1. Purpose of the paper

The purpose of the paper is to provide a forward look of priorities and brief overview of the recent operational and response status of the UK Health Security Agency (UKHSA) since the last Advisory Board.

2. Recommendations

The Advisory Board is asked to note the update.

3. Overview

Since the Advisory Board last met, the most important development for the Agency has been the finalisation of our new organisational design. This will better equip us to deliver on our mission to prepare for, prevent, and respond to health challenges, saving lives and protecting livelihoods.

Our new leadership structure, which introduces four new Groups, has been developed following the recent review and individual consultation with affected staff. Our leaner structure is one step ahead of the direction Ministers are setting, will help our leadership team to be more empowered, with clearer roles and responsibilities, and will enable faster, more effective decision-making.

To ensure a smooth transition to the new model, the implementation of our new structure is being staggered – the Chief Data Officer Group and Chief Scientific Officer Groups have already started the implementation, and the Chief Medical Advisor and Chief Operating Officer Groups will follow through the remainder of January. All Groups and supporting functions will have completed all the necessary work by the end of March.

I also wish to use this opportunity to update the Advisory Board on two notable staffing changes. Firstly, to introduce Jon Cocking, who has now started as our new interim Director of People and Workplace. He joins us from HM Land Registry, bringing with him considerable leadership experience across HR and facilities over the past decade as a senior civil servant. Jon will be working closely with you, especially with Sir Gordon and the People and Culture Committee, and I know you will all join me in welcoming him to the Agency.

Second, I would like to express enormous thanks, both personally and on behalf of UKHSA, to Scott McPherson. Nearly five years ago Scott joined the community testing programme, which was first transitioned into NHS Test & Trace before it was then transitioned into UKHSA. Scott was my very first appointment into a Director General role for the organisation and has been the bedrock of our formal links across Whitehall and knowledge of the civil service and policy functions for UKHSA. Undoubtedly, we would not have weathered our first organisational developmental years in the middle of a pandemic without Scott’s expert strategic hand on the tiller. I will update the Board on the process to recruit to the new role of Deputy Chief Executive and Chief Operating Officer as soon as I am able.

On 9 January, we published our first annual review of our Science Strategy. This sets out the progress we have made towards delivering our vision and priorities through implementation of the strategy. It contains a range of exciting case studies that demonstrate the impact our science has on health and prosperity and indicates further opportunities for work with industry.

Lastly, we will also shortly be publishing our fourth Health and Climate Adaptation report, jointly with NHS England. This outlines progress against the actions set in the previous report in 2021, to improve resilience across the health system and advice and support to the public. Building on this, it then identifies further priorities and actions to drive forward preparedness. The heatwaves last summer, and the severe cold temperatures over the course of this month, serve as reminders of how important this work is and will be as we continue to experience more frequent, more extreme weather as a result of climate change.

As you will be aware, on 13 December we published our Annual Report and Accounts for 2023-24. It is a significant sign of the progress and maturing of the organisation and our deeper ability to control our own activities following the pandemic, that for this year we have received a qualified audit opinion from the Comptroller and Auditor General. It is important to recognise that this was the highest outcome achievable given the financial and budgetary position on which the organisation was required to start work.

Progress made over the past two years to address the complicated situation resulting from the mid-year merger of multiple separate organisations, twice in succession, at the same time as downsizing the Agency from the peak of pandemic response has proved an intensive and challenging but committed pathway to improvement. Extraordinary effort from finance colleagues through the Financial Control and Improvement Programme have moved the organisation to a stable financially assured footing and I would like to record my personal thanks to them all. Alongside them National Audit Office (NAO) and Government Internal Audit Agency colleagues and our own Board and Audit & Risk Committee Chairs, contributed hugely to improving our controls and accounts to achieve the qualification of the opinion - the best outcome that the NAO is able to give following a prior disclaimer.

4. Strategic Forward Look

We ended 2024 on a moment of significant change for the Agency. Now, as we look ahead to 2025, and with an increasingly uncertain wider geopolitical backdrop, it is critical that we capitalise on the opportunities and efficiencies created to maximise the impact of our health protection activities and the role they play in the delivery of the wider Health Mission. To this end, I have set two particular priorities for our reformed leadership cohort.

The first is embedding new ways of working across UKHSA – culture will be key to our success. The reorganisation of our SCS structures and introduction of a new governance framework were significant steps. But they were only the start of a process to enhance our performance. Over the next few months my focus will be on empowering our directors and deputy directors, enabling visible leadership and a positive, collaborative culture. This will also mean ensuring a smooth merger of the directorates forming the Chief Operating Officer Group, especially given that this necessarily is taking place prior to the new Chief Operating Officer starting.

