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| Agency overview | |
|---|---|
| Formed | April 2013 (transitional: April 2012)[1] |
| Preceding agency | |
| Dissolved | 1 October 2021 |
| Superseding agency | |
| Jurisdiction | England |
| Headquarters | Wellington House 133–155Waterloo Road London SE1 8UG[2] |
| Employees | 6,749 (in 2021)[3]: 88 |
| Annual budget | £300 million[4] |
| Parent agency | Department of Health and Social Care |
| Website | www |
Public Health England (PHE) was anexecutive agency of theDepartment of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as a result of the reorganisation of theNational Health Service (NHS) in England outlined in theHealth and Social Care Act 2012. It took on the role of theHealth Protection Agency, theNational Treatment Agency for Substance Misuse and a number of other health bodies.[5] It was an executive agency of theDepartment of Health and Social Care, and a distinct delivery organisation with operational autonomy.[6]
On 29 March 2021, theUK Government announced that PHE would be disbanded and that its public health functions would be transferred, in proposals to reform public health structures.[7] From 1 October 2021, PHE's health protection functions were formally transferred into theUK Health Security Agency (UKHSA), while its health improvement functions were transferred to theOffice for Health Improvement and Disparities (DHSC),NHS England, andNHS Digital.[8]
Proposals for reorganising the National Health Service were published in the early months of theCameron–Clegg coalition, in a July 2010white paper from theDepartment of Health (underAndrew Lansley) titled "Equity and excellence: Liberating the NHS".[9] This was followed by a more detailed paper "Healthy Lives, Healthy People: Our strategy for public health in England" in November.[10]
The bill to implement the proposals was introduced to the House of Commons in January 2011, and was the subject of a report by theHealth Select Committee in October.[1] Responding to criticism, the government published "Healthy Lives, Healthy People: Update and way forward" in July.[11] TheHealth and Social Care Act gained royal assent in March 2012, with all elements of the new system to be operative by April 2013.[1]
The Act established Public Health England as an executive body accountable to theSecretary of State for Health. It took over public health activity from the department and from the regionalstrategic health authorities (which were abolished), and all activities of theHealth Protection Agency, theNational Treatment Agency for Substance Misuse, thePublic Health Observatories, thecancer registries, theNational Cancer Intelligence Network, and theUK National Screening Committee together with its screening programmes.[1]
The Department of Health and Social Care set out PHE's remit and priorities in a letter to its chief executive. The last of such letters, published in July 2021, included tasks to implement the transition to theUK Health Security Agency and theOffice for Health Improvement and Disparities.[12]
PHE's mission was "to protect and improve the nation's health and to address inequalities". It employed approximately 5,000 staff (full-time equivalent), who were mostly scientists, researchers and public health professionals.[13] It announced plans to move its headquarters and 2,750 staff toHarlow on a formerGlaxoSmithKline site in 2017.[14]
PHE laboratories provided an extensive range of microbiological diagnostic tests.[15]
The Secretary of State set the total budget for public health, and determined how it was allocated between PHE and local authorities.[16]
The 2012 Act, which established PHE as a national body, also returned the responsibility for a range of community and public health services to local authorities. Each upper tier local authority was required to appoint a director of public health, an officer of the authority who was responsible for the authority's public health functions including responding to emergencies.[16] As of 2020[update] there were 134 of these posts.[17]
A reorganisation of public health protection in England was announced by the thenSecretary of State for Health and Social Care,Matt Hancock, in August 2020.[18] The move was in response to mistakes in decision making during the COVID-19 pandemic, including issues with the supply of personal protective equipment for healthcare workers, low community testing capabilities, and insufficient data resourcing.[19]
Several health experts, including Jeremy Farrar, Director of the Wellcome Trust, criticised the move to abolish PHE during an ongoing pandemic,[20][21] with Richard Murray, Chief Executive of The King's Fund, stating that PHE "appears to have been found guilty without a trial" and it is "unclear what problem government are hoping to solve".[22] In response, Hancock said the move was needed to bring together disparate leadership to strengthen the UK's response to the pandemic, and that the change would not result in disruption.[23]
PHE would be combined withNHS Test and Trace to form a National Institute for Health Protection, under a new leadership structure headed byConservative peerDido Harding as interim CEO.[24] Her appointment was later found to be unlawful.[25] Michael Brodie, current CEO of theNHS Business Services Authority, was appointed as interim PHE CEO, replacingDuncan Selbie.[18] In March 2021, it was announced that the new agency would instead be called theUK Health Security Agency,[26] commencing on 1 April and led byJenny Harries (formerly a regional director at PHE and DeputyChief Medical Officer for England).[27]
The new UKHSA would focus on infectious disease control, particularly the ongoingCOVID-19 pandemic. Options for PHE's other roles, such as preventing ill health and reducing health inequalities, were to be discussed,[18] with the decision made in March 2021 that these functions would move to "new homes within the health system" including the creation of an Office for Health Protection within theDepartment for Health and Social Care.[26] This was subsequently re-named the Office for Health Improvement and Disparities and launched 1 October 2021.[28] A few PHE staff moved toNHS England/Improvement or toNHS Digital.[citation needed]
While it was originally announced that PHE would be wound up on 31 March 2021, the body continued to have a 'shadow existence' until 1 October 2021, to support the transition of responsibilities to its successor organisations.[29][30] The PHE name and employment contracts remained until 1 October.[31]
