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

Lord Howarth of Newport Excerpts

Tuesday 9th November 2021 Lords Chamber

[Baroness Merron (Lab)]

My Lords, this regret Motion raises concerns about the lack of consultational scrutiny of the regulations introduced by secondary legislation associated with the dissolution of Public Health England and the establishment of the UK Health Security Agency. There is an important background to bringing this regret Motion before your Lordships’ House. The regulations are marked out by a lack of consultation and stakeholder engagement, the creation of a culture of blame for the shortcomings of government, confusion, and ongoing concerns about how the new arrangements will operate and be held to account.

In looking at how this came about, it is difficult to keep up with events, but, for the benefit of this debate, I will attempt to do so. In August 2020, during the parliamentary Recess, the then Secretary of State for Health and Social Care, Matt Hancock, announced in a press release that the Government were forming a new organisation, the National Institute for Health Protection, bringing together the existing health protection responsibilities discharged by Public Health England with the new capabilities of NHS Test and Trace, including the Joint Biosecurity Centre.

The press release advised that the new organisation was to be operational from 2021 and led by the noble Baroness, Lady Harding of Winscombe, who was appointed as the agency’s interim executive chair. This was followed by a Written Statement in March 2021, in which Matt Hancock announced the formal establishment of the UK Health Security Agency, which was previously the aforementioned National Institute for Health Protection, to take effect from 1 April 2021 and to be led by Jenny Harries, the Deputy Chief Medical Officer for England.

Later in the year, on 1 October 2021, the Government announced the launch of the UK Health Security Agency in a press release. On the same day, the Government also announced the launch of the Office for Health Improvement and Disparities, to be led by the incoming Deputy Chief Medical Officer for England. Confusion and obfuscation reigned throughout all of this, with the 2021 regulations—the subject of this regret Motion—being laid before both Houses of Parliament on 3 September 2021 and coming into force on 1 October 2021, as an instrument under the “made negative” procedure.

The House of Lords Secondary Legislation Scrutiny Committee noted in a report published on 16 September 2021that the regulations were “an instrument of interest”, due to the regulations making consequential changes to legislation that had referenced Public Health England. While Parliament was denied scrutiny and consultation was conspicuous by its absence, reaction to the dissolution of Public Health England was far from positive, with more than 70 health organisations, including the Academy of Medical Royal Colleges and the Faculty of Public Health, signing a joint letter.

The signatories were “deeply concerned” that the plans paid

“insufficient attention to the vital health improvement and wider functions of Public Health England”,

including necessary measures to target smoking, obesity and alcohol and to improve mental health. The signatories argued that it was a “false choice” to

“neglect vital health improvement measures”

to tackle Covid-19. I reflect that this is an observation repeatedly pursued in debates and Questions in your Lordships’ House.

Alexis Paton, chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians, argued that the decision to dissolve Public Health England was an attempt by the Government to save global face as a result of their response to the pandemic. Ms Paton stated that Public Health England had nearly 60 targeted programmes to improve health and well-being across the population, and that the loss of any of these services was too high a cost to pay. At the same time, the chair of the British Medical Association’s ruling council, Dr Nagpaul, queried the timing of this decision, questioning whether it was the right time for a major restructure, given the very immediate need to respond to the pandemic. Clearly, it was not the right time. The King’s Fund also stated that the Government’s decision to replace Public Health England with two new bodies would

“increase complexity locally and nationally”,

and indeed this is the case. There were also warnings that the restructuring of Public Health England would sap morale and focus and should have waited until the end of the pandemic.

I am grateful to the BMA for its views on this matter, including that the solution was not to reorganise in the middle of a pandemic but instead to restore funding and capacity, including increased support to local public health services. The BMA observes that previous reorganisations of public health services have not improved public health provision or the experience of the workforce, and that health inequalities have in fact worsened since the last reorganisations—even more so during the pandemic. Concerningly, the BMA also reports that morale is low, with widespread fatigue and burnout, while staff have also experienced inadequate consultation on the restructuring, despite the fact that they would have had so much to offer.

In a survey of public health doctors at the beginning of the year, over 60% said that they believed that the new form of organisation would actually worsen doctors’ ability to respond to public health challenges. Nearly two-thirds said that they were not confident that they would be able to contribute to the design of the new system, and almost three-quarters of respondents to a survey said that they had no confidence that the successor organisation to Public Health England would be sufficiently independent or able to speak truth to power. This is a serious charge sheet from those who work in the field and seek to improve the health of the nation by prevention rather than cure. I put it to the Minister that in the face of all this, it is hard to see how the new bodies could be independent or effective. They are not set up in statute and were created without parliamentary scrutiny or approval. I will be listening closely to the Minister’s response to the substance of this regret Motion. I beg to move.

[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.