Vol 29 - Number 4 Winter 2017 - REHIS Journal 2017.pdf · THE ENGINE SHED, STIRLING The Engine Shed, Stirling. Photograph courtesy of Historic Environment Scotland. ... John Merrylees

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The Royal Environmental Health Institute of Scotland19 Torphichen Street, Edinburgh, EH3 8HXTel: 0131 229 2968 Fax: 0131 228 2926 Website: www.rehis.com

Officers of the InstitutePresident: Lorrainne MacGillivray

Senior Vice-President: David DuffyPast President: Drew HallNorthern Centre Chairman: Bob DrummondNorthern Centre Secretary: Louise CunninghamHonorary Treasurer: Martin Henry

Junior Vice-President: Lisa McCannPast President: Emeritus Professor Kofi Aidoo Southern Centre Chairman: Pat Hoey Southern Centre Secretary: Gwyneth HeaneyCourses Co-ordinator: Martin Keeley

Chief Executive: Tom BellDirector of Professional Development: John Sleith Training Adviser: Dr Jane Bunting

Director of Training: Jackie McCabeTraining Adviser: Raymond Hubbocks

Members of CouncilWendy BarriePaul BradleyGordon BrownAndrew CampbellLouise CunninghamBernard ForteathChristine FraserSusan GeddesKaren Keeley

Gwyneth HeaneySarah MacLeod-BonnarLisa McCannJan MillerChristine MorrisonJohn MurraySheena RedmondColin Wallace

Honorary Vice-PresidentsGeorge GeorgallasKenneth Gibson MSPKenneth Macintosh MSP Stewart Maxwell

Ann Marie PartYoung Samanyika John Scott MSP Dr Jim Smith

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The Journal of The Royal Environmental Health Institute of Scotland

Volume 29, Number 4 Winter 2017

ISSN 0950-3277

Environmental Health Scotland is published by the Council of The Royal Environmental Health Institute of Scotland.

Editor: Tom Bell

The views expressed in this Journal are not necessarily those of The Royal Environmental Health Institute of Scotland, the publisher or the editor. Articles, news items or letters are welcomed for publication but the publisher reserves the right to edit contributions as the editor sees fit. At the editor’s discretion, items submitted for publication will be peer reviewed. All material is submitted at owner’s risk. The publisher cannot be held responsible for loss or damage, however caused.

Copyright: All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher and copyright holder.

CONTENTSThe President’s View 4

Annual Environmental Health Forum 2018 5

Annual Awards Ceremony 2017 6

Examinations and Professional Standards Committee 13

Norovirus Revisited 14

Food Matters 16

Scottish Food Safety Officers’ Registration Board 17

Health and Safety Matters 18

A New Joint Award 20

Scottish Pollution Control Co-ordinating Committee 21

Public Health Microbiology: A Change in Culture? 22

Signing of New REHIS Joint Award 23

Southern Centre Training Event 24

Plan Ahead for Flooding 26

Annual Presenters’ Update Seminar 27

HACCP Implementation in NHS Highland Hospitals 28

Poor...and still paying for it! 31

Mesothelioma Deaths in Teachers and Nurses in Great Britain 35

News in brief 38

On the cover: Drew Hall presents Lorrainne MacGillivray with the President’s Chain of Office.


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To be elected as President of the Institute at its Annual General Meeting on 17 November 2017 is by far the greatest honour and privilege of my professional career to date and I am immensely grateful for the support and trust you have vested in me. Having been a member of the Institute throughout the 25 years I have worked in Local Government I have been fortunate to get to know and work with many former Presidents and I think it is fair to say that I have some big boots to fill. I will do my very best to represent you all and ensure that the Profession and Institute are rightly recognised for the vital and important role we all play in protecting and improving Scotland’s health and well being.

We are already facing uncertainty for the year ahead particularly surrounding Brexit and the financial pressures facing us all. We need to be ready to respond to these and I am confident that our existing strong and effective partnerships will put us in a good position to deliver on any challenges that we are presented with.

I hope to be able to build on the excellent work that has begun in relation to the review of Public Health in Scotland during my year in office. Through our work, in partnership with the Society of Chief Officers of Environmental Health in Scotland, we hope to continue to raise the profile of the Profession at both Scottish Parliament and Scottish Government level and play an active role in setting the public health priorities for Scotland.

The newly established Workforce Strategy Group aims to fully consider the issues facing the profession given the ageing profile of the Environmental Health workforce and the reduction in numbers of those entering it. It is hoped that this work will result in encouraging greater numbers into the Profession to what, at times, is a challenging career but nonetheless one which is highly rewarding and enables us all to clearly demonstrate the difference we make to public health and wellbeing.

I would like to congratulate Drew Hall on what has been a very successful year in office for him and for the support and guidance he has provided me with during the last two years as Junior and Senior Vice-President.

I would also like to acknowledge the exceptional work undertaken throughout the year by all the staff in the REHIS office, to everyone that is involved with our Committees and Working Groups, to the work of both the Northern and Southern Centres to support the membership, to the excellent work of our Approved Training Centres delivering our community training programme and to you all as members for your continued contribution and support.

Finally, I wish you all the very best for 2018 and I look forward to meeting and working with as many of you as I can.

THE PRESIDENT’S VIEWby Lorrainne MacGillivray, President

Lorrainne MacGillivray.


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REHIS ANNUAL ENVIRONMENTAL HEALTH FORUM‘ENVIRONMENTAL HEALTH: PROVIDING A SUSTAINABLE FUTURE’

25/26 APRIL 2018

THE ENGINE SHED, STIRLING

The Engine Shed, Stirling.

Photograph courtesy of Historic Environment Scotland.

The REHIS Annual Environmental Health Forum provides all Environmental Health Professionals, wherever they work, with the opportunity to maintain their knowledge, skills and competence.

The 2018 Forum with the theme ‘Environmental Health: Providing a Sustainable Future’ will consist of a full day plenary session (Wednesday 25 April) and a morning only session (Thursday 26 April). The plenary session will cover a wide range of topical presentations relevant to professionals operating at all levels with their organisations. The workshop sessions will cover Food Safety and Food Standards; Occupational Health and Safety; Public Health and Housing; and Pollution Control and Environmental Protection.

Delegate prices have again been held at 2015 levels to encourage attendance from anyone with an interest in Environmental Health including Environmental Health Officers, Food Safety Officers, Technical Support Staff and Registered Course Presenters from REHIS Approved Training Centres.

The venue, The Engine Shed, Forthside Way, Stirling is adjacent to Stirling train station. Direct train services from Edinburgh take around 50 minutes; from Glasgow around 25 minutes; from Aberdeen around 2 hours; and from Inverness around 2 hours 45 minutes.

The Institute’s President, Lorrainne MacGillivray, looks forward to welcoming you!


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REHIS ANNUAL AWARDS CEREMONY 2017

Award for Meritorious Endeavours in Environmental Health

• Professor George P. Morris

REHIS Diploma in Environmental Health

• Beatrice Aitken

• Kirsty Campbell Cheape

• Sarah Coyle

• Courtney Jack Craig

• Maureen Craig

• Barry Cumming

• Michael Hayes

• Alice Gordon MacLaren

• Emma Clare Mayes

• Sharon Catherine McCormack

• Craig Douglas Myles

• Nicola Paton

• Carole Ray

• Fraser Smith

SFSORB Higher Certificate in Food Premises Inspection

• Gurhazara Singh

SFSORB Higher Certificate in Food Standards Inspection

• Geoffrey Brewis

• Alan Brown

• Patricia Connor

• Karen Gunn

• Gillian McLean

Alistair Orr Award for the Best Final Year Student at the University of the West of Scotland

• Rhuairdhri Magee

John Merrylees Award for the Best Final Year Project at the University of the West of Scotland

• Kerri Milne

A M M Connell Award for the Best Student at the REHIS Professional Examination

• Fraser Smith

Iain McDonald Award for the Best EHO Student in the Occupational Health and Safety Programme Area at the REHIS Professional Examination

• Beatrice Aitken

Food Standards Scotland Award for the Best Candidate in the Food Safety Programme Area at the REHIS Professional Examination

• Alice Gordon MacLaren

Food Standards Scotland Award for the Best Candidate in the Food Standards Programme Area at the REHIS Professional Examination

• Fraser Smith

Health Protection Scotland Award for the Best Environmental Health Officer Student in the Public Health/Built Environment Programme Area at the REHIS Professional Examination

• Maureen Craig

Charlie Penman Award for the Best Environmental Health Officer Student in the Pollution Control/Waste Management Programme Area at the REHIS Professional Examination

• Emma Clare Mayes

The President’s Award

• Fife Community Food Project


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Highfield Award for Advanced Food Hygiene

• Julie Kilbride Winner

• Blanka Bolcarova Runner-up

• Fiona Lemmon Runner-up

Highfield Award for Intermediate Food Hygiene

• Kerri Jewett Joint Winner

• Susan Nicol Joint Winner

• Subrina Murray Runner-up

• Lesley Peters Runner-up

Highfield Award for Intermediate Health and Safety

• Karen Fraser Winner

• Andrea Henderson Runner-up

• Debbie Swan Runner-up

Highfield Award for Intermediate HACCP Practices

• James Aitken Winner

• Steve Mackie Runner-up

Lorrainne MacGillivray, Senior Vice-President offers her congratulations to recipients and thanks to sponsors of the awards.

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REHIS ANNUAL AWARDS CEREMONY 2017MERITORIOUS ENDEAVOURS IN ENVIRONMENTAL HEALTH AWARD

Professor George P. Morris receiving his award from President Drew Hall.

The recipient of the REHIS Meritorious Endeavours in Environmental Health Award for 2017 is Professor George P. Morris.

George Morris was born in Ayrshire in 1953 and joined Ayr County Council’s Garnock Valley district as a Trainee Sanitary Inspector in 1971. He qualified in 1976 before attending the University of Strathclyde where he was awarded an Honours Degree in Environmental Health in 1978. George was transferred to the new Cunninghame District Council (later to become North Ayrshire) where he worked as a Senior Environmental Health officer in the Garnock Valley and the ‘3 Towns & Arran Area’ offices. In 1984 George moved to his first academic post as a Lecturer in Environmental Health at the University of Strathclyde and later at Glasgow University. Many in the Profession will have been greatly influenced by George in their formative years.

In 1994 George was appointed Consultant in Environmental Health with the Scottish Centre for Infection and Environmental Health as well as Visiting Professor in Environmental Health at the University of Strathclyde. George has published widely with a particular focus on his primary research interest of indoor air quality and health. George has extensive experience as a teacher and examiner and was awarded a PhD degree in 2000.

During 17 years of NHS service he worked in the fields of health protection and health improvement.

A five-year secondment as a Science Policy Adviser with the Scottish Government between 2004 and

2009 gave George the opportunity to initiate and lead a new national policy approach to environment and human health. ‘Good Places, Better Health’ and the development of the modified DEPSEA model were driven by him.

George holds Fellowships of the UK Faculty of Public Health and the Royal Environmental Health Institute of Scotland and is currently an Honorary Professor at the University of Exeter.

George now works independently with a focus on navigating complexity in environmental public health and overcoming the challenges of building population health on ecological principles. He is involved in projects across the UK and internationally, and has published widely on the topic of environmental health. He is currently an advisor on environment and human health to the World Health Organisation. He continues to work with a variety of clients on environmental health, increasingly on ecological public health issues. These include the European Environmental Agency and the Dutch Public Health and Environment Institute.

