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The future of public health depends on the sharing of ideas and greater co-operation between agencies, delegates he...
The future of public health depends on the sharing of ideas and greater co-operation between agencies, delegates heard at a debate on the challenges facing public health over the next five years athe Chartered Institute of Environmental Health congress in Harrogate.

Dr Ruth Hall, Chief Medical Officer, Wales, told Congress how Wales is dealing with public health issues. According to Dr Hall, health action zones are proving to be too big and public health initiatives should be based more in the community.

'We should be going for neighbourhood action,' she told delegates. Other lessons learnt from the Welsh experience include securing funding from Europe where possible and ensuring health issues cut across all government policy. She also warned that public health professionals must avoid focusing on organisational reform at the expense of long- term public health objectives they are trying to achieve.

Delegates were also reminded of the dangers of forgetting the basic aspects of public health such as handwashing. 'Two to 3 million people die each year from gastro enteritis-related diseases, and half of those could be prevented by handwashing,' said Dr Nichola Wilkins, chief executive of the Royal Institute for Public Health and Hygiene. With one in 10 patients in the UK acquiring hospital infection, basic public health issues still had to be addressed, said Ms Wilkins.

A recurring theme in the discussion was the threat to public health from falling student numbers. 'We need to listen to young people more,' said Dr Wilkins. 'We have to look at what excites young people, and they are really struck by professions with fast

moving changing profiles.'

It's time to part the past and the 21st century, declared David Fisk, called to comment on the state of environmental health. 'Comparisons with pea-soupers are not helpful,' he said, as we had progressed so far through joint projects and strategies.

Dr Fisk, director of central strategy and chief scientist at the Department of the Environment, Transport and the Regions, had the unenviable task of standing in for keynote speaker Lord Witty. The under secretary of state had been detained in Westminster to take 'pressing decisions' on the worsening petrol crisis.

Talking about projects in which he had been involved, Dr Fisk gave a picture of gradual but considered modernisation, that 'made joined-up government a reality'. Recent strategies - for modernisation, sustainable development and health - were 'relevant to environmental health, with its cross-cutting character'.

The CIEH's contribution to housing safety rating was, said Dr Fisk, a perfect example of multi-agency working. Citing air quality and health and safety at work, Dr Fisk said it was important to focus on merging policy areas with the right approach: 'Joined-up government is a very hackneyed phrase, but it will only work if it's integral.'

The Government's approach showed 'joined-up government at citizen level', said Dr Fisk. The secondment to the DETR of Ian Ashmore from Swindon Council was a recent example of the Government's commitment to bring in local expertise, and Dr Fisk appealed to delegates to get involved in cross-cutting initiatives: 'We're all moving to a more citizen-focused approach,' he urged. 'It's challenging for all of us.'

Public health has not improved in the UK for the past 20 years, CIEH president David Purchon told delegates, and the UK is a mere 18th in a World Health Organisation health league table.

Mr Purchon asked why the National Health Services was overwhelmed by illness yet doing little to improve health. There was also a chronic shortage of key workers, including health workers and environmental health officers across the whole public sector.

Mr Purchon welcomed new institutions in public health including the Health Development Agency, the Food Standards Agency, Regional Development Agencies and empowered local authority services.

He said that the CIEH, as the largest organisation of its kind in the world, had much to offer.

'The knowledge and skills base of our profession is broad,' he said, 'requiring integration of the social, economic and environmental aspects of living. Our traditional role has been in local government, but that is changing. New opportunities now need to be carved out in public and private organisations.'


The North and South Wales Centres have voted to amalgamate into a single national centre, following an overwhelming yes vote in a ballot of CIEH members. With Council's approval, the change will take place next year.

This week, CIEH Wales launched its public and environmental health agenda, which will be used to lobby the Welsh Assembly. The CIEH is also to employ a policy officer to work with the assembly.

Speaking at the document's launch, Chief Medical Officer for Wales, Dr Ruth Hall, praised the initiative. She said: 'It's a very good sign of the practical action you can take to influence the way forward.'

