PHE has been a public health catastrophe

We need more than just a mirage of competence if we are to avoid a similar disaster in the future

Britain has an immensely proud history of public health. John Snow founded epidemiology by mapping a cholera outbreak in Soho and tracing it to a water pump. We have led the way in reducing air pollution, vaccinating children to prevent killer diseases, and biomedical discoveries like penicillin.

Public Health England will be a dark chapter in this history. Fortunately, it is a chapter that is coming to a close. The Sunday Telegraph yesterday revealed that the Government will replace PHE with a dedicated pandemic response agency. This will be modelled on Germany’s Robert Koch Institute.

PHE has failed: rather than improving our health, it contributed to a public health catastrophe. Britain now has among the highest death tolls from Covid-19 and the most damaged economy in Europe.

PHE was established by the Lansley reforms in 2013. An executive agency with operational independence, it was supposed to provide disease control and protection, unleash innovation and support local efforts. Instead, it became entangled in a toxic mix of centralisation and incompetence.

PHE’S remit letter states the organisation’s first and foremost role is to protect against infectious diseases by providing an “integrated surveillance system” and “diagnostic and reference microbiology”. PHE developed a Covid-19 diagnostic test in January but waited until mid-february to roll it out. It was not until March that NHS labs were approved for testing, while PHE rebuffed offers from charities, businesses, universities and even animal-testing labs.

Because of PHE’S failure, testing and tracing was taken over by the Department of Health. But that was too late to stop the initial spread. PHE also failed in its co-ordination and information role. It did not ensure sufficient personal protective equipment stocks or case information to local officials. It also provided woeful guidance to care homes, on face masks for the public and on PPE for healthcare professionals. It has also been caught out exaggerating daily death statistics.

Perhaps PHE could have done a better job if it were not so distracted. The organisation has spent most of the last decade obsessed with so-called “lifestyle-driven health problems”: sugar in soft drinks; how much we drink and smoke. It was also focused on mental health, childhood behaviour and the meaningless tosh that is “health inequalities”.

Even in January and February, as a plague descended, PHE was still tweeting and releasing reports about obesity. Ironically, even in these nanny statist areas, PHE has largely failed.

PHE’S replacement is reportedly to be named the National Institute for Health Protection. In addition to overseas models, it can also look to PHE’S predecessor, the Health Protection Agency. This unassuming organisation, never a household name, undertook traditional public health tasks: operating a first-class network of microbiology labs; co-ordinating the response to infectious disease outbreaks at a local and national level; providing protection against radiation, chemical and environmental hazards; and ensuring the local delivery of flu, tuberculosis and MMR jabs.

Unlike PHE, the new organisation should be fully empowered for pandemic preparedness. It needs the skills, prestige and money to ensure something like Covid-19 never happens again. In practice, this means responsibility for up-to-date stockpiles of PPE, medicines and medical devices.

It also means being staffed by our best and brightest: people able to deliver fast in uncertain situations. These people should plan, but also be agile and responsive. They will need a new culture: open to working with local and national government, as well as the private sector, charities and universities. No offer for support should ever be turned down because of pride. The organisation must also have a permissive approach to innovation: able to approve the emergency use of, for example, low cost RT-LAMP spit-in-a-tube diagnostic tests.

On paper Britain was the best prepared country in the world for a pandemic. We know what happened in practice. In future, we need more than a mirage of competence. Our health depends on it.