Public Health England

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Public Health England
PublicHealthEngland.svg
Agency overview
Formed2013
Preceding agency
Superseding agency
JurisdictionEngland
HeadquartersWellington House
133–155 Waterloo Road
London
SE1 8UG[1]
Annual budget£300 million [2]
Agency executives
  • Interim Chief Executive
  • Michael Brodie [3]
Parent agencyDepartment of Health and Social Care
Websitewww.gov.uk/government/organisations/public-health-england Edit this at Wikidata

Public Health England (PHE) is an executive agency of the Department of Health and Social Care in the United Kingdom that began operating on 1 April 2013. 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 is an executive agency of the Department of Health and Social Care, and a distinct delivery organisation with operational autonomy.[5]

On 18 August 2020, it was announced that Public Health England was to be replaced by the National Institute for Health Protection, a new agency created to deal with the threat of infectious diseases by combining PHE with the NHS Test and Trace operation.

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".[6] This was followed by a more detailed paper "Healthy Lives, Healthy People: Our strategy for public health in England" in November.[7]

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.[8] Responding to criticism, the government published "Healthy Lives, Healthy People: Update and way forward" in July.[9] 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.[8]

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.[8]

Mission, funding and resources[edit]

Each year (most recently in late April 2020) the Department of Health and Social Care sets out PHE's remit and priorities in a letter to the chief executive.[10]

PHE's mission is "to protect and improve the nation’s health and to address inequalities". It employs approximately 5,000 staff (full-time equivalent), who are mostly scientists, researchers and public health professionals.[11] It announced plans to move its headquarters and 2,750 staff to Harlow on a former GlaxoSmithKline site in 2017.[12]

PHE laboratories provide an extensive range of microbiological diagnostic tests.[13]

The Secretary of State sets the total budget for public health, and determines how it is allocated between PHE and local authorities.[14]

Relationship with local authorities[edit]

The 2012 Act, which established PHE as a national body, also returned to local authorities the responsibility for a range of community and public health services. Each upper tier local authority is required to appoint a director of public health, an officer of the authority who is responsible for the authority's public health functions including responding to emergencies.[14] As of 2020 there are 134 of these posts.[15]

2020 reorganisation[edit]

A reorganisation of public health protection in England was announced by the Secretary of State for Health and Social Care, Matt Hancock, on 18 August 2020. PHE would be combined with NHS Test and Trace to form the National Institute for Health Protection, under a new leadership structure headed by Conservative peer Dido Harding as interim CEO.[16] Michael Brodie, current CEO of the NHS Business Services Authority, was appointed as interim PHE CEO, replacing Duncan Selbie.[17]

The new NIHP 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]

Structure[edit]

PHE has the following public-facing divisions:

  • Health protection:
  • Health improvement:
  • Knowledge and information
    • Substance misuse treatment monitoring
    • Disease registration
    • Research and development
  • Operations:
    • Microbiology unit
      • Microbe production
      • Research
      • References
      • Specialist services
    • Regional units (South / Midlands / North / London)
      • Preparation and response against major incidents
      • Local centres (several centres per regional unit, except London)
        • Local health protection
        • Substance misuse treatment services (over more than one centre)
        • Local specialist commissioning (in relation to major incidents, etc.) and advice

Key people[edit]

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.[18] 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.[19]

Other senior personnel include:[20]

  • Yvonne Doyle, Medical Director and Director of Health Protection from 2019, replacing Paul Cosford who became Emeritus Medical Director.
  • Kevin Fenton, Regional Director for London.
  • Jenny Harries was Regional Director for the South of England until her appointment as Deputy Chief Medical Officer for England in 2019.
  • Anne Mackie, Director of Screening Programmes
  • Professor John Newton, Director of Health Improvement.
  • Alison Tedstone, nutritionist, Director of Diet, Obesity and Physical Activity.

