Is it time for environmental health departments and the Food Standards Agency to motivate customers to become more discerning and vote with their feet against businesses who fail to deliver high standards of food hygiene? Dr Jeremy Leach asks professionals and members of the public what they look for when they eat out

Since the introduction of the Food Safety Act in 1990 there has been a plethora of guidance, codes of practice, regulations and industry guides. Governments have fluctuated from a regime of strict enforcement to a very "laissez faire" approach. Set against this is a continued rise in reported cases of food poisoning1, although, as many experts have acknowledged, the reasons for the increase are due to a number of different factors.(2,3,4) There is also evidence to show that far more people mistrust the Government, food companies and farmers to ensure food safety than will trust them.(5) It is a picture that EHOs are all too familiar with.

The evidence on the catering industry is not too encouraging either. According to Guerrier et al, managers and supervisors from the catering industry deem food hygiene significant only when something goes wrong.(6) Food hygiene issues, including cleanliness and temperature control of food were viewed, according to the researchers, in terms of aesthetics rather than food safety. This conclusion was somewhat reinforced at a seminar organised by the Transport and General Workers Union in London. It was reported in the Caterer and Hotelkeeper, that one speaker from the Meat and Livestock Commission said that they had been endeavouring to develop a culture in the trade where both business and individual workers actually want to do things right, not one where they go through the motions of doing it right because of the fear of an inspection.(7)

The issue of quality and its relationship to food hygiene and cleanliness is both interesting and important. Research undertaken by Guerrier et al(6) claimed that managers in the catering industry did not consider food hygiene as making a positive contribution towards quality, and it is unlikely to be viewed in the same terms as other quality variables. That attitude needs to be changed. Zeithaml et al provided a useful definition of service quality, because it focused attention on the views of customers. They defined quality as follows: "The extent of discrepancy between customers expectations or desires and their perceptions."(8) Using this definition, if an eating place fails to meet the standards of food hygiene and cleanliness expected by customers, including both tangible and service issues, then customers will assess it as offering a poor quality service. Faced with the evidence outlined in that article and reiterated in the Journal of the Royal Society of Health, a research programme was designed and implemented.(9)

Research Methods
The research identified factors which the public perceive as important in terms of assessing food hygiene standards in public eating places. These factors were then compared to factors which a sample of professionals with an interest in food hygiene consider the public should find important. The study was designed in two phases. Phase one involved the use of a modified "Delphi Technique" which identified and prioritised the factors and permitted statistical analysis. The sampling frame for this study was the electoral register for Wealden District of East Sussex.(10) The public group consisted of a 0.1 per cent sample (n = 105) systematically selected from the Register. The professional cohort consisted of a number of groups of professionals, working in the Wealden District with an interest in food hygiene (n = 69). This cohort consisted of environmental health professionals responsible for the enforcement of food safety legislation; teachers of technology with a specialism in food; caterers with a qualification in food hygiene to the level of Advanced Food Hygiene Certificate (CIEH) or equivalent; and registered trainers in food hygiene.

Phase two involved a programme of in-depth semi-structured interviews, which investigated and explored in more detail the findings from phase one.

Summary of Results
Phase one of the study generated 144 factors from the public and 233 from the professionals. A number of themes emerged under which the factors could be grouped:

• the exterior of the premises and their management
• the interior of the premises and their management
• staff working in the premises
• the table and immediate environment
• the food and drink
• recommendations, advertisements and facilities.

The themes and individual factors generated in phase one were explored in more detail in phase two. Content analysis of the interview transcripts brought out additional issues which could be grouped under four headings:

• recommendations and awards
• food hygiene as a factor of choice
• management issues
• responsibilities.

The grouping of the themes in this way gave the results a structure, making them amenable to analysis by the public, the Government and the catering industry. Although food hygiene is not a factor of choice when the public select an eating establishment(11) the results of this research indicate that the final decision by a prospective customer to support a particular premises can be changed. In particular, the conditions outside the premises and the standards of food hygiene and cleanliness inside, and a demonstration that these subjects are taken seriously, will have an important influence.

The results also indicate that the public expect the standards of food hygiene to be high, something they appear to take for granted. However if they see something that upsets them or that is not right in terms of food hygiene they are likely to look for other clues to support that first negative impression. But even having formed that negative impression, customers are unlikely to complain: their preferred course of action is to leave and not return. The following statement by one respondent sums up the majority view: "I'd probably put up with what I saw because I don't like complaining. I don't find it easy. I tend to grumble to whomever I'm with and then decide not to come back there again." (Female: 55 - 64)

This attitude means, of course, that the proprietor is unlikely to be appraised of these perceived deficiencies and will be less likely to rectify them. Failure of a proprietor to maintain high standards of food hygiene would, according to the definition of quality given earlier, mean that the business is failing to deliver a quality service to its customers. This makes the assumption by caterers that food hygiene - or the perception of food hygiene - does not make a positive contribution towards quality invalid; to attract customers and develop successfully, proprietors must take the subject more seriously.