The Food and Drink Federation criticised the FSA on its handling of the release of food enforcement figures saying the agency distorted food safety issues for the public.

An FSA press release issued in May claimed that over half of food premises in the UK had broken food law. But according to Michael Hunt of the FDF as only three per cent of enforcement action had been stronger than an improvement notice the press release had been 'scarcely calculated to communicate the true situation' to the public. 'Needless to say we had words with the FSA about this,' he told delegates.

Speaking on enforcement issues Mr Hunt claimed that industry was suffering from a lack of consistency in enforcement policy across the UK. He called for greater co-operation between authorities with increased sharing of expertise in specialist areas to ensure uniform enforcement.

Mr Hunt also supported FSA plans to publicise local authority enforcement activity. 'With central access to local service plans and figures available on manpower and expenditure we will then be better placed to comment on consistency,' he said.

He added that consistency will only be achieved through greater central co-ordination on food enforcement. 'We are looking for a national policy delivered at a local level using local expertise,' said Mr Hunt.

Delegates also heard that the FDF was concerned about the fall in sampling rates and the lack of resources facing the Public Health Laboratory Service and the Public Analyst Service.'Risk based sampling has a role as an intelligence process and is a good platform for focused follow ups to problems,' said Mr Hunt.

Speaking at the same session Nicola Ellen, environmental manager for Safeway Stores, warned that local authorities were undermining her company's sustainability strategy by not allowing night time deliveries.

High-tec lorries now provided a solution to night-time noise and yet 40 per cent of stores were still forced to only take daytime deliveries. Safeway's would be able to reduce their fleet by 15 per cent and cut fuel consumption by 10 per cent if restrictions were lifted she told delegates.

Speakers debating the national noise strategy yesterday called for a review of the way EHOs deal with noise nuisances.

Delegates heard that there is strong evidence the public wants legislation to be tightened to enable local authorities to base action on noise being an annoyance rather than a nuisance. 'Nuisance has been tried and tested over many years and we are comfortable with it,' said Alan Higgins chairman of the CIEH environmental protection committee. 'But we need to move out of that comfort zone and look at what the public are asking for.'

The review would be part of a radical change in how noise issues are resolved including the implementation on a national noise strategy.

Speaking on the implementation of a national noise strategy Richard Mills, director general of the National Society for Clean Air warned delegates that EHOs had an 'enforcement led preoccupation with resolving noise issues' which would have to change if any noise strategy was to be effective.

Regional powers give spur to action

The chance to link strategies has been a key benefit of the new Greater London Authority for Environmental Protection, according to Tim Everett of Sutton LBC.

Ken Livingstone, London Mayor, had had his work cut out in making sure policies for the capital related to each other on all areas of environmental protection.

It was a much-needed approach, said Mr Everett: 'The gap between rich and poor is growing... life expectancy for someone living on the streets of London is just 42.'

Huw Morgan from Swansea BC shared encouraging experiences of the Welsh Assembly. The structure had allowed smaller groups to work with a better understanding of the issues and more effective communication.

It was, said Mr Morgan, a chance to get to know people over a wider range of issues:

'Public health players get to know environmental protection. At the risk of sounding like Graham Jukes, it's a more holistic approach.'

Regionalising government had cut the frustration of trying to get parliamentary time in London, he said. Mr Morgan looked forward to the recruitment of three new posts to be funded by the CIEH for regional policy officers for Wales, Northern Ireland and Scotland.

'This time next year you'll have the policy officers in front of you and can judge for yourselves whether they've been effective,' he said.

Take up may have been slow, but the new joint working partnerships offer 'a more effective response to customer needs', claims Carole Bell from the Department of Health. Ms Bell told delegates at yesterday's debate that joint-working is about 'ensuring people don't work in separate silos.' She urged delegates to get involved and utilise the joint working powers in the 1999 Health Act.

Ms Bell pointed out that the partnerships can be any size and any form whether it is pooled fund, lead commissioning or integrated provision. The key point is getting an agreement between various departments and agencies first and then notifying regional health authorities of plans.

