Correspondence

Letter from Lord Bethell to Dr Jenny Harries, UKHSA chief executive

Published 13 July 2021

From:

The office of Lord Bethell
Parliamentary Under Secretary of State for innovation (Lords)
39 Victoria Street
London
SW1H 0EU

To:

Dr Jenny Harries
Chief Executive
UK Health Security Agency
Windsor House
50 Victoria Street
London
SW1H 0TL

Dear Jenny,

UK Health Security Agency strategic remit and priorities

This letter sets out the new agency’s role and the government’s priorities for the United Kingdom Health Security Agency’s (UKHSA) initial period of operation from May 2021 to March 2022.

The UKHSA is this country’s permanent standing capacity to prepare for, prevent and respond to threats to health. It brings together our world-leading public health science and expertise, cutting-edge capabilities in data analytics and genomic surveillance, and at-scale testing and contact tracing capability, combining elements of Public Health England (PHE) and NHS Test and Trace. It will build upon the experiences from the last decade of public health protection, here and around the world, including building on our successes in tackling COVID-19 over the past year and will work closely with the UK CMOs across its business.

I want to make clear how much the government values the work of PHE and NHS Test and Trace staff, with colleagues across national and local government, and with the NHS and partner organisations across the nation, to lead our public health response to the pandemic through this very difficult period.

Establishing UKHSA is a critical element of the government’s wider public health reforms. During the transition period (until end of September) UKHSA’s organisational design will be developed and the existing organisations – PHE and NHS Test and Trace – will provide capabilities to support you in responding to the pandemic and in carrying out the priorities set out in this letter.

By October, functions, staff, assets and funding will transfer from PHE and the Department of Health and Social Care (DHSC), and UKHSA will be fully operational. UKHSA will of course continue to evolve beyond this point, including adjusting the balance of its effort and capabilities between COVID-19 and other health security priorities.

UKHSA’s role

The COVID-19 pandemic has demonstrated the need for strong national leadership on health protection, an integrated response across public health professional, scientific and operational functions, and for the right capability in the public health system. It has highlighted the impact that threats to health can have on society and on the economy, and it has underscored the importance of ensuring the country has the ability to prevent and bring under control major hazards to health. For these reasons, health security must become a critical component of our national security architecture.

The government has established UKHSA with a global-to-local reach to protect the health of the nation from infectious diseases and other external threats to health by combining leading-edge science and analytics, insightful planning and responsive operational excellence. As the nation’s expert national health security agency, UKHSA will:

• prevent: anticipate threats to health and help build the nation’s readiness, defences and health security

• detect: use cutting-edge environmental and biological surveillance to proactively detect and monitor infectious diseases and threats to health

• analyse: use world-class science and data analytics to assess and continually monitor threats to health, identifying how best to control and mitigate the risks

• respond: take rapid, collaborative and effective actions nationally and locally to mitigate threats to health when they materialise

• lead: lead strong and sustainable global, national, regional and local partnerships designed to save lives, protect the nation from public health threats, and reduce inequalities

In order to deliver its mission and provide health security for the nation from infectious diseases and threats to health, UKHSA will need to excel in the following areas:

Strong surveillance capabilities, rooted in the highest quality data systems, data architecture and analytics will be necessary to drive effective responses to health risks. UKHSA will exploit the potential of new techniques and technologies across a range of disciplines and work in professional surveillance networks with partners across government, such as the Food Standards Agency, Animal and Plant Health Agency and the Department for Environment, Food and Rural Affairs, to ensure that health threats, including those from zoonotic diseases and antimicrobial resistance, are detected earlier and responded to more effectively.

It will be a science-based organisation, developing the evidence base using world-class data and analytical techniques to underpin effective prevention and response work. Leveraging PHE’s existing strengths, UKHSA will utilise its scientific expertise and develop research networks to detect and understand infectious diseases and other threats to health, and act as a catalyst for change and innovation across partnerships and collaborations to strengthen the health protection system.

It will have a strong role in global health security, since global and domestic health security are closely linked, through better links to surveillance and detection beyond our borders and ongoing collaboration and information sharing with international partners, with surge capacity and capability to control and contain public health threats should they reach our shores.

