The future of public health in England

By Sean O'Sullivan, Head of Health and Social Policy on 19 August 2020 Maternity Services

The axing of Public Health England (PHE) and its replacement by a new National Institute for Health Protection (NIHP) raises significant questions about the future of public health services in England.

Weekend reports about the demise of PHE were confirmed yesterday by Matt Hancock, the Secretary of State for Health and Social Care. In a speech to the Policy Exchange think tank, Mr Hancock announced that:

• NIHP will be formed out of the merger of PHE, the Joint Biodiversity Centre and NHS Test and Trace, under the leadership of Baroness Dido Harding (who is currently in charge of NHS Test and Trace). The intention is that this will become a single organisation, operational from spring 2021.
• The Institute will be charged with bringing together the scientific expertise of PHE with the scale and capacity of NHS Test and Trace to tackle COVID-19.
• NIHP will report directly to ministers and support the work of the Chief Medical Officer as well as working with the devolved administrations and local Directors of Public Health
• The Government will consult on the future of PHE’s health improvement responsibilities.

While the Secretary of State may have hoped that his announcement would draw a line under the sand, the changes that he outlined raise more questions than answers.

In particular, with the rate of COVID-19 infections again on the increase and doubts about how much further current restrictions can be relaxed, is now the right time for a major restructuring of the bodies spearheading the pandemic response?

The logic for replacing PHE with a new organisation is also questionable. The Sunday Telegraph report suggested that ministers wanted more control over the management of the pandemic response. Yet PHE is an executive agency of the Department of Health and Social Care (DHSC) and, as such, is already accountable to the Secretary of State and ministers. Since PHE is responsible for fulfilling the Secretary of State’s duty to protect the public’s health, is its abolition more an attempt to deflect criticism from the Government for its handling of the crisis? There may be legitimate criticisms to be made of PHE, but don’t forget that it has been subject to underfunding (as have public health budgets generally) in recent years.

For midwifery, the biggest concern is that the scrapping of PHE will further fragment public health responsibilities and impede progress in promoting good health and tackling inequalities. Beyond the vague promise of a consultation, Matt Hancock’s announcement did nothing to clarify how this work will be continued.

PHE directly manages or commissions programmes of relevance to maternity care, such as immunisation and screening, infant feeding and smoking cessation. These all contribute to making us healthier as a nation and to significantly reducing the pressures on the NHS. We must of course ramp up our ability to fight COVID-19 but in doing so, we should not take our eye off the ball of the public health risks already endemic in Britain.