CIEH EHN November 2020

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www.cieh.org November 2020 Volume 35 Issue 9

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Sarah Campbell editor@cieh.org

Contributing Editors

Katie Coyne, Fiona McKinlay

Design

Matthew Ball

Chief Sub-editor Sian Campbell

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Andrew Littlefield

Executive Director

John Innes john.innes@thinkpublishing.co.uk Think Publishing Ltd Capital House 8th Floor 25 Chapel Street London NW1 5DH 020 3771 7200 EHN is published 10 times per year and printed on paper made from pulp sourced from sustainable materials. The views expressed in the magazine do not necessarily reflect those of CIEH. All information is correct at the time of going to press. Articles published in the magazine may be reproduced only with the permission of CIEH and with acknowledgement to EHN. CIEH does not accept responsibility for the accuracy of statements made by contributors or advertisers. The contents of this magazine are the copyright of CIEH. Ideas and letters to the editor are welcome. EHN is mailed in a wrapper made from potato starch and is fully compostable. You can even use it in your kitchen caddy.

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‘PLACENTA PILLS ARE INCREDIBLE’

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STRIKER ACTION

05 UPDAT E

News Climate change a top concern for young people, survey says; Marcus Rashford and charities renew calls to extend free school meals. COVID-19 Public scepticism hinders pandemic measures; engineering group seeks solutions.

EVE RY I S SU E 32 TALES FROM THE FRONT LINE Lancaster City Council’s Fiona Inston shows England’s CMO Chris Whitty the power of EH.

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G O ON L I N E Find your next job at www.ehn-jobs.com, and see how to further your career at www.cieh.org

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FEATU R E S 12 PLACENTOPHAGY Many women claim ingesting their baby’s placenta is “life-changing”, but how can local authority EHPs help providers ensure that placenta encapsulation is safe for consumers?

1 9 L EGAL BR I E FI NG Opinion Julie Barratt on how to protect EHPs from the new threat of ‘weaponised COVID’. Prosecutions Tanning salon feels the heat, Darlington mess cleaned up, and rubbish tip-off.

2 2 YOU R CAR E E R Learning points From insects to imports … 9 things we learned from the Food Safety Conference.

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Contents

NOVEMBER 2020



Welcome, 1

NOVEMBER 2020 VERSION

WELCOME

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While public scepticism is making it more difficult to control the pandemic, a new register should help put EHPs in key roles

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Stand up and be counted HE UNPRECEDENTED

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W HO’S I NS I DE

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challenges of the COVID-19 pandemic have brought into sharp focus the value of EHPs around the country in contact tracing, business inspections and more. As the UK wrestles with significant numbers of new cases and new tiered restrictions, we have an ever more important part to play in the health of our nation. With that in mind, the Environmental Health Together register will launch very soon to help local authorities find EHPs to fill vital roles. Hosted by the LGA and quality-assured by CIEH, the register comes as a welcome response to the government’s commitment to creating a new register of EHPs to tackle the pandemic. The register is aimed at anyone who holds EH qualifications (accredited degree and/or

TONY LEWIS “We know that our efforts to control the virus and manage the whole outbreak are being undermined by mixed messaging”

JULIE BARRATT “A worrying new trend is what the police describe as ‘weaponising COVID’, when an individual claims to be infectious and spits”

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EHRB) and who is available for work whether part time, full time, in-person or remotely, and in either a remunerated or voluntary capacity. We know how significant a year this has been for all of us working in environmental health, but we are keen to find out more, and gather data to help us promote and champion the profession. I hope that you will all find time to fill in our workplace survey in the coming weeks. We spoke to a handful of EHPs about the impact that public scepticism is having on their work. Find out what they said on page 9.

DEBBIE WOOD Executive director for membership and external affairs NOVEMBER 2020 / ENVIRONMENTAL HEALTH NEWS 3

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Update, 1

NEWS YOU CAN USE NOVEMBER 2020 Follow us on Twitter

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The first day of a week-long Extinction Rebellion protest in London, calling for the Climate and Ecological Emergency Bill to be passed

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STORM SURGE

Environmental harmony a priority for the young New survey finds climate change above pandemic as top concern for 16-24 year olds

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LIMATE CHANGE

is more worrying to young people than the COVID-19 pandemic, according to a new survey. At the end of September, 1,000 people aged between 16 and 24 were asked to select up to two of their top concerns – and climate change was number one. Second to climate change was concerns about the pandemic, then social justice, then poverty, and only after that did worries about the economy rank. WWW.CIEH.ORG

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The short survey, carried out by OnePoll for Sophia Centre Press, also found that almost 75% were hopeful that the impact of the pandemic has led to greater awareness of the need to care for the planet, our health, and one another. The poll was carried out ahead of the launch of a collection of essays – The Harmony Debates - that tackle environmental issues using the idea of ‘harmony’, based on the scientific principle that everything is interlinked.

The book includes contributions from a range of environmentalists and thinkers including Dame Ellen MacArthur, who advocates for a circular economy, and the Prince of Wales. Professor Nick Campion at the University of Wales Trinity Saint David, and editor of The Harmony Debates, said he was especially struck by the survey’s findings that 47% would promote the harmony approach once they knew what it was. He said: “If you ask the question, ‘Do you support

320%

increase in major UK storms over the past five years compared to the first half of the decade

100%

year on year increase in storms during 2019-2020

£4.8 billion cost in damage across the UK in the last decade

78

recorded fatalities in the last 10 years (ACCORDING TO RESEARCH FROM SWINTON INSURANCE)

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Update VERSION

Pressure mounts for free school meals in England

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Little hope in sight for disadvantaged children

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a good thing?’ everybody says, ‘Yes’. But asking ‘Would you promote it?’ implies action and commitment. A lot of people, when asked questions about action – well, you’ll get a much lower response.” Campion said he thought just 10% of participants might say ‘Yes’. He added: “This does suggest that right at the moment, the COVID crisis has generated a sense among this age group that they need to actively work to promote a collaborative and cooperative social philosophy. “I’m old enough to remember the 1980s and yuppies, when the dominant ideology became ‘everything works best if everybody works for their own interests’.” The poll, carried out across a 10-day period to 1 October, found that young people were hopeful that greater awareness would lead to change, with 58% thinking COVID-19 was an opportunity to reset the way society operates, and that society would make positive changes to improve their lives and work as a result. The pandemic has had a profound impact, and 76% of participants said they felt their outlook on life had altered, with 75% saying the way they lived their lives had also changed.

