In Depth

What will Public Health England’s replacement do - and will it succeed?

Critics are questioning decision to hand coronavirus response to the new National Institute for Health Protection

Public Health England (PHE) is to be replaced with a new organisation responsible for dealing with pandemics, Matt Hancock has confirmed.

In a speech on Tuesday, the health secretary (pictured above left with Boris Johnson) said that PHE will be scrapped and control of the UK’s coronavirus response handed to the newly formed (NIHP).

But many health experts have criticised the decision, with the controversy fuelled by the appointment of Tory peer Dido Harding - who oversaw the roll-out of the NHS track-and-trace scheme - as NIHP chair.

Why is PHE being scrapped?

PHE was formed in 2013 as part of a series of government health reforms. An “executive agency” of the Department of Health and Social Care, PHE “was ultimately under the direct control of ministers” and was intended to “protect and improve the nation’s health and well-being, and reduce health inequalities”, says The Times.

The body cost taxpayers a total of £287m in 2018-19, and PHE supporters have “argued that it has faced ‘years of underfunding’ while trying to tackle a particularly wide remit”, the newspaper adds. 

BBC Health Editor Hugh Pym suggests that the organisation was flawed from the start, however, as an “ungainly merger of health protection and prevention initiatives such as obesity strategies”. 

“It was pulled in different directions and had to get by with successive annual budget cuts,” he writes.

The coronavirus pandemic has pushed the system to breaking point, with a number of MPs expressing dissatifaction with PHE’s handling of the crisis

The announcement that the body is being axed comes 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”, The Guardian reports. 

What will the new agency do?

According to Hancock, NIHP will have “a single and relentless mission - protecting people from external threats to this country’s health”. The health secretary said the new body will be “dedicated to the investigation and prevention” of external threats such as pandemics, infectious diseases and biological weapons”.

The “immediate task” will be to deal with the nation’s Covid-19 response, including boosting testing capacity and improving the NHS Test and Trace system, he added.

NIHP will be a national body that operates at a local level, working with councils’ directors of public health and with the devolved administrations of Scotland, Wales and Northern Ireland.

By contrast, PHE operated in just four regions: the north of England, south of England, Midlands and east of England, and London.

And the reaction?

The Royal Society for Public Health (RSPH) has criticised the government for scrapping PHE in the middle of a major pandemic.

RSPH chief executive Christina Marriott said that health leaders “recognise that there have been some serious challenges in terms of our response to Covid-19”, but added that “multiple lessons” need to be learned “before solutions can be in place in advance of the winter”.

“To do otherwise risks avoidable mistakes in subsequent waves of the pandemic which will only harm the public’s health further,” she warned.

Downing Street has also been accused of using PHE as a scapegoat for government failures in responding to the Covid crisis. 

“Public Health England appears to have been found guilty without a trial,” says Richard Murray, chief executive of the King’s Fund think tank.

“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 Guardian notes that 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”. 

Hancock is also facing criticism for handing control of NIHP to Harding, who has limited experience in working in public health. 

“We will find out in due course Harding’s plans to prepare for a future pandemic,” says The Telegraph’s Ross Clark. 

“But I wouldn’t even trust her to get the ‘bring out your dead’ carts onto the street without their wheels falling off.”

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