Public Health England is soon to be no more. In the midst of a global pandemic, at a time when England needs all hands to the pump to deal with the greatest threat to public health in a century, staff will instead be involved in a complex organisational reshuffle to create a new National Institute for Health Protection under the leadership of Dido Harding.
There is something of an irony that, despite resisting calls for an immediate inquiry into the mishandling of the coronavirus pandemic, the government is now acting as if it has already identified the source of failure. Public Health England (PHE) is guilty, the government has declared – without trial, judge or jury. Off with its head!
Certainly there have been failures on many levels. Perhaps the most obvious has been in the area of testing. This is how things were supposed to work: when the pandemic was in danger of spiralling out of control, we had to impose lockdown – a blunt, indiscriminate instrument that is harmful to society and to the economy, even as it stops the Covid surge. But you can’t have lockdown for ever. So when infections are brought back under control you carefully reopen with a targeted system in place to identify new cases, trace those affected and break the chain of transmission. That is the test-and-trace system.
If lockdown is the indiscriminate bludgeon, test and trace is the rapier. Lifting lockdown without a functioning test-and-trace system leaves us defenceless against a new surge. Yet for all the repeated bombast, we don’t yet have a system that works. As John Edmunds, of Sage, put it so eloquently on Newsnight: “Honestly, I couldn’t care less whether it’s world-beating or not, I just want it to be virus-beating. And it’s not.”
This failure goes a long way towards explaining why England’s response to coronavirus has been one of the worst in the world. To start with, there were failures in preparation. One could criticise PHE for not putting testing facilities in place given that a respiratory pandemic has, for many years, been at the top of the National Security Risk Assessment. But the PHE budget has been slashed continuously since its inception in 2013; funding in 2019/20 was £850m (25%) lower than in 2015/16 . Testing capacity was so poor that, on 12 March, the government gave up on testing people in their homes altogether. Again, this decision was made by ministers, not by PHE.
The tracking and tracing part of the system that we have now has been equally controversial. First it was based on a hi-tech app, now junked; then it was organised around a centralised telephone system, rather than tried and trusted local public health systems, an approach that has also now been semi-junked. From the outset, this was outsourced to various companies such as Serco, which provided call-handling staff and with which ministers have previous associations.
This approach was entirely the government’s choice, implemented by their chosen appointee (Dido Harding). It was transparently ideological and demonstrably inefficient; indeed, Serco’s telephone tracers were around 50% successful in reaching contacts; public health tracers were over 90% successful.
The government has recently been forced to admit the failure of this approach by shifting back towards local tracing. This is an improvement, but it ignores even greater problems with the system. Before you can even test people and trace their contacts, you need to find cases and compel people with symptoms to come forward, and come forward early, before they have had a chance to spread infection. After those people and their contacts have been tested, you need to ensure they self-isolate.
The government has offered no support to ensure people are able to self-isolate. Nor has it collected statistics on whether people actually are self-isolating – an extraordinary oversight, given that the whole exercise is practically pointless without this information. If isolating means people – particularly those in the gig economy – will lose their incomes and possibly even their jobs, they are far less likely to come forward to be tested. Likewise, they’re less likely to name their mates, who may also lose out. How can we expect people to look after their community if their community won’t look after them?
Despite clear international evidence indicating the importance of support measures, and domestic stories about people spreading infection because they continued to work even when unwell, the government has done nothing to support people isolating. They have made no moves to ensure those people have access to sick pay or to prevent bad employers from reprimanding workers who have to isolate. The government has designed a system whose aim is to get people to self-isolate – without making it possible for people to do so.
To address these problems, the government needs to recognise that it has got many things wrong. Instead, it seems intent on blaming others. Rather than addressing the very real inadequacies of the testing system, politicians have sought to distract us with an organisational reshuffle. And instead of moving towards a locally based, centrally supported public health approach that is close to the people we need to reach, they have moved still further towards a distant, centralised, opaque system run by political appointees.
The government has blamed PHE for mistakes for which it was never responsible, and placed it under the control of those who were. This is a major disruption and distraction from the efforts against Covid-19. Rather than a new, centralised public health body, England urgently needs an independent inquiry that can identify the actual sources of its Covid failures, and determine which heads really should roll.
•Stephen Reicher is a member of the Sage subcommittee advising on behavioural science, an adviser to the UK and Scottish governments on coronavirus and professor of social psychology at the University of St Andrews.