On 18 August 2020, the Health and Social Care Secretary, Matt Hancock, announced the establishment of the National Institute for Health Protection (NIHP).

The NIHP  brings together the health protection and resilience functions of Public Health England (PHE), the Joint Biosecurity Centre (JBC – which provides data and advice on Covid-19 infection outbreaks) and NHS Test and Trace.

This Insight looks at what is known so far about the new body and reaction from the health sector, ahead of it being formally established in spring 2021.

What is the National Institute for Health Protection and what will it do?

The NIHP will be an executive agency of the Department of Health and Social Care (DHSC) aimed at monitoring and controlling infectious diseases and responding to health protection incidents.

In general terms, health protection includes activities aiming to protect people from “infectious disease, incidents and outbreaks, and non-infectious environmental hazards such as chemicals and radiation.”

According to the Health Secretary, the new body is an “imperative” in order to create a “single unified leadership for the next stage of our response to the [Covid-19] crisis” and to put in place a “stronger, more joined-up response to protect people and the communities in which they live.”

A DHSC policy paper on the new Institute sets out its responsibilities. Most of the functions confirmed to be moving to the NIHP relate to either managing the current Covid-19 outbreak or preparations to deal with any future epidemics/emergencies.

NIHP’s responsibilities will extend to the National Infections Services (such as field services and scientific campuses at Colindale and Porton Down), the regional and specialist public health microbiology laboratory network and the Centre for Radiation, Chemical and Environmental Hazards. At the local level, PHE local health protection teams will fall under the NIHP.

The Health Secretary has said that some of the NIHP’s responsibilities will be UK-wide while others will be England-only and that it does not need a change in the law to implement.

What is happening to the public health functions not mentioned?

Questions have been raised in the Commons about who will take ownership of the long-term work to improve public health that is currently undertaken by PHE. This includes issues such as smoking, air quality, obesity, childhood vaccinations and inequalities.

The Government has said that responsibility for non-health protection functions, like health improvement, remain under consideration. In the DHSC’s February 2021 paper on legislative proposals for a Health and Care Bill, it said proposals for the future design of the public health system would be published “in due course”.

When will the NIHP be operational?

The Government has said new leadership arrangements are effective immediately – namely bringing together PHE, JBC and NHS Test and Trace “under single leadership, with a single command structure and operating model.” The organisation will be “formalised”, however, from spring 2021.

Baroness Harding, the current Chair of NHS Test and Trace, is also the interim Executive Chair of the NIHP, and the Health Secretary said there is a “global search under way for long-term, permanent leadership.”

How has the health sector responded to the announcement?

Health experts have questioned the timing of the reorganisation and raised concerns about the negative impact that it may have on PHE staff.

The King’s Fund charity said the establishment of the NIHP risked causing “significant uncertainty and disruption at a time when the public health community should be fully focused on responding to the pandemic.” The Shadow Health Secretary, Jonathan Ashworth, told the Commons in September 2020 that the restructuring will “sap morale and focus and should wait until the end of the pandemic.”

How the NIHP will interact effectively with local public health systems has also been questioned. The Association of Directors of Public Health (UK) said the new public health system must work: “as one, across organisations, and between national and local, with the ready flow of knowledge, expertise, data and intelligence between them.”

Attention has been repeatedly drawn to uncertainties over the exact functions of the new body. In September 2020, over 70 health organisations wrote to the Prime Minister concerned that plans for the reorganisation of health protection in the UK paid “insufficient attention to the vital health improvement and other wider functions of Public Health England.” They added that there was a “real risk that some of the critical functions of PHE will be ignored.”

About the authors: Elizabeth Rough is a medical and health specialist and Esme Kirk-Wade is a researcher in the House of Commons Library.

Image: Nurse carrying out a bed changeover. Credit: Adrian Wressell, Heart of England NHS FTAttribution 4.0 International (CC BY 4.0)

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