of the quangos’ if they win the next election. Paul Carter, leader of Kent County Council, argues for regulatory powers to be transferred en masse from regional bodies and quangos to councils merged into larger areas. He includes the Health and Safety Executive and the Environment Agency for the chop.

An incoming Conservative government would be unlikely to be so radical. But the party’s official policy, contained in Regulation in the
post-bureaucratic age, is based on the premise that the number of quangos should be drastically reduced and that earned autonomy is a prerequisite for efficient business.

John Penrose, Conservative business, enterprise and regulatory reform spokesperson, laid out his party’s stall at last week’s CIEH earned autonomy conference (see page 2).

Gavin Tringham, head of environmental health at Birmingham Council, gave a thoughtful local authority perspective. He said, uncomfortably from the regulators’ point of view, that in Birmingham, there appears to be little or no correlation between defining premises as high-risk and reducing food poisoning outbreaks or accidents. With the prospects of eye-watering budget cuts ahead, Mr Tringham wondered aloud whether national agencies, like the Health and Safety Executive and Food Standards Agency, should be given responsibility for regulating the largest and multi-site businesses.

He envisaged a model of ‘compliance agreements’ between councils and businesses, combined with random inspections. That is not the Conservative proposal. Geoffrey Podger, head of the HSE, said that ‘inspection holidays’ were out of the question. Clearly, there is much vital detail to be worked out before any viable system of earned recognition can be introduced.

New year, new look

There’s a new look for 2010. Environmental Health News (the paper version!) has been radically redesigned and has many new features, some incorporated from Environmental Health Practitioner. It has been remodelled, following detailed reader research, so as to give an overview of the many disciplines of environmental health, practised in all sectors. These could include carrying out a routine food hygiene inspection, setting up an auditing system for a supermarket chain, standing in a muddy river collecting water samples or carrying out a joint strategic needs assessment for a primary care trust.

That broad spectrum is reflected in this issue of the paper version of EHN. Sally Newing, EHP, profiled in the magazine, is co-director of a consultancy. She uses her local authority-acquired skills to help businesses achieve high standards and comply with the law and, by doing so, enhance their profitability. New professional and technical officer Camilla Bourn had an interesting year studying disease notification in London. In a CIEH-facilitated work placement, she researched how the confused system, in the capital, on reporting food-borne illness could be streamlined and improved. There will be innumerable, similar examples in the coming months.

Environmental health is a community. The magazine will show the detailed work of CIEH members in Wales and Northern Ireland, in regions and branches and in special interest groups. There will be a page for new professionals in each issue and, recognising that enforcement is only one facet of environmental health, not its sole purpose, legal guidance and accounts of prosecutions. Retired members will also be regularly featured.

Reviewing environmental health 100 years ago for the magazine brought home the striking similarities between then and now. National politicians were preoccupied with taxation and social welfare, while in their lively monthly journal, sanitary inspectors lobbied for more resources, vigorously debated professional issues and sought a higher profile.

Environmental health has become an autonomous profession and its practitioners now use their skills, competences and knowledge in many settings. This is reflected in the historic new criteria for CIEH membership approved in December. The CIEH is set to grow. That, too, will be reflected in the
new-look magazine.

Barry tidies up

Until this week Barry was mainly known for its pleasure park and the BBC comedy Gavin and Stacey. But the prosecution of James Hadley has put the Welsh town in the frontline of the battle for safe sunbeds across the UK.

Mr Hadley has promised to fully staff his six salons after the Vale of Glamorgan Council used health and safety law to prosecute his Barry salon.

Unsupervised salons are not illegal but their owners must carry out thorough risk assessments.

If the owners do not address the risk of children burning themselves then they can be prosecuted for failing to have an adequate risk assessment.
If they insist that signs barring under-18s or CCTV are sufficient deterrents, councils can carry out test purchases to establish if they work or not.

Mr Hadley’s Barry salon is an interesting example. The shop had a poster on its front door stating ‘under-16s are not allowed to use sunbeds’ and CCTV. But this did not stop 14-year-old Kirsty McRae burning 70 per cent of her body on one of its sunbeds.

Moreover, when Vale of Glamorgan Council requested the CCTV footage it was told that it was not working at the time.

But even if CCTV is operative, it provides few safeguards. It hard to judge the age of customers on a screen and by the time children are inside the salon it is too late.

Health and safety legislation may be a blunt instrument to use against unstaffed salons but the alternative is for local authorities to sit on their hands until the Department of Health stops vacillating and introduces legislation.

And let us not forget that Mr Hadley has now promised to fully staff all his salons. Many other owners may be making similar decisions.
As Nessa, from Gavin and Stacey, might say: tidy.