There’s nothing like a good old testament scapegoat for placating public opinion but that is not necessarily fair to the goat. Right at the start of the pandemic, Matt Hancock should have known the poor bewildered beast he had tethered in his back yard. Public Health England (PHE) has staff numbering 5,500, 43% being scientists, and last year cost £287M (net).
As an executive agency of the Department of Health and Social Care (DHSC), it is duty bound to publish annually its performance versus pre-set targets. The last annual plan has a long list of achievements but no overall performance metrics, nor targets nor explanation of how PHE achieved those targets.
“Keeping the Public Safe” is the top priority and five achievements were reported under that heading. Disease outbreaks are, and were, dealt with by the NHS; and the extent to which the world should be PHE’s oyster is open to question. The only protection for the UK public was the delivery of the routine annual flu vaccine and there is no mention of how efficacious that was versus prior years.
The analysis of expenditure is revealing. £87M of the expenditure (30%, 2,093 staff) went on “National centres, regional network and capability to identify infectious disease, surveillance and management of outbreaks”. That is pretty much all bureaucracy since, as noted above, since the NHS that dealt with these outbreaks. The next largest, £73M (25%, 1,027 staff) went on “Supporting local government, clinical commissioning groups and the local NHS”. One suspects the local medical staff could have made better use of the cash.
£65M (644 staff) was spent on admin and £32M (79 staff) on “Helping people to take control of their own health”. I am sure we all feel better for that. The most exciting development is the new 40 acre site in Harlow to which PHE plans to move most of the scientists and half of the staff in total. Few people would recognise Harlow New Town as a world science centre. The Gilbey’s Gin distillery was the closest Harlow has ever previously been to science. Co-locating most of its staff near London makes sense but 40 acres seems excessive.
It also symbolises PHE’s empire building but inward-looking orientation which was probably the largest single reason for its failure to deal with the Covid pandemic. Whereas Germany involved its national industrial base in testing and PPE supply, PHE refused to delegate and ignored offers of help. The blame game is now well underway. The Times (17th August) reports: “Duncan Selbie, the organisation’s chief executive, said: ‘This criticism of PHE’s response to testing is based on a misunderstanding about our role.” Well, of course, strategy may not have been but preparedness certainly was and so was organising mass testing. The response is typically narrow.
The last PHE annual report uses the word “pandemic” 10 times but it is not until p.110 (of 168) that we reach any substantial mention: “Pandemic influenza continues to be one of the top risks in the National Risk Register of Civil Emergencies. We continue to maintain an appropriate stockpile of antivirals for pandemic flu preparedness in line with DHSC policy for continuing to be prepared for a more severe influenza pandemic. Future stockpile decisions, will, as they have done in the past, take account of the latest scientific evidence and international comparisons. Any future changes in pandemic flu policy and the impact on stockpiles will be agreed through the governance arrangements in place with DHSC.”
In other words, they are justifying getting rid of their PPE stockpile and if the UK is struck by any pandemic other than good old-fashioned influenza, PHE will not be to blame.
PHE should not be priding itself on having world-beating scientists even if they are. Governments are supposed to govern, not play with test tubes. Certainly government should commission the research we need but not do it themselves. Take that away and the second guessing of the NHS (£73M), the admin (£65M) and telling us to take more exercise (£32M) and there is not enough left to make an executive agency. The case for terminating it was made two years ago. His department has plenty of people to do the key tasks that should be retained, namely planning for future emergencies and ensuring that the relevant resources will be available, health strategy and directing campaigns. We are talking of 100 people, not the 3,000 non-scientists in PHE. Saying goodbye would not bring a tear to the eye.
Sadly, Matt Hancock has a worse plan: reshuffling the cards with NHS Improvement, another redundant quango, but keeping them all in play with a little rebadging to look like progress. The Secretary of State has his public scapegoat but is only pretending to butcher it. Plus ça change.