Exclusive: Many public health responsibilities to return to the NHS

Health secretary Matt Hancock announced the abolition of the seven-year old PHE today and said most of its health protection work would be taken on by the new National Institute for Health Protection.

However, he said no decision had been made over the future of PHE’s remaining functions or – by implication – the fate of many of its 5500 staff. Mr Hancock said a consultation on the best way forward would now begin.

The creation of PHE in 2013 saw many functions move across from the NHS to the new agency. PHE’s health improvement work includes substance misuse treatment, health promotion and screening programmes, as well a wide range of data collection, research, and other responsibilities. It has worked increasingly closely with local authorities since local public health directors became council employees.

One senior government source told HSJ: “There is no clear destination [for the remaining PHE functions], but there is a central working hypothesis that many will become the responsibility of the NHS again.”

The source stressed there was considerable debate about which functions are made the responsibility of NHS England at a national level and which are shared more locally between developing “integrated care systems” and local government. The desire, they claimed, was to use the re-organisation to encourage the NHS to take a greater responsibility for health inequalities.

Some cross-governmental responsibilities, such as tackling air pollution, would move to the Department of Health and Social Care, they indicated.

HSJ understands there is little appetite for creating a new standalone public health agency among senior policy makers. There is also a desire to decide on organisational responsibilities as quickly as possible to provide continuity for staff as they tackle winter and renewed covid pressures.

However, the sources said the consultation would “take months” and that any formal changes in responsibilities was not likely to take place until April 2021 at the earliest. Although Mr Hancock said NIHP would begin work “immediately”, he added that it would not be formally constituted until the “spring”.

The need to realign NHS and public health functions was stressed in theJanuary 2019 NHS long term plan, Sir Mike Richards’ review of screening programmes, as well as the recommendations for new legislation made by NHS England to the government, which the Johnson administration had promised to enact.

However, the timing of the announcement was not welcomed by the senior NHS leaders, HSJ spoke to. They believed this was driven by the government’s concerns over the record of the NHS Test and Trace programme.

“It should not have been done in this way, or at this time”, said one.