George continues to inspire Environmental Health and Public Health Professionals.

George has been a member and Fellow of the Institute for many years and he is very much one of our own.

The Meritorious Endeavours in EH Award is presented annually at the Annual Awards Ceremony in November to an individual or organisation who has/which has significantly contributed to the improvement and protection of health and well-being in Scotland and/or overseas.


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Drew Hall, Colin Wallace and John Sleith with recipients of the Institute’s Diploma in Environmental Health.

Rhuairdhri Magee recipient of the Alistair Orr Award with Drew Hall.

Kerri Milne recipient of the John Merrylees Award with Drew Hall.


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Fraser Smith recipient of the Food Standards Scotland Food Standards Award with Drew Hall and

Ian McWatt of Food Standards Scotland.

Alice MacLaren recipient of the Food Standards Scotland Food Safety Award with Drew Hall and

Ian McWatt of Food Standards Scotland.

Maureen Craig recipient of the Health Protection Scotland Award with Drew Hall and Kate Harley of

Health Protection Scotland.

Emma Mayes recipient of the Charlie Penman Award with Drew Hall.

Fraser Smith recipient of the AMM Connell Award with Drew Hall.

Beatrice Aitken recipient of the Iain McDonald Award with Drew Hall.


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Drew Hall, Jackie McCabe and Dan McDade of Highfield International Limited with Highfield Award recipients and REHIS Approved Training Centre representatives.

Drew Hall, Colin Wallace and John Sleith with recipients of the Scottish Food Safety Officers’ Registration Board Higher Certificates.


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REHIS ANNUAL AWARDS CEREMONY 2017PRESIDENT’S AWARD

The recipient of the President’s Award for 2017 is Fife Community Food Project.

Fife Community Food Project (FCFP) develops and supports food initiatives with vulnerable groups and communities across Fife, with the aim of:

• Developing confidence, skills and knowledge among local people.

• Increasing access to affordable healthy food.

• Building capacity to sustain food activities across Fife.

The Project is made possible through the support of volunteers, partners and funders, which include NHS Fife and Fife Council.

They work in partnership to support, plan or deliver affordable healthy eating programmes and food budgeting workshops. They offer training support for learners, staff and volunteers including:

• REHIS Elementary Food Hygiene

• REHIS Elementary Food and Health

• REHIS Elementary Cooking Skills.

Since becoming a REHIS Approved Training Centre in 2011, 2,232 candidates have achieved REHIS qualifications through the project.

People gaining qualifications are mainly those who are already being supported by FCFP’s partner agencies. These agencies recognise that diet, food and health issues are important, and that there is an opportunity to use food as a medium in which to engage people, assisting with broader aims of building confidence, social and life skills among participants.

The President’s Award is presented annually to an individual or organisation who has/which has significantly contributed to the improvement and protection of health and well-being in Scotland through their/its activities in the Institute’s Community Training activities.

Catherine Nugent and Ian Anderson from Fife Community Food with President Drew Hall.


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EXAMINATIONS AND PROFESSIONAL STANDARDS COMMITTEEby Colin Wallace, Chairman

At the last meeting of the Committee on 22 November 2017 I was re-elected as Chairman together with Sheena Redmond and Karen Keeley elected as Vice Chairs.

Professional Examination Diets

Following the Council’s decision to reduce the number of examination diets from two to one each year and to shift the month from October to May, representations were received from two local authorities regarding concerns in relation to the potential logistical impact on recruitment and training of officers. The Committee considered a report from the Director of Professional Development which outlined these concerns and reaffirmed the decision regarding the reduction of diets from two to one which had originally been made due to financial considerations because of diminishing numbers presenting. Nevertheless, to assist several local authorities in accommodating contractual commitments the Committee agreed to recommend to Council that the single diet be held with effect from October 2019.

A further late representation was received from another local authority highlighting difficulties in practical training of Food Safety Officers (FSOs) pursuing the Scottish Food Safety Officers’ Registration Board’s Higher Certificate in Food Standards Inspection required to enable FSOs to fully comply with the introduction in 2019 of the requirement for combined food safety/food standards inspections. This matter was considered at the Council meeting in December 2017 where it was noted that the decision to introduce combined inspections was not a recent one and many Food Safety Officers had been registered for a considerable time. However, despite the uncertainty as to how this situation may have arisen, and to assist any local authorities in a similar position the Council agreed that a re-sit only diet planned for January/February 2019 should be extended to include an examination for the Food Standards programme area. The Council also agreed that this must be cost neutral to the Institute and therefore the expenditure for delivery of the additional examination will be shared between the local authorities presenting. Forward planning will be overseen by the Director of Professional Development in relation to demand.

Accredited Environmental Health Academic Qualifications

An enquiry has been received from an academic

institution expressing an interest in delivering an MSc in Environmental Health and has requested a copy of the curricular requirements. As the Core Curriculum has not been reviewed for a few years the Committee felt that a review was overdue and agreed to undertake one.

The University of the West of Scotland are considering embarking on a joint venture with the University of the Seychelles which may result in the award of a BSc (Hons) degree in Environmental Health and had requested that the Institute accredit the delivery of the course in the Seychelles. As the Institute cannot endorse the accreditation of the course delivery in the Seychelles it was agreed to support the course in any way it can and recognise that it provides the necessary education required to underpin the practical training of Environmental Health Officers in the Seychelles.

Continuing Professional Development Scheme

The Director of Professional Development’s article on page 15 of this Journal will assist members with the maintenance of their Chartered status through submission of a substantive report, the deadline for which, in this current 3-year period, is 31 January 2018.

European Professional Qualifications Directive

The Institute is a competent authority to determine applications in terms of the European Communities (Recognition of Professional Qualifications) Regulations 2015. An application has been received from an Environmental Health Officer in Greece. The Committee noted that this will be processed in accordance with the prescribed assessment procedure and the cost involved will be in accordance with the previously agreed fee structure.

The committee has responsibility for:

• matters regarding university degree courses teaching which give entry to the Scheme of Professional Practice;

• all matters relating to the Scheme of Professional Practice;

• the Professional Examination;

• CPD Scheme of Monitoring; and

• Disciplinary Procedures and Code of Professional Conduct Compliance.


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As always at this time of the year in the UK we expect to hear about a number of Norovirus outbreaks associated with establishments such as hospitals, nursing homes and schools. However, the high profile outbreak in London last August which affected athletes competing in the World Athletics Championship brings into sharp focus the fact that although often referred to as the “winter vomiting disease”, Norovirus is a bug for all seasons and myriads venues!

As one who has the responsibility for visiting REHIS Approved Training Centres in an advisory capacity I am sometimes made aware that people are surprised at the fact that food, its handlers and premises can be responsible for the source and transmission of the virus.

Writing at the time of the outbreak last August, Michael Roberts, BBC Health Correspondent, correctly said :“If an infected person doesn’t wash their hands before handling food or touching objects and surfaces that you touch there is a good chance you could get sick too.”

Having reviewed research carried out for a number of organisations including the Food Standards Agency and Emory University, Atlanta, I wish to “revisit” Norovirus as a potential food borne pathogen, dividing this report into three sections.

Its nature

• Highly infectious – typically around 10 million particles may be shed in a bout of sickness with millions of particles found in 1 gram of faecal matter. Vomiting is projectile with particles able to travel up to 9 metres.

• Relatively small numbers required to cause illness.

• Very difficult to confirm possible cases and there may be 1 million cases of Norovirus per year in the UK.

• Symptoms include vomiting, diarrhea, nausea and stomach cramps.

• Person to person spread is highly likely.

• Largely unaffected by freezing, brine solutions or vinegar.

• Unlike most bacterial pathogens Norovirus can cope with cold conditions.

• Asymptomatic infections are common.

• It may survive up to 12 days on unwashed surfaces.

• Widespread host susceptibility.

• Cannot grow, although may survive, outside the host.

• Symptoms typically last 24 to 72 hours.

• Foods involved include salads, cut and soft fruits, shellfish, sandwiches, deli meats and ice.

Potential problems

• Food may be contaminated during growing through soil contact, irrigation or by handlers’ hands or contact equipment.

• Can be introduced at the processing stage by hands, contaminated water or ice.

• Soiled and contaminated clothing may be used as a vehicle.

• General inadequate hand washing by the food handler and failing to wash hands before wearing disposable gloves.

• Not washing protective clothing effectively.

• Food handlers cleaning up areas where an episode of vomiting had taken place.

• Cross contamination due to the failure to clean premises and equipment effectively

• Poorly designed food premises.

• Inadequate washing of foods which may arrive at food premises already contaminated

• Using disreputable suppliers.

• Food handlers not regularly changing gloves.

• Lack of awareness and poor practices by staff due to ignorance, poor training and lack of effective supervision.

• Poor personal hygiene facilities offered by employers.

• Food handling staff returning to food handling duties too soon after having had an outbreak of gastroenteritis.

• Using unwashed hands while preparing food.

NOROVIRUS REVISITEDby Raymond Hubbocks, REHIS Training Adviser


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Its control

• The effective selection, training and supervision of all food handlers. Levels of training should be commensurate with the work activity.

• Consistently high standards of personal hygiene demonstrated by all food handlers to include the wearing of clean protective clothing, effective hand washing and reporting of illnesses as identified in the FSA Food Handlers Fitness to Work Guide. The use of gloves for food handling should be thoughtfully and strictly managed to ensure they do not become a physical contaminant or microbiological vehicle.

• All Food Premises to have a Food Safety Management System based on the principles of HACCP.

• Effective design and construction of food utensils and premises which takes account of “workflow”, adequate space, ease of cleaning and facilities which allow effective personal hygiene to take place. This layout would also provide enough suitable facilities for the washing of “ready to eat raw” foods if necessary and sinks/wash hand basins

strategically positioned to ensure their effective use.

• Specialist cleaning staff to be deployed in the event of sickness within the food preparation and service area.

• Careful separation of foodstuffs during preparation and storage with relevant time/temperature formulas used when cooking.

• Careful selection of suppliers for all aspects of the food business.

According to statistics published by Health Protection Scotland the average number of cases of Norovirus over the past 10 years is approximately 2,032. However this figure would be the proverbial “tip of the iceberg” as most cases go unreported.

Foodborne transmission of Norovirus will always be with us. I trust that this report will prove helpful in raising awareness and result in fewer cases in the future.

Further information and guidance to prevent Norovirus infection can be found on the Health Protection Scotland website.

ATTENTION EHO MEMBERS

A reminder to members that 2017 CPD returns should now be with the REHIS office for scrutiny. For those wishing to retain Chartered Status or who are progressing towards it, the deadline for doing a written submission and providing CPD records for 2017 is 31 January 2018. Entries must be signed and corroborated by a senior colleague or by supporting evidence. Further details

are available on the website or from the Institute’s office.

Deadline for 2017 CPD submissions is 31 January 2018.

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FOOD MATTERS

Food is at the centre of being. Without it, life outcomes are poor. When our access to food is well regulated and balanced then we thrive and when our management of food is lacking, we suffer unintended consequence. Food matters are in the conversations taking place across the world, at Brexit meetings in Europe and at home and our health and wellbeing and indeed, our economy is heavily dependent on the regulated, protected supply of safe food to citizens wherever they find themselves.

