PATH-SAFE final evaluation report

Food Standards Agency; RAND Europe

doi:10.46756/001c.138396

Executive Summary

PATH-SAFE (pathogen surveillance in agriculture, food, and environment) was a pilot programme that aimed to improve surveillance of food borne pathogens (FBP) and antimicrobial resistance (AMR) in the UK using a One Health approach. It included partners from across all four nations in the UK and aimed to: pilot surveillance for FBPs and AMR in the environment and agri-food system; bring together and expand existing surveillance initiatives; gather information from end-users of surveillance; and gather data to understand prevalence, source and pathways of FBPs and AMR.

This evaluation focused on the final year of funding of the PATH-SAFE programme (March 2024-2025) to investigate the extent to which PATH-SAFE has contributed to outcomes related to improved surveillance of FBPs and AMR, as well as factors affecting the realisation of outcomes and impacts. This evaluation took a theory-based approach, guided by a logic model and an outcome measurement framework. Evidence to support this evaluation comes from desk research looking at PATH-SAFE documentation and publications, interviews with PATH-SAFE delivery partners, a survey of PATH-SAFE partners and external stakeholders, and case studies. This evaluation built on an evaluation of the first phase of PATH-SAFE, conducted by RAND Europe. While the evaluation provides useful evidence as to the outcomes of PATH-SAFE to date, it took place prior to all of the outputs from PATH-SAFE being made available, and we are unable to assess outcomes and impact after the evaluation ended in March 2025.

Overall, this evaluation has concluded that PATH-SAFE achieved some outcomes that have helped improve surveillance in the UK, but that in many areas additional follow up action and investment is needed to influence practices.

The programme has produced useful data about FBPs and AMR in different contexts, some of which has already informed decision making. The programme also produced knowledge about methods and tools for surveillance and developed several methods that are being incorporated into business as usual. Lastly, PATH-SAFE also helped build and strengthen relationships between different surveillance partners that are valuable in improving surveillance in the UK. Some of the insights and methods that PATH-SAFE produced have already informed practice, indicating that PATH-SAFE is progressing towards achieving its long-term aims of improving surveillance outcomes and informing responses to FBPs and AMR. In addition, PATH-SAFE has already likely informed some decisions about surveillance in the UK, such as through the National Biosurveillance Network (NBN), and has raised awareness of the importance of the agricultural and food system in AMR surveillance.

PATH-SAFE has also produced valuable knowledge about what works in coordinating across surveillance partners and conducting One Health surveillance of FBPs and AMR in the UK. For these insights to be preserved and utilised further, programme-level lessons about should be disseminated to decision makers.^[1] For example:

The central management team was pivotal in coordinating collaboration between PATH-SAFE projects and with external partners, creating accountability mechanisms for project objectives, consolidating lessons learned and facilitating risk management.
Ring fenced programme funding ensured sufficient resourcing and prioritisation of programme activities within partner organisations.
A regular schedule of cross-programme events created knowledge-sharing and networking opportunities which nurtured a shared notion of the programme mission and participants role in a broader undertaking.

Although the programme has produced useful data, knowledge and methods, in many cases additional investment and action is needed to incorporate insights from the programme into surveillance approaches and inform wider approaches to cross-government collaboration and One Health^[2] surveillance. Evidence from this evaluation indicates several recommendations to maximise the impact of the investment in surveillance that occurred through the PATH-SAFE programme:

Long-term investment to support further investigation, implementation and scale up: PATH-SAFE produced useful data, methods and tools, and insights about FBPs and AMR that can help inform decision making. A dedicated follow-up funding package (with clear departmental ownership and follow up actions) should be established for the most promising initiatives to generate evidence on integration within current practices and a cost benefit analysis.^[3] For instance:
- Allocate resources to continue the bulk milk surveillance system that successfully aided the avian influenza response in dairy cattle in 2024, building on the existing relationship with National Milk Laboratories
- Support the expansion of the genomic data platform for Salmonella, E. coli and Listeria that FSS and UKHSA have already committed to trial alongside existing surveillance activities
- Fund further development of wastewater surveillance applications for FBPs, particularly the analysis of wastewater samples routinely collected through UKHSA’s polio surveillance programme
Develop a cross-government surveillance knowledge repository: To help disseminate the knowledge and insights that PATH-SAFE generated, PATH-SAFE management and the core partners involved in PATH-SAFE should:
- Develop a dedicated repository of PATH-SAFE methods, findings, and operational insights, making it accessible to all surveillance stakeholders
- Develop sector-specific guides on surveillance implementation for animal health, food safety, and environmental sectors based on PATH-SAFE’s cross-domain experience and insights generated. This should extend to utilisation of given methods and tools used in the programme
- Convene a policy roundtable targeting Cabinet Office, UKHSA, DHSC, Defra leadership and initiatives, alongside the four nation equivalents. This should serve to develop a strategic roadmap of surveillance design and utilisation across the One Health agenda.
Continued monitoring: The current evaluation is limited in that it cannot assess outcomes and impacts after March 2025, prior to many PATH-SAFE outputs being available. An independent follow-up evaluation should be commissioned in 2027 to
- Track long-term adoption: For example, assess how PATH-SAFE methods or the use of genomic data platform have been integrated into business-as-usual practices
- Measure sustained relationships: Evaluate whether and how the collaboration networks established between agencies like FSA, UKHSA, Defra, APHA, and industry partners have endured beyond the programme
- Determine whether surveillance improvements have contributed to faster outbreak detection or response, as seen in the successful application of bulk milk testing for avian influenza

In addition, the following recommendations focus on future One Health surveillance initiatives in the UK:

One of the key successes of the PATH-SAFE programme was the ability to coordinate between different projects and build relationships across surveillance partners. This was facilitated by a strong central management team, shared ring-fenced funding, and shared meetings and targeted events that helped create a shared awareness and sense of purpose around the programme. These supporting factors should be incorporated into future surveillance initiatives and the wider approach to One Health surveillance in the UK.
Data sharing issues are common across surveillance programmes and in cross-government initiatives. While PATH-SAFE achieved some of its data-sharing goals within the context of the programme, there were challenges that limited the ability to create cross-programme data sharing agreements, which meant that the programme struggled to make meaningful improvements to how data is shared more broadly across biosurveillance projects. Addressing issues related to inconsistent interpretation of guidelines and regulations around data protection, the extent and type of meta data that is collected and shared, linking datasets across sectors and anonymisation at a higher level within the UK can help improve the efficiency of future initiatives, and avoid this issue needing to be addressed by each government department in isolation and through bi-lateral agreements.
Prioritisation of projects that can help improve surveillance in the UK should be conducted according to clear and transparent criteria and in line with departmental and wider government priorities around surveillance. For example, this might include the ability of specific surveillance methods or studies to inform decision making about prevention or mitigation, the cost-effectiveness of surveillance approaches, and ability to integrate methods to existing surveillance programmes. This helps ensure that spending and departmental action is coordinated, and that outputs from separate projects complement one another to improve surveillance outcomes in the UK.
Based on experiences from the PATH-SAFE programme, future surveillance programmes should incorporate:
- An initial funding for pilot phase with clear milestones and continuation criteria.
- Contingent implementation funding (funding tranche specifically for implementation of successful pilots, conditional on meeting specific performance criteria); and
- Required sustainability planning detailing how methods will be incorporated into business-as-usual operations

These actions, if taken, could help achieve longer term benefits from PATH-SAFE and wider surveillance initiatives.

1. Introduction

1.1. FBPs and AMR in the UK

Foodborne diseases remain a significant public health burden, with an estimated 2.4 million cases of foodborne illness occurring each year in the UK alone.(FSA, n.d.) Globally, the World Health Organization (WHO) has reported that unsafe food causes 600 million cases of illness due to contaminated foods and 420,000 deaths annually.(World Health Organisation, 2024) Compounding this challenge is the rise of antimicrobial resistance (AMR) in foodborne pathogens (FBPs) which poses a rapidly escalating threat; latest research outlines that drug-resistant AMR in the agriculture sector in particular could jeopardise food security for over 2 billion people by 2050 (Ncube, 2024).

Against this backdrop, the UK Biological Security Strategy and the AMR National Action Plan highlight the urgency of detecting and tracking emerging pathogens at their environmental sources. Such vigilance is critical for safeguarding health security, ensuring that clinicians and policymakers can respond swiftly to outbreaks and curb the spread of resistance. Likewise, international collaborations, exemplified by evolving initiatives like the Global Consortium for Wastewater and Environmental Surveillance for Public Health (GLOWACON), reinforce the global necessity for innovative approaches to surveillance and data sharing (Launching GLOWACON: A Global Initiative for Wastewater Surveillance for Public Health - European Commission, n.d.).

Various UK government departments have been routinely conducting surveillance activities by collecting and analysing samples from food, livestock and humans to inform decision making. The AMR National Action Plan highlighted the need for these surveillance efforts to be integrated and harmonised across the One-Health sectors covering agriculture, environment and humans to facilitate robust and cross-sectoral analysis (Tackling antimicrobial resistance 2019-2024, 2019). Launched in 2021, the cross-government PATH-SAFE programme aimed to create an enhanced foodborne pathogen and antimicrobial resistance surveillance system for the UK, and integrate genomic data across human, animal, food and environmental domains.

The recently published pathogen priority list by UKHSA highlights the critical importance of continued funding and work in this sector, as a number of priority pathogens identified are directly linked to food ecosystems, with many showing high domestic burden as food-related transmission channels continue to represent significant public health concerns in the UK (UKHSA, 2025).

1.2. PATH-SAFE programme

PATH-SAFE was a pilot programme that aims to improve surveillance of FBPs and AMR in the UK using a One Health approach. It included partners from across all four nations in the UK and included:

Piloting surveillance of FBPs and AMR in the environment and agri-food system
Bringing together and expanding existing surveillance initiatives
Gathering information from end-users of surveillance
Gathering data to understand prevalence, source and dissemination pathways of FBPs and AMR.

