Continuing scandal of invisible deaths

More than two people a week are killed by a partner in the UK – mainly women. Most of the victims are invisible. 

Welcome new legislation places a duty on social landlords to identify and act on signs of domestic abuse. 

Hidden in coroners’ reports and databases, deaths caused by domestic abuse are so common that they are rarely even reported. Most victims are female and we live in a society that recognise male violence as a norm – watch any episode of EastEnders, witness the recent crass remarks of home secretary, James Cleverly, on date rape drugs. 

According to the Crime Survey for England and Wales, 1.7 million women and 700,000 men experienced domestic abuse in 2022. The latest Home Office figures, for 2020/21, show 113 deaths from this cause – more than two per week. Three-quarters of victims were female, a quarter male. Close to half of the deaths were caused by stabbing, the second most common method was blunt force trauma.

The public, rightly, is horrified when a baby or child is beaten or starved by those responsible for their care – according to the NSPCC, an average of 58 young children dies each year, due to abuse or neglect. The most horrific cases, like the recent ones of Victoria Climbié or Arthur Labinjo-Hughes are routinely covered on the front pages of newspapers, with heart-rending photographs. The papers demand, on our behalf, “how could we have prevented this tragedy?”.

Adult deaths caused by abusers who are family members don’t seem to prompt the same visceral emotional response and a collective call for action. Its partly because they are so common. It’s also because systems that could facilitate learning what went wrong and acting on it aren’t working.

Coroners’ preventable deaths reports don’t recognise domestic abuse as a category. The main focus of Community Safety Partnership, another reporting mechanism, is on crime and disorder. The Home Office is brilliant at collecting statistics. It captures, chillingly, who killed whom, with that. Legally, it is responsible for collating the data from domestic homicide reviews, which have been in place since 2011.

It is supposed to identify serious failings and common themes and to communicate lessons to the media. These, in turn, should be picked up by public bodies – such as the police and probation services, social services, councils and housing association. But it isn't happening. The Home Office is not culturally suited to such a role.

Wider definition of domestic abuse

In the UK, reporting and learning mechanisms are lagging far behind new and welcome legislation, in an environment which has become sensitised more than ever to gender-based and institutional violence. Instigated by Theresa May’s government, the Domestic Abuse Act of 2021 was a much-needed and long overdue piece of legislation. It created a statutory definition of domestic abuse including emotional, controlling or coercive, and economic categories and it established a Domestic Abuse Commissioner for England and Wales.

This act’s influence, and a culture change, can be seen in Social Housing (Regulation) Act of 2023, which followed a white paper in 2020. The act – a reaction to the negligence and stripping out of regulations that caused the tragic Grenfell towerblock fire of 2018, sets out a charter laying out tenants’ rights, alongside a newly-empowered social housing regulator, professional training requirements and the welcome concept of consumer standards.

Section 136 and 137 of the white paper specifically mentioned domestic abuse and policies and practices on domestic abuse are required from social landlords, following a dedicated consultation, in the consumer standards. They are required to protect tenants, not just from physical conditions but from abusers, within a new set of professional parameters.

Domestic abuse expert Dr Kelly Henderson welcomes the fact that this narea of danger has been, albeit belatedly, included within the sphere of housing management. Her PhD research was on the role of housing in a coordinated community response to domestic abuse. 

She has worked in social housing management up to director level and now runs a company, Addressing Domestic Abuse, that trains and advises local authorities, housing managers, tenants, police forces and the Home Office. Henderson and legal expert Anna Bennet of Devonshires explained to Inside Housing magazine last year that whereas, before, the focus was on tenants bringing a complaint to their landlord, new standards mean that managers must act on any signs that may be related to domestic abuse.

She stresses: “I think it's important to get the point across that domestic abuse can happen to anybody, regardless of their income, but that you have fewer opportunities to escape abuse if you don't have resources.” Social housing landlords a special responsibility. In the best cases, they have their ears to the ground, they form communities. They are in a good position to identify and help to prevent domestic abuse – if they can’t, who can?

Signs of a problem may be far more subtle than bruising or other indications of physical violence. For a housing manager it may manifest in a non-obvious way, in terms of a tenant’s repair history or in patterns of rent arrears.

She says: “Imagine if there's been three bathroom door lock repairs in a year, that could be a red flag. Does the tenant have control of money and their mobile phone? A tenant might say something in a throwaway comment like ‘you need to ask my partner about this’.”

Of course, such signs may have nothing to do with domestic abuse. The most important skill is listening. She says: “It’s important for you to know about the help services that are available in your area and to explain them. But the worst thing you can do is for the victim to feel ‘I've said no to support once, so I can't ask again’. It's about keeping the door open. So that that when person feels that they are ready, they can come back.”

She adds: “The victim may not want to go down the route of taking legal action. They might just the abuse to stop and to move to a new home and start again.” 

Need to tackle causes

Policies should facilitate management transfer for the victim or, in some cases, the perpetrator – too often it is the victim, usually a woman, who loses her home. And they should be proactive and preventive. She says: “The cause of domestic abuse is perpetrators and we need to tackle the cause. What we are largely doing at the moment is picking up the pieces after them and putting the victim in a refuge.” 

Frequently, she says, domestic abuse is incorporated by landlords into policies on antisocial behaviour. It’s a topic that requires its own specific response. But merely having a policy doesn’t mean that the duty to protect tenants has been fulfilled.

For many landlords, consumer and rights-focused social housing management has just begun. Inevitably, the cultural change that it signals won’t happen overnight. Arguably, a professional re-set is required, which has far-reaching implications. She says: You can't just have consumer standards, introduce domestic abuse, and then not have domestic abuse awareness as a required skill in professional training.” 

Local authorities are resource starved, with many competing priorities, and there aren’t enough shelters. She says: “I think the government needs to invest more money into refuges and to give local authorities ring-fenced funding to provide appropriate services.” 

But money and law, in themselves, are not enough. A holistic community response is required. She says: “It's not just one organisation’s responsibility. It’s something that we all have a duty to act on. If you work in the housing sector, you need to know that it's part of your job to recognise and respond to domestic abuse. That's what I would like to happen.”

Will Hatchett has been a journalist since 1986 He was editor of Environmental Health News from 1998 until 2018. The views expressed here are purely his own.

