CIEH EHN November 2021

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SPECIAL ISSUE THE MAGAZINE FOR CIEH MEMBERS

www.cieh.org November 2021 Volume 36 Issue 9

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VISIONS OF THE FUTURE The changing face of environmental health

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NOVEMBER 2021 VERSION

CONTENTS

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ENVIRONMENTAL HEALTH NEWS

CIEH

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SPECIAL ISSUE

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03 UPDAT E COVID-19 A look at the report into the successes and failures of the UK’s pandemic response.

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V I S IONS OF T H E FUTU R E 05 TELL YOUR STORY Keep shining a light on the profession, says Dr Phil James.

06 COVID-CONVERSATIONS Sterling Crew explains how CIEH’s webinars brought EHPs together to tackle the pandemic.

08 A HEALTHY HOME A clean, safe and secure place to live is vital to wellbeing and health, writes Stephen Battersby.

11 THE BALANCING ACT Huw Brunt shares the experiences of Welsh EHPs juggling COVID and the day job.

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G O ON L I N E

12 HOPES FOR HOSPITALITY Kate Nicholls on the effect of the pandemic on hospitality and the way forward for the sector.

15 THINK BIGGER Nigel McMahon tells why anything is possible with the right support.

16 A PIVOTAL MOMENT IOSH’s Louise Hosking on

prioritising sustainability in occupational safety and health.

18 TURNING POINTS There are positives from the pandemic but many challenges to come, says Jim McManus.

20 NO THRESHOLD IS SAFE Frank Kelly shares some stark stats on pollution and explains why we need to address climate change and air quality together.

30 5 THINGS I’VE LEARNED …

Peter Wright talks pragmatism, problem-solving and looking after public health.

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WHAT HAVE WE LEARNED?

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A summary of the UK’s response to COVID-19 SUBS

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House of Commons Health and Social Care Committee and Science and Technology Committee published their joint report examining the initial UK response to the COVID-19 pandemic. The report, Coronavirus: lessons learned to date, was agreed unanimously by both Select Committees, which consist of MPs from three parties: Conservative, Labour and the SNP. The joint inquiry was established in October 2020 to ask why in the early stage of the pandemic the UK did significantly worse in terms of COVID-19 deaths than many other countries, especially compared to those in East Asia that were much closer geographically to where the virus first appeared.

It acknowledges that some countries that fared better than others in the early months of the pandemic have subsequently had more fatalities. However, it states that decisions on lockdowns and social distancing during the early weeks of the pandemic rank as “one of the most important health failures the United Kingdom has ever experienced”.

The conclusions and recommendations of the report identify a number of consistent themes, including that:

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The report says pandemic decisions made by Boris Johnson’s government rank as “one of the most important health failures the United Kingdom has ever experienced”

● the UK’s response, with the notable exception of vaccine development and deployment, has for the most part been too reactive as opposed to anticipatory;

● there has been too little explicit learning from the international experience, as illustrated in the approach to non-pharmaceutical interventions and Test and Trace; ● the right combination needs to be struck between centralised and localised measures and, in certain cases, implementation of pandemic containment measures was too centralised when it ought to have been more decentralised; ● better engagement with relevant sectors and interest groups was needed to understand on-the-ground experience and inform decision-making, particularly for social care; and ● the response has lacked speed in making timely decisions.

In a joint statement, Jeremy Hunt MP, Chair of the Health and Social Care Committee, and Greg Clark MP, Chair of the Science and Technology Committee, said: “The UK response has combined some big achievements with some big mistakes. It is vital to learn from both to ensure that we perform as best as we possibly can during the remainder of the pandemic and in the future.”

A public inquiry has been promised to examine the response in fuller detail and the two Select Committees recommend that this is launched as soon as possible.

● The report is available at: committees.parliament.uk/ publications/7496/documents/ 78687/default

‘THE UK RESPONSE HAS COMBINED SOME BIG ACHIEVEMENTS WITH SOME BIG MISTAKES’ SEPTEMBER NOVEMBER 2021 2021 // ENVIRONMENTAL HEALTH NEWS 3

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CIEH Chief Executive Officer Dr Phil James wants environmental health to keep on shining now that it’s firmly under the spotlight

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DR PHIL JAMES has been chief executive officer of CIEH since January 2021. Prior to that, he was chief executive of The Institute of Leadership & Management. He also served as group chief executive for the Mineral Products Qualification Council and for the Institute of Quarrying, as assistant chief executive for the British Association of Social Workers, as a senior consultant for Hall Associates Europe LLP, and as regional director for the Chartered Institute of Building.

HERE CAN BE

little doubt that at the height of the COVID-19 pandemic, environmental health found itself in the spotlight in a way that has not been seen in a generation. For me, the question therefore arises – what should we do now to build upon this moment of attention?

HOLISTIC AND FLEXIBLE

First, let’s ask what it is about environmental health that has been highlighted by the response to COVID-19. For one, the pandemic revealed a profession that is already there – poised and active in dealing with and preventing public health outbreaks of any scale.

Environmental health professionals are highly skilled and oriented in assessing risk and solving problems in ways that consider the potential wider consequences of any actions.

Perhaps the most vital of all of its many characteristics, environmental health is not a profession that operates in arrogant isolation, but a holistic and connected discipline capable of working and flexing alongside myriad other professions.

So, this is a story of collaboration, not heroism, of an ensemble performance, not a solo act. And that, for me, is a shining, towering strength of environmental health professionals everywhere.

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A PLACE AT THE TABLE

Many of the challenges facing the profession were also highlighted during the pandemic. For example, dwindling resources meant that environmental health teams had to not only focus upon new sets of priorities, but absorb the pressures felt when other priorities simply had to come second.

So, the case for why environmental health needs to be properly supported has never been clearer – not only through proper funding but by having a place at the table, so that the political and legislative landscape safeguards our health, enables businesses to bounce back, and helps secure a sustainable future for our planet.

But we cannot allow environmental health to shine

only in times of crisis.

Environmental health is not simply a profession in waiting.

Its professionals prevent crises, constantly, and don’t just appear when something goes wrong.

Right now the spotlight is not just on environmental health as a crisis response, it’s falling on the entire profession and discipline.

Let the light shine in so that people can see what you do to protect everyone, everywhere, every day. Let’s talk in a language that will resonate with those we need to influence – those who hold the purse strings, those who shape the law, and those whom we hope to inspire towards an amazing and rewarding career in environmental health. The light is on you. Go out and tell your story.

