In August 2020, in the midst of the Covid-19 pandemic, it was announced in The Sunday Telegraph that Public Health England (PHE) would be closed. This was the first that staff had heard about the closure of their organisation. In a subsequent speech, Matt Hancock (then Secretary of State for Health and Social Care) said that he was in favour of creating a model that would emulate the Robert Koch Institute in Germany.
At the time, the UK and rest of the world were still dealing with an unprecedented pandemic. It was puzzling, therefore, that the national organisation in England responsible for public health should be suddenly terminated with no consultation or discussion. Having been established in 2013, PHE was only seven years old.
This study, led by Peter Littlejohns, emeritus professor of public health, King's College London, sought to understand why this dramatic and unexpected event happened in order to identify possible lessons for future public health policy and, in particular, for PHE’s successor bodies, UK Health Security Agency (UKHSA) and Office for Health Improvement and Disparities (OHID). If addressed, it is hoped that the findings and insights will enable the new bodies to respond more effectively to the current challenges as well as future ones.
The study was conducted over six months between October 2021 and March 2022. It involved three stages:
The rapid literature review and interviews were subjected to thematic analysis and Kingdon’s Multiple Streams Framework was adopted, comprising three streams: a problem stream, a policy stream and a political stream.
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. There was a broad consensus between the three sources of information on what the main underlying issues were. However, whether PHE was destined to fail by virtue of how it was established and funded or because of its much-criticised pandemic response, or as a result of a mix of the two, remains unclear.
There were five underlying issues identified in the research which contributed to the demise of PHE:
• first, severe cuts in public health spending both nationally and locally since 2010 meant that PHE was functioning with reduced capacity across the system by the time the pandemic arrived in England
• second, PHE did not have the capacity to undertake a testing regime of the size and complexity required by the pandemic, the lack of which was the basis of the main criticism of the organisation at the time
• third, the governance of PHE as an executive agency within the Department of Health and Social Care (DHSC) meant that that it was not possible to be truly independent
• fourth, while decisions made by PHE at the start of the pandemic were later considered mistakes (and indeed considered outside the law by a judicial review), at the time there was little information about the nature and possible effects of the SARS-CoV-2 virus and the limited capacity meant that tough prioritisation decisions had to be made
• fifth, the sudden closure of PHE without any form of consultation was widely reported to be due to blame-avoidance behaviour on the part of key actors, principally Dominic Cummings (as former Chief Advisor to the Prime Minister Boris Johnson) and Matt Hancock (as former Secretary of State for Health and Social Care). It was also considered to be based on current political policy favouring the use of the private sector and contracting out functions like test and trace.
The lessons identified from the research, combined with the speed with which UKHSA and OHID were established, suggest that the new bodies may suffer the same fate as PHE unless the lessons are heeded and acted upon.