As communication between central and local government broke down at the start of the foot and mouth outbreak, EHOs found it increasingly difficult to deal with a situation fast escalating out of control. Stuart Spear reports

Talking to environmental health officers who have spent the last four months in the front line of the foot and mouth epidemic, it is not long before the Government's handling of the crisis is described by some as "incompetent", and by many more as "secretive", "uncommunicative" and "obstructive".

Rural EHOs in Devon, Cumbria, Northumberland and parts of Wales, from the start of the outbreak in February, were aware that unless managed carefully the foot and mouth epidemic could become a serious public health issue. Dead cattle, lying in fields for up to three weeks; pyres built near people's homes, where residents may be asthmatic; and animals buried on farms, or in pits of up to half a million carcasses, were all potential threats to public health. It was up to EHOs to ensure rural communities were protected.

MAFF FAILURE
Early on, it became clear that the lead ministry, the now disbanded Ministry of Agriculture Fisheries and Foods (MAFF), was overwhelmed by the scale of the outbreak. Initial attempts to plot the virus by trying to unravel the web of complex animal movements were soon abandoned, while outbreaks mushroomed around the country. As parts of Britain were turned into killing fields, EHOs found themselves working all hours. They were responsible for organising the distribution of disinfectant; arranging waste collections; controlling the movement of unpasteurised dairy products; supporting MAFF; issuing export certificates; and in unitary authorities checking that pet farms, owners of animals on allotments and riding schools were taking adequate precautions.

EHOs also became the point of contact for increasingly worried local communities. According to Jeremy Mann, environmental manager for North Devon DC: "We discovered that the public see local government as an extension of central government in a crisis and expect council staff to be appraised of what is going on. The problem was that we were not being told either, which was a far from ideal situation. There were concerns about odour problems and contamination of water supplies and the local community wanted to know what precautions to take. If they found smut on their child's climbing frame would there be a risk? They just did not have the information."

EHOs quickly realised that communication between central and local government was the first casualty in the battle against the virus. "The lack of communication created so many problems," explains Simon O'Neil, principal EHO for East Devon. "The crisis showed what EHOs are good at, which is using our local knowledge, and that is the one area where we could have been useful in terms of PR and communication. Instead, MAFF officials treated people appallingly. They just turned up shot things and disappeared." EHOs tried to feed as much information as they could to their local communities by advertising grid references for burn sites, but were inhibited by their own lack of information.

A failure to include EHOs in decisions about where pyres should be sited and how they should be constructed, created numerous problems very early on. Pyres were poorly built, using low-grade coal and railway sleepers, creating thick plumes of smoke with high particulate and sulphur dioxide content. There were also reports of tyres being used to speed up the burning process.

"We had very heavy air pollution with huge palls of smoke obliterating premises in some areas," says David Ingham of Carlisle DC. "There were no controls over where pyres were sited - we tried to flag problems up with MAFF but there was no process of consultation. Eventually, after guidance was issued, the pyre burning stopped because then they could be criticised for not following that guidance." However, in some cases on-farm burning carried on for up to five weeks.

But according to Mike Phillips, director of community service for Allerdale DC, councils should take some responsibility for the break down in communication. "Local Government was too slow in responding. We vacillated about working with others. We did not indicate as a profession that we were in the loop and we suffered, as there was no framework in place for working together. In America, they have regular exercises for this sort of thing and we should have had better contingency plans."

PUBLIC HEALTH FEAR
As the crisis moved into March and April, EHOs became more vocal about their concerns that public health issues were not being addressed. The siting of pyres and the burial of cattle near private water supplies were causing serious concerns about the spread of E. coli, salmonella and cryptosporidium.

EHOs in East Devon were concerned that slaughtered sheep were being left for weeks near streams. "We could see that some sheep had been slaughtered right by streams that fed rivers running into valley catchments, used for significant numbers of private water supplies and the aquifer that fed the town of Seaton", said Mr O'Neil.

Dead animals lying exposed for weeks on farmland were also causing distress to farmers and their families. "It was causing general distaste, body fluids were flowing out of gates onto roads," said West Devon environmental health manager David Banks. "We also had reports of rats and birds attacking carcasses, as in most cases carcasses were left uncovered. Overall, we were lucky not to have a serious outbreak of disease from the rats."

CIEH vice-president and Labour MP for Stoke-on-Trent Joan Walley, raised concerns about public health controls and the lack of communication on the ground with ministers. But despite the situation improving in some areas, it was not until May that most local authorities received a comprehensive list from MAFF of where burn sites and cattle burials were located, so they could start testing for water contamination. The potential contamination of food supplies from pyres was also causing EHOs concern, something that was later to prove justified as the Food Standards Agency issued warnings about the possible contamination of full fat milk from dioxins.

But the issue that worried local people and created the most press attention was what the Government was doing about the potential spread of the BSE prion, which is not destroyed at high temperatures. West Devon EHOs first raised concerns about the prion in February. They were worried that it may infect private water supplies or contaminate locally produced food by being carried on pieces of hair rising from burning carcasses on air currents. After contacting their local MP, EHOs realised that MAFF was not monitoring the age of cattle being buried. Devon has a large number of dairy cows over five years old, putting them in the highest BSE risk category as they were born before feed controls were introduced. "It became clear that MAFF did not know what its contractors were doing during the slaughtering," said Mr Banks.