The Scottish food and drink sector is already worth more than £14 billion annually and it’s still growing. The sector has a worldwide reputation for assured quality and safety standards and trades high on that reputation. Environmental Health Professionals in Scotland, working across sectors, deliver the core of the regulatory protective measures and assurance activities that not only support the sector but critically protect public health at the same time.

Supporting the sector through measured regulation, research, science and evidence is part of the Scottish system. Each local authority Food Authority is represented in its region on a liaison group, which in turn is represented on the Scottish Food Enforcement Liaison Committee (SFELC) where regulators and stakeholders share views and work together, producing outputs that benefit Scotland’s citizens. Recognising that food has an international flavour, Environmental Health and other Public Health Professionals come together at the Food Law Enforcement Practitioners Forum (FLEP), working with European colleagues to harmonise standards and give a consistent protective measure to the food chain.

Scottish Food Enforcement Liaison Committee (SFELC)

The SFELC winter 2017 meeting was held in Dundee on December 8. The meeting was preceded by a workshop on the new Scottish Government Diet and Obesity Strategy, ‘A Healthier Future - Action and Ambitions on Diet, Activity and Healthy Weight’. Given the complexity of interactions of diet and activity on health outcomes for citizens and the national impact of poor health related to diet and obesity, SFELC will naturally consider the outputs and workshop discussions and look at the way forward for SFELC in improving Scotland’s relationship with food intake and its future health and wellbeing.

Supporting the food chain, its regulatory matrix and its

integrity is an ongoing theme for SFELC. Discussion themes include regulatory strategy, sampling strategy, metrics for measuring and evidencing the value of regulation and regulatory finance.

SFELC is supported by a number of working groups and subgroups and the progress of these will be reported upon in future journal articles including review and delivery of the Food Law Code of Practice.

Training Matters

The Institute’s Community Training activities deliver training and qualifications for people in all the communities of Scotland and in some cases, much further afield. Finding a community training provider is as simple as accessing the REHIS website at www.rehis.com.

In addition to community training, professional training is delivered by REHIS throughout the year. The Food Update course was held on 21st October in Edinburgh at the Holiday Inn Corstorphine and was well received, delivering sessions on quality in production and manufacture, sampling, regulatory strategy and also a session on novel food regulation. Further professional courses and updates will be available in 2018 along with free-to-members seminars and events provided by the REHIS Southern and Northern Centres. REHIS Members can view the REHIS website events section at rehis.com/events/rehis-events.

Food Law Enforcement Practitioners (FLEP) Forum

Food supplement regulation is a complex issue with standards that are yet to be harmonised across Europe. It is a huge market with a growing proportion of trade being delivered online. The approach to regulation varies from EU member state to member state. To highlight some of the issues, share better ways of working and offer improvement and learning opportunities, FLEP delivered a workshop on Official Control of Food Supplements in November in Brussels, hosted by the Belgian Food Safety Agency at their offices near the Botanical Gardens.

The two-day event brought together Official Control Agencies, scientists and contributions from a producer to discuss issues and current standards. Issues such as risk assessment developments, risk management challenges, negative side effects, maximum and minimum levels, challenges in analysis, borderline products and the challenges of official control were

by Martin Keeley, member of REHIS Council with responsibility for food safety and food standards matters


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worked through. Developments in e-commerce were presented on, with the European Commission advising on the co-ordinated control programme of e-commerce and official controls on food supplements. The event highlighted the coming changes to powers for member states to regulate the growing online market and protect consumers in the market place. A summary of the outputs from the event will be provided to the Heads

of European Food Safety Agencies (HoA).

Further meetings of the FLEP Steering Group will be convened to take forward the recommendations from the workshop groups and outputs of the FLEP Working Groups and arrange for the work streams to be progressed. Planning by the steering committee will begin on the future workshops for FLEP.

Higher Certificates in Official Control

The Board heard that there has been little uptake and interest generated in relation to this qualification. It was agreed that the Board Secretary would contact all Chief Environmental Health Officers reminding them of the potential benefits to local authorities with officers holding an all-encompassing suite of qualifications in food enforcement.

Higher Certificate in Food Standards Inspection

An update was provided on the proposed changes to the Food Safety Code of Practice which will require combined food safety and food standards inspections with an anticipated implementation date in 2019. Nine pilot local authorities have registered as early adopters. It was agreed that an accurate record of officers requiring the additional qualification should be obtained to assist in forward planning.

The pre-requisite educational qualifications required before embarking on practical training in either food safety or food standards remains, as a minimum, an HND or equivalent in either Food Science or Food Technology.

To assist local authorities in recruiting suitably qualified personnel in the lead up to the change in the Code and thereafter, it was considered prudent to formulate a jointly agreed letter with Food Standards Scotland to clarify the matter of minimum requirements and the implications of the proposed changes to the Code of Practice.

SCOTTISH FOOD SAFETY OFFICERS’ REGISTRATION BOARD

***

by Colin Wallace, Chairman

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HEALTH AND SAFETY MATTERS

Since writing my previous article, I have had the opportunity to attend several health and safety related events on behalf of the Institute, including the Health and Safety Executive’s First Annual Conference and the REHIS Health and Safety Update.

HSE Conference

HSE’s First Annual Conference was held on the 18th of September 2017 at the QEII Conference Centre in London, with the keynote speeches also being broadcast to HSE’s offices. The event was well attended by over 250 different organisations, all with a vested interest in health and safety.

The conference was opened by Selvin Brown, HSE’s Director of Engagement and Policy, who set the scene for the day and introduced the two keynote speakers Penny Mordaunt MP, who was then the Minister of State for Disabled People, Health and Work and Martin Temple, Chair of the Health and Safety Executive.

During her keynote address the Minister asked us all to think about our own work life and career, reminding us that the best times are when we care about each

other, encourage those around us to be the best and are in an inclusive environment. Ms Mordaunt went on to remind us that the “Help GB Work Well Strategy” #HelpGBWorkWell is an important agenda for individuals and workplaces, that we need to get right. This approach enables us to get communities to work together at all levels, a theme that was echoed throughout the conference. During her speech the Minister referenced Scottish examples including the Partnership on Health and Safety in Scotland (PHASS) and the Scottish Plan for Action on Safety and Health (SPlASH). Ms Mordaunt also took the opportunity to inform the audience of a new occupational health focused ‘Go Home Healthy’ campaign #WorkRight that was to be launched at the conference.

During his keynote address HSE’s Chair Martin Temple referred to the statistics relating to workplace accidents and ill health and the resultant burden on the economy. Mr Temple went on to discuss what he believes are the three key challenges that he must give his attention to as Chair of the HSE:

• To ensure that HSE effectively handles its responsibilities and maintains a steady pace of improvement and target attention to aid the reduction in the number of reported injuries per year.

• To ensure that HSE delivers on its strategic intent around the health side of health and safety.

• To prepare the HSE for future challenges.

Mr Temple’s full keynote speech can be read at:

hse.gov.uk/events/conference/assets/HSE-Annual-Conference-18-September-2017—HSE-Chair-keynote.pdf.

by Lisa McCann, member of REHIS Council with responsibility for health and safety matters


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Following the keynote speeches delegates attended several different sessions including:

HSE’s sector plans and cross-cutting health priorities that included presentations from four presenters on: HSE sector plans; the cross cutting health priorities that HSE are focusing on; the health and work communication campaign and how you can join in and how insight is helping HSE build its plans.

This was followed by the Experience Zone, which gave delegates the opportunity to: explore health and safety demonstrations; talk to Board Members and HSE Senior Leaders; register or update a helping Great Britain work well commitment and engage with the conference sponsors at their exhibition stalls.

The last session of the day was interactive titled ‘Helping each other work well’ with the aim of exploring possible solutions to key health and safety issues. Senior HSE staff led tables of delegates to discuss answers to questions which included: ‘What is the best health and safety initiative you have seen in the last 3 years?’ and ‘What issue does your organisation or industry most need support or leadership on in the next 3 years?’ This led to positive discussions and sharing of ideas and experiences across the large selection of industries, sectors and professions present.

For more information on the conference, strategies and campaigns please see the following links:

hse.gov.uk/strategy/.

hse.gov.uk/aboutus/strategiesandplans/sector-health-plans.htm.

hse.gov.uk/gohomehealthy/index.htm.

hse.gov.uk/scotland/partnership.htm.

hse.gov.uk/scotland/pdf/scottish-plan-health-safety2016.pdf.

hse.gov.uk/events/hse-conference-2017.htm.

The Health and Safety Update 2017

The annual REHIS Update was held in Edinburgh on 20 September 2017. This facilitated delegates to learn about health and safety considerations in the differing sectors of further education from Angus Clark of the University of St Andrews and the military from Gordon Brown, a member of the Institute’s Council, who works as an EHO for the British Army.

Updates were also provided by the HSE through presentations by Frances Kelley and Tracy McTaggart covering updates from the Local Authority Unit on various sectors and guidance. Selina Brown, a Senior Procurator Fiscal Depute for the Health and Safety Division of the Crown Office Procurator Fiscal Service, gave us an overview of the HSD and what to consider when working on investigations that are likely to involve working with the COPFS and/or the submission of a case for their consideration.

Martin Keeley, also a member of the Institute’s Council, of West Dunbartonshire Council led us through a workplace incident that involved a trike v. a remotely operated bollard. The incident had been caught on CCTV and Martin took us through the various stages of the investigation.

After lunch, Linda Green ensured the audience was engaged by starting her talk with an interactive session before intriguing us all with her move from being a local authority regulator to managing health and safety for Go Ape across the UK and USA.

REHIS appreciates the feedback from delegates at our various events and would encourage members to provide suggestions of speakers and/or topics that they would like to see at future events. If you have any suggestions, please send them by email to: [email protected].


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A NEW JOINT AWARD

On a stunning cold, clear autumn day, I donned my sturdy boots and cosy jacket to set up north to Aberdeenshire to present certificates to a group of students for a new joint award in Campfire Food and Safety. The setting for the presentation was the beautiful forest behind Crathes Castle in a clearing with logs as seating and a campfire as the focal point. This was certainly a break from my usual environment!

The Institute’s Council had just approved a new joint award programme in partnership with BR Safety (Catherine Busson and Lorna Ross) and the North East Scotland Outdoor Learning Group (NESOLG) Forest Schools on Campfire Food and Safety.

Jackie McCabe, Catherine Busson, Julia Mackay, andLorna Ross, on site at Crathes Castle.

During the summer of 2016, Julia Mackay of NESOLG approached Lorna Ross, Food and Safety Support Officer at Aberdeenshire Council, to run a food hygiene course aimed at delegates who cook food in an outdoor setting.

After receiving the request, Lorna reviewed the REHIS Elementary Food Hygiene Course syllabus to determine if the course content would meet the needs of the organisation to provide training to its members. It was evident that sections of the syllabus were irrelevant when applying the principles of food hygiene in an outdoor environment. There were also elements of the REHIS Elementary Health and Safety

Course that may have been relevant but again the complete syllabus was not.

As demand for an outdoor food hygiene course is high throughout Scotland, NESOLG asked Lorna Ross and Catherine Busson, EHO in Aberdeenshire to develop a specific joint award course for leaders in outdoor education in food hygiene and campfire safety. The aim is not only to use this new course as an additional module for NESOLG Forest School trainees but it is acknowledged that there are other outdoor practitioners such as Guides, Scouts, Duke of Edinburgh and outdoor adventure organisations that would also benefit from this training.

