Public Health England

Public Health England (PHE) is an executive agency of the Department of Health and Social Care in the United Kingdom that began operating on 1 April 2013. Its formation came as a result of reorganisation of the National Health Service (NHS) in England outlined in the Health and Social Care Act 2012. It took on the role of the Health Protection Agency, the National Treatment Agency for Substance Misuse and a number of other health bodies.[4] It is an executive agency of the Department of Health and Social Care, and a distinct delivery organisation with operational autonomy.[5]

Public Health England
Agency overview
Formed2013
Preceding agency
JurisdictionEngland
HeadquartersWellington House
133–155 Waterloo Road
London
SE1 8UG[1]
Annual budget£300 million [2]
Agency executives
Parent agencyDepartment of Health and Social Care
Websitewww.gov.uk/government/organisations/public-health-england

Mission and resources

PHE's mission is "to protect and improve the nation’s health and to address inequalities". It employs approximately 5,000 staff (full-time equivalent), who are mostly scientists, researchers and public health professionals.[6] It announced plans to move its headquarters and 2,750 staff to Harlow on a former GlaxoSmithKline site in 2017.[7]

PHE laboratories provide an extensive range of microbiological diagnostic tests.[8]

Structure

PHE has the following public-facing divisions:

  • Health protection:
    • Chemical, radioactive, and environmental hazards
      • Research
      • National poisons database
      • Services for those working with hazardous materials
      • Harm reduction in relation to polluted environments
      • Operations
    • Field epidemiology, including contact tracing
    • Contagious disease surveillance and control
    • Major incident response
  • Health improvement:
    • Substance misuse treatment programmes
    • Health promotion (such as healthy diet or anti-smoking marketing)
    • Health screening programmes (such as cancer screening, STD checks, cardiovascular disease screening, etc.)
    • Reducing health inequalities
    • Specialist healthcare commissioning (in relation to major incidents, etc.)
    • National Cancer Intelligence Network (and other networks)
  • Knowledge and information
    • Substance misuse treatment monitoring
    • Disease registration
    • Research and development
  • Operations:
    • Microbiology unit
      • Microbe production
      • Research
      • References
      • Specialist services
    • Regional units (South / Midlands / North / London)
      • Preparation and response against major incidents
      • Local centres (several centres per regional unit, except London)
        • Local health protection
        • Substance misuse treatment services (over more than one centre)
        • Local specialist commissioning (in relation to major incidents, etc.) and advice

Key people

Duncan Selbie has been chief executive of PHE since its formation; he was previously chief executive of Brighton and Sussex University Hospitals NHS Trust.[9] Other senior personnel include:[3]

  • Yvonne Doyle, Medical Director and Director of Health Protection from 2019, replacing Paul Cosford who became Emeritus Medical Director.
  • Kevin Fenton, Regional Director for London.
  • Jenny Harries was Regional Director for the South of England until her appointment as Deputy Chief Medical Officer for England in 2019.
  • Anne Mackie, Director of Screening Programmes
  • Professor John Newton, Director of Health Improvement.
  • Alison Tedstone, nutritionist, Director of Diet, Obesity and Physical Activity.

Campaigns

PHE took over the responsibility for 'Be Clear on Cancer' campaigns after it was created in the Health and Social Care Act 2012.[10] Campaigns have been run on lung cancer, bowel cancer, oesophago-gastric and kidney & bladder cancer.[11]

PHE is also responsible for Change4Life and ACT FAST.[12]

In January 2014 it launched a campaign against smoking called 'Health Harms' on television and billboards across England.[13]

COVID-19

Public Health England carried out contact tracing in the early stages of the COVID-19 pandemic, but this ceased on 12 March 2020 in view of the wide spread of infection in the population.[14]

From 19 March, consistent with the opinion of the Advisory Committee on Dangerous Pathogens, PHE no longer classified COVID-19 as a "High consequence infectious disease" (HCID). This reversed an interim recommendation made in January 2020, due to more information about the disease confirming low overall mortality rates, greater clinical awareness, and a specific and sensitive laboratory test, the availability of which continues to increase. The statement said "the need to have a national, coordinated response remains" and added "this is being met by the government’s COVID-19 response". This meant cases of COVID-19 are no longer managed by HCID treatment centres only.[15]

From 29 April, PHE collated daily reporting of the number of deaths of people in England with a positive COVID-19 test; the numbers published each day by the UK government had previously only counted deaths in hospital.[16][17]

By July, as the number of deaths continued to fall, PHE reported significantly more deaths than those collated weekly by the Office for National Statistics from death certificates. Concerns were raised – by the Centre for Evidence-Based Medicine[18][19] and others – that PHE's figures were over-estimates, since they included anyone who had a positive COVID-19 test, no matter how long ago. On 12 August it was agreed to publish the numbers of deaths within 28 days of a positive test, as was already done by other UK administrations.[19] The cumulative total was recalculated as 41,329, a 12% decrease.[20] John Newton, a PHE director, wrote that the method established in April was designed to avoid undercounting, and that PHE always intended to review the approach as the pandemic progressed.[21]

Criticism and other published comment

Public Health England has been criticised for downplaying mental health within its overall resourcing and agenda; in 2011 the Royal College of Psychiatrists stated its concern that there appeared to be "few, or no, commitments or resources within either the Department of Health or Public Health England to take the public mental health agenda forward."[22]