Funded projects under the second phase of the programme were organised under four thematic areas focused on different aspects of strengthening surveillance, continuing specific areas from the pilot phase:

Data sharing and analysis- this theme focuses on building the PATH-SAFE genomic data platform as a national-level, cross government tool enabling analysis of genomic data and metadata to facilitate the rapid identification of pathogens and transmission pathways.
Food-borne disease - this theme includes four projects focused on piloting the surveillance of foodborne pathogens in wastewater, coastal waters, the environment and the agri-food system
Antimicrobial resistance- this theme includes five projects focused on understanding the development and spread of antimicrobial resistance within agriculture systems, the food chain and wider environment, and elucidating the routes of transmission to humans.
Onsite diagnostics- this theme is centred on creating guidance for the practical, real-world deployment of deploying onsite diagnostics technologies, especially for official controls in the food sector

PATH-SAFE’s core partners were Food Standards Scotland (FSS), Department of Environment, Food and Rural Affairs (Defra), Animal and Plant Health Agency (APHA), Centre for Environment, Fisheries and Aquaculture Science (Cefas), Environment Agency (EA), Veterinary Medicines Directorate (VMD), Department of Health and Social Care (DHSC), and UK Health Security Agency (UKHSA) Delivery of the programme has also spanned across over 65 partners across government and the devolved administrations, academia and the private sector.

The programme initially received 19.2 million from HM Treasury (HMT) through the Shared Outcomes Fund (SOF) from 2021 to 2024, which was followed by an additional funding period of one year from March 2024-2025. This second phase of funding consisted of 2.2 million from the SOF and 2.5 million in match funding from government and academic delivery partners (Defra, FSA, FSS, PHA NI, Queen s University Belfast, University of Bangor, University of Oxford).

1.3. Focus of evaluation

This evaluation focuses on the final year of funding of the PATH-SAFE programme (March 2024-2025) investigating the extent to which PATH-SAFE contributed to specific outcomes and impacts related to the surveillance of FBPs and AMR in the UK. It follows a process and outcome evaluation of the first phase of funding (2021-2024), also carried out by RAND Europe (RAND Europe, 2024), which was informed by an initial evaluation plan developed for the first three years of the programme (Sana Zakaria et al., 2023).

This evaluation took a theory-based approach, drawing on a logic model that was developed in collaboration with stakeholders from PATH-SAFE and an outcome measurement framework designed to capture progress towards desired outcomes and impacts. Evidence to support this evaluation comes from desk research looking at PATH-SAFE documentation and publications, interviews with PATH-SAFE delivery partners, a survey of PATH-SAFE partners and external stakeholders, and case studies of specific areas where PATH-SAFE data and methods informed decision making. This evidence was then analysed against the outcome measurement framework.

This report describes the results of this evaluation in the following sections:

Chapter 2 provides details on the methods used in this evaluation;
Chapter 3 provides the PATH-SAFE logic model and outcome measurement framework that guided this evaluation;
Chapter 4 describes results of the evaluation in relation to specific outcomes that PATH-SAFE aimed to influence; and
Chapter 5 provides conclusions and recommendations from this evaluation.

Throughout this report, results are described at a programme level, while also providing specific examples from individual PATH-SAFE projects. Annex A provides a brief description of aims, outputs and outcomes at a workstream and project level.

2. Methods

2.1. Overall approach to outcome evaluation

We worked with the PATH-SAFE team to develop a logic model (see section 3.1) for the programme, and to identify assumptions for how the programme aims to achieve outcomes and impact, building on the theory of change developed in the Phase 1 evaluation (RAND Europe, 2024). We also developed an outcome measurement framework (section 3.3) to help evaluate the degree to which PATH-SAFE contributed to anticipated outcomes. To draft and refine the logic model and outcome measurement framework, we reviewed documents describing the second phase of PATH-SAFE and facilitated a workshop with PATH-SAFE delivery partners and the central management team.

Throughout the evaluation, we drew on the logic model and evaluation framework to guide our selection of evidence to measure progress towards desired programme outcomes and impacts. This helped design an evaluation to capture the wide range of outcomes that the programme aimed to achieve and map these to specific data sources from methods utilised throughout the evaluation.

2.2. Desk research and document review

We conducted desk research to identify and review academic and grey literature outputs that either cited PATH-SAFE’s contributions or were a direct result of PATH-SAFE programme. We searched for literature using Google, Google Scholar, and PubMed. Our search strategy was targeted, incorporating terms related to PATH-SAFE, FSA, biosurveillance, AMR, and FBPs published between the start of the programme March 2021 and February 2025.

We also reviewed internal documents from PATH-SAFE, including documents related to governance, project and workstream progress, Strategy and Delivery Board papers, and trackers of activities, outputs and outcomes. We reviewed documents made available on or before 10 March 2025, and extracted information in accordance with the evaluation criteria for the overall programme and each workstream using an Excel template. Closure reports and many other planned outputs were not available at this time based on the timing of the evaluation (ending March 2025, while work on some outputs is ongoing).

2.3. Data collection

2.3.1. Survey

A small online survey was developed to capture insights and perspectives from the central delivery team within PATH-SAFE, delivery partners, and external stakeholders making use of PATH-SAFE outputs. Its primary purpose was to assess the extent to which the programme’s outcomes have materialised and to identify the mechanisms that facilitate or hinder the realisation of these outcomes. The survey was designed based on the outcome measurement framework (survey protocol provided in Annex B). Results were analysed descriptively, with qualitative analysis of open text responses. The survey was sent to approximately 154 respondents, with a completion rate of approximately 21% (n=33). The survey was circulated between 7^th to 29^th November 2024 and had a limited sample size.

2.3.2. Interviews

Semi-structured virtual interviews were conducted to gather deeper qualitative insights and perspectives from delivery partners and the central delivery team involved in the PATH-SAFE program, to supplement data from the survey. The primary focus of these interviews was to assess the extent to which PATH-SAFE has generated outcomes, influenced organisational practices, and contributed to lasting impacts. The protocol is provided in Annex C. Five people involved in overseeing their organisations’ participation in the PATH-SAFE programme were interviewed between February and March 2025. An additional five interviews were conducted for collecting and validating evidence for case studies (described below).

2.4. Case studies

Two case studies were developed to highlight specific examples of PATH-SAFE’s contributions to biosurveillance practices and prioritisation decisions for surveillance. The evidence to support each case study consisted of interview data (from the five interviews described above), desk research and a documentary review.

2.5. Limitations

This evaluation has been conducted throughout the delivery of the PATH-SAFE programme to date, benefiting from multiple data collection points and observation of PATH-SAFE’s progress. However, several key limitations should be considered when utilising the findings from this evaluation.

First, this evaluation relies significantly on self-reported data from those engaged in the programme. Although we made every effort to encourage participation, there were gaps in representation among several government stakeholders that participated in the PATH-SAFE programme. Furthermore, there is a risk that those who agreed to participate in the interview and survey may hold different views than those who did not; for example, they may have more positive or negative perceptions of PATH-SAFE. Although we also conducted desk research to fill gaps in data collection and attempted to verify anecdotal claims through additional desk research and triangulation, the limited sample size for this evaluation should be taken into account.

The timing of this evaluation (ending in March 2025) also means that many of the anticipated outcomes from the programme may not have occurred yet. There are planned outputs that might create additional impact, or conversely some of the planned outputs from the programme may not materialise. Long-term evaluation of outcomes would be helpful in understanding the full impact of the programme on surveillance.

3. PATH-SAFE logic model and outcome measurement framework

3.1. Logic model

The visualisation of a logic model presented in Figure 1 (below) was developed in collaboration with the PATH-SAFE team to describe how PATH-SAFE will produce specific outputs, how these outputs will produce downstream outcomes, and how these outcomes contribute to the long-term desired impacts from the programme. It has been adapted and revised from the ToC developed in the first phase of PATH-SAFE to capture changes between programme phases, and to focus on outcomes that are within PATH-SAFE’s sphere of influence.

3.2. Assumptions in logic model

In describing how PATH-SAFE intends to accomplish outcomes and long-term impacts, several assumptions within the programme logic were articulated. These assumptions were tested in the evaluation to assess whether they stand true in enabling the programme to achieve outcomes and impacts.

The assumptions identified at the beginning of this second phase of the evaluation stated:

As part of the programme delivery, additional investigation will be made to assess what could support scale-up of activities and incorporation into business as usual including cost effectiveness/benefit analysis
Plans will be developed for maintaining specific tools, platforms and activities, based on evidence about which aspects of PATH-SAFE are suitable for maintenance, scale-up and incorporation into business as usual
Stakeholder analysis from delivery teams will be developed to understand specific cohorts of people that will use PATH-SAFE outputs
Communication and influence strategy will be developed to consolidate and disseminate learnings from PATH-SAFE to influence stakeholders and inform practice and decision making

Additionally, it was assumed that within the broader surveillance ecosystem:

Investment in surveillance activities will continue
There will be senior buy-in and leadership for ongoing activities stemming from PATH-SAFE
There will be coordination of surveillance activities across the One Health spectrum
Structures and funding streams will break down siloes across One Health areas
Benchmarking of data on the burden of FBP and AMR will occur

3.3. Outcome measurement framework

Drawing on the logic model, we also developed an outcome measurement framework to guide this evaluation (see Figure 2 below). This framework shaped the evidence sources that were drawn upon through desk research, interviews, the survey and case studies, and influenced how this evidence was analysed to make conclusions about the degree to which PATH-SAFE achieved outcomes.

