Public Health England (Dissolution) (Consequential Amendments) Regulations 2021

Lord Cormack Excerpts

Tuesday 9th November 2021 Lords Chamber

[Lord Howarth of Newport (Lab) [V]]

My Lords, I want to take the opportunity of this debate, arising from the dissolution of Public Health England, to pay tribute to PHE and its chief executive, Duncan Selbie. I also want to ask the Minister to tell us more about the Government’s intentions regarding public health, a matter that certainly deserves consultation, as my noble friend Lady Merron has insisted, and more than the perfunctory scrutiny—or non-scrutiny—normally given to a statutory instrument.

With other parliamentary colleagues—including a good number from your Lordships’ House—in the All-Party Parliamentary Group on Arts, Health and Wellbeing, I worked for some years with Mr Selbie and others in his team at PHE. At a time when the Department of Health, NHS England and clinical orthodoxy were far from recognising the significance of the well-being agenda, social prescribing and the potential of the arts to support health and well-being, PHE was positive and far-sighted. During the three-year period of the inquiry which led to the publication of the APPG’s report, Creative Health, in 2017, PHE worked constructively and thoughtfully with us.

The three key messages in Creative Health, underpinned by evidence, were that the arts can help keep us well, aid our recovery and support longer lives better lived; help to meet major challenges facing health and social care, including ageing, long-term conditions, loneliness and mental health; and help to save money in the health service and social care. Duncan was one of a number of distinguished people, including Professor Sir Michael Marmot, who publicly endorsed the findings of Creative Health. He said:

“This is an impressive collection of evidence and practice for culture and health”.


The publication of Creative Health was, I think it is fair to say, a turning point in the recognition by the health establishment of the importance of social prescribing and the engagement of individual creativity in promoting health and well-being.

In a speech at the King’s Fund in November 2018, the then Health Secretary, the right honourable Matt Hancock, explicitly acknowledging the significance of the Creative Health report, said that from now on prevention must be fundamental to NHS strategy and social prescribing must be fundamental to prevention. He stressed the value of the arts and culture in social prescribing, and the NHS Long Term Plan of 2019 reaffirmed the centrality of prevention. Mr Hancock established the National Academy for Social Prescribing later in 2019.

Much has happened since then. While I can well understand that the new Secretary of State is preoccupied with Covid-19, the clinical backlog that Covid has so much worsened and the pressures on the NHS workforce, I would ask the Minister to reaffirm that the Government’s commitment to their prevention strategy is not diminished and that they continue to recognise the importance of personalised health and of the arts and culture in contributing to health and well-being.

I hope the Minister will also pay tribute to Duncan Selbie and PHE. When it was announced that PHE was to be abolished, I was shocked. It was hard not to believe that PHE institutionally and Duncan Selbie personally were being scapegoated for the Government’s own failures in the early stages of the pandemic. Of course, I wish the successor institutions well and look forward to working with them through the APPG and the National Centre for Creative Health. It is a shame, however, that Mr Selbie was cast aside.

I am concerned that the “build back better” plan envisages shifting the NHS towards prevention only as a long-term priority. However, integrated care systems surely offer an early opportunity for the NHS to work better with local authorities and the voluntary and community sector, including arts providers, on prevention. Will the Office for Health Improvement and Disparities be working with other government departments responsible for education, housing and employment in addressing the social determinants of health?

I hope we can be reassured this evening that the Government recognise their error in having reduced the public health grant by no less than 24% per head over the last six years, with terribly damaging consequences, and that the restructuring that has now occurred is intended to provide more, rather than less, support for public health.

[Lord Cormack (Con)]

My Lords, it is a very great pleasure to follow my friend, the noble Lord, Lord Howarth of Newport. I very much look forward to the day when he will be able to rejoin us here on the Floor of the House. He has made an immense contribution during his parliamentary life, both in the other place and here, and I associate myself with and endorse all his comments about the arts and health. But I wanted to make another, more parliamentary point.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I thank the noble Baroness for securing this important debate on secondary legislation in relation to the Government’s public health reforms, and also for this opportunity to explain why they were made, and the context.

Since the outbreak of the coronavirus pandemic, the country has faced its greatest health and economic challenge for decades. The pandemic has highlighted the immense economic, societal and personal costs that ill health can bring, particularly to the most vulnerable. It has also identified weaknesses in our public health system. That is why, in August 2020, the Secretary of State for Health and Social Care announced the Government’s intention to reform the public health system in England. Since that announcement, we have worked to transform our national health protection capabilities to put prevention of ill health and the tackling of health inequalities at the heart of government and to more deeply embed prevention and health improvement expertise across local and national government and the National Health Service. These reforms are driven by lessons learned from the pandemic and by the need to make sure that we have a public health system fit for the future.

From 1 October this year, a new public health landscape was established, and Public Health England was closed. The health protection capabilities of Public Health England, the at-scale operational capacity of NHS Test and Trace, and the analytical capability of the Joint Biosecurity Centre have been brought together into the new UK Health Security Agency to lead the response to Covid so that we now have an organisation dedicated solely to identifying, preventing and managing threats to health. As some noble Lords have acknowledged, the new Office for Health Improvement and Disparities has been created in the Department of Health and Social Care, and the OHID will help our health system to go further in promoting good health and tackling the top preventable risk factors for poor health and disparities.