S ’S MARCU R UNITED E T S E H C MAN T OKEN OU D HAS SP R ASHFOR meals to all families on universal credit and legacy benefits. Sustain and 108 charities and public health groups – including the CIEH – signed an open letter in

DATA

FOOD FOR THOUGHT?

1.9m

61%

3

74%

food parcels delivered by the Trussell Trust in 2019/20

top reasons for referral: low income; benefit delays; benefit changes

increase in food parcels needed predicted from October to December

increase in use of Trussell Trust food banks since 2015/16

700,000+ of these parcels went to children

(ACCORDING TO THE TRUSSELL TRUST, AND APPLYING TO THE UK)

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“We’re yet again seeing that it’s been left to the charities, to famous footballers and to backbench MPs to try to push the government kicking and screaming into feeding hungry children. It seems when there’s money for all sorts of other schemes, there’s constantly this kind of resistance to supporting families to make sure they’ve got nutritious food for their kids.” Crowther warned that extending free school meals was just a “sticking plaster” and further reforms were necessary. Rashford and a coalition of charities have also called for the free fruit and veg scheme to be expanded to all 4.7 million primary school children, and to extend free school

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Parliament Square, London, 1 September 2020

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England are urging Prime Minister Boris Johnson to extend free school meals into the holiday period, as in Wales and Scotland. As EHN went to press, the campaigners expressed frustration that schools in England were about to break up for half term and yet there was no help in sight for disadvantaged children, and no plan in place for the Christmas holidays. This has become a high profile issue due to campaigning work by Manchester United striker Marcus Rashford, who himself received free school meals, and was last month awarded an MBE for his work. Some backbench Conservative MPs have also voiced concern over the government’s decision not to act. Campaign coordinator for the Children’s Food Campaign at the Sustain charity, Barbara Crowther, said:

WWW.CIEH.ORG


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Rogue landlords in Liverpool beware

Poor conditions to be addressed by new scheme

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support of these measures, as well as additional recommendations such as using the soft drinks industry levy to invest in healthy food for children, and increasing the value of the Healthy Start food vouchers from £3.10 to £4.25, as in Scotland. Crowther said: “Think about the kind of Christmas we want our children to have this year after the difficulties

and the mental health impacts that all of this has had: worrying about going hungry is something we can fix. That’s why we’re calling on the government to do the right thing.” She added: “The best investment we could possibly make to building back better is to keep our children healthy and to give our children an effective education.”

IVERPOOL’S

fight against rogue landlords could be about to rise from the ashes with a new PRS licensing scheme. The city previously ran a borough-wide scheme for five years, which was unexpectedly denied renewal by the Ministry of Housing, Communities and Local Government in January and came to a close at the end of March. Liverpool mayor Joe Anderson launched a judicial review, which is ongoing. Now the city council is consulting on a new scheme to help tackle poor property conditions. While it won’t be borough wide, the head of private sector housing, Louise Connelly, is confident that if given the green light the new scheme could help deliver much-needed improvements. She said: “It’s so important that people have the opportunity to live in a safe and well-managed house.” Connelly added that the council had recently been

No action taken on rotten roof

involved in temporarily rehousing two single parent families, one where the roof of the property had fallen in, and another where a main drain had disintegrated and was backing up. In both instances, the landlords were refusing to take action. On the latter, she added: “The kids have drawn little pictures of rainbows and put them on the front, urging everyone to ‘stay safe’. And yet when you go through their front door, they’re just living in a slum. “And that’s what got to me; I just thought, ‘these children know no different. They just think this is normal. And, you know, how is that going to be good for their life chances, or anyone’s mental health in there?’ It’s not is it.”

IMPACT OF THE FORMER BOROUGH-WIDE SCHEME

A game of legislative ping-pong is playing out between the Commons and the Lords. The battle is over an amendment to the Agriculture Bill that would protect UK food, environmental and animal welfare standards. The Labour Party is hopeful the government may still agree to protect

standards, as Whitehall is under pressure to get key pieces of legislation passed before the end of the Brexit transition period. One such piece of legislation is the Environment Bill, which has to be enacted in order to set up the Office for Environmental Protection, needed to prevent the UK from entering environmental legislative limbo.

IS ANIMAL WEL FARE PLUCKED?