‘THIS IS A STORY OF COLLABORATION, NOT HEROISM, OF AN ENSEMBLE PERFORMANCE, NOT A SOLO ACT’

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1 Phil James, 1

EXPERTS ON THE NEW FACE OF ENVIRONMENTAL HEALTH

Public health and protection

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Sterling Crew looks at how webinars are keeping EHPs up-todate with COVID-19 advice and helping them to protect the public

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As a welcome outcome of COVID mitigation actions, people are now more aware of hygiene and disease prevention

THE BEGINNING AND THE UNCERTAINTY OF RISK

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Ackerley and I joined staff at CIEH to create the COVID Action Team (CAT). Our aim was to keep members and other interested parties informed on how the pandemic was unfolding and what we as Environmental Health Practitioners (EHPs) could do. We established a COVID-19 knowledge hub signposting the very best scientific advice. We tried to articulate what we knew we knew and what we knew we did not know – and we had to accept that there were unknown unknowns.

In the early days of the pandemic, we did not know about the nature of the novel coronavirus, its mode of transmission and its LD50 (lethal dosage).

Probably our biggest impact was the creation of the popular CIEH COVIDConversations, in which we engaged with EHPs in a conversational style. We used ‘group intelligence’ from the attendees to help ask the right questions and come up with answers and practical solutions. Having direct input from more than a thousand EHPs was powerful. It also helped create a sense of a community – that we’re all in this together.

Some of the common themes we discussed included the fast-moving new legislation, where the legal interpretation of former CIEH president Tim Everett proved insightful.

We addressed the modes of transmission and how to nudge the public into adopting safe behaviours, using behavioural science to suggest strategies that could increase compliance. The debate quickly turned to the indirect impact the virus was having on public health such as the ability to provide services and the pandemic’s impact on the nation’s mental health.

It would be unacceptable for us to say it’s all unclear and we just do not know. We tried to set the boundaries of that uncertainty and risk.

It was important that as new evidence became available, our position was reviewed. At the beginning of COVID-19, traditional pandemic controls were highlighted, such as the need to wash hands at appropriate times. It soon became evident that COVID-19 was principally a respiratory disease and we adjusted some of our messaging accordingly.

LEGACY AND LESSONS

I believe we are at a stage when we can now start to reflect and learn the lessons coming out of the pandemic.

At the time of writing, a UK Parliamentary report has just been published, Coronavirus: lessons learned to date (see page 3). The report details the successes and failures of the response to the pandemic and encourages us to learn some crucial lessons from them.

In my opinion the outbreak is not the ‘black swan’ event that it might have seemed. The World Health Organization has long warned that we need to prepare for virus ‘X’. It surprised me how underprepared we and the world were.

Since the pandemic began, we have been social distancing, wearing masks and washing our hands. As an unintended but welcome outcome of these actions there is a growing global awareness of hygiene and disease prevention. We have seen a worldwide reduction in influenza cases for both influenza

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COVID-CONVERSATIONS

Think piece 2: Sterling Crew, 1 STERLING CREW is chair of the Food Authenticity Network’s Advisory Board. He is also an independent scientific advisor and public health commentator. He was elected a trustee of CIEH in 2021 and co-hosts the CIEH COVIDConversations.

A and B viruses, with some flu strains becoming undetectable in the last year and maybe even extinct. I would like to think we will have a hygiene legacy, although a friend said recently: “Thank goodness the pandemic is over; I can now stop washing my hands.”

ENDGAME

The amazing development of the vaccine has been a game changer and, as a consequence of its impact, society has started to reopen.

In the words of Winston Churchill: “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” The pandemic is not over. It would be wrong to have a false sense of security.

There is still a level of uncertainty about the future – UK cases have been rising sharply, although deaths are now well below last year’s winter peak. We may well see the return to public health restrictions this winter despite the success of the vaccine.

EHPs have gained prominence during the crisis and regained some profile and influence.

We must not lose this opportunity to promote the importance of public health in our lives and how EHPs are a national asset.

The COVID-19 pandemic has been the largest public health crisis in generations. A huge shout-out to EHPs, heroes one and all, for the important role they have played. I have never been prouder to belong to our profession and to call myself an EHP.

The next CIEH COVID-Conversations: public inquiry roundtable is on 17 November.

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ENVIRONMENTAL HEALTH TOGETHER

COVID-19 highlights the importance of the sector, says Janet Russell EHP Janet Russell started working with the Department of Health and Social Care in June 2020, helping to link the English Test and Trace system with regional contact tracing infrastructure in Yorkshire and the Humber.

She spoke to EHN [in March 2021] after moving to the Contain Operational Capacity team where she helped to create Environmental Health Together, a register of EHPs for English local authorities needing to recruit EHPs quickly for COVID-related work. Councils have been able to search a pool of 160 registered professionals with environmental health qualifications by region, skills and experience to find the best match for their needs.

She said: “One of the areas that kept coming up regionally was, ‘Where can we get more environmental health officers?’ because the value of EHPs in local

government has been recognised by chief executives and politicians.

“EHPs had a light shone on them because they’d been at the core of working with directors of public health in outbreaks, visiting businesses for COVID compliance and much more. EH is more appreciated and understood at government level than I’ve known in 30 years.”

The programme, administered by CIEH and the Local Government Association, closed last month as government funding for the campaign came to an end.

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‘YOU ARE WHERE YOU LIVE’

Just as ‘you are what you eat’ Stephen Battersby argues ‘you are where you live’, so that to be fit and healthy, the place in which you live should be safe and not cause harm

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STEPHEN BATTERSBY is visiting senior research fellow at the Centre for Environment & Sustainability, Dept of Civil and Environmental Engineering, University of Surrey. He is also a CIEH vice president and former CIEH president.

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review of the Marmot Report recorded (bearing in mind that housing has been identified as a key social determinant of health), the more deprived the area and poorer the housing quality, the shorter the life expectancy. The social gradient has become steeper over the last decade. In part, this can be attributed to financial austerity, but cuts to local government including environmental health departments will not have helped. Indeed, in work for Karen Buck MP, I found that some local authorities had no qualified Environmental

Health Practitioners (EHPs) dealing with housing.

This has implications for the profession, but it must also have repercussions for how poor housing and threats to health are addressed. It worries me that the review of the housing health and safety rating system (HHSRS), rather than updating the evidence and guidance, may be a cover for revising the system so that the professional judgement of a qualified EHP is not required. That said, one issue that has struck me over the years is the apparent declining skill in housing inspections and knowledge of construction. If the dwelling is not inspected properly there will be

no chance of using any system effectively to improve health. The unique skill of EHPs has always been to identify the risks to health (or safety) arising from the defects identified on inspection.