The second is to bring about greater recognition of our scientific contribution across Government. We are well known for our excellent incident response work, but there is less understanding of how we do and could contribute to scientific development and economic growth. I want to ensure that right across government and in the wider public there is a clear understanding that our scientific innovation is not just crucial to giving us new tools to manage incidents, but also has huge potential to support the life sciences sector and provide innovative new treatments and interventions that will mitigate ill health and save lives. Against a global backdrop of growing misinformation and distrust of healthcare institutions and key public health interventions, the role of transparent, robust, public science for public good has never been more important.

The start of the new financial year is also fast approaching, and over the next two months we will therefore need to reach a final agreement with Department of Health and Social Care and HM Treasury on our financial settlement for 2025/26 and complete our internal business planning aligned to our new structure. I am optimistic that there is growing recognition of the importance of our role and the need for longer term sustained investment in our science and technology infrastructure and associated skills. It is likely the settlement will be sufficient to support our current ability to deliver an effective service to the taxpayer, though I am realistic there will remain areas where resilience and preparedness could be strengthened through further investment.

5. Update on Activities

As we have headed into winter, there has rightly been focus on and public interest in the pressures facing NHS services. Our surveillance and analytics of seasonal respiratory and gastrointestinal infections remains a major strand of support for the NHS in management of these pressures. This has been compounded by periods of extreme cold weather.

We have also supported the NHS through the release of flu antivirals from our pandemic stockpile to ensure sufficient supply was available to treat patients suffering from seasonal infection. This was carefully considered to provide access to treatment in extant cases without compromising our contingency in the event of an emergence of a pandemic strain, with potential to cause more severe disease.

However, while attention is rightly on seasonal waves of infection affecting people and impacting health services, we must not lose sight of emerging infectious disease threats. The continued occurrence of infections from highly pathogenic avian influenza remains a concern. This includes the first two severe cases of H5N1 infection in North America, one in a child in Canada with no known exposure to infected animals and another in an older adult in the USA with exposure to domestic and wild birds who has sadly died. Cambodia has also reported its first fatal case of H5N1 infection.

As part of our preparedness to respond in the event of a broader outbreak of H5N1 in humans, we have completed a purchase of more than 5 million doses of human H5 vaccine. This will strengthen our resilience by ensuring that vaccines are immediately available in a pandemic scenario for those likely to be at the highest risk, while a vaccine tailored to combat the specific outbreak strain is developed. This sits alongside our existing advance purchase agreement for such tailored pandemic vaccines if or when they are needed.

At the end of November, we confirmed a second imported case of clade Ib mpox in the UK and last week we confirmed a third imported case (the fifth and sixth cases in the UK overall). Both cases had recent travel to countries where clade Ib mpox is known to be circulating and neither links to the previous UK cases.

Following an enhanced tracing of the November case’s contacts we have identified no onward transmission within the UK. The 21 day follow up period for contacts has been completed meaning that the likelihood of any further cases arising from this case is very low. Tracing and support for contacts of the January case are ongoing.

Cases of this nature are anticipated in line with our current risk assessment and do not represent a change in the overall risk to the wider public within the UK. Similar imported cased of clade Ib have now been confirmed in several additional countries. This includes the first reported case in France and a cluster of cases reported in China.

We are continuing to closely monitor the epidemiology of mpox in the Democratic Republic of the Congo and other countries affected by community transmission, alongside Africa Centres for Disease Control and Prevention and World Health Organization. The ongoing situation remains broadly stable but with the clade Ib virus still circulating at a high level and co-circulating with clade Ia in some regions, including in Kinshasa.

Finally, last week both myself and our Director of Public Health Infection Programmes, Professor Mary Ramsey, gave evidence to the COVID-19 Public Inquiry for Module 4 (Vaccines and Therapeutics). This included some important discussion of how UKHSA brings together the critical clinical and scientific work of Public Health England with the industry engagement and partnership of the Vaccines Taskforce to strengthen the end-to-end development, trialling, manufacture, and deployment of immunisations.

It also signals the busiest period of work for our Inquiry teams, working simultaneously on five modules all requiring statements from those in UKHSA, but also externally from those who have worked in predecessor organisations, as well as close monitoring of each module hearing as the lines of inquiry develop.  I remain hugely grateful to all those responding through this high intensity period of work.

Professor Dame Jenny Harries

Chief Executive

January 2024