The results of this research indicate that the public claim to look for many different clues to build up a picture of the standards of food hygiene in an eating place. When compared with the factors highlighted by the professional group there were many similarities, although the levels of importance attached to individual factors varied considerably. There is also evidence that the assessments made by the public group were based on aesthetics rather than food safety. This highlights a need for a public education campaign.

The public claim to assess a business and the people working for it on numerous different criteria. The standards they claim to expect are far above those required by law. This is welcome news for enforcement agencies that are constrained by law and can only make recommendations, knowing that in many cases those improvements will not be implemented. Prevailing low standards in some catering establishments can give the industry in general a poor reputation, and in many cases enforcement agencies are perceived by the public as ineffectual because the public may be unaware of the legal constraints on enforcement officers.

Conclusions
The time for a new approach to an old problem is now. The FSA has a clear objective: "To protect public health from risks which may arise in connection with the consumption of food (including risks caused by the way in which it is produced or supplied) and otherwise to protect the interests of consumers in relation to food."(12) The Government, through its election manifesto placed food safety high on the agenda.(13) The Government's White Paper: Saving Lives: Our Healthier Nation sets out plans aimed at improving the health of everyone and reducing inequalities in health.14 The document restates the role of the FSA in providing independent and authoritative advice to the public on all food safety and standards issues.

In the white paper Modern Markets: Confident Consumers, the Government makes it clear that it views confident, knowledgeable and demanding customers as good for business.(15) It asserts that good information helps consumers make the best choices, and the better informed they are the readier they are to complain, and the more business will be under pressure to improve performance and services. An education campaign is needed to inform the public about the important part that they could play to improve standards of food hygiene and cleanliness in public eating-places. It should include strategies for complaining effectively.

The catering trade needs to be convinced that having high standards of food hygiene and general cleanliness makes good business sense rather than food hygiene being viewed, as it is by many, as just a requirement of the law. Proprietors of eating-places should consider developing a strategy for managing quality in relation to food hygiene in the work environment. This would require benchmarking data from a consortium of experts, including caterers. An accreditation or award scheme could then follow. These strategies aimed at raising standards, need to be coupled with a sensible, firm and consistent approach to enforcement, with a particular focus on hazard analysis and staff training. Then a real opportunity may exist to improve the standards of food hygiene and protect public health.

Dr Jeremy Leach is an environmental health manager at Wealden DC. He has recently completed a doctoral research programme at the University of Brighton.

References
1. Office for National Statistics (1998), Communicable Disease Statistics Series 1989 and 1993, annual MB2 Monitors 1994 to 1997 Quarterly MB2 Monitors, London: HMSO.
2. Lacey, R W (1993), "Food Poisoning: The Rise Continues", British Food Journal. 95 (3)
3. Maurice, J (1994). "The Rise and Rise of Food Poisoning", New Scientist. No: 1956
4. Coghlan, A (1998). "Is Anything Safe to Eat?", New Scientist. 157 (8) p 4
5. Goode, J, Beardsworth, A, Haslam, C, Keil, T and Sherratt, E (1995) "Dietary Dilemmas: Nutritional Concerns of the 1990s", British Food Journal 97 (11) p3 - 12
6. Guerrier, Y, Kipps, M, Lockwood, A and Sheppard, J (1992) "Perceptions of Hygiene and Quality in the Food Service Operation", Progress in Tourism, Recreation and Hospitality Management, Bellhaven Press, Vol. 4 p 182 - 194.
7. Caterer and Hotelkeeper 1997 Tolley's Food Safety Supplement, 23-29 October.
8. Zeithaml, V A, Parasuramen, A and Berry, L (1990). Delivering Quality Service - Balancing Customer Perceptions and Expectations. New York: The Free Press.
9. Leach, J C (1996), "Raising Food Hygiene Standards - Could Customer Power and the New Laws Hold the Key?", Journal of the Royal Society of Health, 116 (6) p351-355.
10. Wealden District Council (1996) register of electors, Crowborough: Wealden DC.
11. Auty, S (1992) "Consumer Choice and Segmentation in the Restaurant Industry", the Service Industry Journal, 12(3) p 324 - 339.
12. Food Standards Act, 1999, London: The Stationery Office Limited.
13. New Labour - Because Britain Deserves Better (p21), London: Labour Party, 1997.
14. DoH (1999). Saving Lives: Our Healthier Nation, London: The Stationery Office
15. Department of Trade and Industry (1999), Modern Markets: Confident Consumers CM4410, London: The Stationery Office Limited.