Problems surrounding the potential contamination of private water supplies were further compounded by MAFF's failure to follow guidance from Seac, the Government's advisory body on BSE. Scientists had advised that the ash of animals over five years old should be removed for incineration. But ash was being buried on farms regardless of the age of cattle and is only now being removed. As Mr Banks explains: "The problem is that we don't have any confidence in MAFF's records, which are at best incomplete."

Problems faced by West Country EHOs were being shared by colleagues in the north. But they had the additional problem of odour from large-scale burial pits. Again, lack of consultation with local communities was causing civil unrest with police involved in protests at Widdrington, near Morpeth in Northumberland - the Widdrington pit contained over 100,000 sheep carcasses.

LESSONS LEARNT
As reported cases of foot and mouth now start to decrease, has the profession learnt anything from the crisis? Better and earlier inter-agency liaison is needed not just with government bodies but with neighbouring authorities and county councils (see points below). Also, experiences should not be forgotten, as was the case with the 1967 outbreak. "Protocols between the district councils, the MoD and directors of public health over pyres, which cover fuel used and site identification, are now in place and it would be a shame to lose them," said Mr Mann.

The foot and mouth outbreak is likely to create a legacy for EHOs. Under the contaminated land regime they are responsible for assessing the potential risk of foot and mouth sites. "A view was taken on burial and burn sites by the Environment Agency to do with groundwater, hydrology and conservation issues, but wider public health issues were overlooked," explains Mr Phillips, who has started assessing Allerdale DC's burn and burial sites for the council's contaminated land register. He says: "There may not be pathways or receptors from these sites now but they still have to be dealt with as they are grey areas due to plans farmers may have for further developments."

So issues surrounding foot and mouth look set to rumble on. Hopefully, problems faced by EHOs will be highlighted in the forthcoming government report on the outbreak promised by Margaret Beckett, Secretary of State for Environment Food and Rural Affairs. But the profession also needs to assess its own performance during the crisis and what lessons can be learnt should the country face a similar outbreak in the future.

There are many lessons to be learnt from the foot and mouth outbreak. Andrew Millie and Simon Evans have prepared an initial plan

1 Better and early liaison with the following groups:

• colleagues in other departments (rapid formation of multi-skilled groups within authority to make decisions);
• neighbouring or similarly affected local authorities;
• the director of public health and staff, eg CCDC; and
• (in this particular case) MAFF, MoD and the Environment Agency.

Note that having established or re-stimulated existing working relationships, these now need to be fostered and kept alive, despite the inevitable future staff changes, until the next disaster and despite the lack of an ongoing focal point.

2 Dedicated points and persons to contact including dedicated telephone lines for local authority use to single individuals or small groups of individuals (it is particularly important that the agency in charge sets up such a facility).

3 Creation of "cells" based on local authority boundaries for the purpose of contact and dissemination of information.

4 The need on both sides to establish relationships and trust and thus encourage better joint-working.

5 From the outset, a clearly defined legislative procedure, eg environmental health's normal powers versus exemptions given with the emergency situation. Plus, details of authorised guidance from central government or government agencies.

6 Greater consideration on the provision of information to the general public, and acknowledgement that residents and businesses frequently turn to their local authority for information and reassurance over government departments.

7 Avoidance of the "media gets it first" scenario by ensuring that local authorities are fully briefed in advance.

8 Media hype and misinformation must be countered and better controlled.

9 Acknowledgement that local authorities are not normally geared to work consistently and over prolonged time frames outside office hours and that for this to happen, special arrangements must be made. In addition, recognition that local authority staff numbers are limited and do not begin to compare with government departments or the MoD. Problems particularly arise where specialist skills are required (eg EHOs, water samplers, persons specialising in re-housing the homeless).

10 The Bellwyn Scheme needs to be reviewed and amended.

11 Media handling skills need to be developed.

12 The handling of pressure groups, groups with personal/special interests and pressuring individuals must be reviewed and developed.

13 Greater and new links need to be forged between public health (the province of the area and regional health authorities) and environmental health departments. There seems to be universal agreement between the parties on this point and further meetings are proposed.

14 The split of responsibility and links between environmental health departments and emergency planning departments, in this case at the county level, need revisiting (although these are well established and worked well, foot and mouth disease provided a new slant and issues raised need to be discussed).

16 Need for more detailed plans to cover emergency evacuation situations, for the district/county split to be revisited and for funding arrangements to be explored.

17 At district level, there is a need to have both an operational and a strategic overview from day one, possibly run on a three-tier basis (eg the gold, silver, bronze adopted by the police).

18 An acknowledgement that local authorities and EHOs are an important resource. Local authorities in general must be brought into both the decision making and information loops at the outset of a problem.

This initial 18-point plan has the potential to be developed further, perhaps towards the creation of a professional code. If other EHOs have points to add from their own experience, please contact the editor by e-mail at ehj@chgl.com and any comments will be forwarded to the authors.