On 18 August 2020, the UK Government announced PHE and NHS Test and Trace would be replaced by a new independent body: the National Institute of Health Protection (NIHP).
With the UK having published its latest obesity strategy just weeks prior, the PHE reorganisation has prompted concerns the government may no longer be held accountable to these commitments.
At the Westminster Health Forum policy conference this week, the Department of Health and Social Care’s (DHSC) Jenny Oldroyd was asked whether she agrees “there is a need for an independent body which can hold the government’s feet to the fire?”
The deputy director of Obesity, Food and Nutrition, was also called upon to provide some ‘reassurances’ that the ‘welcome aims’ of the new obesity strategy can be delivered “when we see how PHE is going to be reconfigured after its disembowelling”.
‘An evidence generator is absolutely critical’
When the government announced the rejig, Health Secretary Matt Hancock praised PHE, and said preventing ill health and reducing health inequalities would remain a ‘top priority’.
At the Westminster Health Forum event, the DHSC’s Oldroyd told delegates she was ‘really pleased’ to see there was a recognition of the ‘excellent work that PHE do on obesity’ during the announcement.
“The expertise that they bring to the conversation around healthy eating and weight in this country [is important, as is] the independence that they bring – and that has been seen at various points where debates have emerged, for example, around sugar levies.”
As to whether the new NIHP would ‘hold the government’s feet the fire’, Oldroyd said the role that PHE has taken over the years – one of a ‘kind of evidence generator’ in the system – is ‘absolutely critical’.
“You’ll recognise it’s very difficult for us to say at the moment what format that would continue in, and that’s a really live conversation.
“But I think through all of the Secretary of State’s communications on this, and all the department’s communications, it’s going to be very clear that we don’t see a way forward without the kind of expertise [and input] that PHE bring.”
Concern for reorganisation
Concern for PHE’s reshuffle has been evident since the news was first announced last month. And concern for the reorganisation of central government in the UK has been felt even longer.
Back in 2010, the National Audit Office (NAO) published a report examining reorganisations of central government, which concluded that those undertaken between May 2005 and June 2009 did not ‘demonstrate value for money’.
Despite the average annual cost of reorganisations (there were over 90 reorganisations to central government during this time) being close to £200m, the NAO said central government bodies were weak at identifying and securing the benefits they hope to gain from reorganisation.
“The decisions to reorganise departments and arms length bodies are often taken at short notice and with inadequate understanding of what could go wrong,” noted the public spending watchdog.
“This approach leaves management teams – particularly in departments where reorganisations often start on the day they are announced – planning and implementing reorganisation simultaneously. Only a quarter of arms length bodies had project plans in place before they announced reorganisations.”
More recently, the Health Foundation, Nuffield Trust and The King’s Fund voiced their dismay at the reorganisation of PHE in particular.
In a joint letter, signatories from the three organisations said dismantling PHE in the midst of a pandemic carries ‘serious risks’. “Increased focus on infection control must not come with a loss of focus on the other areas of PHE work – tackling major avoidable public health challenges such as obesity and growing health inequalities.
“These result in more deaths and disability than COVID-19, particularly affecting the areas that the government has pledged to ‘level up’.”
On a call with Sussex University’s Lavinia Bertini earlier today, the obesity expert told FoodNavigator her main concern is that “it’s not clear what the new body is responsible for”.
PHE has led many existing campaigns and obesity programmes across the country, Bertini explained, which are often aimed at promoting healthier foodscapes. “It is unclear what is going to happen to these campaigns and programmes, which are really important.”
And concerning the new obesity strategy directly, Bertini highlighted that PHE was tasked with providing obesity management training to healthcare professionals. Now, “it’s not clear who is taking up that role”.