Andrew Dismore

At today’s London Assembly Mayor’s Question Time, Andrew Dismore AM, Labour London Assembly member for Barnet and Camden raised concerns over the Government decision to abolish Public Health England. (Video here)

Mr Dismore said:

‘The Government has decided to scrap Public Health England. You may be aware that PHE is based in Colindale in my constituency, and is a major local employer. Do you agree with me that the decision to scrap PHE is a political move by the government in order to scapegoat them for their own poor response to the COVID crisis. Do you further agree that the middle of a global health crisis is the worst possible time to scrap the body leading the national response to the virus? Given the high toll of Coronavirus on London, its loss is especially devastating to this city, isn’t it?’

The Mayor said that the National Institute for Health Protection is working on an interim basis until next April, in the middle of the biggest pandemic anyone has ever seen, which doesn’t make sense. When doing crisis management, few would advise a reorganisation of structures, unless you were aiming to deflect attention. This is what is driving cynicism and conspiracies.

The Mayor urged the government to focus on dealing with the virus, working collegiately with others, and then look at lessons to be learned later. That could well involve reorganising Public Health England, but the Government are making changes to their structures before an inquiry has been done to look at lessons learned.

ENDS

Notes for editors

The National Institute for Health Protection

This new body brings together NHS Test and Trace, PHE, and the Joint Biosecurity Centre. Announced on 18 August, a single leadership structure was effective “immediately”. The three organisations will be merged sometime after winter.[1]

Baroness Dido Harding, currently head of NHS Test and Trace, has become the interim executive chair of NIHP. Baroness Harding has been criticised for the poor performance of NHS Test and Trace, the delay to a tracing app, and the lack of engagement with borough public health teams.[2]

Michael Brodie has been appointed interim CEO for PHE, replacing Duncan Selbie who will depart imminently, having run PHE since its establishment in 2013. Brodie is currently the chief exec of NHS Business Services Authority, responsible for various administrative and commercial management for the rest of the health service.

Changing roles in public health

In a speech launching NIHP, Health and Social Care Secretary Matt Hancock said “The National Institute for Health Protection will have a single and relentless mission: protecting people from external threats to this country’s health”.[3]

Though PHE will become part of the new structure, its prevention and health promotion roles are likely to disperse across other bodies. Hancock said:

“Levelling up health inequalities and preventing ill health is a vital and a broad agenda. It must be embedded right across government, across the NHS, in primary care, pharmacies, and in the work of every local authority.

“So we will use this moment to consult widely on how we embed health improvement more deeply across the board, and I’ll be saying more on this over the coming weeks.”

Thus NIHP’s role is rooted in health security rather than health inequalities, prevention and promotion per se. The Health Secretary indicated it would have an interest in these fields where they create greater vulnerabilities to external threats, such as with obesity and covid-19. It will maintain PHE’s duties around controlling the spread of disease, but with a focus on the capabilities required for infectious disease rather than non-communicable illness.[4]

Localism and partnerships

Several boroughs set up their own contact tracing efforts out of frustration with the national project.[5] This led to Test and Trace changing its operations to move 6,000 contact tracers into dedicated local area teams, including supporting door to door contacts where other methods fail.[6]

Directors of public health will remain borough employees. Their national chain of command seems likely to transfer to the new structure, but it is not clear what this means for their health inequalities role.

The Government intends for NIHP to partner with private sector and academic organisations more actively than PHE. They have mentioned the Robert Koch Institute in Germany – another suitable comparison may be DARPA in the USA.

 

[1] NIHP needs a nippy start, HSJ, 19 August 2020 https://www.hsj.co.uk/daily-insight/daily-insight-nihp-needs-a-nippy-start/7028263.article

[2][2] NHS Test and Trace’s national call centres fail to reach almost 40% of contacts, The Independent, 14 August 2020 https://www.independent.co.uk/news/health/coronavirus-nhs-test-trace-call-centres-contact-figures-a9668536.html

[3] The future of public health, DHSC, 18 August 2020 https://www.gov.uk/government/speeches/the-future-of-public-health

[4] Government creates new NIHP, DHSC, 18 August 2020 https://www.gov.uk/government/news/government-creates-new-national-institute-for-health-protection

[5] Local authority sets up test and trace system, the Guardian, 4 August 2020 https://www.theguardian.com/uk-news/2020/aug/04/local-authority-blackburn-with-darwen-sets-up-test-trace-system-english-scheme-covid

[6] NHS Test and Trace service to strengthen regional contact tracing, DHSC, 10 August 2020 https://www.gov.uk/government/news/nhs-test-and-trace-service-to-strengthen-regional-contact-tracing