Public Health England (Dissolution) (Consequential Amendments) Regulations 2021

The House of Lords Secondary Legislation Scrutiny Committee noted in a report published on 16 September 2021that the regulations were “an instrument of interest”, due to the regulations making consequential changes to legislation that had referenced Public Health England. While Parliament was denied scrutiny and consultation was conspicuous by its absence, reaction to the dissolution of Public Health England was far from positive, with more than 70 health organisations, including the Academy of Medical Royal Colleges and the Faculty of Public Health, signing a joint letter.

The signatories were “deeply concerned” that the plans paid

“insufficient attention to the vital health improvement and wider functions of Public Health England”,

including necessary measures to target smoking, obesity and alcohol and to improve mental health. The signatories argued that it was a “false choice” to

“neglect vital health improvement measures”

to tackle Covid-19. I reflect that this is an observation repeatedly pursued in debates and Questions in your Lordships’ House.

Alexis Paton, chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians, argued that the decision to dissolve Public Health England was an attempt by the Government to save global face as a result of their response to the pandemic. Ms Paton stated that Public Health England had nearly 60 targeted programmes to improve health and well-being across the population, and that the loss of any of these services was too high a cost to pay. At the same time, the chair of the British Medical Association’s ruling council, Dr Nagpaul, queried the timing of this decision, questioning whether it was the right time for a major restructure, given the very immediate need to respond to the pandemic. Clearly, it was not the right time. The King’s Fund also stated that the Government’s decision to replace Public Health England with two new bodies would

“increase complexity locally and nationally”,

and indeed this is the case. There were also warnings that the restructuring of Public Health England would sap morale and focus and should have waited until the end of the pandemic.

I am grateful to the BMA for its views on this matter, including that the solution was not to reorganise in the middle of a pandemic but instead to restore funding and capacity, including increased support to local public health services. The BMA observes that previous reorganisations of public health services have not improved public health provision or the experience of the workforce, and that health inequalities have in fact worsened since the last reorganisations—even more so during the pandemic. Concerningly, the BMA also reports that morale is low, with widespread fatigue and burnout, while staff have also experienced inadequate consultation on the restructuring, despite the fact that they would have had so much to offer.

In a survey of public health doctors at the beginning of the year, over 60% said that they believed that the new form of organisation would actually worsen doctors’ ability to respond to public health challenges. Nearly two-thirds said that they were not confident that they would be able to contribute to the design of the new system, and almost three-quarters of respondents to a survey said that they had no confidence that the successor organisation to Public Health England would be sufficiently independent or able to speak truth to power. This is a serious charge sheet from those who work in the field and seek to improve the health of the nation by prevention rather than cure. I put it to the Minister that in the face of all this, it is hard to see how the new bodies could be independent or effective. They are not set up in statute and were created without parliamentary scrutiny or approval. I will be listening closely to the Minister’s response to the substance of this regret Motion. I beg to move.

I hope the Minister will also pay tribute to Duncan Selbie and PHE. When it was announced that PHE was to be abolished, I was shocked. It was hard not to believe that PHE institutionally and Duncan Selbie personally were being scapegoated for the Government’s own failures in the early stages of the pandemic. Of course, I wish the successor institutions well and look forward to working with them through the APPG and the National Centre for Creative Health. It is a shame, however, that Mr Selbie was cast aside.

I am concerned that the “build back better” plan envisages shifting the NHS towards prevention only as a long-term priority. However, integrated care systems surely offer an early opportunity for the NHS to work better with local authorities and the voluntary and community sector, including arts providers, on prevention. Will the Office for Health Improvement and Disparities be working with other government departments responsible for education, housing and employment in addressing the social determinants of health?

I hope we can be reassured this evening that the Government recognise their error in having reduced the public health grant by no less than 24% per head over the last six years, with terribly damaging consequences, and that the restructuring that has now occurred is intended to provide more, rather than less, support for public health.

It is noticeable that, on 13 July, the Government published a document setting out UKHSA’s remit and priorities, in the form of a letter from the noble Lord, Lord Bethell, then Parliamentary Under-Secretary of State for Innovation, to Dr Jenny Harries, the UKHSA’s chief executive. It stated that:

“UKHSA is accountable to the Secretary of State for Health and Social Care and the Parliamentary Under Secretary of State for Innovation”,

which I think means to the Minister, but unlike PHE, the letter from the noble Lord, Lord Bethell, made no reference to UKHSA having operational independence from the Government. I ask the noble Lord, Lord Kamall, whether that omission was deliberate.

I have the same question about the Office for Health Improvement and Disparities. We are not debating that tonight, but it comes within the package of new measures that are being brought in. This is not, I understand, an executive agency but is described on the Government’s website as “a high-profile group”. The website does state that

“OHID is part of the Department of Health”,

So, again, there is no pretence at independence.

We are at risk of repeating the same mistakes that occurred with PHE. Ministers proclaim these new bodies, they are given a veneer of independence, but as soon as something goes wrong, or Ministers do not like the messages—and they often do not like the public health messages these bodies give out—Ministers jump in and attempt to micromanage. Accountability is confused, reporting lines are blurred, the public are certainly confused and Parliament is unable to scrutinise them effectively because they come within the Minister’s responsibilities as part of the department.

Of course, the ultimate test of these arrangements is how they will work if another dreadful pandemic hits us, or in relation to how we will improve the overall health of the people of this nation. Clearly, the jury is out on that—we do not know—but I would have more confidence if these bodies were more independent and subject to much greater parliamentary scrutiny than they are apparently going to be.

Let us remember that, at the beginning of 2020, the King’s Fund produced a report saying that it thought that the public health reforms had worked but they had not been sufficiently funded. Internationally, Public Health England was regarded as being as prepared for a pandemic as virtually any other country in the world. That things fell down needs to be thoroughly examined by an inquiry. An inquiry has not even begun, yet we are already at the point where people have made judgments, reached conclusions and found scapegoats. Heads and deputy heads have rolled.

We are not going about this in the right way. I want Ministers in due course to think again in the light of the report of that inquiry about what constitutes the right mechanism for managing their public health responsibilities. They need an organisation that understands public health in its entirety. How many of us think that the pandemic was unrelated to the extent of non-communicable diseases in this country, to the extent of disparities in this country and to extent of the obesity epidemic that we suffered?

We have so many interconnections between inequalities and public health problems, and our resilience against communicable diseases, that we should never think of managing public health in separate, siloed organisations again, but that is exactly what the Government are doing, without, frankly, having thoroughly understood what happened in in 2020 and 2021. I hope that they will go back and say, “Prevention is not the job of the NHS. Prevention is the job of the Government.” Public Health England was the organisation whose job it was to do that. If it was not strong enough in 2020 to do it, Ministers might look at what they did in the preceding years that might have undermined that role and think carefully about how they should take on the responsibility of building an integrated and fully functioning public health organisation for this country in the future, certainly not simply fragment it.