WWW.CIEH.ORG

3,500

category 1 and 2 hazards discovered

2,500

legal and fixed penalty notices issued

70%

of properties in breach of licence conditions

(ACCORDING TO LIVERPOOL CITY COUNCIL)

UK FOOD STANDARDS AT RISK

Better living in Liverpool

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A BOL D A PPROAC H NEW ZEALAND’S PM, JACINDA ARDERN, HAS BEEN WIDELY PRAISED FOR HER

How a country beat COVID EH chief Tanya Morrison explains how robust measures helped New Zealand tackle the coronavirus pandemic

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EW ZEALAND’S

approach to the COVID-19 pandemic, led by our government, was to go hard and go early. This was arguably a bold approach for such an unknown and evolving global crisis. Four alert levels were developed and New Zealand entered a full lockdown (Level 4) earlier this year. The key message for the weeks that followed was ‘stay home, save lives’ as we attempted to curb the growing number of cases, and limit the impact of COVID-19. A great deal of trust was instilled in any person being asked to self-isolate for 14 days, get tested and complete the daily surveys (via telephone or

email) as part of the contact tracing requirements. On the chance that a person was not truthfully self-isolating, they were referred to the New Zealand Police to enforce. The police were also the lead agency tasked with enforcing lockdown conditions, such as when people’s movements were outside their local area or bubble. The Ministry for Business, Innovation and Employment (MBIE) led on ensuring business trading was following the applicable alert level requirements. In New Zealand, District Health Boards and the Ministry of Health employ health protection officers (HPOs). HPOs, as opposed to environmental health

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Tanya Morrison, national president, New Zealand Institute of Environmental Health

officers (EHOs), were actively involved in contact tracing, border surveillance and COVID-19 management from the beginning, and this work is ongoing. EHOs were called on to assist generally only when case numbers were high and extra support was required. Then local authority EHOs were involved with contact tracing, disease investigation or supervision of disinfection, while others helped at the borders with incoming

passenger surveillance. The contact tracing process worked well overall with confirmed cases, and their potential close casual contacts generally being very cooperative and willing to provide information. Effective contact tracing was key in limiting the spread of COVID-19. Directly after lockdown, many EHOs were busy completing overdue programmed work such as inspections of licensed premises. Several months down the track, we are nationally at alert level 1, and the day in the life of an EHO is the same predominantly as in pre-COVID times.

A longer version of Morrison’s account will be published online in EHN Extra WWW.CIEH.ORG

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LEADERSHIP IN THE PANDEMIC


Is scepticism hindering progress? EHPs have their say over the cost of losing the public’s patience with COVID measures

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second wave of COVID-19 there is a level of public scepticism we didn’t experience in March. EHN wanted to find out why ideas like herd immunity, so at odds with public health practice, had gained some traction and what – if any – impact this is having on EHP work.

YOU R V I EWS

TONY LEWIS

Royal Agricultural University People are looking for hope I guess. And they’re prepared to listen to the siren voices, instead of listening to the scientific voices … when we [EHPs] look at what’s going on in society. It makes us cross because we know that our efforts to control the virus and manage the whole outbreak are being undermined by mixed messaging, poor messaging, and an unwillingness to take the required steps. From an EH point of view, that’s the frustration – we know what needs to be done. It’s not rocket science, it’s not new … test, trace and isolate … we will still be here in a year’s time unless we are prepared to take the measures that we need to.

Look at the Isle of Man. I know it’s tiny, but they have put in place the measures that are necessary. They do treat things harshly but they’ve got it under control. Look at what the Republic of Ireland is doing.

CHRIS ASHFORD

Isle of Man The biggest conflict over here is the difference of opinion between keeping the borders closed, tightening them, or opening them right up. But I think the majority of people are in favour of keeping the borders as they are, or actually strengthening controls. Only residents can travel here but have to self-isolate for two weeks, and key workers coming over have to comply with restrictions.

Everybody else just goes about their normal business. So we’ve had people put in jail – UK workers who’ve come over, and popped into Tesco’s when they should have gone straight into self-isolation. The way that people treat it over here is a lot more serious.

HELEN O’LOUGHLIN

Flintshire, Wales Yes, it is having an impact because you’re having to talk round things more with people: hour long phone calls about the whys and wherefores of them being a contact. Which isn’t helpful at all. Well, don’t forget, case numbers have gone up as well. So you’re having more contact with people about it.

JOHN MACHIN

Nottinghamshire People have had enough. I can’t see how places like Manchester and Liverpool are going to get out of lockdown because it seems to be the only thing that the government knows how to do. If Leicester is anything to go by, it doesn’t work.

JOHN ASHTON

ALICE MOLLON / IKON IMAGES

Former DPH, Liverpool The government has failed to take the public with it, because of the sorts of things we’ve talked about: the breakdown of trust and poor communications, poor examples set – Dominic Cummings and all of that, fiddling with the figures. There’s no trust and you can’t deal properly with something like this without trust. Trust is a big issue in public health, in emergencies in particular. Ashton’s book Blinded by Corona is out now, published by Gibson Square Books.

WWW.CIEH.ORG

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Update, 1

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EHRB CERTIFICATE OF REGISTRATION AWARDS REPRO OP SUBS ART PRODUCTION CLIENT

Ansu Badjie, Wayne Baillie, Oluwafunke Balogun, Edward Banford, James Beeson, Louis Best, Raymond Binya, Jason Bramwell, Sarah Brewer, Lucy Brundell, Arya Dayanandan, Jessie Drysdale, Chantelle Fell-Stanton, Tammy Gardiner, Thomas Gee, Kavitha Gopinath, Wayne Gray, Benjamin Green, Katie Griffiths, Hollie Gwynne, Sophie Harkin, Abbie Hilton, Doreen Katusiime, Abigail Kikta, Josee Laborieux, Heather Landex, Joanna MacEnhill, Aoife Magill, Chantal Martin, Oliver Matthews, Hannah McCartney, Olga Mech, Emily Mills, Elham Moazami-Farahany, Ciara Mooney, Fipa Nindi, Joy Ofremu, Kelechi Ogbonna, Alice Osborn, Gemma Page, Anjana Papnai, Charlotte Pritchard, Jagtar Punia, Adam Rayner, Michele Roberts, Peter Rogers, Deanna Rowley, Silvie Saberi, Laura Salmon, Jacqueline Seroka, Elizabeth Skidmore, Danielle Smith, Derek Smith, Helen Southby Thomas, Sarah Stefano, Miriam Stenning, Paige Stokes, Saman Tabibzadeh-Tehrani, Pamela Taylorson, Kirstin Tranter, Andrew Zielinski.