Barry Tennison, director of public health and health strategy at West Herts Health Authority told delegates examples of joint-working practices in his authority. Although he said that it was 'not always straightforward to run the partnerships,' there was great potential and there have already been many success stories. He cited an example of a partnership, which had organised GP access to homeless people.

Ms Bell explained that the arrangements are discretionary and partners only have to notify regional health authorities of plans.

But several delegates expressed their concern that with limited budgets, spending would be allocated to NHS trusts if councils didn't sign up. The NHS plan, published in the summer, only refers to social services departments as partners in jointly commissioned and organised services. There is a£500m fund for social services to provide new intermediate health services from 2001, but environmental health departments are not mentioned.

According to Ms Bell, the potential difficulties facing joint working are the five Ts: territorialisation; traditionalism, timidity, tribalism and terrorism.


Don't wait to be asked to get involved in regeneration, Simon Llewelyn of the DETR's housing association and private finance division, told delegates. 'You've actually got to go out and make the effort,'because it's very easy to be sidelined,' he added.

Mr Llewelyn admitted that housing had been played down in Labour's regeneration initiatives because of the failure of previously poorly designed and co-ordinated schemes

He told EHOs: 'You led the way in regeneration initiatives in the past, with area renewal programmes and their predecessors... but if you think that you are just in a housing role, I hope that by the end of the session you will think differently.'

This was a key moment, he said, following the housing green paper and the comprehensive spending review which had allocated large budgets to housing.

Council priorities in regeneration should be less anti-social behaviour, creating neighbourhood wardens, better lettings polices and reducing empty properties.

Eamonn Boylan, housing director for Manchester MDC, said that the housing market was so depressed in parts of north and east Manchester that it was beyond saving. He said that present compulsory purchase powers were expensive, cumbersome and inefficient.

He also called for HMO licensing, for council powers to impose blanket licensing schemes in low-demand areas and for the restriction of housing benefit for bad landlords.


John Kirk, Chairman of the Education Committee introduced award ceremony.

Ronald Williams award

Gold medal went to Alistair Tomlinson, who trained at Cardiff City Council and studied at the University of Wales in Cardiff.

Silver medal to Matthew Aldridge, trained at Wyne (check spelling) Forest District Council, studied at King's College, London.

Bronze medal to Abigail Orme, trained at Sevenoaks District Council, studied at University of Greenwich.

Morley Parry award

Awarded to Damien Martin from Belfast City Council. Received by Gary McFarlane (don't know his role) as problem of petrol crisis.

Danish Bacon study tour

Sponsored by Danish Bacon and Meat Council, awarded to Hannah Booth from Southampton City Council.

NSF International Sabbatical Programme

Bob Tanner from NSF introduced winner - Annabel Caine from East Herts District Council, which she joined in 1996. Exchange travel scholarship for four week long study tour to the US. Candidate asked to submit 2000 word essay, proposing topic for tour and how tour will be conducted. Annabel's report on body piercing.

Tidy Britain Group Spring Clean awards

Winner of the first prize of£500 is Elmbridge District Council. Organised a range of events supported by companies and the local community. Thirty-four organisations and seven schools. Accepted by Anthony Jeziorski, Head of Client Services and Councillor Graham Winton, Chairman of the Environmental Services Committee.

Second prize of£250 went to Chelmsford District Council which collected 15 tonnes of rubbish form the river Can and Elmer, including hundreds of shopping trolleys. Accepted by Mr B (Barry) Saunders, Environmental Protection Manager and technical officer Eileen Lawless.


Mike Bailey from National Power

Christopher Baxter from Chesterfield Borough Council

Don Boon from London Borough of Croydon - Director of Env Servs

Stephen Cooper from Northern Ireland (Newry and somewhere)

Tim Everett from London Borough of Sutton

Richard Langbridge from Canterbury Distict Council

Keith Osborn from North West water

Peter Weaver from Taunton Dean (check) Borough Council

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