One noble Lord raised the issue of prevention and cure. One of the conversations I have had with many health experts in my short time in this job has been about how we make sure that we save more money and lives and achieve better health by focusing on prevention rather than, necessarily, cure. I know that noble Lords will remember the debate we had the other day on obesity and what is being done by the OHID there. Now, working with a new cross-government Cabinet committee for health promotion, we will drive and support the whole of government to go further in improving health and tackling health disparities. Alongside this, we have strengthened NHS England’s focus on prevention and population health, transferring to it important national capabilities that will help drive and support improved health as a priority for the whole NHS. Important national disease registries have also moved to NHS Digital.

On the recently laid secondary legislation and the question of ensuring that there is consultation and scrutiny, the amendments themselves do not give effect to the establishment of the UK Health Security Agency, or OHID, or the dissolution of PHE. Public Health England and the UK Health Security Agency are executive agencies of the Department of Health and Social Care, and NHS Test and Trace was part of the department. The restructuring of public health functions in England was therefore an administrative process. The regulations in question were made and laid in accordance with the negative resolution procedure. They make minor consequential amendments to existing legislation, to ensure that the statute book accurately reflects the administrative changes that have taken place. They are not the vehicle for implementing the substance of our public health reforms. There will be further regulations containing references to Public Health England, which need to be updated. I assure noble Lords that they will be amended in accordance with the affirmative resolution procedure and will be debated in Parliament.

I turn now to some of the individual points made. On engagement with stakeholders, since the reforms were announced, a senior stakeholder advisory group was established to advise the Department of Health and Social Care on the best arrangements for national prevention and health improvement functions. I thank the noble Lord, Lord Hunt, for pointing out that praise for Public Health England was not universal. Many will have read articles from health experts, probably the most damning of which was You Had One Job. Questions had to be asked, but we looked at the stakeholder advisory group—its membership and terms of reference are published—and the group included public health, the third sector, think tanks, the health service, local government and other expertise. It worked quickly and we are grateful to all who contributed. Throughout the reform programme, we actively supported and welcomed views from key stakeholders across the spectrum of public health.

We have engaged quite widely, commensurate with the need to make quick progress and not foster a lingering uncertainty for staff, delivery partners and stakeholders. A Written Ministerial Statement was made in March, when we formally established the UK Health Security Agency from 1 April. We also published our evolved proposals in March, including the establishment of what is now OHID, and we invited views on a number of questions to support the successful implementation of the reforms.

Going forward, there is a new cross-government Cabinet committee for health promotion. This means that, across government, we will drive forward action on the wider determinants of health, ensuring that health is a shared outcome and priority. We will make sure that we work across government in a joined-up way.

Also, the creation of OHID—with the “D” for disparities—makes sure that, right at the centre of public health, we are looking at inequalities in the system. Far too often across this country, public health has been seen as the preserve of the privileged white middle class, as opposed to poorer communities. It is important that we make sure that this is no longer the preserve of the privileged white middle class, but of the working class, other people and immigrant communities, who understand some of these disparities in their communities.

Our reforms are explicitly designed to ensure that the different dimensions of public health have the dedicated national attention that each threat faces. The UK Health Security Agency focuses on health security; the Office for Health Improvement and Disparities, on better health and tackling these health disparities; NHS England, on delivery of NHS services to protect and improve health; and NHS Digital, on securing our gold-standard disease registers.

This year, we increased the local authority public health grant and allocated over £100 million of additional funding to local authorities. We are also investing £500 million over the spending review period to improve the Start4Life offer, and we have confirmed additional investment of £300 million to help people to achieve and maintain a healthy weight. Rather than proposing a one size fits all, we are also looking at pilot projects. We look at this as a process of discovery; we all have to admit that we do not have infinite knowledge and sometimes do not always foresee unintended consequences. By piloting projects and allowing the discovery process to take place, we can learn more.

In terms of the pandemic and future pandemics, the UK Health Security Agency’s sole purpose is to ensure the UK is protected from all future health threats, including pandemics, and to make sure we continuously assess our preparedness plans for infectious disease outbreaks. In future, critics can no longer say, “You had one job; why didn’t you do it?” We are focusing on health security.

We are hoping that the Office for Health Improvement and Disparities will work on prevention across all parts of government, given the cross-cutting nature of public health, making health improvement and disparities a focus of government. We are looking at a number of projects and key Covid programmes, making sure that we build back better and that we learn from the issues.

The noble Lord, Lord Hunt, asked about independence and accountability. The public health system in government needs a trusted source of independent scientific advice on health improvement to support evidence-led national decision-making and a focus on health inequalities. The Office for Health Improvement and Disparities will continue to make available and publish public health advice, research, evidence and data analysis, as Public Health England did previously, through a newly recruited Deputy Chief Medical Officer. The Chief Medical Officer will provide professional leadership for the Office for Health Improvement and Disparities, while Ministers will remain in charge of and responsible for policy decisions in that direction.

We hope that these reforms to the public health system that have been explained today will do that, and keep us safe and healthy into better times ahead. Vigilance, prevention and reform are the key words to keep us all safer and, I hope, improve the health of the nation, not only in certain communities but to tackle those disparities where they may have felt ignored in the past.

[Lord Cormack (Con)]

Does my noble friend accept that scrutiny by Parliament is essential?