Quango Unchained: Government launches plan to scrap Public Health England

August 25, 2020

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3 min read

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What's going on here?

With ministers unhappy with the way Public Health England (PHE) has responded to COVID-19, Secretary of State for Health, Matt Hancock, has announced that PHE is to be replaced.

What does this mean?

PHE was formed in 2013 as part of a reorganisation of the NHS in England. It currently has 5,500 full-time staff who are involved in preparing and responding to health-related emergencies.

In August 2020, PHE attracted criticism after it had been reporting significantly more deaths than those collated by the Office for National Statistics. PHE’s estimates included anyone who had died after a positive COVID-19 test regardless of how long ago that test was. Following the introduction of a UK-wide methodology to record COVID-19 deaths, the accumulated death toll decreased by 12%.

The new agency, the National Institute for Health Protection (NIHP) will merge PHE with the NHS Test and Trace service and the Joint Biosecurity Centre. This model is based on Germany’s Robert Koch Institute which took control of Germany’s response to the pandemic and oversaw 113 COVID-19 related deaths per one million people compared to the UK’s 638. Hancock hopes that the NIHP will be better placed to anticipate and mitigate any risks of a second COVID-19 wave.

However, due to the details and timing of this reshuffle, many believe that Hancock’s plan is an attempt to divert attention away from mistakes made by the government.

What's the big picture effect?

Critics have been quick to point out the dangerous timing of Hancock’s restructure. Although NIHP will not be formally operating until April 2021, the three bodies will begin working together immediately. The Institute for Government (an independent think tank seeking to improve the government’s effectiveness) conducted a report in November 2019 which found that the first few months of organisational changes can have a detrimental effect on productivity and morale. This means that in the face of a second wave, NIHP employees could be distracted from their efforts against COVID-19.

Many are also concerned over the threat to independence this reshuffling has. Although NIHP, like PHE, will be structured as a quango, meaning that it is at arm’s-length from the government, Hancock’s decision to appoint Baroness Dido Harding as NIHP’s interim chief will likely see a different power dynamic. Harding has been a Conservative life peer since 2014 and is married to a Conservative MP and member of a right-wing advisory board which campaigns to scrap the NHS in favour of an insurance system. Appointing a leader whose politics are analogous to the government’s could mean NIHP will be less autonomous than PHE. Aside from this threat to the NIHP’s independence, questions have arisen as to Harding’s experience. Harding is currently the head of the NHS’ Test and Trace system which, despite the system undergoing a series of evolutions, is still criticised due to its lack of effectiveness.

In November 2017, a peer review of PHE was conducted by the International Association of National Public Health Institutes, which seeks to improve nations’ disease prevention and response. Eight international experts (including Lothar H. Wieler, president of the Robert Koch Institute) found that “PHE is a strong, capable, coordinated, united and efficient public health agency that rivals any in the world”. Alongside a number of recommendations and further commendations, the report underlined the importance of PHE as an unbiased source of scientific advice to political leaders.

The reduction in operational independence and the dangerous timing of this restructuring add to critics’ concerns of how the government is handling COVID-19. Regardless of whether Hancock’s plan is an act of scapegoating in the face of a public inquiry or a genuine attempt to mitigate a second wave, considering PHE’s budget has been slashed annually since its creation, a rebranding might not solve the problem.

Report written by Keir Galloway Throssell

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