Policy paper

The future of public health: the National Institute for Health Protection and other public health functions

Published 15 September 2020

This was published under the 2019 to 2022 Johnson Conservative government

Further to the Secretary of State for Health and Social Care’s announcement of the new National Institute for Health Protection (NIHP) on 18 August 2020, this document provides a high-level overview of our plans to better protect and improve the public’s health, including where we will act immediately to strengthen our health protection systems and our focused response to COVID-19 ahead of the winter.

The measures set out in this document underpin our commitment to protect the public’s health, improve population health resilience and level up unacceptable variations in health.

The future of health protection – the National Institute for Health Protection

To give the UK the best chance of beating COVID-19, and continue to monitor, identify and be ready to respond to other health threats, now and in the future, we are creating a brand-new organisation to rigorously extend our existing science-led approach to public health protection – the National Institute for Health Protection.

Public Health England (PHE) has a superb professional and scientific base, on combating infectious disease, other health hazards and other risks to health such as obesity. PHE’s dedicated and highly skilled workforce has an excellent track record in dealing with health protection incidents both large and small. But, as with most public health agencies globally, PHE has not had the at-scale response capacity we have needed to handle a full-blown pandemic.

We therefore responded at unprecedented pace to COVID-19 by building our dedicated, additional testing capacity at scale, then launching NHS Test and Trace, and strengthening our intelligence and analytical capability, including establishing the new Joint Biosecurity Centre (JBC).

The NIHP will bring together the existing health protection responsibilities discharged by PHE with the new capabilities of NHS Test and Trace, including the JBC, creating a single agency with a razor-sharp focus on COVID-19 and the challenges posed by domestic and global threats to health. This builds on the existing close working between PHE and NHS Test and Trace which includes a series of joint appointments and joint teams.

Directors of public health are on the front line of our response to COVID-19 as well as health protection more broadly and have a vital leadership role to play. The NIHP will build on the ‘local first’ approach and experience of the existing system, working closely with councils and local directors of public health to ensure the public gets the best possible service, responsive to the health needs of local communities.

This combination of some of the world’s best science with new capability at scale means all our public health protection science, intelligence, testing and delivery expertise will be working together, able to respond more quickly and at a scale needed to deal with a global pandemic, positioning us both to deal with and recover from COVID-19 and to have enhanced planning and response capacity for future pandemics and global health challenges.

The responsibilities of the NIHP will include:

1. PHE local health protection teams to deal with infections and other threats
2. support and resources for local authorities to manage local outbreaks
3. COVID-19 testing programme
4. contact tracing
5. the Joint Biosecurity Centre
6. emergency response and preparedness to deal with the most severe incidents at national and local level
7. the National Infections Services, for example field services and scientific campuses at Colindale and Porton Down
8. the regional and specialist public health microbiology laboratory network
9. the Centre for Radiation, Chemical and Environmental Hazards
10. global health security capability
11. the UK public health rapid support team (joint with the London School of Hygiene and Tropical Medicine)
12. research and knowledge management, and working with academic partners through Health Protection Research Units
13. providing specialist scientific advice on immunisation and countermeasures

The NIHP will take on existing UK-wide responsibilities for health protection from PHE and NHS Test and Trace, including the Joint Biosecurity Centre. This will include supporting all 4 CMOs with rich scientific and analytical advice and insights. Current UK-wide arrangements delivered by PHE and Test and Trace, including for example high containment laboratories and provision of testing supplies, will continue. Further work will be required between now and spring 2021 to ensure a smooth transition to the new organisation. We will continue to involve the devolved administrations in conversations as this develops, including on the organisational design of the NIHP.

We will also ensure that appropriate links are made to decisions around the future of PHE’s remaining health improvement functions.

The future of health improvement, prevention and wider PHE functions

As we establish the new NIHP with a focus on our capacity and capability to respond to health threats, we also need to establish the right future system and organisational arrangements for improving the health of individuals and our population. The impact of COVID-19 on key groups of the population has highlighted the importance of levelling up health to support future resilience.

As part of this work, we will be considering the best future arrangements for the wide range of non-health protection functions that currently sit within PHE and are vital for health improvement, prevention and delivery of health services. These functions include but are not limited to:

1. providing evidence and support for national and local government on policy decisions for health improvement
2. providing expert advice, support and assurance on vital health services in the NHS and local government, including screening and immunisation programmes
3. delivering health interventions in the form of social marketing campaigns to support individuals to take control of their health
4. undertaking some important cross-system activity including maintaining the national cancer registry

The services individuals receive from the NHS and local government are also vital in supporting individuals to maintain good health and resilience. We remain keen to consider how best to support a greater focus on prevention in the delivery of local health services, and to improve integration so that people receive the joined-up care and support they need. We will be engaging with partners across the system in the coming months on how we can best achieve this, including by supporting local authorities and integrated care systems to maximise their impact on prevention and population health improvement.

We will engage widely to determine the best future arrangements on prevention, health improvement and delivery of public healthcare services, considering carefully the opportunities and risks of each of the options, including the implications for PHE staff and for other organisations. There will be a clear focus, as now, on non-COVID (or other pandemic) health protection issues which will continue to be managed by PHE working with local directors of public health.

