Corporate report

UKHSA Advisory Board: 2022 to 2023 achievements and delivery

Updated 10 May 2023

Date: Tuesday 14 March 2023

Sponsor: Scott McPherson

Purpose of the paper

This paper notes UK Health Security Agency (UKHSA) achievements in the 2022 to 2023 financial year.

Recommendation

The Advisory Board is asked to:

• note UKHSA’s achievements and progress in delivering on our mission and goals
• note the significant organisational change and improvements that have been undertaken to ensure UKHSA has the requisite skills, infrastructure, structures and culture to succeed in future

Introduction

UKHSA is the UK’s permanent standing capacity to prepare for, prevent and respond to public health threats through the provision of health protection. Our ongoing establishment acknowledges the need and significant internal ambition to make the UK better prepared to protect people’s lives and livelihoods and to fully realise the UK’s scientific excellence across both the public and private sector.

Over the course of the 2022 to 2023 financial year, UKHSA has made measurable progress in establishing itself as a high-performance, cost-effective agency delivering value through people, data, technology, science and innovation. The sections below summarise our notable achievements throughout the financial year.

Health protection and response

Over the course of the year, UKHSA has responded to a diverse range of high-profile health emergencies, hundreds of routine health incidents that occur each month and contributed to the safety and success of major international events including the Commonwealth Games and COP 26. Our impact spans operational response, data epidemiology, analytics, surveillance, training and infection prevention and control, in addition to the work of our strategy, policy and programmes teams who help shape public health advice and briefings for ministers and the public.

As part of the Living with COVID-19 strategy and the decline in overall COVID-19 positive detections, UKHSA has quickly and efficiently decommissioned our lab capacity, physical testing sites and tracing capability, making an in-year saving of over £11 billion, including the demobilisation of our nationwide network of almost 1,000 test sites that was completed 3 months early and £24 million under budget. We were also able to donate over £9 million worth of surplus equipment to worthy causes, including charities supporting Ukraine. To maintain appropriate preparedness, testing and ongoing variant and vaccine evaluation, UKHSA has developed a robust COVID-19 contingency plan with delivery plans agreed across His Majesty’s Government (HMG) and the wider health system.

Over Christmas, in response to rapid shifts in China’s pandemic policy, UKHSA stood up a testing programme for incoming arrivals from China in a matter of days. This strengthened the ability of the UK to detect new COVID-19 variants and demonstrated our leadership and commitment to early and transparent sharing of sequencing data. This work has proven that despite the significant proportionate ramp down of UKHSA resources as we learn to live with COVID-19, UKHSA has successfully built agility to scale up health security measures at pace, demonstrably strengthening the capacity of predecessor organisations and systems.

The UK reported some of the highest case numbers of mpox (monkeypox) in the world with a high of 350 cases per week in summer 2022. UKHSA’s public health and health protection policy teams contributed to a successful vaccination campaign, procuring 154,000 vaccines that have reached over 65,000 individuals, also procuring 1,000 courses of Tecovirimat for those with severe clinical disease. The UK was the first to publish its outbreak control vaccination strategy, with UKHSA publishing an mpox elimination strategy in collaboration with all four nations public health agencies. Our Data, Analytics and Surveillance team supported Civil Contingencies Secretariat (CCS) at the Cabinet Office to prepare a Reasonable Worst-Case Scenario (RWCS) for mpox using tools and techniques developed for real-time analysis.

UKHSA stood up the first dedicated incident management team to provide oversight of cumulative winter impacts including:

• respiratory illnesses
• norovirus
• weather
• energy
• industrial action impacts on health

Amid rising national influenza hospitalisation rates and uncertainly over COVID-19 infections, UKHSA’s utilised surveillance and short-term forecasts to provide advice to ministers and public health advice to the population in an effective way, supporting the NHS in identifying likely service demand and mitigating risks. UKHSA also contributed to the delivery of the COVID-19 autumn and winter 2022 boost programme with 100% drawn down into the nations and circa 90% administered.

UKHSA’s senior medical advisors continue to monitor and support on health security impacts associated with the war in Ukraine. Many displaced populations have been at risk of communicable diseases (for example COVID-19, measles, polio) as well as tuberculosis and HIV. At the request of UK-Med, UKHSA provided training in Ukraine on the first response to and the early clinical management of Chemical, Biological, Radiological and Nuclear (CBRN) incidents.

UKHSA has worked with the Home Office, NHS England (NHSE) and other local partners to support the response to the increase in the number of cases of diphtheria in the asylum seeker population since January 2022. UKHSA’s recommendations have led to the establishment of a vaccination centre at the Manston processing centre. UKHSA has also developed a range of resources, leaflets and posters that have been translated into a range of languages.

