View Point: Health experts react to Matt Hancock’s speech

The Health Secretary, Matt Hancock yesterday announced in his speech that Public Health England (PHE) is to be scrapped and to be replaced by a new organisation. 

The newly formed National Institute for Health Protection (NIHP) will be run by businesswoman Baroness Harding.

We spoke to some health experts to understand their views on the matter:

Richard Murray, Chief Executive of The King’s Fund, said:

“Public Health England (PHE) appears to have been found guilty without a trial. It is unclear what problem government are hoping to solve by carving up PHE and redistributing its responsibilities. Undoubtedly, there are questions to be answered about England’s handling of the Covid-19 crisis, but the middle of a pandemic is not the time to dismantle England’s public health agency.”

“The proposed changes could bring greater accountability and transparency to England’s track and trace system. While that would be welcome, the reshuffling of public health duties risks significant collateral damage. PHE’s role goes far beyond pandemic response and includes, among other things, tackling obesity, reducing health inequalities and improving life expectancy, all of which will be key to the country’s recovery once the worst of the pandemic has passed.”

“If the government wants to avoid the mistakes of the past, it must be crystal clear on what it hopes the new National Institute for Health Protection will achieve, how the many other critical public health duties will be delivered across government and how the whole system will be adequately funded.”

Nigel Edwards, Chief Executive of the Nuffield Trust said: 

“The Government risks making a major misstep by dismantling its own Public Health agency at such a crucial time, creating a huge distraction for staff who should be dedicating themselves to the next stage of the pandemic. There is no clear argument as to why this rebranding and reshuffling will solve some of the problems highlighted by the Secretary of State today.”  

“There is no doubt that Public Health England is far from perfect: serious questions should be asked about the agency’s role in some of the failures around testing, contract tracing and PPE in the early stages of the pandemic. But the correct way to respond to these questions is a proper and evidence-led investigation of what went wrong across Government. Without this, we risk a disproportionate response to problems that could be dealt with through straightforward managerial action.”

“Simply dismantling and reconstituting an agency, under the direct control of the same ministers and department as previously, doesn’t seem to hold out much hope of improvement. It also raises many important questions. What exactly will happen to the many other functions of the agency beyond infection control? If Public Health England’s disease control arm has struggled at times, why should merging it with equally struggling Test and Trace programme lead to an improvement for either one?”

Responding to the government’s announcement of plans to establish a new public health agency, Dr Jennifer Dixon, Chief Executive of the Health Foundation, said:

“The pandemic has significantly challenged the health and care sector in England, in particular its preparedness, resilience and management of emergencies like COVID. But reorganising the nation’s public health agency in the middle of a pandemic is highly risky, and its justification, or the nature of the change, hasn’t been fully set out by the Department of Health and Social Care. Public Health England’s (PHE) effectiveness as an agency has been hampered by a 16% funding cut, and a 22% cut to the wider local public health system since 2015.”

“It makes sense to boost PHE’s focus on infection and control and link this more fully to the NHS test and trace programme, and the work of the Joint Biosecurity Centre. But PHE employs 5,500 people, covering a huge range of public health functions across the country – a reorganisation will be a distraction at the worst possible time.”

“Setting up and abolishing or merging national agencies like PHE is all too common, and frequently demoralising, wasteful and lacking justification. PHE has been in place for only 7 years, whereas the Robert Koch Institute in Germany (on which the new agency is apparently modelled) for over 125 years. If the Government wants a longer term focus on health protection in an agency, it must examine its own actions in reducing the stability and resilience of national public bodies over the years.”

“PHE’s responsibilities also include addressing slower burn but equally major, public health challenges, such as growing obesity and avoidable inequalities in health. We’ve seen clearly in the pandemic that those in poorest health are themselves at greatest risk of COVID-19. If the country is to be levelled up as the government pledged, the national coordination and oversight of wider public health that PHE currently provides to local authorities will need equal focus and investment. This starts with a proper cross government strategy to tackle inequalities by focusing on the most deprived areas.”