Examination of Witnesses (Questions 800
MONDAY 15 MARCH 1999
and DR DICK
800. So does the FSA have any role in that
as you see it, given it will need proper data, will it not?
(Dr Mayon-White) I believe it will because this
will be part of this co-ordinating role, because there are different
players, different laboratories, who would be providing data or
potentially providing data, and certainly one would see the Food
Standards Agency having an important co-ordinating function not
least of course because it reaches all parts of the UK.
801. Just to pick up the point Mr Paterson
was asking, Mr Paterson pointed out, and I agree with him, that
the vast majority of food poisoning cases are in fact caused in
the homeI have been a GP for a long time and that is certainly
my understandingand the outbreaks we have talked about
are relatively rare, although from a public health point of view
they might be important (and they certainly grab the media headlines)
in terms of overall numbers they are actually a small proportion.
Can I come back to the question which was asked earlier and ask
the Faculty of Public Health Medicine what can a Food Standards
Agency do to try and reduce the much larger numerical burden of
food poisoning in the home?
(Dr Mayon-White) I would say that the term "food
poisoning caused in the home" is confusing an issue. I think
the majority of cases certainly occur from domestically-prepared
food but part of the cause of these cases lies in the fact that
the person who has bought the food (e.g. chicken) which is already
contaminated with food poisoning bacteria or other micro-organisms.
Part of the work of the Food Standards Agency is going to be,
surely, in public education and this should be covering not just
food hygiene but nutritional elements as well. I would see the
Food Standards Agency being able to help prepare, across the whole
country, high quality advice for the public on the safe preparation
of food, but at the same time reassuring the public that other
parts of the food chain that lead up to the domestic kitchen are
also having the same pressure put on them to improve food hygiene.
802. You say that surely the Food Standards
Agency will be taking these into account, but that is exactly
what this Committee is here to look at. Do you think that the
Bill as currently drafted will give the Food Standards Agency
not only the right powers but also the right steer to do exactly
(Dr Mayon-White) I think that lies partly in the
make up of its advisory committees and the Faculty would very
much hope that the public health practitioner professional voice
is clearly within the advisory committees.
803. That brings me on to the subject of
nutrition which is something that is very dear to my heart. What
do you think the FSA's role will be in improving public health
(Dr Maryon-Davis) I think one of the key roles
is to ensure that people have an informed choice when it comes
to choosing particular foods and also some public education about
what constitutes a balanced diet. I think the wording of the draft
Bill does encompass that, but I am particularly concerned about
consultation over the objectives and practice. I am not sure that
the wording of the Bill is quite clear about whether or not we,
the public, will be consulted upon when it comes to how the Agency
draws up its objectives and its practice and I would like further
clarity on that so that we have an opportunity to influence that.
804. I entirely agree with that. How do
you think that the Food Standards Agency will be able to maintain
the balance between the food safety function and the nutritional
(Dr Maryon-Davis) In various clauses where it
says "and other food related matters" I would like to
see it specifically mention food standards and nutrition as I
think it is most important that that happens because I think there
is a real danger that the nutritional aspects of the Agency's
work could be very easily marginalised by the major concern of
805. So the nutritional aspect is extremely
important and is currently underplayed, is that what you are saying?
(Dr Maryon-Davis) I think it is very much underplayed
in the draft Bill as it stands. It gives it scant mention. I think
it needs beefing up.
806. When this has been put to Ministers
and other witnesses an element in their answers has been that
health is influenced by other factors besides diet and usually
they mention exercise. Therefore, the argument is it would be
too difficult to isolate the dietary aspects of health and it
might give a false impression. I notice that in Sweden there is
an expert group on diet, physical exercise and health and that
expert group reports both to the food side and to the health administration
at large so that there is a bringing together and then a twin
reporting function. Does that strike you as being a useful device?
(Dr Maryon-Davis) I think it may well be. As currently
envisaged the main committee advising on diet and health would
be a joint effort between the Agency and the Department of Health.
I can see the reasons for that. I can see that the Department
of Health has to have that wider policy perspective, but at the
same time the Agency is in a unique position to provide major
input as far as the diet is concerned. One of things it has as
a unique selling feature is its independence and its transparency
and those are terribly important things when it comes to dietary
messages about health.
807. Professor Duerden, you mentioned one
of the factors being problems about poor temperature control.
It reminded me of how the Health Select Committee some years ago,
when looking at listeria and listeriosis, recommended that domestic
refrigerators should be required to have integral thermometers
to make it easy for householders to keep the temperature under
check, but to our surprise that was fiercely resisted by the then
Government. Do you and your colleagues from public health think
that is a sensible suggestion or not?
(Professor Duerden) Certainly the maintenance
of appropriate cool conditions in refrigerators is absolutely
essential to the safe holding of food and whether you build the
thermometer into the fridge or not, a control on the temperature
and a monitoring of the temperature would be regarded as important.
Professor Gilbert was particularly involved with those activities.