The course is divided into two parts with part one being food hygiene – covering the main subject areas within the REHIS Elementary Food Hygiene Course syllabus but modifying some areas to the outdoor setting; food storage, handling, preparation by the campfire and cooking with the campfire, personal hygiene and cleaning and disinfection using alternative methods in the outdoors. Part Two is campfire safety – this will include campfire design and building, gathering wood, the safety aspects, gaining landowner permission and extinguishing campfires.

I met with Lorna, Catherine and Julia at Crathes Castle who introduced me to a few of the delegates who were part of the pilot course. This included representatives from the Brownies and Guides association, early-year practitioners and NESOLG trainees. Julia built and lit the campfire with effortless efficiency and we had an informative discussion about the new course. Feedback was all positive with the delegates claiming the course to be invaluable to ensuring the safety of their students whilst preparing and eating food in an outdoor setting. We enjoyed our coffee and mince pie in the outdoors with the only drawback being the strong odour of campfire smoke lingering on our clothes!

I would like to congratulate Lorna, Catherine and Julia in this exciting and necessary course. It is their intention, later, to invite other Approved Training Centres to deliver the programme at locations around Scotland.

by Jackie McCabe, Director of Training


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SCOTTISH POLLUTION CONTROL CO-ORDINATING COMMITTEE

Scottish Pollution Control Co-ordinating Committee (SPCCC) acts as a hub for the liaison groups, their specialist subgroups and the Scottish Government, as well as other interested parties (SEPA, EPS, STEP, SoCOEH). Attendees are experts and contributors across the main themes of Air Quality, Contaminated Land, and Noise issues that affect Scotland.

I have tried again to split the article into the main themes and picked out a few points of interest. Members again are reminded that the full approved historical SPCCC minutes are available in the members section of the REHIS website. These are also now being circulated by email to REHIS members. All four regional liaison group minutes are attached to each SPCCC minute. They can be an excellent starting point to see if a Scottish colleague has had a similar concern to yours. The pollution liaison network is long standing and well utilised. Please don’t be afraid to use it.

Contaminated Land Update

The inaugural combined Sub Group meeting was held on 29 August 2017 with discussions on a variety of topics from allotment to the quality of contaminated land reports. Although the minute has yet to be approved, the feedback to SPCCC was that this bringing together event was worthwhile and would be repeated again next year.

Air Quality Update

National Clean Air day and International Environmental Health day (which was themed on indoor and outdoor air quality) highlighted some of the promotional work by various Councils and REHIS in this highly topical area.

The Scottish Government through the Environment, Climate Change and Land Reform ECCLR Committee continues to gather evidence into its enquiry on Air Quality. Written submissions are available at parliament.scot/parliamentarybusiness/CurrentCommittees/105533.aspx. Interesting also the Scottish Government announced its programme for government for 2017/2018 and significantly there were a variety of commitments specifically focused on transport, low emission zones and other air quality related matters.

beta.gov.scot/publications/nation-ambition-governments-programme-scotland-2017-18/.

At the start of October the Scottish Government confirmed that Glasgow will be the first city to bring in a Low Emission Zone helping to achieve the political commitment made in this arena. beta.gov.scot/news/first-low-emission-zone-for-glasgow/. I am sure we will follow this with interest to see how it informs the future National Low Emission Framework which is out for consultation consult.scotland.gov.uk/transport-scotland/building-scotlands-low-emission-zones.

Noise Update

ASB Noise Guidance 2004 remains under review and fortunately through the SPCCC we managed to get some Environmental Professional representation at the later discussions. Many of you will know that Linda Storie (Scottish Government Official Covering Noise issues) retired earlier this year. We were pleased to welcome Heather McCabe (Scottish Government) to her first meeting in September. Heather advised that the Environmental Noise Directive Strategic Maps are about to go live. Noise Action Plans for each agglomeration are to be published by July 2018.

Personally I wanted to thank those that helped re-launch the Pollution Update Course in March this year, covering the themes of the SPCCC. The online follow up survey provided positive feedback and a willingness for this to be delivered again. Our planning at REHIS/SPCCC is already on schedule with early indicators that the event will happen early March 2018. When speakers’ details are confirmed REHIS will publicise in the usual manner. If you are keen, or you know of someone/some subject that is worth covering and would be of interest to your fellow professionals then let me know. Don’t be daunted if you are approached, all you’d be doing is standing up and talking about what you already do.

Finally a massive thank you is extended to Iris Whyte who has chaired SPCCC since April 2011. Iris has diligently and politely influenced pollution-related issue across the whole of Scotland, devoting significant amounts of time to do so in her usual professional manner. Iris has announced her retirement from local government and is intending to step down from the role as Chair, when a suitable replacement can be found. On behalf of REHIS and other partner agencies we wish her well, good health and a long and pleasant retirement.

by David Duffy, member of REHIS with responsibility for pollution control matters


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Dr Michael Lockhart, Clinical Lead for the newly forming Public Health Microbiology Team at Health Protection Scotland, provides some background information and explains the longer terms plans for this exciting new project.

What is Public Health Microbiology?

To help explain our plans it is important to understand what we mean by Public Health Microbiology. Our definition is adapted from the ECDC consensus definition and describes Public health microbiology as a specialty which spans the fields of human, animal, food, water and environmental microbiology, with a focus on human health and disease. It requires laboratory scientists, epidemiologists, and clinicians to generate, integrate, analyse and communicate epidemic intelligence. Public health microbiology supports the monitoring of known and emerging threats and facilitates the evaluation of effective interventions, providing a source of expertise in the management of incidents and outbreaks.

What are the key aims of this work?

• To support the development of a Microbiology Reference Laboratory service in Scotland that is optimised for healthcare in the 2020s.

• Deliver a Pathogen Whole Genome Sequencing capability for Scotland that will ensure we can keep pace with the development of this technology with the rest of Europe.

• Deliver an Information Technology infrastructure that will ensure consistent and reliable centralised capture of microbial intelligence, from all relevant laboratories to support public health in Scotland.

• In partnership with key stakeholders support the development of an integrated and resilient human clinical diagnostic microbiology service for Scotland.

• Engage with the network of veterinary and environmental microbiology laboratories with an aim of intelligence-sharing to support public health in Scotland.

• A confident and competent workforce whose educational requirements are supported by the development of a national public health microbiology workforce education development framework, with a focus on

appropriate CPD provision for all staff that have an interest and role in public health microbiology service provision.

What could be the benefits?

All of those involved in this project believe that it will have a number of benefits which include:

• Providing early warning of evolving public health threats to allow early intervention and minimisation of the impact of these threats.

• By working with key partners, we think this will help provide efficient microbiology services across Scotland that are resilient, adaptable and able to provide surge capacity when needed.

• Provide the means for the integrated analysis of microbial intelligence applying one-health principles, allowing the identification of key interventions which will minimise the risk of the development of future microbial threats, wherever they may occur.

How are things being developed?

Senior staff from NHS National Services Scotland have identified a gap around this topic area, and have been guiding our developments. We have a small clinical team forming at Health Protection Scotland (HPS), who are leading on pulling this together. Governance is through the Scottish Health Protection Network (SHPN), and critically we are supported by a group of fantastic staff from both HPS and the SHPN.

That all sounds fine, but what does it mean for Environmental Health Officers?

We believe that if we pull together all of the work mentioned above, it will ensure that EHOs will have all of the key emerging information on infection at their fingertips, supported by the cutting edge technology to make sense of our changing microbial world. Also if we can work in partnership with the key experts in the country, it will make accessing the intelligence that’s available that much easier. An example of this is that the group overseeing the development of this work at the SHPN includes membership from a wide variety of key stakeholders. Finally, with our focus on making available educational opportunties on important topics

PUBLIC HEALTH MICROBIOLOGY: A CHANGE IN CULTURE?by Dr Michael Lockhart, Public Health Microbiology Team, Health Protection Scotland


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in Public Health Microbiology, we hope that we can help ensure everybody keeps up to date on the new possibilities that the emerging microbiological technologies hold for us all.

What do you want me to do about it?

We are at the beginning of the hard work to pull this together. One group we know we haven’t engaged with yet are EHOs. It would be good to know if what we are aiming to do sounds like it will help the EHO community in Scotland. It would also be useful to know are we missing any pieces of this puzzle. Are there any topics you think we need to address that aren’t

mentioned above? What workforce development opportunties could we progress that would help you? Please get in touch using the email address below –any and all comments gratefully received to help us make sure we develop a programme of work that will help you!

EHOs are invited to forward comments using the title “REHIS Feedback” to email address: [email protected].

If a standard REHIS qualification is not considered to be appropriate, the Institute works with a partner to develop a sector or organisation specific qualification, which can then be accredited and certified by the Institute.

Joint Awards are qualifications that have been designed to meet the specific outcomes needed by the partner organisation. The partner organisation determines the outcomes required and the level; REHIS provides the certification for the course and the appropriate award. The Institute applies the same level of quality assurance to joint awards as it does to its own courses.

REHIS is delighted to announce the recent signing of a new joint award programme in partnership with BR Safety (Catherine Busson and Lorna Ross) and the North East Scotland Outdoor Learning Group (NESOLG) Forest Schools on Campfire Food and Safety. (See article on page 20).


SIGNING OF NEW REHIS JOINT AWARD

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Signing of the Campfire and Safety Joint Award agreement. From left to right: Catherine Busson (standing),

Lorna Ross, Jackie McCabe (standing) and Tom Bell.


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Maintaining our Profession for the Future: The contribution Environmental Health makes to Scotland’s Public Health Agenda

The Southern Centre AGM in September was preceded by a training event on the contribution of the Environmental Health Profession to the public health agenda in Scotland. The aim of the event was to build on the success of last year’s training seminar which also focused on the same theme of raising awareness of the wider role of Environmental Health in protecting and improving Scotland’s public health.

The scene was set by the first speaker, Professor George Morris who asked the question Where Should Environmental Health Pitch its Tent? Professor Morris acknowledged the success of the Environmental Health profession in protecting public health and responding to advances in scientific and epidemiological understanding. However, it was argued that we are now entering a new ‘era of ecological public health’ which identifies the relationship between health and the physical environment. Professor Morris argued that the failure to recognise the contribution of the physical environment and in particular the environment at a local and neighbourhood level has led to Environmental Health being under-represented in public health issues such as the obesity epidemic, mental health and wellbeing and inequalities between socio-economic groups in communities.

Professor Morris stressed that Environmental Health professionals have many of the skills needed to play a key part in an effective response to the challenges of the ecological era and are able to operate and convey public health messages at a local level. However, this requires a change in where the profession is currently ‘camped’ in what may be argued as an over-ridged adherence to a narrow, compartmentalised and hazard-focused health protection agenda.

Following on from this discussion, the Southern Centre was pleased to welcome Asif Ishaq. Asif has recently taken up post with the Scottish Government’s Population Health Directorate where he is leading on national public health priorities. Asif provided some background to his current role and the work being progressed in relation to the Public Health Review. Following an extensive engagement and evidence gathering period, the review group published their report in February 2016. Asif’s work is now focused on identifying which public health priorities need to be addressed.

Director of Training for REHIS, Jackie McCabe, gave an excellent overview of the community training provided by the Institute and the valuable role this training provides in educating communities, voluntary groups, businesses and others in areas which ultimately improve public health. REHIS is an awarding body for a number of qualifications including Food Safety, Control of Infection and Food and Health - all of which are delivered via over 500 Approved Training Centres.

