Examination of Witnesses (Questions 140
- 159)
WEDNESDAY 24 FEBRUARY 1999
PROFESSOR T H PENNINGTON
Dr Moonie
140. Surely the main problem with CJD is
that we still do not know what the incubation period is for the
new variant so you cannot make a decision?
(Professor Pennington) That is true. All you can
say is perhaps you can give an estimate as to how long you have
to wait before you can start talking about it, yes.
141. Can I come back to one of the earlier
points we were making. I think we are in danger of missing something.
We were talking about merits of registration versus non registration.
I think we have to accept that a very large number of food outlets
are not registered and therefore outwith the system at present.
If you construct a hypothesis that they are responsible for a
significant proportion of food poisoning outbreaks, which would
seem reasonable, Joe's greasy kebab stall at the end of the street
when the discotheque is coming out, and add to that the fact that
since their contact with the general population is probably relatively
randomised compared with the kind of outbreaks that we study and
therefore the cases which develop and go individually to the GPs
will receive a nostrum and no bacteriological testing. Do you
see what I am getting at?
(Professor Pennington) Yes.
142. We are setting up an expensive system
of monitoring to monitor parts of the system which carry the least
risk to public health whereas we are not doing anything to monitor
the part that is.
(Professor Pennington) I think it is open to local
authorities to go and chase these people and prosecute them if
they are contravening the Food Safety Act, even if they are not
registered. Okay, it makes it more difficult to know that they
exist but I think any competent enforcement authority should know
what is happening in their patch, as it were, and be able to do
something about it.
143. Would it not be helpful if registration
was made the norm and everybody who sells food to people has to
be registered?
(Professor Pennington) That really answers my
point about them not knowing who they have got in their patch.
Audrey Wise: You mean
sells on a regular basis?
Dr Moonie: No licence
on the thing—they pay £90 a year to give them a licence
to stick on their cart—no licence, no sell.
Audrey Wise: If they
are selling on a regular basis.
Dr Moonie: Automatically,
yes.
Dr Brand
144. I am sorry I was late, I was at the
DTI, not discussing food. Do we have any epidemiological evidence
on whether the problems occur within the food industry or in Lewis's
greasy spoon or Diana's home and mine? We are actually putting
a lot of effort into the industrialised pathway and not so much
at the other end.
(Professor Pennington) A lot of the evidence we
have comes from looking at outbreaks. It has to come from looking
at outbreaks because the individual sporadic cases very rarely
get tracked back to their sources. Very often outbreaks will stem
from a larger rather than smaller enterprise just by virtue of
the fact that they have more people passing through and they are
serving more people at any one time. If they do have a contamination
incident it will affect more people. Maybe there is a bias towards
the knowledge we have pointing the finger at, say, restaurants,
which is certainly the case, when it would be surprising if it
were not restaurants that were in the frame because of the way
they operate. A very small business will obviously affect fewer
people.
145. It would be reasonable to have a different
level of regulation for industrial producers or commercial producers
as opposed to domestic type productions, I am thinking about Women's
Institutes and cricket teas, that sort of thing?
(Professor Pennington) There comes a problem of
where do you stop, how often do these people cook food and so
on? That is an issue. If amateurs are cooking food they are obviously
hazarding the public but if they are only doing it once a year
how can you run a registration system for that? There is a difficulty
at that end of the system. The very large enterprises I would
see as less of a problem for the FSA, or they should be a smaller
problem, because they will be already regulating themselves, inspecting
themselves, they have the resources to train their staff properly
and so on. There is obviously an onus on a local authority to
make sure they are doing it properly. It is the medium and smaller
businesses I think where there is more of a problem because they
have less resource to do training which would be deemed to be
adequate. There is perhaps less at stake for them in the sense
of some guy who is setting up restaurants on a regular basis on
a small scale, if he has a food scare which damages his business
he just goes off and sets another business up somewhere else.