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.[21] Campaigns have been run on lung cancer, bowel cancer, oesophago-gastric and kidney & bladder cancer.[22]

PHE is also responsible for Change4Life and ACT FAST.[23]

In January 2014 it launched a campaign against smoking called 'Health Harms' on television and billboards across England.[24]

COVID-19[edit]

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.[25]

PHE carried out contact tracing in the early stages of the COVID-19 pandemic, but this ceased on 12 March 2020 in view of the wide spread of infection in the population.[26]

From 19 March, consistent with the opinion of the Advisory Committee on Dangerous Pathogens, PHE no longer classified COVID-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 the government’s COVID-19 response". This meant cases of COVID-19 were no longer managed by HCID treatment centres only.[27]

Mortality data[edit]

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.[28] 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.[29][30]

By July, as the number of deaths continued to fall, PHE reported significantly more deaths than those collated weekly by the Office for National Statistics from death certificates. Concerns were raised – by the Centre for Evidence-Based Medicine[31][32] 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.[32] The cumulative total was recalculated as 41,329, a 12% decrease.[33] 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.[34]

Handling of test results[edit]

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 outsourced Test and Trace operation[35] (notifications of test results to individuals were not affected).[36] PHE retrieved the missing results after determining that the cause was ill-thought-out use of Microsoft's Excel software.[37] Matt Hancock, Health Secretary, said in Parliament that the error "should never have happened".[38]

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".[39]

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.[40]

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."[41] 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.[42] 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".[43] Scientific evidence accumulated since has cast further doubt on PHE's claim. [44]

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.[45]

See also[edit]

References[edit]