Figure 1.PATH-SAFE logic model

Activities	Outputs	Outcomes	Impacts
Collecting and analysing samples (across multiple settings and pathogens)	New data and datasets (e.g. wastewater sequencing data; data on AMR and pharma residue in shellfish, AMR in abattoirs, pet food and care homes, AMR genes across different sources, Campy.)	More partners have access to and use data in conducting surveillance and responding to threats Increased sharing of information and data between surveillance stakeholders	Improved surveillance outcomes (e.g. reduction in timelines to detection and source attribution, efficiency and cost effectiveness, accuracy) Improved responses to FBDs and AMR (e.g. timeliness and effectiveness of response) Improved outcomes related to outbreaks and health Economic impacts – Less economic losses due to FBDs and increased confidence in food sector
Data platform expansion	Data platform with analytical capabilities for 3 pathogens
Analysis and knowledge generation Communications activities and events	New knowledge communicated in academic papers, conferences, presentations	Improved knowledge about AMR and FBD that is useful for surveillance and risk mitigation (e.g. source attribution, fungal diversity, waste and shellfish, biofilms, waste from healthcare settings, raw pet food, prevalence of FBD and AMR) among key stakeholders that conduct surveillance and respond to threats Filling specific information gaps regarding the prevalence of AMR and FBD, helping to identify when levels increase compared to baseline Influencing practice and informing decision making about surveillance, AMR and FBDs through knowledge generated from PATH-SAFE: Use of data and flow of information between partners Surveillance approaches Methods and tools used in surveillance
Methods development and validation, development of tools	New methods and tools (e.g. wastewater surveillance refinement, testing shellfish, source attribution model, genomic surveillance in abattoirs, scaling up OSD)	Use of improved methods and tools for surveillance Understanding of effectiveness and feasibility of methods (to inform decision making about surveillance methods) Improved capability for methods development amongst delivery partners
Collaborations between delivery partners, through PATH-SAFE meetings and events, and through links with other sectors Linking with international efforts related to surveillance	Relationships formed through PATH-SAFE New ways to share data and communicate between partners	New networks to improve how information is shared and how surveillance is coordinated between partners (building on PATH-SAFE relationships) Better understanding of synergies and efficiencies between surveillance activities amongst surveillance partners and stakeholders within central government
Conducting a pilot programme for surveillance of AMR and FBD	Practical, hands on experience conducting collaborative projects related to surveillance of AMR and FBD Quantification of resources required for pilot Proof of concept for collaborative, cross-government surveillance approaches	Understanding of resources and infrastructure required to implement surveillance projects, what works well, and challenges amongst surveillance partners and stakeholders within central government Improved capability to conduct future collaborative surveillance projects and implement new approaches to surveillance Improved understanding of food as a connecting pillar of surveillance amongst surveillance partners and stakeholders within central government

Figure 2.Outcome measurement framework for PATH-SAFE

Outcome	Type of evidence considered	Date source and method
Improved surveillance practices	Knowledge of PATH-SAFE outputs and how they can be used by key stakeholders Use of knowledge, tools and methods developed by PATH-SAFE in decision making and practice Changes in decision making and practice(e.g. risk mitigation, surveillance, outbreak response) Understanding of food in the one health nature of surveillance Better performance of surveillance compared to status quo	Desk research Citations of PATH-SAFE outputs in policy documents or sources that describe practice (UK and international) Survey/interviews Feedback from decision makers and other stakeholders that use PATH-SAFE outputs to inform surveillance Impact case studies about decision making (informed by survey/interviews and document review)
Access to and use of data/data platform Increased data sharing	Type of and number of partners that use data platform Use of different features in platform Quantity and type of data (e.g. pathogen) processed through platform and shared through PATH-SAFE How data/information informed decisions Changes in behaviour/decisions due to use of data	Desk research Citations of data platform and other PATH-SAFE data sources via desk research Survey/interviews Feedback from users of platform and data. Information about use of data platform by those involved in implementing it. Impact case studies about data use (informed by survey/interviews and document review) Data analysis User data from data platform (outside scope to analyse raw data)
Improved methods and tools for surveillance Better understanding of effectiveness and feasibility of methods Improved capability for methods development	Use of outputs that describe surveillance methods and knowledge from PATH-SAFE How information informed knowledge, practice and decision making Further research and thinking that builds on knowledge from PATH-SAFE Funding to further investigate and scale up methods from PATH-SAFE Use of methods and tools as part of business as usual (BAU) Performance of methods developed in PATH-SAFE to existing methods	Desk research Citations of papers from PATH-SAFE PATHSAFE documents about funding leveraged for additional activities/investigation, and describing impact on business as usual Survey/interviews Feedback from key stakeholders that use knowledge and methods from PATH-SAFE
Improved knowledge about AMR and FBD that is useful for surveillance and risk mitigation Filling specific information gaps related to AMR and FBD
Improved knowledge about data sharing Networks to improve how information is shared and how surveillance is conducted between partners Better understanding of synergies and efficiencies between surveillance activities	Use of “lessons learned” outputs regarding data sharing Processes to share data/information beyond PATH-SAFE activities Ongoing communication and collaborative activities between stakeholders involved in PATH-SAFE Identification of synergies and efficiencies between stakeholders More efficient processes to share information and conduct surveillance	Desk research Citations of outputs about data sharing Citations of PATH-SAFE in documents describing ongoing activities PATH-SAFE documents describing funding leveraged information from delivery team surveys Review of highlight reports Survey/interviews Information about collaborative activities and number of new collaborations/partnerships formed Impact case studies about collaboration and coordination
Understanding of resources and infrastructure required to implement surveillance projects, what works well, and challenges Improved ability to conduct future collaborative surveillance projects and implement new approaches to surveillance Improved understanding of food as a connecting pillar of surveillance	Use of knowledge from PATH-SAFE in decision making about future pilots and surveillance projects Additional coordination activities across surveillance partners that is informed by experience from PATH-SAFE Investment in food as an area for surveillance, based on experience and knowledge generated by PATH-SAFE	Desk research PATHSAFE documents that describe new coordination mechanisms, funding streams, and pilot programmes PATH-SAFE documents describing communication and influencing strategy (to inform decision making and practice) Review of highlight report Interviews/survey Information about funding leveraged based on knowledge generated from PATH-SAFE from delivery teams Feedback from decision makers about how PATH-SAFE has informed decision making about other surveillance projects (in the food system) Impact case studies about influence of PATH-SAFE on future investments and projects

4. Results

In this chapter, we discuss the outputs that PATH-SAFE has produced and the types of outcomes it has led to or contributed towards, specifying the extent of this. In addition, we summarise the factors that facilitated the programme, and challenges that the programme faced.

While the chapter focusses on outputs and outcomes, it is worth noting some programme level activities given their value and scale. PATH-SAFE collected over 8300 novel samples across different settings, conducted additional analysis on over 2500 routinely collected samples, and analysed over 3500 pre-existing archived samples. The programme also sequenced over 11,500 new isolates, and over 6500 pre-existing or archived isolates.

4.1. PATH-SAFE outputs

4.1.1. Range of outputs generated

PATH-SAFE projects have produced outputs, ranging from novel datasets (samples, sequences, analytics), new knowledge on pathogen baselines and transmission pathways, and testing of methods and tools for new use cases.

Across the two phases of the programme, PATH-SAFE has produced over 100 outputs, including approximately 25 peer reviewed journal articles from commentaries and perspectives to research articles (Haynes et al., 2024; George Fisher et al., 2024; Hill, Stentiford, Walker, & Baker-Austin, 2024; Scott et al., 2025; Silvester, Woodhall, et al., 2025). In addition, the programme has over 80 additional outputs planned including peer-reviewed publications, genome sequence data, and project reports, which are reportedly planned to be completed or published after March 2025. At a project level, most PATH-SAFE projects published reports communicating findings from the first phase of the programme. However, given the timing of this evaluation, project reports from the second phase of the programme are not yet available, as work is ongoing. In addition to the article that is already available consolidating lessons from the first phase of PATH-SAFE (Haynes et al., 2024), additional reports are also expected at a programme level that consolidate wider learnings from phase 2 the programme.

More specifically the programme has generated:

A genomic data platform with analytical capabilities to support genomic analysis of three different pathogens (Salmonella, E. coli and Listeria) and associated AMR;
Knowledge based outputs such as journal articles, project reports and conference presentations inclusive of both technical/scientific knowledge and operational knowledge of how to establish a cross-government surveillance pilot;
New data and improved baseline knowledge about AMR and foodborne pathogens in different settings, including aquatic environments, abattoirs, care homes and hospitals;
Methods and tools that can be used in surveillance, including for wastewater surveillance, genomic surveillance, attribution and onsite diagnostics, and surveillance in shellfish, abattoirs and care homes;
An AMR platform focused on One Health AMR surveillance data, developed in the first phase of PATH-SAFE (not continued under the PATH-SAFE programme in Phase 2)

In addition to these measurable and technical outputs, PATH-SAFE has also fostered new relationships and collaborations across government departments, laboratories, industry and academia, strengthened existing partnerships and developed shared ways of working across surveillance stakeholders. These relationships can be considered an output from the programme and were consistently cited by PATH-SAFE partners and external stakeholders as a valuable contribution of the programme. For instance, to address surveillance gaps in AMR for ruminants, the programme worked with National Milk Records (NMR), the SRUC team in Inverness, Arla, APHA, FSS, and food business operators to enable sample collection (Veterinary Medicines Directorate & Animal and Plant Health Agency (APHA), 2024). In the continuation phase, new stakeholders like raw pet food manufacturers and port health authorities were engaged in surveillance activities for the first time under the AMR theme. These relationships have contributed to outcomes related to collaboration and coordination (discussed in Section 4.2.1).

4.1.2. Utility of outputs to stakeholders outside of PATH-SAFE

The degree to which outputs from PATH-SAFE will contribute to long-term impacts will depend in part on how they are used by stakeholders making decisions about and conducting surveillance activities. However, this evaluation took place prior to many stakeholders using outputs from PATH-SAFE, and we cannot assess actual use of PATH-SAFE outputs past March 2025.

While actual use of all the outputs cannot be measured in this evaluation due to the short time lapsed between output development and end of the programme and the evaluation, there is some evidence that external stakeholders have used and plan to use some outputs from the PATH-SAFE programme. Out of the external stakeholders^[4] that responded to our survey (n=18), more than half reported that they used or intended to use scientific results from the programme, outputs describing overall learning, and data or datasets from the programme. However, fewer respondents reported they had used or intended to use the data platform (44%) or methods and tools (33%) from the programme. Of respondents reporting they planned to use PATH-SAFE outputs, most reported use would be intermittent, on a one-off or ad-hoc basis, except for scientific results from the programme which respondents reported they would use more frequently. However, as this survey was conducted prior to many of the outputs from phase 2 of PATH-SAFE being publicly available, actual utility of outputs amongst external stakeholders is not yet known.

