Health leaders join forces to voice fears about public health shake-up

Over 70 health organisations and alliances have sent a joint statement to Boris Johnson, Matt Hancock, and the interim leadership of PHE.

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By Caroline White

Over 70 health organisations and alliances have joined forces to voice fears about the government’s plans to replace Public Health England (PHE) with the National Institute of Health Protection from next April.

They have sent a joint statement to Boris Johnson, Matt Hancock, and the interim leadership of PHE, insisting that certain principles are essential for health improvement and the functioning of public health.

A wide range of leading health organisations have endorsed the statement, including the Association of Directors of Public Health, the Faculty of Public Health, the Royal Society for Public Health, the Academy of Medical Royal Colleges, the British Medical Association, the SPECTRUM public health research collaboration, the Smokefree Action Coalition and the Richmond Group of health and care charities.

The statement acknowledges that the reorganisation affords opportunities, "but only if there is greater investment combined with an emphasis on deepening expertise, improving co-ordination, and strengthening accountability.”

And it warns that: "Reorganisation risks fragmentation across different risk factors and between health protection and health improvement. Organisational change is difficult and can be damaging at the best of times, and these are not the best of times. A seamless transition from the current to the new system is essential.

The statement, launched today in a letter to The BMJ from key signatories, sets out the principles which all agree must underpin the new health improvement system.

These include the need for renewed investment into public health to address the years of cuts the sector has endured; an interconnected approach with the right infrastructure and expertise to support national, regional and local delivery; and the need to sustain local government system leadership at local level, while strengthening co-ordination with the NHS.

Dr Nick Hopkinson, a respiratory specialist at Imperial College London, and chair of Action on Smoking and Health, represents the Smokefree Action Coalition as a signatory to the letter.

He said: "We are in a state of public health emergency because of COVID-19, and system reorganisation at this time brings with it great risks, as well as opportunities. That is why the public health community has come together to set out for government the principles that we all agree must underpin any reorganisation of the health improvement and wider functions of Public Health England.

"If we are to recover from the global pandemic and recession, health improvement is not a ‘nice to have’ but an essential component of a successful response to the challenges we face."

Professor Maggie Rae, president of the Faculty of Public Health, and a signatory to The BMJ letter, added: "Reorganisation of Public Health England brings with it a real risk that some of the critical functions of PHE will be ignored. The pandemic has shone the light on the health inequalities that exist in the country and it is clear that those with the poorest health have been hit hardest."

"Scaling up, not down, the health improvement functions of PHE is a prerequisite if the government is to deliver on its commitments to ‘level up' society; increase disability-free life years significantly, while reducing inequalities; to improve mental health; increase physical activity; reduce obesity and alcohol harm; and to end smoking.

"Ensuring there is adequate funding, a robust infrastructure and sufficient public health expertise to deliver at national, regional and local level, is fundamental."

Another letter signatory Professor Linda Bauld, chair of Public Health at the University of Edinburgh and director of public health research consortium SPECTRUM, emphasised: "While COVID-19 is a pressing emergency, the truth is that chronic non-infectious diseases are still overwhelmingly responsible for preventable death and disease in this country.

"What’s more, those with the poorest existing health have the worst outcomes from COVID-19. A future public health system must be robust enough to protect us from the threats posed by both infectious and non-infectious diseases."

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