New public health agency must be independent, say doctors
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3590 (Published 15 September 2020) Cite this as: BMJ 2020;370:m3590Read our latest coverage of the coronavirus outbreak
Public Health England’s replacement must be fully independent from the government and must be able to hold it to account on matters of public health, doctors have agreed at the BMA’s annual representative meeting.
They passed a motion on 15 September saying that covid-19 had highlighted the importance of having a “well resourced national health protection function” and calling for the new agency to include a national public health infection service that is “professionally led and in charge of strategy, operations, education and training, with an appropriate budget and regional offices.”
The motion,1 which passed in full with no speakers against, also said that all consultants in public health should be employed on contracts equivalent to those of NHS consultants to ensure that they have “adequate guarantees of freedom to make professional advice public.”
The government must also review the fitness for purpose of the UK’s current health protection systems, the motion said.
Wider determinants of health
In August the government announced its plans to abolish Public Health England (PHE) in a shake-up that will merge it with NHS Test and Trace and the Joint Biosecurity Centre to form a new agency—the National Institute for Health Protection—under a single leadership team. It said that the agency would formally operate from spring 2021, focusing on public health protection and infectious disease capability.2
Proposing the motion, Peter English, of the BMA’s Public Health Medicine Committee, said, “This motion was written before the announcement of the abolition of PHE, but this does not make it irrelevant. If anything, it makes it all the more important that we are clear about how we believe public health services should develop.
“The pandemic has demonstrated that public health is a vital part of the NHS . . . It’s about far more than health protection. It’s about influencing the wider determinants of health which have a massive impact on the health of individuals and populations. It’s about levelling out inequalities which are being exacerbated enormously by the pandemic.”
He concluded, “In England, employment of civil servants in PHE and local authorities has impaired public health doctors’ ability to speak out and advocate on behalf of the public they serve. That is why this motion is here.”
Speaking in support of the motion, Khadija Meghrawi, leader of Bristol University’s BAME Medical Students Group, said, “It’s so important that public health remains objective and separate from government politics . . . In this pandemic, it’s so important to remember we are here to level out the health inequalities, including those faced by BAME [black, Asian, and minority ethnic] communities which are often not giving the priority that is needed for political reasons.”
The sentiment of the motion was also supported by the BMA council chair, Chaand Nagpaul. He said, “The stem of the motion talks about having a properly funded public health service; this has been diminished over a decade to a grossly under-resourced service.
“We need to correct that and invest in the public’s health . . .We need to make sure that whatever we see in the future is a proper, publicly accountable body and not controlled by political motives.”