Experts not to blame

sir – The rush to blame and reorganise Public Health England (PHE) because of difficulties managing this pandemic (report, August 19) must be stopped. A plethora of medical royal colleges, societies, coalitions and individuals have called for a “no-blame” investigation or independent review into how to prevent a second wave of Covid-19 infections.

History is important. PHE was created by the Conservative government during the 2013 reorganisation of the NHS – an event so large that its chief executive, David Nicholson, joked that it could be seen from outer space. PHE emerged as an executive agency of the Department of Health, formed of 70 organisations previously funded to work with the NHS. As a former director of an English cancer registry – and one who led 60 staff through the transition – I can vouch for the hard work involved. It took much of 2012 to plan, and several years for the new organisation to bed down. Many experienced leaders lost their jobs or left, and staff learnt to operate as civil servants. PHE was charged with improving the population’s health and protecting it from communicable diseases and other threats.

The professionals who manage communicable disease outbreaks are seriously dedicated, with years of experience behind them. Moreover, public health is much broader than one pandemic, as the inequalities in who suffers most from Covid-19 have shown. While we have some of the best epidemiologists in the world, our underfunded public health system has been overwhelmed. At this point we must understand what has happened and support and strengthen PHE, not attempt to reorganise it.

John Snow, a doctor in Victorian London, famously had the handle of a water pump in Broad Street removed in a decisive act to stop a cholera epidemic. Creating a new organisation may feel decisive, but it is not a precise intervention. Sadly, the lessons of history have not been understood.

Dr Elizabeth Davies

London SE26