After the coffee break, Edel Ryan, Environmental Health Manager of Midlothian Council, presented a very thought-provoking account of a recent incident in the Midlothian area where increased levels of CO2 were detected in a new housing development. In her presentation, Carbon Dioxide – A Mining Legacy, Edel outlined the steps taken by her team to investigate the matter and the work with partners, such as the NHS and HPS, to identify the cause and extent of the incident. Edel’s presentation highlighted the key role that Environmental Health Officers play in making difficult decisions to protect health as in this case, the residents had to be moved and the properties demolished.

SOUTHERN CENTRE TRAINING EVENTby Lynn Crothers, Vice-chair REHIS Southern Centre


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After a last minute cancellation by another speaker, Craig Smith, Environmental Health Manager with West Lothian Council, proved to be an excellent stand-in by giving an entertaining but persuasive presentation titled Trust Me! I’m an EHO on the value that Environmental Health services provide not only in financial terms but also the added value that can be difficult to measure and publicise.

After lunch, the next speaker was Megan MacPherson. Megan is a Public Health Adviser with NHS Health Scotland. NHS Health Scotland is a national health board working to reduce health inequalities and improve public health. In 2013, Megan became involved in the development of the National Place Standard. The Place Standard is a way of assessing places which is carried out through an online tool which provides a simple framework for structuring discussion and debate about places where people live. The place where people spend their time has an important effect on wellbeing as it can influence the opportunities that residents have access to and ultimately the inequalities that they are exposed to. Megan provided examples of how the tool has been used since it was launched including planning new developments, providing services for local communities and regenerating neighbourhoods.

The final speaker was Eleanor Pratt, an Air Quality Policy Officer with SEPA who is currently seconded to the Scottish Government to progress the Clean Air for Scotland (CAFS) Strategy. Eleanor was able to provide an overview of the large amount of activity that is involved in delivering the key outcomes of

the CAFS strategy including a National Modelling Framework (NMF) and the introduction of Scotland’s first Low Emission Zone (LEZ) which at the time of the presentation was between Glasgow and Edinburgh.

Eleanor’s closing presentation brought the day ‘full circle’ in reminding the delegates of the comments made by Professor Morris earlier in the day about importance of understanding the quality of the physical environment in relation to population health.

On behalf of the Southern Centre, I would like to pass on my gratitude to the speakers who provided the delegates with an interesting and thought-provoking event, particularly for those who will shape the future of the Profession.


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This winter, the Scottish Environment Protection Agency (SEPA) is launching a campaign to provide the public with advanced notice of potential flooding. Through a newly created suite of winter marketing materials and a strategic approach to communicating, this campaign will be able to more accurately target communications activity to those at risk of flooding. It will also be able to provide up to 3 days notice of potential flooding, giving people more time to prepare and take action.

In order for this campaign to be accurate and effective, SEPA’s Flooding Communications team will work with the Scottish Flood Forecasting Service, a partnership between SEPA and the Met Office, to monitor the likelihood and impacts of flooding. If significant or severe flooding is imminent, the campaign will be activated and messages will be broadcast to the areas at risk. Messages will be advertised over 3 days on both national and local radio stations, on social media and online and will also be shared with key partners and flood action groups for further dissemination.

The communications activity will complement SEPA’s Floodline Service, which provides free messages to customers when SEPA issues a Flood Alert, Flood Warning or Severe Flood Warning in their area, and will encourage more people to sign up to the service.

What to do if you hear one of SEPA’s messagesIf significant or severe flooding is forecast in your area (imagine similar impacts to the flooding brought by Storm Frank in 2015), you may come across a message from SEPA while listening to the radio, scrolling through your social feeds on Twitter or Facebook or while reading the news online or on your phone. Consider sharing these messages around your networks and think about adding key advice from an environmental health perspective, such as avoiding direct contact with floodwater, washing your hands and throwing away food, drink and medication that has come in contact with floodwater.General advice on preparing for flooding this winterBeing flooded can be a life-changing event, and with many people in Scotland at risk of flooding from rivers, the sea and stormy weather, it’s important to know your flood risk and have the appropriate measures in place to protect yourself, your family and pets, property or business/organisation. Being prepared - by knowing what to do and who to contact if flooding happens - can

help you reduce the damage and disruption flooding can have on your life.

The first step to being prepared is to contact Floodline to check if you are in one of our Flood Warning Areas. If you are in a flood risk area, you may want to sign up to receive free messages from Floodline to let you know when and where flooding is likely to happen. You can choose to have these messages sent to your phone as an automated voice message or a text message (or both). You could also sign up on behalf of a friend or loved one and get notified when flooding is predicted in their area. Even if you are not in a direct flood risk area, you can still sign up to be notified of flooding in your wider, local authority area or for another area of interest in Scotland. It is important to remember that even though your property may not be at risk of flooding, other services in your area, such as public transport or access for emergency services may be affected. If you need to prepare for imminent flooding, there are several actions you could take including moving your car or valuables away from potential damage; checking Travel Scotland online to find out if your travel route may be disrupted; notifying others in your area who are also at risk and contacting your local authority to find out if they have any flood protection products available. If you would like to sign up to Floodline, please call 0345 988 1188 and one of our advisors will help you to register or visit floodlinescotland.org.uk for more tips and advice.

PLAN AHEAD FOR FLOODINGby Rebecca DeVivo, Communications Officer (Flooding), SEPA


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ANNUAL PRESENTERS’ UPDATE SEMINAR

Over 120 Registered Course Presenters from a wide range of REHIS Approved Training Centres including industry, colleges, local authorities, NHS, prison service, community groups and private training organisations attended the recent update seminar for presenters in food hygiene and health and safety. The presenters who attended enjoyed the chance to network and share experiences and receive information to update and refresh their training. It was pleasing to see so many delegates attend the seminar, which took place at the Hilton Carlton Hotel in Edinburgh, with quite a few having to battle train delays and detours to make it.

The morning started with Lindsay Matthew of Dundee City Council who gave an informative presentation on food standards and labelling followed by Chris Hunt from Edinburgh Scientific Laboratory Services speaking about food testing. Crawford Sibbald, EHO, Falkirk Council, finished up this session with a really interesting presentation about food imports and port health.

After a short coffee break, Dr Kasia Kazimierczak of Food Standards Scotland (FSS) gave a useful presentation on the FSS food surveillance strategy followed up by the double act of Duncan Smith and Ross Clark, also from FSS, giving an update on the food incident and crime unit. Grant Douglas, an EHO from Fife Council, concluded the morning session with a fascinating insight into his life as a Food, Health and Safety manager whilst working in the airline and hospitality industry within United Arab Emirates and Singapore.

After the lunch break, delegates were asked to discuss in groups how training can contribute to a positive food safety culture within industry. This resulted in a really lively discussion which energised everyone after their lunch.

Dena McKay, an extremely experienced presenter from Jobs and Business Glasgow, then led the afternoon session with an entertaining yet informative talk on why she thinks the new REHIS Cleaning and Disinfection Course is a welcome addition to the suite of courses. Dena was followed by Leanne Webber, also from Jobs and Business Glasgow, who gave an excellent update on First Aid which included a demonstration of a choking vest with our very own Raymond Hubbocks posing as a ‘choking casualty’!

Sheila Dunn from the Scottish Credit Qualifications Framework partnership (SCQF) presented information about the SCQF levelling and credit rating process of courses and how the Scottish framework relates to the rest of the UK and European qualifications. Sheila also highlighted the many benefits to the student, the employer and training organisation on having courses formally credit rated. It is worth noting that the Institute currently has six courses formally credit rated on the SCQF framework and another seven under review.

I concluded the seminar by giving a brief overview of new developments within REHIS including course updates, e-learning, and the excellent news about the SCQF rating for the REHIS Food Hygiene and Health and Safety courses. I also reminded the presenters of the facility to register all courses, request packs and submit results online – a service that the majority of our centres now use.

I would like to take this opportunity to thank all the speakers and REHIS presenters who took time out of their busy schedule to attend and for fully participating. Copies of all the presentations are now on the Institute’s website. The feedback received was positive and beneficial to assist with planning the next seminar in 2018.



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HACCP IMPLEMENTATION IN NHS HIGHLAND HOSPITALSby John Lee, Chartered Environmental Health Officer

Introduction

My current role is Hotel Services Support Manager – Quality and Training with NHS Highland. A key part of my role is carrying out Food Safety audits of NHS Highland premises to ensure food safety obligations are met and to establish trends in compliance levels with a particular focus on implementation of the NHS Scotland Food Safety Assurance Manual. This is a new internal role and therefore no anecdotal information is available other than management reports highlighting the degree of Food Hygiene training undertaken and copies of Food Hygiene reports provided by the relevant Local Authority Environmental Health Service.

Raigmore is NHS Highland’s only District General Hospital. There are three Rural General Hospitals – Belford in Fort William, Caithness General in Wick and Lorn and Islands in Oban. In addition there are a number of Community Hospitals throughout the area in each of the Operational Units.

Description

The Scottish Government Health and Social Care Directorate commissioned the NHS Scotland Food Safety Assurance Manual to demonstrate a consistent approach to Food Safety and compliance with Hazard Analysis Critical Control Points (HACCP) and Food Safety legislation. The manual has been written for use as a guidance document with the understanding that NHS Boards may be required to undertake local risk assessments to develop local based procedures if unable to implement the requirements of the manual.

My basic aim was to evaluate the degree of compliance with Food Safety and to investigate the actual difficulties that exist during the HACCP implementation process in the District General Hospital and Rural General Hospitals mentioned above. Evaluation was based on interviews with staff both managerial and operational and a bespoke checklist screening of important processes – incoming materials control, storage, freezing and refrigeration, food preparation, food distribution and general HACCP prerequisites application – sanitation procedures, pest control, personal hygiene etc.

In due course the relevant findings will inform an action plan to secure long term Food Safety compliance.

Considerations

Risk assessment is part of the risk analysis process which includes risk management and risk communication. In

hospitals, it is mainly used to estimate risks related to Food Safety and Food – Borne illness. It can be used to develop HACCP systems and control multiple risk factors, as consistency in food preparation, employee awareness and participation in Food Safety. Patients in hospitals are provided with two forms of treatment, the medical (pharmaceuticals treatment, surgery etc.) and the nutritional (carefully planned meals that provide all the ingredients necessary for each patient’s case). Both treatments are of equal importance and should be safe for patients. Some do consider the hospital food service system to be the most complicated production process within the hospitality sector.

Studies concerning the barriers of HACCP implementation in hospitals have underlined the lack of HACCP prerequisites in hospitals, the lack of in-house HACCP skills, the high cost, staff turnover, lack of manager/management involvement and poor ownership of externally designed HACCP plans.

Out of the 4 hospitals involved in this study two were following HACCP methodology, one had just started to introduce the system and the remaining hospital was still at the planning stage and looking to review current food production systems.

Outcomes

Based on the actual findings from the hospitals audited, specific key elements have been identified which if considered and addressed will help to implement and successfully operate a HACCP system in a hospital environment.

