Public Health England
Public Health England (PHE) was an executive agency of the Department 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 the National Health Service (NHS) in England outlined in the Health and Social Care Act 2012. It took on the role of the Health Protection Agency, the National Treatment Agency for Substance Misuse and a number of other health bodies.[4] It was an executive agency of the Department of Health and Social Care, and a distinct delivery organisation with operational autonomy.[5]
Agency overview
April 2013 (Transitional - April 2012)[1]
1 October 2021
Wellington House
133–155 Waterloo Road
London
SE1 8UG[2]
£300 million[3]
On 29 March 2021, the UK Government announced that PHE would be disbanded and that its public health functions would be transferred, in proposals to reform public health structures.[6] From 1 October 2021, PHE's health protection functions were formally transferred into the UK Health Security Agency (UKHSA), while its health improvement functions were transferred to the Office for Health Improvement and Disparities (DHSC), NHS England, and NHS Digital.[7]
Establishment[edit]
Proposals for reorganising the National Health Service were published in the early months of the Cameron–Clegg coalition, in a July 2010 white paper from the Department of Health (under Andrew Lansley) titled "Equity and excellence: Liberating the NHS".[8] This was followed by a more detailed paper "Healthy Lives, Healthy People: Our strategy for public health in England" in November.[9]
The bill to implement the proposals was introduced to the House of Commons in January 2011, and was the subject of a report by the Health Select Committee in October.[1] Responding to criticism, the government published "Healthy Lives, Healthy People: Update and way forward" in July.[10] The Health 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 the Secretary of State for Health. It took over public health activity from the department and from the regional strategic health authorities (which were abolished), and all activities of the Health Protection Agency, the National Treatment Agency for Substance Misuse, the Public Health Observatories, the cancer registries, the National Cancer Intelligence Network, and the UK National Screening Committee together with its screening programmes.[1]
2020–2021 reorganisation[edit]
A reorganisation of public health protection in England was announced by the Secretary of State for Health and Social Care, Matt Hancock, in August 2020.[17] 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.[18]
Several health experts, including Jeremy Farrar, Director of the Wellcome Trust, criticised the move to abolish PHE during an ongoing pandemic,[19][20] 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".[21] 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.[22]
PHE would be combined with NHS Test and Trace to form a National Institute for Health Protection, under a new leadership structure headed by Conservative peer Dido Harding as interim CEO.[23] Her appointment was later found to be unlawful.[24] Michael Brodie, current CEO of the NHS Business Services Authority, was appointed as interim PHE CEO, replacing Duncan Selbie.[17] In March 2021, it was announced that the new agency would instead be called the UK Health Security Agency,[25] commencing on 1 April and led by Jenny Harries (formerly a regional director at PHE and Deputy Chief Medical Officer for England).[26]
The new UKHSA would focus on infectious disease control, particularly the ongoing COVID-19 pandemic. Options for PHE's other roles, such as preventing ill health and reducing health inequalities, were to be discussed,[17] 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 the Department for Health and Social Care.[25] This was subsequently re-named the Office for Health Improvement and Disparities and launched 1 October 2021.[27] A few PHE staff moved to NHS England/Improvement or to NHS Digital.
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.[28][29] The PHE name and employment contracts remained until 1 October.[30]
PHE had the following public-facing divisions:
Duncan Selbie was the chief executive of PHE from its formation until 2020; he was previously chief executive of Brighton and Sussex University Hospitals NHS Trust.[31] In the reorganisation announced in August 2020, Michael Brodie was appointed as interim CEO.[17] Brodie was finance director at PHE from its formation until 2019, when he became CEO of the NHS Business Services Authority.[32]
Other senior personnel include:[33]
Campaigns[edit]
PHE took over the responsibility for 'Be Clear on Cancer' campaigns after it was created in the Health and Social Care Act 2012.[36] Campaigns have been run on lung cancer, bowel cancer, oesophago-gastric and kidney & bladder cancer.[37]
PHE was also responsible for Change4Life and ACT FAST.[38]
In January 2014 it launched a campaign against smoking called 'Health Harms' on television and billboards across England.[39]
Criticism and other published comment[edit]
Public Health England has been criticised for downplaying mental health within its overall resourcing and agenda; in 2011 the Royal 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".[56]
The agency was criticised by Professor Martin McKee in January 2014. He said that continuing health inequalities among London boroughs was a scandal, and claimed coalition reforms had left it unclear who was supposed to analyse health data and tackle the problems highlighted.[57]
The agency was criticised by The Lancet for allegedly using weak evidence in a review of electronic 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."[58] 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 in The Lancet, but on their broad review of toxicological evidence.[59] 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".[60] Scientific evidence accumulated since has cast further doubt on PHE's claim.
[61]
A 2017 question in the House of Lords revealed that a position underpinning UK Government policy, namely "that well run and regulated modern municipal waste 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.[62]
