Public Health England (Dissolution) (Consequential Amendments) Regulations 2021 — House of Lords, 2021-11-09
Topic: Health
Gillian Merron (Labour, Centre-left): 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.