Scrapping Public Health England won’t be a quick win, ministers warned

IfG says new National Institute for Health Protection faces same problems as predecessor with added disruption from reorganisation
Matt Hancock Photo PA

By Jim Dunton

26 Aug 2020

The Institute for Government has warned ministers that replacing Public Health England with a new National Institute for Health Protection will cause disruption amid the ongoing pandemic and might not even fix the problems faced by PHE.

Last week, health secretary Matt Hancock confirmed that PHE – created in 2013 – would be scrapped, with the new NIHP focusing on work to combat biological weapons, pandemics and infectious diseases. The future of PHE’s preventative work targeting cancer, tobacco and obesity is yet to be detailed.

But Whitehall-focused think tank the IfG has cautioned that replacing PHE with a new agency will not solve the problems it encountered or improve accountability to ministers – and the move will serve as a distraction for professionals whose primary focus should be on dealing with Covid-19.

Researcher Sarah Nickson said last week that while PHE had been criticised for the slow build-up of its testing capacity, its failings – such as excessive centralisation – were shared by ministers responsible for the agency, however much those lines of accountability had been played down.

“PHE is an executive agency of the Department of Health and Social Care, so its ministers were always responsible for any missteps,” she said. 

“But the idea of PHE as an untamed quango, at arms’ length from the control of frustrated ministers, was allowed to persist both inside and outside government.

“Dominic Cummings, the prime minister’s chief adviser, had reportedly been considering emergency legislation to take control of PHE before discovering, in June, that it had been reporting to health department ministers all along.”

Nickson said NIHP would have the same status as PHE, with the same level of ministerial control, and the government would find it harder to evade responsibility in future now it had been stressed that the agency would report directly to ministers. 

“If the government was looking for someone to blame for gaps in its pandemic response, PHE was an easy target: it made mistakes on testing and had long raised ire on the conservative side of politics for its perceived ‘nanny state’ approach to obesity, smoking and alcohol,” Nickson said.

“But in replacing it with a new agency, in the middle of a pandemic, the government risks replacing one problem with another.”

She said PHE’s centralised approach to its work had contributed to the problems it had faced and that NHS Test and Trace had also struggled to balance central co-ordination with local input.

“It is unclear how folding these bodies into a new one will improve willingness or ability to collaborate with other parts of government, local authorities or the private sector,” Nickson said. “If ministers were unhappy with PHE’s methods, it was always open to them to direct PHE to change this.”

Nickson said that although NIHP would not be formally operating until spring 2021, setting it up during a pandemic would be an enormous task. 

“The changes announced by the health secretary are far from cosmetic – civil servants working for NHS Test and Trace and the Joint Biosecurity Centre will be brought into the new agency, while those working on the preventative side will be moved to a new location, which is yet to be determined,” she said.

“Organisational changes within government are highly disruptive at the best of times – let alone in the middle of a pandemic. 

“Past institute research has shown that these changes can take years to bed down, and in the first months of a new or refocused department or body, civil servants can be distracted trying to make the organisation work instead of focusing on the policy issues it has been set up to deal with.”

Following Matt Hancock’s announcement that PHE was being scrapped the organisation’s chief executive, Duncan Selbie, told staff he was stepping down. NHS Business Services chief exec Michael Brodie will serve as interim chief until the appointment of a new leadership team.

Meanwhile, former TalkTalk chief executive Baroness Dido Harding was appointed as chair of the NIHP. The Conservative peer was already head of NHS Test and Trace. 

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