However, this week’s announcement that politicians have identified their first scapegoat as Public Health England (PHE) shows that the blood-letting has begun. The downgrading of PHE is the final nail in the coffin of the then Conservatives’ Secretary of State for Health, Andrew Lansley’s 2013 NHS reforms – nothing is now left.
When it launched in 2013, PHE was heralded as the means of bringing together all the public health strands (local and national) into one national organisation (purported to be based on the Centre for Communicable Disease Control [CCDC] in the USA) – this was to be the most powerful of new public health institutions.
Under the latest reforms, PHE are going to lose their responsibility for infectious disease control and concentrate in the future on issues such as obesity. NHS Test and Trace will be combined with PHE infectious disease components to create a new National Institute for Health Protection, the interim chief being Baroness Dido Harding. This new institution is being designed by Mckinsey as an example of what the Secretary of State for Health, Matt Hancock calls the “holy trinity of academia, government and the private sector”.
Ironically, in these (nearly) post-Brexit days, the new institution is to be modelled not on an USA institution but a European one – the Robert Koch Institute, which is an independent agency that has taken control of Germany's response to the pandemic. It would be funny if it was not so tragic that before the 2013 re-organisation of the NHS, the UK had a world-leading institution that concentrated solely on infectious disease – the Health Protection Agency, but it was dismantled. So once again politicians are creating institutions that their immediate predecessors had abandoned.
In my Royal College of Physicians Milroy Lecture in 2016 on state medicine and public health and subsequent paper, I highlighted that the quality of health care in the UK has been severely compromised by the lack of understanding by successive UK politicians of what is required to deliver a sustainable clinical and public health service. Their constant reorganisations leave the service in a weakened state that is very susceptible to new major health challenges, such as a pandemic.
I hope that when the final review of the UK pandemic response is undertaken, it takes this broader perspective as well as concentrating on individual decisions. During my time at NICE, when the press was very hostile, the Financial Times could always be relied on to give a balanced view. Some things do not change, and I would recommend a read of this FT article exploring the UK government’s response to the pandemic.