Two days ago, Matt Hancock announced Public Health England (PHE) is to be axed and replaced by the National Institute of Health Protection. I am about to rebranded for the fourth time in my career in public health and we are running out of colours. We’ve from gone the teal of the Public Health Laboratory Service, to the questionable choice of burnt orange of the Health Protection Agency, to the maroon of Public Health England. While we await to find out if our new PowerPoint slides will have a suitably brown backdrop, one thing is certain: with each colour change, the public can be less certain that the advice we give is truly independent and based on the best available evidence.
PHE has failed according to the government. In what way, is uncertain but it seems to fall under three broad areas: Firstly, the failure to scale up testing as the epidemic accelerated in March, secondly, test and trace and thirdly, the measurement of COVID-19 deaths. Number 1 did not fall under PHE’s remit, it fell to DHSC and the NHS to scale up testing. Number 2 creaked under a privatised system and while the much-promised app did not appear, progress was only made once it was transferred back to local public health experts. Number 3, without PHE taking over this task from DHSC through careful negotiation, the DHSC system would only account for hospital deaths (excluding 30% of COVID deaths) with fewer checks and balances. I am not saying these issues were difficult to handle or preventable, just that blaming one organisation is unfair, untrue and unhelpful.
In reality almost all of the PHE workforce have been focussing on COVID-19. We have developed the COVID-19 antigen and antibody test, undertaken enhanced surveillance from testing, to hospital admission, ICU care to death, developed new reporting systems to monitor COVID-19, provided clinical guidance on an extensive array of settings, undertaking outbreak investigations on unprecedented scales while undertaking our day jobs (unfortunately, people still get E. coli during an unrelated pandemic). Employees have simultaneously received three begging emails from HR (you are working too many hours!), our usual teams (you are needed for business as usual!) and our COVID teams (we are short staffed and desperate!)
No one is saying Public Health England is perfect, and neither are its employees. Ironically, its main fault has arisen from the fact it is directly accountable to the DHSC, which has reduced the speed with which it can react and increased its bureaucracy, It is perhaps true that recent leadership of the organisation has favoured “health improvement” – chronic illnesses such as obesity, mental health, drugs and alcohol, and importantly, seeking to understand and address the structural factors that continue to drive inequalities – over health protection and infectious disease epidemiology. However, while preparations for pandemics have been in constant review, the scale and impact of SARS-COVID-19 has overwhelmed everyone.
The reasons for the creation of the National Institute of Health Protection is clear: by scapegoating PHE the government both absolves itself of any blame and removes the need for any independent enquiry. Any future criticism does not need to be addressed as the matter has been dealt with. This is despite PHE already being accountable to the government. There are also the sinister rumours of privatisation creeping into the new organisation. Hancock alluded to this as the need for a change in culture in working with private partners and inviting key pharmaceutical companies to his speech. It angers me that anyone would see any benefit in spending public money to fund organisations that are themselves motivated by profit than addressing societal need; but then perhaps the government too have now “had enough of experts”.
The epidemic is far from over. What the winter months will hold is difficult to predict but at least some sort of resurgence is inevitable. The very time that should be spent strengthening and building up what is working and developing resource to minimise the impact of a second wave, the organisation will be broken up. The lucky ones among us will probably have to spend their time trying to produce important papers against a back drop of bureaucratic resistance because the brown type face has not yet been signed off. We will be distracted by endless meetings and hours spent filling in spreadsheets justifying our core work in case someone decides to cut our area of work on a whim. The less fortunate of us within health improvement will be trying to see how they fit in already underfunded, fragmented local authorities while dropping the work they were doing to address health inequalities, which itself is critical in understanding COVID-19.
Ultimately, it doesn’t matter what colour is selected for our new logo. In black and white, we just want to get the job done. Bruised, insulted and exhausted, we will continue to work to limit the damage of creating a new organisation tasked with addressing the pandemic, more tightly bound to government than ever before, in a time when all focus should be on addressing the pandemic. This is because we want to prevent deaths, we want to reduce morbidity and unnecessary suffering. We want to address the structural differences in society that causes such enormous disparities in health outcomes overall and in relation to COVID-19. The demise of PHE means we fight harder than ever to do this, and we will continue to use experts and evidence to make a difference.