Friends of enterprise

Fixed-term parliaments, new constituency sizes, a May referendum on a UK-wide voting system, more powers for the Welsh Assembly — this parliament, which will last until next spring, has introduced masses of political change. At its heart are two large pieces of legislation — the Health and Social Care Bill and the Localism Bill. Together, they will alter radically the shape of central and local government.

Under the Localism Bill, two professions located squarely in local government face the prospect of significant change — housing (new forms of tenancy, funding and regulation) and planning (new powers for communities superceding existing procedures). The Health and Social Care Bill is more significant for environmental health because it could herald a new funding stream but the Localism Bill could also undoubtedly have an impact.

At the Conservative spring conference, prime minister David Cameron banged the drum for enterprise — this is a country of ‘start-ups, go-getters, risk-takers’, he said. And the enemies of enterprise? Bureaucrats imposing rules and regulations, town hall officials with their laborious planning procedures and — a new one — public sector procurement managers, favouring large companies for bids over small ones.

Two of the six principles underlying the Localism Bill have potential implications for environmental health — reducing regulation and diversifying supply in the public sector. But if Mr Cameron sought to portray EHOs as enemies of enterprise this would be wholly wrong because, actually, they are its friends.

As often demonstrated by credible research, small businesses rely upon advice from well-qualified, knowledgeable professionals. EHOs and trading standards officers are business facilitators just as much as regulators.

In its quest for localism, which is not a bad direction of travel, the government tends to define excessive bureaucracy as an opponent of progress. But it’s worth remembering where the measurement regimes, performance indicators and targets came from that restricted professional initiative and slowed down decision-making. It was central not local government.

Are the town halls being made to pay for errrors that originated at the centre?

All change for regulation

The term ‘landscape change’ cropped up a lot at the Year Ahead conference. The phrase is apt. At the moment, developments in regulatory services look like the plot of an Australian soap.

New readers start here. The Office of Fair Trading (OFT) is to be merged with the Competition Commission and the OFT’s consumer protection functions are be passed to trading standards officers.

Meanwhile Consumer Focus, the citizens’ advocacy body, has been scrapped and the work of the Consumer Direct helpline transferred to the Citizens Advice Bureau, whose funding is being cut. A consultation by the Department for Business Innovation and Skills is due in March.

The trading standards world is eagerly anticipating, with a little anxiety, taking on its important new responsibilities — helping to crack down on national financial scams.

At the same time, environmental health is being pulled in two directions simultaneously. On one hand, we have the proposed transfer of funding for public health functions to local government; on the other, the Food Standards Agency is reviewing the feasibility of a national food hygiene service for the UK (EHN, 28 January, page 5). The two policies would appear to be entirely contradictory.

Meanwhile, an important white paper is imminent, on regulatory enforcement, from the Local Better Regulation Office, which is also consulting on five new priority regulatory outcomes (see page 5).

And, in the background, we have the Big Society. Prime minister David Cameron told the The Telegraph this week that there should be a ‘presumption that public services… should be open to a range of providers’.

Undoubtedly, Mr Cameron would include environmental health and trading standards services in his list. Barnet Council has jumped the gun by planning to outsource them — triggering, as EHN went to press, a vote for industrial action from Unison members.

Mr Cameron increasingly characterises local government as ‘the state’, allegedly remote, top-down and disconnected from communities. But regulatory services are far from top-down — they work from the grassroots. And surely they can best deliver policies, such as improving health and reducing inequalities, located within a coherent, accountable structure — local government? In a world of atomised, fragmented services, we will all be poorer.

Perfect storm in housing

A perfect storm is enveloping the private rented sector. Housing benefit cuts may drive some poor, vulnerable tenants into the hands of unscrupulous landlords. The chronic shortage of social housing and legal aid cuts could force them to stay in unhealthy, unsafe conditions.