(Professor Gilbert) One wishes that the refrigerators
had it built in in the first place. The alternative is the little
ones that you stick inside and these are very good and they are
very inexpensive. I have to say in fairness that standards of
temperature control in this country are probably better than they
have been for many years. This has been mentioned time and time
again and you did mention the subject of listeria and the good
news there, of course, is that the listeria figures now are very
low indeed and as low as they have ever been in this country.
We have always had a problem in relation to temperature control,
but I think at the moment that is not my major concern. My major
concern is that really a very high percentage of raw meat, poultry
and this sort of product which you can buy is actually contaminated
when we bring it into the kitchen and that is where I believe
we need a co-ordinated response all the way across the food chain
with our veterinary colleagues. If I could see the Food Standards
Agency doing one thing it would be setting targets for the industry
and everybody else to meet.
808. Quite. I was not at all meaning to
imply, nor did the then Health Committee, that having integral
thermometers would be the key. Clearly, reducing contamination
in the first place is the key. It seems sensible to make it as
easy as possible for people.
(Professor Gilbert) I agree. Food poisoning is
a preventable disease not being prevented and there is one major
thing which I do not think necessarily comes out in the documents
and it is the very important lead the FSA can take on the educational
front. We have got the great and the good telling us what to do.
I think it really does need to be co-ordinated. As I said, it
is a preventable illness and I believe that this is a major area
that the FSA can take a very significant lead on.
(Mr Baker) Can I support the co-ordinated approach
because I think that temperature control is equally as important
before it gets into the home. There is a need to maintain the
control mechanism all the way from the slaughter house because
if you do not then you do have a potential problem. It goes back
even further than that because if you can actually start the process
with healthy animals on the farm then you have got a greater potential
for safe food and that is where I think we see our major product.
809. Of course. The Health Committee, I
hasten to say, regarded it as a "minor useful thing"
and therefore was very surprised to have it resisted, so it became
more major than we expected. Mr Baker, I noticed that you said
that personalities were the most important thing in communication
and if you got the personalities right then you would get good
communication and obviously one can see in human terms that is
likely. Do you not think that that is a little bit hit and miss
or random? Do you think that one of the functions of the Food
Standards Agency should be to ensure that there are systems in
place which reduce reliance on having just good personalities
who can communicate? I would feel very uneasy if we had to rely
entirely on personalities. I would like systems. Is that something
the FSA should be taking into account?
(Mr Baker) I agree totally with you that there
must be procedures in place and systems in place to ensure that
you have got adequate communication as far as it is feasible to
do so, but I am afraid personalities still come into it. So you
do set down a framework for communication and I think that that
is extremely important. Do not get me wrong, I think that communication
has worked extremely well because of personalities or in spite
of personalities in the past and I think that we have got a measure
of control over quite a few of the problems.
810. Some people are describing this partly
as a need for a change in the culture and a generalised shift
in attitudes and methods. Do you think that it is fair to say
that there is a need for that and that the Food Standards Agency
should have a different culture itself and encourage an improved
culture or changed culture in the other institutions involved?
(Mr Baker) Yes, I think that would be a considerable
benefit. My colleague indicated that there will probably be a
change in culture at the farm level because instead of looking
for disease we will be trying to promote health and I think that
that is a very important message that the FSA could get across.
(Mr Stevenson) As a veterinarian working on farms
every day, I can see that that change of culture really is happening
and it is on the back of BSE, unfortunately, but the time is ripe
to develop that and with the structure of the FSA I think that
people are looking for assistance, they are looking for information
and they are ripe for entering into the communications backwards
and forwards. They have realised that there is a need for very
strong verification and the enforcement of procedures right down
onto the farm and I am seeing every day now that there is a clear
understanding of the need for really strong verification of procedures
and auditing of procedures.
811. Professor Gilbert stressed the role
of education for the Food Standards Agency. Do you believe that
the definitive advice should come from the same authority on food
safety as well as nutrition? Should it be the Agency itself that
promulgates that advice or should we see something within the
Bill that links it to the Health Education Authority?
(Professor Gilbert) I would like to see the Agency
taking the lead because I do believe that at the back of all this
is to try and prevent food poisoning and there are messages which
go out which are sufficiently convincing. The media is only used
sometimes to spread bad news. If it is backed up by health education
authorities then that is fine, but it seems to me that if you
are talking about food safety then you have to talk about prevention
because that is what we are trying to do, is it not? Therefore,
I do think this is a very significant role. It is getting the
message over to the general public but it is also teaching teachers
and teaching trainers which I think is also very important.
(Dr Maryon-Davis) There are distinctions with
the HEA. The HEA's particular skills are in terms of getting the
messages across, it is using the various media that are available,
but I think those messages themselves need to be formulated and
that is where the Food Standards Agency's role is mainly formulating
those messages and then working with others to get the messages
across and it will be horses for courses, who does what best.
One point about the relationship with the Department of Health.
We are told that there will be concordats with the various departments.
I do not think it is sufficiently clearly worded in the Bill,
but I think we should have an opportunity to comment on the proposed
concordats as well because it is through those concordats that
the work is carved up between the various agencies.
