Public Health England was set up to fail; will history repeat itself?

by Natalie Rhodes – PHM UK working group member

In August it was announced (via The Sunday Times…) that Public Health England (PHE) is to be merged with the NHS Test and Trace and the UK’s Joint Biosecurity Centre, marking the end of public health in England as we know it. A new organisation will be set up called the dawn of the ‘National Institute for Health Protection’ (NIHP), expected to be in operation from Spring 2021.

The government’s decision to announce the disbanding of PHE in the middle of a pandemic strikes as an interesting, and dangerous, choice of timing. It also came at a time when the government has been using PHE as a scapegoat to pass the blame for their poor COVID-19 response. Whilst there’s no denying that PHE should have been able to better respond to the pandemic, it’s crucial that we acknowledge the damage done to public health in England over the past decade and be wary of the NIHP meeting the same fate.

PHE’s plagued past

The formation of PHE in 2013 was itself the result of a restructure of several health bodies, most notably the former Health Protection Agency. They were originally established to serve as an arm’s length body, meaning that whilst it was still accountable to parliament it was not a ministerial department, this protected it from political influence to a certain extent. However, PHE lost this privilege and became an executive body of the Department of Health and Social Care. This meant that it lost its ability to act as an independent voice, allowing it to be influenced by political priorities. Additionally, over the course of its short 7-year existence, the PHE’s funding was cut by 40%, leaving it severely underfunded and under-resourced, undermining its ability to respond to COVID-19..  

What does the future hold for NIHP?

The NIHP is yet to be in operation, but we are already seeing the all too familiar shadow of privatization and corporate takeover loom over the new agency. For example, it’s reported that McKinsey & Co, the consultancy company known for its secretive and widespread role in global health, was paid over half a million pounds to determine the vision, purpose, and narrative of the new body. This demonstrates the government’s continued efforts to outsource public services to the private sector.

The appointment of Dido Harding as interim CEO of NIHP has been criticized for its complete lack of transparent or open selection process which has been seen by some as an act of cronyism and nepotism owing to her strong political connections. Harding is a Tory MP with a strong corporate rather than health background. She used to head up TalkTalk and is currently leading the NHS (read: Serco) Track and Trace program, both roles which have attracted strong criticism. It may seem surprising that someone with no substantial public health experience is to run the organization that is responsible for protecting the public health of a nation. However, her strong private sector knowledge fits in well with the government’s vision of a progressively privatized health system.

Despite the hefty price tag attached to developing the purpose of the NIHP, it is still unclear what its plans are for public health beyond responding to infectious diseases. This represents a worryingly poor level of understanding of the role of public health and of wider social determinants of health, including issues such as poverty, housing, and structural racism to name just a few.  We hope that the current narrow focus of NIHP is simply just a PR exercise to boost morale in the government’s response to COVID-19, and not indicative of a long term lack of focus on other crucial roles of public health.

It’s not too late, we all have a role to play  

Despite this, we should not yet give up hope for public health. We hope that our words are not solitary ones and serve to echo the concerns of others who are also passionate about public health and fighting for health justice. You then help us disseminate our message by sharing this blog or writing to your local MP.

Public health is so much more than infectious disease, it is about protecting people, improving health outcomes, and tackling inequality. We must not let the NIHP be held back by austerity, we need investment in a public health body which serves the public first and not just viewed as a punchbag or as an item up for sale. Investment in public health is investment in a stronger and healthier country. 

 


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