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Covid: Matt Hancock unveils National Institute for Health Protection Health chiefs attack 'risky and unjust' decision to scrap PHE
(about 5 hours later)
Health secretary says body will protect public against pandemics, infectious diseases and external threats Replacement of Public Health England by new body prompts widespread criticism
The government’s new public health agency will protect the public against external threats to the UK, pandemics and infectious diseases, Matt Hancock has pledged. The abolition of Public Health England is hugely risky and will distract staff who are working hard to stop a second wave of Covid-19, major health bodies have warned ministers.
The health and social care secretary made the announcement on Tuesday as he unveiled the National Institute for Health Protection, which is being created after the controversial scrapping of Public Health England (PHE). The government’s decision to axe PHE and replace it with a new National Institute for Health Protection prompted widespread criticism and claims that it was simply “shifting deckchairs”.
Speaking at the Policy Exchange thinktank, Hancock said: “To give ourselves the best chance of beating this virus once and for all – and of spotting and being ready to respond to other health threats, now and in the future, we are creating a brand new organisation to provide a new approach to public health protection and resilience.” The health secretary, Matt Hancock, is scrapping the agency after weeks of speculation that ministers, including Boris Johnson, were unhappy with its performance over the testing of coronavirus swab samples and tracing of people suspected of being infected, especially early in the pandemic.
He said the institute would bring together “the expertise of PHE with the enormous response capabilities of NHS test and trace and the Joint Biosecurity Centre to put us in the best possible position for the next stage of the fight against Covid-19 and for the long term”. However, doctors and hospital bosses have leapt to PHE’s defence and branded the move unfair, unjustified, and part of a government effort to distract from its own failings over Covid-19.
Hancock confirmed that Dido Harding, the current boss of NHS test and trace, would lead the new organisation in its first few months, as the Guardian had revealed earlier. Critics have questioned her suitability for the role given the test and trace operation’s poor track record in tracking down carriers of coronavirus, getting them tested and disclosing the details of their close contacts. “Public Health England appears to have been found guilty without a trial,” said Richard Murray, the chief executive of the King’s Fund, the influential health thinktank. “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 unveiling of the institute was accompanied by continuing criticism by health experts of the government’s decision to scrap PHE, which was motivated by ministerial frustration at its performance during the pandemic. The shake-up is being pushed through even though the government admits it does not know who will take forward PHE’s work in tackling obesity, reducing smoking and tackling health inequalities, as the new institute will not be responsible for them under the current plans. It will be formed from a merger of PHE, NHS Test and Trace and the Joint Biosecurity Centre, the last two of which were only set up in recent months as part of the response to the pandemic.
Nigel Edwards, the chief executive of the Nuffield Trust thinktank, 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. The failure to spell out who will drive forward the prime minister’s new anti-obesity strategy just two weeks after its launch drew a warning that without a government agency taking responsibility, the country’s battle to lose weight could be lost.
“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?” Christina Marriott, chief executive of the Royal Society for Public Health, said: “Covid-19 makes it vitally important that prevention is not sidelined – but so does every year when 40% of avoidable deaths are as a result of tobacco, obesity, inactivity and alcohol harm. Clear national leadership on this is critical for the public’s health. The uncertainty created by today’s announcement is not acceptable.”
Harding claimed that bringing together PHE, NHS Test and Trace and the JBC would boost Britain’s efforts to limit the damage done by the Covid-19 pandemic, which has so far resulted in more than 65,000 deaths, according to the Office of National Statistics. “[It] puts us in the strongest position to stop the spread of the virus [and is] designed to strengthen our response, and to radically ramp up our fight against this disease, whilst also protecting PHE’s essential work beyond Covid that is so important for the nation’s health.” “The reorganisation will be a distraction at the worst possible time,” said Dr Jennifer Dixon, chief executive of the Health Foundation. “Setting up and abolishing or merging national agencies like PHE is all too common and frequently demoralising, wasteful and lacking justification.”
Michael Brodie, the chief executive of the NHS Business Services Authority, has been appointed as the institute’s interim chief executive officer. But there will be “a global search” for the senior figures to lead the body in the longer term, Hancock said. Ministers cut PHE’s budget from £397.9m in 2015 to just under £300m this year and cut the public health grant that local councils in England receive by 22% over the same period. They must look at their own record on those decisions when apportioning blame for public health failures, Dixon added. Outgoing PHE chief executive Dun Selbie is becoming a senior adviser to the Department of Health and Social Care.
However, with the new institute focusing on Covid-19 and the threat from other infectious diseases, it is unclear who will be responsible for key areas of public health work, such as efforts to keep people healthy by tackling obesity, smoking and alcohol misuse. Nigel Edwards, chief executive of the Nuffield Trust thinktank, said: “There is no clear argument as to why this rebranding and reshuffling will solve some of the problems highlighted [by Hancock].
The Department for Health and Social Care (DHSC) said that “preventing ill health and reducing health inequalities also remains a top priority”. But it appears to have no clear plan as to who in government or the public sector will undertake such work in the future. “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,” added Edwards, who labelled PHE’s abolition “disproportionate”.
It simply said that “over the coming weeks and months the DHSC and PHE experts will engage on future options on decisions around the future of PHE’s remaining health improvement functions, including how to support a successful wider public health system to ensure we have the best possible capability and capacity to support people to improve their health”. In a speech on Tuesday at the Policy Exchange thinktank, Hancock insisted that the creation of the institute would “put us in the best possible position for the next stage of the fight against Covid-19 and for the long-term”. It will focus on external threats to the UK, pandemics and infectious diseases.
Duncan Selbie, whose post as PHE’s chief executive is disappearing with its abolition, is taking on a new role as a senior adviser to the DHSC on global and public health. He confirmed that Dido Harding, the Conservative peer who already runs the widely criticised NHS Test and Trace programme, will chair the new body, as the Guardian revealed on Monday.
Liberal Democrat leadership contender Layla Moran MP dubbed Harding’s appointment “a reward for failure”, given Test and Trace’s poor record in ensuring that coronavirus carriers and their close contacts were found, tested and urged to isolate to reduce the risk of transmission. It has so far only managed that with 78% of identified cases of the virus and 72% of their contacts, despite being handed £10bn by the Treasury, much of which is going to the private firms carrying out the work, Serco and Sitel.
Harding, who also chairs the health service regulator NHS Improvement, said the coming together of the three organisations would “strengthen our response [and] radically ramp up our fight against this disease”. She will lead PHE’s successor until a permanent chair is recruited.
Dr Richard Horton, editor of the Lancet medical journal, tweeted: “So. Farewell then, PHE. You stood up for public health against governments that slashed public health budgets over a decade. And now you have to take the blame for one of the worst national responses to Covid-19 in the world. Strange, no?”