Examination of Witnesses (Questions 785
- 799)
MONDAY 15 MARCH 1999
PROFESSOR BRIAN
DUERDEN, PROFESSOR
RICHARD GILBERT,
MR KEITH
BAKER, MR
BOB STEVENSON,
DR ALAN
MARYON-DAVIS
and DR DICK
MAYON-WHITE
Chairman
785. Good afternoon, gentlemen, welcome
to what is now the last evidence-taking session of this Committee.
I know some of you have probably been in front of parliamentary
committees before but our remit is to look at the draft legislation
as opposed to looking at issues in relation to food safety, although
we know it is very difficult to concentrate on a few words on
paper; it is the implications of the few words we have been looking
at. I wonder if I could ask as a matter of record if you could
introduce yourselves and the organisations you come from?
(Dr Maryon-Davis) Dr Alan Maryon-Davis and I represent
the Faculty of Public Health Medicine with my colleague on my
left here.
(Dr Mayon-White) Dr Dick Mayon-White also from
the Faculty.
(Professor Gilbert) Professor Richard Gilbert
from the Public Health Laboratory Service.
(Professor Duerden) Professor Brian Duerden, Deputy
Director of the Public Health Laboratory Service.
(Mr Stevenson) I am Bob Stevenson and I am a veterinary
practitioner and I am representing the BVA.
(Mr Baker) I am Keith Baker, I am President of
the British Veterinary Association.
Chairman: Thank you.
I will ask Martin Smyth to start the questioning.
Rev Smyth
786. Thank you. I think we are all interested
in what might happen if there is a Food Standards Agency and how
it will impact upon the delivery of public health in this country.
How will it help, for example, in the investigation and control
of major outbreaks?
(Professor Duerden) From the perspective of the
PHLS, we are responsible for microbiological investigation and
supporting Consultants in Communicable Disease Control and Environmental
Health Officers. We would look to the Agency to help co-ordination
of these bodies, to build on the links we already have and to
further extend our links with the Environmental Health Departments
and with our veterinary colleagues to provide a more cohesive
body to investigate these outbreaks.
(Dr Mayon-White) I am an epidemiologist and consultant
in communicable disease control, so it falls to me to investigate
outbreaks of food-borne infection at a local or regional level.
I think the mechanism for doing that is in place, where I think
the Food Standards Agency could make a real difference is on learning
the lessons that we are learning from the outbreaks, helping those
to be transformed into public information for the benefit of the
public in relation to food hygiene.
787. I take it that you see it as a co-ordinating
body, you would not see them having independent advice or scientific
research behind them?
(Mr Baker) As a veterinary profession we see it
as a multi-disciplinary approach because we start at the farm
level as practitioners and go on through the food chain in terms
of meat hygiene and other things like that. We accept I think
that a Food Standards Agency will probably seek its own scientific
advice but it actually needs to seek that advice from the people
who have some experience in the area.
788. As I understand it, research from the
Public Health Laboratory Service has shown that for every case
of infectious intestinal disease reported to the PHLS there are
136 cases in the community. How do you think the FSA will affect
both of these figures?
(Professor Duerden) The work that has led up to
those figures was actually a major study funded by the Medical
Research Council and obviously the PHLS was involved in that.
What they found was that not everybody who becomes ill goes to
see their doctor, and not everybody who sees their doctor has
a specimen examined which gets you through to having a confirmed
specific diagnosis. We would hope that the Food Standards Agency
would encourage a higher level of reporting and a higher level
of investigation. In particular, there are two aspects which are
in the documentation that at the moment we do not have. One is
compulsory laboratory notification. Even when a laboratory isolates
particular organisms, although they are encouraged to report that
centrally, there is not a legal obligation on them to do so. The
other half of notification is through clinicians, the doctors
diagnosing cases, and there is an obligation for notification
of food poisoning to the proper officers and what the study has
shown is that does not happen as effectively as one would hope.
789. How do you think it will become more
effective? We certainly are not wanting everyone with a tummy
ache to be reporting it as infectious.
(Dr Mayon-White) I think the Food Standards Agency
should not be pressing everybody who has mild gastrio-intestinal
symptoms to be seeking medical advice if they feel they can manage
without seeing a doctor. Adding to what Professor Duerden has
said, it would be an asset if the Food Standards Agency can help
doctors and laboratories to report, partly because we would see
the Food Standards Agency improving the use that is made of that
data and that in itself is an incentive for people to report good
diagnoses of food-borne infection. The second thing is that it
probably would help, because of its co-ordinating role, environmental
health officers, the veterinary profession, food producers as
well as the medical establishment, to work to bring the data together.