ONLINE Explore your next career step at www.cieh.org/ professionaldevelopment

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EHP on expert team to solve COVID problems Engineers join forces in pandemic to come up with practical health innovations

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GROUP OF

engineers and a lone EHP have set up a crack team of experts to tackle COVID-19 problems – and environmental health is invited to get involved and help find solutions as well as request help. Professor of biomedical engineering at Keele University, Peter Ogrodnik, first offered his help to the Department of Health at the start of the pandemic but his offer was not taken up. So Ogrodnik – who has spent 30 years in medical device research and development and heads Keele’s master’s in medical engineering design programme – set up his own project to deal with some of the issues raised by COVID-19. Joining forces with the Institution of Engineering Designers he has formed a coalition of volunteers that have since been working on a range of projects, including open source patterns for reusable, non-sterile scrubs with anti-microbial coatings; ways to minimise virus transmission from door handles; face protections for school teachers; and modelling

DATA

BUDGET AND STAFF CUTS

49%

cut in local authority spending on H&S between 2009 and 2019

54%

cut in the number of local authority H&S inspectors

EHP consultant Penny Malone is working on a series of public health films with Ansys, an engineering software firm

hospital wards to minimise risk of transmission. EHP consultant Penny Malone was invited to provide public health expertise and she has been working on a project with engineering software company Ansys to pull together a series of public health films. Malone said: “This initiative created by Peter is a new model

for innovation in healthcare. His aim is for healthcare bodies such as the NHS, care services, the Red Cross, Médicins Sans Frontières – in fact any not-for-profit organisation that impacts healthcare – to come to Eng4Healthcare with a problem that needs solving.”

The charity is also looking for partners that can act as sponsors, and has a fundraising page (justgiving.com/ crowdfunding/eng4nhs). If you want to get involved, or have a public health problem that needs solving, email: penny. dawson-malone@eng4.org.uk

Face coverings for teachers is just one of the engineering group’s projects

£

60%

cut in local authority Trading Standards funding between 2009 and 2018

24%

reduction in FSA staff numbers

51%

cut in FSA funding between 2009 and 2019

(ACCORDING TO DATA FROM CAMPAIGN GROUP UNCHECKED UK)

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Placentophagy VERSION REPRO OP SUBS ART PRODUCTION

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Local authority EHPs have an uneasy relationship with providers of placenta products. Guidance on how to deal with them has been lacking, but this could be about to change as the Food Standards Agency prepares to issue advice BY FAY SCHOPEN ILLUSTRATION BY MICHAEL KIRKHAM

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IM KARDASHIAN

West did it after the birth of her second child; so did her sister Kourtney, who called it “life-changing” in an Instagram post. In Britain, fans include Colleen Rooney and Rochelle Humes. We’re talking placentophagy, aka placenta consumption, usually in the form of pills. The placenta, an organ that provides the growing foetus with oxygen and nutrients in the womb, produces hormones during pregnancy, including oestrogen and progesterone. Proponents are enthusiastic about the benefits that ingesting placenta offers new mothers, saying its hormones, and, importantly, iron, are readily bioavailable, giving new mothers energy and helping them heal faster after birth.

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Other possible benefits include increased milk production and a reduction in postnatal depression. While the scientific evidence is mixed (see page 17), the practice is growing in popularity. Search for the term ‘placenta encapsulation’ on social media, and tens of thousands of images and stories crop up – the majority overwhelmingly positive. Ways of ingesting placenta include raw consumption, usually in smoothies, or simply by being cooked and eaten, but encapsulation, where the placenta is dehydrated – usually after being steamed at 70°C – before being crushed and put into pills has become the most popular form of placentophagy in the UK. One of the best known organisations for practitioner training is the Independent Placenta Encapsulation Network (IPEN). Its director, Donna Taylor,


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Ultimately, how to categorise what placenta product specialists do is an issue for the Food Standards Agency (FSA) rather than individual environmental health officers. Since 2014, the FSA has been considering adding the placenta to its list of novel foods. This would allow the agency to issue clear guidance for local authorities to follow when assessing specialists, something many EH professionals would welcome. As EHN went to press, this decision was imminent. Emily Whittaker, a public protection officer with a local authority in Kent, says she was contacted by a birth doula earlier this year who wanted to register her placenta encapsulation business with the council. She was training with IPEN and had sent a registration for a food business through Whittaker’s authority’s online system.

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“Excellent infection control is needed when handling high-risk products in a home environment”

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Bathing a baby born at home, their umbilical cord still attached

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When Whittaker investigated further she found no consistency. “No two local authorities were the same,” she says. She was concerned, she adds, because providers are almost always making products in their own homes – just one placenta products provider, Placenta Plus in Liverpool, is laboratory-based. Whittaker says a standard of “excellent infection control and structural requirements are needed when handling high-risk products in a home environment.”

DIFFERENT RISKS

Whittaker spoke to officers from two other councils who allowed businesses to trade using a risk assessment approach, based on similar practices to handling raw meat. But this is potentially a problematic approach, she says: “We don’t understand the pathogenic risks in human Cutting by-products in the the cord same way that we do with meat products. A human by-product will carry different pathogenic risks.” These include group B streptococcus. “There are crosscontamination issues as there would be with any food product, but there are other issues too, such as risks of infection from hepatitis, HIV and other blood-borne infections. This is crossing the borders between food safety and clinical infection control,” adds Whittaker. Ultimately, specialist training for officers is lacking, she says. Fully qualified EH professionals who have done meat inspection courses, for example, are trained to look at parts of an animal and assess whether it is healthy. “How many people could look at a placenta and tell you whether it’s healthy or not?” she asks. Carly Lewis helped set up the Placenta Remedies Network (PRN) for placenta remedy providers in 2015, and is currently its acting chairperson. PRN was created, she says, to provide a “gold standard” for specialists to adhere to. Lewis began her career as a birth doula but stopped to focus on remedies in 2014. She began making them in 2013 after seeing the “insanely amazing” difference in one client who took placenta pills after having twins. Lewis, along with birth doula Nikki Mather, has since co-founded PRISM to train and accredit those creating remedies. WWW.CIEH.ORG

