Ask your average EHP what they find challenging about working in the capital and they invariably reply ‘the variety’. The working day can suddenly be side-tracked by an emergency such as a terrorist threat, rail crash or explosion.
You must be prepared for the unexpected, such as in November 2006 when Westminster EHPs had to respond to the spread of radioactive polonium-210 as the fatally poisoned former KGB agent Alexander Litvinenko moved through the city centre.
Then there are the social changes that impact one of the world’s most culturally diverse cities. In the last two years hundreds of shisha bars have opened up across the city, selling to communities as diverse as city traders and students. Shisha can generate thousands of pounds profit a week and is proving difficult to control.
The CIEH London Region, made up of 33 London boroughs and the London Port Health Authority, is unique in the way that it is constituted.
Its members work hand-in-hand with the Association of London Environmental Health Managers (Alehm), a charity set up 10 years ago to co-ordinate the interests of environmental health managers from each borough and promote public health across the capital. Alehm and CIEH London Region members sit on each other’s boards, share common goals and, in effect, work as one representative body.
One of the London Region’s highest priorities over the past year has been how best to co-ordinate environmental health activity across the capital. Preparations for the London 2012 Olympic and Paralympics games have brought the five host London boroughs into close contact as they work together on Europe’s biggest building project.
The Olympic project will be covered in a future edition of EHN. However, the principle of joint working has already spread beyond the Olympic site, with pan-London projects now incorporating emergency planning, safe food, student support, smoke-free, gastrointestinal disease, healthy eating, health and safety and much more.
The Buncefield oil depot fire in 2005 drew attention to the need for a stronger network of technical support in an emergency. Recognising that most emergency incidents impact on the environment and on health, the London Fire Brigade, working with local authority chief officers and Alehm, launched the London Scientific and Technical Advice Cell (STAC) last September.
Its job is to provide advice to emergency planning teams in the event of a major incident. Scientific and technical advisers from utilities, government agencies and local authorities have been brought together to sit on the advice cell, to provide gold and silver command with the best possible advice for any particular incident. Two EHPs from each London borough sit on the cell.
The unusual thing about the environmental health profession is that we have access to such a broad network of expertise
says Alehm chair Steve Miller, who was involved in setting up the London cell.
Out of the 66 EHPs on the STAC there will always be someone who will at least know someone who has the information needed. This has been an important step forward in cementing our role as a profession that has expertise that we use pragmatically.
The STAC system is to be extended to other regions across the country.
Another problem common to all CIEH regions is the shortage of student placements. Competition for placements is tough and two universities, King’s and Middlesex, produce new batches of students each year, so the problem in London is as acute as elsewhere.
In an effort to resolve this, Alehm and the CIEH have set up the London EHO Consortia Scheme. Local authority members pay £3,200 a year, which pays for a London student development officer who organises placements for students, supports them and helps with practical training. Each placed student receives a £2,100 bursary from the consortia.
The advantage of the consortia is that it offers more flexibility, so a local authority can take someone just for two months if they want, and we can move the student around
… says Tay Potier, London Regional policy officer.
Because we have recruited the students into the consortia, we can also be sure we are sending students that the local authority will be happy with and we can support both parties.
Ten London authorities are members and eight students were placed last year. Other boroughs either recruit locally or run individual programmes. Any London student or a student who plans to work in London can access support from Kath Lewis, the London student development officer. Over the next year, the consortia hopes to attract private companies and government agencies into the scheme.
Improving health across London
Alehm and the CIEH London Region often combine forces to attract funding. Last August, Alehm received £200,000 of FSA funding to take the Safer Food Better Business (SFBB) programme into its next phase. Focusing on zero- and one-star rated food premises, and working with the Newham-based charity HealthWorks, the project is initially targeting high-risk food premises in the Olympic host boroughs and will be extended to other London boroughs from April.
HealthWorks in London is using the funding to recruit EHPs and technical officers to give poor performing food premises three hours of coaching followed by a one-hour visit, to implement SFBB.
The whole point of this project is to target the highest risk premises and to reduce and manage the contribution required by individual local authorities,
Past projects have tended to be a burden on authorities so this is designed to be as smooth as possible by using people experienced in local authority work, working in the evenings and weekends, and who have experience in dealing with this type of premises.
Alehm and the London Region are also using HealthWorks to investigate how to control the explosion of shisha bars and the flouting of the smoke-free legislation across London and other major cities. With Department of Health funding, HealthWorks is bringing together the experiences of enforcement officers across affected boroughs to produce guidance
Shisha, popular across the Middle East and North Africa, is a mixture of tobacco molasses and fruits or spices smoked through a water pipe or hookah. It is promoted as a non-addictive alternative to smoking, providing a relaxing way to socialise. A typical session can last up to 30 minutes and cost between £5 and £15. The significant profits made by bar owners pose an enforcement problem, with fines of even £1,000 considered an occupational hazard.
Accessing shisha bars also pose problems. Owners often use locked doors and intercoms, will claim it is a private dwelling and deny ownership or management. Enforcing shisha bars can be labour-intensive and costly for authorities, often for limited results. Guidance on making prosecutions easier will be published this year.
With so many agencies working across London, it is not only local authorities that need better co-ordination. Alehm and the CIEH, with HPA funding, recruited masters student Camilla Bourn to investigate how standards of gastrointestinal infectious disease reporting and surveillance could be improved across the capital (EHN, 15 January 2010, page 17). Camilla discovered that the four Health Protection Units that cover London have slightly different memoranda of understanding with local authorities for reporting infectious disease. She has made a number of recommendations calling for more co-ordinated communication.
Sian Hale has now taken over from Camilla and will this year help implement the recommendations in the report.
It is the Alehm and CIEH London Region study and technical groups operating across London where much of the front-line environmental health work gets done. These expert groups in food safety, housing, environmental protection and health and safety aim to provide consistency across the capital while ensuring the continual professional development of their members.
To co-ordinate responses for food and health and safety, the London region has set up a central co-ordinating group made up of the sector chairs and representatives from the Food Standards Agency, the Health and Safety Executive and the Health Protection Agency.
This structure enables London to target priorities in a co-ordinated way and so produce a business plan that identifies training needs and ensures we have a pan-London approach to health and safety and food safety.
says Alehm secretary Keith Hill.
It also provides us a structure where information flows smoothly from the top down and from the bottom up and ensures we make best use of resources by setting pan-London priorities.
With sharp public sector cuts expected, local authorities across the capital have also been studying how they can combine services to provide economies of scale and so cut costs.
In East London six London boroughs have signed an agreement to investigate sharing services. The London boroughs of Havering, Barking and Dagenham, Redbridge, Tower Hamlets, Waltham Forest and Newham have been considering combining procurement and human resources.
An initial meeting last month chaired by Alehm’s Steve Miller discussed the possibility of combining regulatory services including environmental health.
There may be some quick wins like pest control, animal welfare, mortuary services and even some food safety functions,’ says Steve. ‘We are also looking at emergency planning. We currently have six emergency planning control centres across the boroughs and we have to ask whether we actually need six in east London.
Joint working and the sharing of environmental health services across boroughs are themes we will hear more about as EHN investigates how CIEH regions across the UK plan to confront the challenges facing the profession over the coming year.