  1. ^ "Public Health England". gov.uk. Retrieved 4 December 2019.
  2. ^ "PHE response to a Sun newspaper column". gov.uk. Retrieved 28 April 2020.
  3. ^ "Government creates new National Institute for Health Protection". GOV.UK. Retrieved 18 August 2020.
  4. ^ "Structure of Public Health England" (PDF). Department of Health. Retrieved 13 July 2015.
  5. ^ Agreement between the Department of Health and Social Care and Public Health England: February 2018
  6. ^ "Liberating the NHS white paper". GOV.UK. Department of Health and Social Care. 12 July 2010. Retrieved 18 August 2020.
  7. ^ "Healthy Lives, Healthy People: our strategy for public health in England". GOV.UK. Department of Health and Social Care. 30 November 2010. Retrieved 18 August 2020.
  8. ^ a b c "Twelfth Report: Public Health". House of Commons. Health Committee. 19 October 2011. Retrieved 18 August 2020.
  9. ^ "Healthy Lives, Healthy People: update and way forward". GOV.UK. Department of Health and Social Care. 14 July 2011. Retrieved 18 August 2020.
  10. ^ Churchill, Jo (4 May 2020). "PHE priorities in health and social care: 2020 to 2021". GOV.UK. Department of Health and Social Care. Retrieved 21 August 2020.
  11. ^ Public Health England. "About". Retrieved 8 February 2015.
  12. ^ "Public Health England closer to moving to Essex". Pharmaceutical Journal. 25 August 2017. Retrieved 8 October 2017.
  13. ^ "Specialist and reference microbiology: laboratory tests and services". GOV.UK. Retrieved 12 April 2020.
  14. ^ a b Heath, Sarah (13 March 2014). "Commons Research Briefing: Local authorities' public health responsibilities (England)". House of Commons Library. Retrieved 21 August 2020.
  15. ^ "Directors of public health in England". GOV.UK. Public Health England. 14 August 2020. Retrieved 21 August 2020.
  16. ^ "Dido Harding to lead new pandemic agency for England". Financial Times. 17 August 2020. Retrieved 21 August 2020.
  17. ^ a b c "Government creates new National Institute for Health Protection". GOV.UK. Department of Health and Social Care. 18 August 2020. Retrieved 21 August 2020.
  18. ^ "Duncan Selbie". GOV.UK. Retrieved 12 August 2020.
  19. ^ Imrie, Jane (28 May 2019). "This week's North East appointments". Bdaily Business News. Retrieved 21 August 2020.
  20. ^ "Leadership chart" (PDF). GOV.UK. Public Health England. July 2020. Retrieved 12 August 2020.
  21. ^ "CRUK Be Clear on Cancer". Retrieved 16 November 2014.
  22. ^ "NHS Choices". Retrieved 16 November 2014.
  23. ^ "PHE Campaigns". Retrieved 16 November 2014.
  24. ^ "Powerful anti-smoking campaign launched to show cyanide and arsenic damage". Metro. 29 December 2013. Retrieved 8 January 2014.
  25. ^ Brine, Steve (22 March 2019). "PHE priorities in health and social care: 2019 to 2020". GOV.UK. Department of Health and Social Care. Retrieved 21 August 2020.
  26. ^ Tapper, James (4 April 2020). "Recruit volunteer army to trace Covid-19 contacts now, urge top scientists". The Guardian. ISSN 0261-3077. Retrieved 18 April 2020.
  27. ^ "High consequence infectious diseases (HCID); Guidance and information about high consequence infectious diseases and their management in England". GOV.UK. Archived from the original on 3 March 2020. Retrieved 17 March 2020.
  28. ^ Public Health England, Weekly COVID-19 surveillance report published, first published 23 April 2020, updated 29 August 2020, accessed 4 September 2020
  29. ^ "Coronavirus death toll tops 26,000 as figure now includes care home and wider community deaths". ITV News. 29 April 2020. Retrieved 1 May 2020.
  30. ^ "PHE data series on deaths in people with COVID-19: technical summary". GOV.UK. Public Health England. 29 April 2020. Retrieved 1 May 2020.
  31. ^ Loke, Yoon K; Heneghan, Carl (16 July 2020). "Why no-one can ever recover from COVID-19 in England – a statistical anomaly". CEBM. Retrieved 14 August 2020.
  32. ^ a b "New UK-wide methodology agreed to record COVID-19 deaths". GOV.UK. 12 August 2020. Retrieved 13 August 2020.
  33. ^ "Covid death recount reduces UK toll by 5,000". BBC News. 12 August 2020. Retrieved 13 August 2020.
  34. ^ Newton, John (12 August 2020). "Behind the headlines: Counting COVID-19 deaths". publichealthmatters.blog.gov.uk. Retrieved 13 August 2020.
  35. ^ "Nearly 16,000 virus cases missed after IT error". BBC News. 5 October 2020. Retrieved 6 October 2020.
  36. ^ "PHE statement on delayed reporting of COVID-19 cases". GOV.UK. Public Health England. 5 October 2020. Retrieved 6 October 2020.
  37. ^ Kelion, Leo (5 October 2020). "Excel: Why using Microsoft's tool caused Covid-19 results to be lost". BBC News. Retrieved 6 October 2020.
  38. ^ "Test error 'should never have happened' - Hancock". BBC News. 5 October 2020. Retrieved 6 October 2020.
  39. ^ "House of Commons - HC 1048-III Health Committee: Written evidence from the Royal College of Psychiatrists (PH 50)". publications.parliament.uk.
  40. ^ "Top 10 causes of death in London boroughs highlight health inequalities". The Guardian. 8 January 2014. Retrieved 8 January 2014.
  41. ^ The Lancet (2015). "E-cigarettes: Public Health England's evidence-based confusion". Lancet. 386 (9996): 829. doi:10.1016/S0140-6736(15)00042-2. PMID 26335861.
  42. ^ "Underpinning evidence for the estimate that e-cigarette use is around 95% safer than smoking: authors' note" (PDF).
  43. ^ Gornall, Jonathan (2015). "Public Health England's troubled trail". British Medical Journal. 351 (1136): 5826. doi:10.1136/bmj.h5826. PMID 26534902.
  44. ^ Eissenberg, Thomas; Bhatnagar, Aruni; Chapman, Simon; Jordt, Sven-Eric; Shihadeh, Alan; Soule, Eric (2020). "Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes". American Journal of Public Health. 110 (2): 161, 162. doi:10.2105/AJPH.2019.305424. PMC 6951374. PMID 31913680.
  45. ^ Countess of Mar. "Incinerators: Health Hazards (HL3533). Written question dated 23-11-2017 and answer from Lord O'Shaughnessy dated 05-12-2017". House of Lords. Retrieved 30 January 2018.

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