 

Community safety is nobody's problem

No-one would say that crime and policing, or local government, are in a ‘good place’ in the UK. It adds up to an environment in which antisocial behaviour, which is often perpetrated by the victims of multiple service failures, is falling between the cracks – a problem affecting everybody that is owned by nobody.

It was a bad year for policing, following a terrible two decades. The police’s professional reputation which failed to recover following the damning verdict of ‘institutional racism’ delivered by the Macpherson Report in 1999, has diminished even further. Fallout following the murder by Minnesota police of George Floyd in 2020 led to a UK version of ‘black lives matter’.

Since then, we have experienced the murder of Sarah Everard by a serving Met officer, Wayne Couzens, the police’s mishandling of the subsequent Clapham Common vigil, the forced departure from office of Met Police commissioner, Cressida Dick and her successor, Sir Mark Rowley, being forced to vigorously defend a London police service that is widely perceived by the left as being ‘racist’ and, by the right, as excessively ‘woke’. 

In 2023, the Met Police lurched deeper into crisis, meanwhile councils faced the prospect of even smaller budgets. This year, an ‘ASB action plan’ launched in March recycled buzz words such as ‘hotspot policing’, ‘immediate justice’ and, an old favourite, ‘zero tolerance’. The ‘community trigger’, a power available under the 2014 Crime and Policing Act, a mechanism for bringing together professionals, has been relabelled by as a ‘community case review’.

It wasn't a year that changed anything – more cuts, more deckchair shuffling, more irrelevant announcements, designed to please right-wing newspapers and social media influencers. In the face of a breakdown of multiple professional services, life for all of us is more dangerous and uncivil – the world is less secure and so are the places where we live.

The crime that councils cater to, labelled thematically as ‘community safety’ covers multiple areas, some extremely serious. They include, in ascending order of life-or-death seriousness,

graffiti and fly-tipping, street drinking, neighbour disputes, for example over noise, safeguarding issues, domestic abuse, knife crime. In many cases, they are not ‘owned’ by a particular service but covered by many.  

Today, virtually all public services are thinly stretched – most front-line council line staff have retreated to their core professional roles, for example in food safety, housing management or environmental protection. In many areas, resources for police community support officers (PCSOs) and other street-level enforcement services have virtually disappeared.

No-one walks the beat anymore or ‘owns’ the streets. The police are covering far too many bases, including dealing with victims of the virtual collapse of mental health services – lost souls trapped in an endless limbo of custody suites and hospital A&E departments – while their charge and prosecution rates for crime are falling. Everyone agrees that psychiatric care is not the police's job. But whose job is it?  

Micro-managed by vote-seeking politicians, police services are suffering from a deepening identity crisis – what are they actually for? No-one knows and no-one is seeking to adress a policy issue that seems –  like the funding of social care or the composition of the UK's second chamber – to be just too large and intractable to solve. Our political systems, not fit-for-purpose, cannot reform themselves. It's a death spiral – a narrative of ineluctable decline.

Role of technology

In terms of communiy safety, It’s all the more important then, says consultant and ASB professioanal, Jim Nixon, formerly a police officer, for the multiple agencies that operate alongside the police to work more efficiently and to reduce their overheads. This is where technology can play a vital role, complementing the skills and judgement of trained professionals.

Councils and housing associations dealing with antisocial behaviour often used to ask tenants to keep ‘diaries’ logging day-to-day instances of noise nuisance and other forms of antisocial behaviour. They can now make smartphone enabled apps available to their tenants. Evidence is definitively captured that can inform solutions, or, in some cases, be used as evidenced in court. Supporting media can be attached and video recordings are automatically edited to provide GPS tagged and time and date stamped extracts.

This year, a report from the housing ombudsman highlighted the systematic failures of a well-known housing association, to deal with multiple noise issues raised by a vulnerable tenant that had contributed to his suicide.

The use of apps can saving officer time and costs for enforcement services by up to four-fifths. It also, argues Nixon, helps to highlight systemic or structural issues, so that noise problems can be prevented rather than merely reacted to – for example, by better neighbour management policies or, for new properties and refurbs, more stringent building regulations.

Nixon says: “Landlords may try to push a noise issue down the ASB route when, actually, it has nothing to do with ASB. It may be caused by hard flooring, or poor sound insulation. Landlords should work harder to find out what’s going on, before they start labelling people as ‘victims’ or ‘perpetrators’.”

Nixon is a believer in the ground rules that were laid down for the Metropolitan Police by Sir Robert Peel, in 1829. They hold that it’s best to work within a framework or community consent and that the test of enforcement efficiency is “the absence of crime and disorder, not the visible evidence of action”. 

Suella Braverman our last Home Secretary, did not follow the precepts of the founder of modern policing. She was probably unaware of them. But she is Home Secretary no longer. That’s the thing with this area of policy. New politicians arrive frequently, muddying waters that had not been allowed to settle since the last one. Ill-informed, and short-term in outlook, they play up to headlines and gimmicks, rather than looking systematically at policy paradigms and cause and effect. It's one of the UK's long-term problems.

Will Hatchett has been a journalist since 1986 He was editor of Environmental Health News from 1998 until 2018. The views expressed here are purely his own.
 

Battle for safe milk

Buying milk used to be a life-or-death gamble, especially for the poor. But laws ensuring public safety were resisted for more than a century. In an age of novel pathogens and growing scientific obscurantism, it’s a warning.

How safe is the milk you buy from local shop? We’re talking about cow’s milk here – not the kind made from oats, peas or soy beans. Pretty safe, right? If you aren’t allergic to it, you can be almost 100% certain that legally-compliant milk consumed before its expiration date isn’t going to make you ill.

Having said that, recent exchanges between environmental health professionals on RHE's 'Communities' platform indicate that milk being sold via vending machines, now popping-up in a myriad of locations across the UK, may present significant risks to the health of the public, unless careful and diligent management is exercised by those owning and operating them.

The sale of unpasteurized or ‘raw’ cows’ milk is prohibited in England except from farm premises, where microbial controls can be more confidently guaranteed, thanks to visits from EHOs. Legislation and effective food safety enforcement normally protect us.

But that wasn't always the case. Bovine TB was identified as health risk to humans who drank milk from infected animals in the 1890s. Yet milk pasteurisation did not become compulsory in England, Wales and Northern Ireland until 1985. It is estimated is that a million deaths were caused in Great Britain by bovine TB contracted from infected milk from 1850 to 1950.

