Public Health England - Health Committee Contents

2  Transition to Public Health England


9. PHE's written evidence stated that the creation of PHE and the transition of staff and functions from feeder organisations were undertaken successfully.[8] The Department of Health shared this view and said that PHE achieved its objective of "being fully operational, with all functions transferred safely, to ensure no 'dip' in delivery".[9] The Department's written evidence said that:

    In the six months since its formal go-live date, PHE has successfully welcomed over 5000 staff and created a well-functioning organisation. PHE's performance in areas such as the MMR catch-up campaign demonstrates encouraging progress.

    Inevitably there has been a focus on setting up new systems and relationships and building a new organisation-a process which will take time. DH and PHE are working closely together to ensure that there is a robust but constructive accountability relationship between the centre and PHE.[10]

10. PHE's additional written evidence provided a breakdown of the staff transferred into the organisation. In total PHE incorporated staff from 120 "host organisations"[11] of which 3,686 staff were based in the Health Protection Agency (HPA).[12] In oral evidence Dr Cosford provided the Committee with an illustration of PHE's role in managing threats to public health using the resources inherited from the HPA. The example cited by Dr Cosford outlined the ability of PHE's laboratories to sequence a new virus brought into the country by a patient from the Middle East and to provide an "immediate response to a new, emerging, very serious potential harm".[13]

11. Since April 1 2013 PHE has been tasked with running a number of national public health awareness campaigns. PHE's evidence provided an overview of two key campaigns that they have deployed:

    ·  "Stoptober—this is PHE's national 28 Day Stop Smoking Challenge. There were 1.25 million visits to our website during the campaign period, and nearly 500,000 Stoptober support products were ordered included packs, apps, text and email support; and

    ·  "Change4Life—PHE's flagship obesity prevention social marketing campaign and a key aspect of our work programme now has more than 200,000 Facebook fans, more than 70,000 local supporters and more than 200 national partners, generating an in-kind contribution that has been independently valued at over £14 million per year."[14]

12. PHE's national programmes also include direct interventions. PHE's evidence stated that they were:

    leading the national and local responses to the recent upsurge in measles cases, co-ordinating with the DH, the NHS and with local government. This has included undertaking a national catch-up programme to vaccinate 10-16 year old children and the management of local cases and outbreaks of measles. Numbers of measles cases have fallen significantly, although further efforts to sustain vaccine coverage are required.[15]

13. In addition PHE is responsible for leading on vaccination programmes against rotavirus, childhood flu, pertussis in pregnancy, and shingles.[16]

14. In written evidence both the Local Government Association (LGA) and London Councils' expressed their satisfaction with the public health transition arrangements. London Councils' evidence said they "welcomed the active engagement of Public Health England [...] some pan London governance structures across health and care".[17] They added that "[s]trong personal relationships have been established and provide a sound foundation to build upon".[18] The LGA's evidence said "PHE clearly understand at the most senior level the role of local government and the importance of local government's role in the new system."

15. The Committee has received evidence that, in its first seven months of operation, PHE has established itself as a new entity whilst ensuring continuity of public information campaigns. Evidence also indicates that PHE acted effectively to address the 2013 measles outbreak by delivering the vaccination catch-up programme. This suggests that PHE met its objective of ensuring that the transition to the new arrangements did not result in a 'dip in delivery' of existing programmes. Most importantly, the Committee recognises that throughout the transition PHE maintained continuity of the vital work undertaken by the Health Protection Agency.

Emergency preparedness

16. PHE's document outlining its priorities for 2013-14 identifies the importance of implementing a national surveillance strategy to "ensure the public health system responds rapidly to new and unexpected threats".[19] The incorporation of the Health Protection Agency into PHE means that PHE "will be responsible for front line health protection via its local centres which will support their local authorities".[20]

17. In written evidence the UK Faculty of Public Health questioned whether the system for emergency preparedness enjoyed a proper delineation of responsibility between local authorities, PHE's 15 local centres and national bodies. Their evidence said:

    While recognising that statutory regulations give Directors of Public Health [...] responsibility for provision of information and advice, they have no direct role in response to emergencies, while the specific health protection roles and responsibilities of PHE and the local authority Director of Public Health (DPH) remain unclear. This is clearly unsatisfactory, particularly in relation to incidents and outbreaks-and unsafe.