There is though a word of caution which is tied in with what you
said, and that is that I do not think the Food Standards Agency
should be judged on the reported level of food-borne infection
at least not in its early days. Our experience is that the better
the service you provide, the more is reported to you, and so you
would expect at least in the early years to have more reports
of food-borne infection. That is not the Agency failing, it is
an improvement.
(Mr Baker) We would look at this multi-disciplinary
approach again because as far as zoonotic disease is concerned,
particularly salmonella, there is a requirement on the Veterinary
Laboratory Service for any laboratory which isolates the salmonella
organism to report it to a responsible officer within MAFF or
one of the agencies of MAFF, and we would hope that as a result
of that you would get better investigation across the board in
terms of animal and human infection.
790. Dr Mayon-White made the comment that
it should not be judged in the early stages if there is an increase,
however after a period if there was an increase in the number
of IID cases notified would you regard that as a failure or as
a measure of success of the Food Standards Agency?
(Mr Stevenson) I would look to the Agency to perhaps
consider those new results. Certainly in veterinary terms on the
farm we are actually trying to prove that things are actually
right on the farm rather than hurrying out when things are wrong.
So hopefully after a period of time getting things right on the
farm, through assurance schemes and health plans, mean the potential
for those diseases, even the registerable and scheduled ones,
would diminish, as would some of the others which are not under
schedules or notification. As long as we have continuous surveillance
on the farm, we have a multi-disciplinary approach and we have
a flow of information from the farm to colleagues on the right
(the PHLS) and back, then I think we can actually start proving
that things are right on the farm.
(Professor Duerden) We would want to see that
carried through throughout the whole food chain, from the farm
through food processing and the distribution system to the point
of sale of food, to get the whole thing into one continuum, and
get best practice established all along the line.
(Professor Gilbert) I think the other thing we
always have to remember is that we do not know what percentage
of outbreaks of cases are actually reported. If we want some good
news, the number of reported cases of food poisoning went down
a little last year. The figures for salmonella were about 25 per
cent down and this is before the Agency has even started. So one
does get these ups and downs a little bit.
791. In the light of that, is there a real
need for an FSA?
(Professor Gilbert) Oh yes.
792. Because you have been moving, you have
been working together over the years, things are going fairly
well, yet immediately there is an outbreak everybody is up in
panic, and we cannot guarantee there will not be an outbreak,
can we?
(Mr Baker) You cannot, quite frankly. Just the
fact you set up a Food Standards Agency is not going to solve
the problem on the ground. I think perhaps what everybody is saying
is that what it may do is improve co-ordination on the ground.
(Mr Stevenson) I think really there is an ideal
opportunity to build in the principles of hazard identification
and risk assessment and the hazard principles right through the
food chain, so that there is some sort of realisation that just
the establishment of a Food Standards Agency is not going to be
an immediate solution to the problem. But, nonetheless, by adopting
principles which involve analysis of risk and communicating that
down through the Agency, then we can start to improve the whole
situation.
793. Since you are all engaged in the science
end, you would accept it has always been your view to get the
best available scientific data, and since this will be one of
the guiding principles of the FSA how do you think the nature
and standard of such data should be decided?
(Professor Duerden) There are two sources of data
on food-borne infection from a proven point of view—one
is from the patient, the notification of those people who are
ill, the other is the isolation of the causative organisms from
the patients and from the food stuffs. It is the integration of
the activities across the board to bring those three together—
clinical notification, confirmation of the illness in the patient
and the isolation from the food source—that will prove the
links and lead to better advice on prevention.
794. I think Mr Baker made the point earlier
that from the scientific end you are always working for that,
so one would suspect that this has been happening, and one would
have thought that the FSA should be taking the advice, while they
may have independent research, from those who are already expert
in the field. Am I right in suggesting that perhaps we have not
been communicating right across the field the best results of
our scientific research?
(Mr Baker) Often communication comes back to personalities
and you will find that where the personalities mesh you will get
communication, and if they do not then communication will not
take place. This is my experience anyway. I would suggest that
in the majority of cases communication is there and what we would
be looking for in terms of a Food Standards Agency is even better
across-the-board communication.