Some PATH-SAFE outputs have already been cited in studies and policy documents as of March 2025. For example, journal articles describing findings from PATH-SAFE have been cited by journal articles related to fungal AMR (Martin & Hart, 2023), methodological papers in genomic, environmental and (primarily) wastewater surveillance (Alex-Sanders, Woodhall, Farkas, Scott, Jones, et al., 2023; Martin & Hart, 2023; Scott et al., 2024; Walker et al., 2024), and One Health surveillance approaches, including in low-income countries (Hill, Stentiford, Walker, Baker-Austin, et al., 2024). PATH-SAFE has also been referenced more widely in policy documents (discussed in Section). Some PATH-SAFE outputs have already been cited in studies and policy documents as of March 2025, and over 30 peer reviewed publications related to the programme were reviewed. For example, journal articles describing findings from PATH-SAFE have been cited by journal articles related to fungal AMR (Martin & Hart, 2023), methodological papers in genomic, environmental and (primarily) wastewater surveillance (Alex-Sanders, Woodhall, Farkas, Scott, Jones, et al., 2023; Martin & Hart, 2023; Scott et al., 2024; Walker et al., 2024), and One Health surveillance approaches, including in low-income countries (Hill, Stentiford, Walker, Baker-Austin, et al., 2024). PATH-SAFE has also been referenced more widely in policy documents (discussed in Section 4.2.3). It would be helpful to monitor these types of citations in the longer term to understand long-term outcomes from the PATH-SAFE programme.

PATH-SAFE’s central management team has supported communication activities to disseminate information from the programme, to facilitate outcomes and impact realisation. For example, they have organised events to communicate the findings from the programme (e.g. an AMR roundtable event in December 2024), written regular newsletters to communicate with external stakeholders, and facilitated coordination between projects and with other programmes outside of PATH-SAFE (PATH-SAFE: Events and Communications | Food Standards Agency, n.d.). They have also been proactive in identifying potential end-users of PATH-SAFE outputs and linking policy stakeholders to individuals involved in PATH-SAFE with relevant expertise (Int A, (PATH-SAFE Newsletter December 2023 | Food Standards Agency, n.d.)).

4.2. PATH-SAFE outcomes

PATH-SAFE has contributed to positive outcomes related to surveillance for FBPs and AMR across different contexts, particularly in the agricultural and food systems. For example, PATH-SAFE has produced outcomes related to:

A data platform that, if incorporated into practice beyond PATH-SAFE, can help improve meta-data availability, data integration and analysis in surveillance for specific pathogens; (PATH-SAFE Programme National Foodborne Disease Genomic Data Platform | Food Standards Agency, n.d.)
Data that can help inform decision making about surveillance in different contexts and that provides a baseline for future surveillance activities; (Int. A, Int. D, Survey)
Methods, tools and knowledge about how to conduct surveillance in different contexts that, if incorporated into practice, can improve how samples are collected, how they are processed, and how data from different sources is analysed and integrated into surveillance; (Int. A, Int. D, Survey, Alex-Sanders, Woodhall, Farkas, Scott, & L, 2023)
Strengthened relationships and ways of working across government departments and other surveillance partners; (Int. A, Int. C, Int. D)
Knowledge and lessons learned about feasibility, gaps and utility from having conducted a cross-government, One Health surveillance pilot (Int. A, Int. B, Int. D, Survey);
Awareness raising of the importance of the agricultural and food system in AMR surveillance.

In the sections below we provide evidence on different types of programme-level outcomes.

It is important to note that longer term impacts are unlikely to have been realised at this point in time in the project, which was reflected in the survey and interview responses. The participants often reported that they expected the programme to be influential in decision making, however few provided specific examples of where PATH-SAFE had influenced practice or business as usual at this stage. While the programme is expected to generate longer-term benefits, the degree to which these are realised depends on several factors, referring to the key assumptions within the logic model (see Chapter 3 and recommendations):

To generate benefits, stakeholders need to access and utilise the knowledge, data, methods and tools developed through the PATH-SAFE programme
Additionally, in many cases follow up action is needed to support further investigation, implementation and scale up of methods
Prioritisation of which areas are most suitable for follow up may help inform investment decisions.

4.2.1. Data

Data from PATH-SAFE has been used to inform decisions about surveillance.

PATH-SAFE projects have produced large and varied datasets on FBPs and AMR across the agricultural and food system, including from abattoirs, milk production sites, livestock feed, aquatic environments, shellfish, hospitals and care homes.

For instance, the programme produced data on campylobacter-specific AMR determinants, which were added to PubMLST, enhancing searchability for six antibiotic classes. PATH-SAFE also enabled data collection in key gaps identified in AMR surveillance through pilots of AMR surveillance in dairy cattle, beef cattle (Int A) and sheep livestock, which established new baselines and have been used in the VMDs Veterinary Antimicrobial Resistance and Sales Surveillance (VARSS) reports (Int D (Veterinary Medicines Directorate & Animal and Plant Health Agency (APHA), 2024)).

This data has been useful in providing a baseline understanding of FBPs and AMR across different contexts, which is valuable in informing future investigations and surveillance activities, and in developing countermeasures to respond to FBPs and AMR. The evaluation revealed specific decisions about surveillance in cattle and sheep which were informed by data from PATH-SAFE:

When the programme revealed unexpected levels of resistance in samples from beef cattle, this informed a more targeted survey in cattle, which reportedly helped narrow the scope of future surveillance activities and saved resources (Int A).
The sheep survey established by PATH-SAFE also provided a new baseline of FBP and AMR prevalence in healthy sheep at slaughter. This generated evidence that the AMR risk from sheep meat production appears to be less than that for other livestock and poultry production in the UK, which helped inform de-prioritisation of the sheep survey and aid in efficient resource management.^[5]
Similarly, PATH-SAFE provided data on AMR risk from imported livestock feed, which plugged an information gap. Risk of AMR was estimated to be low, which helped inform decisions to de-prioritise animal feed as a surveillance metric for the time being.^[6]

In addition, PATH-SAFE projects collected spatial-temporal data on resistant pathogens and genes in river catchment areas (Environment Agency, 2024c), on the prevalence of resistant genes in shellfish, and on antimicrobial concentrations in aquatic environments (and estimated concentrations in soil based on extrapolations of water-related data) (Environment Agency, 2024a). The project also produced additional data using real-time PCR for screening for norovirus, Shigella/EIEC, Salmonella spp, Campylobacter spp, and Shiga toxin-producing E. coli (STEC) in wastewater samples routine collected by UKHSA in their polio surveillance programme.

While PATH-SAFE has demonstrated value in creating baselines and plugging evidence gaps, aiding in prioritisation and de-prioritisation decisions, in one particular case PATH-SAFE also provided infrastructure and capabilities that could be repurposed to respond to an urgent need for a new surveillance scenario, as outlined in the case study in Box 1 below. This case study demonstrates an example of where PATH-SAFE’s work has led to specific changes in decision making and practice, improving how surveillance is conducted in the UK. In particular, it demonstrates that producing an output was not enough to generate impact – for the method and insights that PATH-SAFE produced to create a real difference in surveillance, these needed to be used by stakeholders involved in and outside of PATH-SAFE.

Box 1.Case study on informing surveillance prioritisation and wider use case

Context

As a pilot programme, it was anticipated that one of the impacts of PATH-SAFE might be to inform decisions about which surveillance activities should be prioritised or deprioritised for procurement or development. However, an unanticipated benefit that has emerged has been the utility of surveillance setup to be adaptive for different use cases by providing existing infrastructure and agility to pivot according to need. To exemplify this, we focus here on the study carried out under the WS2b.4 ‘National Milk Lab Raw Milk AMR Testing’ project which aimed to assess the feasibility and efficacy of bulk milk tank biosurveillance with national coverage. The outcomes of this study proved valuable for informing the UK’s rapid surveillance response to the 2024 Highly Pathogenic Avian Influenza outbreak in dairy cattle originating in the United States.

Using PATH-SAFE insights to inform important decisions

This project, which began in 2022, aimed to estimate the prevalence of resistant pathogens and AMR genes in UK’s dairy cattle population using samples from bulk milk tanks and address the limited understanding of the AMR landscape in dairy cattle by establishing baseline and regional variability data on AMR bacteria in raw milk.^[7]

The pilot also aimed to assess the feasibility of partnering with the dairy industry to implement the survey, setting up the required sampling logistics and frequency, and achieving nationally representative surveillance. It sought to determine whether existing sampling infrastructure under the National Milk Laboratories could be effectively leveraged for pathogen monitoring in dairy cattle.^[8]

The bulk milk project built a working relationship with National Milk Laboratories (NMLs) via regular contact, community events, and webinars NML’s existing sampling infrastructure was utilised, and the team at APHA created protocols for sample handling, transport logistics and laboratory processing, established a functioning workflow alongside APHA s existing laboratory routine, and refined methods for identifying and characterising FBD and AMR in bulk milk samples.^[9] They achieved representative national coverage, sampling approximately 26% of the total GB dairy cattle population.

Scaling of surveillance

This project piloted a new system, building upon existing sampling infrastructure, which functioned well and enabled them to assess the current prevalence of AMR and FBP in bulk milk. Sampling many locations over time allowed them to identify regional and seasonal differences in the pathogens present. Alongside the protocols for sampling, transport, processing and analysis, they also assessed the costs of implementing this system.^[10]

Baseline prevalence and variation and adaptive infrastructure

Establishing the baseline prevalence of AMR and FBP in milk, as well as the regional and seasonal variation, is a valuable contribution to our understanding of the landscape of AMR across the agri-food system and has the potential to inform decisions around risk management and mitigation in this area. The bulk milk study is now informing the National Biosurveillance Network’s work on incentivising private veterinary labs to share AMR data with government to aid in its National Action Plan delivery (Int A).

