What Powers Does Kent’s Director of Public Health Have Over Sewage Pollution?

Following on from yesterday’s article, Kent E. coli Cases, Sewage and the Public Health Risk, the next question is unavoidable. If sewage pollution is plainly a public-health matter — and it is — what, exactly, can Kent’s Director of Public Health do about it?

Britain has developed a very particular way of dealing with sewage. First comes the statement. Then the meeting. Then the promise to work with partners. Then the carefully moisturised concern. Meanwhile, the sewage carries on turning up in rivers, streams and coastal waters with the quiet confidence of something that has noticed nobody in authority seems entirely sure who is supposed to stop it.

So here is the blunt answer. Dr Anjan Ghosh, Kent’s Director of Public Health (pictured), can do more than the system might like to admit, even if he cannot do everything residents might wish. He cannot fine Southern Water or personally drag it into court. But he can call this what it is: a public-health danger. He can push the issue into the health-protection system, press other authorities to use the powers they already have, and make it much harder for public bodies to hide behind process, pass-the-parcel governance and the ancient local-government art of looking busy while the water gets dirtier.

Let us start with the part that is true, rather than the part that merely sounds satisfying. Dr Anjan Ghosh, Kent’s Director of Public Health, cannot personally fine Southern Water, revoke a discharge permit or march into court as Kent’s one-man anti-sewage avenger. The hard regulatory powers over wastewater discharges sit mainly with the Environment Agency and Ofwat. The Environment Agency says it regulates wastewater releases through environmental permits and can inspect, investigate and enforce. Ofwat says it has statutory powers under the Water Industry Act 1991, including enforcement orders and financial penalties. So no: Kent’s Director of Public Health is not a lone regulator in a suit.

But that does not make him powerless. The Government’s own guidance says a Director of Public Health is a statutory chief officer, the principal adviser on health matters to members and officers, and an independent advocate for the health of the population. It also says the DPH is responsible for the local authority’s role in planning for, and responding to, emergencies that present a risk to public health. In plain English, he is not there to decorate the management chart and turn up at worthy conferences. If Kent has contaminated water, faecal pollution, E. coli concerns and possible wider exposure risks, this is firmly in his lane.

That matters because dirty water is not merely an “environmental issue” — which, in official language, often means something unpleasant that everyone hopes another department will adopt. Health-protection law is concerned with infection or contamination that presents, or could present, significant harm to human health. UKHSA guidance says Directors of Public Health lead or support the local authority’s public-health response to incidents, provide system leadership, population advocacy, mobilisation of local authority resources, and and support communication with the public and communities. So, if the evidence justifies it, Dr Ghosh can treat sewage-polluted watercourses and seas as a serious health-protection matter and press for a coordinated response. What he does not acquire is a magic legal wand over Southern Water.

E.coli rates for community based infections rather than hospital based infections

What, then, can he actually do? Quite a lot. And the backdrop matters. Using NHS hospital admissions data, admissions in England for water-borne diseases rose from 2,085 in 2010/11 to 3,286 in 2022/23 — roughly 60 per cent higher. That does not prove every one of those cases was caused by sewage pollution, and nobody honest should claim that. But it does underline the public-health stakes. Dr Ghosh can call the problem what it is. He can put it squarely into Kent’s health-protection machinery. He can escalate concerns to UKHSA, NHS bodies, the Integrated Care Board, the Health and Wellbeing system, regulators and district councils. He can press for risk assessment, coordinated sampling, public warnings, clear communication and a properly joined-up incident response. He can also put the health case on the public record in a way that becomes politically difficult to ignore. In local government, evidence plus embarrassment is often the nearest thing to voltage.

And there is another part of this story that Kent really should stop tiptoeing around. Community-onset, community-associated E. coli infections cost the NHS money. They can mean GP appointments, tests, antibiotic prescriptions, hospital care and follow-up treatment. That is public money and clinical time that could be spent elsewhere. We cannot honestly say every one of those infections came from sewage in rivers or seas; the data do not allow that. But where contaminated water contributes to preventable illness, the public are hit twice: first in the water, and then in the health bill. To that extent, sewage pollution is not just a foul environmental disgrace. It is an avoidable drain on scarce NHS resources. The DPH does not need to prove every case came from one outfall to say the health implications are real. That is his job.