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declined to talk to EHN. But both IPEN and a body called Placenta Remedies Support and Training (PRISM), set up in 2018, say the training they give is rigorous, including courses in hazard analysis and critical control point, food hygiene and infection control. Both bodies tell members to register as a food business with their local council. However, it’s an area fraught with misunderstanding and difficulties. In 2014, a court case between Dacorum Borough Council in Hemel Hempstead and the co-founder of IPEN, Lynnea Shrief, ruled in favour of the council – saying the smoothies and capsules Shrief was producing were considered a health risk because she could not guarantee that the cold chain – the handling, storage time and storage temperature of the placenta – was being maintained.


‘IT’S IMPORTANT FOR MUMS TO KNOW WHAT’S OUT THERE’ Ali Dibbins, 28, from Bournemouth, gave birth to daughter Isla in March 2019. After finding out about placenta ingestion from her sister, she opted for encapsulation.

Ali Dibbins and daughter Isla

Anyone wanting to join PRN must undertake training. So far, PRN has 30 members registered with local authorities; of these, 15 have star ratings reflecting their levels of hygiene and standards. The other 15 do not – many councils only give these to businesses where the public enter the premises. PRN is also working with another 12 providers which have contacted their local WWW.CIEH.ORG

authority, and either haven’t heard back, or are going through the process of assessment. The situation is complex: not all councils will assess the businesses in the first place, and some will allow remedies made with steamed and dehydrated placenta, but not raw placenta. For now, Whittaker and the birth doula who contacted her are in limbo. “We’re waiting,” she says, and adds that she is

“I really wanted to breastfeed Isla, and I heard the remedies decreased your chances of postnatal depression – those were my main reasons. “The lady who made my pills came and got my placenta within a couple of hours of my giving birth. I had the pills within two days and I started taking them. It was like taking a vitamin. “It was a really long labour – 49 and a half hours – and it was awful towards the end. I had an episiotomy and Isla was delivered by forceps. “So I was really surprised by my healing; it was pretty quick, and I didn’t have too much postnatal bleeding. My milk

supply was good. These pills are incredible and hardly anyone knows about them. “There was only one person in my area making the pills, so when Isla was 10 months old I started training with PRISM; I qualified at the beginning of this year. I was assessed by my local council and have a five-star rating. The environmental health officer was really open to the idea of placenta encapsulation. “It may not be for everyone, but it’s important for mums to know what’s out there. Yes, the evidence is anecdotal, but I’ve had mums come back to me and say they feel great. Getting that feedback means the world to me.”

open-minded about assessing placenta specialists. “If the consistency is there and we were given clear guidance by the FSA, we would certainly look at changing what we do so that assessment is fair to everybody,” she says. It may be early days for PRISM, but its aim is the same as Whittaker’s: to “get standards up and everybody following safe practices,” says NOVEMBER 2020 / ENVIRONMENTAL HEALTH NEWS 15

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THE SCIENCE BEHIND PLACENTOPHAGY

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The majority of positive evidence is anecdotal. And although experts know broadly what a placenta is composed of, each organ is unique.

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A 2018 literature review by a team from JENA University, published in the German scientific journal Geburtshilfe und Frauenheilkunde [Obstetrics and Gynaecology], looked at evidence from published studies between 1918 and 2018. It stated: “The ingestion of raw or dehydrated placenta could influence postpartum convalescence, lactation, mood and recovery.” While risks from “microbiological contamination and

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the content of potentially toxic trace elements” were considered to be low, the researchers argued that: “Further studies focusing on the bioavailability of the hormones after oral ingestion and their potential physiological effect are necessary to evaluate the use of placental preparations.” Whether or not funding will ever be made available to do this – given that placenta remedies are not a product large drug companies can easily monetise – is another issue.

Lewis. She, along with many campaigners, does not believe the placenta should be classed as a novel food, because it does not fit the criteria. “It’s not a new fad, and dehydration as a way of processing food is not new. It is a nutritional food product,” she says. Lewis lives in Farnham, Surrey, and is accredited by Waverley Borough Council with a five-star food hygiene rating. The council, she says, is “brilliantly supportive”, with her business undergoing an initial rigorous three to four hour inspection process. Following that, a simple audit – provided the process hasn’t changed – follows every two years. “I’ve met with two environmental health officers – and both were new to placenta encapsulation,” Lewis says. “But once they see how strict your processes are, they get it.” She is delighted her hard graft has paid off. “We’ve worked tirelessly to get to the WWW.CIEH.ORG

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“Women should have the choice about what to do during and after their childbirth” point where we know the standards are safe for our clients,” she says.

BENEFICIAL HORMONES

Victoria Mustafa has been a qualified nurse since 2007, and a midwife since 2012. She suffered postnatal depression following the birth of her son in 2013 – and didn’t leave the house for six months. But in 2017, after her second child was born, she took placenta pills. “I took them for a few weeks and assumed they weren’t working, so I stopped,” she says. Within 24 hours, she noticed a difference and felt “down

and tired” again. She resumed the pills and felt better. “I know it’s not a placebo effect,” she says. She is now a part-time placenta remedies specialist herself. Mustafa cites scientific studies, particularly the work of Dr Sophia Johnson from JENA University in Germany, that show the placenta contains beneficial hormones and iron. The bottom line is all about autonomy for women, says Lewis. “Women should have the choice about what to do during and after their childbirth.” “I’m doing this to give back to women,” adds Mustafa. “It absolutely transformed my life, and I want to help others.”