A large company has much more at stake.
146. This is your common sense interpretation
of what we all think is the case but that is not the evidence
you have got which comes out.
(Professor Pennington) The evidence does not say
that the very large businesses are causing a lot more problems
than the smaller businesses. The evidence is that, for example,
restaurants and institutions are sources of outbreaks of food
poisoning but that is partly due to the fact that they are catering
for large numbers of people using a single food source. We did
have a problem in interpreting that in terms of who are the real
villains of the piece. I think they are all villains of the piece
in fact.
Chairman
147. Professor Pennington, is it not true
that the major problem for the FSA as constituted in this Bill
is that it will not have the powers of enforcement, effectively
it is still left at local authority level? Do you think that is
a problem?
(Professor Pennington) I do not think that should
be a problem, no. If the FSA does its work properly in terms of
making sure that local authority enforcement standards are as
high as those of the best, which is clearly one of its functions,
how well that will be done is difficult to say because that is
not going to be a very easy task. The FSA will obviously have
to develop ways of doing that and establishing a machinery for
doing that to raise the standards for local authorities that are
not doing as well. How they will find that out is not going to
be particularly easy because this is all a very dynamic process.
I think that is going to be a very difficult task for it to do,
but I agreed with the idea that basically it should leave this
to the local authorities rather than take over the whole business
itself, rather like the Meat Hygiene Service, the way that was
in a sense taken over from local authorities.
Dr Stoate
148. I am very concerned that you are talking
about only concentrating on the outbreaks of food poisoning rather
than the sporadic cases. Are you saying that we do not know which
proportionally are the biggest problem?
(Professor Pennington) I think the problem about
the sporadic cases is that very often one cannot do any epidemiology
on them just because they are sporadic cases and it is difficult
to track them back, except one can use microbiological methods
to track them back, for example, so, generally speaking, a lot
of what we know does actually track back to outbreaks where one
can look at the factors that were important in letting the organism
through into the food, for example.
149. But the point about outbreaks is that
they are relatively infrequent and although they might be high-profile
when they crop up, they do not happen very often and Salmonella
might be a slightly different case, but things like E.coli,
they are tiny in numbers.
(Professor Pennington) The overwhelming majority
of cases of food poisoning are sporadic.
150. So in that case I want to come back
to David's point which I was going to pick up earlier about guiding
principle number three. If indeed the FSA is supposed to act proportionate
to the risk, then the risk of sporadic outbreaks is far greater
than the risk of genuine outbreaks, so surely they should be spending
more effort on sporadic problems rather than the outbreaks?
(Professor Pennington) Yes, the difficulty is
what you do about the sporadic cases and Campylobacter
is a case in point where the vast majority of cases are sporadic
and the vast majority of cases are never tracked back to a food
source, and it may be that only half of them are a food source,
or it may be that 90 per cent are a food source and I do not think
anybody can say at this time. All we can say is that if you go
into a supermarket and test the chickens in the supermarket, you
will find that 30 per cent of the carcases have Campylobacter
on them, and we do not even know whether those Campylobacters
on the chickens are the ones that cause food poisoning in people
because at the moment we are in this very unsatisfactory state
of having some of the data to whet the appetite really for more
data and at the end of the day we will begin to dissect this out,
but at the moment it does not look as though we are going to get
quick, easy answers to where Campylobacter is coming from,
for example.
151. But clearly if the greater risk is
of the sporadic cases, then is it not, therefore, far more important
that the Food Standards Agency concentrates far more on that and
gets some of these questions answered? I am a bit concerned that
that is not going to happen.
(Professor Pennington) I feel that, on the one
hand, it will find out more about Campylobacter because
it will be able to commission research about that. On the other
hand, by essentially making sure that the Food Safety Act is applied
properly through its role on the enforcement side and its general
measures that it will take, it will address these sporadic cases
because one hopes that the incidence will fall when, for example,
enforcement is done properly, and by that I mean enforcement that
addresses, for example, hazard analysis, that we get hazard analysis
running in food businesses to a much greater degree than we are
at the moment, which is thought to be the practical solution to
food safety problems.