• Managerial Effect – this was observed to be of key importance for efficient HACCP implementation in the hospitals. Management commitment is the number one key element in both starting and operating Food Safety systems. Hospital Managers should believe in the importance of quality systems, devote the necessary time to the process and arrange for the required money needed for buying new equipment or redesigning the food processing areas. They must make decisions, underline their personal commitment to the hospital kitchen personnel and be involved in the internal auditing process of the food safety systems. Without active management involvement a HACCP system is almost impossible to operate successfully.


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• Lack of Internal Monitoring Procedures – if available they would assist in the decision-making process in certain areas namely, cleaning schedules in the kitchen, food purchase and storage procedures. The establishment of internal monitoring procedures will ensure that the burden imposed by an individual regulatory demand or process is appropriate to its significance in protecting the health and safety of the patient, the personnel, the public and the environment. No consistent internal monitoring was being carried out.

• Personnel Involved in Food Processing – they must understand the required personal hygiene procedures that have to be followed, have to be well trained (this must be reviewed on a regular basis and refreshed accordingly). There were some difficulties observed in effective hand washing and wearing of protective head covering within the members of the kitchen personnel that were many years in the job. Illness reporting procedures were also a bit inconsistent.

• Specific HACCP prerequisites together with amendments to the NHS Scotland Food Safety Assurance Manual at each hospital need to be aligned with the specific character of the hospital menus – more boiled and cooked meals served at appropriate hot temperature for immediate consumption rather than cold meals. This helps in establishing and maintaining food safety. The time / temperature relationships during freezing, thawing, refrigeration, thermal processing, sanitation procedures and pest control programmes need to be well outlined and followed during food preparation in the hospital kitchens.

• Concerning the handling of minimally processed food in hospitals a number of recommendations can be considered. Special care must be taken to reduce microbial risks through vegetables disinfection / sanitation in menus that are designed to be consumed without further heat treatment. Good manufacturing and good hygiene practices are essential. Through the NHS procurement system only suppliers on the dedicated list should be used. These suppliers have all been certified and therefore meet required standards of food safety and hygiene. However on occasions this has been found not to be the

case. Due to the geographic challenges of providing a service in Highland and Argyle & Bute during periods of inclement weather it has been necessary to source foodstuffs from what would be considered as more “local suppliers”. This places importance on ensuring that goods inward checks for integrity and temperature control are carried out robustly and consistently.

• All kitchenware, food cutting boards and food contact surfaces of the equipment used in the preparation and serving of food and all food storage utensils must be thoroughly washed and sanitised after each use. Non–food contact surfaces including the walls, floor, ceiling etc. must be cleaned at such intervals as to keep them in a clean condition and good state of repair. This is covered in bespoke cleaning schedules for each of the hospitals but implementation was identified to be inconsistent particularly during periods of staff shortages and staff illness. The cleaning schedules referred to are complemented with Standard Operating Procedures (SOPs) that address specific tasks. The SOPs set out utensils / areas to be cleaned, frequency of cleaning, method of cleaning and chemical dilution and contact time. The specified contact time for the disinfectants created significant challenges in particular situations, predominantly food preparation tables and worktops. A review of the disinfectants used will need to be carried out to identify products that offer a more meaningful and practical contact time. An additional cause for concern related to manual washing of dishes, cutlery and equipment during periods when the mechanical dishwashers had broken down or were malfunctioning. This appeared to be carried out in an inconsistent manner. An appropriate SOP will need to be developed and implemented.

• An integral part of the HACCP system is temperature monitoring using probe thermometers. This was being carried out consistently and a SOP does exist for checking and calibrating these probe thermometers. The SOP states that probe thermometers are checked for accuracy on a monthly basis using the ice point method and the boiling point method. However what did give cause


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for concern was the procedure to be followed for calibrating the probe thermometers. This should be carried out six monthly by comparing against a professionally calibrated thermometer. The professionally calibrated thermometers were found to be out of date or the six monthly calibration procedure was not being followed. This will need to be reviewed with an option under consideration of changing to probe thermometers that come with an annual calibration certificate. These will be provided to each hospital and will be replaced annually. This is likely to be more cost effective and will ensure consistent implementation.

Conclusion

My experiences visiting the hospitals concerned and meeting with key individuals has highlighted key elements that are crucial for implementing and successfully operating the NHS Scotland Food Safety Assurance Manual in NHS Highland hospital premises. It is abundantly evident the specific requirements of an effective Food Safety Management System (HACCP) in hospitals has significant benefits but there is a clear need for further investigations together with cooperation from all within the organisation who have a key and integral part to play.

The NHS Scotland Food Safety Assurance Manual is very much a generic Food Safety Management tool. I am of the firm opinion it is a good fit with large district general hospitals, it fits well with the catering operation carried out at Raigmore Hospital. However, with regard to the rural general hospitals it requires to be adapted and tailored to suit the local needs. To a certain extent it has been adapted but there are gaps which are highlighted above. Taking this forward I will be prioritising and putting an action plan in place. Any Food Safety Management system is only as good as how well it is implemented. To ensure this can be progressed consistently for 2018 I will be prioritising 3 areas, namely, management engagement, internal monitoring procedures and training. Addressing these areas will help ensure the other concerns identified will be effectively considered and attended to.

In NHS Highland, management of the catering operation sits with Hotel Service Managers. The managers I have dealings with come from a mix of nursing, catering and administration. Catering

is just one of their responsibilities so there are competing pressures. All have the REHIS Diploma in Advanced Food Hygiene. By engaging with them and the hospital management team I will highlight the necessity of robust food safety management to ensure adequate priority is given to Food Safety together with sufficient budget. This will be a challenge given the current climate but as my role is new within the organisation I will be able to use my professional knowledge and experience to influence accordingly and help to raise awareness. A network of deputes does exist but in some cases their level of Food Hygiene training needs to be improved to ensure a good appreciation of HACCP. As a minimum I would expect them to have passed the REHIS Intermediate Food Hygiene within 2018. Training is included within my remit so I will be able to provide assistance in this area of work.

Internal monitoring is integral to any Food Safety Management system. Although a template does exist within the NHS Scotland Food Safety Assurance it is not a good option for smaller hospitals. I will develop a monitoring tool, trial it for a period of time in a couple of the hospitals and then through a series of coaching and training sessions share it with the Hotel Service Managers and deputes. This in itself will ensure improved consistency and pick up themes of non compliance which will inform subsequent reviews of the Food Safety Management system.

A training framework does exist in NHS Highland which helps ensure it meets their statutory and mandatory requirements. Induction training should be taking place within the first few weeks followed by completion of the REHIS Elementary Food Hygiene within 3 months. There are gaps with some new staff. As part of the framework all catering staff should undertake refresher training sessions at a minimum frequency of 3 years in respect of food hygiene and handling of food. This is not being followed in strict accordance with the framework. I will need to drill into this to establish exactly why this is the case but at this point I am confident lack of resource and challenging geography will have a bearing. I will look into wider use of e–learning options. In addition I will look at specific refresh training options for the Hotel Service Managers, deputes and supervisory staff which will deal with HACCP in more detail.


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POOR….AND STILL PAYING FOR IT!

In 1977 the National Consumer Council published a book ‘Why the Poor Pay More’. This book examined the extent to which those on low incomes were disadvantaged. Not only do they have less money to spend but being poor, and perhaps also living in areas of deprivation, they are more likely to receive poor quality services, poor value for money, and suffer from poor health. As part of the REHIS Scheme of Continuing Professional Development this written submission, which partly takes the form of a literature search and partly using personal experience and the experience of others working in the field of deprivation and health, will look at a number of the issues, mainly smoking and to a lesser extent excess alcohol consumption, which contribute to Scotland’s notoriously poor health record.

The health status of people in Scotland has for many years given cause for concern, although inroads are being made to combat the main areas of concern. Among developed countries Scotland has the highest death rates from heart disease and cancer. More people die prematurely in some parts of Scotland than in some areas of England and Wales. It is an established fact that those on low incomes experience poorer health and a reduced life expectancy than those who are better off. Also, there are geographical factors in that people living in the west of Scotland have poorer health than those living in the east. There is also a geographical difference between, for example, the health of those living in the well-off parts of East Renfrewshire compared to the not-so-well off parts of the City of Glasgow. Scotland’s Charter for a Tobacco-free Generation by 2034 was launched in 2015 but achieving this is, at present, some way off. To achieve some of the targets requires, for example, 70,000 fewer smokers in SIMD 5 (the most advantaged group) but 250,000 fewer smokers in the SIMD 1 group (the most disadvantaged group). Looking at current progress it suggests that the target will be met for the SIMD 5 group, but that a significant increase in the rate of quitting smoking will be required amongst adult smokers in the SIMD 1 and 2 groups.

The National Health Service is now almost 70 years old (established 5 July 1948). In the last 70 years the NHS has changed dramatically in terms of what it provides, how it is administered here in Scotland and how much it costs to run. In 1948 UK life expectancy for males was 65.8 years and for females 70.1 years. The most recent annual estimates for Scotland are for boys born in 2015 to live 76.9 years on average, 59.9 of these in a ‘healthy’

state. Girls born in 2015 would be expected to live 81.0 years on average, 62.3 of these years being ‘healthy’. Statistics support the fact that those living in generally affluent areas live longer and enjoy better health for longer than those living in deprived areas. Ill health and death are unequally distributed amongst the population of the UK and these inequalities have widened rather than diminished since the establishment of the NHS in 1948. In August 1980 the UK Department of Health and Social Security published a report of a working group established under the chairmanship of Sir Douglas Black (The Black Report). This report, which was not particularly welcomed by the then Conservative government, showed in great detail the extent of which ill-health and death were unequally distributed among the population of the UK, and suggested that these inequalities had widened rather than diminished since the establishment of the NHS. Controversially the report concluded that these inequalities could not solely be laid at the door of failings in the NHS but rather too many other social inequalities influencing health such as income, education, diet, employment, housing etc. The report recommended a wide range of social policy measures to combat inequalities in health but, sadly, the findings and recommendations of this report were virtually ignored by the government even to the extent that very few copies were printed resulting in very few people having the opportunity to read it. At the REHIS Conference held in Inverness in May 1988, Dr David Player, then District Medical Officer and Director of Health Development, South Birmingham Health Authority delivered a paper titled ‘The Health Divide: Inequalities in Health in the 1980s’ which underlined much of what the Black Report, published earlier, had said about inequalities and the effect this has on personal health.

