Select Committee on Food Standards Minutes of Evidence


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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