Building on the extensive capabilities built up by NHS Test and Trace in managing emergency procurement and stockpiles, manufacturing, supply and distribution of healthcare products and services to support the government’s response to the COVID-19 pandemic, UKHSA will be operationally excellent, including the ability to access flexible surge capacity where necessary in order to prevent, investigate, mitigate and respond to all infectious diseases and chemical, biological and nuclear public health hazards in the UK.

As a system leader for health security, UKHSA will provide intellectual, scientific and public health leadership at national and local level as well as on the global stage, while recognising the important role and remit of local authorities, building and maintaining strong, impactful relationships across local and national government, the NHS and global partners. UKHSA will exert its influence over the system to ensure threats to health security are acted on and brought under control. Within the UK it must develop and sustain strong partnerships both locally and nationally, across the 4 nations and with the 4 UK chief medical officers (CMOs), reflecting the need to act, support and influence on different geographies.

Across its strategic priorities and delivery capabilities, UKHSA must be a trusted source of advice to government and to the public. UKHSA will work closely with the CMO, who should be involved in coordinating all elements of public health, as the government’s chief public health adviser and professional head of the public health system, as well as with other UK CMOs. UKHSA will ensure it is resilient and prepared to respond to all future threats to health, with a professional line to the CMO.

As a key part of the country’s national security infrastructure, UKHSA will help to protect the country from the societal and economic shocks we have witnessed during the pandemic, and act as an engine for the UK’s life sciences sector and diagnostics industry. UKHSA will need to be properly integrated into national security structures, supporting the government’s National Security Strategy.

UKHSA will contribute to the government’s ‘levelling up’ agenda through a rigorous focus on reducing inequalities in the way different communities experience and are impacted by infectious disease, environmental hazards, and other threats to health, targeting action towards disproportionately affected groups. It will work to understand ever better the needs of citizens, and to build that understanding into the design and continuous improvement of services, contributing to a post-COVID-19 health system that is built back better, fairer and more resilient.

Priorities for 2021 to 2022

During 2021 to 2022, the government’s priorities for UKHSA are to:

1. Continue the response to the COVID-19 pandemic, contributing to the full roll-out of our successful vaccination programme and supporting the country through the Roadmap out of lockdown towards the return to normal social and economic activity and responding to cases and outbreaks and maintaining other activities, including the enhanced activity at the border, as necessary

2. Build on the legacy of the current response to this pandemic to put in place a resilient and scalable infrastructure that puts the UK in the strongest possible position to protect the public from new and existing threats to health that may emerge, ensuring effective emergency preparedness, resilience and response for health emergencies

3. Take action internationally to strengthen global health security, including ensuring the government has high-quality technical input in delivering its wider international health protection priorities, by supporting delivery of our G7 and COP26 priorities on improving global systems for disease surveillance and pandemic preparedness, and making a full contribution to the World Health Organization’s (WHO’s) global vaccines programme

4. Bring together the staff and capabilities of NHS Test and Trace and PHE to establish UKHSA as a dynamic and innovative agency that maximises the health security of the country through operational and scientific excellence

Further details on these priority areas can be found in annex A. During 2021 to 2022, UKHSA’s strategic priorities and design will be developed further, building upon the continued response to COVID-19 and lessons from the pandemic, and upon the government’s broader public health priorities. UKHSA will need to remain agile over the course of the year in responding to the COVID-19 pandemic.

Reporting

UKHSA is accountable to the Secretary of State for Health and Social Care and the Parliamentary Under Secretary of State for Innovation, lead minister for health protection, for delivering or supporting delivery of these priorities and professionally accountable on technical issues to the CMO. In doing so, UKHSA will demonstrate how it is acting to reduce health inequalities across its work programmes. Progress against agreed deliverables will be reviewed regularly, including through formal assurance arrangements with the senior departmental sponsor, allowing progress to be monitored and action taken to address any risks to delivery.

I will continue to meet senior leaders of UKHSA regularly to discuss progress.