The impact of COVID-19 has also been felt most acutely by those on low incomes and living in poor conditions, in addition to those who are vulnerable by virtue of their age. Part of the problem is that housing has come to be an investment or asset rather than somewhere to establish a home.

The World Health Organization approach is that the dwelling is the physical structure, and the home is the social, cultural and economic structure created by the individual

1. DRY Damp dwellings are an optimum environment for cockroaches, dust mites, rodents and moulds, all of which are associated with asthma and allergies.

2. CLEAN (HYGIENIC) Dwellings that can be effectively cleaned reduce the possibility of pest infestations and exposure to contaminants.

exacerbate health problems.

4. SAFE Falling hazards are the most commonly identified serious hazards in the English Housing Survey but unintentional injuries include burns and poisonings. This should also take account of fire

3. PEST-FREE Studies have shown a causal relationship between exposure to mice and cockroaches and asthma in children.

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safety, and the ongoing issue of cladding and other problems related to the spread of fire highlight this.

5. CONTAMINANT-FREE Exposures include lead, radon, pesticides, volatile organic compounds (e.g. formaldehyde), carbon monoxide, oxides of nitrogen, sulphur dioxide Unhygienic surroundings increase the risk of pest infestation

(products of combustion) and second-hand tobacco smoke.

problems related to prolonged exposure to excessive heat or cold.

6. VENTILATED Studies have shown that fresh air improves respiratory health and the COVID-19 pandemic has highlighted the importance of good ventilation.

9. ACCESSIBLE Lack of accessibility in and outside the home can result in reduced physical activity, trips, falls, isolation and poor mental health. I would also suggest that this should include having adequate space, and no crowding.

7. MAINTAINED Poorly maintained dwellings are at risk from damp, pests and other stressors.

8. THERMALLY CONTROLLED When adequate temperatures cannot be maintained occupants are at risk of health

10. AFFORDABLE Households which spend more than 30% of their income on housing are considered “cost burdened” by NCHH, a slightly different approach from the UK’s “affordable rents”.

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10 PRINCIPLES FOR A HEALTHY HOME

According to the Marmot Review, the more deprived the area, the shorter the life expectancy

or household. The US National Center for Healthy Housing (NCHH) has proposed 10 principles for a healthy home (see below left).

While I would not disagree with any of the 10 principles, I would also include ‘Quiet’, as sound transmission and noise is a problem in many homes and can cause considerable stress.

The Northern Housing Consortium reported through the pandemic that many households were living with long-standing repair and quality issues, some of which got worse or more obvious during lockdown. The report says that “the COVID-19 lockdown has shown in the starkest of terms that run-down homes are resulting in run-down people.”

Poor housing conditions have an impact on public health and increase pressure on medical services (the Building Research Establishment has demonstrated costs to the NHS). This is true regardless of ownership and the profession needs to be highlighting this, even where their employing authority is also the owner/landlord of the property causing harm.

EHPs need to speak up, whether the landlord is their employing local authority or a housing association. If they feel unable to do so, then perhaps there is a need for more independent EHPs, willing to help lawyers in litigation.

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‘OWNERS CAN BECOME VERY DEFENSIVE’

The EH officer (EHO) helping to make buildings safer post-Grenfell Steffan Micah spoke to EHN [in July 2020] in his role as part of the Local Government Association’s national fire safety Joint Inspection Team, funded by the Ministry of Housing, Communities and Local Government (MHCLG). It was set up following the Grenfell fire tragedy to inspect cladding and take action where necessary.

He said: “When combustible ACM cladding on buildings over 18m was banned, it was felt that the best way to address problems with landlords failing to remediate was to use Housing Act 2004 powers.

“Few local authorities have a fire expert in their environmental health teams so a national multidisciplinary team was formed: that’s us. The team consists of a team leader, a principal EHO,

two EHOs, a fire engineer, a building control expert and a legal adviser. We cover England only, with the devolved nations having their own regimes.

“Cases are referred to us by MHCLG and it is up to local authorities whether they take up our assistance. We have no enforcement powers but we’ll help with enforcement action and attend court. Once an authority has agreed to our help, we review and inspect the block over two days. Most of the blocks visited have been much more complex than the one in the HHSRS worked example.

“Building owners and managers are often confident we will find nothing wrong with their building. This can quickly change following our visit when it becomes clear what the consequences

could be. They can become very defensive.

Post-inspection a lot of further documents are usually provided by the building owners.

“Progress is not as quick as we’d like: the legal and construction processes often mean the remediation of combustible cladding takes 12-18 months, but we expect to see more blocks made safer.”

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Think piece 3: Stephen Battersby, 1

‘THE COVID-19 LOCKDOWN HAS SHOWN IN THE STARKEST OF TERMS THAT RUN-DOWN HOMES ARE RESULTING IN RUN-DOWN PEOPLE’

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CHANGING PRIORITIES

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Chief Environmental Public Health Officer, Welsh Government, Dr Huw Brunt on juggling the continued response to COVID-19 alongside attending to the day job ver the past 20 months, local government environmental health services in Wales (alongside other public protection services such as trading standards and licensing) have played a key role in supporting the public health system’s response to the COVID-19 pandemic.

Throughout, the Public Protection Wales group (comprising senior officers from each of Wales’s 22 local authorities) has worked with Welsh Government, the Welsh Local Government Association and partners to offer leadership, coordination and expert advice.

Officers’ professional skills have been stretched and tested like never before, but delivery has exceeded expectation.

Notable achievements in Wales have included: l Regular input to dynamic policy and legislation development

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DR HUW BRUNT became Chief Environmental Public Health Officer, Welsh Government, in January 2021. He is a public health consultant with a background in environmental health and a PhD in air quality and public health research. With more than 20 years’ experience, he has held a variety of roles across local and central government, and the NHS in Wales.

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l Support to create and deliver

the Test Trace Protect service

l Oversight of community

infection transmission risks through local and regional Incident Management teams l Risk management in a range of settings including social care and education l Investigating issues of counterfeit and mislabelled PPE

PROACTIVE APPROACHES

One area of work where public protection specialists have demonstrated real leadership qualities is regulation, monitoring and enforcement. Proactive approaches have been required to advise businesses, event organisers and others on the application of new risk assessment approaches, while reactive regulatory and enforcement work has helped manage identified risk.

