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Controversial from creation to disbanding, via e-cigarettes and alcohol: an obituary of Public Health England

BMJ 2020; 371 doi: (Published 20 November 2020) Cite this as: BMJ 2020;371:m4476
  1. Richard Vize, journalist
  1. London
  1. richard.vize{at}publicpolicymedia.com

The (first) fall guy for the UK’s covid response was hamstrung by its lack of independence from government. Richard Vize charts its highs, lows, and ultimate downfall

Public Health England was born from the most controversial reforms in NHS history—and it’s been killed off just seven years later, the first casualty of a blame game over tens of thousands of deaths from covid-19.

Under the Health and Social Care Act 2012 as championed by the then health secretary Andrew Lansley, Public Health England (PHE) was established as an executive agency of the Department of Health, meaning that it had operational independence but took instructions from ministers. In contrast, the Health Protection Agency, which PHE replaced, had had independence as a non-departmental public agency.

This lack of autonomy would undermine PHE’s relations with parliament, would stoke criticism from public health specialists, and would eventually prevent it from defending its reputation when the covid pandemic took hold.

Dual role

As well as taking up the Health Protection Agency’s role of protecting the public from infectious diseases and environmental hazards, PHE absorbed numerous other organisations including the National Treatment Agency for Substance Misuse, the public health observatories, cancer registries, and national screening programmes. The Rare and Imported Pathogens Laboratory, at the government science facility in Porton Down,1 also came with the Health Protection Agency.

The new PHE agency, launched in April 2013, was responsible for both managing infectious diseases and tackling the social determinants of ill health, such as obesity and alcohol abuse. It promised to “protect and improve the nation’s health and wellbeing, and reduce health inequalities,”2 using “world-leading science, knowledge and intelligence.”3 Meanwhile, public health directors—already joint appointments between primary care trusts and local authorities—moved to local government when primary care trusts were abolished.4

Hertfordshire County Council’s public health …

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