Conclusion 8

Mismanagement of wastewater and sewage is a serious public health concern and heightens the threat of AMR. Storm overflows involve sewage getting into waterways such as rivers. They increase the prevalence and diversity of resistant pathogens in the environment and are a serious public health concern. In 2016, 862 storm overflow sites were monitored for spills, and they averaged 15 spill events in the year each. By 2023, the number of storm overflow sites monitored had increased to around 14,000, and they averaged 33 spill events each in the year. However, information on AMR in the environment and how it is affected by the UK’s management of wastewater is limited. An independent evaluation of the 2019–24 NAP by the Policy Innovation and Research Unit criticised the relative lack of action taken to address the issue of wastewater in relation to AMR. DHSC stressed to us the importance of clean water and good sanitation as a public health issue, and the relevance of measuring the performance of water companies in public health rather than just environmental terms. VMD noted the importance to AMR of planned investment in wastewater treatment and told us that by the summer of 2025 Defra should have received recommendations from the Independent Water Commission on how to tackle systemic issues in the water sector. The Committee may be revisiting this in future as part of their inquiry into ‘Water Sector Regulation’. 6 recommendation To manage the public health risks from wastewater, Defra should: • treat the management of wastewater as a public health concern and set out public health goals relating to water; • monitor the impact of increased investment by water companies; and • conduct more research to better inform its decisions on the regulation of wastewater.