Professionals have needed to respond proportionately to sector/ setting-specific requirements and dynamic population health risks.

To support the pandemic response, local authorities have needed to make difficult decisions to reconfigure and re-prioritise environmental health and other public protection resources.

The consequence of this has been that some core activity has been scaled back. It should be noted, however, that statutory work and urgent risks have been attended to (for example, infectious disease outbreaks and acute environmental incidents).

Core work is now picking up, but alongside COVID-19 risks and control measures which are still very much live. Services have to perform a balancing act to deliver an ongoing proportionate response to COVID-19 while simultaneously bringing ‘the day job’ back online – whether that’s broader communicable disease control, food safety, health and safety, environmental protection, housing and communities or healthy behaviours work.

There is no doubt that moving from response to recovery will be challenging. Environmental health and broader public protection will likely look and feel different to pre-pandemic experiences – adapting and evolving services will be critical. Helpfully, the transition offers an opportunity to ‘take stock’ of priorities across the work portfolio, but it will be important to act efficiently and make the most of all available resources.

Looking ahead – with public protection an established, respected and authoritative part of the public health system in Wales – making sure there is sustainability and resilience in professions and specialist services is crucial to deliver on the agreed agenda. To achieve this, innovative, collaborative action is needed to seek to enhance professional development, drive recruitment and retention, and secure long-term workforce plans.

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Think piece 4: Huw Brunt, 1

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Staff shortages and supply problems are adding to the legacy of lockdown for hospitality businesses

HOPES FOR HOSPITALITY

CEO of UKHospitality Kate Nicholls on the whirlwind of the past 20 months

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The pandemic sent shockwaves of seismic proportions through the sector and has been the greatest challenge hospitality has faced in a generation. The disruption and enforced closure of venues resulted in £100bn of lost sales for the sector. It also brought renewed focus and investment in health and safety equipment and practices, as well as significant changes in how venues operate. However, hospitality operators’ first port of call has always been to ensure staff and guests are in safe environments, so the pandemic represented a shift rather than a wholesale change in approach.

How has UKHospitality been able to support the hospitality sector during the pandemic?

We have been tirelessly highlighting the industry’s plight. As a result of lobbying, we have seen vital interventions from government, such as the furlough scheme, business rates holiday and temporary reductions in VAT, which have helped save many, but unfortunately not all, businesses.

We’ve also been supporting businesses in the sector to adapt to frequently changing restrictions, providing them with the advice and information required to be compliant. The close working relationship and cooperation between hospitality and environmental health professionals has been crucial in ensuring WWW.CIEH.ORG

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How would you describe the impact of the pandemic on hospitality?

Think piece 5: Kate Nicholls, 1

I N T H E FI E L D venues adhere to COVID regulations and create safe environments for guests and staff alike.

What adaptations and innovations has the pandemic led to?

Operators have had to look at their businesses from top to bottom to ensure they’re operating as efficiently as possible, whether that be adjusting the layouts of venues or staff scheduling and rotas to reduce potential transmission, all while still providing guests with a great experience. Technology has been at the forefront – for example, the adoption of mobile order and pay was accelerated, and this will have long-term impacts on how hospitality businesses operate.

Where is the sector at right now?

This summer hospitality was able to open fully with no operating restrictions for the first time since March 2020 and consumers have proved they have missed going out. However, challenges remain. Chronic staff shortages and supply disruption, in addition to rising costs, mean the sector is far from out of the woods and continued government support with a permanent lower rate of VAT and reform of business rates is crucial.

Our focus now is on recovery and rebuilding.

While we are in a far better position now, coronavirus isn’t going to go away and during this period a strong and cooperative relationship between the hospitality sector and environmental health will be even more important than usual.

What does the UK need to do to be better prepared for a future crisis?

The pandemic and the huge impact it has had on all of society was unforeseeable, so I have tremendous sympathy for those in government during the past 20 months.

However, we have seen that with a crisis such as COVID that requires extensive government intervention, this has to be married with a strong working and collaborative relationship with business and industry to ensure the measures taken are the right ones and are as effective as possible.

How has the pandemic changed customer perceptions of public health protection?

There’s heightened awareness and improved understanding of public health protection.

Operators now need to meet the increased expectations among consumers and will need to continue to work with the environmental health profession to do so. This will ultimately see standards across the sector improve, which is a great positive.

Where do you see the future of hospitality?

Hospitality is such a vibrant and dynamic WWW.CIEH.ORG

LIFE AFTER LOCKDOWN

Carole Milligan, chartered Environmental Health Practitioner (EHP) at Islington Council told EHN (July/August 2020 edition): “With many businesses closed completely, some operating remodelled services and others fully functioning, the council had to revamp its approach to environmental health. Inspections that a few months earlier would have involved a thorough site visit were carried out remotely with businesses required to submit photographic, video and documentary evidence.

“We’ve had to use a number of inventive ways to verify that the controls are put in place. We also produced a lot of guidance for businesses during lockdown, for those that had been operating and those that had closed their premises.”

The guidance was delivered online, through

sector. I hope that, rather than looking behind us and worrying about survival, the sector is able to look ahead with great optimism and plan for growth. Hospitality has the power to transform people’s lives with fulfilling and diverse careers filled with opportunity and to rejuvenate our communities and high streets.

I hope to soon be speaking about this rather than warning about the threat of job losses and business closures.

You are speaking at the CIEH Safe Food Conference on 11 November. What do you hope the event will achieve?

It’s a great opportunity for hospitality and the world of environmental health to come together, not only to evaluate what’s happened in an extraordinary and whirlwind 20 months grappling with the pandemic but also to reset and look ahead. Challenges still remain, around food waste, climate change and other matters, and so a close relationship between us all will continue to be vital.

EHPs were crucial in helping businesses reopen safely

printed materials and via a duty line staffed by EHPs. Alongside guidance on how to deal with COVIDspecific measures such as social distancing, queuing systems, handwashing and sanitisation, EHPs offered advice on how to expand safely into new business areas.

Milligan added: “To stay open, some businesses had to offer services they didn’t have a lot of experience in, like setting up a takeaway or delivery option. There may have been things they hadn’t considered, like how to communicate allergen information. We supported them with that.”

KATE NICHOLLS is CEO of UKHospitality.

