Corporate report

UKHSA Advisory Board: UKHSA’s local, national and international relationships

Updated 16 November 2022

Date: Wednesday 16 November 2022

Sponsor: Scott McPherson

Presenters: Scott McPherson and Oliver Munn

Purpose of the paper

This paper provides an update on areas of focus for the UK Health Security Agency (UKHSA) in building and strengthening relationships with local, national and international partners.

Recommendation

The Advisory Board is asked to:

• endorse our approach to strengthening local, national and global relationships, including:

  • developing relationships across regions and local areas
  • clarifying roles, responsibilities and lines of accountability across the health protection system in England
  • collaboration with devolved governments
  • systems and networks enabling global health protection action

• comment on further areas that should be explored to strengthen UKHSA’S relationships and partnerships

Overview

UKHSA, as a national body, has a remit for system leadership across health protection. This system, however, is made up of numerous critical partners who must work collaboratively to prevent, detect, analyse and respond to threats.

The reorganisation of national public health structures, the establishment of UKHSA, and the learning from recent health protection responses (including COVID-19 and monkeypox) have given us an opportunity to assess opportunities to develop and strengthen critical stakeholder relationships further.

This assessment is being undertaken by our Strategic Engagement Team to understand the full breadth of our engagement partners and which work with our critical stakeholders is best enabled centrally. Central enablement will focus on:

• providing consistency for relationships that span several areas of UKHSA business
• better sharing of information where there are multiple UKHSA touchpoints
• setting shared objectives and priorities
• allowing ongoing monitoring of these objectives to ensure delivery of UKHSA’s remit and evidenced contribution to the system partners

This paper summarises current and future work to strengthen relationships across local national and international partners.

Local level

Local health protection services keep safe individuals, families and communities and local expertise shapes our response. The core of UKHSA’s local engagement is through UKHSA regional teams in the Health Protection Operations Group. Regional Deputy Directors hold relationships with key senior stakeholders, including NHS regions, integrated care systems (ICSs), local authority chief executives, Directors of Public Health (DsPH) and mayoral offices.

There is significant complexity across the regions, generated by differing administrative boundaries and the varying size and tiers of local authorities. This has led to bespoke regional engagement approaches. There is evidence of strong relationships across the regions, however the complex picture makes it difficult to make any overall assessment of the effectiveness and quality of engagement.

In addition to established networks, during the pandemic UKHSA’s predecessors developed regional partnership teams (RPTs). RPTs had regular engagement with other government departments (OGDs) and local authorities, and facilitated, informed and influenced policy discussions internally and across Whitehall. In the formation of UKHSA, the role of the RPTs has merged with regional health protection teams (HPTs) and now incorporates central engagement and insight functions. Following this merger, UKHSA’s next areas for development include building our relationships with OGDs at regional level and with the new ICSs.

As well as developing local relationships across the regions, UKHSA has been tasked by ministers with enhancing the resilience and scalability of national and local health protection systems.

UKHSA is working with key partners – in particular the Association of Directors of Public Health and the Chartered Institute of Environmental Healths – to co-design a programme of work to strengthen the health protection system learning from historic ways of working, health protection frameworks and recent experience in the pandemic. The 2 priority outputs identified for the future of the health protection system (FHPS) programme are to co-design with partners:

1. A set of national principles for joint working for the health protection system.
2. A system-wide framework, clarifying roles and responsibilities and lines of accountability.

National level

On a national level, UKHSA is a central player within the health family, working closely with the Department of Health and Social Care (DHSC) and National Health Service (NHS). In addition to our coordination function, UKHSA influences wider government strategies, working closely with many Departments including the Cabinet Office, Home Office, Foreign, Commonwealth and Development Office (FCDO), Department for Education, Department for Culture, Media and Sport (DCMS), Department for Business, Energy and Industrial Strategy (BEIS), Department for Environment, Food and Rural Affairs (DEFRA) and the Ministry of Defence.

Most significantly UKHSA has engaged with the wider National Security agenda – providing keyholder input to the Cabinet Office’s Biological Security Strategy (BSS). This provides an update on the biological risks that the UK and our interests overseas face between now and 2030.

UKHSA is responsible for several key deliverables and outcomes under the BSS. This includes the 100 Days Mission (100DM) domestic secretariat, and a National Biosurveillance Network. UKHSA has worked closely with departments such as DEFRA and Cabinet Office to explore options and gather evidence on how a National Biosurveillance Network could enable us to detect threats more quickly, building on the One Health agenda.

UKHSA is also engaged in the wider resilience and contingencies work across government – in particular scoping a pan-biothreats radar (including antimicrobial resistance) in the National Situation Centre (based in COBR, Cabinet Office).

The Centre for Pandemic Preparedness (CPP) is building more integrated relationship across government for those departments which share responsibility and interest in pandemic preparedness. We do this primarily by incorporating existing work contributions to the Pandemic Influenza Preparedness Programme and the Pandemic Diseases Capabilities Board as well as broader ministerial and senior official discussion on the BSS and the new streams of work (for example 100DM) highlighted above.