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Feature Placenta encapsulation, 3

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Legal briefing and prosecutions, 1

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The public have been advised to wear face coverings precisely because COVID-19 can be transmitted in saliva

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Assaults on emergency workers and COVID-19 related crime

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Spit and imagine the consequences

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The weaponising of COVID-19 has worrying implications for the work safety of EHPs

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Written by BY JULIE BARRATT

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E ARE ALL FAMILIAR

with the duty contained in the Health and Safety at Work Act that makes employers responsible for the health – both physical and mental – of their employees when at work. In the current COVID-19 pandemic this duty has required a review of precautions and practices put in place to protect enforcement officers who may be visiting premises where there is a potent risk of COVID-19 transmission. Physical distancing, the use of technology and the wearing of PPE are required, all of which should help as long as they are properly implemented. Much more difficult to protect is mental health. There is no doubt that COVID-19 is very frightening. Many employers have thought innovatively to address the fear – wobble rooms, coffee catch-ups online and one-to-one counselling for their staff. Counsellors

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report that the biggest fear for enforcement officers is of introducing infection to their own families, and that many will find ways to avoid doing so, such as living away from their families for extended periods to avoid accidental transmission. A worrying new trend is what the police describe as ‘weaponising COVID’, when an individual claims to be infectious and spits at an officer. In recent weeks offenders have been convicted for spitting at police officers investigating a breach of COVID regulations and a road rage incident, and at a shopkeeper attempting to detain an alleged shoplifter. The sentences ranged from four to 11 months imprisonment. Few would disagree that one individual spitting at another is disgusting – in law it is an assault and can be prosecuted as such. Where the spitter claims to be infected with COVID-19, the stakes are raised considerably.

prosecutions for assaults on emergency workers in first month of lockdown

424

defendants were charged with a coronavirus-related crime

97%

pleaded guilty

19,771

offences charged under the Assaults on Emergency Workers (Offences) Act in its first year

73%

of these were assault by beating SOURCE: CROWN PROSECUTION SERVICE, JAN/MAY 2020

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We know that the virus is transmitted in saliva, so it is entirely reasonable that any enforcement officer who has been spat on by someone claiming to be infectious should be very concerned by the possible outcome. At the beginning of the pandemic it would probably have been a long way from most people’s reasonable anticipation that their COVID-19 risk assessment would have to consider the impact of staff being spat on by individuals claiming to be infectious. Physical steps to be taken in such an event are relatively straightforward. Much more difficult is dealing with the mental health of the affected officer. Whether the spitter is COVID-19 positive or not, the fear that they might be will be very real and, until a test can be carried out to confirm one way or the other, that fear will be acute and debilitating. In such cases officers will need support in the short term until test results are known, and in the longer term too, as the fear of such an incident being repeated might make undertaking further enforcement work impossible. Threatened infection, whether real or false, is happening – we have the evidence that shows it. Employers need to ensure that their COVID-19 risk assessments address both the physical and mental impacts of such an incident, and that actions follow the words.

PRO S ECUT IONS This month’s selection of interesting cases and the lessons learned

A sign atCockroach the Hotter Than Hell to tanningadds saloncrunch in Bradford cookie dough (inset) reads “It’s better to arrivegelato late than pale”

Julie Barratt is an EHP, barrister, trainer (owner of JB Legal Training), author and president-elect of CIEH 20 ENVIRONMENTAL HEALTH NEWS / NOVEMBER 2020

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Flouting of coronavirus restrictions turns up the heat on tanning salon AUTHORITY: Bradford Council DEFENDANTS: Brogan Hayes OUTCOME: £1,000 fine; £250 costs; £75 victim surcharge OFFENCES UNDER: Health Protection (Coronavirus, Restrictions) (England) Regulations 2020

HAD A SUCCESSFUL PROSECUTION? Please tell us about it: email editor@cieh.org

THE STORY When the UK entered into a nationwide lockdown, many non-essential customer-facing businesses, including hairdressers, beauty and tanning salons, were ordered to close their doors from 26 March onwards. However, West Yorkshire Police and members of the public alerted Bradford Council to the illegal trading of a tanning salon in contravention of the coronavirus business closure regulations in force at the time.

in mid-May and noted it still had customers. The Hotter Than Hell salon was served a prohibition notice on 19 May demanding its closure, but the business was still found to be open when the officers visited again on 15 June. On both visits, Ms Hayes was hostile to the officers and was later charged with five offences, becoming the first person in Bradford to be prosecuted under the new coronavirus legislation.

HOW IT PLAYED OUT Following the initial notification in May, the environmental health officers engaged in a graduated approach to enforcement. Preliminary informal approaches included phone calls, emails and a letter to explain the legislative requirements and reasons for closure, but when business owner Brogan Hayes ignored the warnings, officers visited the salon

LESSONS LEARNED EHO Liam Smith said: “Keep a copy of the regulations that were in force at the time of the offence as they change rapidly and it can be difficult to find unamended or repealed ones later. Try to expedite a quick court hearing, otherwise you run the risk that circumstances move on and courts may not see the significance of the offence.” WWW.CIEH.ORG

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Saliva and COVID-19


AUTHORITY: Darlington Council DEFENDANTS: Rebecca Moore; Connor and Michael Thompson OUTCOME (MOORE): £500 fine; £288 costs; £50 victim surcharge OUTCOME (THOMPSON): £220 fines each; £310 costs; £32 victim surcharge OFFENCES UNDER: Anti-social Behaviour, Crime and Policing Act 2014

