Health Matters | Paul Corrigan's blog

In July the Government published its response to its initial reforms about public health. Whilst their original reforms had failed to excite as much public interest as their plans for GP commissioning, they did contain some very radical changes to the relationship between the Department of Health and public health.

Rather oddly, at a national level the public health reforms went in the opposite direction to those proposed for the NHS. Whereas the stated aim of the NHS reforms was to remove the Secretary of State’s accountability for the NHS (something that the 2011 reforms of their 2010 reforms changed radically), their original reforms of the Department’s relationship to public health abolished the independence of the Health Protection Agency (HPA) and brought their powers under the direct control of the Secretary of State.

Not only was this oddly in contradiction to the rest of the Government’s original NHS reforms, but to anyone who recognised the vital importance of independent public health advice, it looked possibly dangerous. In our society there are moments when the fact that the Secretary of State gets clearly independent advice about public health issues is of great importance to the public.

For whatever reasons, the public now only very marginally trust politicians. They usually think there are ulterior motives for all their actions. To the point where if a Cabinet member were to say on the news that there is a good possibility of  an epidemic, a great many of the public would wonder why they are saying this, rather than actually worrying that there might really be an epidemic.

This is a big problem because there may well be occasions when there is going to be an epidemic and it’s important for the public to take this message seriously. That’s why the independence of the HPA was an important matter of public safety.

So when, in the early months of the new Government, they appeared determined to place the HPA, along with other independent public health organisations, onto their ‘bonfire of the quangos’ a number of people became anxious – way beyond the traditional public health community.

At moments of great danger the public need to trust the advice they receive. The HPA’s independence from the Secretary of State provided some of that trust.

That’s why it’s important that the Government’s reforms of their reforms have dragged the idea of an independent national public health organisation out of the bonfire.

Its July public health consultation document said,

“2.47 Giving public health real focus and priority within central government was welcomed by many respondents to the consultations, but there was much concern expressed during the consultations and the Listening Exercise about the possible threat to the independence of scientific advice if Public Health England was simply a part of a Whitehall Department. We know that the credibility of the public health advice given by specialists relies on respect for their professional training and knowledge, and from the integrity and credibility that arises from working for an organisation that can challenge and inform government. We have listened to that feedback and now intend to establish Public Health England as an Executive Agency of the Department of Health, subject to completing the normal government approval processes for establishing new bodies.

2.48 As an Executive Agency, Public Health England will have a distinct identity and a Chief Executive with clear accountability for carrying out its functions”

In amongst all of the other policy U turns this one has gained little publicity, but it is a very important change.

Independent national public health bad in 2010.

Independent national public health good in 2011.

The organisation they are creating will be a powerful one,

“Public Health England will be established as an integrated public health delivery body. It will bring together in one organisation the public health skills, knowledge and capabilities that are currently distributed across a wide range of health organisations. Those bodies whose functions will in future be the responsibility of Public Health England are listed below – together they currently employ approximately 4500 staff:

• the Health Protection Agency;

• the National Treatment Agency for substance misuse;

• the Regional Directors of Public Health and their teams in the Department of Health and Strategic Health Authorities;

• the regional and specialist Public Health Observatories;

• the Cancer Registries and the National Cancer Intelligence Network;

• the National Screening Committee and Cancer Screening Programmes”

This is an important new institution which will be created as a new quango.

NOT having this as a part of the DH will itself cause problems since the Government have made it clear that the Secretary of State at the DH must play a national cross-Government role in leading public health issues and to do that he will need staff. It’s to be hoped that the staff of Public Health England will help the Secretary of State with this role.

And, just as a footnote, spare a thought for the DH at the centre of all of this.

Last July they lost the control of the NHS and gained public health. This June they regainedthe national duty to ensure that the NHS is provided – and lost public health.