It is true that Public Health England has largely failed as the engine of test and trace, but the reasons are complex and systemic (Ministers criticised over plan to scrap Public Health England, 16 August).
PHE was set up in 2013 with statutory responsibility to meet government targets on public health, but its relationship with local public health departments was only advisory, a curious and dysfunctional paradox. It has always been isolated from core healthcare and thus built to fail, unable in practice to pull the necessary levers.
But now is not the time for yet another major restructuring, and the chosen model risks making exactly the same mistakes by creating another overcentralised body, remote from the clinical coalface. We badly need to reintegrate our response to Covid-19 into local public health and general practice, which have been delivering the goods since 1947, but are starved of information and funding. We are instead throwing good money after bad into the private sector. The most beneficial step in the short term would be to mandate the full collaboration of a reinvigorated PHE with local public health departments and the NHS, and the preparation of a joint action plan. It is still not too late to flatten a secondary wave.
Philip Barber
Consultant respiratory physician, Manchester
• In the manner of the revolution devouring its own children, the government has found a convenient scapegoat in PHE, spawn of the misguided Lansley reforms, to carry the can for its mismanagement of the Covid-19 crisis. Warnings were given from the start that the fragmentation of the public health function between central government and local authorities would lead to the loss of clear lines of control, with severe weakening of the ability to respond to a pandemic.
Tory peer Dido Harding, the head of England’s discredited test-and-trace programme, is now to be given the job of sorting out the mess (Dido Harding to run agency replacing Public Health England, 17 August). Given her role as a steward of the Jockey Club, which approved the Cheltenham festival, described by former chief scientific adviser David King as “the best possible way to accelerate the spread of the virus”, her new appointment sounds much like outsourcing responsibility for rearranging the deckchairs on the Titanic to the iceberg. A new comprehensive public health system must be based on the achievement of public good rather than corporate interests and private profit.
Dr Anthony Isaacs
London
• The government’s competence and arrogance is spotlighted by the decision to axe PHE. On the face of it, this is a bewildering rearrangement of the deckchairs at a time of national crisis. But it’s almost certain that beyond governance and senior management, the National Institute for Health Protection will just be PHE with a reworded mission statement.
Beyond this is a deeper issue: we are assured that now is not the time for an enquiry into the handling of the Covid-19 crisis . Yet somehow the government has been able to find the time to reflect deeply on what has happened and conclude that the fundamental problem happens to be with a public body, rather than its own incompetence.
I’m only surprised they had the wits to select a body sufficiently detached from the NHS to avoid even further disquiet. All I can ask is – who feels that they, their families and loved ones are safer as a result of this masterclass in misdirection?
Neil Wyatt
Branston, Staffordshire