PHE had the following public-facing divisions:[citation needed]
Duncan Selbie was the chief executive of PHE from its formation until 2020; he was previously chief executive ofBrighton and Sussex University Hospitals NHS Trust.[32] In the reorganisation announced in August 2020, Michael Brodie was appointed as interim CEO.[18] Brodie was finance director at PHE from its formation until 2019, when he became CEO of theNHS Business Services Authority.[33]
Other senior personnel include:[34]
PHE took over the responsibility for 'Be Clear on Cancer' campaigns after it was created in theHealth and Social Care Act 2012.[37] Campaigns have been run on lung cancer, bowel cancer, oesophago-gastric and kidney & bladder cancer.[38]
PHE was also responsible forChange4Life and ACT FAST.[39]
In January 2014 it launched a campaign against smoking called 'Health Harms' on television and billboards across England.[40]
The bullet points setting out PHE's priorities for 2019/20 in the annual directive from the Department of Health and Social Care included coordination of the response to public health emergencies under a heading "Leaving the EU". In addition, an "integrated surveillance system" and "investigation and management of outbreaks of infectious diseases" were listed in an annex.[41]
PHE carried outcontact tracing in the early stages of theCOVID-19 pandemic, but this ceased on 12 March 2020 in view of the wide spread of infection in the population.[42]
From 19 March, consistent with the opinion of theAdvisory Committee on Dangerous Pathogens, PHE no longer classifiedCOVID-19 as a "high consequence infectious disease" (HCID). This reversed an interim recommendation made in January 2020, due to more information about the disease confirming low overall mortality rates, greater clinical awareness, and a specific and sensitive laboratory test, the availability of which continues to increase. The statement said "the need to have a national, coordinated response remains" and added "this is being met by thegovernment's COVID-19 response". This meant cases of COVID-19 were no longer managed byHCID treatment centres only.[43]
PHE began publishing a weekly COVID-19 epidemiology surveillance summary each Thursday from 23 April, combining community, primary care, secondary care,virology and mortality surveillance data to support national and regional planning in relation to the pandemic.[44] From 29 April, PHE collated daily reporting of the number of deaths of people in England with a positive COVID-19 test; the numbers published each day by the UK government had previously only counted deaths in hospital.[45][46]
By July, as the number of deaths continued to fall, PHE reported significantly more deaths than those collated weekly by theOffice for National Statistics from death certificates. Concerns were raised – by theCentre for Evidence-Based Medicine[47][48] and others – that PHE's figures were over-estimates, since they included anyone who had a positive COVID-19 test, no matter how long ago. On 12 August it was agreed to publish the numbers of deaths within 28 days of a positive test, as was already done by other UK administrations.[48] The cumulative total was recalculated as 41,329, a 12% decrease.[49]John Newton, a PHE director, wrote that the method established in April was designed to avoid undercounting, and that PHE always intended to review the approach as the pandemic progressed.[50]
On 2 October 2020, it was realised that almost 16,000 COVID-19 test results received by PHE from commercial laboratories since 25 September had not been loaded into dashboards or passed to the outsourcedTest and Trace operation[51] (notifications of test results to individuals were not affected).[52] PHE retrieved the missing results after determining that the cause was ill-thought-out use of Microsoft'sExcel software.[53]Matt Hancock, Health Secretary, said in Parliament that the error "should never have happened".[54] The following month, economists at theUniversity of Warwick estimated that the delayed contact tracing led to more than 125,000 additional infections and 1,500 deaths,[55] although PHE disputed their findings.[56]
Public Health England has been criticised for downplaying mental health within its overall resourcing and agenda; in 2011 theRoyal College of Psychiatrists, commenting on the plan to create PHE, stated its concern that there appeared to be "few, or no, commitments or resources within either the Department of Health or Public Health England to take the public mental health agenda forward".[57]
The agency was criticised by ProfessorMartin McKee in January 2014. He said that continuing health inequalities among London boroughs were a scandal, and claimedcoalition reforms had left it unclear who was supposed to analyse health data and tackle the problems highlighted.[58]
The agency was criticised byThe Lancet for allegedly using weak evidence in a review ofelectronic cigarettes to endorse an estimate that e-cigarette use is 95% less hazardous than smoking: "it is on this extraordinarily flimsy foundation that PHE based the major conclusion and message of its report" ... this "raises serious questions not only about the conclusions of the PHE report, but also about the quality of the agency's peer review process."[59] Authors of the PHE report subsequently published a document clarifying that their endorsement of the 95% claim did not stand on the single study criticised inThe Lancet, but on their broad review of toxicological evidence.[60] The agency has also been criticised for "serious questions about transparency and conflicts of interest" regarding this review, that PHE's response "did not even begin to address the various relationships and funding connections" in question, and that this "adds to questions about the credibility of the organisation's advice".[61]Scientific evidence accumulated since has cast further doubt on PHE's claim.[62]
A 2017 question in theHouse of Lords revealed that a position underpinning UK Government policy, namely "that well run and regulated modern municipalwaste incinerators are not a significant risk to public health remains valid", was asserted in advance of the results having been obtained from a study commissioned by Public Health England to answer the question whether municipal waste incinerators did, in fact, constitute a significant risk to public health.[63]
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