The future of public health and health prevention remains uncertain after the creation of a new agency last week.

The controversial new National Institute for Health Protection has combined NHS Test and Trace with the work of Public Health England and the Joint Biosecurity Centre. Ministers say it will be better able to cope with future outbreaks and pandemics.

Senior doctors have questioned what will happen to other public health work, which was already divided between PHE and local council public health departments.
Public Health England was originally formed from 70 different agencies and some of its work, especially in areas of health promotion, may be returned to the NHS rather than retained in the merged body. The new institute is to be “led” by Baroness Dido Harding, who has been in charge of test and trace – but Mr Hancock said this was interim leadership. It will also operate across the UK proving “support” to the four UK chief medical officers.

It is to have a new interim chief executive, Michael Brodie, head of the NHS Business Services Authority, while the PHE chief executive Duncan Selbie will become a “senior adviser” to the government on public health.

Mr Hancock said: “To give ourselves the best chance of beating this virus once and for all – and of spotting and being ready to respond to other health threats, now and in the future – we are creating a brand new organisation to provide a new approach to public health protection and resilience.”

British Medical Association chair Dr Chaand Nagpaul called for the new institute to be “free from political influence.” He pointed out that the PHE had worked with a budget of £400 million while NHS test and trace was allocated £10 billion. He said: “We are therefore, concerned that it will report directly to the Secretary of State and his department, especially given that the public needs to have confidence that they are receiving expert information and advice. The Institute also needs devolvement at a local authority level, working with local Directors of Public Health, who must equally be regarded as being independent. These reforms must also redress the significant dwindling of funding of public health services year on year, along with the diminished attention the Government has given to public health systems in England, particularly at the local level.”

The BMA’s public health committee chair Dr Peter English added: “We know from our members that many public health staff are burnt out and now demoralised. The Government needs to do much more to win back their trust and to attract much needed additional staff to the sector.”

Nigel Edwards, chief executive of the Nuffield Trust, said: “Simply dismantling and reconstituting an agency, under the direct control of the same ministers and department as previously, doesn’t seem to hold out much hope of improvement. If Public Health England’s disease control arm has struggled at times, why should merging it with equally struggling Test and Trace programme lead to an improvement for either one?”

Richard Murray, Chief Executive of The King’s Fund, said: “Public Health England appears to have been found guilty without a trial. It is unclear what problem government are hoping to solve by carving up PHE and redistributing its responsibilities. Undoubtedly, there are questions to be answered about England’s handling of the COVID-19 crisis, but the middle of a pandemic is not the time to dismantle England’s public health agency.”

Colin Hutchinson, chair of Doctors for the NHS, said: “A merger between NHS Test & Trace and Public Health England into an organisation containing so many players with a commercial interest who have already demonstrated their incompetence in achieving the one task that they have been set, smacks of dogma, rather than sound management.”

Professor Andrew Goddard, president of the Royal College of Physicians, said: “Today’s announcement could be the moment we have long been waiting for. A real recognition by Government of the need to invest in public health and prevention which will, in turn, help reduce health inequalities and create a healthier society.”