Correspondence

Letter from Andrew Gwynne MP to Professor Dame Jenny Harries, UKHSA Chief Executive

Published 24 October 2024

From:

Andrew Gwynne MP
Parliamentary Under Secretary of State
Department of Health and Social Care
39 Victoria Street
London
SW1H 0EU

To:

Professor Dame Jenny Harries
Chief Executive
UK Health Security Agency
10 South Colonnade
Canary Wharf
London
E14 4PU

Dear Jenny,

UK Health Security Agency strategic remit and priorities financial year 2024 to 2025

This letter sets out the priorities for the UK Health Security Agency (UKHSA) for the financial year 2024 to 2025.

I would like to thank officials for their work since January 2024 to set out core responsibilities and priorities across the financial year 2024 to 2025. To complement this letter, UKHSA’s annual business plan and outcomes framework will set out the full list of your priorities and success metrics, developed and agreed with the Department of Health and Social Care (DHSC). These will be informed by your Strategic Plan 2023 to 2026 and supporting strategies. 

UKHSA’s mission, as part of a mission-driven agenda for government which delivers ambitious, measurable and long-term objectives, is to prepare for and respond to infectious diseases, including pandemics, environmental hazards and other external health threats, to keep all our communities safe, save lives and protect livelihoods.

UKHSA provides expert public health scientific expertise; data creation, collation, sharing and analysis; and surveillance capabilities and operational response to strengthen public health protection and security capability across the UK. You provide the UK with the permanent standing capacity to prepare for, prevent and respond to threats from:

• infectious diseases (covering the main routes of transmission that can give rise to epidemics or pandemics: gastrointestinal, respiratory, sexual, blood-borne, touch and vector-borne)
• chemical, biological, radiological and nuclear hazards
• other environmental hazards, such as extreme weather events
• health hazards that arise from disasters

UKHSA’s remit and responsibilities relate to England on devolved public health matters and the UK on reserved matters. Since health hazards do not respect administrative boundaries, it is vital that you work closely with lead agencies in Scotland, Wales and Northern Ireland and contribute to the delivery of high levels of health security throughout the United Kingdom.

UKHSA will continue to build and sustain strong, impactful relationships across local and national government, including with local authorities, agencies in the devolved governments, the Crown Dependencies, UK Overseas Territories and other system partners across the UK to ensure threats are effectively identified, mitigated and addressed at home and abroad.

As an executive agency of DHSC, UKHSA will:

• provide strong national leadership on public health security and health protection
• ensure a cohesive response across England and the UK’s health protection functions
• provide effective clinical, scientific and operational functions to support the health system’s ability to protect the public from health hazards

UKHSA, where applicable, will align and input to relevant work within the health and social care system, across government and internationally. UKHSA will routinely engage with DHSC, ministers and across government to support transparency and efficient delivery and continued co-ordination in undertaking Parliamentary and public engagement.

UKHSA’s engagement with international partners should advance the UK’s global health objectives as set out in the Global Health Framework.

As part of our health mission to tackle the social determinants of health, UKHSA will ensure that reducing disparities in health outcomes is a core objective of activities across their remit, and support actions taken by DHSC to reduce health disparities. You will co-ordinate with partners to ensure all members of the community are, as far as possible, equitably protected from exposure to and consequences of public health threats.

UKHSA will be a trusted source of public health advice and scientific expertise and work closely with the Chief Medical Officer (CMO), the UK’s most senior medical adviser and head of the public health profession. The CMO will be the ultimate arbiter for advice on scientific and clinical matters, will be formally consulted by UKHSA on wider public health protection strategy and will be the professional lead for UKHSA’s most senior medical professionals. The CMO will co-ordinate closely with UKHSA in support of the agency’s global public health remit. UKHSA will also work closely with the CMOs for Scotland, Wales and Northern Ireland.

UKHSA will synthesise its multiple areas of expertise into a single organisational view when developing advice to the public health system and relevant ministers.

The annexes attached set out UKHSA’s key deliverables to focus on during the 2024 to 2025 financial year (annex A), as well as the enduring core capabilities that you should continue to build as the nation’s expert dedicated public health security agency (annex B).

Annex A: key deliverables for UKHSA, financial year 2024 to 2025

In 2024 to 2025, the government expects UKHSA to undertake the following activities, underpinning these with smart deliverables, KPIs and success metrics in line with the Cabinet Office’s Arm’s length body sponsorship code of good practice.