A graduate of Fitzwilliam College, Cambridge and King’s College London, she was a researcher in Parliament and the European Parliament before starting a long association with hospitality at Whitbread, as government relations manager. She later worked in public affairs agencies, including establishing her own communications consultancy.

Kate was awarded an OBE in 2021, for services to hospitality.

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THINK BIGGER

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Nigel McMahon, Chief Environmental Health Officer (EHO), Department of Health, Northern Ireland, on the role of environmental health (EH) during and beyond the pandemic – and how anything is possible if we focus on where we want to get to

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You have been working in COVID-19 response during the pandemic. What has that entailed?

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NIGEL MCMAHON is Chief EHO in the Department of Health, Northern Ireland. He is a policy adviser to the chief medical officer and the health minister on a broad range of issues relating to how the environment impacts on health. He began his career as an Environmental Health Practitioner (EHP) in local government. He later joined the Civil Service and was head of the Air and Environmental Quality Unit in the Department of Agriculture, Environment and Rural Affairs before joining the Department of Health.

In February 2020, I was asked by the chief medical officer to work with our legal advisers to make coronavirus disease (COVID-19) a notifiable disease under the Public Health Act. That was followed by extensive work on the UK Coronavirus Bill, and I led on making coronavirus restrictions regulations that have been the main legislative vehicle used to support attempts to limit the spread of the disease.

What EH skills did you bring to the COVID-19 role?

It really has been an ‘all hands on deck’ approach with many colleagues finding themselves redeployed into unfamiliar roles.

What has helped me greatly as an EHP is a familiarity with the law, combined with a practical understanding of compliance and enforcement.

We might usually take 9-18 months to work through a policy process that results in legislation.

In the case of COVID-19 legislation and the use of urgent procedures, on occasion regulations have been made within hours of a decision taken by the Northern Ireland Executive. We have made nearly 80 sets of coronavirus restrictions regulations since March 2020, and that doesn’t include all the international travel regulations.

What lessons will you bring back from the COVID-19 work?

At times we have worked very long hours, at pace, on things that WWW.CIEH.ORG

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have had a societal impact. It hasn’t always been perfect, but I think we have a responsibility to learn and build on that.

It is clear that EHPs can contribute very positively at the policy level, as well as delivering on-the-ground implementation and support. I have worked closely with EHNI, the local authority heads of service group, in the past and look forward to building back that relationship between central and local government in the future.

One of the most positive initiatives for me was the

COVID-19 Cross-Departmental Working Group with membership from all nine government departments and key stakeholders, including local government and the Police Service of Northern Ireland. The group facilitates joint working to deliver an appropriate response in a very fluid situation and is certainly a model that could work well in other scenarios.

What are the big messages for EH from the last 18 months?

I think that the work on COVID-19 has raised the profile and importance of EH in the consciousness of many, but for how long? One lesson for EH has to be to ‘think bigger’. Focus on where we want to get to and not on the apparent obstacles. Tell those who will listen what we can offer, not wait for them to ask.

I would also like to see more work on EH professional identity, underpinned by legislation and governance. People have said to me that defining EHPs in legislation is not going to happen. If COVID-19 has taught me anything, it’s that anything is possible with the right will and support.

‘I WOULD LIKE TO SEE MORE WORK ON EH PROFESSIONAL IDENTITY, UNDERPINNED BY LEGISLATION’

As well as supporting and implementing policy on the ground, EHPs are equipped to make policy, says Nigel McMahon NOVEMBER 2021 / ENVIRONMENTAL HEALTH NEWS 15

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Think Piece 6: Nigel McMahon, 1

Public health and protection

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A PIVOTAL MOMENT

Louise Hosking, President-Elect of the Institution of Occupational Safety and Health (IOSH) on pushing the sustainability agenda To what extent have the past two years been a turning point for public health?

LOUISE HOSKING is President-Elect of IOSH. In mid-November she becomes its president. She is a Chartered Environmental Health Practitioner (EHP) who worked for Cambridge City Council after graduating from Nottingham Trent University. This led to an environmental health role at the Co-operative with increasing focus on health and safety. After working for Savills as head of Environmental Health & Safety Louise created her own consultancy.

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A recent IOSH survey asked if members felt more valued since the beginning of the pandemic. In total, 43% said they did, while 63% said occupational safety and health (OSH) was highly regarded within their organisation.

It’s clear the work that we all do to prevent people becoming harmed and unwell is being valued across stakeholders in a way we’ve never seen before.

What has the OSH profession learned from the past couple of years?

Organisations have been leaning on OSH. We can go into a situation and help evaluate risk effectively and well. It’s what we do.

Everything was changing quickly during the pandemic and we had to respond. We had to be agile, forward-looking, practical and we had to adapt our language and messaging at the appropriate times.

We’ve shown we are not the stereotype of

public perception. We have worked more closely with leaders. Directors are working alongside us on high level risk assessment. They’re the risk owners and we’re there as facilitators. We are demonstrating how our skill set will add value to their business. It’s a critical time.

The main theme for my presidential year is going to be around ‘sustainability’ in its broadest terms. We’re aligning some of IOSH’s goals to the UN’s Sustainable Development Goals. We’ll encourage businesses and organisations to embrace and balance social, environmental and financial values to achieve success by becoming more sustainable. Investors are tracking those organisations because they will ultimately be more successful.

What does environmental health mean to you?

I’m very proud of my environmental health foundation. I remember being on the 10th floor at Nottingham Trent University’s Newton Building in my first week of lectures looking out across the city. The lecturer was talking about the great strides we’ve made to provide safe food, decent housing, to clean up our air, water and land, to provide safe places to live and to work. Over history this has saved more lives than any medical breakthrough. I’ve never forgotten that, this still drives me.

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Think Piece 7: Louise Hosking, 1

Where do you see environmental health fitting into the UK’s public health picture in the future?

When people think sustainability, they think the ‘environment’, but it’s more than this. For me, environmental health captures the whole of social capital and as business focuses on ESGs this is hugely important right now.

Environmental Health Practitioners (EHPs) have massively varied roles, and with many members working in local authorities it means they’re also close to the political action.

The challenge – and the opportunity – for environmental health is to advocate at the highest levels. EHPs are unsung heroes, often in the background, but they have direct access, through local government, to politicians. My hope for the future would be that EHPs achieve greater recognition.

How do you see IOSH and CIEH working together in the coming months?