As we saw with BSE and, more recently, Covid-19, new zoonotic pathogens can emerge at any time. Political delay while science is uncertain is understandable – even advisable. But, in the case of milk, proven aetiologies between animal and human disease went unheeded by policy makers for a century. It’s a shocking example from history and a warning – especially as the links between science and policy are now loosening, in era when social media channels amplify ignorance.

The first laws allowing EHOs to crack down on filthy dairies and cowsheds, that were known incubators for animal and human disease were passed in 1879. Buying milk was a life-or-death gamble, especially for the poor, who needed it most for its fat, carbohydrates, vitamins and minerals.

Milk could be watered down and adulterated with chalk, flour or arrowroot. It could also be contaminated with bacteria causing typhoid, enteritis, diphtheria, scarlet fever and TB. In 1907, a Royal Commission stated definitively, following a debate that had raged since the 1880s, that bovine TB could transfer, in a lethal form, to humans.

Despite this significant announcement, legislation protecting the public was successfully resisted by vested interests for decades. In rural districts, adoptive laws imposing hygienic standards on dairy farmers were rarely and unevenly enforced. 

Milk was poisoning the poor

That was less the case in large cities. But their medical officers of health knew that, each day, trainloads of TB-infected milk were arriving from the countryside to serve fast-growing populations. It was an issue of grave concern – a public health scandal – especially for infants who relied on milk, ‘nature’s perfect food’, to avoid rickets and malnutrition.

From the 1890s, the Liverpool and Manchester Corporations and the London Council used private acts of Parliament to assume powers allowing them to prevent the sale of milk from tubercular cows. Uniform national legislation was urgently needed to tackle what was now a well-known and preventable threat to public health, but the implementation of Herbert Samuel's 1914 Milk and Dairies Bill of 1914, designed for that purpose, was postponed by the onset of the First World War and it took many more years for uniform protection of the public from infected milk to be assured.

Clean milk’s most persuasive champion of the new century appears in The Sanitary Journal in February 1916, in which a talk he gave to EHOs is recorded. Wilfred Buckley was born in Birmingham in 1873 and amassed a fortune from his family's exporting business. Returning from the US in 1906, he purchased a 1,000-acre estate in Moundsmere, Hampshire, and set himself up as a sheep, poultry and dairy farmer.

Buckley had a personal interest in hygienic dairy farming. His daughter contracted bovine TB in 1902. With a fellow dairy farmer, the wealthy newspaper proprietor, Waldorf Astor MP, owner of the Cliveden Estate and vice president of the Pure Food and Health Society of Great Britain, he had set up the National Clean Milk Society (NCMS) in 1915.

The society advocated the mandatory refrigerated transportation of 'certified' milk of guaranteed cleanliness and hygiene score cards for dairy farmers. These had been successfully adopted in the US but not in Britain, whose farming practices remained firmly rooted in the nineteenth century. 

Buckley was a persuasive campaigner. He used multimedia techniques – pamphlets, posters, articles, films and lectures illustrated with magic lantern slides – to put across his shocking and compelling message – an average sample of milk contained the same number of bacteria per cubic centimetre as a municipal sewage farm.

As a result, he was gaining powerful allies, including the king's surgeon, Sir Frederick Treves. A 'milk drought' was also impelling government intervention in the milk supply, as had taken place in munitions and housing. In October 1916, milk reached the shocking price of 6d a quart in some London districts, resulting in a demonstration by mothers and infants in Hyde Park.

Wars tighten standards

In December 1916, a Ministry of Food Control was created. Its second minister, Lord Rhondda, adopted unprecedented national powers. In October, Buckley was appointed director of milk supplies, a position in which he was able to exert considerable influence on Lord Astor's official inquiry into milk production.

Milk prices were now fixed and the Local Government Board was given powers to regulate distribution and sale, including reduced prices for mothers and children. Most significantly, from Buckley's point of view, milk grading was initiated, on a small scale.

From September 1918, dairies with high hygiene scores could be licensed to produce grade A milk, which was awarded a 3d a pint premium. Grade B milk was slightly less clean, but still of a high standard. The scheme was inherited from the Local Government Board in 1919 by the new Ministry of Health but, to the frustration of the UK's first health minister, Liberal MP, Christopher Addison, it was not mandatory and was patchily adopted.

After the war, Buckley continued to give lectures for the NCMS and helped to set up the National Milk Publicity Council. He died aged 60, in 1933, un-knighted despite his years of valiant campaigning.

Through the 1920s and 1930s, the opposition of the farming lobby to dairy reform prevailed. It would take another war and further technological developments for effective mandatory national standards to be introduced. The Milk (Special Designations) Bill of l949 ushered in certified TB-free herds and the widespread use of pasteurisation, the efficacy of which had been known in the nineteenth century. One of the strongest advocates of the bill had been the Labour MP, Edith Summerskill, who was Parliamentary secretary to the food ministry and a campaigner for women's rights. As a doctor she had seen, seen first-hand, the effects of poor nutrition on mothers and young children in the 1930s.

Will Hatchett has been a journalist since 1986 He was editor of Environmental Health News from 1998 until 2018. The views expressed here are purely his own.

 

How the poor eat

The UK’s obesity crisis is getting worse. And the government is doing less and less.  Meanwhile, just as they were in Edwardian Britain, the poor are blamed by the well-fed for their irresponsible behaviour.

In 1901, social reformer and chocolate magnate, Joseph Rowntree, calculated, from a comprehensive survey, how much money a family in York would need a week in order to sustain “physical efficiency”. It was 21s and 8d (£1.08 in today’s money). By his calculation, a little more than half of that would be spent on food. But such an income, he asserted, would only provide a meagre diet, less varied than that enjoyed by able-bodied paupers in workhouses.

Rowntree concluded that around half of York’s population were living in poverty and 28% In extreme poverty, unable to acquire even basic necessities, such as food, fuel and clothing. Echoing the conclusions of a similar survey, conducted by a wealthy shipping line owner, Charles Booth in the East End of London between 1886 and 1903 this assertion caused shock and, in many cases, frank disbelief, among the affluent.

How could this be possible? These people must be improvident or feckless, the wealthy opined, in their favourite newspapers, wasting their money on alcohol, tobacco and trips to the music hall. In any case, if they were educated in healthy diets, they would not need to go hungry. 

