The article examines recent changes to public health governance in England: the unexpected abolition of Public Health England (PHE) in August 2020, following criticism of its performance during the Covid-19 pandemic, and its rapid replacement with two new agencies: the UK Health Security Agency in March 2021 and the Office for Health Improvement and Disparities in October 2021.

The authors, including the ARC’s Professor Peter Littlejohns, emeritus professor of public health in the Centre for Implementation Science at King’s College London, and colleagues at Newcastle University and UCL, argue that it is vital to understand the circumstances around the abolition of PHE and to identify lessons to ensure that the new public health system is fit for purpose.

Drawing on evidence from a series of interviews with leading public health and policy officials about the rise and fall of PHE, as well as published documents (see the report: Lessons from the demise of Public Health England, below), the authors argue that the remits of the new public health bodies need to be much clearer and that their governance arrangements risk undermining their independence from government, a key criticism of the executive agency PHE.  

These issues demand urgent attention if the new structures are to succeed and avoid a similar fate to Public Health England. This is important because the effectiveness of public health structures has long-term implications for the health of all of us.

Professor Peter Littlejohns, emeritus professor of public health, King’s College London

The government’s decision to replace PHE followed mounting criticisms of its performance during the early stages of the Covid-19 pandemic, especially regarding its ability to test, track, and trace the disease, and its general unpreparedness for a pandemic. However, some commentators saw it as the “first casualty of a blame game” over the UK’s high death rate.

The two new agencies to replace it were created rapidly and with little consultation, the authors argue. Those agencies are:

  • UK Health Security Agency (UKHSA), an executive agency (like PHE), responsible for UK-wide public health protection and infectious disease capability
  • Office for Health Improvement and Disparities (OHID), a non-ministerial governmental body in the Department of Health and Social Care, accountable to the Secretary of State for Health and Social Care and the Chief Medical Officer for England. OHID’s priorities include tackling obesity, improving mental health, promoting physical activity, and addressing health inequalities.

The authors argue that the two new agencies face many of the same challenges as PHE in terms of their lack of independence from government, hindering their ability to “speak truth to power”. They also argue that there is a lack of clarity over their roles, how they will work with each other, and how they will cooperate effectively with other central and local government departments and agencies.  

The authors are particularly critical of the decision to separate the management of communicable diseases from non-communicable diseases in the new agencies, because of the close links between them in terms of public health, a factor that has been starkly highlighted by the Covid-19 pandemic.

The absence of a coherent joined-up strategy for tackling public health problems, the disproportionate emphasis on the NHS, the backlog of elective care, and the overstretched workforce do not bode well for what the UKHSA and OHID could offer. I hope the findings from the UK Covid-19 Inquiry will point the way forward in making future choices. There is some urgency about getting the findings into the public domain as quickly as possible if they are to inform the new bodies' working arrangements before it is too late

Professor David Hunter, emeritus professor of health policy and management, Newcastle University, and lead author of the article

Report: Lessons from the demise of Public Health England - where next for UK public health?

The researchers have published a full report (Littlejohns et al, Sept 2022) drawing together conclusions from the six-month research project reviewing the policies and actions behind the establishment and closure of Public Health England. The aim of the report is to provide learning for PHE’s successor organisations – the UK Health Security Agency and Office for Health Improvement and Disparities – but its conclusions are much broader, focusing on how public health policy should be enacted in a post-pandemic UK. Read the report.

Find out more

The arguments in the Lancet Public Health article were stimulated by ideas generated in a project supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

About the authors

  • David J Hunter, emeritus professor of health policy and management, Newcastle University
  • Peter Littlejohns, emeritus professor of public health, King’s College London
  • Albert Weale, emeritus professor of political theory and public policy, School of Public Policy, University College London