This work also proved impactful in another way, when in March 2024 the United States Department of Agriculture reported the first detection of Highly Pathogenic Avian Influenza H5N1 in domestic cattle outside experimental conditions (APHA, 2024). The UK government needed to determine whether it was also circulating in British dairy herds. Existing data sources were used to assess this, including reviews of dairy cow mastitis cases^[11], reviews of ‘diagnosis not reached’ clinical samples, and close review of data from farms with both cattle and infected poultry. No new signals were found. While these methods were expected to be effective, the FSA and public health authorities requested additional pathogen-specific data to rule out silent circulation (Int A).

While bulk milk tank surveillance was being implemented in the US, regarded as the best option given the potential for national coverage, feasibility to implement this in the UK was unclear.

Defra led a cross-government meeting on this issue, and during a discussion on bulk milk tank testing as an option, a senior member of PATH-SAFE informed Defra of the PATH-SAFE bulk milk pilot. In addition, the PATH-SAFE management team convened experts from across government, academia and industry to discuss methods, approach and infrastructure, and provided data from the programme to inform rapid development of a proposal. After detailed discussions about the feasibility of implementing widespread bulk milk testing and the available infrastructure, this proposal was taken to the Animal Disease Policy Group for agreement. This allowed them to confidently decide to prioritise bulk milk tank surveillance as the best method to rapidly assess the presence of Highly Pathogenic Avian Influenza in GB dairy cattle. Without data generated by the PATH-SAFE pilot from bulk milk testing, it would have been challenging and time-consuming to firstly establish the feasibility of using bulk milk tanks surveillance to assess H5N1 in domestic cattle, and secondly to undertake required surveillance with limited alternatives such as the much smaller scale Brucellosis survey infrastructure.

National Milk Records were contacted through connections formed during the PATH-SAFE pilot, several large dairy companies agreed to contribute samples, and data sharing agreements were promptly signed. Between May and June 2024, the APHA conducted a cross-sectional survey testing 508 bulk milk samples from 455 dairy farms across England, Scotland, and Wales and provided strong evidence that HPAI was not circulating in British dairy herds at that time (APHA, 2024). Another survey is likely to take place in Spring 2025.

Wider ecosystem implications

This is an example of a PATH-SAFE feasibility study informing an important surveillance decision following proactive outreach by decision-makers responding to an urgent need. PATH-SAFE pilots have provided a wide range of useful information on the feasibility and performance of different surveillance approaches, and many are in a position to inform future routine prioritisation and de-prioritisation decisions.

This example has also highlighted the need for proactive engagement and communication of PATH-SAFE’s work to develop unanticipated use cases for added value to the surveillance sector. For example, wastewater surveillance is being explored for detection of Foot and Mouth disease while bulk milk testing is being assessed for business as usual surveillance using antibody testing and metagenomic sequencing. The Defra Surveillance Intelligence Forum, who are crucial for informing responses to future urgent issues, among others, would be beneficial recipients of tailored PATH-SAFE outputs.

As a pilot programme, PATH-SAFE has collected data over a defined period of time, and additional data collection would be useful.

PATH-SAFE has produced useful data as evidence above however, as a pilot programme, it has collected data over a defined period of time. While this provides a preliminary picture of FBPs and AMR in the agri-food landscape, in some cases additional accompanying data collection and analysis will be needed to make decisions about whether to invest in certain surveillance activities and/or wide scale implementation. Continued sample collection and data generation is also needed in some areas to understand change over time in levels of FBPs and AMR.

For example, PATH-SAFE produced data from wastewater surveillance in a care home site, as part of a pilot that would link this to other relevant data (e.g. prescriptions, health care records). The data from this pilot was used in decision making at the pilot site (see Box 2). However, there was not agreement that the insight that the current data provides is sufficient to make decisions about wider future wastewater surveillance activities in other care home settings. Additional investigation is needed to determine the value of that data in decision making, which can then inform decisions about whether to invest in additional implementation or scale up.

In delivering some of the projects within PATH-SAFE, data has been shared between partners involved in delivering the programme. For example, UKHSA and Cefas shared data on waste-water based surveillance of norovirus; APHA and QUB shared phenotype and genotype data to train an AMR model; Cefas and FSS shared sequences from E. coli in shellfish to train a source attribution model; SRUC and APHA shared data from a survey of cattle; APHA and the National Milk Laboratories shared data from bulk milk testing; and FSA, VMD and APHA shared abattoir and imports data. In addition, data that PATH-SAFE produced from sequencing isolates has been shared on public databases such as Enterobase, ENA, SRA, NCBI, and PubLMST.

However, there have been significant challenges related to data sharing (discussed in more detail below), which limited the ability to create cross-programme data sharing agreements. While PATH-SAFE led to more data sharing in the context of the programme, it has not resolved wider data sharing issues that make surveillance difficult (which, as discussed below, would be unrealistic to expect one pilot programme to resolve). This is reflected in survey results - only 38% of external stakeholders (n=18) and 50% of delivery stakeholders (n=14) agreed that PATH-SAFE has improved data sharing, and partners were unsure that any gains in data sharing would be maintained. To improve data sharing, respondents mentioned the need for better agreement around data sharing and access procedures.

Data sharing challenges are common in the surveillance space and in cross-government collaborations, and PATH-SAFE also faced data sharing challenges from the outset. These challenges slowed progress early in the programme and affected how partners could participate in the programme. For example, there were sensitivities around sharing certain types of data, especially genomic data and data that might be personally identifiable. Partner organisations also had differing requirements around data sharing, which were reportedly not fully understood at the beginning of the programme, and which took time to resolve.

While challenges in sharing data across surveillance partners and government departments is not unique to PATH-SAFE, there are lessons from the programme that can help improve how data sharing is approached more widely. For example, engagement about data sharing with all of the partners involved in PATH-SAFE took time at the beginning of the project. Allowing time in the funding cycle to engage potential partners early and have a more extended discussion of data sharing challenges at the beginning of project delivery might have helped prevent delays. While partners were able to establish project-level data sharing agreements, a programme-level agreement, while difficult to establish, might have helped avoid inefficiencies from multiple different partners each conducting separate discussions.

Many of the challenges related to data sharing that the PATH-SAFE programme faced were not within its power to solve. Therefore, additional action at higher levels within government to prepare for sharing different types of data to support public health and surveillance would likely be helpful - for example, see the roadmap published by the UK government on Transforming for a Digital Future: 2022 to 2025 Roadmap for Digital and Data (Central Digital and Data Office, 2023). Lessons from PATH-SAFE and other initiatives that have faced similar issues should be shared amongst stakeholders involved in decisions about data sharing more widely, to avoid facing the same issues in future projects.

PATH-SAFE has delivered a genomic data platform for Salmonella, E. coli and Listeria to improve surveillance analytics for partners.

The genomic data platform developed by the PATH-SAFE programme (described in more detail in Annex A.1), has capabilities to improve how genomic data is analysed, the consistency and comparability of data, and the availability of meta data. The platform also enables data to be shared across surveillance partners, where agreements allow, although data sharing agreements and requirements were still being discussed amongst partners as of March 2025. The goal of these discussions is to enable information to be shared more regularly on the platform.

The degree to which the platform achieves desired outcomes depends, in part, on whether it is maintained, expanded to other pathogens and to other users, and is used as business as usual. This requires additional investment beyond PATH-SAFE. As of March 2025, APHA, FSS and UKHSA, have committed to resolving data sharing barriers and trialling the platform alongside their other surveillance activities. This indicates that they view the platform as valuable and creates potential that it will be incorporated into standard operations.

4.2.3. Methods and tool development

PATH-SAFE has produced knowledge about applying new and existing surveillance methods and tools to different settings.

Many PATH-SAFE projects aimed to improve the methods and tools available for surveillance across different settings in the agricultural and food system. Projects did this through a number of different mechanisms: by improving on or adapting existing methods; by validating existing methods; by producing new methods, protocols or workflows; and by providing a proof of concept for the application of AMR and FBP surveillance approaches in new settings. There is evidence that PATH-SAFE has advanced knowledge about how to conduct surveillance, including knowledge about where or when to sample, sequencing, and how to analyse data (e.g. for shellfish, raw pet food, milk, livestock feed; in abattoirs, hospitals, aquatic environments, care homes; using onsite diagnostics).

Delivery partners that responded to the survey (n=14) largely agreed that positive outcomes related to development methods and tools have been achieved through PATH-SAFE (see Figure 3 below), though only 14% agreed that methods and tools developed through PATH-SAFE have already led to specific improvements in surveillance to date. Open text responses suggested that additional investment is needed for operationalisation of, and tangible improvements in, methods and tools (e.g. high-throughput qPCR for environmental surveillance, wastewater and air surveillance for AMR, deployment framework for onsite-diagnostics). The contributions from PATH-SAFE to methods development are valuable, despite not many methods being incorporated into business as usual yet. External stakeholders that responded to the survey (n=18) were less confident than delivery partners about outcomes relating to tools, with 72% of end-users uncertain about whether PATH-SAFE has developed methods and tools suitable for scale-up.^[12]

Figure 3.Delivery partner survey responses regarding outcomes related to methods (n=14)

In particular, PATH-SAFE has led to methodological advances in:

Wastewater surveillance – PATH-SAFE generated new knowledge about AMR and FBP wastewater surveillance in different settings, including providing a proof of concept for wastewater surveillance in care homes, hospitals and wastewater treatment plants, and to assess risk associated with shellfish. The programme also produced new methods for wastewater surveillance. This included PCR tiling, an approach to whole genome sequencing for norovirus in wastewater, methods for nanopore sequencing wastewater samples, and piloting wastewater-based epidemiology as a tool for surveillance of norovirus in the community (Alex-Sanders, Woodhall, Farkas, Scott, Jones, et al., 2023; Scott et al., 2024, 2025; Silvester, Perry, et al., 2025; Walker et al., 2024).
Environmental surveillance – PATH-SAFE generated knowledge about environmental sampling and how different methods could be applied in monitoring of environmental AMR (Environment Agency, 2024c; Pilot Surveillance of Antimicrobial Resistance in River Catchments in England: Summary, n.d.). PATH-SAFE also demonstrated the feasibility of using live shellfish samples from existing surveillance systems to test for AMR genes and antimicrobial drug residues, establishing that the shellfish may act as a useful ‘sentinel’ for AMR (Wiebke Schmidt et al., 2023).
Building level air surveillance – PATH-SAFE generated knowledge about using air microbiome surveillance in care homes.
Sequencing, genomics and metagenomics – PATH-SAFE developed a method to compare Onso short-read sequencing with nanopore approaches, which can inform hybrid metagenomic assemblies.
Attribution models – PATH-SAFE developed and validated a source attribution model attributing E. coli in food, shellfish harvesting areas and human infections to their likely animal sources.
Onsite diagnostics – PATH-SAFE reviewed onsite diagnostic technologies to assess their readiness for implementation and piloted the use of two of them in detecting food borne pathogens at a border control sites and in irrigation waters. This provides a proof of concept for using on site diagnostics outside of laboratory settings for FBPs, and identifies areas where additional evidence is needed to inform decision making.
Bulk milk testing – PATH-SAFE led to a new method for bulk milk testing as a proxy for AMR in dairy cattle.
Sampling approaches – PATH-SAFE trialled different sampling methods in abattoirs and tested whether abattoir environment samples can be used as a proxy for caecal sampling, and identified new sampling approaches in imported animal feed ingredients surveillance
qPCR – PATH-SAFE developed a new multiplex qPCR panel for common gastrointestinal viral targets, and validated microbe detection qPCR assays for FBP targets.^[13]
Clustering isolates – PATH-SAFE also created a new method for clustering isolates to speed up isolate comparison and thus enable faster analysis.
Re-use of existing samples – PATH-SAFE demonstrated that real-time PCR can be used for nucleic acid screening for norovirus, Shigella/EIEC, Salmonella spp, Campylobacter spp, and Shiga toxin-producing E. coli (STEC) in wastewater samples routine collected by UKHSA in their polio surveillance programme.

In addition to specific methods and tools, PATH-SAFE produced knowledge that can help improve how surveillance is conducted across different settings. For example, PATH-SAFE investigated biosolids as a viable pathway for antifungals to reach soil (Martin & Hart, 2023) and analysed potential transmission pathways related to the use of antimicrobial disinfectants (Environment Agency, 2024b), both of which helped understand how antimicrobials enter the environment, where they cause risks, and therefore where surveillance and prevention measures might be targeted. PATH-SAFE pilots also generated useful information on the strengths and weaknesses of surveillance methods. For example, in Phase 1, a PATH-SAFE project revealed weakness in the methods routinely used in bacterial genome characterisation through short-read assembly and tested alternative approaches, which led to a change in the way that all hybrid (short and long-read WGS) data is processed across APHA.

Several methods developed by PATH-SAFE have been incorporated into practice.

Some methods from PATH-SAFE have been incorporated into business as usual. For example, FSA, VMD and APHA are continuing work to incorporate a One Health bioinformatic analysis approach to raw pet food surveillance into business as usual. In addition, external stakeholders are also reportedly building on work on surveillance in hospitals (Digital Hub for AMR), bulk milk surveillance and onsite diagnostics (Pirbright Institute). The bulk milk testing approach developed by PATH-SAFE was used to investigate an avian influenza outbreak in the US (Box 1, HAIRS Risk Statement: Avian Influenza A(H5N1) in Livestock, n.d.).

There is also evidence that some of the other methods and tools developed by PATH-SAFE may be ready to be incorporated into practice within partner organisations. For example, PATH-SAFE partners are seeking funding to continue work and to explore incorporating the following methods and tools into business as usual (PATH-SAFE Programme National Foodborne Disease Genomic Data Platform | Food Standards Agency, n.d.):

Genomic data platform for Salmonella, E. coli and Listeria
E. Coli and Salmonella source attribution models (including further improvement of model);
Caecal sampling in cattle within AMR surveillance;
AMR surveillance for raw pet food ingredients; and
Generation of baseline FBD and AMR prevalence data in food

However, as outputs from these projects are not yet available, this evaluation has not been able to assess the maturity of these methods or whether additional investigation is needed to incorporate methods into standard practice. Other methods and tools that PATH-SAFE helped develop (e.g. for AMR surveillance in sheep and animal feed ingredients) have also been identified as ready for wider implementation, although a decision has been taken to de-prioritise them based on data produced by the programme that indicated a lower risk of AMR than other potential sources.

Implementing these new methods and tools will require support, resources for implementation and scale up, departmental ownership over follow up action, and consideration around how to incorporate new methods alongside existing surveillance practices. However, not all projects have secured additional funding as of March 2025, and so it is unclear which methodological advances produced by PATH-SAFE are likely to produce long-term benefit.

In some cases, more investigation would be needed to inform decision making about wider implementation of methods and tools from the PATH-SAFE programme

To produce benefit, insights from PATH-SAFE regarding methods and tools for surveillance must be incorporated into practice. However, this takes time and resources beyond what was provided to PATH-SAFE in the context of the pilot programme. Despite PATH-SAFE producing potentially useful methods and tools for surveillance, along with knowledge that can help improve how surveillance methods are applied across the agricultural and food systems, there are few examples that have been incorporated into practice to date. As a pilot programme, it is expected that additional investment will be needed to support further investigation in some areas.

For example, while PATH-SAFE produced a proof of concept for using wastewater, air and surface surveillance alongside other sources of data in a care home, it is not yet clear whether this method is effective and cost effective, and whether it would be useful in other care home settings. For more information on this example of methods development through PATH-SAFE, please see the case study in Box 2 below. This case study demonstrates the outcomes that can be expected from surveillance-related feasibility studies and pilots in limited settings. In particular, this case study demonstrates the localised impact that PATH-SAFE had on practices within a single care home, which in turn provided a proof of concept for applying wastewater surveillance to other settings.

Box 2.Case study on surveillance across different settings

Context

The PATH-SAFE programme aimed to enhance biosurveillance of foodborne pathogens (FBPs) and antimicrobial resistance (AMR) across the UK. Workstream 2c at Queen’s University Belfast (QUB) tested the feasibility of different sampling methods in a care-home environment in Northern Ireland (NI). It filled important gaps in our knowledge of AMR and FBP prevalence in care homes, the best methods for monitoring this, and care homes’ potential contribution to the flow of AMR between humans and the environment. It is also a good example of how surveillance data can be connected to immediate action, even in a pilot project, and we focus on this in this case study.

Biosurveillance informing local action

The relative contribution of care homes as reservoirs and sources for the spread of AMR is relatively poorly understood, compared to contribution of hospitals. This means decision-makers lack evidence on how best to intervene. The significance of care home wastewater for the flow of AMR to the environment is also not known.^[14]

Biosurveillance methods for this context are not well established, whether this involves sampling air, wastewater, or surfaces.

After recruiting a care home and building a good relationship with its management team, a feasibility study was carried out to assess air sampling, wastewater sampling, and surface swabs as methods for detecting and monitoring pathogens. Samples were tested for specific pathogens of interest as well as using untargeted methods.^[15]

The QUB team also carried out surveys of residents, their relatives when residents could not participate, and staff. They asked their views on AMR and what their main concerns were. Analysis and reporting is ongoing for these core activities of the project.^[16]

Alongside the core activities of this project, the project team also identified an opportunity to connect their data to action. As results were available within 24 hours of sampling, they provide a near real-time assessment of the pathogens currently circulating in the care home. In some cases, this can be before symptoms appear and the staff become aware of them. After establishing that sharing information with the care home about the pathogens identified was possible and clarifying that they were unable to provide any advice, the project team began sending prompt results emails, including heatmaps of the care home common environment to show where pathogens were found (Int A).

Care home pathogen prevalence detection

The project’s reports are expected to provide valuable information about the prevalence of AMR and FBP within a care home, and important steps towards a more comprehensive understanding of the contribution of this setting.^[17] The potential contributions of air, surfaces, and wastewater for flow of AMR within and out of the care home are also valuable. Due to the various untargeted methods used, additional information about other pathogens has also been generated.

The results and comparison between the different sampling methods is a step towards establishing best practice and identifying the best options to develop further.

The prompt updates to the care home management about the pathogens found in different areas of the care home enabled them to act quickly when a concerning pathogen, such as SARS-CoV-2 or norovirus was found. When they detected a pathogen requiring action (in their view), they implemented stricter infection control measures such as mask-wearing and enhanced cleaning (Int A).

Results from the feasibility study are not yet finalised, and the project’s impact will not be fully realised until the results can be shared with decision-makers to inform action about the broader application of this method in other care home settings. However, sharing the real-time results with the care home management was an opportunity for more direct and immediate impact. While this was not a planned impact, and was not tracked systematically, the care home reported a significant decrease in staff sickness in these areas and a corresponding reduction in agency staff costs. They also reported no major viral outbreaks since the surveillance began (April 2023 -March 2024) (Int A, (Project Brief 2c - Wastewater Based Epidemiology as a Tool for Tracking Foodborne Pathogens & Antimicrobial Resistance within Care Homes, 2023)).

New use case identified for surveillance

This project was not planned with any direct impacts in mind beyond filling evidence gaps and testing methods in a new context. But during delivery, the team proactively noticed an opportunity to share valuable information with people who could act on it. The trust they built with the care home management, their attention to their professional and ethical constraints and duties, the rapid turnaround of their analysis, and their prompt and accessible communication enabled them to use this opportunity effectively.

This experience stimulated the project team to consider more opportunities for direct impact alongside their basic research, and to consider testing the hypothesis that the surveillance led to effective actions and desirable outcomes (reduced staff and patient sickness, reduced agency staff costs).

This project is a good example of how those planning and delivering biosurveillance pilot projects can connect the data they generate to the ability to make better decisions and take effective actions.

Some areas have been identified by PATH-SAFE partners are ready for further investment to support continued investigation. For example, PATH-SAFE partners are seeking or exploring funding for additional investigation in the following areas:^[18]

Testing of catchment to coast models for pathogen surveillance;
Comparison of PATH-SAFE data from wastewater surveillance of FBPs to data from the IID3 programme;
Continuing additional analysis of wastewater samples that are routinely collected by UKHSA for polio surveillance;
Continuing additional analysis of wastewater samples that are routinely collected by UKHSA for polio surveillance;
Research on AMR in the environment.