In reality, the poor lived on white bread, tea, sugar, stewed greens and cheap cuts of meat. The thrifty and eagle-eyed would shop at antisocial times, such as Saturday nights when spoiled food was disposed of. They would buy food in tiny quantities. Groceries were generally bought by the ounce, meat and fish by the halfpennyworth. Popular purchases included cheese crumbs from the grocer and cods' heads for fish cakes, 'pairings' from the tripe shop and bones from the butcher that could be boiled into a watery soup. No KFC or McDonald's then.

Life on a pound a week

For the poorest, bread could account for an eighth of family income. Some food was, frankly, weird. In Birmingham, a dish called 'slosh' or 'slop' consisted of the leavings of a tea pot, poured over a slice of bread and drained off, with the addition of a knob of margarine. Universally, a stale loaf would be toasted and mashed with tea and sugar (milk was too expensive) to provide an alternative to rusks for babies. 'Cag-mag' was butchers' trimming, often of dubious quality, parcelled together. A shilling's worth of cag-mag could be made into a stew on a Saturday night and served up for breakfast on a Sunday morning. Yum.

For comparison, Edward VII, Britain’s monarch from 1901 to 1910, known by his subjects as ‘Bertie’ and ‘tum tum’, enjoyed four meals a day and dinners of 12 or 14 courses – pheasant stuffed with truffles, quails filled with foie gras, sole poached in Chablis garnished with oysters and prawns and boned snipe with Madeira sauce were favourites. He would have a cold chicken placed at his bedside, in case he became hungry in the middle of the night.

An Australian-born journalist and feminist, Magdalene Reeves, researched typical expenditure and diet in south London in 1911. It was the year after King Edward, died, aged 68, his demise hastened by his heavy smoking and gluttony.

Her pamphlet for the Fabian's Women's Group, ‘Family Life on a Pound a Week’,  breaks down the 50p that were spent by a city warehouse worker, Mr W, and his wife every week on food. At 15p, meat made up the largest part of the budget. In descending order, came bread, butter, flour, milk, tea, sugar, dripping, potatoes and greens. She writes: "Cold meat, with bread and butter and tea, would be provided for the evening meal. The "eternal bread, butter and tea” would be breakfast.

Life wasn’t that different for the hard up when author George Orwell travelled to industrial Lancashire and Yorkshire in 1936 to research, ‘The Road to Wigan Pier’. Publisher Victor Gollancz had commissioned an account of unemployment and social conditions in the north of England. It was. But he took violent exception to Orwell’s description of how ordinary people perceived socialists – as bearded sandal-wearers, vegetarians and nudists.

Orwell’s description of the psychology of the poor and their attitude to food is acute. Like Booth, Rowntree and Reeves, he carefully itemises the weekly budget of an unemployed Yorkshire miner and his wife. It totals £1.60 with almost a third allocated to rent. He observes: “The miner's family spends only tenpence a week on green vegetables and tenpence halfpenny on milk and nothing on fruit; they spend one and nine on sugar and a shilling on tea. The basis of their diet is white bread and margarine, corned beef, sugared tea and potatoes.”

He adds: “Would it not be better if they spent more money wholesome things like oranges and wholemeal bread, saved on fuel and ate their carrots raw? it would, but the point is that no ordinary human being is ever going to do such a thing. The ordinary human being would sooner starve than live on brown bread and raw carrots. When you are underfed, harassed, bored and miserable, you don’t want to eat dull wholesome food. You want something little bit ‘tasty’.” Like “three pennorth of chips” he suggests – in today’s terms, a Deliveroo Big Mac or a pizza.

Obesogenic environment

Our food choices are not rational. They are governed by emotions and volitions that we do not understand and by simple proximity and convenience. The same arguments that were deployed against Booth and Mayhew are still used today – that the poor could eat healthily, if they wanted or chose to. But the odds are stacked against them more than ever.

Unhappy humans are still governed by perverse instincts of immediate gratification from energy-rich sugar and carbs, as identified Orwell, but they face additional problems that he did not anticipate. We live in a world which encourages us to eat unhealthily from every supermarket aisle and billboard and in which sugar and salt-laden, ultra-processed and additive-filled foods are relatively cheap and ubiquitous. It has been called an obesogenic environment.

A hundred years after Orwell’s journey to Wigan, the food landscape has changed radically. Today, just eight companies control 90% of UK food supply. A quarter of places to buy food on the high street are fast-food outlets and food advertising is dominated by confectionery, snacks, desserts and soft drinks.

According to The Food Foundation, the most deprived fifth of the UK population would need to spend 50% of their disposable income on food to meet the cost of the government recommended healthy diet – a metric that is worsening year by year. This compares to just 11% for the least deprived fifth. The default UK diet – low in vitamins and minerals, high in starchy carbohydrates, fat and sugar, has produced an epidemic of obesity. And it’s getting worse.

A Defra select committee reported this July that rising food prices caused by the Covid pandemic, Brexit, climate change and the Ukraine mean that a fifth of UK households are resorting to unhealthy, high-calorie diets, due to trouble in accessing good quality food at reasonable prices. The report says: “The promotion of cheap, calorie-dense foods lacking essential nutrients has resulted in 30% of the population becoming obese. This figure is expected to rise to 40% by 2035, with NHS spending on Type 2 diabetes treatments outweighing current expenditure on treating all cancers.

Government retreat

The government has retreated in the face of this unravelling catastrophe. Attempts to modify our obesogenic environment appeared, in a modest form, in 2011 in the form of a ‘voluntary public health responsibility deal’ for the food industry. In 2016, a sugary drinks tax was introduced. But in June 2022, Henry Dimbleby’s 300-page Defra commissioned food strategy, proposing taxes on salt and sugar, free fruit and veg for those on low incomes, advertising restrictions and expanded free school meals was kicked into touch, causing Dimbleby to resign.

Introducing, in his Conservative party conference speech, a modest progressive restriction on the sale of cigarettes, Rishi Sunak said that the smoking is the UK’s biggest entirely preventable cause of ill-health, disability, and death. However, as campaigners pointed out, obesity costs £27billion a year through its knock-on effects – £10bn more than tobacco.

