Report on the circumstances leading to the 1996 outbreak of infection with E.coli 0157 in Central Scotland, the implications for food safety and the lessons to be learned.

ANNEX III (Para 1.5 refers)

THE PENNINGTON GROUP: INTERIM REPORT AND PRIORITY RECOMMENDATIONS

STATEMENT TO THE HOUSE OF COMMONS BY THE SECRETARY OF STATE FOR SCOTLAND: WEDNESDAY, 15 JANUARY 1997

With permission Madam Speaker I wish to make a statement about the interim report from Professor Pennington's Expert Group, copies of which are available in the Vote Office. The whole House will wish to thank Professor Pennington and his colleagues for the speed with which they have reported. Quite properly they wish to reflect further on some of these issues before finalising their report by the end of February.

Professor Pennington was asked to examine the circumstances that led to the outbreak and to advise me on the implications for food safety and general lessons to be learned. He has focused on 4 key areas: research, surveillance, enforcement and the handling of an outbreak. This outbreak has raised some fundamental questions about current food safety procedures in relation to the threat posed by E.coli O157. E.coli O157 should be seen in its proper context: it is much more virulent than most other causes of food poisoning, and requires a smaller infective dose than other organisms such as salmonella.

On research, Professor Pennington recommends work in two main areas - knowledge of the prevalence in livestock of the particular type of E.coli that caused the recent outbreak, and more accurate methods of typing E.coli strains using DNA finger printing. I have given instructions that that work should be done as a matter or urgency in consultation with the relevant research bodies, including the Advisory Committee on the Microbiological Safety of Food.

We have a wealth of clinical information from the treatment of about 1,000 patients during the outbreak. I therefore propose to commission an analysis of that information, which will help to develop our knowledge of the natural history of the infection and assist the management of outbreaks. I am asking Professor Pennington to consider that in his final report.

To back up research and help the understanding and control of food poisoning outbreaks, good surveillance, data collection and disease analysis are clearly essential. Although the report does not indicate that the current mechanisms caused any difficulties in the present outbreak, it suggests that more systematic arrangements in Scotland would be helpful. The Report therefore recommends that urgent consideration be given to introducing improvements to surveillance and that proposals be worked up to permit electronic reporting and analysis of data. I fully support those recommendations, and my Department is already taking action to make more systematic the way in which food poisoning data are reported from laboratories in Scotland. I will make resources available for the establishment of an electronic reporting system.

Professor Pennington makes several recommendations on enforcement.

Existing arrangements on food hygiene are based on European Union Directives, brought into force by Regulations under the Food Safety Act 1990. The Codes of Practice under the Act were widely consulted upon and, of course, they were laid before the House.

Professor Pennington recommends urgent consideration of the legislation and action, through licensing, to ensure that equivalent standards of hygiene apply to premises principally selling to the final consumer as to those premises subject to the Meat Products (Hygiene) Regulations. He also recommends urgent action to ensure physical separation of raw and cooked meat products by using separate counters, refrigerated equipment and separate staff. Pending the outcome of consideration of the legislation, he recommends that the Advisory Committee on the Microbiological Safety of Food should be asked to review its guidance on cross-contamination. I have asked them to do so.

The recommendations have far reaching implications. I have instructed my officials to examine the practical implications of the recommendations and, in doing so, to consult consumers, health professionals, environmental health officers, processors and retailers. It would be helpful to Professor Pennington to have more detailed information on the practical aspects. Therefore, with that in mind, I have asked the Meat and Livestock Commission - the Government's statutory advisers on the industry - to carry out an urgent study of the issues so that Professor Pennington can take them into account in his final report.

Professor Pennington made three recommendations on the Codes of Practice under the Food Safety Act 1990, all of which my colleagues and I accept. He recommends first a review of Code of Practice 16, which relates to the Food Hazard Warning System. That system, operated by the Government, is to warn Environmental Health Departments of possible or actual food hazards on the basis of information from other areas. Professor Pennington concludes that the difficulty for food authorities is setting the balance between dealing with routine matters at local level and advising central Government of emerging problems. As Code of Practice 16 is currently written, the decision to notify central Government is a judgement made locally. Professor Pennington suggests that it may be better to define an 'isolated incident' as one which is contained within the boundaries of the food authority. It should, however, be incumbent upon that authority to notify central Government the moment that it has evidence that food distribution is beyond the local authority boundary. It would also be essential to retain the 'major local incident' provision so that central Government are informed immediately even if the problem is contained within the authority's area but involves a significant number of people; an organism such as E.coli O157 or a problem such as botulism.

An allied recommendation is that the code should place greater emphasis on risk and assessment of all factors relevant to protection of the public. That key addition would cover such matters as the organism's virulence, the extent of the food's distribution, the consumer group's vulnerability and the confidence that could be attached to product recall. The revision would make it clear that careful assessment of the risk involved is fundamental to informing decisions.

Professor Pennington also recommends a review of Code of Practice 9, on food hygiene inspections, to ensure better targeting of resources on high risk premises.

I accept all those recommendations. Good lines of communication from local to central Government and timely release by local outbreak control teams of information to the public are crucial, as the paramount consideration must always be the protection of public health. Similarly, I agree that there should be careful targeting of resources on the high risk premises. This guidance for enforcement officers will be reflected in the revised Codes of Practice which will go out to consultation shortly.

Professor Pennington makes observations on the potential for cross-contamination in slaughterhouses, focusing specifically on the slaughtering of cattle in a clean condition. My Department is pursuing this issue with the Meat Hygiene Service, which is well advanced in preparing practical guidance on the definition of acceptable standards of cleanliness in animals presented for slaughter.

Hazard Analysis improves food safety by focusing on critical points in the preparation and handling of food. Professor Pennington therefore recommends that the implementation of these requirements be accelerated, particularly for high risk premises which handle raw and cooked foods. I agree. My Department will urge Environmental Health Departments to take early action on it, so that Hazard Analysis covers all high risk premises in their area as soon as possible.

Finally on enforcement, Professor Pennington recommends, in the longer term, a review of the health risk condition contained in the Food Safety Act 1990, which governs, among other matters, the actions taken by Environmental Health Officers in emergencies. The key question is whether the present position unreasonably inhibits Environmental Health Officers in, for example, taking decisions under the emergency prohibition provisions in Section 12 of the Act to close premises merely on suspicion of connection with an outbreak. I have asked my officials to examine the practical operation of the emergency powers available to EHOs as a matter of urgency and in doing so to consult consumers, health professionals, environmental health officers, processors and retailers.

On handling an outbreak, Professor Pennington recommends that every Health Board and local authority should make sure that they have in place joint plans, as required by the existing Scottish Office guidance, setting out mechanisms and procedures for dealing with them when they occur.

Professor Pennington also emphasises the importance of having one person leading the team, which should be able to act and take decisions as it sees fit. I agree on the importance of clear leadership and with Professor Pennington's expectation that this would most likely come from the Health Board. I also agree that the local authorities and the Health Boards must delegate to the team maximum powers to take the necessary action.

I propose to invite Health Boards and local authorities in Scotland to review their procedures and let me have their response to Professor Pennington's interim recommendations by the time he produces his final report.

Professor Pennington also suggests that the Scottish Office should review the present guidelines on the investigation and control of outbreaks and endorses the creation of a Scottish Office team under the Chief Medical Officer as was done for this outbreak. I agree.

This has been an extremely serious and tragic outbreak, one of the worst of its sort in the world. I am grateful to Professor Pennington and his colleagues for producing their interim report so quickly. I have set out today the Government's response to the interim recommendations. This is a matter to which the Government will attach the utmost priority in the coming months.