There are also other areas that would require further investigation for which additional funding is not currently available. For example, PATH-SAFE partners have assessed that funding is not currently available to support investigation related to wastewater surveillance in hospitals, abattoirs, and care homes, air surveillance in farms, and shellfish-based surveillance of FBPs. However, funding may be sought or become available in the future for further investigation in these areas, or by other actors in the surveillance space.

4.2.4. Collaboration and coordination

PATH-SAFE has produced and strengthened relationships between individuals and organisations that participated in the programme, and knowledge about the remit and activities of other partners.

PATH-SAFE involved delivery partners working collectively within and across individual projects, along with programme-level mechanisms to promote collaboration and coordination. As such, relationships have been a key output from the PATH-SAFE programme. Although these are less quantifiable than some of the other outputs from the programme, relationships are a critical aspect of improving surveillance. Given the complex and densely populated ecosystem of surveillance across multiple sectors and applications in the UK, relationship building and awareness of other stakeholders are key for maximising opportunities, reducing waste and duplication of effort, and identifying gaps where little to no activity might be ongoing or planned. Therefore, the relationships built through PATH-SAFE have the potential to improve how surveillance is conducted and coordinated.

There is strong evidence that PATH-SAFE has produced and strengthened relationships between partner organisations. This has included improving understanding of what other organisations are responsible for, the role of different partners in One Health surveillance, and by creating interpersonal links between individuals and teams involved in PATH-SAFE. The central management team was reported by interview and survey respondents to have greatly facilitated relationship-building, collaboration and coordination amongst the PATH-SAFE network, which was also supported by the delivery of collaborative projects and attendance at shared events. Shared, dedicated funding was also reported to support relationship-building within PATH-SAFE, as it provided ring-fenced resources to support the aims of the programme, allowing for time and space to broker collaboration alongside the more operational aspects of project delivery. Many PATH-SAFE partners are seeking joint funding to continue collaborating after the programme ends, which is evidence that the relationships built through PATH-SAFE have enabled new areas of work that are worth seeking additional funding to support.

Delivery partners that responded to the survey (n=14) agreed PATH-SAFE has produced (86%) and strengthened (79%) relationships or collaborations between organisations. Delivery partners reported that they expect these relationships will result in positive outcomes relating to sharing information (86%) and data (67%), collaborating (79%), analysing and interpreting surveillance results (64%) and creating efficiencies (64%) (see Figure 4). Similarly, 89% of external stakeholders that responded to the survey (n=18) agreed that PATH-SAFE has resulted in new relationships and collaborations between key stakeholders in surveillance.

Figure 4.Delivery partner survey responses regarding outcomes related to collaboration (n=14)

These improved relationships are largely based on individuals rather than institutional bonds, meaning that they may fade as individuals change roles or move roles between organisations. Some departments, however, are looking to embed these collaborations more structurally through shared programmes with other organisations, which may help contribute to lasting impact from PATH-SAFE (Int B). Additionally, as participating in PATH-SAFE has led to several bids for future collaborative work, which may help extend these relationships beyond the life of PATH-SAFE. The knowledge held by individuals about other organisation s remits and ways of working will also likely facilitate partnerships and collaborations between institutions into the future.

Along with relationships between government departments, there is also evidence to support that PATH-SAFE has contributed to improved relationships with certain sectors, and that the programme has produced useful lessons regarding engagement with the private sector. For example, PATH-SAFE enabled collaboration between government departments and industry partners to address surveillance gaps related to ruminants, including working with National Milk Records, Arla, and other food business operators to enable sample collection (VMD & APHA, 2024). Raw pet food manufacturers and port health authorities were also engaged in the process of delivering PATH-SAFE, who had not previously collaborated with government departments in national surveillance initiatives. Respondents to the survey also commented regarding improvements in relationships across government and industry stakeholders (e.g. livestock industry) and how these experiences can meaningfully inform future engagement with the private sector.

While it is still unclear whether these gains in engaging with the private sector will be retained in the long-term, there is already some evidence of positive outcomes that have occurred from PATH-SAFE’s engagement with private industry. For example, piloting AMR surveillance in beef cattle reportedly produced lessons regarding sensitivities and considerations around working with this sector, including around the heightened sensitivity to negative press and scrutiny from the red meat industry compared to other sectors that have traditionally been involved in surveillance (Int A). The collaboration between government and industry in establishing bulk milk surveillance also reportedly laid the foundations for rapidly establishing surveillance in cattle for avian influenza (Int A).

There is also opportunity for further impact related to the private sector in terms of data access. For example, the private veterinary sector holds regional veterinary data currently unavailable in surveillance, which could be linked in with environmental sampling to inform action in the animal sector (Int A). Similarly, additional data that water companies hold could be used to carry out additional analyses for public health benefit at relatively low cost (Int B)

4.2.5. Proof of concept evidence in influencing and awareness raising

PATH-SAFE has generated knowledge about conducting One Health and food-based surveillance across government departments and the Four nations.

PATH-SAFE represents a large, cross-government programme that has piloted new approaches to One Health AMR and FBP surveillance in the agricultural and food systems. From having carried out this programme of work, PATH-SAFE has produced knowledge about what can be accomplished in a pilot programme and what works (and does not work) in cross-government surveillance. The programme has also generated lessons about breaking down silos between surveillance partners and conducting One Health surveillance for AMR and FBPs and has produced a model of funding projects with strong central coordination. Programme-level lessons from delivery of PATH-SAFE can help inform future One Health, cross-government surveillance programmes.

Similarly, PATH-SAFE has likely led to an increased awareness of the role of food in surveillance. For example, PATH-SAFE has engaged extensively with other programmes and stakeholders within the UK and internationally about AMR and FBP surveillance. The programme has also been cited in key documents in relation to food-based surveillance including Biological Security Strategy (BSS), Antimicrobial Resistance National Action Plan (NAP) and UK Veterinary Antibiotic Resistance and Sales Surveillance Report (VARSS). PATH-SAFE has also contributed to additional bids for funding to conduct food-based surveillance, and may have contributed to the Cabinet Office’s inclusion of food within its biosurveillance approach by serving as a proof of concept for food-based surveillance of FBPs and AMR.

Out of external stakeholder that responded to the survey (n=18), 78% agreed that PATH-SAFE has served as a proof of concept for cross-government surveillance projects. Delivery partner respondents (n=14) also indicated PATH-SAFE will be influential in decision making about surveillance pilots and practices, resourcing and coordination within surveillance (see Figure 5). Open text responses indicate PATH-SAFE has led to improved understanding of AMR risks in food systems, and shaped decisions about research in partner organisations.

Figure 5.Delivery partner survey responses regarding areas PATH-SAFE will influence (n=14)

Lessons from PATH-SAFE can help inform future approaches to surveillance. For example, as discussed in Section 4.2.2, PATH-SAFE faced many challenges related to data sharing, which are common across surveillance initiatives, cross-government collaborations and more broadly. The lessons that the programme produced based on facing and working through these challenges can help other initiatives avoid similar pitfalls related to programme delays from data sharing and governance-related issues (Int C). Similarly, the programme also led to lessons around the importance of early engagement with partners, and sufficient lead-in time to refine ideas, get resources in place and develop robust plans (Int A, Int D).

Incorporating lessons from PATH-SAFE into future decision making will require outputs focused on lessons from the programme, and a dissemination strategy for getting these outputs to key decision makers. There are not yet programme-level outputs available that communicate these lessons, although a programme-level closure report is planned. PATH-SAFE has also participated in events and meetings where lessons learned have been shared more widely. For example, a workshop was held January 2024 at the Royal Institution, London where attendees gathered to present the findings and discuss the challenges, needs and opportunities for implementing a successful national biosurveillance programme (Posen & Heywood, 2024). Additionally, in December 2024 PATH-SAFE, in collaboration with the Microbiology Society, organised the One Health AMR Surveillance Roundtable, bringing together key stakeholders from across government to review the field of AMR surveillance and PATH-SAFE’s role in it. The roundtable enabled discussions on the future of One Health AMR surveillance, and explored opportunities to continue the agenda post PATH-SAFE. The AMR National Action Plan (NAP) surveillance working group was identified as the right forum to take discussions forward in the future (Microbiology Society, 2024). PATH-SAFE also hosted a conference in February 2024 to disseminate work, and disseminated results at the September 2024 Government Science and Engineering conference.

Individual projects have also engaged in similar discussions to disseminate lessons learned. For instance, results from the project focused on genomics of AMR in sheep, bulk milk and animal feed were presented at the VMD AMR symposium. In addition, the project focused on AMR in Campylobacter organised multiple seminars, workshops and outreach lectures which brought together data scientists, microbiologists, commercial breeders and veterinarians where lessons learned from the programme were discussed.

4.2.6. Informing future surveillance projects

Knowledge from PATH-SAFE may have informed other strategies in the UK.

PATH-SAFE stakeholders have met with representatives from other surveillance initiatives, including the NBN, GAP-DC, UKMFC and Cabinet Office initiatives around biosurveillance to share results from the programme and lessons learned (e.g. approaches to collaboration and engagement). In addition, PATH-SAFE is mentioned in key strategies related to surveillance, including the BSS, the AMR NAP and the NAO report on the UK’s response to AMR, which indicates it is well placed to influence other initiatives and wider approaches to surveillance in the UK (Confronting Antimicrobial Resistance 2024 to 2029, 2024; UK Biological Security Strategy (HTML), 2023). These meetings, relationship and citations of PATH-SAFE’s work provide evidence that the programme may have influenced decisions, although it is unclear the extent to which specific decisions were influenced by PATH-SAFE alongside other factors. However, some stakeholders have reported that PATH-SAFE has influenced other initiatives. For example, PATH-SAFE has reportedly provided insight and advice to cross-governmental initiatives such as the NBN through engagement in advisory activities to the NBN board and through the Shared Outcomes Fund (Int A, Int D). This insight reportedly related to ways of working, operational principles, and reporting approaches (Int D) and approaches to collaboration and engagement.