THE STORY Darlington Council were made aware of two cases of rubbish and household waste building up outside the properties of Rebecca Moore, and Connor and Michael Thompson. HOW IT PLAYED OUT Since March 2019, Miss Moore had received written warnings asking her to dispose of her rubbish in a hygienic manner and ensure her garden in West Auckland Road was kept rubbish free. Despite these warnings, the problem persisted. Similarly, residents at the Thompson residence ignored prior warnings to remove rubbish in their yard on their rented property in Lewes Road. All three defendants were charged with a failure to comply with a Community Protection

Rubbish at the West Auckland Road property contributed to a local rat infestation

Notice issued under Section 43(1) of the Anti-social Behaviour, Crime and Policing Act 2014. LESSONS LEARNED EHO Patrick Chisholm said: “The case at Lewes Road was particularly illuminating. In that instance the landlord of the property appealed against the Community Protection Notice which had been served on him, arguing that he could not be expected to be held responsible for the behaviour of his tenants. “The landlord (who represented himself in the appeal) claimed that he didn’t have the legal basis to

Complaints from local residents led to an inspection

Rubbish dumped outside property acts as the tip-off for an overcrowding problem AUTHORITY: North Lincolnshire Council DEFENDANTS: Javed Khan OUTCOME: £12,000 fine; £2,499 costs OFFENCES UNDER: Housing Act 2004

Waste wasn’t the only issue at the Scunthorpe property

WWW.CIEH.ORG

THE STORY When North Lincolnshire Council received complaints about accumulations of rubbish outside a Scunthorpe property owned by Mr Javed Khan, EH officers became suspicious about the number of occupants living there. They inspected the property and found seven people from five households living in the two-storey terraced house; four bedsits on the first floor, and a single person occupying the ground floor flat. HOW IT PLAYED OUT The layout of the rooms meant that none of the occupants had access to the back yard of the premises, where the bins were kept, which led to waste being dumped in

enter the property and clear away his tenant’s rubbish. The council, using a copy of the landlord’s own tenancy agreement, was able to argue that the landlord did have the legal right to enter the property in order to carry out repairs and maintenance.”

the front yard or else dropped from the first-floor windows. Mr Khan failed to engage with the council throughout the investigation, and later failed to attend a formal PACE interview or appear in court. LESSONS LEARNED From this case, the EH team told us they learned that indiscriminate amounts of household waste seen outside a property can indicate multiple occupancy and other problems. One of the team said:

“This case demonstrates the importance of using good intelligence to focus resources where they are needed most in order to tackle rogue landlords. We know that occupants of houses in multiple occupation are less likely to complain about their housing conditions, so other lines of evidence, such as waste build-up or noise nuisance, can be a good indicator of other concerns. Often these relate to overcrowding and poor housing conditions which require further investigation and enforcement.” NOVEMBER 2020 / ENVIRONMENTAL HEALTH NEWS 21

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Legal briefing and prosecutions, 2

Two tenants ignore repeated warnings to clean up the mess in their own backyards


YOUR VERSION

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Ever-changing COVID-19 restrictions are pushing many hospitality businesses to the brink and morale is low in the sector

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9 T H I NGS …

We learned from October’s CIEH Food Safety Conference The current challenges affecting practice and policy herald more turbulent times to come

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ATE THOMPSON,

director of CIEH Wales, welcomed delegates with the words: “How things have changed, my oh my.” This sentiment was borne out over 12 sessions that covered a wide range of issues from primary authorities to eating insects, against a backdrop of uncertainty, change and cutbacks. The key takeaway was that there have been a multitude of challenges to food safety during the pandemic that have affected current practice and that will have an impact on future policies. And, with Brexit around the corner, we’d all better buckle up for a bumpy ride. 22 ENVIRONMENTAL HEALTH NEWS / NOVEMBER 2020

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1. CONFUSION REIGNS IN THE HOSPITALITY SECTOR There was an appeal for sensitivity when dealing with the hospitality sector, where optimism is at an all-time low and people who have spent 25 years building up their business are facing ruin. “It’s hard to know what’s going on,” said Dr Lisa Ackerley, food safety adviser for UKHospitality. “Any answer we give today might be out of date by 4pm the same afternoon. The guidance is often last-minute and legislation might follow some hours behind an announcement. It’s a period of great uncertainty.”

She advised delegates to look at guidance, the legislation and the UKHospitality FAQs every day before taking any action. See www. ukhospitality.org.uk/page/FAQs

2. FOOD LABELLING POSES A FRAUD RISK Fraud is a big issue, said Dr Ackerley. “Unfortunately, lots of fraudsters are taking advantage of cheap, rubbish food and selling it on as something it isn’t. People will say they’ll never eat something unless it’s been produced in certain welfare conditions – but most of the time you don’t know because of the way labelling is done. WWW.CIEH.ORG


“As soon as something comes into the country it can be made into another product and it becomes British. The consumer doesn’t know where it comes from unless the supplier chooses to tell them its exact provenance.”

3. JUST EAT PLANS TO DELIVER ON FOOD SAFETY COVID hasn’t been a disaster for everyone. Food delivery platform Just Eat, for example, is now the world’s largest online marketplace for food outside China. Steven Glass, global head of food safety at Just Eat, says the company is employing more delivery drivers (rather than relying on restaurant staff or the self-employed) to make COVID-compliance easier. The company has also introduced contact-free deliveries, supplies free PPE and is mid-way through its plan to improve food-hygiene ratings in partner restaurants.

4. WE NEED TO PREPARE FOR EATING INSECTS

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Professor Gideon Henderson, chief scientific adviser at Defra, cautioned that it’s vital to think about our food supply from an environmental point of view. “What are the big levers we can pull on for an increase in biodiversity and a substantive decrease in greenhouse gas emissions from agriculture and food production?” he asked. “We need to think about some brave moves,” he added. “For example, moving a lot of our cows – and more of our crops – indoors. Also, thinking about alternative sources of protein, such as insects, yeasts and fungi as we move to having less dependence on meat.”

