In keeping with the momentum of 2020, HM Government’s Secretary for Health and Social Care, Matt Hancock, announced via The Telegraph newspaper on a Sunday that he is to axe Public Health England (PHE), merging it with NHS Test & Trace and rebranding it as a National Institute for Health Protection and placing it under direct control of ministers.
Mr Hancock cites PHE’s failings in managing the coronavirus pandemic as his primary motivation for making such changes.
Let’s take a look at this in more detail.
PHE is an executive-agency of the Department of Health and Social Care. It is a distinct body, created through administrative action rather than legal instrument, purposed at delivering an array of public health programmes on behalf of, and within the policy framework of, the Department of Health and Social Care. PHE is led by a Chief Executive, currently Duncan Selbie who has been in post since the inception of the Agency, “who is accountable directly to the relevant departmental minister for delivery and day to day activities” (Cabinet Office, 2018).
So when Mr Hancock describes the apparent failings of PHE, he is describing the apparent failings for which is is accountable. When he states his new Institute of Public Health will be under direct control of ministers, he is describing the exact position of PHE as it is today and has been since it’s founding.
Where did PHE come from? PHE was brought into existence following the passing of the Health and Social Care Act (2012) by the Conservative Government of the time. PHE absorbed a number of other bodies importantly including the Health Protection Agency (HPA), the body tasked at the time with the protecting the country from public health threats such as infectious diseases and bioterrorism. The Health and Social Care Act further complicated the delivery of public health by moving responsibilities from the NHS through to local authorities, creating a tripartite delivery mechanism for public health in the UK.
The creation of NHS Test & Trace (something in my opinion that has nothing to do with the NHS but affixes itself to the positive public perception that comes with the ‘NHS’ badge) is a welcome funding stream in enabling large scale contact tracing, albeit far too late in the day for this current pandemic. Ordinarily this contact tracing responsibility would sit with PHE’s Health Protection Team (HPT).
PHE’s HPTs are a fantastic, knowledgeable and dedicated asset that we should be proud and reassured to know exists. I have had the privilege of working with regional PHE HPT colleagues on a number of infectious disease incidents and outbreaks, from Monkey Pox Virus, to Legionella, and to the current day COVID-19 crisis to name a few. I have witnessed first-hand their expertise and efficiency in activating and mobilising public health networks and tools, such as robust contact tracing, in response to outbreaks.
Their response to the initial few weeks of contact tracing for COVID-19 in my region was a sight-to-behold, but something that quickly grew in resource intensity and rapidly became too much for the organisation to handle without more resource.
Does moving the ‘NHS’ Test & Trace service into partnership with PHE make sense? Yes, of course it does. However the rebranding of the organisation, inevitable senior leadership reshuffle, and apportioning of blame by the Government towards PHE is just shameful.
Everything we know about learning from incidents tells us that apportioning-blame contributes to the camouflaging of lessons. We need a blame-free inquiry, and we need a Government that isn’t quick to pass the buck ahead of any such inquiry.
This restructure is far from a welcome distraction whilst we remain in a global pandemic, at risk of a second wave of infections, and brace ourselves for winter pressures.