Why act on one public health issue and not another and fail to save the NHS billions? Put on the back foot in an interview with the BBC, Sunak said that here is “no safe level of smoking” and it “isn't the same as eating crisps or a piece of cake”. These statements are misleading and disingenuous. The argument that we are “free” to choose junk food, or not to, is a fig leaf – especially for the poor. 

The tobacco industry is also in retreat and has shifted its gigantic marketing budgets in wealthy countries from smoking to vaping, especially among the young, with flavoursome addictive options. The UK food industry, led by the Food and Drink Federation has lobbied hard, and successfully, against measures that would risk reducing its profits, so that nearly all healthy food options are more expensive than the alternatives. Where is the freedom in that?

Will Hatchett has been a journalist since 1986 He was editor of Environmental Health News from 1998 until 2018. The views expressed here are purely his own.

This blog was posted on the RHE Global website

Forgotten hero of health and social housing

Few politicians have had such a profound positive impact on the health of the people of Britain as Christopher Addison, our first health minister. He deserves far more recognition.

In an era of minnows and mayflies – politicians whose main agenda is to enrich their families and friends and to court popularity with right-wing newspapers, it’s useful to be reminded that other worlds are possible. In other words, there have been examples of people in high office, in the UK, who have sought to improve society and its institutions for the benefit of the most disadvantaged and who have followed principles that are broader than mere self interest. Liz Truss is not one of them, neither are John Redwood or Jacob Rees-Mogg.

But one such individual was Christopher Addison (not the comedian). A doctor and surgeon who came from a wealthy Lincolnshire farming family, Addison was elected as Liberal MP for Hoxton in London in 1910. His motivation? He had been born into a privileged family and he wanted to help poor people. Sounds improbable? This man walked the walk. In the UK we value delusional flamboyance in our political leaders. We like hucksters. Dull people (Addison was a bit dull, to be honest) are overlooked. Rishi Sunak is dull. But he's the wrong kind of dull – a bean counter who is clueless in the realm of emotional intillgence. Addison was the right kind.

In a career spanning four decades, two political parties and two world wars, Addison's loyalty, his skill in dealing with real-world problems and his unwavering values (yes, there are such things) made him a trusted confidant to three prime ministers – David Lloyd George, Ramsey MacDonald and Clement Attlee. He was a member of Lloyd George's inner circle that that held breakfast meetings to sort out the nation's problems during the First World War, the ‘kitchen cabinet’, and he was so close to Attlee during the next war that the two men were called ‘Clem and Chris’.

Addison set up the Medical Research Council in 1920, legislated for nurses' registration and chaired a committee, in 1931, that recommended the creation of national parks. He shepherded two key health acts into life and was responsible for a piece of legislation, the ‘Addison Act’, that led to the building of an estimated 200,000 council houses. It's a pretty amazing legacy.

How many hundreds of thousands of people have enjoyed better and healthier lives because he was able to translate his princples into practice? But there is no museum in Hogsthorpe, his birth village in Lincolnshire, celebrating his life and achievements. He is mainly remembered through the Addison Act, and a piece of anatomical terminology, ‘Addison's plane’, relating to the abdomen. Other than that, he is almost completelty forgotten.

The reason for his relative obscurity is that Addison was a details person, a pragmatic, behind-the-scenes fixer. While highly principled, he wasn’t a showy orator or a glory-seeker. He just got things done and he came into his own in wartime, when UK governments assumed wide-ranging, command and control powers over people’s lives.

Addison is talent-spotted

When Dr Addison was elected to serve working class Hoxton as an MP, aged 41, he was already a highly-respected fellow of the Royal College of Surgeons, as an anatomist. This new role must, initially, have been a culture shock for a man from a well-off rural background. Plugged into the medical establishment and a master of minutiae, he was soon talent-spotted by Liberal Chancellor of the Exchequer, Lloyd George. He helped Lloyd George to get the 1911 National Insurance Act onto the statute books. It provided compulsory, state-run financial assistance for sickness – Addison’s first health victory.

During the First World War, he was appointed to a key role (ironically for a doctor), in July 1916, as Minister of Munitions. He facilitated healthier conditions for munitions workers and commissioned state-funded estates to house them, with wide streets and generously-sized gardens. This was Addison’s second health victory, excluding those of his medical career.

He was a natural choice to be appointed by Lloyd George, now Prime Minister, as Minister for Reconstruction, in July 1917. The tide of the war was turning and pressing questions pre-occupied the government – where would demobilised soldiers live, what would happen to the economy when ramped up war production was wound down, how would reconstruction be funded and what about social welfare?

The Poor Laws and workhouses still provided a harsh and punitive safety net for the poor. Lloyd George envisaged a radical post-war resettlement. He envisaged something like a ‘welfare state’ after the war – personal social services would be underpinned by state benefits and hated workhouses would be consigned to history. The Local Government Board, the Victorian branch of the civil service that ran the Poor Laws, stood in Lloyd George’s way. The PM simply abolished it, appointing Addison as the man to wind it down.

His bold vision was for a new Ministry of Health. This unprecedented creation would work alongside councils, which would improve and replace slum housing and ensure safe food. Tuberculosis, which thrived in in insanitary, overcrowded living conditions would provide a particular focus for its work. Addison became Britain’s first health minister in 1919, when the Local Government Board was dissolved. The previous year, his Maternal and Child Welfare Act required councils to provide day nurseries for working women – Addison’s third health victory.

His fourth and arguably greatest health victory, the Housing and Town Planning, or ‘Addison’ Act, of 1919, was designed to facilitate a large-scale, post-war house building programme, through a new mechanism, an exchequer subsidy. Addison intended at least half a million homes attractive, affordable rented homes to be built. Less than half that number were achieved. But the act literally changed Britain’s landscape. It must rank as one of the most far-sighted and effective health-promoting measures of the twentieth century.

Eye-catching estates

Small local building firms could be used to construct houses and councils could contribute financially, by levying a rate of up to one penny. Designs were modelled by council architects on the pattern of the Tudor Walters report of 1918, which, had been informed by the arts and crafts housing built by the London County Council, and munitions estates, including Well Hall in Greenwich and Gretna and Eastriggs, in south-west Scotland.

Featuring houses built in short rows, with pitched roofs, large gardens and communal ‘village greens’, the cottage estates of the 1920s and ’30s are still eye-catching. It was healthy, attractive, affordable rented housing for people on low incomes, efficiently-delivered, long before council housing was stigmatised, starved of funding and abandoned by Conservative and Labour governments.

