EHJ November 2004, pages 346-348
This month, the CIEH is considering lobbying for the introduction of a score on doors policy to drive up food hygiene standards in restaurants. David Clapham explains why he thinks the UK should follow the example set in New York and other parts of the US

If you thought you could increase the number of restaurants and takeaways that were perfectly satisfactory on a routine food hygiene inspection by a factor of three, would you be interested? No further visits, prosecutions or notices needed, Food Standards Agency targets met and time for other educational work, or even some health and safety at work inspections. Could you afford not to explore the possibility of using this new "compliance tool"?

This rate of improvement has been the experience in New York where, in a mere six months, the figure for routine inspections being satisfactory on the initial visit has gone from 21 per cent to 63 per cent. What brought about this improvement was the introduction of food hygiene scores on a public website, also showing details of what was found during the last inspection. The site is user-friendly and allows you to search for a restaurant in your locality or near your vacation hotel - ideal for tourists or locals looking for somewhere to eat.

A study by the Stanford Graduate School of Business on hygiene ratings in Los Angeles also found "overwhelming evidence that not only did consumers change their behaviour once the ratings became public, but restaurants also improved their hygiene levels". The study found hygiene scores improving dramatically with 25 per cent of restaurants that had an "A" score (good) rising to over 50 per cent after the scheme's launch. One of the paper's authors, Phillip Leslie noted that "the worst restaurants showed the most improvement". The researchers found that sales at "A" graded restaurants rose by 5.7 per cent or $15,000 while "C" graded restaurants fell by 1 per cent. The Standford study also showed that food-related illness fell by 13 per cent for the area studied, while rising by 3.2 per cent in adjacent areas.

Given the public's fascination in the grubbier side of our work, illustrated by the success of the programme Life of grime, and given the enthusiasm people on placements in environmental health departments show for visiting "bad" restaurants, the signs are that a well-publicised site should attract a lot of interest.

Whether someone complies with legislation is dependent on many factors, some of which have been identified for small and medium enterprises in the food business. It is no use assuming that the reason for non-compliance is ignorance of food hygiene practice or legislation, when the owner knows all about it but thinks it makes no difference - or knows and believes it is important but can't afford it, or does not believe he or she is capable of making it work. Or perhaps the owner is too busy satisfying the tax inspector or trading standards officer because the local EHP is usually too nice or too busy to prosecute, and will probably give them yet another "one more chance".

We need to recognise that the main driver for running a food business is to make money. Or, for small restaurants and takeaways, it is to not go out of business. In the US, 46 per cent of money spent on food is spent in restaurants and on a typical day 44 per cent of adults eat out. As the UK is already starting to follow this pattern, anything that affects business profits will provide a powerful incentive. What better way to enable a clean restaurant to make more money than an inspector telling their potential customers what they cannot be sure of by simply visiting the place.

We are all aware of the "clean front of house - filthy rear of house" syndrome. With this impartial information from the local authority, customers can then make sensible choices. Is hygiene important to diners? In the experience of Los Angeles, many will only visit "A" graded restaurants - it's probably the same here. We will, of course, need to change the present system where A means bad and F means good.

Look at it another way. Our primary customer is the public not the restaurateur. The taxpayer pays us to inspect food premises and so should know what we do with their money and what our privileged view of the kitchen and prep areas reveal.

There are, of course, counter-arguments to this idea: the rating scheme is flawed, it upsets businesses, rating does not equate to risk of food poisoning, things may change between inspections, all premises should be perfectly safe to eat in, etc. In the US, discussions highlighted the arguments on both sides of the debate. Those for the idea tended to be using it already and found it to be useful, those against it had not tried it but preferred to "work with business" and pointed out that the scoring system they used was somewhat flawed in its predictive abilities. Some argue that we need to work with and educate proprietors, not publicise what they do in the kitchen to an ignorant public. As well as this being slightly patronising, I would suggest that business should work with us too and the website can explain any shortcomings of the inspection system. The site for Boston, for example, includes a disclaimer and explanation you have to accept before being allowed into the site.

The question remains, however, would a scores on doors system be legal? Advice has been sought from the legal profession on this and things, unsurprisingly, are not clear. It seems that at present although "probably" legal, there is some debate, and councils could be at risk from being sued by disgruntled owners claiming to have lost business, where we could not prove we were being accurate. There is also the question of whether information gained for inspection purposes can be used for other ends. There are no specific powers that say local authorities can publicise this information and thus there is the ultra vires problem, ie would we be acting outside our powers by doing this and thus be acting illegally. The FSA has been given specific powers to publicise food related issues (Food Standards Act 1999, section 19) but it remains under the provisions of the Data Protection Act 1998 and must consider, "whether the public interest in the publication ...is outweighed by any consideration of confidentiality attaching to it".

Greenwich LBC has just started a site that lets people know whether a food business has been awarded a certificate under their food hygiene award scheme. However, a national web page with links to individual authorities, or at least a ready made template, would be even better than each council having to design and produce its own website. Perhaps this is a job for the FSA?

Because of the possible legal problems, we approached the Department of the Deputy Prime Minister via the parliamentary under-secretary of state for employment relations, to request a new piece of legislation requiring local authorities to publicise their food inspection activities. To date, we have heard nothing positive.

The Scottish Consumer Council has called on the FSA to set up a working group to examine the best ways of making the findings of inspections available to the public. They commissioned a report with the help of Royal Environmental Health Institute of Scotland. It found that only a third of enforcement officers were happy with the present system of providing the public with information about formal infringement action against food businesses, with the rest indicating that the public should be informed at an earlier stage. The report also found that over half the respondents thought that members of the public should have access to inspection assessments. Most thought that this should be through an FSA website, the rest preferring notices posted in the shops themselves.

But it's not just EHPs who think that a food hygiene score website is a good idea. The Consumer's Association, MPs, the parliamentary under-secretary of state for employment relations, high ranking people in the FSA, the London food group, many local councillors, and members of the public all agree.

Is there any light on the horizon? There could be, in the shape of the Freedom of Information Act 2000. The legislation gives a general right of access to information held by public authorities in the course of carrying out their public functions. Authorities are already required by the act to maintain a "publication scheme" which details all the information that authority will make available without being asked. Having contacted the local council's expert and the ODPM's hotline, it appears that this legislation would allow a local authority to publicise food hygiene information. Both the people I spoke to about it were keen to see a pilot. In fact, the question that naturally arises is - what would a local authority do, if on the 2 January 2005, a member of the public requested information about a particular restaurant, for example on what the food hygiene score is and what did the last letter/notice say? Could we refuse to give that information and would we want to? The exemption clause (which allows us to refuse to give the information) is section 30 and covers: "information held by a public authority ...if it has at any time been held by the authority for the purposes of any investigation which ... (it) has a duty to conduct with a view to it being ascertained whether a person should be charged with an offence". It also covers the "obtaining of information from confidential sources". Both of these may apply to a food hygiene inspection. However, there is an over-riding concept that despite the possibility of this, it would be in the public's best interest to divulge the information. Perhaps a well-constructed web site could actually just make it easy for a member of the public to request this information. Let's hope so.

New York website: http://www.nyc.gov/html/doh/html/rii/index.html