Pandemic and major epidemics preparedness

UKHSA will:

• work to develop specific operational response plans in line with the principles set out in the refreshed strategic framework. This will include pandemic response planning across all routes of transmission for UKHSA while also supporting DHSC on wider pandemic planning and the respiratory response plan for a UK-wide health and care response as well as wider government threat-response planning
• support the capabilities assessment led by DHSC to ensure that there is a co-ordinated approach for future investment
• support the refresh of the pandemic and emerging infectious diseases risks under the National Security Risk Assessment (NSRA). This will include leading work to develop new modelling for vector-borne diseases, to assess the potential additional burden of disease, and support planning assumptions for partners across government
• support the development and implementation of a refreshed Pandemic Preparedness Strategy, subject to ministerial agreement, through a capabilities-based approach - equipment, people, skills, infrastructure

Vaccines

UKHSA will:

• use your clinical, scientific, data and laboratory expertise to proactively contribute to, anticipate and encourage advancements and innovation in vaccine technology; and explore opportunities related to research and development, manufacturing, supply chains and delivery methods. Close collaboration between your clinical experts and vaccine developers is essential in this process and will include horizon-scanning and assessment of emerging health threats that could potentially be addressed through vaccination. This includes utilising expert clinical, scientific and commercial support to develop, implement and improve vaccine programmes
• provide scientific, clinical and commercial expertise to support the policy considerations of the Joint Committee on Vaccination and Immunisation’s (JCVI) recommendations, including to bring in national immunisation programmes on respiratory syncytial virus (RSV) and varicella, with further targeted programmes on mpox and gonorrhoea
• continue to lead the procurement and supply of COVID-19 vaccines, working with a range of stakeholders and sectors to provide advice to ministers. As part of this, you will work with the JCVI, DHSC CMO, Deputy CMO and DHSC policy teams to identify and define vaccine requirements for successive years. This should inform procurement for future COVID-19 vaccine campaigns and the longer-term COVID-19 vaccine strategy
• manage the Moderna-UK strategic partnership contract to maximise its opportunities, work with DHSC to fully understand its impacts and opportunities, make the necessary links across other programmes and create projections on how the annual minimum purchase commitment (AMPC) can be optimised. Similarly engage with other life sciences companies to understand and make use of wider opportunities to better protect the health of the public

Antimicrobial resistance national action plan

UKHSA will:

• support delivery of the UK 5-year action plan for antimicrobial resistance 2024 to 2029, building on the 2019 to 2024 national action plan
• develop an implementation plan setting out the detailed activity that you will undertake to deliver those commitments, and against which organisational progress will be assessed. This will include leading the collation of data on resistant infections and antimicrobial use from across the UK to monitor progress against UK targets

Critical national infrastructure

UKHSA will:

• provide advice to DHSC ministers on the strategic options to replace and modernise UKHSA’s high containment laboratories and its wider estate
• develop a revised business case to secure wider government approval
• put in place strong programme arrangements to deliver the agreed scope as quickly and efficiently as possible, taking into account recommendations from the National Audit Office (NAO) and Public Accounts Committee (PAC)

Strategic exercise programme

UKHSA will:

• establish a routine UKHSA corporate emergency response exercise programme to test your organisation’s preparedness to risk assess and respond to the key public health threats and hazards identified in the NSRA and through UKHSA’s All Hazards Intelligence horizon scanning programme

For those programmes outside of UKHSA’s internal emergency response exercises, you will:

• continue to provide a training and exercising programme within the resources available, which will be agreed by DHSC and support emergency preparedness, resilience and response (EPRR) capability in UKHSA, DHSC and NHS England (NHSE)
• work across government and with the health and social care sector to lead the preparation and then delivery in 2025 of a tier 1 exercise on pandemic preparedness
• deliver the following cross health sector training and exercising:
  • a series of Emergo exercises and EPRR training modules for NHSE
  • a series of virtual exercises for DHSC, including on chemical, biological, radiological and nuclear (CBRN) incidents
• the programme should be comprised of tabletop and command post exercises that test organisational and cross-sector preparedness

Border health security

UKHSA will:

• continue its work on port health, providing an assessment of its current capabilities. This should support UKHSA’s engagement with DHSC, relevant departments and devolved governments to work together to assess the cross-system requirements for border health security measures that can be scaled rapidly to provide an effective response to an infectious disease threat. This will also act as the basis for work with the devolved governments to strengthen UK-wide border health security under the Common Framework
• the strategic framework will also support UKHSA and the other nations to meet the objectives of the international health obligations

Finance and accounts improvement

UKHSA will:

• produce draft accounts before the summer recess and lay audited accounts by the statutory deadline
• agree on a multi-year accounts and audit plan with the NAO and DHSC, alongside a robust monitoring and escalation framework and the provision of additional third-party assurance that will improve the timeliness of accounts laying in future years and work toward improvements in the audit outcome
• improve financial forecasting with a period 6 detailed review mid-year, ahead of the spending review and business planning in autumn 2024, to agree budgets in advance of the financial year-end

Preparation and response to inquiries

UKHSA will:

Maintain proportionate capabilities and resources to enable the organisation to respond to requests from the COVID-19 Inquiry and other public inquiries as required and while maintaining essential health protection services, as a core participant to all modules of the COVID-19 Inquiry and as an executive agency of DHSC.