The truth is it is expensive to be poor. Scotland has a notoriously poor health record with those on low incomes experiencing worse health than those who are better off and they also have a reduced life expectancy. When you are poor and on low income you are disadvantaged, not only because you have less money to spend, but you are more likely to receive poor value for money and/or poor quality service. People living in poverty only buy necessities which can actually cost more. For example, people on low incomes do not have access to bulk buying and therefore pay more for staple items. People are also unable to access cheaper and more beneficial items due to limited

by Bernard Forteath, Chartered Environmental Health Officer


32

access to transportation. Adults in the 15 per cent most deprived areas of Scotland were considerably more likely than those in the rest of Scotland to be smokers (34% and 18% respectively). As deprivation decreases there is a general trend of decreasing cigarette smoking prevalence. Almost half of adults who are permanently sick or disabled (48%) or unemployed and seeking work (46%) are current smokers. The local convenience store in a deprived area is unlikely to stock a good choice in fresh fruit and vegetables for example but more likely to offer choice of cheap alcohol and cigarettes. And there is usually every opportunity to buy these commodities. For example, there is a shop selling tobacco for roughly every 80 smokers in Scotland, and for 8 times more tobacco retailers than pharmacies. The location of tobacco retailers is concentrated in deprived communities and there is an association with higher smoking uptake. Despite having less money to spend, those on a low-income typically pay proportionally more, both to borrow money and to use services. Life on a cash budget is actually more expensive because people who are poor are a higher commercial risk for financial and utility service providers. For example, people on lower incomes are often refused bank accounts and therefore miss out on discounts that are offered for those paying by direct debit. But the serious health consequences of deprivation, particularly for those who smoke or consume excess alcohol can be seen below:-

• in the 15 per cent most deprived areas of Scotland were considerably more likely than those in the rest of Scotland to be current smokers (34 per cent and 18 per cent, respectively). There is a trend of generally decreasing cigarette smoking prevalence with decreasing area deprivation. Although the pattern is broadly similar to that in previous years, prevalence has reduced in all deprivation quintiles in the last year, most notably from 39 per cent in the 20 per cent most deprived areas

• almost half of adults who are permanently sick or disabled (48 per cent) or unemployed and seeking work (46 per cent) are current smokers

• smoking causes and exacerbates a number of chronic respiratory diseases and cardio-vascular disease, and can worsen the health of people with long-term conditions such as asthma. Smokers are less likely than non-smokers to describe their health as ‘good’ or ‘very good’ (64 per cent and 77 per cent,

respectively) while 12 per cent of smokers said their health is ‘bad’ or ‘very bad’ compared with 5 per cent of non-smokers. Source: The Scottish Government. Scotland’s People Annual Report: results from 2014 Scottish Household Survey. 2015.

Alcohol is the third leading risk factor for death and disability after smoking and high blood pressure.

Alcohol-related hospital stays in Scotland-from Alcohol-related Hospital Statistics Scotland 2015/16

• There were almost 35,000 alcohol-related hospital stays in 2015/16.

• Around 90% of the alcohol-related hospital admissions are to general acute hospitals and around 10% to psychiatric hospitals.

• 92% of alcohol-related hospital stays resulted from emergency admissions.

• 71% of alcohol-related hospital stays were men.

• Rates were highest in the 55-64 age group for men and the 45-54 age group for women.

• Rates were nearly 8 times higher for people living in the most deprived areas compared with the least deprived.

• NHS Greater Glasgow and Clyde had double the rate of alcohol-related hospital stays compared with NHS Dumfries and Galloway.

All sections of society suffer from the effects of smoking and excess consumption of alcohol but those living in the most deprived areas Scotland are more adversely affected. For example, drinking heavily is disproportionately harmful for the poorest in society, with a greater risk of dying or becoming ill due to alcohol consumption. A recent study by Glasgow University and published in The Lancet found that although increased consumption was associated with harm in all groups of people, it was disproportionately harmful for the poorest in society. An excessive drinker living in an advantaged area will be at a seven fold increased risk of harm from alcohol compared to a light drinker living in the same area. However, excessive drinkers in a deprived area showed an eleven fold increased risk of harm from alcohol.


33

A World Health Organisation (WHO) report in 2015 on tobacco taxation raised a troubling question for policymakers across the world. Scientific evidence points to tobacco being a leading global disease risk factor and it begs the question as to why then are so few governments levying appropriate levels of tax on cigarettes and other tobacco products? It is widely accepted that raising taxes on tobacco products is one of the most cost-effective measures to reduce consumption of products that kill, while also generating substantial domestic revenue for health and other essential programs - investments that benefit the entire population. Their report showed that while only 33 countries impose taxes that constitute more than 75% of the retail price of a pack of cigarettes - the taxation level recommended to have an impact on consumption - most countries that do tax tobacco products have extremely low tax rates. And some countries do not have a special tax on tobacco products at all.

In the UK tobacco is relatively heavily taxed which raises substantial income for the Exchequer. It is important to note that tax revenues raised in Scotland go directly to Westminster while the costs of dealing with the effects of smoking are borne by the Scottish Government. In 2015/16 the amount raised from tobacco duty was £1,189 million or 2.2% of the total non North Sea revenue but based on a conservative analysis, the societal costs of tobacco use amount to around £1.1 billion due to the cost to the NHS treating cancer, cardiovascular and respiratory diseases caused by smoking. A similar picture can also be demonstrated for the consumption of alcohol which raises £996 million in duty which again goes direct to the Exchequer while the costs of treating misuse lie with the Scottish Government. Both are significant sums of money raised from consumers when compared to Vehicle Excise Duty at £456 million and £147 million raised from the Landfill tax. Whatever the exact amounts might be we should never be complacent and accept smoking as a net contributor to the UK budget considering the large non economic costs to the quality of life for families, and to a large extent communities, affected by the illness and death of thousands of citizens annually.Between 1991 and 2001 interventions designed to reduce tobacco use and protect health, increases in tobacco product taxes and prices have been shown to be the single most effective and cost-effective measure in line with WHO recommendations. Between 1991 and 2001 in the UK the retail price of cigarettes increased by around 80% in real terms largely as a result of the 3% real-term increase tobacco duty ‘escalator’

introduced by the Conservative Government in 1993, and subsequently increased to 5% by Labour in 1997. However, in 2001 the escalator was abandoned due to concerns over the relatively high price in the UK being a driver of smuggling, hence between 2001 and 2007 tax as a proportion of the retail price of cigarettes actually fell slightly. The cost to consumers of smoking, particularly those living in deprived areas or on restricted budgets is considerable. The cost of a cigarette in Scotland ranges between 37 to 53 pence. Taking statistics from the Scottish Health Survey we know that the average smoker in Scotland has 12.6 cigarettes a day which adds up to around £1650 a year. In April 2013 the gross median weekly earning for full-time employees in Scotland was £508.30. Using the Annual Survey of hours and earnings issued by the Office for National Statistics from April 2017 the Median full time gross weekly earnings is close to the £550 figure for the whole of the UK. Of course this figure is for full time employment. But not everyone living in a deprived area, for example, is working or earning anywhere near this amount. According to national surveys of household expenditure, poorer income households spend a greater proportion of their total household income on tobacco, and for that matter alcohol. The cost of smoking alone in a family where both adults smoke could be over £3000, rising to over £4000 per annum in households who smoke more than the average, so if you are unemployed and living on benefit this is a significant amount predicated against the household income.Smoking remains Scotland’s largest cause of preventable illness and death, yet many smokers say that they want to quit. Nicotine constitutes approximately 0.6-3.0 % of the dry weight of tobacco and is as addictive as heroin. Recent work by ASH Scotland has been exploring the number of other factors that push people to smoke and make it harder for them to quit when they wish to do so. These factors include stress, anxiety and boredom. Living in a deprived community with little help in coping with the lack of hope or optimistic plans for the future make it doubly difficult for those who wish to quit to do so. So when these factors are in evidence it is statistically more likely that people will smoke. Smoking rates in the most disadvantaged communities are several times higher than those in the most advantaged communities. As a result we see that half of all people out of long-term work smoke. A third of all tobacco smoked in the UK is used by people with mental health issues. In Scotland there are around 90,000 people in Scotland living with dementia and this number is predicted to double within the next 25 years. But evidence indicates


34

that a heavy smoker increases their risk of developing dementia by up to 70%.

Reducing health inequalities in Scotland has been a major priority for the Scottish Government and its predecessors for many years, and will remain so for the foreseeable future. There is no easy answer when trying to reduce the use of tobacco and alcohol. Full employment would make a massive difference as there is a link between socioeconomic status and the harm caused by smoking and the excessive consumption of alcohol. Increasing the tax on tobacco products does reduce tobacco consumption, but it can also use up a greater proportion on household income. Also, the intention of the Scottish Government to reduce alcohol consumption in Scotland by the introduction of minimum pricing may also, apart from helping to reduce consumption, lead to unintended consequences of a greater proportion of household income being used on alcohol.Summary of findings:

• The causal relationship between poverty and ill health continues to be a major problem in Scotland and the rest of the UK.

• Just under half of adults who are permanently sick or disabled (48 per cent) or unemployed and seeking work (46 per cent) are current smokers.

• Hospital admissions for alcohol related problems are nearly eight times more for people living in the most deprived areas than those living in least deprived areas.

• If you are poor and living in a deprived area you are more likely to suffer from poor health, receive poor value for money, and receive poor quality services.

• The health issues caused by the use of tobacco and excess alcohol include various types of cancer, stroke, heart disease, dementia, mental health issues, bronchitis and pneumonia.

References available on request.

Note by Director of Professional Development:

The article by John Lee (pages 28 to 30) and this article by Bernard Forteath were submitted in compliance with the recently introduced regulation requiring Environmental Health Officers to present one written submission in a 36-month period for CPD purposes. These articles provide good examples of how new learning can enhance an Environmental Health Officer’s knowledge, skills and competence through the written submission.

REHIS WELCOMES THE SUBMISSION OF ARTICLES FOR

PUBLICATION IN

ENVIRONMENTAL HEALTH SCOTLAND

REHIS WELCOMES REPORTS OF INTERESTING

COURT CASES FOR PUBLICATION IN

ENVIRONMENTAL HEALTH SCOTLAND


35

Many schools and hospitals constructed or renovated during the post-war period were likely to have had asbestos installed in their structures to provide fire resistance, noise attenuation or robust wall boards. Crocidolite was widely used until the late 1960s. Amosite was used in numerous applications such as thermal insulation and asbestos insulating boards until about 1980. Chrysotile would also have been used in asbestos cement and flooring products until the mid-1990s. Asbestos cement products could contain crocidolite until the mid-1969s or amosite until the late 1970s. Consequently, notwithstanding current HSE guidance, asbestos cement products installed prior to about 1980 cannot be considered to have contained chrysotile only.

As mesothelioma can result from environmental levels of exposure to crocidolite or amosite., e.g. Newhouse and Thompson (1965), it is considered relevant to assess whether teachers and nurses have experienced more mesothelioma deaths than would be expected in equal numbers of age and gender-matched persons not exposed to asbestos in the general population.

From HSE (2013) between 2002 and 2010 125 secondary, primary and nursery teachers and 64 nurses died from mesothelioma.

In the HSE occupational statistics the total number of “Observed” mesothelioma deaths is assigned proportionally to the total number of age and gender-matched deaths in each occupation and is presented as the “Expected” number of deaths for each occupation. The number of “Observed” deaths is then divided by the number of “Expected” deaths and multiplied by 100 to give the “Proportional Mortality Ratio”, (PMR), so that any occupation where the “Observed” equals the “Expected” has a PMR of 100.

The Observed, Expected and PMR figures for teachers and nurses for the period 2002 and 2010 are shown in Table 1 at the end of the article.

As can be seen, the PMR for female teachers is 101, i.e. effectively the “Expected” figure and all other relevant PMR in the occupations of interest are below about 85, i.e. lower than “Expected”.

HSE (2003) commented that for hypothetical populations not exposed to asbestos, the PMR would be 6 for males and 36 for females.

If the “Expected” figures are multiplied by 0.06 for males and 0.36 for females the table can be corrected as shown in Table 2 at the end of the article.

From the corrected data teachers and nurses had about 5 and 3 times respectively more mesothelioma deaths than expected in populations not exposed to asbestos.

For persons who never professionally disturbed asbestos-containing materials there are two likely causes of developing mesothelioma; exposure to asbestos in buildings containing asbestos-containing materials and idiopathic mesothelioma.