The agency was criticised by Professor Martin McKee in January 2014. He said that continuing health inequalities among London boroughs was a scandal, and claimed coalition reforms had left it unclear who was supposed to analyse health data and tackle the problems highlighted.[23]

The agency was criticised by The Lancet for allegedly using weak evidence in a review of electronic cigarettes to endorse an estimate that e-cigarette use is 95% less hazardous than smoking: "it is on this extraordinarily flimsy foundation that PHE based the major conclusion and message of its report" ... this "raises serious questions not only about the conclusions of the PHE report, but also about the quality of the agency's peer review process."[24] Authors of the PHE report subsequently published a document clarifying that their endorsement of the 95% claim did not stand on the single study criticised in The Lancet, but on their broad review of toxicological evidence.[25] The agency has also been criticised for "serious questions about transparency and conflicts of interest" regarding this review, that PHE's response "did not even begin to address the various relationships and funding connections" in question, and that this "adds to questions about the credibility of the organisation’s advice".[26]

A 2017 question in the House of Lords revealed that a position underpinning UK Government policy, namely "that well run and regulated modern municipal waste incinerators are not a significant risk to public health remains valid", was asserted in advance of the results having been obtained from a study commissioned by Public Health England to answer the question whether municipal waste incinerators did, in fact, constitute a significant risk to public health.[27]

Merger

In August 2020, it was revealed by The Telegraph that Public Health England is to be "scrapped" and replaced by a new body, called the National Institute for Health Protection.[28] It will aim to combine PHE and the NHS Test and Trace operation, in response to the coronavirus pandemic.[28]

See also

References
  1. "Public Health England". gov.uk. Retrieved 4 December 2019.
  2. "PHE response to a Sun newspaper column". gov.uk. Retrieved 28 April 2020.
  3. "Leadership chart" (PDF). GOV.UK. Public Health England. July 2020. Retrieved 12 August 2020.
  4. "Structure of Public Health England" (PDF). Department of Health. Retrieved 13 July 2015.
  5. Agreement between the Department of Health and Social Care and Public Health England: February 2018
  6. Public Health England. "About". Retrieved 8 February 2015.
  7. "Public Health England closer to moving to Essex". Pharmaceutical Journal. 25 August 2017. Retrieved 8 October 2017.
  8. "Specialist and reference microbiology: laboratory tests and services". GOV.UK. Retrieved 12 April 2020.
  9. "Duncan Selbie". GOV.UK. Retrieved 12 August 2020.
  10. "CRUK Be Clear on Cancer". Retrieved 16 November 2014.
  11. "NHS Choices". Retrieved 16 November 2014.
  12. "PHE Campaigns". Retrieved 16 November 2014.
  13. "Powerful anti-smoking campaign launched to show cyanide and arsenic damage". Metro. 29 December 2013. Retrieved 8 January 2014.
  14. Tapper, James (4 April 2020). "Recruit volunteer army to trace Covid-19 contacts now, urge top scientists". The Guardian. ISSN 0261-3077. Retrieved 18 April 2020.
  15. "High consequence infectious diseases (HCID); Guidance and information about high consequence infectious diseases and their management in England". GOV.UK. Archived from the original on 3 March 2020. Retrieved 17 March 2020.
  16. "Coronavirus death toll tops 26,000 as figure now includes care home and wider community deaths". ITV News. 29 April 2020. Retrieved 1 May 2020.
  17. "PHE data series on deaths in people with COVID-19: technical summary". GOV.UK. Public Health England. 29 April 2020. Retrieved 1 May 2020.
  18. Loke, Yoon K; Heneghan, Carl (16 July 2020). "Why no-one can ever recover from COVID-19 in England – a statistical anomaly". CEBM. Retrieved 14 August 2020.
  19. "New UK-wide methodology agreed to record COVID-19 deaths". GOV.UK. 12 August 2020. Retrieved 13 August 2020.
  20. "Covid death recount reduces UK toll by 5,000". BBC News. 12 August 2020. Retrieved 13 August 2020.
  21. Newton, John (12 August 2020). "Behind the headlines: Counting COVID-19 deaths". publichealthmatters.blog.gov.uk. Retrieved 13 August 2020.
  22. "House of Commons - HC 1048-III Health Committee: Written evidence from the Royal College of Psychiatrists (PH 50)". publications.parliament.uk.
  23. "Top 10 causes of death in London boroughs highlight health inequalities". The Guardian. 8 January 2014. Retrieved 8 January 2014.
  24. The Lancet (2015). "E-cigarettes: Public Health England's evidence-based confusion". Lancet. 386 (9996): 829. doi:10.1016/S0140-6736(15)00042-2. PMID 26335861.
  25. "Underpinning evidence for the estimate that e-cigarette use is around 95% safer than smoking: authors' note" (PDF).
  26. Gornall, Jonathan (2015). "Public Health England's troubled trail". British Medical Journal. 351 (1136): 5826. doi:10.1136/bmj.h5826. PMID 26534902.
  27. Countess of Mar. "Incinerators: Health Hazards (HL3533). Written question dated 23-11-2017 and answer from Lord O'Shaughnessy dated 05-12-2017". House of Lords. Retrieved 30 January 2018.
  28. "Public Health England to be scrapped and replaced by new body - Telegraph". Reuters. 15 August 2020. Retrieved 15 August 2020.

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