UKHSA responded to the identification of vaccine-like poliovirus in London sewage between February and June 2022. UKHSA worked closely with the NHS to ensure children aged 1 to 9 years in London are vaccinated, reaching over 250,000 doses. UKHSA, in partnership with the Department of Health and Social Care (DHSC), Medicines and Healthcare products Regulatory Agency (MHRA) and the NHS, has led the response that expands our surveillance, raises awareness and training in professional groups, and improves data and vaccination.

The UK has been experiencing the largest outbreak of avian influenza on record, carrying a risk of transference to humans. UKHSA is managing the risk to human health via our public health teams and our Centre for Pandemic Preparedness (CPP). UKHSA has worked with the Department for Environmental, Food and Rural Affairs (Defra) and Animal and Plant Health Agency (APHA) who are leading the response to avian influenza in birds, developing a pilot for asymptomatic swabbing of exposed persons in England to detect emerging respiratory virus threats.

UKHSA worked with regional health teams and our health protection teams (HPTs) on media reporting and public health support in response to a significant increase in seasonal persistence of scarlet fever and invasive group A streptococcus (iGAS) through the autumn. UKHSA’s HPTs worked rapidly to help detect and respond to an uptick in disease in the community, delivering nearly 100,000 units of antibiotics from the national pandemic preparedness stockpile to save lives.

Across the year, UKHSA has demonstrated the value we offer across a range of other health issues. Our specialist teams have:

• detected and alerted salmonella in chocolate and listeria in smoked salmon
• delivered our national action plans on tuberculosis, HIV, hepatitis and antimicrobial resistance (AMR)
• led the government response to the summer heatwaves and more recently provided communications during the winter cost of living crisis

Operationally, 2 members of the UK Public Health Rapid Support Team were deployed to provide technical assistance on the ground in response to Ebola virus disease outbreak in Central Uganda in September 2022. UKHSA’s health protection operations teams were also involved in responding to the incident at Queen Elizabeth Olympic Park where 29 people were taken to hospital with breathing problems and a major incident was declared following chlorine leak.

Health security

This year, UKHSA has established the CPP to bring together the UK’s existing and new pandemic expertise, data, research, and surveillance. The CPP has captured learnings from the pandemic, working closely with teams across UKHSA, DHSC, national security structures, academia, across government, and internationally to improve and drive our overall shared understanding of the threat landscape and preparedness priorities.

The CPP is UKHSA’s contributor to the 100 Days Mission, a global collaboration to reduce the time taken to develop and deploy new diagnostics, therapeutics, and vaccines against future pandemic threats to 100 days to protect the public. UKHSA has established a Wellcome-funded work programme on respiratory viruses and microbiome to develop the methodology and tools that will enable UKHSA to earlier detect new or emerging respiratory viruses and antimicrobial resistance.

Beyond our immediate operational response over the year, we are also building our links to industry to enhance our ability to respond to the next pandemic. In October 2022, UKHSA formally welcomed the former Vaccine Task Force (VTF) into UKHSA as the new UKHSA COVID-19 Vaccine Unit (CVU) to help us realise new ambitions as a global scientific leader working hand in hand with industry. UKHSA also launched the new Vaccine Development and Evaluation Centre (VDEC) as the focal point for our partnerships with industry and international bodies.

Through the CVU and VDEC, UKHSA concluded negotiations and signed a non-exclusive definitive agreement for a 10-year strategic partnership between HMG and Moderna to produce upwards of 250 million vaccines a year in the event of a pandemic and provide the UK with priority access to Moderna’s COVID-19 mRNA and other respiratory vaccines. Moderna will build a UK-based research and development and manufacturing facility near to our Chilton laboratory with work expected to commence in early 2023, with the first mRNA vaccine expected to be produced in the UK in 2025.

Under the partnership, Moderna will invest in research and development in the UK including in a Global Research and Development Centre which will encompass clinical trials, research grants and PhD studentships. We are also in dialogue with other industry partners on future collaboration.

At UKHSA’s first conference in October 2022, we launched the UKHSA’s Centre for Climate and Health Security that will act as a focal point for all our climate health activity. It will build on the work that UKHSA and predecessor agencies carried out to study and mitigate the health impacts of climate change and strengthen the scientific evidence available to policy makers.

By 2040, our vision is for a world in which antimicrobial resistance is effectively contained, controlled, and mitigated. UKHSA has been working alongside DHSC and the devolved governments to develop the next UK 5-year AMR national action plan, using our world leading clinical and laboratory surveillance for AMR and Antimicrobial use to drive coordinated efforts nationally and internationally to reduce the burden of AMR through a cross-sectoral One Health approach.