Annex B: UKHSA’s core capabilities

As an effective public health agency, UKHSA should provide the following enduring core public health protection functions.

Pandemic and major epidemics preparedness

UKHSA will:

• provide core health protection capabilities that are scalable in response to incidents and ensure plans are in place to scale beyond the scope of our core capabilities in the event of future pandemics and major epidemics. This will include, but is not limited to, leading on:
  • surveillance
  • diagnostics
  • case management and contact tracing
  • scientific and expert advice
  • emerging and high consequence infectious disease responses
• plan and respond to epidemics and pandemics via the main transmission disease routes (respiratory, vector-borne, contact, food and/or water borne and sexual and/or blood-borne), with plans to have the capacity and capability to scale up all relevant aspects of a public health response in the event of an emergency, until wider state capacity could be deployed, working closely with other bodies
• continue to develop pathogen genomics and surveillance capabilities by investing in efficient and long-lasting data and technology infrastructure, building on the world-leading expertise established during the COVID-19 pandemic while maintaining the ability to ramp up in response to an incident
• build capability to deliver a ‘genomics-first’ approach to infectious diseases, including for epidemic and pandemic preparedness to enable the rapid detection and/or characterisation of potential emerging infections and outbreaks
• continue to support the development and implementation of the research and innovation framework for pandemic prevention, preparedness and response to deliver enhanced co-ordination of UK government research funders. This includes:
  • conducting research
  • providing evidence summaries for key research areas
  • identifying research gaps
  • delivering a UK-specific priority pathogen list
  • supporting with table-top exercises to test the framework

Infectious disease threats

UKHSA will:

• continue to provide effective nationwide health protection services to detect and contain infectious disease outbreaks, minimising harmful health impacts
• support interventions to prevent antimicrobial resistance and, working with other professionals, monitor, prepare, plan and respond to antimicrobial resistance (AMR)-related infections at local, regional and national levels (through public health protection teams) thereby supporting delivery of the UK’s national action plan to reduce the impact of AMR domestically and globally
• provide overseas public health protection and system strengthening against outbreaks, epidemic threats and humanitarian crises in partnership with other organisations and government departments, including fulfilling international responsibilities and World Health Organization (WHO) commitments

Emergency preparedness, resilience and response

UKHSA will:

• take lead responsibility for infectious and endemic diseases in domestic incident planning and response. This includes leading the response across government and the health and care system (including with NHSE and bodies in the devolved governments’ administrations)
• provide expert scientific advice to ensure the health protection impacts of environmental incidents and emergencies, including flooding, meteorological hazards and terrorism, are considered within a relevant incident response
• provide expert advice on and, as appropriate, undertake health protection activities at the borders including seaports, airports and rail crossings to aid the local detection and management of outbreaks and help prevent wider community transmission
• continue to provide and develop the national security intelligence function through the ‘all hazards situational awareness’ (AHSA) function to monitor, update and raise awareness on national and international incidents and risks

Chemical, biological, radiological and nuclear (CBRN) preparedness

UKHSA will:

• within current retained capacity, prepare, plan and respond robustly and rapidly to the public health impacts of all non-infectious disease external threats and incidents including any CBRN events. This includes leading the identification and assessment of public health impacts for threats related to CBRN and providing technical, scientific and clinical advice to inform planning and during incident response
• increase your capacity to support the CBRN programmes - this should include technical, clinical and scientific specialists
• manage procurement, and develop and deliver storage and distribution options for relevant CBRN countermeasures
• undertake an assessment of UKHSA’s current capability to prepare for and respond to a CBRN incident, identifying areas for improvement and future investment

Vaccinations, immunisations and therapeutics

UKHSA will:

• manage procurement, storage and distribution for:
  • national immunisation programmes and childhood influenza
  • COVID-19 therapeutics
  • pandemic preparedness pharmaceuticals and emergency clinical countermeasures (including pandemic specific influenza vaccines and antivirals)
• systematically assess and drive forward the epidemiological and scientific evidence base for new opportunities for existing or novel vaccine development and/or vaccine programmes, including the potential use of new vaccine and other emergency countermeasure platforms, working closely with the department and across HM Government, including Office for Life Science (OLS), National Institute for Health and Care Research (NIHR) and Medicines and Healthcare products Regulatory Agency (MHRA)
• manage the Vaccine Development and Evaluation Centre to strengthen preparedness for priority infectious diseases threats through laboratory-based studies to support the development and evaluation of vaccines and therapeutics
• support DHSC and NHSE to reduce the impact of vaccine preventable diseases, working alongside the JCVI in line with elimination and eradication strategies focusing in areas where coverage has significantly diminished, or elimination status has been lost. This includes efforts to reduce disparities in vaccination coverage that may put specific regions and communities at higher risk
• provide secretariat and modelling support to the agreed set of expert committees

Scientific infrastructure

UKHSA will:

• maintain a network of specialist reference and high containment laboratories and the capability to monitor, warn and prepare for public health threats to the UK that may arise outside its borders or domestically, including the ability to detect rare, serious infections. These laboratories need to be able to handle serious consequence human and animal pathogens, as well as radiation, chemical, toxicological and environmental hazards, provide specialist diagnostics and public health microbiology services to the NHS and others, deliver infectious disease surveillance control and reporting to enable testing to be scaled up at pace

• work to maintain and develop a secure digital infrastructure, enabling you to securely, and at pace, share high-quality data lawfully both internally and externally with relevant partners for health protection purposes and in particular in the event of emergencies
• maintain critical national public health protection infrastructure, keeping it secure

Climate change and health

UKHSA will:

• support DHSC to make the case for action on climate and health through the Centre for Climate Change and Health - this includes supporting the health system to implement the National Adaptation Programme (NAP)
• prioritise research from UKHSA’s report into the health effects of climate change and work with partners to commission and conduct this research
• assess the implementation of the Adverse Weather and Health Plan and work with partners to overcome barriers and maximise best practice

International health

It is noted that UKHSA global efforts will focus on 3 global strategic priorities:

• pandemic prevention, preparedness and response
• global surveillance
• health systems strengthening

UKHSA will:

• improve global health and protect the UK’s global health interests, as set out in the Global Health Framework, including by:
  • providing expertise to the UK government, and supporting international activity, to appropriately strengthen the UK’s influence through engagements and activity overseas
  • driving activity to support overseas public health protection. This includes between outbreaks through the International Health Regulations (IHR) Strengthening Project and, once they have started, via the UK Public Health Rapid Support Team

Working with academia and industry

UKHSA will:

• enable health and prosperity through its scientific work and assets, building on existing dynamic and productive relationships with a range of partners
• as part of this strategy, continue to work with academia, including through the NIHR Health Protection Research Units, to support innovative science to better understand hazards to public health and develop practical ways to prevent and control them; and work with industry, in particular in the life sciences, to prevent and mitigate public health hazards through innovative approaches and collaboration such as with pharmaceutical companies on vaccine research and development of diagnostics

Governance and accountability

UKHSA will:

• continue to strengthen solid corporate foundations for the organisation. This includes developing organisational structures that:
  • allow all aspects of the agency to prepare and flex to respond to public health threats and incidents
  • enable the agency to operate at optimal effectiveness and efficiency and provide value for money
• work through the finance and control improvement plan and develop further processes to address the historic and transferred issues that have resulted in disclaimed audit opinions, to enable an improved audit opinion for the organisation to be secured as rapidly as possible and ensure accounts can be laid pre-summer recess
• have the capability, capacity and resilience to deliver across the agency’s commercial function
• continue to embed good governance, risk management and accountability structures throughout the organisation, in line with those expected in the ’Executive agencies: a guide for departments’ guidance (see Public bodies), and drive efficiencies and effectiveness through shared services where there is evidence of likely improvements
• plan and use the organisation’s resources in an affordable and sustainable manner, within agreed limits and delegations, as set out in the Framework document and schedule of delegations
• continue towards a sustainable, resilient permanent workforce that can deliver its functions and can adapt to changing public health threats and demands in line with ministerial targets, developing and utilising cross-government and/or specialist clinical and scientific professional recruitment frameworks to enable strong recruitment and retention in support within allocated resources. Additionally, continue to focus on developing a culture that invests in people and nurtures talent, enabling you to attract and retain individuals with crucial scientific, public health and technical skills

Parliamentary and public accountability

UKHSA will:

• fulfil all Parliamentary and public accountability functions that are expected of an executive agency, for example, timely answering and contributing to Parliamentary questions and freedom of information requests
• provide all staff with understanding of Parliamentary and ministerial briefing responsibilities in a potential incident situation - for example, early briefing, preparation for urgent questions and regular situation updates to ministers