Public Health England - Health Committee Contents

4  Relationship with Government

Independence 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.[36]

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.[37]

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".[38] Similarly, the Department of Health's evidence recognised that the operational autonomy of PHE had been questioned. The Department said that:

    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.[39]

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".[40] 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".[41]

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".[42] 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 effective.[43]

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.[44] 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.[45]

38. The 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.

39. We 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".

40. As 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.


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 in England.

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 said:

    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 active consideration.[46]

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 Health England"[47] and "anything that can limit the widespread availability of cheap strong alcohol within our communities is a good thing".[48] In response to the Government's announcement of July 2013, PHE said:

    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".[49]

44. Duncan Selbie told the Committee that PHE had given an unambiguous view on minimum unit pricing of alcohol[50], 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.

45. If 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 clearly heard.

36   Public Health England (PHE 02), para 6 Back

37   British Medical Association (PHE 011), para 4 Back

38   Public Health England (PHE 02), para 23 Back

39   Department of Health (PHE 21), para 28 Back

40   Q21 Back

41   Department of Health (PHE 021) para 37 Back

42   Ibid Back

43   Ibid, para 28 Back

44   Q106-108 Back

45   Q113 Back

46   Public Health England, Public Health England responds to the Government's decision on minimum unit pricing, 17 July 2013, Back

47   Q87 Back

48   Ibid Back

49   Public Health England, 17 July 2013 Back

50   Q3 Back

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Prepared 26 February 2014