“IN STRONG, CAPABLE, coordinated, united and efficient public health agencies that rival everyone in the world, ‘was the judgment of a review conducted in 2017 by representatives of some of the world’s top public health organizations, including the president of’ the well-known Robert Koch Institute, on Public Health England (PHE). Three years later, PHE is kicked. Responsibility for dealing with external threats such as infectious diseases and biological weapons will be taken over by a new organization, the National Institute for Health Protection, which will also include the Joint Biosecurity Center, which provides expert advice on pandemics. How could this happen with an outfit held in such high regard?
PHE was created in 2013 by a merger of 129 organizations, and won those plaudits in part for managing the daunting task of bringing them all together. But the breadth of responsibilities, which included obesity and smoking cessation, such as pandemics and poisoning, cost it something in focus, and its shortcomings were exacerbated by an instinct to do everything itself. The lack of outsourcing testing to private sector laboratories and universities, which could have helped increase capacity, contributed to a shortage. The contact tracing system with fewer resources was overwhelmed in early March.
But the government is at least partly responsible for these missteps. Since Britain had a lot of warning about the pandemic, it should have provided the necessary resources for testing, tracking and tracing earlier. By the time it did, the government had lost confidence PHE, and created NHS Test and trace to get the job done, with private sector outsourcing companies such as Serco and Sitel providing the manpower.
It decides to close PHE has received a mixed response. “You probably need a separate center for pandemic preparation,” says Sir John Bell, regius professor of medicine at Oxford University. ‘We’ve had nine pandemics or close talks in the last 20 years [SARS COV-1 and avian flu twice each, MERS, swine flu, Ebola, Zika and SARS COV-2 once each]. We will have nine again in the next 20 years. ”
But some in the public health industry argue that PHE has taken the rap for mistakes made by the health and social care department and NHS Test en trace. The failure of local authorities directly with good data, for example, has made managing local outbreaks unnecessary. “We have an analyst who does nothing but clean up their data when it finally comes,” says a local health director.
There are also questions about the nature of the change. Britain has been criticized for its centralized approach to the crisis, and Health Minister Matt Hancock said in announcing the establishment of the new agency that Germany was a model for it. But Germany’s public health system is run by its local authorities, which support the Robert Koch Institute by providing science and standards. De NIHP will be a large, centralized organization, replacing the large, centralized organization that is axes. “This is the result of a gossamer-thin analysis of the German system, and is being done to save Hancock’s skin. What is needed is good local infrastructure, ”says a director of public health.
Dido Harding, the boss of the organization, who has management experience in food retail and telecoms, is not universally considered the right choice. “It’s the culture of amateurism,” says a health system analyst. “The Germans would never appoint someone like this for this job.”
The timing is also controversial. “The lesson of reorganization with health care is that the cost of limiting it in the short term outweighs all the benefits in the medium to long term,” says the analyst. “It’s an incredibly stupid move,” says a health official. ‘We’re in the middle of a pandemic. I have had four meetings in the past few days PHE would participate, and they did not come up. “There are fears of that PHE staff think perhaps more about their perspectives than about covid-19. “All the people who have to concentrate on the next wave will polish them CVs, ”says the analyst. “This is management 101.”■
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This article appeared in the UK section of the print edition under the heading “Turning German?”