This is what Stephen Battersby, CIEH president, told BBC news at the weekend. His warning was repeated throughout the day and picked up by the press. He highlighted a shocking fact familiar to EHOs: nearly half of all privately rented homes are substandard. That’s 1.5 million homes with excess cold, dangerous wiring or hazardous stairs. About one million of those are officially classed as dangerous.

Housing minister Grant Shapps told viewers, who had just seen a young woman living in squalor, that Britain’s private rented sector was a success and most tenants were happy with the service they received. He claimed regulation was not the answer and defended the government’s decision to abandon plans for a national register of landlords.

So is Mr Shapps content with 1.5 million households — including some of the most vulnerable — living in substandard conditions? Councils, he argued, should use selective licensing to clamp down on bad landlords.

But research for the Association of Residential Lettings Agents last year found that only 12 of 400 councils have introduced selective licensing (which allows them to register landlords in areas with low housing demand or anti-social behaviour) and only 15 landlords have been prosecuted for failing to comply with it.

David Salisbury, chair of the National Landlords Association, echoed Mr Shapps’ hostility to regulation. Councils, he said, should leave the majority of reputable landlords alone and concentrate on the minority of rogues. This is the rotten apple argument — but statistics suggest that half the apple barrel is rotten.

The response of Campbell Robb, Shelter chief executive, was more thoughtful. He praised the work of EHOs and urged the government and councils to protect departments from cuts.
EHOs must make members aware of their worth. A good start would be to use the CIEH’s housing database to demonstrate the economic and health cost of bad housing and the difference a well-resourced EH department can make.

Food safety review announced

UK food business is diverse. On the one hand, we have the mobile hot-dog stand, on the other we have complex multinational businesses, with centralised ordering, auditing and regulatory compliance systems, instantly reacting to changing consumer tastes and trends.

Food business is big business. Four supermarket chains now account for 60 per cent of all grocery sales — and this is growing. Food inspection covers a broad canvas. More than two-thirds of inspected premises are restaurants and catering businesses, about a third are food retailers (from the corner shop to the supermarket chain and all points in between) and a small proportion — 4 per cent — are food manufacturers.

The Food Standards Agency, set up in 2000, is tasked with ensuring the microbiological safety of all food manufactured, sold and consumed in the UK; environmental health practitioners and technicians are the foot soldiers. Now the agency has commissioned a full-scale review of UK official food safety controls (page 5).

An FSA board paper, advocating rationalisation of the current system, says the UK’s food system is ‘one of the most sophisticated in the world’, increasingly working across national boundaries. However, the paper argues that there is a ‘fragmented’ and inconsistent delivery by local and national agencies and consultants. Figures are given on variations in local authority staffing, inspection and enforcement levels.

In fact, the UK’s enforcement model is already adapting to the increasing centralisation and sophistication of the food business, through primary authority partnerships — applicable to both retailers and restaurants and embracing health and safety and trading standards — and in a move towards earned recognition, which offers an important role for private sector EHPs and is supported by the CIEH.

The CIEH believes that local inspection, based on face-to-face contact and local intelligence, has advantages and that EHPs, with their long tradition in public health delivery, can make valuable connections across services and policies. At the moment, resourcing in local authorities is inconsistent and patchy and anyone can set up a food business without knowledge or qualifications. It is more urgent to reform those anomalies than to set up a centrally-delivered food inspection system.

Primary authority – is big best?

The Local Better Regulation Office (LBRO) was Gordon Brown’s baby. Its godfather was Sir Philip Hampton, who delivered a report on better regulation in 2005.

The LBRO’s birth was brought forward from 2009 to 2007. It acquired its full powers from the Regulatory Reform and Sanctions Act, which was passed in 2008.

With a change in government and a new focus on the cost of quangos, everyone wondered whether the LBRO would be abolished. And what about its flagship activity, organising primary authority partnerships?