Lord Bethell

Annex A

During 2021 to 2022, the government has 4 priorities for UKHSA.

1. Continue the response to COVID-19

UKHSA should focus on the continued response to COVID-19 for as long as this is needed, working closely with DHSC, CMO and all our delivery partner organisations. The overriding goal is for UKHSA to play its role in protecting the lives and livelihoods of UK citizens as we ease restrictions while seeking to balance health (including mental health), economic and social factors, taking into account how they disproportionately impact certain groups, as well as the epidemiological evidence. To do this, you should:

• continue to work closely with the NHS, both nationally and locally, in the delivery of the COVID-19 vaccination programme including by providing storage and distribution facilities and by monitoring and advising on COVID-19 vaccine effectiveness, and supporting the Joint Committee on Vaccination and Immunisation (JCVI)

• support and deliver public health guidance and communications tailored to the needs of different populations and areas, including on the safety and effectiveness of vaccines, and strategic communication to drive awareness, engagement and take-up of testing, supported self-isolation and vaccination, to maintain public trust

• continue and further develop surveillance and modelling capabilities and research-led, evidence-gathering activities to inform action at national and local level, focusing surveillance development on a better understanding of COVID-19

• continue to develop and deliver the governance framework known as the Local Action Committee (bronze, silver and gold), which enables ministers and CMO to review the latest epidemiological analysis, engage local partners, and rapidly determine response measures

• provide symptomatic and asymptomatic testing services at scale, including the universal testing offer, in line with levels of prevalence adjusting the mix of testing to reflect the changing nature of the pandemic and the evidence of effectiveness and behavioural insights

• continue to support local authorities in delivering public health activity at the border, major ports and airports, and deliver the managed quarantine services and enhanced port health functions, including analysis of the epidemiological picture overseas to provide advice on green, amber and red travel lists, to protect the UK from outbreaks of imported variants of concern

• provide and support rapid and effective contact tracing services, working in partnership with local authorities, to reach as many as possible of those who test positive and their close contacts

• continue the work to understand and improve the support for people who need to self-isolate and to promote high levels of compliance with these obligations

• develop surveillance and genomics capabilities and technologies to identify and analyse variants of concern early and respond rapidly to reduce risk of transmission

• continue to work in partnership with the devolved administrations in Scotland, Wales and Northern Ireland, building from the success of the Memorandum of Understanding on testing and other collaborative action as the whole of the UK works together to improve health security and respond to the remaining stages of the pandemic

• work with local partners including local authorities and the NHS to take action to reduce inequalities from the impact of COVID-19 on different communities and ensure that all members of the community are (as far as possible) equally protected from the disease

• work closely with DHSC to provide expert public health advice to ministers on the need for changes to guidance and legislation, such as informing shielding policy, that will best meet the changing needs of this pandemic response

Beyond this initial stage, UKHSA should plan for the next phases of the pandemic and, subject to ministerial confirmation of your plans, must ensure that UKHSA’s COVID-19-related activities are operating at a sufficient level to keep the virus under control, respond to localised outbreaks and help prevent a return to higher national alert levels. UKHSA will also need to monitor surveillance data closely and advise government on an appropriate and timely response if a third wave of the virus arises later in the year.

2. Protect the public from new and existing threats to health

UKHSA has a vital role in helping to identify and implement lessons learned from the management of this pandemic, both during these remaining stages and beyond, including assessing and responding to the longer-term public health impacts. This includes:

• work with stakeholders to leverage our COVID-19 investments in consumer diagnostics and in testing to deliver improved health security as well as wider benefits for the health of the nation

• expand genome sequencing and analysis capacity and capability to establish a world-leading pathogen genomics system to detect and provide local, regional and national surveillance of infectious threats with strategies to provide this capability within the regional and national health and public health framework – working with devolved administrations towards a UK whole-pathogens genomics strategy and contributing to development of a stronger global disease surveillance system

To support the domestic health security of the UK, UKHSA should continue to support the subject matter expert committees, local and national management of incidents and routine health responses, managing emergency health threats (chemical, biological, radiological and nuclear), risk assessment work including heatwave and cold weather planning, as well as:

• as a Category 1 responder under the Civil Contingencies Act, work with DHSC to provide an effective emergency preparedness, resilience and response to all public health emergencies, including surveillance, analysis, risk assessment, management of and response to infectious disease incidents and outbreaks, building on the advice from its expert advisory committees where appropriate

• working alongside DHSC and other partners to lead a refreshed approach to pandemic preparedness and high consequence infectious diseases (HCIDs), including a review of emergency and clinical countermeasures and re-procurement of Pandemic Specific Vaccine Advance Purchase Agreement

• continuing to improve our world-class childhood and adult immunisation programmes including supporting delivery of measures outlined in the government’s initial All Vaccines Strategy publication, including working towards regaining the UK’s measles elimination status, as well as the development of subsequent future vaccine strategy and extant vaccination programmes

• supporting the government’s goal to contain and control antimicrobial resistance (AMR) through delivery of the commitments in the UK National Action Plan for AMR 2019 to 2024, including international commitments

• providing scientific expertise in the detection, prevention and control of sexually transmitted infections and HIV to inform the development of the government’s Sexual and Reproductive Health Strategy and support the commitment to eliminate HIV transmission by 2030, and support NHS commissioning through monitoring the inequalities impact of reconfigured sexual health, HIV and hepatitis service delivery in response to COVID-19

• contributing to the cross-government Clean Air Strategy by leading a national programme of work to:
  • develop and share the evidence base on air quality impacts on health
  • improve how information on the health impacts of air pollution are communicated
  • encourage and support behaviour change at every level

• continuing to deliver ongoing domestic health protection activity, including by acting as the focal point on the international health regulations for communications with the WHO and the EU on incidents and outbreaks, and deliver a signed common framework agreement on increased co-operation on public health protection and health security between the 4 UK nations;

• delivering commitments, including a memorandum of understanding, for technical and scientific co-operation with the European Centre for Disease Prevention and Control

• supporting preparations and provide public health guidance to safely host the 2022 Commonwealth Games, G7 and other major national public events

• supporting progression of the Science Hub Programme business case to create the future UK infrastructure for public health scientific capabilities and capacity

3. Strengthen global health security

In addition to responding to the pandemic, the UKHSA should establish itself as a leading voice on the global stage so that a more robust international health architecture can protect the public’s health from all threats to health. To do this, you should:

• play a leading role in international health security initiatives in consultation with DHSC, including UK’s ambitions in the Global Health Security Agenda and Global Health Security Initiative, commensurate with the world-leading capabilities of the agency

• support delivery of G7 and COP26 priorities particularly on improving global systems for disease surveillance and pandemic preparedness

• lead the establishment and delivery of the New Variant Assessment Platform

• continue to provide expert input to the WHO on public health issues, make a full contribution to the WHO Immunization Agenda 2030 initiative, and support DHSC in analysing WHO and other international proposals particularly around health emergencies reform

• deliver on specific Official Development Assistance-funded projects, in particular the international health regulations strengthening and UK Public Health Rapid Support Team contributions to global health security

• continue to deliver on commitments to meet our health security obligations under the UK-EU Trade and Co-operation Agreement

4. Establish UKHSA as a dynamic and innovative organisation

The UKHSA is being established with an active capability to respond to the current pandemic. It will need to retain capacity initially in order to continue responding to COVID-19, and then quickly evolve as it transitions to a steady-state, so that the structure and culture is fully aligned with UKHSA’s mission to provide health security for the nation. In UKHSA’s first year of operation, it should focus on work to complete its full establishment, including:

• supporting the smooth transfer of functions, teams, data assets and systems into the new organisation, ensuring that adequate IT, people and estates plans are put in place to support this, as well as ensure the wider health system can continue to have appropriate access to data and information

• supporting DHSC to make the case for post-pandemic resourcing as part of the spending review, including work to agree the agency’s future operating model and first full business plan

• establishing robust internal governance mechanisms, including completing establishment of the board and Audit and Risk Committee

• developing further the network of local, national and international relationships needed to promote health security