We will also work with local directors of public health and integrated care systems to explore the best way to support them to fulfil and expand their roles on prevention and population health improvement.

Winter readiness and delivery in 2021

PHE and NHS Test and Trace will continue to deliver all of their existing functions until spring 2021, when the NIHP will be formally established and arrangements for the future of PHE’s health improvement functions will have been agreed and begun to be implemented. PHE staff will continue to be employed by PHE until at least spring 2021.

Our absolute priority is ensuring we are in the strongest possible position to tackle COVID-19 and any other health threats over the coming winter. While the transition into the new public health landscape will take time to get right, we are making decisive changes now.

We are immediately bringing together PHE, JBC and NHS Test and Trace^{[footnote 1]} under single leadership, with a single command structure and operating model to tackle the COVID-19 pandemic. Once the challenges of winter are over, the new organisation will be formalised from spring 2021.

Baroness Harding will lead the NIHP initially and we have commenced the search for a permanent CEO, who will be appointed in due course. Supporting Baroness Harding in her role will be Michael Brodie, who has been appointed Interim Chief Executive Officer of PHE. Michael is currently CEO of the NHS Business Services Authority and previously Director of Finance for PHE.

The Chief Executive of the NIHP will be accountable to the Secretary of State for Health and Social Care through the DHSC Permanent Secretary. The NIHP will be a ‘single voice of truth’ on health protection advice and guidance, accountable to the CMO for England and supporting all of the UK CMOs in this role. The exact future accountabilities and relationships will be determined through the transition process.

It’s vital that this transition does not distract our dedicated and highly skilled public health workforce from the tasks in hand: protecting the population from COVID-19, improving the nation’s health, preventing ill health and reducing health inequalities.

Prevention of ill health remains a top priority. Over the coming months, PHE will continue its important health improvement and wider prevention work, supporting the government’s ambitions to give children the best start in life, tackle risk factors such as obesity and smoking (among others) and to reduce health inequalities. This work will continue to report into health ministers.

Transition to new structures and next steps

Transition to the NIHP

To support the design of the new NIHP and the transition to the new organisation, we have established a Transition Team which will be made up of staff from PHE, DHSC and NHS Test and Trace. This team will report into a Transition Board chaired by the Director General for Public Health and PPE at DHSC and will include members across all 3 organisations, including the Chief Executive of the NIHP and the Chief Executive of PHE. The Transition Board will purposely look at the global best practice on pandemic preparedness and health protection systems and agencies to inform organisational design.

We will continue to closely involve the devolved administrations throughout this work, including on the organisational design of the NIHP. A formal decision on the organisational classification of the NIHP will be taken as part of the design process over the coming months. The future budget for the NIHP will be agreed at the Spending Review in the autumn.

Transfer of health improvement functions

We are committed to fully engaging PHE staff and representatives of other organisations in the public health system and other interested parties on the right options for the future arrangements on prevention and health improvement, including PHE’s existing functions. Our aim is to ensure we have the best possible capability and capacity to support better health and more equal health.

There are a number of options for the future of these functions. We will consider carefully the opportunities and risks of each of the options, including the implications for PHE staff and for other organisations. These options include:

• devolving functions to a more local level such as local authorities and/or integrated care systems
• creating a separate national organisation dedicated to driving progress on prevention, health improvement and, potentially, public healthcare services
• retaining health improvement responsibilities within DHSC and/or other government departments
• embedding health improvement responsibilities into existing health arm’s length bodies such as NHS England and NHS Improvement
• a combination of the above options

As a first step, we have established a new Population Health Improvement Stakeholder Advisory Group to provide expert advice to ministers on this aspect of the work from leading thinkers in public health, local government and health care. This group will input into a high-level options paper to be published in October, which will provide anyone who wishes to feed in views with an opportunity to do so. Alongside this we will run a series of roundtables to gather views from across the system.

The future budget for prevention and health improvement, including existing PHE functions, will be agreed at the Spending Review in the autumn. We aim to publish our final recommended approach and a delivery plan by the end of 2020, post Spending Review. 

Timeline for full establishment of the NIHP and transfer of health improvement functions

August 2020

• NIHP joint appointments agreed

• NIHP announced

September 2020

• Programme Transition Board established

• Population Health Improvement Stakeholder Advisory Group established

• Rapid review of existing Health Protection Institutes around the world to inform the design work for the NIHP

October to December 2020

• Publish high-level options paper on future system and arrangements for prevention, health improvement and public health care services, including PHE’s health improvement functions

• Spending Review settlement

• NIHP Chief Executive recruitment

• Work with staff, partners and the wider programme teams to determine the organisational functions and form for the NIHP

• Wider stakeholder engagement on initial options for strengthening national and local health improvement and prevention arrangements

• Final set of recommendations for strengthening national and local health improvement arrangements published

• Final set of recommendations for NIHP organisational design and operating model

Spring 2021

• PHE formal staff consultation

• NIHP established and fully operational

• PHE’s health improvement functions transferred to future host organisations

1. The NHS Test and Trace business plan, published on 30 July, sets out more detail on action being taken to prepare for winter. ↩