Devolved governments

UKHSA has a remit that is predominantly England-only with some UK-wide functions. UKHSA, the devolved governments (DGs) and public health agencies (PHAs) work in close collaboration. As health is a devolved matter, the engagement between UKHSA and the 4 nations has 2 key sets of activities; reserved (UKHSA lead) as well as collaboration (shared ownership). On reserved activities, UKHSA provides a number of functions on a UK-wide basis including core global operations functions. In addition to these more formal arrangements UKHSA staff have a long history of working and researching with professional colleagues from devolved administrations and their PHAs on both operational response, evaluation and research.

COVD-19 also provided an opportunity for this relationship with DGs to be enhanced. The 4 nations worked in close partnership on the National Testing Programme and Joint Biosecurity Centre, in turn strengthening our collective operational response, data, and analysis. More recently, the monkeypox outbreak response has evidenced that the routine cross UK response arrangements in place pre-pandemic continue to work effectively. Increasingly recommendations for managing health security risks and operational response are being produced on a four nations basis. For the monkeypox outbreak an overarching strategy based on agreed public health recommendations for a UK vaccination approach has been developed as has an approach to vaccine allocation based on public health risk.

Underpinning this collaboration are several statutory, formal and informal governance arrangements. Following the UK leaving the European Union, the Health Security Regulations (EU Exit) 2021 and Common Framework for Public Health Protection and Health Security were agreed by all 4 UK governments. This established the UK Health Protection Committee (UK HPC) and the underpinning, 4 Nations Health Protection Oversight Group as the statutory body responsible for UK health security.

The Health Security Regulations place a duty on all 4 nations to work together in the interests of UK Health Security. This includes obligations to share data and information on an extensive list of diseases. The current UK HPC work programme includes:

• borders review
• emergency preparedness, resilience and response
• notifiable diseases

On a working level, operating within these regulations, there is a UKHSA-DG Board which focuses on UKHSA’s activities and their implications for the DGs. UKHSA also has several bilateral arrangements with the DGs and PHAs, governed through memoranda of understanding (for example the provision of environmental public health services to Wales).

International level

The fact that many health threats to the UK population are likely to develop elsewhere in the world and the tangible evidence from the current pandemic of the significant global geographical and temporal variation means that the way we manage future health threats will likely require even greater international collaboration. In order to protect the UK, we need to strengthen global health security, tackle health threats at origin, and learn from and with international partners. UKHSA is developing a global strategy to provide direction and outline our role in the changing global health security landscape

Naturally some of our global relationships are inherited from UKHSA’s predecessor agencies and most of these continue to strengthen. UKHSA plays a leading role in supporting the delivery of the World Health Organization (WHO), G7, G20 and quadripartite global health priorities and commitments, including the WHO Pandemic Instrument and the Global Health Security Agenda and Initiative. We work closely with DHSC, the Foreign, Commonwealth and Development Office (FCDO) and DEFRA on delivering these.

We have strong European relationships, notably with France, Germany, Netherlands and Norway with whom we are refreshing existing MOUs to continue these close ties. Our relationship with the European Centre for Disease Prevention and Control (ECDC) has been formalized through an MOU which covers all EU Member States.

Under the auspices of UKHSA we have made significant progress in consolidating the relevant existing relationship as well as forging new ones. UKHSA has signed MOUs with:

• the Africa Centres for Disease Control and Prevention, the Nigeria Centre for Disease Control, Zambia’s National Public Institute and Ministry of Health
• the West Africa Health Organisation
• the WHO Eastern Mediterranean Regional Office
• the Korea Disease Control and Prevention Agency

In addition, UKHSA hosts 8 WHO collaborating centres and 8 WHO reference laboratories.

The Official Development Assistance projects that UKHSA delivers, with funding from DHSC and FCDO, are part of the UK’s G7 commitments to strengthen compliance with the International Health Regulations (IHR). This involves working with countries directly, and with regional and global agencies to strengthen core capabilities needed for compliance with the IHR. We have programme delivery offices in Ethiopia, Nigeria, Zambia and Pakistan and UKHSA embeds in Africa CDC, WHO Regional Office for the Eastern Mediterranean and in the Association of Southeast Asian Nations. We also deliver strengthening programmes in our UK Overseas Territories.

The UK Public Health Rapid Support Team (UKPHRST), a partnership between UKHSA and the London School of Hygiene and Tropical Medicine (funded by official development assistance (ODA) through DHSC), has a strong relationship with the WHO Global Outbreak Alert and Response Network and frequently deploys to health emergencies through WHO and bilateral requests from countries. The UKPHRST is a specialist team ready to respond to disease outbreaks around the world before they develop into health emergencies. The team also conducts rigorous operational research to improve epidemic preparedness.

There will be new relationships we need to foster as UKHSA – the Centre for Pandemic Preparedness and the Centre for Climate and Health Security are scoping who their key partners should be as they develop their remits and UKHSA’s greater focus on income generation and industry engagement will create new opportunities.

Scott McPherson
Director General, Strategy, Policy and Programmes
November 2022