    In practice Directors of Public Health find themselves in the frontline of many infection control and chemical incidents. They also commission major services which are likely to be called upon. It is necessary to further clarify who will do what in response to situations and exactly what the Secretary of State's powers to direct local authorities and Public Health England are in practice.[21]

18. In 2012, the Association of Directors of Public Health (ADPH) gave evidence to the Communities and Local Government Committee where they questioned how emergencies would be managed under the new public health system.[22] In their evidence to this inquiry, however, the ADPH emphasised the engagement and inclusiveness of PHE at a national level and said that:

    ADPH has worked closely with PHE to develop both the structures (national and local) and effective working relationships that are vital to the success of the public health system in England. In particular, detailed work was undertaken with the HPA and subsequently PHE to develop solutions to key local health protection issues, including: Infection Prevention & Control; Out of Hours arrangements for health protection; and emergency preparedness and response.[23]

19. In oral evidence, Dr Paul Cosford, Director for Health Protection and Medical Director, Public Health England told the Committee how PHE has addressed concerns regarding its ability to manage emergencies. Dr Cosford said:

    Since 1 April, we have responded as before to 4,500 incidents of various kinds across the country. They have varied up our emergency response scale. We have had three we have taken national control of. So the systems have been up and running and working.

    There have been some concerns about precisely who is responsible for what at a local level. [...] The principles are that Public Health England leads on the specialist health protection response. It will chair an outbreak control committee, for instance, if there is an outbreak, make sure that the right specialist advice is provided on how to control an outbreak of infectious disease or mobilise our air quality monitoring cells when there is a fire that is spewing noxious chemicals across a community. The NHS is responsible for responding and providing the clinical response. The local authority is responsible for making sure that those plans work properly and are working in effect for the local population.[24]

20. Richard Gleave, PHE's Chief Operating Officer, added that PHE has:

    put together a group that has the Faculty of Public Health, the Local Government Association, the Association of Directors of Public Health, NHS England and us. We are coming together to address the specific issue of what happens with the individual responsibilities in different sorts of incidents, because the range of incidents is enormous. [...] The breadth of knowledge that we need to provide as Public Health England to support the local teams is crucial.[25]

21. Mr Gleave also explained the level of authority PHE enjoys in emergency situations and outlined how the relationship between PHE and local authorities should operate. He said:

    What we provide is clear and unequivocal advice about how an incident should best be managed. We also feel that, because of the Secretary of State's powers that oversee the whole of the system, if we had a substantial concern that an incident was being mismanaged locally we would take a more active role in it. The best solution is that people locally—the key agencies locally—draw upon our expertise and support and manage it properly. That is the purpose of the whole planning and resilience system—to set up those systems and processes so that people know how to respond in those situations. Then we provide the expert support.[26]

22. Mr Gleave further confirmed that PHE has the ability to intervene in managing a local crisis. He told the Committee that the legal power to do this originates from the Secretary of State:

    but we do not need to go to the Secretary of State in order to engage. If that led to a judicial review with the advantage of hindsight, so be it, but we would say that protecting the public's health is of absolutely paramount importance in these situations.[27]

23. The Committee recognises that PHE has worked to clarify responsibilities for emergency preparedness and has addressed a number of concerns raised in advance of the organisation's launch. The Committee is concerned, however, that the Faculty of Public Health reports that these responsibilities remain unclear, and recommends that the Government takes urgent steps to put these important issues beyond doubt.

8   Public Health England (PHE 02), para 11-12 Back

9   Department of Health (PHE 21), para 3 Back

10   Ibid, para 36 Back

11   Public Health England (PHE 022), p 15-17 Back

12   Ibid, p 15 Back

13   Q70 Back

14   Public Health England (PHE 02), para 19 Back

15   Ibid, para 20 Back

16   Public Health England, Our priorities for 2013-14, April 2013, p 9 Back

17   London Councils (PHE 16), para 3 Back

18   Ibid Back

19   Our priorities for 2013-14, p 9 Back

20   Communities and Local Government Committee, The role of local authorities in health issues, HC 694-I (2012-13) Ev 166  Back

21   UK Faculty of Public Health (PHE 020), paras 7-8 Back

22   HC 694-I (2012-13), para 111 Back

23   Association of Directors of Public Health (PHE 013), para 6 Back

24   Q99 (Dr Cosford) Back

25   Ibid (Mr Gleave) Back

26   Q101 Back

27   Q102 Back

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Prepared 26 February 2014