812. I understand that at least one of your
organisations is in favour in principle of statutory notification.
I do not want to go into any of the problems of it. Could you
each in turn tell the Committee if you are in favour of the principle
of statutory notifications of food poisoning?
(Professor Duerden) Yes. For many years the PHLS
have been in favour of a statutory responsibility on the laboratories
to notify positive isolations of food poisoning organisms as well
as other communicable diseases. Notification is just one aspect
of communicable disease. There currently is a statutory obligation
on medical practitioners to notify when they make a diagnosis
of food poisoning. It is the laboratory side that is not obligatory,
although obviously we do get a lot of notifications.
(Dr Mayon-White) We support very strongly notification
of laboratory information.
(Mr Baker) In terms of veterinary laboratories,
there is already a requirement to notify isolations of salmonella
and brucella. We hope we do not get any brucella cases these days
because we think we have got rid of it. I think we would be in
favour, but we are talking from the veterinary side and not from
the public health side.
Chairman: Thank you.
813. I wonder if we could talk a little
bit about surveillance. What surveillance, if any, should the
FSA be carrying out independently of that that is done by existing
(Professor Duerden) We would look to the Agency
to help and support in improving the surveillance programmes that
there are in place and really surveillance from our perspective
comes in in two ways: one is the surveillance of infection in
people, in other words it goes back to the notification we have
just talked about to ensure that we know what the pattern of disease
is; and then there is the surveillance of contamination in food
by regular monitoring of foodstuffs in surveillance programmes
here. Both of these are in place. Both of them happen. Again the
co-ordination and the national picture could be enhanced with
links to surveillance in the veterinary field as well.
814. I wonder if you could enlarge on that
because at the moment do we not have a problem in that there are
all sorts of bodies coming in doing a bit of regulation and a
bit of surveillance here and there and it is possible that you
could have a series of visits from different authorities over
a few days? How would you like to see that improved with co-ordination?
(Dr Mayon-White) I would be strongly opposed to
the Food Standards Agency having surveillance which was independent
of the other systems. In many cases there would be the risk of
duplication even to the point of interference and there would
be a lack of accountability for what was done. There may be surveys
or parts of surveillance which the Food Standards Agency wishes
to do itself, but those should be discussed with the other agencies
that have inspection and surveillance activities. It is a co-ordinated
function. I feel very strongly about this business of a food producer
being inspected by different people at different times. That almost
always loses the impact of that inspection because, in fact, the
producer is saying these guys do not know what they are doing.
(Mr Baker) We would support that. I think that
the Food Standards Agency ought to be able to co-ordinate the
approach to surveillance, but from a veterinary point of view,
we would like to see a continuing surveillance programme because
the epidemiology of a lot of the organisms that cause food poisoning
in man is not necessarily well known at the farm level and so
one needs to know more about what is happening at farm level if
one is going to help produce healthy animals and therefore directly
improve human health. We would like to see more co-ordinated surveillance
815. Does the PHLS anticipate that it can
have a concordat with the FSA to produce timely provision of information?
(Professor Duerden) I would certainly hope so,
yes. We would expect to be required by the Agency to produce the
figures on national surveillance of both infections and the food
contamination side of surveillance.
816. Do you think that this concordat should
cover advice about surveillance and interpretation of that?
(Professor Duerden) Yes, most certainly. There
is expertise available in the disease processes and in the food
microbiology side within the Service and with our associated colleagues
outside the Service, but we have particular expertise there that
we would hope the Agency would want to take advantage of and would
not wish to duplicate but would wish to use.
817. How can this concordat be put together
for the maximum benefit of public protection?
(Professor Duerden) I would expect that standards
would be set by the Food Standards Agency nationally for the way
investigations are done, for the level of surveillance and targets
for contamination reduction and disease reduction. We would then
be expected to provide the evidence of what was happening to monitor
these targets and to conduct some of the investigations with our
colleagues in the other agencies on behalf of the Agency.
818. And you would want those targets published
and reviewed so it was very open?
(Professor Duerden) I would think it would have
to be. That is what the public would expect and we would expect
819. I would like to examine your respective
relationships with the Food Standards Agency. How do you see your
members netting in with what the Food Standards Agency is supposed
to be doing?
(Dr Mayon-White) At the moment, if I had a food-borne
outbreak of a problem that I was dealing with I would talk with
people in the PHLS and so on just as they would talk with people
in the Department of Health and say, "Look, I think there
is a problem which is a national problem or it is bigger than
just my patch, I think there is potential for preventative action."
What I would now see as being different with the Food Standards
Agency is instead of going to an organisation that has got several
other important topics on the agenda, I know I would be going
to the Agency and this is their topic, they want to hear from
me and they want to work with me on this particular problem. I
think that would be very exciting and potentially very strong.
Equally I can get back from them advice and information on what
they are planning, what they are doing, what are the proper standards
that I could expect with this on food. I think having the Food
Standards Agency, to be for the public health doctor the one agency
that brings it all together, will be very good.