Addison’s fourth victory was to be short-lived. In 1921, amidst alarm from the Treasury about rising costs, Lloyd George slashed the housing programme and humiliatingly demoted his former political ally to ‘minister without portfolio’. Playing up to right-wing newspapers owned by Lord Rothermere, that were soon to turn on him, he accused Addison, in Parliament, of possessing “an unfortunate interest in public health” and of being “too anxious to build houses”.

It's sad when two politicians who function effectively as a political unit – Owen and Steel, Blair and Brown,  Sunak and Johnson (they brought out the best in each other) – fall out. Usually, the cause is ego and thwarted ambition – one of the duo begins to resent the other one. In this case, Lloyd George – organisational genius, highwire artist and ladies man – simply ratted on his friend. The so-called ‘Welsh wizard’ valued poll ratings more than his principles and friendships. There is no nice way to put this – he threw Addison under a bus. He did this so as not to lose the backing of the Daily Mail and the Daily Mirror and Rothermere's bizarre political organizaton the Anti-Waste League – a weird combination of the current-day Taxpayers' Alliance and the Nazi party.

Addison was puzzled. He did not resign immediately but brooded for three months, before throwing in the towel. A year later, he lost his seat, in the 1922 general election that obliterated the warring Liberal party – a shock from which it has never recovered. These were Addison's ‘wilderness years’. It was a time for him to tack stock and reflect on what was important. He returned to the family farm in Lincolnshire, and wrote a two-volume primer on socialism and a stinging critique of Lloyd George’s cynical and self-defeating policy u-turn, The Betrayal of the Slums.

In this cogently-argued book, which is still in print, he pointed out that the housing programme’s budget had been arbitrarily reduced to £200,000 for whole of Britain, while the government was spending more than £200m annually on war services. Addison wrote: “The cost of this neglect is that we are committed to an increasing expenditure on combating the results of deplorable housing conditions.”

Return to Parliament

When Addison returned to Parliament, it was as Labour MP for Swindon in 1929. Drawing on his farming background, he served as an agricultural advisor to Labour Prime Minister, Ramsey MacDonald, later reviled as a ‘traitor’ by the unforgiving Labour party. He served, briefly, as a minster of agriculure, in 1930.

MacDonald's hold on power was tenuous. The fascist-leaning Daily Mail had helped to bring down his minority governent in1924, with a forged document, the Zinoviev Letter, alleging a communist conspiracy involving the Labour party.

The global economy was on the ropes. Politics were volatile. In a strong parallel with today, the authoritarian fringes of fascism and communism were finding a home in western democracies. When MacDonald joined the Conservatives in a National Coalition in 1931 – viewed as an infamous move by the Labour party – Adddison resigned from the front bench. He identified as a socialist, but he was not a member of the pacifist, appeasement-favouring wing of Labour, whose leading light, George Lansbury, led the Labour party from 1932 to ’35.

Addison lost his Swindon seat in the 1931 election, regained it in a by-election in 1934, but lost it again in 1935, even though Labour, now led by Attlee, did quite well. It was the end of his time as an MP, but not as a Parliamentarian. He was granted a hereditary peerage in 1937. As Baron Addison, he became one of small number of Labour lords.

In 1945, being one of the oldest statesmen around and a popular figure on all sides, he became Leader of the House of Lords. This was a politically crucial role. His main job, which he skifllfully accomplished, was to steer radical Labour legislation, including a radical nationalisation programme, through the Conservative-dominated upper chamber.

In 1920, as health minister, Addison had commissioned the Dawson report, that had recommended that the UK's hospitals were unified into a single national system and that general practitioners combined preventative and curative medicine. It must therefore have given him enormous satisfaction to advise Attlee and Aneurin Bevan, as the National Health Service Act of 1946 took shape.

The Dawson report had gathered dust on a Whitehall shelf for 25 years, but now, because of Labour's landslide victory of 1945, what was soon to be known as the National Health Service, was being created.

Bricks and mortar legacy

In 1951, Addison tried to persuade Bevan not to resign as labour minister, over the imposition of prescription charges. It was one of his last political interventions. He was ill by then, with the pancreatic cancer that caused his death, aged 82, in December.

Hundreds of people sent messages of condolence to his memorial ceremony at Westminster Abbey, including Winston Churchill. Addison was criticised by his socialist colleagues for his lifelong friendship with Churchill – they had both served Asquith’s Liberal reform agenda at the beginning of the century and, in the 1930s, opposed appeasement with Hitler, against the mood of their parties.

Addison was no Parliamentary firebrand – even his resignation of 1921 received little attention. He preferred to stay in the background, helping to turn the wheels of government. It's strange to relate that biographies of the ‘big beasts’ of politics that he helped and served alongside barely mention him. He must be one of the most least known significant British politicians of the twentieth century.

It could be said that his most tangible legacy was the council housing of the inter-war period, embodying his conviction, which is as relevant as ever, that investing in sound, affordable rented housing can help to level up social inequalities and reduce the incidence of wholly preventable illness.

In the first health minister’s second constituency, Swindon, there is an Addison Crescent, one of more 90 streets in Britain, all in areas of social housing, that bear his name. I think that Addison would be pleased by that. Perhaps bricks and mortar is best legacy to have.

Will Hatchett has been a social policy journalist since 1986. He was editor of Environmental Health News from 1998 until 2018. The views expressed here are purely his own. This blog draws on his chapter on Christopher Addison in Pioneers in Public Health: Lessons from History, Ed. Jill Stewart, Routledge, 2017.

Pic shows Addison Road, Allenton, Derby, thanks to Municipal Dreams

This blog was written for RHE Global

Humans versus robots

 

Some people fear that AI will put food safety professionals out of a job. Are these fears justified? What will a future of machine learning based algorithms mean for public protection services? 

AI seems tailor made for food safety. Both the food supply chain and the catering sector generate copious amounts of data that is dense with meaning. But interpreting it needs a lot of leg work.

Now we have a technology that can both capture that data and glean intelligence from it, effortlessly – like a seasoned EHO casting their eyes around a storeroom. So, is AI a fantastic opportunity for public protection? Or is it a threat? Is it going to put a lot of EHOs and food technicians out of businesss?

