Public Health England - Health Committee Contents


Conclusions and recommendations


PHE's role on the new public health system

1.  The meeting the Committee held with the management of Public Health England was the first opportunity for the Committee to examine the work of the agency and the transition to the new public health arrangements in England. Whilst we are satisfied that some functions are operating well, the Committee has concerns regarding PHE's policy work, the way in which policy priorities are identified and the nature of PHE's relationship with Government (Paragraph 8)

Transition

2.  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. (Paragraph 15)

Emergency preparedness

3.  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. (Paragraph 23)

Establishing priorities

4.  The Committee is concerned that the responses to Committee questions on shale gas extraction suggest that PHE has not yet established prioritised programmes of work which reflect the objectives of the organisation and have been endorsed by the Board. We believe it was unwise for PHE to follow through the work on shale gas extraction which had been initiated by the HPA without first taking care to satisfy itself that this work reflected both the public health priorities of PHE, and the research quality criteria embraced by the new organisation. The resulting report did nothing to build public confidence in PHE as the premier guardian of public health in England. (Paragraph 30)

5.  The Committee welcomes this objective and believes it should be the foundation for establishing PHE's policy priorities. Within the work of PHE there is a clear distinction between its responsibility to operate established programmes and campaigns—such as Stoptober, change4life and vaccination programmes —on behalf of the Department of Health and broader work to promote or support specific policy priorities, some of which may be regarded as contentious. The Committee is concerned that there is inadequate clarity about how the organisation will approach crucial policy issues such as obesity, minimum unit pricing of alcohol, and standardised packaging of tobacco products. The public expects PHE to be an independent and forthright organisation that will campaign on behalf of those public health objectives and policies which it believes can improve the nation's health. We note that PHE focused in the first instance on achieving a smooth transition to the new arrangements and the Committee believes that PHE has so far failed to set out a clear policy agenda. (Paragraph 31)

Independence from the Department of Health

6.  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. (Paragraph 38)

7.  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". (Paragraph 39)

8.  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. (Paragraph 40)

Minimum Unit Pricing Policy

9.  Duncan 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. (Paragraph 44)

10.  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. (Paragraph 45)

NHS Health Check

11.  PHE has said in relation to the Health Check programme that it will undertake research to "generate the evidence we need to look at the impact and effectiveness of the programme." The Committee believes that this process is essential and that analysis of the clinical and economic benefits of health checks should be fundamental to this. As part of this process, PHE should consider the opportunity cost of investing in Health Checks instead of other proven public health initiatives. (Paragraph 52)

Public Health Staff

12.  The Committee is concerned by the reports in written evidence of a capacity problem in the public health workforce. It is also concerned that some Directors of Public Health do not enjoy a direct relationship with the Chief Executive and Cabinet members of their local authority. The Committee does not believe that it is possible for Directors of Public Health to drive public health reform if they are subordinate to other officials within local bureaucracies. (Paragraph 60)

13.  Public health is now an important function of local government, but PHE has an explicit duty of oversight over the public health function at both national and local level. The Committee therefore recommends that PHE should announce on its own authority that it intends to make a formal report to Parliament if it believes that the public health function in a particular local authority area is unable adequately to discharge its responsibilities. (Paragraph 61)


 
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Prepared 26 February 2014