Public Health England hasn’t had a good crisis. But replacing it with a new agency will be disruptive and may not fix the problem, says Sarah Nickson
Coronavirus has claimed a major government scalp: Public Health England (PHE). The health secretary, Matt Hancock, has announced the agency will be replaced by a new National Institute for Health Protection, which will focus on external threats: biological weapons, pandemics and infectious diseases. For the current health crisis, it will take charge of contact tracing, testing and the analytical capability of the Joint Biosecurity Centre. The future of PHE’s preventative work, such as on cancer, tobacco and obesity, is uncertain.
The announcement is not a surprise. PHE has been criticised for the slow build-up of testing capacity, which made it difficult for NHS and social care staff to access testing and contributed to the decision to cease contact tracing in March. But PHE’s failings – like excessive centralisation – are also those of its ministers, and replacing it with a new agency won’t necessarily put the government’s response on a stronger footing.
PHE is an executive agency of the Department of Health and Social Care (DHSC), so its ministers were always responsible for any missteps. But the idea of PHE as an untamed quango, at arms’ length from the control of frustrated ministers, was allowed to persist both inside and outside government. Dominic Cummings, the prime minister’s chief adviser, had reportedly been considering emergency legislation to take control of PHE before discovering, in June, that it had been reporting to health department ministers all along.
The new agency will have the same status as PHE, with the same level of ministerial control; having stressed that it will report directly to ministers, the government will find it harder to evade responsibility in future.
The new organisation will, like PHE, be a centralised body – and this lay behind some of the problems behind PHE’s approach. At the outset, PHE explicitly rejected using non-government laboratories to build testing capacity in favour of those run by itself and the NHS. One of its senior officials described this as "more efficient", even as countries pursuing decentralised strategies, like South Korea, had greater success building up testing capacity. But NHS Test and Trace has also struggled to balance central co-ordination with local input. It is unclear how folding these bodies into a new one will improve willingness or ability to collaborate with other parts of government, local authorities or the private sector. And if ministers were unhappy with PHE’s methods, it was always open to them to direct PHE to change this.
Another major problem with testing has been muddled responsibilities: it was never entirely clear whether decisions on testing strategy were the domain of PHE or DHSC. This made it harder for parliamentary committees, among others, to hold anyone to account. The announcement of the National Institute came with the clear statement it would be responsible for testing. The move is welcome – but ministers could have resolved any ambiguity months ago, without the upheaval of scrapping one agency and setting up another.
Even though the new agency won’t be formally operating until spring 2021, setting it up during a pandemic will be an enormous task. The changes announced by the health secretary are far from cosmetic – civil servants working for NHS Test and Trace and the Joint Biosecurity Centre will be brought into the new agency, while those working on the preventative side will be moved to a new location, which is yet to be determined.
Organisational changes within government are highly disruptive at the best of times – let alone in the middle of a pandemic. Past Institute research has shown that these changes can take years to bed down, and in the first months of a new or refocused department or body, civil servants can be distracted trying to make the organisation work instead of focusing on the policy issues it has been set up to deal with.
If the government was looking for someone to blame for gaps in its pandemic response, PHE was an easy target: it made mistakes on testing and had long raised ire on the conservative side of politics for its perceived ‘nanny state’ approach to obesity, smoking and alcohol. But in replacing it with a new agency, in the middle of a pandemic, the government risks replacing one problem with another.