One would imagine that an AFSO (automated food safety operative), could carry out an inspection in nanoseconds. It wouldn’t need to set foot on the premises. In fact, there wouldn’t be an inspection.

Smart fridges, ovens, extractors and chillers, connected by the internet of things, multiple sensors and object recognition-enabled cameras able to detect grease, bacteria, insects and rodent movements and droppings, would provide a stream of real-time data back to HQ.

A little red light would blink and a text would go to the service head at the slightest sign of an issue. A well-designed algorithm would predict a problem brewing before it happened. And it would factor in customer ratings, complaints and social media posts.

We’re probably closer than we might think to the AFSO, says Helen Statham, head of health, food and fire safety at SSP Group, especially in food manufacturing.

Statham was formerly risk and compliance lead for a high street fast-food brand and served as director of food safety and trading standards for a London borough. She says, comparing the robot and the human: “In my opinion, there’s space for both. But EHOs do need to think about their role differently and envisage a future in which AI is involved.” 

Importance of behaviour

Intelligence, she notes is not necessarily ‘intelligence’. Compliance is important, but the largest determinant of food safety is behavioural – that’s why one shift in a fast-food outlet can be exemplary and the next chaotic. CCTV is already widely used by food business, for security purposes and to generate evidence to defend legal claims.

It’s not much of a jump from there to using it for food safety – how often do staff wash their hands? Are they putting their blue gloves on? How often are tables cleaned? What do they do at the end of a shift?

Here, we get into a potentially tricky area of compromising staff privacy. But Statham says: “The intention shouldn’t be to tell them off and it’s not an alternative to an audit or an EHO visit. Too often, as EHOs, we’re telling people where things go wrong, but we’re not understanding why it went wrong – the behaviour that led to it. That’s where technology comes in – as a tool for improvement.”

For large brands, she notes, the risk of reputational damage is a powerful motivator for compliance. For small businesses it often isn’t. For them, Statham argues, there is little evidence that enforcement and routine inspection work – fines for food safety offences are so small that they are regarded as an occupational hazard.

Food safety training is not mandatory for those setting up a business and they know that they won’t be inspected before they open. These issues need to addressed, regardless of technology.

In Statham’s ideal scenario, tech-enabled enforcement could free up time for highly-skilled EHOs to train the ignorant and pursue the ill-intentioned – the ‘bad actors’. There will always be enough work of this nature to keep them busy. 

Data into action

Food safety expert, Sterling Crew, president of the Institute of Food Science and Technology, agrees. In his view, AI won’t supplant human food safety professionals, but enhance what they do. He says: “What AI does is to translate data into information, provide analysis and guide corrective action. it’s a great tool for EHOs to use, but it’s not a replacement. The need for human intervention won’t go away. But that invention will be smarter.”

Crew is excited rather than challenged by the future. We are still only scratching the surface, he says, of what is possible. Emerging technologies and sophisticated affordable equipment, such as hand-held mass spectrometers, once only available in professional labs, are revolutionising food safety, in the catering and manufacturing sectors. They are also great for eliminating fraud from supply chains and for reducing waste. Science fiction is becoming science fact.

He says: “I have been in the food sector for more than 40 years, starting my working life as a regulator. I expect to see more changes driven by AI in the next decade than at any time in my life.” He concedes that professional bodies, technologists and scientists are often viewing AI with concern, fearing for their jobs. But, with resources in food safety enforcement so tightly stretched, he argues that they have more to gain than to lose.

Technology evolves, humans adapt. Could it be that the main problem with the AI revolution is that it’s happening so quickly? This article was written by a human, by the way. Or was it? Crew says: “We are at the beginning of an AI revolution in food safety. It has the potential to have the same impact as the industrial revolution, when blue-collar workers’ lives changed forever. AI will have a similar impact on white-collar workers. Including regulators and food technologists.” 

This Blog was written for RHE Global

Will Hatchett has been a journalist since 1986 He was editor of Environmental Health News from 1998 until 2018. The views expressed here are purely his own

On flip-flops and the art of politics

They are great for walking quickly and painlessly across hot, gritty terrain – perfect in fact. So why are the Conservatives using this footwear reference as metaphor for Labour’s alleged political inconsistency? It doesn’t make sense.
 

This supposedly clever barb – you can actually buy Kier Starmer flip-flops from the Conservative Party Shop – is, to say the least, ironic. Flip-flop? I mean, look at the post coalition years since 2015, when the Conservatives have been in office.

It’s been a torrid time, what with Brexit, the Grenfell disaster, the pandemic and the invasion of Ukraine. We’ve had five prime ministers, seven chancellors (that’s almost one per year), six environment secretaries and 12 (count them) housing ministers – some of them barely having time to take their coat off before they were heading for the door.

The Conservatives sweated the small stuff. They also sweated the big stuff. We started off with fiscally prudent posh boys, Dave and George, in number 10 and number 11 (it’s got a bit confusing who lives were). This was familiar territory – privilege in a polo shirt. But there was something different about them. Not only did they acknowledge that ‘the north’ (of England) existed – they launched and appeared to believe in a ‘northern renaissance’ and even a ‘midlands engine’. Good God.

The Brexit vote happened – an under-whelming endorsement for an idiotic policy that has benefited no-one, apart from hedge fund managers who sought lower taxes and patriotically ‘shorted’ their own currency. Dave left in a huff. Things got really strange then. The new incumbent of number 10 was Home Counties Theresa, with her pointy leopard skin footwear hinting at a personality that she did not possess. Theresa badged herself as a ‘nice Conservative’ while blowing on a dog whistle and making the UK hostile to its Afro Caribbean citizens. There was a touch of Abigail’s party about the ‘dancing queen’. But she wasn’t comfortable in her own skin. How could she be as a ‘nice Conservative’.

It had dawned on the people of these four nations long before her botched election of 2017 and her car crash conference speech that October, when a letter F dropped off the wall behind her out of sheer embarrassment, that it had made a dreadful mistake. Prime minister? She could host a dinner party, but the guests would leave early. Hammond her money guy at number 11 raised cautious pessimism to an art form. He made Gordon Brown look reckless. And then? OMG. Bullingdon Club Bojo – Churchill in clown shoes.