We have branches within IOSH, which allow our members to come together, and we also have sector groups, which might cover a particular industry. Construction is our largest, but we also have the Food & Industries group where many are both CIEH and IOSH members, as an example. Members are keen to make connections, which can only be positive. Events are currently virtual and open for all. As with CIEH, IOSH is a membership body and a professional association. We’re working globally to align messaging with organisations like the International Labour Organization, which gives us the opportunity to influence worldwide. One of the positives to come out of all of this is we are all much more connected globally.

What keeps you awake at night in terms of the public health landscape in the UK? We’re at a pivotal moment where the things that we do, and the things that we fail to do, will be pored over for generations to come.

There is so much good that we can do and it’s about being able to communicate our message successfully. Climate change unfortunately means our skills will be in greater demand. We’re going to see increased poverty and extreme weather, which will bring more disease. What keeps me up at night is that I can’t get enough done. I need 48 hours a day.

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What makes you optimistic for the future?

What I’ve seen our members do over the past two years is phenomenal. We have an opportunity to change the way that we do business. We can push the sustainability agenda and show that it’s good for people, it’s good for the planet and it’s good for business.

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IOSH aims to prevent people becoming harmed and unwell at work

‘WE’RE AT A PIVOTAL MOMENT WHERE THE THINGS THAT WE DO, AND THE THINGS THAT WE FAIL TO DO, WILL BE PORED OVER FOR GENERATIONS TO COME’ I N T H E FI E L D

THE RIGHT FIT

At the beginning of the pandemic, Terence Harris, head of compliance and safety at Liverpool University Hospitals NHS Foundation Trust, was responsible for face-fitting thousands of hospital staff for respiratory protective equipment. He said [in EHN, Dec 20/Jan 21 issue]: “The Health and Safety Executive mandates that anyone using a tightfitting respirator must be fit tested.

“There are 16,000 staff in our Trust. Not everyone requires a fit test but a significant proportion are clinically based. It was a case of pulling together the knowledge, creating a policy, buying the equipment and then creating and delivering a course to train staff across the Trust on how to do the test, and then monitoring that process through a quality

assurance programme. We also introduced Ambient Particle Counting (APC) machines, which measure the ambient particles around the wearer’s face mask against the particles inside the mask.

“We had to show clinical staff we understood their duty to patients but also explain they had a duty to themselves and patients to make sure that they’re safe.

“We secured that buy-in and we have a rolling programme in place for fit testing, a robust policy and a bank of more than 100 staff who are trained to do the tests. And we’ve got machines in all the category one areas that staff are using.

“All of that was done within four weeks. The team and I have never been busier and I’ve never felt pressure like it. But knowing we achieved it is such a great feeling.”

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Public health and protection VERSION REPRO OP

3 TURNING POINTS FOR PUBLIC HEALTH …

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We now have better connections, clearer communications and greater prominence but there’s still much to do, writes Jim McManus

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Public health directors were crucial in the smooth roll-out of the COVID-19 vaccination programme

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1. THE PUBLIC HEALTH FAMILY HAS REALISED IT’S MORE OF A FAMILY

Local public health services can’t do their job without national and vice versa. If you look at the COVID-19 vaccine, at first it was going to be entirely and purely an NHS roll-out. But we pressed the fact that local authorities have got huge skills here, saying: “Use the best of what local authorities can do.” Local directors of public health have expertise others don’t have because this has been our bread and butter for years, and in partnership we had a really fast initial roll-out.

My job in recent months has involved an awful lot more negotiating with different parts of the system. This is what’s changed most for me personally: working together as a family across agencies. That being said, I think

there is still a continuing cultural issue with some national bits of the system, including sometimes NHS England, which need to understand local capabilities better.

2. THE UNDERSTANDING GAP BETWEEN LOCAL AUTHORITIES AND WHITEHALL HAS REDUCED

I’ve had conversations in the past with civil servants who think local resilience forums are the same as local authorities. That gap in understanding has reduced now because there has been more communication and appreciation between local authorities and central government. We need to understand that environmental health is absolutely crucial in any public health system.

3. THE PUBLIC KNOWS WHAT DIRECTORS OF PUBLIC HEALTH CAN DO

All that health protection work that we’ve been doing quietly for years is now in the public mind. And we’ve had the chief medical officer for England talking us up. It’s been proved beyond a shadow of a doubt that local government, certainly in England, is absolutely the right place for directors of public health to be.

A COVID-19 SECURE APPROACH FOR BUSINESS Following a successful pilot, and in partnership with Shield Safety, Borough of Broxbourne Council has rolled out its COVID-19 Secure approach across the borough

COVID-19 Secure, a major public-private sector partnership launched in response to the pandemic, is an independently verified standard that supports businesses in putting robust and compliant COVID safety practices in place, helping them reopen and trade safely.

To date, more than 250 businesses across the borough of Broxbourne are listed as ‘Approved’ on the register. This

Neptune Fish & Shish displays its Safe to Trade sticker

… AND 2 CHALLENGES FOR THE FUTURE

SHUTTERSTOCK, TIM BENTON

1. THE LEGACY OF INEQUALITIES

COVID-19 will have left a lot of damage by the time we enter recovery mode. It’s made public health inequalities worse, and there’s a lot of misinformation and disunity out there. We have had cuts to the public health budget, worsening mental health, increased poverty and poor housing problems. We have to try to bring cohesion with local government and we need to really focus on improving the health of the population.

2. BUILDING A ROBUST PUBLIC HEALTH ECOSYSTEM

To do that we need a good, strong, well-funded family of public health systems WWW.CIEH.ORG

number is set to grow as COVID-19 Secure is about to be introduced in five more districts in Hertfordshire.

Recognised by government bodies and prominent blue-chip businesses as the leading COVID-19 control scheme in the UK, COVID-19 Secure also has a robust monitoring process supported by ratings, feedback and a public register.

The key objective for the Broxbourne project was to reduce transmission of COVID-19 and to generate confidence in the community.

Rebecca Broadbelt, head of Environmental Health & Licensing for Broxbourne Council, has received positive feedback from the public and business owners that local residents felt safer and more able to make informed choices on

venues after seeing the COVID-19 Secure window stickers on the high street. One said: “Seeing businesses showing safety credentials made me feel more confident about dining out with my family.”

Businesses also felt supported as the scheme was paid for by the council.

The council worked with Shield Safety to roll out the scheme and used its contact tracing officers to visit businesses that needed extra support. Each business that signed up was visited by a Shield Safety auditor who supported them in ensuring the necessary risk assessments and due diligence checklists were in place.

