Dissolution of Public Health England

In August 2020, the then Secretary of State for Health and Social Care, Matt Hancock, announced that the Government was forming a new organisation, the National Institute for Health Protection (NIHP). In a press release, Mr Hancock stated that the NIHP would immediately “bring together the existing health protection responsibilities discharged by Public Health England (PHE) with the new capabilities of NHS Test and Trace, including the Joint Biosecurity Centre”. He explained that this was the first step towards becoming a single organisation, “focused on tackling Covid-19 and protecting the nation’s health”. However, he also noted that to “minimise disruption” to the work in dealing with the pandemic, the organisation would be formalised and operational from 2021. It would be led by Baroness Harding of Winscombe (Conservative), who was appointed as the agency’s interim executive chair.

In a written statement on 24 March 2021, Matt Hancock announced the formal establishment of the UK Health Security Agency (UKHSA), which was previously the NIHP, from 1 April 2021. The UKHSA, led by Jenny Harries, the Deputy Chief Medical Officer for England, would be tasked with planning “for the risk of future infectious disease pandemics and other major health threats, maintaining this focus both during a crisis and in better times”.

On 1 October 2021, the Government announced the launch of the UKHSA. In a press release, the Secretary of State for Health and Social Care, Sajid Javid, said that the agency would “take on a critical role in protecting the public and ensuring we are prepared for health threats and future pandemics”.

On the same day, the Government also announced the launch of the Office for Health Improvement and Disparities (OHID). The aim of the OHID, which would be led by the incoming Deputy Chief Medical Officer for England, Dr Jeanelle de Gruchy, would be to tackle health inequalities across the UK. In a press release, the DHSC provided further information on the OHID’s remit:

The new body will tackle the top preventable risk factors for poor health, including obesity caused by unhealthy diets and lack of physical activity, smoking and alcohol consumption. It will work across the health system to drive forward action on health disparities, including improving access to health services across the country, and coordinate with government departments to address the wider drivers of good health, from employment to housing, education and the environment.

Purpose of the regulations

The Public Health England (Dissolution) (Consequential Amendments) Regulations 2021 (the 2021 regulations) made consequential amendments to several regulations due to PHE being dissolved. The 2021 regulations’ explanatory memorandum noted that by 1 October 2021 (when the regulations came into force), the following PHE functions would be transferred:

  • the health protection capabilities of PHE and NHS Test and Trace would be assumed by UKHSA;
  • a new Office for Health Improvement and Disparities would sit within the Department of Health and Social Care (DHSC), incorporating PHE’s functions that “directly support national health improvement policy”; and
  • the rest of PHE’s health improvement and healthcare public health functions would move to NHS England and NHS Digital.

Therefore, the amendments in the 2021 regulations saw references to PHE in several earlier regulations substituted with a reference to either the UKHSA, the DHSC, or deleted, as appropriate.

The 2021 regulations were laid before both Houses of Parliament on 3 September 2021 and came into force on 1 October 2021. As an instrument under the made negative procedure, they became law automatically but could have been revoked if a motion to reject them was agreed by either House within 40 sitting days. The objection period ended on 1 November 2021.

Parliamentary scrutiny

The House of Lords Secondary Legislation Committee noted that the regulations were an “instrument of interest” in a report published on 16 September 2021. This was due to the regulations making consequential changes to legislation that had referenced PHE.

The House of Lords is scheduled to debate a regret motion relating to the regulations on 9 November 2021. Tabled by Baroness Merron, the Shadow Spokesperson for Health and Social Care, the motion reads:

Baroness Merron to move that this House regrets that the Public Health England (Dissolution) (Consequential Amendments) Regulations 2021 (SI 2021/974) have been introduced further to (1) the dissolution of Public Health England, and (2) the establishment of the UK Health Security Agency, via secondary legislation and without proper consultation or scrutiny.

Reaction to Public Health England being dissolved

The decision to dissolve PHE had been met with criticism from several health organisations. In September 2020, more than 70 health organisations wrote to the Prime Minister, Boris Johnson, to express their concerns with the Government’s plans. In this joint letter, signatories including representatives from the Academy of Medical Royal Colleges and the Faculty of Public Health stated that they were “deeply concerned” that the plans “currently pay insufficient attention to the vital health improvement and other wider functions of PHE”. This includes PHE’s 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.

Similarly, Alexis Paton, the chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians, argued that the decision to dissolve PHE was an attempt by the Government to “save global face” as a result of its response to the pandemic. In an article for the Independent, Ms Paton stated that PHE had nearly 60 targeted programmes in place to “improve health and wellbeing across the population” and that the loss of any of those services was “much too high a cost”.

Additionally, Dr Chaand Nagpaul, the chair of the British Medical Association’s ruling council, questioned the timing of the decision. In an interview with the Guardian, Dr Nagpaul stated that “we must seriously question whether now is the right time for undertaking such a seemingly major restructure and detract[ing] from the very immediate need to respond to the pandemic”.

The decision was also criticised by several MPs. Both the Shadow Secretary of State for Health and Social Care, Jonathan Ashworth MP, and the Liberal Democrat Spokesperson for Health and Social Care, Munira Wilson, criticised the timing of the Government’s decision. In response to a statement on Covid-19 in the House of Commons in September 2020, Mr Ashworth argued that the restructuring of PHE would “sap morale and focus and should wait until the end of the pandemic”. In addition, Ms Wilson criticised the announcement being made during a parliamentary recess, which meant that there was “no opportunity for parliamentary scrutiny”. Responding to the criticisms, Mr Hancock stated that the decision was “all about ensuring that we are as well prepared as possible for tackling this virus and that the total focus of the [then] new NIHP is on the prevention of infectious diseases”.

Although several organisations questioned the decision, some saw it as an opportunity to strengthen the country’s healthcare system. The King’s Fund stated that the Government’s decision to replace PHE with two new bodies would “increase complexity locally and nationally”. However, it also described the establishment of the OIHD as an “opportunity to bring a public health approach to wider government policy”. Similarly, the Health Foundation said that although dissolving PHE during the pandemic was seen as “highly risky by many commentators”, there were “opportunities to strengthen previously weak elements of the [healthcare] system”. Additionally, the Times argued that Britain’s “worse outcomes in the first phase of the pandemic” in comparison to other countries, such as France and Germany, was “evidence that the current structures have failed”. Consequently, the newspaper stated that a new institutional set-up was “needed” to “better enable England to withstand a second wave this winter”.

Read more

Cover image by gov.uk.