The LBRO has subsequently survived and, despite a tentative start, ‘primary authority’ has taken off. Primary authority is now part of the landscape. In fact, with the signing up of Tesco (page 7), it now covers three-quarters of multi-site food retailing. For business, it is to be supported by a new form of accreditation — corporate membership of the CIEH (page 5).

In another area of policy, as we show on this issue’s letters page (page 17) views are divided on whether the transfer of public health responsibilities and resources will revitalise environmental health in local government.

Whatever happens, ring-fencing for public health money won’t last, so those in local government will need to grasp the nettle quickly, in order to demonstrate their utility. People dying of cold in their homes will not serve public health (page 22). At a time of contractions, there are many priorities to fight for and private sector housing improvement should be high on the list.

Regardless of what happens in public health, smarter regulation is here to stay. For large, multi-site businesses the primary authority scheme, which appears to have advantages, both for the regulators and regulated, will become the norm.

Merging of services, increasing integration of environmental health and trading standards, more third-party accreditation of businesses and inspections carried out by arm’s length bodies, accountable to local authorities — all are the way of the future.

CIEH policies are adapting effectively to these developments in public health and regulation. When the climate is changing, there is no point in clinging stubbornly to old ways — at least, if one wants to make improvements to the health of people with limited resources.

Public health leadership

The year ended with a bang. The role of the environmental health service within local government was not merely acknowledged but praised by health secretary Andrew Lansley and his public health minister, Anne Milton (see page 5). And the same message was woven through the public health white paper, Healthy lives, healthy people (see page 10).

The document promises a leadership role to local authorities, ring-fenced funding, representation on health and wellbeing boards and premium payments for successful outcomes.

Historically, reversing legislation in 1972 that removed directors of public health from local authorities and placed them in the NHS, they have now been returned to councils. But today there are professional routes, partially developed by the CIEH, which will allow such posts to be occupied by people from non-medical backgrounds, including suitably-qualified EHPs.

From a government priding itself on abolishing quangos, we have some new ones — an NHS Commissioning Board, a National Institute for Health Research and a Policy Research Unit on Behaviour and Health. The functions of the Health Protection Agency are merged into the new Public Health England.

The so-called Public Health Responsibility Deal will provide an interface between government, the voluntary sector and business, advising on food, alcohol, physical activity, health at work and behaviour change. Some critics have already accused it of being unduly weighed towards business (EHN, 19 November, page 9). The Change4Life campaign has been retained. Now, in place of social marketing, a government wary of creating a nanny state has adopted what it calls a ‘nudge’ philosophy.

There is a lot to play for. Directors of environmental health, public protection and regulatory services may have to fight to ensure their places on health and wellbeing boards, alongside colleagues from adult social services, and district councils lobby to receive their share of the ring-fenced funding.

Above all it will be important to ensure that enough of a local government environmental health service survives to form the core of the new public health workforce. The battles are just beginning.

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?

Housing cuts

It takes something remarkably ill-conceived to unite virtually everyone in the housing world in opposition. But that is exactly what the chancellor George Osborne has done by capping and cutting housing benefit for private tenants, increasing rents for new social tenants and reducing government funding for new social housing by 60 per cent.

Thousands of poor private tenants living in areas with inflated property prices will be forced to move when the cap comes in next year. London councils estimate that 82,000 households, or 200,000 people, could become homeless as a direct result of the changes.

The social sector will provide little refuge because it is already massively oversubscribed. At the last count there were 1.8 million households on waiting lists in England.

However, there are some people who will welcome these unwanted tenants with open arms. Barry Markham from the National Landlords Association warns that rogue landlords may offer them the chance to stay close to their jobs and children’s schools providing they are prepared to put up with overcrowded and substandard accommodation.

To make matters worse, the coalition has also decided that people under the age of 35 (rather than the current 25) will only receive housing benefit if they live in shared flats. This effectively opens up a whole new market in frequently dangerous and unhealthy houses in multiple occupation.

