Professor Chris Whitty Chief Medical Officer for England – pictured – warned that sewage in rivers and seas is a public health problem, not merely an environmental embarrassment. Canterbury researchers have now described elevated E. coli in the Stour River, including strains showing resistance to last-resort antibiotics. And Kent hospital data show community-associated E. coli bloodstream infections remain stubbornly high. But one point must be stated in letters large enough for every councillor, regulator and water company lawyer to read from orbit: hospital cases caught in the community do not prove those infections came from sewage in rivers or seas.
For years, the sewage debate has been conducted in the usual British style: a little outrage, a little bureaucracy, a little technical gobbledegook, and a great deal of standing near filthy water pretending the real issue is still somehow under review. The public, meanwhile, have grasped the basics perfectly well. Human waste in water used by human beings is a bad idea. Profoundly bad, in fact. Not “sub-optimal”. Not “challenging”. Bad.
Professor Chris Whitty said as much in 2022. His point was not complicated. Keeping human faeces away from water people may ingest is one of the great achievements of public health. Once sewage gets back into rivers, coasts and recreational water, the issue is no longer just ecological. It is about infection risk. That matters in Kent, because this county has spent years talking about sewage as if it were either a seaside nuisance or an unfortunate branding problem for the tourism industry. It is neither. It is a public health problem wearing wellies.
On 4 March 2026, Dr Iain Goodall told Canterbury City Council that weekly sampling of the River Stour at 16 sites across Canterbury had found a 12-month median background E. coli level of around 1,200 colony-forming units per 100 millilitres, with intestinal coliform levels running two to three times higher still. He said that, measured against bathing-water standards, the river would be rated poor — in other words, not the sort of water anyone should feel comfortable swimming or paddling in, or letting their dog splash through.
He also described further antibiotic-resistance testing on 220 samples from high-use sites. Twenty-two per cent produced viable E. coli colonies after antibiotic exposure. Of the multidrug-resistant colonies, around 10 per cent showed polymyxin resistance and 20 per cent carbapenem resistance — both antibiotic classes of last resort. That concern now looks wider than Canterbury alone: just today, the Guardian has reported that samples from Lough Neagh contained genes resistant to multiple antibiotic classes, including carbapenems (last resort antibiotics), underlining how polluted waters can become part of the wider antimicrobial-resistance problem. That is not a minor technical wrinkle. That is the sort of evidence that ought to make every complacent briefing note burst quietly into flames.
There is also a broader national context. Watershed Investigations reported in December 2024, polluted bathing sites containing harmful bacteria and genes associated with antibiotic resistance. Professor Whitty’s own intervention – two years earlier was equally blunt: rivers, seas and waterways used by the public should be free from sewage. And what with Dr Iain Goodall’s evidence and the report in the Guardian today, demonstrates there is an ongoing issue Put these four things together and the old comforting fiction collapses. This is not just about whether the water looks disgusting, or whether a beach gets an embarrassing warning sign in August. It is about what is in the water, what it can do, and whether the agencies supposedly in charge are prepared to speak in plain English about the consequences.
Now for the caveat that must not be fumbled, exaggerated or quietly shoved into a filing cabinet marked “inconvenient”. The Kent hospital E. coli figures record community-onset, community-associated (COCA) E. coli bacteraemia cases. In plain English, that means bloodstream infections judged to have been picked up in the community rather than in hospital. It does not tell you where the infection came from. It does not mean a patient caught it from sewage in a river or the sea; that level of detail is simply not recorded, and it is not available at GP-surgery level either. It could have come from any number of sources, including food, person-to-person spread, underlying illness, farming, drain water, sea swimming, paddling, or other environmental exposure. Some cases may involve contaminated water, but the public data cannot tell us how many. There is no public dataset that links an individual presenting at a Kent hospital to a particular river, outfall, beach or sewer. So nobody should pretend otherwise. Not us, not campaigners, not politicians, not anyone.
What the data can show is more limited than some would like, but it is still plenty grim enough. It can show whether community-associated E. coli bloodstream infections are low, high, rising, falling, or wobbling all over the place like a politician caught without a briefing note. Using the exact COCA measure in the public data, Kent’s four acute trusts recorded 917 cases in 2023, 788 in 2024 and 902 in 2025. That last figure works out at roughly 2.47 cases a day — so, on average, two to three people a day arriving at hospital with community-associated E. coli bacteraemia.
And that still understates the problem. These numbers cover hospital presentations only. They do not capture people who saw their GP, were treated elsewhere, or never sought help at all. In other words, this is not the whole picture. It is the sharpest end of it. Add in the caveat that several Dartford & Gravesham months were unsigned despite recording zero cases, which may indicate missing data or poor-quality returns, and the neat easy narratives collapse. The figures do not show a simple year-on-year rise, and they do not show the problem disappearing either. What they show is a persistently serious burden that shifts around, stays high, and ought to make “nothing to see here” sound every bit as ridiculous as it is.