Katie Jones, Shield Safety’s commercial manager, said: “While the council focused on raising awareness of

that includes everyone from the new UK Health Security Agency to the NHS to environmental health and public health departments in local authorities. And for that we need the culture of leadership and the funding streams to be right.

In England, local health protection boards work really well because you’re never going to get one agency doing everything. In our health protection board, there’s such determination to do the best for our population – across the voluntary sector, police, districts and so many others. I don’t see a single person for whom that isn’t true.

And we really need to get the NHS to work with us. I heard someone say recently that social care is there to help the NHS. No – social care is there to deliver quality of life. This is not about the NHS – this is about place and local services that people need. The NHS is precious, but let’s not misuse it.

the initiative and encouraged businesses to register, our team helped businesses ensure that they had the correct practices in place to reopen safely. It was this collaborative approach that was key to the tremendous success of the project.”

Broadbelt agreed, adding that one business owner described the Shield Safety auditor as like having their own business adviser, which was especially valuable around the time when guidance and legislation were changing almost daily.

She added that schemes such as COVID-19 Secure and the risk assessments they include would become even more important as the country heads into an uncertain winter.

To find out more about the scheme, email hello@shieldsafety.co.uk

JIM McMANUS is director of Public Health at Hertfordshire County Council, interim president of the Association of Directors of Public Health, a CIEH vice president and a chartered psychologist. He led the Association of Directors of Public Health’s policy work on local outbreak plans and COVID-19 suppression and co-created the national public mental health collaborative for COVID-19.

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Think Piece 8: Jim McManus, 1

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Environmental protection VERSION REPRO OP SUBS ART

Outdoor pollutants can move into indoor spaces and react with chemicals there

PRODUCTION

NO THRESHOLD IS SAFE

CLIENT

Frank Kelly on air pollution: old enemies, new challenges and opportunities ahead

C

LEAN AIR IS

fundamental to our health and yet the polluted equivalent is the largest environmental risk to public health. This shocking statistic calls for exacting research to inform effective policies that will substantially lower the risk.

Areas of knowledge that will undoubtedly drive future science and legislation include the capacity of air pollution to adversely affect health at much lower concentrations than previously understood, compositional shifts in airborne particulate matter (PM), indoor spaces and the inextricable overlap between air pollution and greenhouse gas emissions.

There is overwhelming evidence that air Prof Kelly demonstrates the interdisciplinary nature of environmental science

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pollution can affect multiple organ systems in the human body, even at very low exposure concentrations. Indeed major advances in air pollution research have shown that there is no evidence for a threshold below which exposure can be regarded as safe. These findings have received the ultimate endorsement in the updated World Health Organization Global Air Quality Guidelines (WHO AQGs), which recommend ambitious new air quality levels to protect the health of populations. In advocating that every individual will benefit from cleaner air, this new guidance is a powerful incentive for all countries to instigate ambitious air policies designed to improve public health.

NEW AREAS OF CONCERN

Shifts in the composition of particulate air pollution are creating emerging areas of concern. These require a significant effort to increase the evidence base needed to appraise abatement measures. In the UK, particles from non-exhaust traffic emissions (from brakes, tyres and the road surface) already constitute 60% and 73% (by mass), respectively, of primary PM2.5 and PM10 emissions from road transport.

While this understudied and unregulated source will become more dominant as older vehicles retire and electric vehicles increase, the characteristics of non-exhaust PM (with respect to size and composition) suggest that it may be particularly harmful to human health. Airborne WWW.CIEH.ORG

Think Piece 9: Frank Kelly, 1

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TACKLING CLIMATE CHANGE DAY TO DAY

Izzy Dawson is Senior Technical Officer of Mendip District Council Izzy Dawson spoke to EHN [September 2021].

She said: “I assist EHPs in the investigation of air and noise pollution, and noise complaints.

I advise clients about the negative effects of bonfires on the environment and air quality and encourage other measures such as composting, which can help mitigate methane

microplastics are another particulate pollutant of growing concern owing to a continuous increase in global mass production of plastic.

Furthermore, findings that atmospheric deposition of microplastics can reach 1008/m2 per day in central London further indicates potential hazards and supports research efforts to uncover their sources and fate through to population exposure and potential toxicity.

Until recently pollution has been deemed an outdoor issue. However, there’s an increasing appreciation that indoor environments, where exposure to air pollution predominantly occurs, is characterised by a chemically diverse and complex air quality. This is a consequence of the presence of multiple sources from multiple activities (eg cooking, cleaning, heating), society’s introduction of technologically complex materials and chemicals, and the creation of airtight environments to improve energy efficiency.

In addition, air pollutants generated outside, such as ozone, can move into buildings through windows and cracks, where they can react with chemicals generated from indoor activities to form new pollutants. Despite such a complex scenario and array of hazards, the characterisation, exposure and health effects of indoor air pollutants are woefully understood.

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DUAL ACTION

Measured actions to address the damage that poor air quality inflicts on health will contribute to, and benefit from, efforts for climate neutrality. Shifts in power generation necessary to achieve the 80% reduction in emissions set out in the UK’s 2008 Climate Change Act are forecast to reduce PM2.5 concentrations by more than 40% by 2050. Estimates suggest that by 2154, this would save 500,000 to 1.1 million WWW.CIEH.ORG

production from wasted food and other organics in landfill sites.

“We are situated in a rural area and receive odour complaints arising from slurry spreading. I investigate whether the farm is utilising the latest guidance for spreading to minimise odour and, importantly, ammonia emissions.

Composting at home can help reduce methane emissions from landfill

“In terms of climate change, I am most concerned about excess heat and flooding because UK housing stock is not equipped to adapt to the changes.

Disadvantaged populations are more

cumulative life years. Even greater health benefits may be achieved by improving air quality through decarbonising energy generation if projected adverse effects from increases in burning biomass are prevented.

In England, the Environment Bill that sets out legally binding air quality limits is undergoing final amendments. It is tempting to speculate on the extent to which these limits will be reduced in light of the new science that led to the updated WHO AQGs. Any such reductions will require measured policies and strategies and, in turn, these will benefit from the closure of some of the knowledge gaps described above.

Strategies targeting transport and the built environment must work towards cleaner and fewer vehicles. A cleaner element will be encouraged by providing adequate charge points for electric vehicles. Fewer vehicles and with that a shift to active forms of travel and public transport (without marginalising the elderly and people with disabilities) will ensue from improved urban planning that connects us with what we need. When air pollution limits are exceeded, local authorities need to act strategically to close or divert roads to reduce the volume of traffic, especially near schools and vulnerable communities.