The justification for the cuts is the size of the housing benefit bill. It has indeed grown to vast proportions — from only £0.4bn in 1980/81 to more than £15bn in 2007/08. Yet this is only because successive governments have failed to fund the building of enough affordable homes.

It seems ministers have decided that the private rented sector should house the vulnerable but, as CIEH president Stephen Battersby told the BBC Panorama programme last week, councils will not be able to protect them if EHOs are made redundant.

A council in the Midlands is preparing to shed 7.5 environmental health posts by Christmas. These kinds of cuts may become routine unless councillors are made aware of the value of the profession. A good start would be to get them to watch Panoramaon rogue landlords.

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A watershed moment

Three events that have taken place this month provide a watershed for environmental health that will have implications for the profession for many years to come. They are the wide-ranging quango cull; the comprehensive spending review and the Young report, whose recommendations go far beyond the report’s health and safety brief, touching many areas of relevance to environmental health.

Designed to recoup a deficit of £83bn from the nation’s finances, the scope of the CSR is unprecedented, at least since the ‘Geddes axe’ of 1921. Its full details, department by department, were awaited as this issue of EHN went to press, but they will undoubtedly have massive implications across the public sector and the benefits system, with a disproportionate affect upon the poorest and most vulnerable.

That is the constituency served by environmental health practitioners and the CIEH has put up a cogent case for why cuts made to local authority environmental health services, would be extremely short-sighted.

The work of practitioners in local government, which is increasingly integrated with wider public protection, regulatory and licensing functions, is not always high-profile, particularly, paradoxically, when it is most effective. But it is vital to healthy communities and an efficient business sector — a fact that is recognised by the Local Better Regulation Office, whose functions will continue and, indeed be more important, in the post-CSR world.

The third watershed development, the Young report, which is analysed this issue offers both opportunities and challenges for environmental health.

The report endorses wider accreditation for health and safety advisors and calls for a mandatory, national, food hygiene rating system – both developments welcomed by the CIEH. In addition, it advocates more joint food and health and safety inspection.

EHPs are well-equipped, from their professional training and knowledge, to carry out this role and CIEH members, in all sectors, will provide the nucleus of food and health and safety inspection services, whoever carries them out.

Listen to the experts

Like a zookeeper throwing fish to seals, Lord Young of Graffham delighted the Conservative Party conference in Birmingham by promising to bring some common sense to health and safety.

The attendees didn’t exactly bark with joy and slap their flippers but they certainly liked what they heard. But it is one thing to please party activists and quite another to make a coherent critique of health and safety.

Lord Young, whose official review of health and safety is expected next week, claimed that safety rules were sensibly applied to high-risk industries but became ‘a joke’ when applied to low-risk workplaces.

As barrister and EHP Julie Barratt explains in this issue (see page 16) there is no requirement for a manager running a local Tesco to follow the same rules as a nuclear power plant — the law simply says employers should identify risks and, where practical, remove them. There is, in short, already ample common sense in the system.

It is also worth noting that offices and shops are not risk-free. Office work can lead to large and avoidable levels of musculoskeletal disorders, particularly back pain and repetitive strain injury. Shops also report high levels of violence against staff.

Lord Young rightly referred, with approval, to the UK’s excellent health and safety record. In 1974, before the Health and Safety at Work Act came into force, 651 workers died and 336,701 were injured in workplace accidents. These figures had fallen to 121 deaths and 94,790 injuries in 2008/9.

If there is a risk averse culture, as Lord Young alleges, and excessive red tape, discouraging people from taking part in reasonable activities, it is rarely the fault of qualified practitioners but those whose remit covers health and safety but who are not trained or qualified in it. Practitioners, both in the Health and Safety Executive and local authority-enforced sectors, including CIEH members, should, in fact, be listened to more.

Lord Young has, rightly, been highly critical of the fact that people can practice as health and safety advisors without possessing an accredited qualification. The CIEH agrees with his concern. It is working with other professional bodies to set up a registration system to address this glaring loophole.