While this provides some evidence of PATH-SAFE’s influenced on other surveillance programmes, the evaluation was not able to confirm what other factors influenced decision making about these key initiatives in the UK. We are therefore unable to assess PATH-SAFE’s contribution to specific decisions.

4.3. Factors affecting realisation of PATH-SAFE outcomes and impacts

While this evaluation primarily focused on outcomes, it also collected evidence on what has facilitated and what has hindered PATH-SAFE’s ability to accomplish outcomes. Fundamentally, PATH-SAFE was a pilot programme with many component projects, each working closely with and monitored by a central team, but operating semi-independently. Projects were funded for a defined time period, and future funding after that period was uncertain. Below, the strengths and challenges of this approach are explored in more detail. Below, we discuss the factors that affected how PATH-SAFE achieved outcomes, drawing on the evidence from this study and from the Phase 1 evaluation (RAND Europe, 2024)..

4.3.1. Strengths and facilitators

The structure of PATH-SAFE allowed the programme to generate knowledge rapidly across a wide variety of partners involved in different parts of surveillance for FBPs and AMR across agri-food and the environment. Aspects of the programme that were particularly helpful include:

The central management team was consistently cited as a key asset to the PATH-SAFE programme, which was essential in monitoring progress, coordinating between projects, facilitating communication, and facilitating collaborations between partners involved in the programme. The central management team also provided key support in identifying and creating opportunities for collaboration and coordination and brokering relationships within the PATH-SAFE programme and with external stakeholders.
The reporting mechanisms that the central management team put in place to monitor progress and gather data for grant reporting were thorough. This reporting helped keep projects accountable for progress and identify emerging risks and challenges to project delivery.
PATH-SAFE was funded through dedicated, ring-fenced funding from the SOF, and funding from the programme could not be used for business as usual operations within partner organisations. This funding arrangement helped ensure the programmes were sufficiently resourced and prioritised within partner organisations.
PATH-SAFE included a regular schedule of shared monthly meetings amongst delivery partners and separately amongst the Strategic Board, as well as shared, programme-wide events such as webinars and conferences. These shared events and opportunities for virtual and in-person networking helped create opportunities for relationships to build between partners and created a shared vision of the programme and its objectives despite the wide range of projects that operated semi-independently within PATH-SAFE.
While some projects have confirmed funding, it is still unclear which other projects from PATH-SAFE will receive additional investment for follow-up action. FSA will be retaining some members of the PATH-SAFE central management team, using existing core funding (Int D). This continuity in staff can help facilitate longer-term outcomes by allowing time for lessons from PATH-SAFE to be disseminated and taken up, especially within FSA (Int D).

4.3.2. Challenges and limitations

While PATH-SAFE structures and ways of working facilitated some of the outcomes it has achieved, there were also challenges and limitations to their approach. Many of these limitations can be expected of a pilot programme but would need to be addressed to achieve impact beyond the life of the pilot. Learning from what did not work in the PATH-SAFE programme can help inform future investments in surveillance and improve cross-government surveillance projects. Aspects of the programme that were particularly challenging include:

PATH-SAFE was funded for a period of three years, followed by an additional one year extension. This funding period saw early challenges in engaging with external stakeholders, procuring services, and addressing data sharing issues caused delays in the whole programme, in some cases leading to not delivering projects as initially planned. The shorter-term nature of the initial funding also meant that partners had to spend time and effort seeking additional sources of funding and making the business case for their projects. This occurred after the first three years of funding, as well as at the end of the programme in 2025 for projects that aimed to continue after PATH-SAFE funding ended.
PATH-SAFE faced significant issues around data sharing, which are common across other surveillance and cross-government initiatives, including limitations in accessing confidential health data and the legal requirements around data sharing (especially for genomic data). These issues caused delays and increased the burden upon stakeholders responsible for sharing data needed within the programme (Int C). Additional resources and time to discuss and resolve data sharing issues amongst PATH-SAFE partners earlier in the process, as well as a more flexible funding period may have lessened delays and allowed for the programme to deliver projects as expected despite delays initial delays.
While the monitoring requirements were needed to keep track of progress, maintaining accountability and meeting funder requirements, they required time and resources from partners that otherwise might have been spent on project delivery. Reporting requirements were adjusted to be less onerous during the programme, in line with funder requirements, which was reportedly successful in balancing monitoring requirements with ease of use.
Now that the programme is ending, it is not certain whether projects will receive further investment that is needed for additional investigation or for implementation/scale-up. While many projects have applied or are planning to apply for additional funding, ownership over follow-up action is not always clear in areas that have been collaboratively delivered in the PATH-SAFE programme, such as wastewater surveillance. For projects where there is evidence to support follow-up, more resourcing and clearer departmental ownership would facilitate outcomes to be achieved.
There is no period after PATH-SAFE funding to facilitate communication and dissemination activities at a programme-level, or to allow time for project teams to follow up on outputs that were produced at the very end of the programme. Allowing more time for dissemination at the end of the programme within the funding period might have helped spread lessons from the programme during the lifetime of the pilot project.

Along with these specific challenges that PATH-SAFE has faced, there are also questions that stem from the programme s structure (funding separate projects with central coordination) that will need to be addressed in future One Health surveillance activities. For example, departments have selected what projects to put forward for funding based on their priorities. This is partially due to PATH-SAFE’s structure, where the central team is not responsible for selecting which projects are most suitable for further investigation and scale up, but instead are meant to facilitate and help coordinate between the projects that have been funded, and partially due to the role of central government in prioritisation.

Currently, no areas have been identified by the programme as being unsuitable for further investment (e.g. due to scientific uncertainty, lack of feasibility), and it is outside the scope of this evaluation to determine whether any projects are not suitable for further scale up. Identifying areas that are not working or are not suitable for further investment can be a valuable outcome from a pilot programme, and would allow for more efficient use of resources (Int A). Further assessment of which initiatives from the programme are most suitable for scale up based on clear criteria would be beneficial.

5. Conclusion and recommendations

5.1. Conclusion

PATH-SAFE aimed to improve surveillance for FBPs and AMR in the environment and agri-food system in the UK. While it is too early to assess longer-term outcomes and impacts of this programme, the evaluation has found that PATH-SAFE has:

Produced data that is useful in informing decision making about surveillance, including valuable baseline data in different contexts
Produced new knowledge about surveillance of FBPs and AMR in different contexts and about collaborating across government departments and other surveillance partners
Advanced knowledge about methods and tools for surveillance
Built and strengthened relationships that are valuable in improving surveillance in the UK
Raised awareness around the importance of agri-food system surveillance for FBPs and AMR

Overall, the PATH-SAFE programme achieved many of its intended outcomes. However, it has had a limited impact on business as usual surveillance practices to date. Some of the insights and methods that PATH-SAFE produced have already informed practice, indicating that PATH-SAFE is progressing towards achieving its long-term aims of improving surveillance outcomes and informing responses to FBPs and AMR. While PATH-SAFE has produced valuable knowledge, in many cases additional investment and action is needed to incorporate insights from the programme into business as usual surveillance approaches, which can be expected of a pilot programme. Outputs from the are still being produced, and funding is being sought to support follow up work, and long-term impact will only be achieved with additional investment.

PATH-SAFE also has the potential to inform wider approaches to cross-government collaboration and One Health surveillance in the UK. Along with insights from individual projects, there are cross-programme lessons about what works in coordinating across surveillance partners and conducting One Health surveillance. For these insights to be preserved and to disseminate them to decision makers, outputs that communicate programme-level lessons would be helpful, which are currently planned as of March 2025.

5.2. Recommendations

The evidence collected in this evaluation point to several recommendations to maximise the impact of the investment in surveillance that occurred through the PATH-SAFE programme, and to help ensure that lessons from the programme are incorporated into practice. The following recommendations focus on maximising impact from the programme, in the context of the programme ending in March 2025:

Long-term investment to support further investigation, implementation and scale up: PATH-SAFE produced useful data, methods and tools, and insights about FBPs and AMR that can help inform decision making. A dedicated follow-up funding package (with clear departmental ownership and follow up actions) should be established for the most promising initiatives to generate evidence on integration within current practices and a cost benefit analysis.^[19] For instance:
- Allocate resources to continue the bulk milk surveillance system that successfully aided the avian influenza response in dairy cattle in 2024, building on the existing relationship with National Milk Laboratories
- Support the expansion of the genomic data platform for Salmonella, E. coli and Listeria that FSS and UKHSA have already committed to trial alongside existing surveillance activities
- Fund further development of wastewater surveillance applications for FBPs, particularly the analysis of wastewater samples routinely collected through UKHSA’s polio surveillance programme
Develop a cross-government surveillance knowledge repository: To help disseminate the knowledge and insights that PATH-SAFE generated, PATH-SAFE management and the core partners involved in PATH-SAFE should:
- Develop a dedicated repository of PATH-SAFE methods, findings, and operational insights, making it accessible to all surveillance stakeholders
- Develop sector-specific guides on surveillance implementation for animal health, food safety, and environmental sectors based on PATH-SAFE’s cross-domain experience and insights generated. This should extend to utilisation of given methods and tools used in the programme
- Convene a policy roundtable targeting Cabinet Office, UKHSA, DHSC, Defra leadership and initiatives, alongside the four nation equivalents. This should serve to develop a strategic roadmap of surveillance design and utilisation across the One Health agenda.
Continued monitoring: The current evaluation is limited in that it cannot assess outcomes and impacts after March 2025, prior to many PATH-SAFE outputs being available. An independent follow-up evaluation should be commissioned in 2027 to
- Track long-term adoption: For example, assess how PATH-SAFE methods or the use of genomic data platform have been integrated into business-as-usual practices
- Measure sustained relationships: Evaluate whether and how the collaboration networks established between agencies like FSA, UKHSA, Defra, APHA, and industry partners have endured beyond the programme
- Determine whether surveillance improvements have contributed to faster outbreak detection or response, as seen in the successful application of bulk milk testing for avian influenza