King’s College London: Public health reforms in England risk creating a system unfit for purpose

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Public health researchers at King’s and the NIHR ARC South London criticise recent reforms to public health governance in England, highlighting potential problems for the future, in a piece published by The Lancet Public Health today.

The article examines recent changes to public health governance in England: the unexpected abolition of Public Health England (PHE) in August 2020, following criticism of its performance during the Covid-19 pandemic, and its rapid replacement with two new agencies: the UK Health Security Agency (UKHSA) in March 2021 and the Office for Health Improvement and Disparities (OHID) in October 2021.

The authors – including Peter Littlejohns, Professor of Public Health in the School of Life Course & Population Sciences and the Centre for Implementation Science, and others at Newcastle University and UCL – argue that it is vital to understand the circumstances around the abolition of PHE and to identify lessons to ensure that the new public health system is fit for purpose.

Drawing on evidence from a series of interviews with leading public health and policy officials about the rise and fall of PHE, as well as published documents, the authors argue that the remits of the new public health bodies need to be much clearer and that their governance arrangements risk undermining their independence from government, a key criticism of the executive agency PHE.

These issues demand urgent attention if the new structures are to succeed and avoid a similar fate to Public Health England. This is important because the effectiveness of public health structures has long-term implications for the health of all of us.”
– Professor Peter Littlejohns
The government’s decision to replace PHE followed mounting criticisms of its performance during the early stages of the Covid-19 pandemic, especially regarding its ability to test, track, and trace the disease, and its general unpreparedness for a pandemic. However, some commentators saw it as the “first casualty of a blame game” over the UK’s high death rate.

The authors argue that UKHSA and OHID face many of the same challenges as PHE in terms of their lack of independence from government, hindering their ability to “speak truth to power”. They also argue that there is a lack of clarity over their roles, how they will work with each other, and how they will cooperate effectively with other central and local government departments and agencies.

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