“There is nothing in this proposal that would enable him in my mind to do anything that he can’t already do with his existing powers.” That was Andrew Lansley, the last health secretary to push through a controversial shake-up of public health in 2012, on his successor Matt Hancock’s justification for abolishing Public Health England.
He is not the only one questioning the logic, purpose, timing and potential effects of PHE being merged – via a reorganisation in the midst of the coronavirus crisis – into the new National Institute for Health Protection alongside NHS test and trace and the joint biosecurity centre. It is unusual for a government initiative on health to attract such a wide range of scepticism and criticism, from ex-Conservative MPs, senior doctors, scientists, public health experts and thinktank bosses.
But what the NHS Confederation dubbed an exercise in “shifting deckchairs” yielded that consensus of concern. Dr Sarah Wollaston, until December the Tory chair of the Commons health select committee, said that “seeking to scapegoat them [PHE] is extraordinary after cutting public health funding and excluding local directors of public health from decision-making on Covid.” The move seems rushed, poorly timed and potentially part of an emerging Covid-19 blame game.
It is easy to see why some critics see the shake-up as both the government’s revenge on PHE for all the negative publicity early on in the pandemic around the inability to test more than 2,000 swab samples a day and the abandonment of contact tracing on 12 March, and as a pre-emptive strike on the agency’s reputation ahead of a public inquiry even Boris Johnson agrees is coming. The former was a consequence of PHE’s limited laboratory capacity, as both England’s chief medical officer, Prof Chris Whitty, and the government minister James Brokenshire have acknowledged, while it was ministers, not PHE, who ordered contact tracing to stop.
As Lansley added on LBC radio: “Some of the blame has been placed upon PHE in circumstances where the decisions concerned were the decisions of government.”
Hancock’s move raises many questions. The new body will, like PHE, be an executive agency of his own Department of Health and Social Care. So why not just give PHE clearer orders instead of scrapping it, given all the time and loss of focus involved? And, to quote the Nuffield Trust chief executive, Nigel Edwards: “If PHE’s disease control arm has struggled at times, why should merging it with [the] equally struggling test-and-trace programme lead to an improvement for either one?”
The government has twisted itself into ever more illogical knots over public health since 2010. It wanted “big food” to help tackle obesity – but let an industry whose profits depend on fat, sugar and salt decide how much of those their products should contain. Ministers have regularly stressed the importance of preventing illness and helping people lead healthier lives in order to help the NHS but then cut both PHE’s budget and the public health grant to local councils. Now it is axing a body with a good reputation internationally that Hancock in his speech on Tuesday lauded as “brilliant” for its role in combatting the coronavirus, and replacing it with an untried hybrid new set-up that carries obvious risks.
