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.
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".
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
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. PHE's additional written evidence
provided a breakdown of the staff transferred into the organisation.
In total PHE incorporated staff from 120 "host organisations"
of which 3,686 staff were based in the Health Protection Agency
(HPA). 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
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:
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
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."
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.
13. In addition PHE is responsible for
leading on vaccination programmes against rotavirus, childhood
flu, pertussis in pregnancy, and shingles.
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".
They added that "[s]trong personal relationships have been
established and provide a sound foundation to build upon".
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."
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.
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".
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".
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.
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.
In their evidence to this inquiry, however, the ADPH emphasised
the engagement and inclusiveness of PHE at a national level and
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.
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.
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.
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.
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 locallythe
key agencies locallydraw upon our expertise and support
and manage it properly. That is the purpose of the whole planning
and resilience systemto set up those systems and processes
so that people know how to respond in those situations. Then we
provide the expert support.
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.
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
8 Public Health England (PHE 02), para 11-12 Back
Department of Health (PHE 21), para 3 Back
Ibid, para 36 Back
Public Health England (PHE 022), p 15-17 Back
Ibid, p 15 Back
Public Health England (PHE 02), para 19 Back
Ibid, para 20 Back
Public Health England, Our priorities for 2013-14, April
2013, p 9 Back
London Councils (PHE 16), para 3 Back
Our priorities for 2013-14, p 9 Back
Communities and Local Government Committee, The role of local
authorities in health issues, HC 694-I (2012-13) Ev 166 Back
UK Faculty of Public Health (PHE 020), paras 7-8 Back
HC 694-I (2012-13), para 111 Back
Association of Directors of Public Health (PHE 013), para 6 Back
Q99 (Dr Cosford) Back
Ibid (Mr Gleave) Back