The man’s delusional self-belief and knockabout antics, matched with a willingness to lie at all times made us smile – at first. He stormed the 2019 election like caustic soda unblocking a drain – admittedly against an ineffective opponent. And then. The mould of doubt crept acros the ceiling. We had messed up again! Shouldn’t there be an HR policy for appointing prime ministers, some people wonderered – psychometric testing, a lie detector? Lend this man your car and he would lose the keys. You wouldn’t let him anywhere near the sherrry bottle.

Disjointed narrative

The national narrative has never been more disjointed. It’s not just the flip-flopping of the personalities of our anointed leaders – from almost normal seeming and competent (Dave and Theresa), to recklessly flamboyant (Boris), to mad (that women who gate-crashed the number 10 party with poppers and bondage gear) then back to dull – head boy Rishi, with his shiny prefect’s badge and his carefully polished shoes.

It's also a policy thing. Johnson laid waste to the economic theories of Hayek, Thatcher’s free-market god, and a hero to Dave and Theresa. He was a fiscally incontinent turbo-charged Keynesian who threw money around like a drunken sailor. He knew that there was life in the north of England, like Cameron and Osborne did, but he actually went there (avoiding Liverpool of course) and flashed the cash.

The David Blaine of politics, he hypnotized and bribed people north of Watford into voting for him! That’s simply not Conservative. One can go shooting in the north or even represent a constituency there (Baldwin had Bewdley, MacMillan had Stockton-on-Tees) – but, for a true Conservative, the job of the north is to embody a plucky form of failure, not to be an electoral base or an economic powerhouse.

In some ways, Conservative policies are reverting to type after the hallucinatory madness of Johnson and Truss (that was her name – did that really happen?). The brief revival of the north that Dave and George laid the groundwork for and Boris nurtured is being killed off by neglect and indifference. Rishi, the man who tried to buy groceries with a Blockbuster card, is not really that bothered about the north and he doesn’t get net zero.

Flip-flopping? Aside from macroeconomic policy yawing around like a crippled oil tanker and Boris’s flirtation with fascism, there haven’t really been coherent policies as one would recognise them in the past eight years. One of the main reasons for this, in my submission, is the mercurial figure of Michael Gove. He is a politician with a brain and a work ethic, who leaves unfulfilled projects and a trail of disaster behind him, rather like John Prescott did, but for different reasons.

As environment secretary, between 2017 and 2019, he shepherded a surprisingly not terrible Environment Act into life, which set a credible template for a post EU Britain, respectful of the environment and net zero. And he laid the basis for a waste and resources strategy designed to increase recycling rates and make the UK economy more circular. Since he left the job, no-one has been in charge. The waste and resources strategy is a shambles – it’s not happening – and the government is backing away from its net zero commitments as fast as it can, even though half of Europe is spontaneously combusting.

At the moment Thérèse Coffey, is nominally running things as Defra secretary, but she convinces no-one in her defence of privatised water companies, which are clearly more interested in shareholders receiving dividends than stopping sewage flowing into rivers and the sea. And she has done nothing to demonstrate that the UK’s commitment to achieve net zero by 2030 carries any conviction.

Gove was also the main architect of levelling up – the name of a well-intentioned policy aspiration, inherited from Cameron, Osborne and Johnson, a department and a piece of legislation. When he left that portfolio, in July 2022, the levelling up policy was dumped in a skip, like your mum and dad’s CD collection. Confusingly, he is now back in the role – a job that he is quite good at. But he won’t be around for long. The name ‘levelling up’ is becoming embarrassing. It won’t survive the next departmental re-organisation.

Consistent inconsistency

Which brings us to other areas of policy discontinuity. Cameron and Osborne built quite a lot of houses – although they didn’t like social housing – why would they? They were too posh to understand it. They began to re-organise planning in a sensible and logical way and set up some solid and credible skills and employment strategies across the economy, including an industrial one – Rishi doesn’t like industrial strategies so he dumped that idea. Whoops. Shame. May and Hammond carried on the housing baton from their predecessors and they were kinder to councils.

Two years ago, planning returned to year zero, when Robert Jenrick decided to scrap the local authority-run system that we have had since the 1940s and start again. But his grand plan was unceremoniously scrapped last year, when it transpired that this would have led to building more houses in the Tory-dominated green belt and risk an electoral meltdown. Not many people noticed, apart from a few technical specialists and policy nerds (like me). But that was the mother of flip-flops.

In December, as the 12th housing minister since 2010 was taking his coat off, the ‘top-down housing targets’ that had been rigorously imposed for councils under Cameron, May and even Johnson – in a rare example of policy continuity – were got rid of. Completely. First there were housing targets, then there weren’t and now, with Gove dipping his finger back in the saucepan, there might be targets again, in a modified form. To say, the least it's confusing. Isn't it somewhat disingenuous to say that there is crisis and that we need to build more houses and then to dismantle the policy infrastructure needed to create them?

The Conservatives, true to type, have demonstrated that they don’t want to build anything anywhere that would threaten their votes. So, development in cities, not the countryside, is Gove's new mantra. The new houses, or, rather, boxy flats with miniature balconies, will be squashed into overcrowded urban spaces, where poor people live, alongside city workers who are willing to trade living space for gym membership. It's a crap idea, straight from the blue heartlands.

Politics has had more twists and turns than a Netflix series in the past eight years. We’ve been gifted with Theresa’s May’s ‘kind’ Conservatism, Boris Johnson goose-stepping through Whitehall, Liz Truss’s mad interregnum and now, Rishi Sunak, a dull bean counter. Sunak is the UK’s chief finance officer, not its CEO. He will implement a policy if you instruct him too. But he won't team-build or make a rousing speech, or lose any sleep over it. All he really cares about is trying to balance the books. That's his job.

For the Conservatives, flip flopping is interpreted as pragmatism, for the  Labour party, its portrayed as weakness. And, since 2015, we’ve had more flip flops than a beachwear shop, which is probably why the Conservative party, punch drunk from thirteen bruising rounds, is still clinging to power.

Footwear should be appropriate to the time and place in which it is worn. When you are in opposition, you obviously need to be quick on your feet and not to tie yourself up with pledges which a ruthless right-wing press will taunt you with as unfulillable, if you get too close to office.

If I were Keir Starmer, I would certainly wear flip-flops. I know where he could buy some from – the Conservative Party Shop. But they are rather expensive. They cost £16.99. He would be far better going to a pound shop – a sector of the economy that has flourished under the Conservatives. Maybe not for long. Now even Wetherspoons is in trouble.