11th December 2009
Graham Jukes understands the sentiment behind the Chinese curse “may you live in interesting times”. In his 22 years working for the CIEH he cannot remember when the profession has faced such interesting challenges than it faces today.
The fallout from the global recession, combined with a philosophical shift in the government’s approach to the regulation of business is, he believes, set to fundamentally alter the way environmental health is delivered.
As chief executive, it falls to Graham to reshape the CIEH to cope with what he says will be big changes for most members of the profession. This month, he will present to CIEH trustees radical proposals to alter the charity’s governance, clarify its mission statement, expand its membership and offer members effective regional representation on a national professional council.
The merger of the weekly membership magazine EHN and EHP into a new fortnightly, EHN, to be launched on 15 January, with the fortnightly EHN Extra is also part of his vision.
Graham first came across environmental health in 1971 when he worked for three years as an administrative officer to the medical officer of health at the London Borough of Hammersmith and Fulham. He remembers being amazed at
the number and variety of people public health inspectors helped. “It made me feel that I wanted to be more empowered and wanted to make the kind of changes that I was seeing.”
Qualifying as an EHO, and later chartered EHP, his career took him through a number of London authorities. He became deputy chief EHO at Tower Hamlets LBC before joining the CIEH as assistant secretary in 1988.
Having dedicated much of his free time working voluntarily for the charity as a trustee on many of its committees, and for its centres and branches, he was now drawing a salary delivering CIEH policy. It was, he claims, like being paid to indulge his passion – a feeling he maintains more than two decades later.
Legislative changes
Graham believes deeply in environmental health and in the role the CIEH plays in providing healthier, cleaner and safer communities. He points to the smoking in public places campaign waged by the CIEH for many years as a recent shining example: “The smoking legislation just shows how effective laws can be when they are properly thought through.” He also points to the CIEH’s role in formulating legislation such as the Environmental Protection Act 1990 and the ending of crown immunity in hospitals, as well as its influence in the creation of the Food Standards Agency after the BSE debacle.
But he says members cannot afford to be sentimental about the profession’s role or how it is delivered. “We are part of the changing environment that we live in and we are part of the way society copes with changes to public health delivery and we can only be part of that solution as long as we remain relevant, welltrained and responsive professionals.”
A sentimental attachment to the past, he believes, has been reflected in the specialist/ generalist debate that led to the creation of the 2007 and now 2010 curriculums responsible for shaping the profession’s future skills. “It’s all about providing members’ skills for tomorrow’s employers,” explains Graham. “We are already specialising and yet some people believe that by losing our generalist status we are losing who we are. But life has moved on and the interventions we now provide have become highly complex.
“Historically, our members came from the plumbing trade because public health was based around sanitary solutions. Our members now have a strong science base, holistic academic training and it is now about risk assessment, the evidence base and priority planning. Our forebears could never have imagined we would be applying something like social marketing to change behaviour when regulation was the only tool available to them. We have no choice but to specialise if we are to remain relevant.”
Generalist skills
However, he believes that generalist skills will always underpin the profession. The modular nature of the new curriculums mean those who choose to can still study the four traditional disciplines of food safety, health and safety, environmental protection and housing. “Much in the way that a GP is skilled at recognising disease from a whole range of symptoms, but passes patients on to specialists, so I see there being a vital role for generalist EHPs in local government capable of identifying and providing solutions to address local public health need.”
For those wishing to specialise there are two routes – the 2007 and 2010 curriculums for new members to the profession and competency frameworks, as pioneered this year in the field of health and safety, for those wishing to develop skills on the job.
“As we develop more competency frameworks employers will be able to assess the competency of an individual for a particular role. Equally, someone will be able to see what skills they need to do that job. Someone, for example, who wants to work for a PCT will have to demonstrate their ability to determine health across communities. The employer will be able to assess that competency based on a set of framework tools. The existing health and safety competency framework is a model we see developing in all areas of our work.”
The strength of the new degree curriculums and qualification routes is that they remove the current placement logjam facing students who will no longer have to rely on local authorities but will be free to complete placements with organisations relevant to their specialism.
Most importantly, the curriculums allow students to specialise and so meet the needs of future employers. An example is a specialist module being worked on with the Health Protection Agency for those who wish to work in public health at a regional level.
Earned autonomy, the principle of freeing enforcement resources to focus on high-risk businesses by allowing large to medium reputable businesses to audit their own safety procedures, is another example. In the food sector, earned autonomy will mean EHPs specialising in food manufacturing to meet the needs of the big food manufacturers and retailers.
Better regulation is the first of the two catalysts of change that Graham expects to impact the profession most over the next few years. The introduction of earned autonomy, says Graham, is inevitable, although he accepts that much of the detail needs further debate. It will mean a lot more jobs for EHPs working as auditors in the private sector, freeing up local government EHOs to focus on higher risk businesses. “Medium to large companies will have to put systems in place that provide evidence of compliance rather than relying on the public purse to provide a free auditing service, as is happening now,” says Graham.