UKHSA has continued to monitor global and national emerging variants, working with partners on COVID-19 sequencing, sequencing 750,000 COVID-19 genomes detected in patients hospitalised in the NHS and supported clinical response to severe infections with antivirals. We have also published over 1000 peer-reviewed scientific papers, supporting the production of 10 Joint Committee on Vaccination and Immunisation (JCVI) reports (statements) on COVID-19, mpox, polio, HPV and the childhood immunisation schedule. The World Health Organization (WHO) Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE) recently adopted the UKHSA rapid risk assessment methodology for assessment of new variants, recognising the exemplar nature of UKHSA’s work.

In recognition of UKHSA’s collective work across the year, the COVID-19 dashboard team were named winners of the Royal Statistical Society Statistical Trustworthiness, Quality and Value Award and DataIQ Awards. The team were also shortlisted for The Royal Statistical Society Champion award and nominated in the Civil Service Awards for Best use of Data and Technology. In addition, 2 of UKHSA’s staff were also recognised in the most recent New Year’s Honours for dedication to the detection and prevention of serious diseases and immunisation programmes, and for commitment to data and transparency in public health.

Global health and engagement

Connecting with other nations and building UKHSA’s reputation in delivering value to global security and sharing scientific insights and surveillance data has been a focus during the year. In doing so, UKHSA has signed memorandums of understanding with:

• the European Centre for Disease Prevention and Control
• Africa Centres for Disease Control and Prevention
• the Nigeria Centre for Disease Control
• Zambia’s National Public Health Institute and Ministry of Health
• the West Africa Health Organisation
• the Korea Disease Control and Prevention Agency
• the Public Health Agency of Sweden

These relationships are cornerstones of our pandemic preparedness, sharing experiences, building trust, and allowing us to influence the practical arrangements for future pandemic surveillance and response. Over the year, UKHSA senior leaders and officials have represented the UK at the World Vaccine Conference in Barcelona, the Gates Foundation health forum in Berlin, the International Association for Public Health Institutes conference in Stockholm and advocated for climate health improvement at COP 26 in Egypt.

Organisational improvement and efficiency

UKHSA has worked tirelessly over the year to re-shape a fit for purpose organisation that provides value to the taxpayer and invests in its people and nurtures talent. We have vigorously pursued efficiencies, ramping down our workforce from just over 11,000 directly employed staff to 6,700 from the Agency’s peak of circa 18,000 at the height of the pandemic.

The UKHSA People Strategy and delivery plan has delivered a change management programme, which has reduced our senior leadership structure with a circa £20 million per annum cost saving, reducing the use of consultants by 94% and contractors by 86% while recruiting over 2,300 skilled roles to build our permanent, core workforce.

UKHSA has delivered further savings through:

• consolidating estates to drive efficiencies
• combining offices in London to reduce overheads
• pursuing further efficiencies with the forthcoming move to Canary Wharf

Looking ahead to the next 2 years, UKHSA has committed to absorb pay and inflationary pressures, reduce its administrative budgets and absorb elements of the COVID-19 response into Core to provide a basis for fighting future pandemics.

UKHSA has significantly matured our governance structures by implementing an organisation-wide change management and development programme led by our Executive Committee, along with the establishment of the Advisory Board and its 4 committees:

• Audit and Risk
• Science and Research
• Equalities, Ethics and Communities
• People and Culture

The Parliamentary and Public Accountability Team has had a busy year following the pandemic and a period of political and economic change within the UK attracting a high level of media and public scrutiny. UKHSA has responded to:

• 17,000 enquiries
• 1,800 information rights requests
• 1,700 responses to Parliamentary and Prime Minister’s Questions

UKHSA’s Public Inquiry Team, supported by our senior leaders and teams across the organisation have successfully responded to the opening of requests for the first modules of the COVID-19 public inquiry. This has been a chance for us to identify and implement lessons on the UK’s preparedness and operational response to ensure UKHSA is operationally and professionally making changes to deliver optimally for the future.

Challenges and opportunities

UKHSA’s operating picture over the course of the year has happened during a time of significant political and economic challenges, affecting our ability to fully establish the organisations strategic direction and budget as we strive to significantly redevelop our legacy systems and technology infrastructure. There is also recognition of the work that needs to be done to respond to an overall decline in People Survey results, particularly around uncompetitive pay, and change; the need to progress further on equality both internally and in wider health outcomes, and to implement robust mechanisms for financial governance considering the National Audit Office’s audit on UKHSA’s first 6 months of accounts.

Notwithstanding the challenges UKHSA faces as we continue to form and stabilise, the achievements across the year in delivering and adapting through change are a tribute to the resilience and culture within the organisation. UKHSA will continue to build on our work across this financial year to finalise our strategic direction and value proposition within our budget envelope, continuing to be bold in demonstrating impact across the health system, supporting the UK’s economy, and improving our partnerships across public and private sectors.

Scott McPherson
Director General, Strategy, Policy and Programmes
March 2023