The monthly pattern makes the same point in a more vivid way. East Kent sits highest for much of the period. Medway and Maidstone & Tunbridge Wells remain substantial. Dartford & Gravesham appears to drop sharply in some later months, but those drops coincide with unsigned zero returns, so any triumphant reading of improvement would be premature at best and daft at worst. The graph does not tell a fairy tale of steady progress. It tells a much less convenient story: a county living with a sizeable burden of serious E. coli bloodstream infection outside the neat comfort of hospital-acquired classifications.
This is where the two stories meet, without pretending they are the same story. One is the river-and-sea story: sewage pollution, elevated E. coli, resistant organisms, bathing-water warnings and ordinary people coming into contact with contaminated water. The other is the health story: community-associated E. coli bloodstream infections recorded by Kent trusts. They are not the same dataset, and one does not by itself prove the other. But only a fool would insist they have nothing to do with each other.
Professor Whitty has already set out the basic principle. Dr Iain Goodall has produced evidence of faecal contamination and resistant organisms in the river. Environment Agency warnings at Dymchurch and Littlestone show that poor water quality is not some imaginary scare story invented by campaigners with too much time on their hands. If people are using water contaminated with human faecal organisms, there is a public health risk. That is the point. It really is that simple.
And E. coli bacteraemia is not there to brighten up a spreadsheet. It is a serious bloodstream infection, and some cases are fatal. Councils have powers to investigate foul watercourses, and to use the statutory nuisance route where the facts justify it, should not need that spelled out twice. As ShepwayVox has already set out, section 259 of the Public Health Act 1936 and sections 79 and 80 of the Environmental Protection Act 1990 give councils a real enforcement path: investigate, decide whether a statutory nuisance exists, and, if satisfied that it does or is likely to recur, serve an abatement notice. Ashford Borough Council has already shown, in the Speringbrook Sewer case, what using those powers can look like in practice: a named officer assigned, a site visit carried out, evidence gathered, lines of inquiry set, and public-health angles considered. Folkestone & Hythe District Council, at that stage, was not doing that. And now FHDC is investigating, that settles the central point beyond much argument: councils plainly do have powers in this area when it chooses to use them. The risk for any authority is obvious. Councils have the legal tools to test, inspect and act, but if they prefer caution, drift and letter-writing instead, it should not be too startled when residents conclude that the real discharge problem is not only in the water, but in the quality of local governance.
There is another dodge that needs to be retired as well. “Community-associated” does not mean “not our problem”. Quite the reverse. If infections are community-associated, then they are, by definition, a community problem. That takes this issue far beyond hospital infection control. It reaches into housing, drainage, sewer infrastructure, water quality, agricultural run-off, private systems, public information and, ultimately, whether councils and regulators are prepared to act before more people become seriously ill.
This is where Kent’s sewage debate becomes almost painfully British. The public are handed warnings, dashboards, classifications, acronyms and earnest promises of joint working. What they actually want, in a fit of outrageous unreasonable behaviour, is cleaner water. An app is not clean water. A steering group is not clean water. A carefully drafted paragraph about “multi-agency engagement” is not clean water. And a solemn insistence that no single hospital case can be traced to one specific river does not make the wider public health risk disappear.
So let us be precise. We are not saying Kent’s community-associated E. coli bacteraemia cases were caused by sewage in rivers and seas. The data does not allow that claim, and nobody honest should pretend otherwise. What we are saying is that Professor Whitty was right to frame sewage as a public health danger; that the Canterbury findings raise serious concern about faecal contamination and resistant organisms in the Stour; that the Stodmarsh crisis shows this is not a neat local glitch but a wider East Kent failure involving rivers, treatment works, planning and protected sites; and that Kent NHS trust data show a substantial continuing burden of community-associated E. coli bloodstream infection. Those cases are serious, costly to treat, and part of a wider public-health landscape in which sewage pollution is plainly making already dirty waters dirtier. The only serious response now is urgency, not another round of administrative aromatherapy.
At some point, all the jargon, dashboards and solemn promises of “multi-agency engagement” collapse into one embarrassingly simple question: why are people still being exposed to water contaminated with human waste? Kent does not need another parade of officials explaining that the matter is “complex”. It needs cleaner rivers, cleaner seas and authorities willing to use the powers they already have. Because the first job of a sewer is not to provide material for a committee paper. It is to keep sewage away from people. And when that basic task starts going wrong, nobody should be shocked if residents conclude that the system is not merely leaking effluent, but credibility too.
The Shepway Vox Team
Discernibly Different Dissent