In buildings containing asbestos-containing materials in good condition airborne fibre concentrations are typically about 0.0005 fibres/ml, DoEnv (1986, 1983), Massey et al (1997). Although such a concentration appears to be very low it is low only because of the volume unit chosen and is actually 500 fibres per cubic metre: the volume unit used in describing almost every other airborne contaminant. Since the average child and adult inhales about 5-10 cubic metres per school day they will inhale about 2,500-5,000 fibres per school day if exposed to about 0.0005 fibres/ml.

Before any analysis of the mesothelioma deaths it is necessary to appreciate that for those retired or not in work the occupation entered in the death certificate was the last reported employment and that the occupational death figures only apply up to age 74 as occupation is not recorded after that age in England or Wales. The data therefore do not cover anyone who had previously been a teacher or a nurse and had changed careers or left to have a family and either never returned to work or took up a different career after their family went to school.

If it were assumed that teachers and nurses generally entered their careers at about age 20, had spent about 30 years working only in buildings containing asbestos-containing materials in good condition and so had been exposed to about 0.0005 fibres/ml throughout that period, their lifetime cumulative exposure would have been about 0.015 fibre/ml.year and their average risk of developing mesothelioma would have been about 60 and 3 per million to age 80 if exposed to amosite or chrysotile respectively. Note that for a uniform 30 year exposure to asbestos exposures during the first 6-7 years of exposure are responsible for about half the total mesothelioma risk and exposure in the last 10

MESOTHELIOMA DEATHS IN TEACHERS AND NURSESIN GREAT BRITAIN

by Robin Howie, Robin Howie Associates, Edinburgh


36

years contributes about 10% the risk, from Hodgson and Darnton (2000).

On the assumption of latent periods of 30-50 years from initial exposure and deaths between 2002-2010 the exposures to asbestos would have occurred between about 1960 and about 1980. Such period would have included the period when amosite was being widely used in thermal insulation and to provide fire resistance.

A search for data on teacher numbers from government websites failed to identify any such data.

However, Whitaker’s Almanacks (1960, 1972, 1986, 2002) provided relevant data, primarily for maintained schools in England only. If it were assumed that in England state schools employed about 85% of all teachers in England and that England employed about 85% of all teachers in Great Britain, total teacher numbers would have been about: 1958 - 430,000; 1970 - 530,000; 1985 – 512,000; 1998/99 – 550,000: about 500,000 mean. From Hawe (2008) the number of staff in NHS nursing and midwifery services was about : 1961 - 250,000; 1971 - 360,000; 1980 -500,000: 1991 - 500,000: about 400,000 mean.

From the above it will be assumed there were an average of about 500,000 teachers and about 400,000 nurses during the likely period of exposure that was responsible for the observed mesothelioma deaths during the period 2002-2010.

Assuming a mesothelioma risk of about 60 per million to age 80 from amosite in asbestos-containing materials in good condition in buildings there would have been about 30 mesothelioma deaths in each of teachers and nurses.

Given that 125 teachers and 66 nurses up to age 74 died from mesothelioma over the period 2002-2010 teachers and nurses experienced about 4 and 2 times higher mesothelioma deaths respectively than would be expected from typical asbestos fibre concentrations in buildings containing asbestos-containing materials in good condition.

Many cancers can result without influence from external sources. Such cancers are generally called idiopathic. Tan and Warren (2009) concluded that for mesothelioma the idiopathic rate for males was about 1.06 per million per year. These authors considered that the data for females were too sparse to estimate their likely idiopathic rate. However, it will be assumed herein that the idiopathic rates for both males and

females will be broadly similar at about 1.1 per million per year.

From HSE (2017) <2% of mesothelioma deaths up to age 74 during the period 2002-2010 occurred below age 49. It can therefore be assumed that for both males and females the idiopathic risk to age 74 will be about 25 years x 1.1 = 28 per million. That is, for populations of about 450,000 persons up to age 74 the number of idiopathic mesothelioma deaths in each profession would be about 12 , i.e. about half the number of mesotheliomas caused by being in buildings containing asbestos-containing materials in good condition.

As the epidemiological data cannot distinguish idiopathic mesotheliomas from those caused by environmental exposures to asbestos it is possible that some “idiopathic” mesotheliomas may actually be due to exposure to low levels of asbestos fibres in the general environment.

In conclusion, the number of teacher and nurse mesothelioma deaths observed in Great Britain between 2002 and 2010 substantially exceeded the number of deaths expected in populations not exposed to asbestos, from exposure to asbestos-containing materials in good condition or from idiopathic mesotheliomas in the general population.

The observed excess mesothelioma deaths suggest that both teachers and nurses were likely to have been exposed to airborne asbestos fibre concentrations significantly higher than typical in buildings containing asbestos-containing materials in good condition.

From Hodgson and Darnton (2000) the likely cumulative exposures over 30 years would need to have exceeded the equivalent of about 0.15 fibres/ml.years of amosite for teachers or about 0.06 fibres/ml.years of amosite for nurses to cause the number of observed mesothelioma deaths in each profession during the period of interest.

The above figures indicate that airborne asbestos fibre concentrations in both schools and hospitals need to be substantially reduced and that programmes of high sensitivity sampling, in combination with the use of analytical Transmission Electron Miscopy used to count all asbestos fibres, not only fibres longer than 5um and fibres wider than 0.2um, as adopted by HSE’s Health and Safety Laboratories, e.g. Burdett (2012), to identify where control actions are necessary.

References available on request


37

Tables

Occupation Gender Observed Expected PMR

Teachers, secondary, primary and nursery

Male

Female

Total

68

57

125

~105.5

~56.4

~162

~64

~101

~77

Nurses

Male

Female

Total

12

52

64

26.0

60.9

~87

~46

~85

~74

Table 1: Observed, Expected and PMR figures for teachers and nurses - 2002 to 2010.

Occupation Gender Observed Corrected Expected

Corrected PMR

Teachers, secondary, primary and nursery

Male

Female

Total

68

57

125

6.3

20.3

~27

~1100

~280

~460

Nurses

Male

Female

Total

12

52

64

1.6

18.7

~20

~760

~280

~320

Table 2: Corrected Expected figures for males and females.


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NEWS IN BRIEFby Tom Bell, Chief Executive

REHIS Eating Well for Older People Course

The REHIS Eating Well for Older People Course is a new course developed by REHIS in partnership with Edinburgh Community Food and NHS Tayside. It is a welcome addition to our suite of qualifications in Food and Health.

The course aims to provide participants with the knowledge and appreciation of the importance of good nutrition for older people and how to support them to eat well. The course is non-clinical and would be suitable for anyone working with older people in the community or for older people themselves. The course is supported by a course handbook full of excellent information and useful recipes.

The course is designed to be flexible and can be delivered in a variety of ways, providing the minimum teaching time (3 hours) and course objectives are covered. It is available to all Food and Health Approved Training Centres.

For more information, please contact Jackie McCabe, Director of Training.

New member of staff

I was delighted to welcome Carol Campbell to the administrative staff of the Institute. Carol replaces Angela Flynn, as Administrative Assistant, and will work closely with Margaret O’Hare, Training Administrator, Community Training. Angela moved on to a new post within the local authority sector in December. I take this opportunity to wish Carol and Angela all the very best in their new positions.

PR/Media Update

A number of public relations and media opportunities for the Institute have arisen since the last edition of the Environmental Health Scotland was published. The two most recent opportunities covered the diverse topics of air quality and congestion charging, and pest control.

David Duffy, the Senior Vice-President, gave evidence to the Scottish Parliament’s Environment Committee at Holyrood in November on congestion charging and the likelihood of a positive impact on air quality in Scotland.

I was interviewed about novel and traditional rodent control techniques by Mhairi Stewart presenter of BBC Radio Scotland’s Newsdrive programme in December.

The Journal

At its December meeting the Council of the Institute agreed, following consultation with the membership, to cease the publication of Environmental Health Scotland in the traditional print format and to publish it in e-Book format.

The decision was taken following a survey of the membership on the future of the Institute’s publications.

The next edition of Environmental Health Scotland, the Spring 2018 edition, will be published in the new format.

An article by Paul Bradley, Chair of the Environmental Health Promotion Committee, on the ongoing publications review and consultation, will feature in the Spring 2018 edition of Environmental Health Scotland.


39

THE ROYAL ENVIRONMENTAL HEALTHINSTITUTE OF SCOTLAND

The Institute was incorporated as a Company Limited by Guarantee on 16th February 1983, to give effect to the amalgamation of The Royal Sanitary Association of Scotland and The Scottish Institute of Environmental Health.The Institute was Incorporated by Royal Charter on 8th March 2001, following which the Company was wound up.

The Royal Environmental Health Institute of Scotland is a registered Scottish charity, Number SC009406.

The objects for which the Institute is established, contained in Article 3 of the Charter, are for the benefit of the community to promote the advancement of Environmental Health by:

a. stimulating general interest in and disseminating knowledge concerning Environmental Health;

b. promoting education and training in matters relating to Environmental Health; and

c. maintaining, by examination or otherwise, high standards of professional practice and conduct on the part of Environmental Health Officers in Scotland.

The Royal Environmental Health Institute of Scotland is an independent and self-financing organisation. It neither seeks nor receives grant aid. The Institute’s charitable activities are funded significantly by the subscriptions received from its members.

The Institute’s affairs are managed by a Council which is elected by members. The Royal Environmental Health Institute of Scotland is a founding member of the International Federation of Environmental Health.

The Institute frequently uses the acronym: REHIS®.

REHIS and the Crest device are registered trademarks of The Royal Environmental Health Institute of Scotland.

Developing and Maintaining a Positive Food Safety CultureThe importance of food safety culture and its effect on the implementation of food safety practices is increasingly recognised. However, there is a lack of information on the theoretical underpinning and practical application of food safety culture. This book seeks to redress these deficiencies.

Price per copy 1-9 copies: £13.5010+ copies: £11.50+ postage & packing

Health and Safety for ManagementThis folder includes all the latest information on health and safety legislation, training and best practice for managers to implement in their workplace. It is indispensable reading for owners and managers of all businesses, managers and trainers of health and safety.

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The Risk Assessment HandbookThis handbook covers the background and legislation associated with risk assessments, common accidents, incidents and near misses in workplaces, different types of risk assessment and how risk assessment relates to enforcement.

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A Question of Licensing for Scotland (for servers and sellers of alcohol)An excellent resource for personal licence holders and trainers, A Question of Licensing for Scotland provides 2 hours of licensing training for staff who sell or serve alcohol (as required by Scottish law).

Price per copy1 copy: £62-24 copies: £3.5025-49 copies: £2.7550-99 copies: £2.50100+ copies: £2.00+ postage & packing

Food Safety Culture PresentationThis presentation is ideal for those delivering a Level 3 Food Safety Culture course. This presentation includes an introduction to the concept of food safety culture, components and composition of a food safety culture, and developing and promoting a positive food safety culture.

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Level 3 Allergens Training PresentationThis product includes 2 presentations on a single disc. The first supports the delivery of the Level 3 allergen courses and the second covers general allergen information and is designed for use during internal training for all food handlers and front of house staff.

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Documents

Vol 29 - Number 4 Winter 2017 - REHIS Journal 2017.pdf · THE ENGINE SHED, STIRLING The Engine Shed, Stirling. Photograph courtesy of Historic Environment Scotland. ... John Merrylees