1. Supporting local decisions to improve public health outcomes Dr Deborah Turbitt

2. Attributable to 20 leading causes in both sexes 2 Global burden of disease 2010…

3. 3 Inequalities in London…

4. How does a public health system add value? An effective public health system: Anticipates the changing nature of populations Enables wider mitigation of damage to people’s health. Harnesses evidence, knowledge and technological advances to improve health and wellbeing equitably Unites fragmented means of service delivery through good partnership and high quality commissioning Secures equitable access to appropriate care Achieves impact at scale 4

5. How will PHE Support the System… Articulating an authoritative national voice for public health in England Protecting the population from communicable disease and environmental hazards Providing knowledge, evidence, intelligence and research Influencing through national/international relationships and acting as opinion leaders for health Developing the public health specialist workforce Providing direct advice and services 5

6. 1. Reducing preventable deaths 2. Reducing the burden of disease 3. Protecting the country’s health 4. Giving children and young people the best start in life 5. Improving health in the workplace 6. Promoting place-based public health systems 7. Developing our own capacity and capability 6 Our priorities for the next year

7. Notification 27 th December 2012, 09.30am Microbiologist, Queen’s Hospital 46 year old female admitted with diarrhoea previous day Died at 2am History of Christmas Day lunch at restaurant Other family members ill No sample obtained

8. Investigation Message left for widower to call HPU Ward staff knew name of restaurant The Railway Hotel, Hornchurch Havering EHO’s were informed Previously no concerns Agreed immediate visit

9. Inspection Previous inspections were good All temperature controls appeared in order Experienced chef No food samples retained from 25/12 No immediate concerns Menu obtained

10. Christmas Menu Prawn cocktail Tomato & orzo pasta soup Melon fan Chicken liver pate Roast turkey Sirloin steak Salmon fillet Stuffed butternut squash

11. Extent of illness Contact details of people who booked Hotel served 128 meals at lunch Some groups reported no illness Some had been ill but did not wish to complain Most agreed to participate in survey Some agreed to stool samples

12. Sample results 7 stools samples submitted from 2 groups Negative for salmonella, shigella, E. coli O157, campylobacter, S. aureus, B. cereus, norovirus, rotavirus, adenovirus, astrovirus and sapovirus. Clostridium perfringens enterotoxin recovered from 6 samples C perfringens antitoxin gene in all 7

13. Initial survey results Case definition = diarrhoea or vomiting or abdominal cramps since 25 th December 2012 Response rate 67/120 (56%) 16 cases, 51 non-cases

14. Initial survey results