Predictably, the decision to scrap Public Health England as the coronavirus pandemic continues to rage, replacing it instead with a new organisation to be headed by Baroness Dido Harding, has provoked widespread criticism and outrage across the health sector.
The organisation – certainly not without its flaws – has been “found guilty without a trial”, according to Richard Murray, the chief executive of the think The King’s Fund. “It is unclear what problem government are hoping to solve by carving up PHE and redistributing its responsibilities.”
Health secretary Matt Hancock has vowed that its replacement, the National Institute for Health Protection (NIHP), will begin work with immediate effect and bring together PHE and NHS Test and Trace, as well as the analytical capability of the Joint Biosecurity Centre under a single leadership team, to “strengthen” public health.
Others are less hopeful. The government has been accusing of trying to “shift the blame”, as shadow health minister Jonathan Ashworth put it, and using PHE as a scapegoat for its own failed decision-making. Questions have rightly been raised of the timing, while industry experts and NHS bosses have asked how this structural overhaul will actually improve the country’s handling of the pandemic.
“A structural reorganisation mid-pandemic is time consuming, energy sapping,” Mr Ashworth added. “It’s risky, indeed irresponsible.” Fellow Labour MP Alex Norris said that the government should be moving in the direction of decentralisation, not away from it. “The real shift we need is towards an effective local test-and-trace system that delivers mass testing and case finding,” he warned.
Mr Hancock has argued that bringing all operational activities “under one roof” will help to streamline the nationwide effort in tackling Covid-19, but such an approach fails to take into consideration the inherent weaknesses which have so far hampered England’s response.
Take Test and Trace as an example. This “world-beating” system has proven itself anything but. The contact tracing service, partly outsourced to private companies like Serco and Sitel, failed to reach almost 40 per cent of people in close contact with those who tested positive for Covid-19 in the week ending 5 August. These sort of statistics have hung over the system since it was first launched.
Amid intense criticism that the programme is simply not for purpose, the government recently cut the number of contact tracers by a third and redeployed the rest of the workforce to coordinate with local health authorities, in what the Department for Health and Social Care described as a “new way of working” and a “more tailored service”.
For months, public health directors have called on the government to hand responsibility for Test and Trace to local authorities, and while No 10 appears to have finally caved, the decision to now centralise this service under NIHP is likely to create fresh friction between the national and regional forces working within this space.
As well as Test and Trace, and all the issues wrapped up in this, the NIHP will also be absorbing a vastly underfunded PHE. The health body has suffered from repeated cuts in recent years, meaning it was ill-prepared to tackle the pandemic from the offset. Despite the UK’s scientific strengths inside and outside PHE, it “wasn’t set up for success”, says Dr Beth Thompson, head of UK/EU Policy at Wellcome. The concern, then, is that rather than addressing PHE’s shortcomings, they will merely be subsumed by Mr Hancock’s new agency – with no real solution on offer.
Then there’s the matter of Ms Harding, the Conservative peer whose failed running of Test and Test, lack of medical expertise and previous experience as chief executive of TalkTalk – a company repeatedly rated among the worst broadband providers in the UK – has seen her fall upwards and appointed as interim chief of the NIHP.
Mr Hancock has said the new institute would have a “single and relentless mission” of protecting people from external health threats including a second wave, future pandemics, biological weapons and infections diseases – but many have pointed out there is little in Baroness Harding’s history to suggest she has the qualifications or know-how to oversee these sort of operations.
The same goes for those health issues which PHE has traditionally dealt with and that extend beyond the pandemic, such as obesity and sexual health. “What the hell does Dido Harding know about cervical screening, substance misuse, sexual health, contraception, smoking cessation, obesity or even pandemic planning?” asked Labour MP Jess Philips in the wake of the peer’s appointment, with little detail yet to be provided on how the NIHP will cater for these vital areas of public health.
Her new role “makes about as much sense as Chris Whitty being appointed the Vodafone head of branding and corporate image”, said Dr Michael Head, a senior research fellow in global health at Southampton University.
The health secretary has defended Baroness Hardy, saying that she has helped to build one of the world’s largest diagnostic systems “essentially from scratch”, while emphasising her “excellent” external experience as a prominent British businesswoman. Others will argue that she has served as chair of the regulator NHS Improvement since 2017, a role in which she quickly adapted to the demands and pressures of health policy.
But despite this, her appointment to what is now surely one of the most important positions in the national health system has garnered little support. That her husband is MP John Penrose, who sits on the advisory board of a think tank which called for “the NHS to be replaced by an insurance system”, adds to mounting concern that the government is blurring the lines between the private and public health sectors.
Nigel Edwards, chief executive of the Nuffield Trust think tank, summarised it as such: “The government risks making a major misstep by dismantling its own Public Health agency at such a crucial time, creating a huge distraction for staff who should be dedicating themselves to the next stage of the pandemic.” Indeed, only time will tell how this gamble pans out as the government and country prepares for what is to come during the dark months of winter.
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