Insects are a good source of protein WWW.CIEH.ORG

5. SAGE ADVICE ON FOOD FRAUD Organised crime is playing a bigger role in our global food supply system, warned Professor Chris Elliott of the Institute for Global Food Security, Queen’s University, Belfast. What types of food? From salt to saffron, he said, essentially everything, from the cheapest to the most expensive ingredients. One that he highlighted as rife in the UK is the humble sage. “One tonne of sage is worth five times more than the equivalent in prime beef. It’s quite difficult to cheat in meat, but adulteration in sage goes up to 50%, so people are making an extra £60,000 per tonne. It’s a very good way to make a fortune,” he said.

6. INLAND EHPS WILL HAVE A ROLE TO PLAY IN IMPORTED FOOD POST BREXIT Brexit will herald the biggest shake-up in imported food controls in decades and, according to Helen Buckingham, regulatory consultant at OneResolution, inland EHPs offer a vital second line of defence. “Imported food work that’s done inland is about verification: should this be here, is there any paperwork, can you obtain it? The chances are that any queries will be more about labelling than food safety. My advice is to ask questions: What is it, where’s it from, what do you do with it – do you chew it, do you eat it? “If you find something locally you don’t think is right, make notes, take photos and tell your local border control post – they’ll look out for it and might be able to stop it entering the country.”

7. THE DIRECTOR OF CIEH WALES HAS BEEN MISTAKEN FOR AN IMMIGRATION OFFICER This admission from Kate Thompson came after Home Office speakers stressed that illegal working tends to go hand in hand with other breaches. EHOs can report any immigration concerns at www.gov. uk/report-immigration-crime. You should also look for signs of modern slavery. Are people being vague and evasive about their living and working arrangements? Do workers look malnourished,

Artisan foods are potentially high risk

unkempt or appear withdrawn? Are they afraid of you? Are their working or living conditions overcrowded or unsanitary? If you have concerns, contact the police.

8. ARTISAN FOOD MANUFACTURERS OFFER A CHALLENGING ENVIRONMENT Food safety specialist Dr Belinda Stuart-Moonlight told delegates that artisan food production offers a unique challenge to regulators. “There are a lot of slow, natural processes and food is produced in a non-industrialised way – but it is potentially high risk. Production is often experimental and intuitive and it can be difficult to write critical control points.” There are also difficulties when it comes to determining authenticity of ‘Whitstable oysters’ or ‘Iberico ham’, for example, and allergens are frequently a concern.

9. LOW FHRS RATINGS LEAD TO IMPROVEMENT IN WALES Dr Panos Panagiotopoulos, senior lecturer in information management, Queen Mary University of London, has analysed the statistics relating to food hygiene ratings and come up with a surprising find. In England, a low score (0-2) is statistically more likely to result in a subsequent low score in the next inspection, whereas in Wales it’s likely to result in a higher than average score next time. Is this because the revisit policy is applied more strictly in Wales?

In partnership with

Key sponsor

Sponsors

To sign up for future CIEH conferences and events, please visit www.cieh.org/events NOVEMBER 2020 / ENVIRONMENTAL HEALTH NEWS 23

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Morecambe offers Chris Whitty some wise advice

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When EHP Fiona Inston realised she was going to have the undivided attention of the chief medical officer of England for an hour, she made sure she didn’t waste the opportunity t was a stunning day when Chris Whitty, England’s chief medical officer, came to visit in September. He was in the area to look at coastal towns and the impact of health challenges and deprivation. He’d been in Blackpool in the morning and in the afternoon he came to Morecambe. I got a heads-up a few days previously that I’d have some time with him. In the end I had about an hour. We did a

I

From left: Yak Patel, CEO of Lancaster District Community & Voluntary Solutions; Fiona Inston, head of public protection at Lancaster City Council; Chris Whitty, chief medical officer for England

32 ENVIRONMENTAL HEALTH NEWS / NOVEMBER 2020

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walk through some of our communities and went to our community food hub where there’s a food bank, talking through some of our challenges – but also showing him our fantastic buildings and the view over to the Lakes. Naturally I bent his ear – nicely – about COVID-19 and how we’ve dealt with it. But my real interest is in a holistic overview of public health so I wanted to show him how we work with partners to tackle health inequalities locally. We had a look at life in Morecambe, including

SPREAD THE WORD Don’t underestimate 1 the importance of the profession. EH is a diverse area and other people are truly interested in hearing about the role and how it supports the wider determinants of health. TRUST YOUR OPINIONS It is important not 2 to be fearful of raising ideas which may not conform with the national vision. Your experiences and opinions are valid. These conversation can trigger wider discussions.

Home-Start and some of the early years local charities. We talked about adverse childhood experiences and food poverty, our youth work, some of the challenges around a population health approach, and about working with the Clinical Commissioning Group and the integrated care community. Whitty had a real interest in our work. He was really switched on to the challenges on the ground. He was interested in how I got into this job, so I explained to him my degree in EH and a bit about the challenges around retaining people in the profession and how it doesn’t have the profile it should have. I’m not sure he really knew much about EH before our conversation. I followed up the visit with an email containing some recommendations on how government could help EH officers to increase standards to protect the public, such as COVID measures becoming legislation rather than guidance, and creating powers for immediate closure based on imminent risk. The chief medical officer forwarded it to the Cabinet Office, saying what I’d said was “extremely sensible” and “this seems an open goal to me” – so I feel that was really good in terms of advocating EH. We have a really important role. We need to take the opportunities to trumpet EH where we can.

Fiona Inston is head of public protection at Lancaster City Council

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Front Line Fiona Inston, 1

L EAR N I NG POI N T S DO YOU HAVE A TALE TO SHARE? Email editor@cieh.org

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Good community work brings the sunshine to Morecambe