Thread by @ADMBriggs

Just to unpack today's announcement a little.

PHE has been operating for the past 7 years to provide a huge range of functions. Health protection is of course a key part (it employs 2,500 scientists and manages >10,000 disease outbreaks/yr)

(thread)

https://twitter.com/ADMBriggs/status/1294770009454137348

But it also
-does emergency planning & mgmt (not just infectious disease - fires/chemicals...)
-does research
-promotes health improvement
-does global health
-works with the NHS
-advises nationally & supports local gov
-collates, manages, responds to PH outcome data

This includes much quieter but hugely valuable things like evidence reviews, return on investment tools, managing disease registries, publishing the Health Matters series on what works, developing public health data tools and dashboards (i.e. fingertips)

It does this as an executive agency of the Department of Health, under control of the Secretary of State, with an operating budget of around £400m, whilst making yr on yr cuts following 2015 spending review (NHS T&T budget is £10bn).
hsj.co.uk/finance-and-ef…

It may not be the most ideal model-it's had its problems since it's creation around independence and (perceived) ability to speak its mind (see @rob_aldridge for more on this).

But to dissolve it in the middle of a pandemic seems like an enormous act of self harm.

As @davidjbuck asks, what is this change trying to solve? NHS Test and Trace is not run by PHE. The escalation of testing has had sig PHE involvement but also private sector, army, NHS, local gov, social care, etc. Now it is at least starting to bed in.

https://twitter.com/davidjbuck/status/1294896735907708928?s=20

If it's about T&T, then PHE health protection teams & local gov have been working together to effectively and efficiently manage disease outbreaks for years. They just need to the data and resources to get on with it. Getting rid of PHE is not part of that solution.

I don't know of any external consultation process around this. What will happen post-COVID and what will happen to the non-Health Protection Agency functions? Will these go to local gov PH teams and if so, what additional funding/powers will be transferred for this?

And there's much of PHE that wouldn't sit with local gov, like global health, and evidence reviews, and data collection/analysis, and digital tools, and more. Where do these go? And who will have a national voice for health improvement and inequalities?

If all these have been thought through, and there's a plan which not only maintains a national voice for public health and inequalities, one that is not only close to ministers but can speak independently. Then great. This could be positive. But I see no evidence of that.

And to establish *yet another* national org within weeks is going to be hugely challenging (impossible?). We it will have issues with setting up and implementation (we're only just trying to figure out how to manage expanding local gov NHS T&T functions)
gov.uk/government/new…

And doing this with the agency that is managing complex COVID cases, outbreaks, test sites, providing national advice, and housing 2,500 of the country's best scientists whilst cases are rising and within 3 months of flu season seems frankly dangerous.

https://twitter.com/ADMBriggs/status/1293896636318482433?s=20

Not to mention, think of the PHE people waking up this morning about to go on call to find this on the front page.

There's no appetite for further wholesale top-down reform in health. Sure, some tinkering around integrated care systems' statutory footing, NHS payment mechanisms, and health and social care incentive structures would be helpful. But not this. And not now.

I'm sure this will all come out in the COVID public inquiry. But we can't wait that long.

@deb_cohen @carolecadwalla @profchrisham @felly500 @HPIAndyCowper @Davewwest @HSJEditor @BBCHughPym @denis_campbell

And also @tim_esPH @sarahwollaston @Jeremy_Hunt @JonAshworth may be helpful/of interest.