Economies of scale
The other catalyst for change is cash, or the lack of it. The traditional stand-alone environmental health department has already been subsumed into wider council directorates. The global recession and the consequent slashing of public sector spending will now lead to the next phase of this process as directorates merge across clusters of local authorities to provide economies of scale in delivering services.
In effect, says Graham, we are moving towards the regional delivery of environmental health and it is a short step from that to specialist EHPs delivering their services through regional offices of the Food Standards Agency, Environment Agency, Health Protection Agency, Health and Safety Executive and through primary care trusts, a process that has already begun.
He anticipates a smaller number of generalist EHPs delivering a public health surveillance and commissioning service through local government while a far larger number of specialist EHPs move into the private sector and eventually into regional delivery agencies. So what changes to the CIEH is he proposing to support this?
The first and most significant change started three years ago with the setting up of the regional structure, replacing the old branches and regions based around local authorities. “We recognised that environmental health delivery through local government was changing and we wanted a regional structure that catered for all members, regardless of which sector they worked in,” explains Graham.
“We also wanted a regional base capable of engaging with regional government. It has been quite a challenge in terms of creating and resourcing the new regions and we are still in the process of achieving that. But now we are entering the next phase of organisational change where we address democratically the representation of the views of the regions.”
Graham believes some CIEH members have misunderstood the role of their elected trustees, believing they are there to represent the views of members at council.
In reality, the trustee is there in a legal capacity to oversee the actions of the CIEH to ensure it conforms to its charitable role. President Stephen Battersby and last year’s chairman, Mark Elliot, have been developing proposals to cut trustee numbers while giving members a greater say in governance.
“Our vision of the council of the future is one that provides a far more representative voice, providing a forum where we debate policy issues important to the regions like, for example, what role we should be playing during last month’s Cumbrian floods or what policies we should be adopting to mitigate climate change.”
He also believes that with members working through ever more diverse agencies, there will be a greater need for members to come together to talk to colleagues about environmental health issues. He sees the national and regional forums providing that function.
Regional engagement also involves more structured communication mechanisms. It was for this reason that the decision was taken last month to merge CIEH magazines into a single fortnightly product, taking the best of both EHP and EHN. On the alternate week members will receive EHN Extra by email, providing the up-todate news coverage members have been used to.
“In part this is about reducing our carbon footprint, much like other environmentally conscious magazines like The Ecologist have done, but it is also about streamlining our communication tools and being much smarter about the ways we communicate through our website and emails.”
Another significant change for the CIEH will be the growth of its membership base. At present the CIEH has 10,500 members. Graham estimates there could be up to 40,000 more people working in central, regional and local government, the private sector and the armed forces that, to differing degrees, work in the field of environmental health. These include at one end of the spectrum HSE inspectors, while at the other it could be those who hold a level 4 CIEH qualification.
“I am expecting the opening up of membership to happen in the new year. We will obviously have to wait for the council decision but if they agree to changes to the regulations you can expect to see during 2010 campaigns to attract new members into the CIEH.”
Greater access
How does Graham answer the criticism that by potentially allowing in tens of thousands of new members he is diluting the professional credibility of the organisation?
“For many years we have been asked to extend our reach to not only those trained in environmental health but also those who work in environmental health,” he explains.
“It is important to understand that we are not a professional protectionist organisation, we are a charity that delivers its mission to create safe, clean and healthy communities through our members.
“We denote different educational standards through our tiers of membership. Chartered members, for example, are highly sort after because of their academic skills and competency. It’s important that others working in environmental health can be part of our body so they can access support and training to help them develop their skills along the right lines.”
In September the CIEH Council agreed to restructure the business side of the charity. A new executive board has been set up to co-ordinate charity and business activity to ensure it complies with the charitable mission (see below).
“The CIEH must not only be seen as a charity but also as a successful business facing social enterprise for the enhancement of health. An example is the accreditation of our training courses through which we help train up millions of people to understand how good practice raises standards of public health,” says Graham.
He sees the CIEH’s international activity as another area of growth. “We see effective environmental health delivery around the world as a vital component in addressing public health problems in areas like Africa, India and China. The CIEH is repositioning itself to help them provide solutions.”
Now approaching his tenth year as chief executive, Graham sees his legacy to date as ensuring the CIEH is fit for purpose as it addresses the changes facing the profession.
Does he enjoy living in interesting times? “I'm very lucky to have a job that makes a real difference to people’s lives by influencing the factors that make public health improvements. My job is to ensure the CIEH is continually fit for purpose in an ever changing world. Yes, I enjoy living in interesting times.”
CIEH mission statement
Mission: To promote effective environmental health practice. Vision: Leading, inspiring and delivering a safe, clean and healthy world.
Strategic goals
Set and maintain high standards in education, training and professional behaviour
Promote excellence in environmental health delivery and practice
Be the voice of the profession
Increase knowledge of environmental health practice
Provide products and services to support environmental health gains
Be an inclusive membership community