4 Relationship with Government |
from the Department of Health
32. PHE's written evidence outlined
its status in government and the degree of independence it claims
to enjoy. PHE said that it:
has been established as an Executive
Agency of the Department of Health (DH), it is led by its Chief
Executive, supported by an Advisory Board with a Non-Executive
Chairman and Non-Executive Members. PHE has operational autonomy,
as set out in its framework agreement, and is free to publish
and speak out on those issues which relate to the nation's health
and wellbeing in order to set out the professional, scientific
and objective judgement of the evidence base.
33. However, the notion that PHE staff
members are free to challenge national policy is questioned by
the evidence submitted by British Medical Association (BMA). The
BMA's evidence argued that PHE's status as a civil service body
limits the ability of medical professionals within PHE to speak
out on matters of public health and to challenge government policy.
The BMA's evidence said:
BMA members who are employed by
PHE report that the requirement to adhere to civil service rules
and regulations is having an impact on their ability to do their
work. Particular concerns have been raised about [...] the ability
to publicly discuss or criticise public health policies.
34. In their written evidence PHE acknowledged
that feedback from their formal survey of stakeholders had told
them that "more needs to be done to demonstrate that the
advice and guidance PHE provides is truly independent of Government".
Similarly, the Department of Health's evidence recognised that
the operational autonomy of PHE had been questioned. The Department
it is important that PHE is and
is seen as a trusted and impartial champion for the protection
of the health of the nation and free to provide advice based firmly
on the science and the evidence.
35. Speaking in reference to PHE's report
examining the impact of shale gas extraction, Mr Selbie told the
Committee that the report was "checked in the normal way,
through consultation with other Government Departments, and was
published in agreement with the Department of Health".
The Department of Health's written evidence said that the Department
and PHE "are working closely together to ensure that there
is a robust but constructive accountability relationship between
the centre and PHE".
36. The Department's written evidence
reiterated that as "part of DH (Department of Health) but
operationally autonomous, PHE has the opportunity to influence
but still "speak truth to power".
The Department also cited Earl Howe's comments during the third
reading of the Health and Social Care Bill in the House of Lords
on 19 March 2012. The Earl Howe said:
It will be good practice for PHE
and the department to consult each other about communications
on public health matters, but with a view to agreeing the content,
not censoring it. PHE data will be subject to the code of practice
on official statistics, which severely restricts access to certain
material by Ministers or officials before it is published. Within
three years of PHE becoming operational we will undertake a review
of its governance to ensure that it is entirely appropriate and
37. In oral evidence, the Committee
asked Duncan Selbie which Government policies might be damaging
to the nation's public health objectives by increasing health
inequalities. In response Mr Selbie said that at this stage of
the organisation's development it would be too controversial to
directly address this question.
He added that:
As an agency, we are not in a position,
from the evidence, to say about specific policies. If you ask
a general question about whether Government action is helping
or not, there are aspects of what the Government will be doing
that are not helpful.
Committee is concerned that that the Chief Executive of PHE should
regard any public health issue as 'too controversial' to allow
him to comment directly. For similar reasons that the Government
is committed to an independent voice for the Care Quality Commission,
the Committee believes that PHE should be able to address such
matters without constraint.
are concerned that there is insufficient separation between PHE
and the Department of Health. The Committee believes that there
is an urgent need for this relationship to be clarified and for
PHE to establish that it is truly independent of Government and
able to "speak truth to power".
part of this process the research priorities of PHE should be
based on an analysis of public health priorities in England undertaken
by PHE. PHE should not look to the Department or to other parts
of Government to prompt its research or, still less, to authorise
its findings. PHE can only succeed if it is clear beyond doubt
that its public statements and policy positions are not influenced
by Government policy or political considerations.
MINIMUM UNIT PRICING POLICY
41. The Committee believes that the
example of policy on the minimum unit pricing of alcohol (MUP)
serves as a useful case study for demonstrating the necessity
of a genuinely independent voice to promote improved public health
42. On 17 July 2013, Jeremy Browne MP,
then Minister of State in the Home Office announced that the Government
would not be proceeding with introduction of a minimum unit price
for alcohol. In response to this PHE published a statement which
Public Health England shares the
disappointment of the public health community that the introduction
of a minimum unit price (MUP) for alcohol is not being taken forward
at this point, although it recognises that this remains under
43. In oral evidence Professor Kevin
Fenton, PHE's Director of Health and Wellbeing, told the committee
that tackling alcohol misuse "is a top priority for Public
and "anything that can limit the widespread availability
of cheap strong alcohol within our communities is a good thing".
In response to the Government's announcement of July 2013, PHE
There is strong evidence that MUP
would make cheap and higher-strength alcohol less available, with
the greatest impact being in younger and in heavier drinkers.
[...] PHE will take forward a comprehensive and scientific review
of all the available evidence to inform the Government's final
decision on implementation of this measure".
Selbie told the Committee that PHE had given an unambiguous view
on minimum unit pricing of alcohol,
but the Committee does not believe that PHE has yet struck the
right tone in its public comments. Given the toll alcohol misuse
takes on the nation's health, if PHE believes that MUP is necessary,
and the evidence base supports it, then PHE must be unequivocal
in expressing such a view.
PHE believes that the Government's policy approach to alcohol
pricing will not produce the best public health outcome the Committee
believes it is under an obligation to set out its view in public
and draw attention to the relevant evidence. In short, the Committee
believes that Public Heath England was created by Parliament to
provide a fearless and independent national voice for public health
in England. It does not believe that this voice has yet been sufficiently
36 Public Health England (PHE 02), para 6 Back
British Medical Association (PHE 011), para 4 Back
Public Health England (PHE 02), para 23 Back
Department of Health (PHE 21), para 28 Back
Department of Health (PHE 021) para 37 Back
Ibid, para 28 Back
Public Health England, Public Health England responds to the
Government's decision on minimum unit pricing, 17 July 2013,
Public Health England, 17 July 2013 Back