(Dr Mayon-White) The other thing which would come
from a Food Standards Agency is some focus on which food-borne
infections are more important or more immediate than others. This
is something which leads to what we would call enhanced surveillance,
so you would pick on particular problems—it might be salmonella
for a particular period of time, it might be E-coli 0157—which
are recognised across the Agency and which everybody is working
on as being the most important. For those things we can, if we
realise that there is some gain from focusing our attention, get
better data and better strategic control of that problem.
Mr Paterson
795. Do you think that food poisoning is
a growing problem, or is it stable or declining?
(Professor Gilbert) There is no doubt that over
the years the figures have gone up. I think every expert that
you ask actually believes in recent years the figures have gone
up significantly and it is a true increase, and I do not believe
it is because of better investigation or better reporting. I think
in the last year or so they perhaps have levelled out but I do
not think that means very much over a period of time. All the
publicity we have had has been correct. In my view there has been
a definite increase in food poisoning over the years.
796. So why do your figures for 1998 salmonella
show the sharpest drop in ten years?
(Professor Gilbert) It is very difficult. Is it
because we had a long, cold summer? Is it because the salmonella
isolation rates from different foods is slightly less? At this
stage it is very difficult to know but a 20 per cent fall is certainly
very encouraging. I should be even more encouraged, of course,
if at the end of this year it has gone down even further. One
would hope from surveys of the most likely type of food vehicles
that the incidence of salmonella in eggs and poultry has gone
down, if it has then that has a knock-on effect on food poisoning
outbreaks.
797. Do you have any statistics for the
sources of food poisoning? Is the main source incompetent preservation
and cooking of food in the home or is it malpractice by retailers
or caterers?
(Professor Gilbert) If one takes the information
we have on outbreaks of food poisoning, you could break it down.
I have not got the percentages in front of me but I can let you
have them very quickly—the percentage of outbreaks due to
poor temperature control, failures in cross-contamination, inadequate
cooking, this type of thing, but you can only do this if the information
is really available to you at the time of the investigation. It
is very difficult retrospectively going back to this information.
(Dr Mayon-White) The other factor to add to that
is that most food we eat does not cause illness, and that is because
there are several measures—good cooking, clean food and
good handling—and the outbreaks tend to have several things
going wrong at the same time to cause an outbreak. Therefore,
it would be wrong to try and ascribe most of the causes of sources
of food-borne illness on one particular problem. You need to see
it as being a series of hazards which added together build up
a risk.
(Mr Stevenson) Certainly on the farm, food-borne
illness organisms are difficult to suspect clinically. If you
have clinical evidence then we would rely on the VLA to do the
appropriate analysis and come up with the results. One of the
things which is definitely happening on the farm now is the level
of awareness of the need to get things right is increasing, so
more continuous surveillance on every farm for potential zoonotic
organisms is taking place. We then rely on good communications
with the Veterinary Laboratory Agency, which is struggling a bit
in terms of the distance away from farms and practices but they
are the eyes and ears; they provide the evidence if we suspect
and if we are monitoring, but they are additional eyes and ears.
We rely on those laboratories at the beginning of the chain, we
do not have that sufficient scope and scale and scatter through
the country to actually assess samples we send in, and we would
be anxious and in fact we are anxious about that.
798. I have been told that 80 per cent of
food poisoning is caused in the home. Would you think that is
an accurate figure?
(Professor Duerden) Most of the figures are guess
work. Many do occur in the home. Isolated cases, one or two cases,
the ones that we know most about, are the bigger outbreaks which
are very often through catering establishments or from commercial
catering because more people are infected in any one outbreak.
We said that the numbers have fallen, of course the number of
salmonella food poisoning infections fell last year, but that
did not apply to other causes. There was still a small rise in
campylobacters last year, and of course E.coli 0157 continued
to rise, so it was only a fall in one, obviously one very important
type of food poisoning but it was not across the board.
Ms Keeble
799. I wanted to ask a bit about standards
of data because does that not partly depend on, for example, what
tests are taken? Who do you think should be responsible for determining
the tests? For example, if a GP has not encountered E-coli then
they might not ask for a sample to be tested for that. Who should
make sure that tests carried out in a case of suspected food poisoning
are standard ones to detect a range of possible sources?
(Dr Mayon-White) I think that there are two approaches
to this. One is with health authorities and with primary care
groups who together will be purchasing laboratory services. That
is certainly one of our wishes, that all laboratories test for
the food-borne illnesses which we think it important to be detected.
At the same time, the laboratory services, of which the Public
Health Laboratory Service is a good example, are working within
the profession, within the service, to have the right standard
tests available.
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