The lead story in last weekend’s Sunday Telegraph newspaper announced: ‘Hancock axes failing public health body,’ adding ‘PHE (Public Health England) to be scrapped this week and replaced by a privately-run German-style pandemic response agency.’
The plan is that the body known as ‘Public Health England’ is to be merged with ‘NHS Test and Trace’, creating a new structure called ‘The National Institute for Health Protection’.
We are told that the reason for this merger is because the UK response to the pandemic has been ‘sluggish’.
Certainly, the UK testing response to the coronavirus pandemic has been disastrous and is one of the key reasons why the UK has the highest excess death rate for the disease in Europe.
Germany’s Robert Koch Institute has been in charge of a much more successful German response to the pandemic.
It is run by top virologist adherents to World Health Organisation methods.
The new National Institute of Health Protection is to be formed in September and will take six months to be fully established with many thousands of staff.
It appears that NHS Test and Trace is to be changed so that privatised call centres, run by outsourcing companies Serco and Sitel – which performed very poorly in contact tracing, are to be ended, with the job, instead, handed back to local councils to be organised by their highly experienced staff.
Leading virologists, scientists and public health doctors have been calling for this for six months!
However, it is to be privately run and the proposal that Baroness Dido Harding, who has no training in infectious diseases or public health, should be in charge will be met with universal dismay by health service workers.
And the suggestion that the merger of PHE and NHS T&T can somehow raise Britain’s testing response up to Germany’s level will be impossible without sufficient testing available.
Anyway, PHE was never in charge of the testing response to the pandemic.
The Department of Health and Social Care (DHSC) and government ministers was and is responsible, as is NHS England, the commissioning body of the NHS set up by the Cameron government through the 2012 Health and Social Care Act, which brought in a market of private companies to provide NHS care.
Therefore, the response of DHSC and NHSE to the pandemic has been to prevent the UK’s network of publicly provided NHS laboratories and universities from properly providing the millions of tests to control the virus.
NHS and PHE labs only do around 25,000 tests a day.
Instead, a rushed contracting-out of the bulk of testing was handed to a tranche of private companies lauded by Health Minister Matt Hancock, in the first weeks of April at the height of the pandemic.
These tests are performed in huge centralised ‘lighthouse labs’ miles from local hospitals and GPs.
They have been beset by constant problems and are incapable of doing the job.
To this day there are still only around 250,000 tests a day being provided, when well over a million a day are needed to supply a proper ‘test and trace’ system and to perform the necessary weekly testing of health and care workers.
The latest plans, although they now recognise that testing and tracing is far better done by councils, still put the private sector at the heart of the response.
The fact is that it is the government’s determination to sideline NHS pathology structures and local government public health facilities and force through the privatisation of the bulk of testing, that has been one of the main planks of the fiasco that has been the UK response to the pandemic.
And this drive to privatise the NHS is central to these new plans.
Responding to last Sunday’s news, Dr Chaand Nagpaul, chair of the British Medical Association (BMA) UK Council, said: ‘We already have public health expertise in this country which is of the highest quality but despite the hard work of our colleagues in the last six months, substantial budget cuts and fragmentation of these services over years have hampered the response to the Covid-19 pandemic.
‘We must absolutely not allow PHE and its staff to shoulder the blame for wider failings and Government decisions.
‘Public Health England should be part of a fully-integrated Public Health and NHS both locally and nationally.
‘We also believe that Public Health doctors must be able to voice their views and policies independently in the interests of the public’s health and without ministerial constraints.
‘With more than 1,000 new UK cases of Covid-19 being recorded for the fifth day in a row, we must seriously question whether now is the right time for undertaking such a seemingly major restructure and detract from the very immediate need to respond to the pandemic.’
Dr Peter English, chair of the BMA Public Health Medicine Committee, said: ‘Any reforms must remove the existing barriers, which have prevented Public Health professionals from doing their job at the scale required to completely suppress the spread of Covid-19 and prevent a second wave of infection.
‘It is now clear that the way forward is to provide Public Health experts both locally and centrally with the necessary resources to do this effectively.
‘Meanwhile, there must also be assurances that their work in other areas, such as cancer screening, obesity, substance misuse and child poverty, are not completely deprioritised in focusing on the pandemic response.’
Dr Nagpaul added: ‘The BMA strongly believes that the nation’s Public Health medicine service should be truly public, completely independent of political influence.
‘Further, its work must not be outsourced to private companies, which has during the pandemic, squandered millions of pounds into piecemeal initiatives, many of which have not been delivered.
‘It must be able to operate with full transparency in order to advise Government, inform the public and do its work which is so vital to the health of the nation.
‘We will seek further details, as such a significant restructure would have far-reaching implications for our dedicated public health colleagues and the health and wellbeing of the public at large.’
Meanwhile, doctors’ low confidence in tackling the huge NHS backlog has been laid bare in a BMA survey.
NHS England recently set targets to resume normal levels of activity over the next few months, but when asked by the BMA whether they thought these would be met, 70% of more than 3,000 doctors who responded said this was either highly (40%) or fairly (30%) unlikely.
Key findings from this latest tracker survey of doctors in England and Wales include:
- 60% of doctors are not very or not at all confident in their local health economy managing demand as normal NHS services resume;
- half of doctors are not very or not at all confident in being able to manage a second wave of Covid-19;
- 26% of doctors said that in the last two weeks non-Covid demand has increased to pre-pandemic levels, with 17% saying that demand is now even higher than it was before.
The survey results come after NHS figures last Thursday showed record waits in a number of areas, including the wait between being referred by a GP to first treatment, and the number of people waiting longer than a year for treatment rising to the highest in over a decade.
BMA analysis of the latest figures also shows regions that are particularly impacted, with Dorset and areas in the North East and Essex facing the longest waits for treatment at 20 weeks or longer.
Patients should wait no longer than 18 weeks from referral by a GP to treatment in England, and the national target is to have 92% treated within this timeframe. However, statistics showed that nationally, only 52% were, and the BMA analysis shows that in one area this figure was as low as 38%.
BMA council chair Dr Chaand Nagpaul said: ‘Although staff are being told that the NHS will begin to return to “business as usual” they have little confidence that it will be able to cope with the backlog of millions of patients left untreated during the first spike of the pandemic.
‘Doctors are worried for their patients and the risk of their condition deteriorating as a result of further delays, given that more than 50,000 patients are already waiting longer than 12 months for treatment – 46-fold the number from a year ago – and 45% of doctors told us they are seeing patients presenting later than before with their symptoms.’
He warned: ‘Doctors need to be given the opportunity to rest and take care of their own wellbeing alongside tackling the backlog of care – we cannot have tired and ill doctors treating patients.
‘And they and their employers shouldn’t be penalised if they cannot meet these targets.
‘This pandemic has brought sharply into focus how underfunded and understaffed the health service has been in recent years.
‘Now is the time to address this and properly fund the NHS, increase staffing numbers and give it the resources and capacity required to meet the needs of patients not just in the wake of a health emergency but in the long-term.’
