Outline of the Report

The purpose of our Investigation was to make recommendations so as to reduce the risk of contracting E. coli O157 in those who visit Open Farms and to improve the health protection response to future outbreaks of E. coli O157 infection.

Guided by the Terms of Reference, the Independent Investigation Committee requested evidence from key stakeholder organisations and a number of individual experts. The background evidence is brought together in four Chapters that comprise Part A (The Context) of the Report. This is followed by two Chapters in Part B (The Outbreak) that describe the outbreak of E. coli O157 at Godstone Farm with a synopsis of interviews with the parents of affected children. In Part C (Management of the Outbreak) we evaluate and analyse the management and control of the outbreak and in Part D (The Challenge of Reducing the Risks) we provide a critical assessment of the way in which the risks associated with E. coli O157 are assessed and managed and propose solutions to meet this challenge. Our recommendations and conclusions are gathered together in Part E.

From the outset of the Investigation we were presented with two fundamental issues. First, an Open Farm was define for us by the Health Protection Agency as one that invites members of the public to visit and that facilitates direct contact with the animals. However, it became clear that venues which allow the public to have contact with animals are many and varied. To focus on the types of premises and the animal contacts that led to the outbreak of E. coli O157 at Godstone Farm requires us to defin the type of premises that are the primary attention of our investigation and the target of our recommendations.

We therefore define Open Farms as ‘those premises that maintain farm animals, actively attract visitors for leisure purposes, have visitor facilities and encourage, permit and allow animal contact, and such premises need not be open on a daily basis nor solely operating as commercial leisure activities’. Our recommendations for regulation, inspection and operational procedures are predominantly focused on Open Farms like these and are outlined in Parts D and E. However, the risks that may arise from all agricultural animal contact have been considered and appropriate risk management practices that should be made available are also commented on in Chapter 8 of Part D.

The second important issue for us was that public health is a devolved matter and there are significan differences in the structures and responsibilities in each of our devolved countries. The report has primarily described the situation in England but we have sought evidence from across Great Britain and Northern Ireland and have noted that in many aspects therein lies a considerable wealth of experience and knowledge. We have sought to make recommendations in Part E that are pertinent to England but we recommend that in view of the complex regulatory arrangements for Open Farms each devolved territory should initiate an examination of these recommendations to ensure their implementation for the protection of public health.

PART A THE CONTEXT

Chapter 1: Escherichia coli O157 sets out the nature of the organism E. coli O157, its pathogenicity and the range of clinical symptoms it can produce. A review of the epidemiology of E. coli O157 is included, together with the nature of sporadic cases versus outbreaks. Examples of other outbreaks of E. coli O157 associated with animal contact are also described.

Chapter 2: Standard Public Health Procedures for E. coli O157 discusses the process of controlling an outbreak beginning with how an outbreak is recognised and the key organisations involved in outbreak control.

Chapter 3: Open Farms describes the wide range of Open Farm premises that offer educational visits and/or entertainment to the public. A summary of the functions of the many non-regulatory organisations related to the Open Farm industry is provided, together with an overview of the existing schemes for accreditation of educational visits to farms.

Chapter 4: The Regulatory Framework for Open Farms presents an overview and lists the main regulatory Bodies responsible for the inspection of Open Farm premises. Reference is made to the Guidance that is used to monitor and inspect standards at Open Farms. This chapter reviews the current UK legislation and compares the framework in the UK with that of Europe, the USA and other countries.

PART B THE OUTBREAK

Chapter 5: The Outbreak at Godstone is described in detail. A timeline setting out the main events during the outbreak is included, as well as details of the clinical impact of the outbreak.

Chapter 6: The Views of Parents is a synopsis of interviews with parents whose children were affected by the outbreak. A compilation of the interviews is included in Appendix 8.

PART C MANAGEMENT OF THE OUTBREAK

Chapter 7: The Management and Control of the Outbreak deals with how and how quickly the outbreak was identifie and what was done to control it. This Chapter examines the work of the outbreak control team and reviews what was done to disseminate information about the outbreak.

PART D THE CHALLENGE OF REDUCING THE RISKS

Chapter 8: Assessing and Managing the Risks contains a critical assessment of the current levels of hazard and risk as applied to Open Farms. The perception of risk of E. coli O157 infection on Open Farms is also assessed and a view is presented on what additional prevention and control measures are needed in the light of the outbreak at Godstone.

Chapter 9: Meeting the Challenges. In this Chapter, the Committee provides a critical assessment of the existing regulatory framework and presents a series of potential solutions to improve the regulatory structure.

PART E CONCLUSIONS AND RECOMMENDATIONS

Chapter 10: Conclusions and Recommendations brings together and puts into perspective the key points from all the separate strands of the investigation and presents the conclusions of the Investigation Committee. This chapter also combines the full set of recommendations from the preceding chapters.