152. But how do you enforce something if
you do not even know what it is you want to enforce because so
far you have said that you cannot track back these sporadic cases,
so how can you enforce?
(Professor Pennington) What we are looking at
is applying general principles of food safety, so rather than
saying, "We have a lot of sporadic cases of X, let's look
at where they are coming from", what one would say is, "If
you cook food properly and you do not get cross-contamination,
you will get rid of these sporadic cases".
153. I am still coming back to this rather
worrying aspect that if it looks a bit difficult, it might get
aborted, whereas the big, high-profile outbreaks, you do something
about it in case The Sun finds out about them, whereas,
on the other hand, the much larger problem of food hygiene at
home, we are not even taking it on.
(Professor Pennington) I think the food hygiene
issue at home is a very difficult one. It is far easier in a sense
to have an approach like HACCP. One can make people in business
apply it and one can make sure it is applied properly at the end
of the day, but you cannot make housewives apply HACCP in the
kitchen.
Mrs Organ
154. Or WITs.
(Professor Pennington) That is right.
Audrey Wise
155. Or househusbands.
(Professor Pennington) So there is a real issue
there and I do not know how you do that. How do you persuade people
to change their behaviour? That is essentially what we are asking
about here. I think I have talked about this before in other places,
that hand-washing, for example, is a key critical control point
for not getting cross-contamination and the worst offenders of
people who do not wash their hands and should are doctors and
nurses and they have had extensive microbiological training and
that is one of the reasons why we have so much infection in hospitals,
that the staff are too busy in between cases to wash their hands.
So there is a major problem here about how one changes human behaviour
and preferably in a subtle sort of way with this aim in view.
Dr Stoate
156. But I am still rather hung up on this
idea that it all looks a bit difficult, so let's not do it and
I am still left with that rather nagging feeling that if we are
not careful, we will end up with an Agency that does things it
can do and pretends that the other things do not exist.
(Professor Pennington) Well, this is why I said
at the beginning that it has in a sense to have a crusading kind
of zeal about it and be proactive and aggressive—I think
I used the word "aggressive"—because if it does
not do that, it does not have a hope in hell.
Mrs Organ
157. And it is very important that we have
public confidence in this and yet because we are not attacking
at all the issues where there is a major outbreak and it is widespread,
people will then say, "Well, we have got this Food Standards
Agency, it is costing us millions and we are having to pay a 90
quid levy for it and it does not make an ounce of difference,
so it has failed".
(Professor Pennington) I have concerns, for example,
about some of the enforcement that is done. I am wearing a tie
from the Chartered Institute of Environmental Health, so I am
on their side, but a lot of the enforcement that is done is still
the traditional sort where the premises are inspected rather than
the people who are working in them, for example, as to what they
are doing there and I see the FSA's role as being crucial there.
The culture change is probably going to have to be greater there
than with any of the other staff that I ungraciously mentioned
earlier, but there is a traditional way of doing enforcement which
is wrong and wastes public money and there are ways of doing enforcement
which are focusing on these critical control points in food processing
and cooking and so on which will make a real difference.
158. Do you think there are structures in
this Bill that will actually move that shift from looking at premises
to looking at personnel and househusbands and all the rest of
it?
(Professor Pennington) I think there are structures
there which would allow that to happen. They will not make it
happen, but they will allow it to happen because the Agency has
got this role in monitoring the enforcement and I do not think
that is just saying, "Yes, they are doing it well",
or "They are doing it badly", but you will have to be
much more interactive with the enforcers to get them to do the
enforcement that actually produces results rather than just ticking
a list of performance indicators.
159. And you think the structures in the
Bill in the way the Agency has been set up are robust enough for
that?
(Professor Pennington) Yes.
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