Public Health England dropped the ball on the pandemic — but the new restructuring offers hope
Mike Tyson’s infamous line about everyone having a plan until they get punched in the mouth could be the epitaph for Public Health England.
The quango made many mistakes in its response to Covid-19, but planning for an influenza epidemic was perhaps the most fatal. PHE had swine flu, rather than the SARS coronavirus, in the back of its mind and wasn’t agile enough to change course when it became clear that Covid-19 was a different beast.
It failed in the basic tasks of collecting and sharing data, it was slow to increase testing capacity, and it made the conscious decision to reject the strategy of mass testing that was working in countries like South Korea and Germany.
Its incompetence was later confirmed when it emerged that it had been significantly over-counting the number of Covid-19 deaths in England.
Given that PHE’s primary duty was, in its own words, to “protect the public from infectious diseases and other environmental hazards”, its multiple failures over coronavirus may seem like a “you had one job” situation. But it never thought of itself as having one job.
Instead, much like that other multi-billion pound “public health” agency the World Health Organisation, PHE spread itself thinly over a wide range of medical, political and social issues. Until recently, it was perhaps best known for its obsession with sugar and quixotic crusade to reformulate popular food products. From the outset, it acted as a state-funded pressure group advocating for a range of nanny state policies.
There will be no room for such distractions at the National Institute for Health Protection, the new agency that will replace PHE. When he announced the formation of this new body in August, health secretary Matt Hancock promised it would have a “single and relentless mission: protecting people from external threats to this country’s health”.
Hancock made a clear distinction between “health protection” and “health improvement”. The former involves infectious disease, biosecurity and environmental hazards. The latter involves personal risk factors, such as physical inactivity and smoking.
For too long, both agendas have been muddled together until the banner of “public health”. But of the two, only health protection requires government action. People can make efforts to improve their own health, but they cannot be expected to shield themselves from infectious or environmental threats.
It would be naive to think that the abolition of Public Health England means the government has given up on lifestyle paternalism — only this summer it announced some of the world’s most draconian anti-obesity policies. The question is who will take the lead on the nanny state agenda in the absence of PHE.
Some of the single-issue campaign groups that orbited the PHE mothership will be keen for the government to set up another bureaucratic leviathan in its image, but any temptation to create yet another new agency should be resisted.
The obvious solution is to return public health responsibilities to the NHS and Department of Health. It is easy to forget that PHE is only seven years old. Until 2013, the Health Protection Agency took care of infectious diseases and environmental hazards, while the NHS and Department of Health covered public health campaigns and data collection. The system worked well and there is no obvious reason not to go back to it.
The restructuring offers an opportunity to audit what Public Health England was doing and slash the dead wood. It should not be merely a case of changing management and letterheads. Not everything PHE did was a failure, but it was prone to flights of fancy and sometimes embarked on projects that extended far beyond its remit and expertise. Before transferring its responsibilities back to the NHS and Department of Health, the government should weed out the duds.
PHE dropped the ball on Covid-19. Getting it right next time is a matter of life and death.
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