Following Health Secretary Matt Hancock’s announcement (18 August 2020) that Public Health England (PHE) will be replaced with a new National Institute for Health Protection, Professor Stephen Peckham of the Centre for Health Services Studies (CHSS) says:
‘Since the beginning of July there has been speculation that Public Health would be abolished due to its failure to manage the COVID-19 pandemic. Stories of abandoning Track and Trace in March, a lack of testing, overstating daily deaths and poor leadership have been laid at Public Health England’s (PHE) door by newspapers and politicians. Now Matt Hancock has announced its abolition and the establishment of a new National Institute for Health Protection bringing together the current NHS Test and Trace Programme – which was outsourced to private providers – and PHE’s pandemic response work.
‘The new organisation – apparently modelled on the independent Robert Koch Institute – is to be in place in September 2020. There will be further organisational changes but these will not be finalised until 2021. While there has been much criticism of PHE it is not clear that a major reorganisation in the midst of a public health emergency is either sensible or desirable. While there have clearly been failings in dealing with the pandemic, making PHE take the blame may be missing the point.
‘There has long been criticism of the highly centralised structure of PHE and its lack of collaboration with and support for local authorities. However, PHE fulfils a huge range of roles. While national media attention has been focused on areas such as obesity, PHE’s work in many other areas is significantly important for protecting health. For example, on air quality PHE has provided critical guidance and planning for other central government departments and local authorities.
‘Given PHE was the key national agency for combatting the pandemic, it is plausible that blame for failings can be laid at their door. However, PHE was not, and is not, solely responsible for the pandemic response. Planning and developing responses to the pandemic has been coordinated through SAGE which has advised ministers on potential public health actions. Responses have also been guided by political considerations about when to lockdown, when to impose quarantine, and when to open up sectors of the economy. In his speech today at the think tank Policy Exchange, the Secretary of State acknowledged that while we have some of the best public health services and staff in the world, ‘we did not go into this crisis with the capacity for a response to a once-in-a-century scale event.’ Perhaps the actual problem though is that for many years the Government has been reducing budgets for PHE and local authority public health services and limiting their capacity.
‘So while PHE has been blamed for stopping testing and tracing in March – one of the key reasons for this was that there were insufficient resources to continue, given the rapidly increasing number of COVID-19 cases. The lack of resources and a desire to lead and control everything centrally has severely hindered the ability of our public health system to respond to the pandemic. The new NHS Test and Trace service is a national service provided by a range of private companies including SERCO, SODEXO and Deloitte, and appears to have largely failed to engage with local public health departments. It was contracted to private providers and has proved to be inefficient and failing to provide the level of tracing needed. One of the key problems is that the Government has tried to do everything centrally when what was needed was a close collaboration with local public health services leaving many local authorities trying to plug gaps in the system.
‘Failings in the public health response can just as easily be laid at politicians’ doors for not adequately funding or preparing for a pandemic which has been predicted for many years and those advising nationally. Whether disbanding PHE mid pandemic and replacing it with yet another centrally run organisation that is embedded in the private sector is questionable, and yet again appears to ignore the potential of more locally based services. We are also left not knowing what will happen to the remainder of PHE services – if other areas of public health now suffer because the Government wants to show it is taking action to solve the ‘shortcomings’ of PHE.’