Across all living environments that span the indoor/outdoor continuum, decisions, informed at all times by the science, need to deliver integrated strategies to effectively address air quality and climate change simultaneously, so that we can look forward to a healthier planet and population.

vulnerable to the negative effects of climate change and social inequalities need to be addressed as rigorously as climate change to enable more of the population to engage with positive change.”

FRANK KELLY is Humphrey Battcock chair of Community Health and Policy at the MRC Centre for Environment and Health, Imperial College London. He previously served as chair of Environmental Health at King’s College London, where he was director of the Environmental Research Group, director of the NIHR Health Protection Research Unit in Health Impact of Environmental Hazards and deputy director of the MRC Centre for Environment and Health.

‘AIR POLLUTION CAN AFFECT MULTIPLE ORGAN SYSTEMS IN THE HUMAN BODY EVEN AT VERY LOW EXPOSURE CONCENTRATIONS’ NOVEMBER 2021 / ENVIRONMENTAL HEALTH NEWS 21

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Environmental health VERSION

Noise issues can often be resolved with a friendly chat, rather than a formal process

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5 THINGS I’VE LEARNED …

Peter Wright on environmental health’s pragmatic approach and key role in helping people

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1. WE’RE A GREAT FIT WITH PUBLIC HEALTH

Councils are all about making people’s lives better, but there are very few departments in that council where it’s actually your day job. Environmental health has a strong affinity with public health and we’re good at fixing things.

We are pragmatists and problem-solvers.

Our insight into how councils work is frequently beneficial to people new to Public Health teams.

Environmental health is close to public health in most councils in England. This relationship is vital as it helps make sure that the entire council system focuses on public health measures and opens up new areas where our skills and pragmatic approach are important.

The really great thing (in my view) about the pragmatism that Environmental

Health Practitioners in councils bring to their work is that it’s infectious. In the services where I work we really notice that people who haven’t gone through the environmental health qualification have as much of a fire in the belly as those who have. Helping people is contagious, and every day my colleagues make me proud.

2. WE NEED TO THINK AND WORK DIFFERENTLY

The five pillars of environmental health look a bit shaky and it’s crucial for us to recognise new areas in which our pragmatism helps solve problems. It would be a disaster for the local government service to slowly drift out of relevance as regulations are relaxed post-Brexit.

In my own council of Gateshead, in 2016 we were getting so many budget cuts, we WWW.CIEH.ORG

3. THE BIGGER PICTURE IS WHAT’S IMPORTANT

There’s a phrase: ‘What gets measured gets done’. In reality, if you’re measuring the wrong things, it’s pointless. We try to measure how many people we’ve helped to have a better life. If we do more of that next year than this year, that’s success. Whether or not we’ve achieved response times or end-to-end times really doesn’t matter to most of our clients. What’s important is that we made their life better.

We need to find time to work outside of our pillars – on community safety or smoking or obesity, for instance. If we don’t help in those and other areas, there’s a danger we might become irrelevant.

It stops the community getting access to the very best support for having a better life. Issues like these need environmental health’s understanding.

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4. WE NEED TO QUANTIFY AND BROADCAST OUR CONTRIBUTION

My hope is that we will be recognised in the future for the role we play in preventing illness and promoting wellbeing. We need to work hard to do this, and this won’t be easy for us.

Prevention activity and its impact is hard to measure, but we’re pragmatists so we need to try, otherwise our future in councils might be death by a thousand cuts. It’s estimated that our work with ‘Nadine’ (see case study, right) saved the local system around £250,000 a year.

That’s what we’re trying to quantify.

I do hope we’ll stay local. Getting a fire in the belly about fixing problems for people is reliant on being close to the WWW.CIEH.ORG

community. We would lose so much if some or all of our services were drawn into regional or national organisations.

5. WE NEED ACEHO IN LOCAL GOVERNMENT

PETER WRIGHT manages Private Sector Housing at Gateshead Council along with a prototype public support service.

He is currently acting chair of the Association of Chief Environmental Health Officers (ACEHO).

ACEHO’s purpose is “to create the foundation and pillars of a successful future for environmental health in councils”.

‘IT’S CRUCIAL FOR US TO RECOGNISE NEW AREAS IN WHICH OUR PRAGMATISM HELPS SOLVE PROBLEMS’

I’m concerned by the way politics has polarised. People in our line of work are rarely respected by those at the extremes of the political spectrum. England does not have an established network of senior practitioners that can feed into the relevant policy agendas at government level.

We are establishing the Association of Chief EHOs to try to gain recognition and influence for the local authority service in England.

Our first ACEHO board meeting will take place in early November. A parallel but independent local government group can work on securing a more prosperous and relevant future, while CIEH continues in its role of training, being an awarding body, sustaining the profession across the full range of sectors and representing us with national bodies and government.

I’m confident that the combined efforts of the CEHOs in England will secure the future of a service that the public truly needs.

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HELPING TO FIX LIVES SAVES MONEY

How treating ‘Nadine’ for her addictions cut demand costs Peter Wright: “At Gateshead, we had a problem with Nadine (not her real name). She had a chaotic lifestyle as an alcoholic, drug addict and shoplifter.

“We worked out that she cost the council and police £250,000 per year. At that time, our projection for extra demand coming into social care over the next five years was £64m. Cuts can’t make those kinds of savings, so we needed to look at people like Nadine and head off their demand costs by helping fix their lives.

Treatment orders may be more effective than prison

“We sought a compulsory treatment order for her. She was given support to get off drugs and to stay away from the dealers who wanted her back.

“Being part of helping

256 Nadines a year isn’t an unrealistic challenge if we start to pay attention to the signals of greater need that are in front of us in our work every day, and if we make time to be part of the solution.”

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Think Piece 10: Peter Wright, 1

knew we had to work differently. An important part of that was to get rid of anything that didn’t contribute to us achieving our purpose, which is helping people to live a better life.

We repurposed our noise nuisance service and simply asked complainants what they wanted us to achieve when we picked up their complaint. Nobody wanted a process of filling out forms. Instead, it was “Can you have a word with my neighbour about their dog, or their loud music?” We freed up officers to go and see people. Many were being carelessly noisy and were willing to change their behaviours. There were also ones against whom we had to use antisocial behaviour powers and many who were struggling alone with huge problems. It’s different, difficult and demanding, but we help more people more quickly than before.