Now to the question Kent will inevitably try to blur. Can Dr Ghosh simply tell environmental health officers in Kent councils to investigate? In a one-tier unitary council, the answer might be simpler. But Kent is a two-tier area. In two-tier systems, responsibilities are split between county and district councils. Environmental health sits with district, borough and city councils, not with Kent County Council. So we cannot honestly say Dr Ghosh can simply bark an order at district environmental health officers as if they were his own staff. They are not. What we can say is that he can ask, press, escalate, advise publicly and privately, and make it politically and professionally very difficult for those councils to sit on their hands. He can also tell Kent County Council’s own leadership, in plain terms, what the health risk is and what he thinks the lower-tier authorities should be doing about it.

And those lower-tier councils do, in fact, have real powers. Government guidance says councils must investigate complaints that could amount to a statutory nuisance. If they agree a statutory nuisance is happening, has happened, or is likely to happen, they must serve an abatement notice. For foul watercourses, section 259 of the Public Health Act 1936 says that a pond, ditch, gutter or watercourse that is so foul as to be prejudicial to health or a nuisance counts as a statutory nuisance for the purposes of the Environmental Protection Act 1990. This is not a fringe legal theory invented on social media. It is old-fashioned black-letter law. So when councils behave as though testing, inspecting and acting are exotic constitutional innovations, they are not describing the law. They are describing a choice.

Environmental health officers are the people who turn that from polite concern into something that can actually bite. UKHSA’s incident-management guidance says EHOs can investigate potential sources, support sampling in relation to water and environments, liaise with laboratories, undertake enforcement where it falls to them, and preserve the chain of evidence for possible criminal proceedings. The Food Standards Agency’s summary of local authority environmental health work also describes EHOs as officers who follow up complaints, investigate outbreaks, collect samples for laboratory testing, enforce environmental health laws and give evidence in court. In plain English, they are not there merely to admire clipboards. They are there to investigate, gather evidence and, where the law allows, move the matter forward.

There is also the little matter of annual public health reports. This is not a “nice extra” if the diary allows. The National Health Service Act 2006 says the Director of Public Health must prepare an annual report on the health of the people in the area, and the local authority must publish it. Government guidance says this annual report is the clear exception where the duty sits personally on the DPH to write it. Yet on the official Kent Public Health Observatory annual-reports page, the latest annual report listed is still the 2021 report on coastal communities. “Annual” is usually understood to mean yearly, not “whenever we all feel emotionally ready”. That gap deserves an explanation.

Does the E. coli picture automatically mean a formal public-health emergency? No, not on the public evidence alone. The law speaks of infection or contamination that presents or could present significant harm to human health. That means the right question is not whether the words “public health emergency” sound exciting in a headline. The right question is whether the evidence justifies a stronger health-protection response: escalation, incident management, coordinated investigation, public communication and proper use of existing legal powers. On that, Dr Ghosh has room to move. He can absolutely treat serious sewage contamination and exposure risks as a health-protection problem and press for an incident-style response. What he cannot do is turn himself into the Environment Agency, Ofwat and district environmental health departments all at once.

We also looked for a public example of an English Director of Public Health personally bringing a legal case against a sewage company. We have not found a verified one. The public record points in a different direction: Directors of Public Health warn, convene, escalate, advise and push; regulators and environmental health teams in your local councils hold the sharper enforcement levers. That is less satisfying than the fantasy of one official riding to the rescue with a summons in hand. It is also, as far as we can verify, how the system actually works.

So where does that leave Kent? In a position more damning than many officials seem to appreciate. Dr Ghosh cannot personally prosecute Southern Water. But he can stop Kent pretending sewage in public water is just a grubby environmental footnote. He can force the problem into the public-health frame where it belongs. He can press district councils to use statutory nuisance powers where the facts justify it. He can push regulators to use the legal teeth they say they already have. He can tell the public, openly, that contaminated water and faecal organisms are not something to be managed with euphemisms and partnership diagrams. He cannot be the executioner. But he can absolutely be the man who drags the corpse into the middle of the room and asks why everybody else is still pretending not to smell it.

And that, in the end, is the real scandal. Not that one official lacks every power under the sun. But that Kent has more than enough powers scattered across more than enough bodies, and still manages to behave as though the river is a mystery and the law is a rumour. A redirected enquiry is not a strategy. A dashboard is not enforcement. A steering group is not a clean river. And if public bodies with duties to protect health, investigate nuisances and regulate sewage pollution still cannot produce action equal to the smell, then the contamination problem is no longer confined to the watercourse. It has spread into local authority governance.

The Shepway Vox Team

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