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18 August 2020

Matt Hancock’s plan to scrap Public Health England leaves questions unanswered

The Health Secretary's speech gave us no clear picture of the future of the new body.

By Ailbhe Rea

Sometimes you really notice the lack of journalists in the room. The Health Secretary Matt Hancock delivered a speech this morning confirming Public Health England will be scrapped and replaced with a new body. He was speaking at Policy Exchange at what was the think tank’s first in-person event since the beginning of the pandemic. It was streamed online, with a handful of public health experts and leading figures from the private sector attending in person.

Policy Exchange events are typically lively affairs. As its director, Dean Godson, likes to say before opening up the floor to questions after a major speech, “no question is too outrageous”. Today, however, with apparently no journalists in the audience for this major announcement on the structural changes to the UK’s pandemic response – and, crucially, its preparedness for a second wave – plenty of questions went unanswered, because they simply weren’t asked.

The first was over the controversy about the fact that Dido Harding, the Conservative peer and former TalkTalk boss who has led NHS Test and Trace since May 2020, is to oversee the new body. The obvious question to ask was: by what process was she appointed? Between her record to date on NHS Test and Trace, which is failing to meet its target of reaching 80 per cent of contacts of people who have tested positive for coronavirus, her limited public health experience, combined with her known close personal ties both with Matt Hancock and former prime minister David Cameron, there were legitimate questions to ask about whether Harding really is the best person for the job.

Indeed, there was a funny line in the Health Secretary’s speech today about how Harding would “lead the global search” for the new body’s “future leadership”. Is that an indication that, despite the controversy, the Conservative peer will only be an interim leader of the new National Institute for Health Protection? A tacit acknowledgement that, for all of Harding’s extensive private sector experience, more precise sector knowledge will be brought on board soon? Another question left hanging in the air, with no one to ask it.

Public Health England as it has existed since its formation in 2013 is no more. It has been the executive body responsible for, basically, anything “preventative” in our healthcare system: from preventing obesity, to cancer screenings, to identifying chemical, radioactive and environmental hazards, to crisis response. 

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Now, its work in tackling obesity and addiction, among other things, will be handed to local councils and GPs. There’s another unanswered question: given cuts to local councils and the climbing social care costs that they shoulder, will any extra funding be allocated to these priorities, given the Prime Minister’s emphasis on an anti-obesity drive only last month?

What will be left, by merging remaining PHE responsibilities with NHS Test and Trace, is a new organisation no longer tackling the whole gamut of public health, but one with a more streamlined “single and relentless mission” to “protect the country from external threats”, Hancock said. The National Institute for Health Protection pulls together all of the different operational capabilities of our Covid response, and will, the Health Secretary hopes, lead to a “stronger, more joined-up” response in the event of a second wave, combined with a stronger focus on identifying and responding to other potential threats. The crucial promise from Hancock today was that the National Institute for Health Protection will have the “capacity to act fast, and at scale”. 

Most of the debate around Public Health England’s effectiveness in responding to the coronavirus pandemic has centred on the question of testing. It was revealed in May that the decision to cancel mass testing and contact tracing in March was made because testing on that scale would have been beyond the system’s capacity. There followed confusion later in the pandemic response as to which organisation was responsible for developing a mass testing programme, resulting in delays to getting such a system up and running. Public Health England has argued that the buck stops with government, which does ultimately oversee this executive agency; PHE’s staff are civil servants, its chief executive is accountable to ministers at the Department of Health and Social Care, and the figure ultimately responsible for the organisation is the Secretary of State, Matt Hancock. People from Public Health England and elsewhere have also argued that the problem is no organisation was made responsible for testing, while chronic under-funding of PHE meant the organisation couldn’t organise such a programme when requested to by SAGE later in the pandemic. 

This was a question that did actually get asked today, but received no straightforward answer from the Health Secretary: how much extra funding will the new National Institute for Health Protection receive in order to “act fast, and at scale”? And if the funding won’t be there, is the new body doomed to replicate the problems of Public Health England? 

“We couldn’t have done this without the private sector,” Hancock declared today, saying that the role to be played by private companies in responding to external health threats had been the biggest lesson he had learned from the pandemic. Of course, dissenters across politics and health care would argue that such involvement from private companies might not have been necessary, had there been adequate funding for PHE. Is an increased use of, or reliance on, the private sector for the UK’s pandemic response the main implication of scrapping Public Health England?  That’s the biggest unanswered question of all.