Prevention is Better than Cure

39 Victoria Street, SW1 

“Humphrey.” 

“Yes, Minister?” 

“As I understand it, as the NHS is becoming unaffordable, our Grand Strategy is to beef up public health to the point we’ll all be skipping about like new-born lambs and won’t need it, or not so much of it anyway.” 

“That is the gist and it is why we welcomed the Dimbleby report, although I’m not sure sugar and salt only being available from the NHS is a good idea.”

“The nub, Humphrey, is that we have to simplify and clarify our public health agenda and who is going to carry it out?” 

“Yes indeed, Minister.” 

“I’ve just read your 13th July letter to the Chief Executive of Public Health England.” 

“I think you may be referring to the missive from the Parliamentary Under Secretary of State for Prevention, Public Health and Primary Care.”

“I know Jo Churchill. Her name may be on it but the style is remarkably similar to the same day’s letter to the new UK Health Security Agency Chief Executive, allegedly from Lord Bethell the Parliamentary Under Secretary of State for Innovation, but, if I may say so, rather more like your fair hand. Jim Bethell’s main qualifications for the job are being a pal of the late lamented Secretary of State and running that south of the river nightclub, the Ministry of Sound.  He was good at that. The “Ministry of Sound” would be rather a good name for our Department, what?” 

“I could not possibly comment, Minister.  We are here to serve.” 

“Anyway, isn’t it a bit late for Public Health England to be given a pile of priorities? I was told it will definitely be closed by the end of the year, and maybe by the end of September.  That’s just five months to do all the things it hasn’t done so far.” 

“’Depend upon it, sir, when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully.’  That is Samuel not Boris, Minister.” 

“So, by the end of the year, you say Public Health England will reduce health inequalities with a spot of marketing and advice. It will also support the government’s target of reducing the number of adults living with obesity, halve childhood obesity by 2030 and provide up to 455,000 additional adult lifestyle weight management services, along with 6,000 additional children and family lifestyle weight management services, and trial an extended brief intervention via the National Child Measurement Programme for 60,000 to 85,000 children. Also a new Healthy Weight Coach training module for Primary Care Network staff and expanding the Better Health campaign to motivate people to make healthier choices and to develop and drive take-up of the popular NHS weight loss plan app. Did I mention ‘initiate development of a public facing Nutrient Profiling tool to support businesses to calculate the nutrient profiling scores of their products’? And it has another six laundry lists like that. Might it be quicker just to list the items that are not priorities?” 

“Oh, dear me no, Minister.  For us everything is a priority.  Otherwise, we would never get anything done.” 

“But Public Health England never does get anything done, Humphrey.  I thought that was why we are sacking the Chief Executive, along with the customary encomium of course, and closing it down?” 

“What matters, Minister, is to have clear objectives – and plenty of them. You cannot fault us on that. Furthermore, none of these priorities, apart from the obesity ones, are attached to anything so vulgar as delivery dates or numerical targets and there’s no link, so far as we know, between the obesity targets and anyone losing any weight. These are excellent priorities because no one will ever know if we have achieved them.” 

“I’m sorry to break this to you Humphrey but everyone, even the chap on the Clapham omnibus, knows that Public Health England has been utterly useless and its handling of the pandemic has been dire. Even securing Covid vaccines had to be handed to someone else or we’d still be waiting. Why else would we be sacking the Chief Executive and closing it down?” 

“I do agree, Minister, but people do not appreciate the sterling work Michael Bodie and his team have been doing, often working with charities, universities and the private sector.  PHE has been generous in allowing others to take the credit. Now those wonderful results will grow as the UK Health Security Agency, under Jenny Harries, takes over.” 

“Yes, I noted that in the two letters, except last year we said that the National Institute for Health Prevention under Dido Harding would be taking over.  And the charities were up in arms as we wouldn’t promise to maintain the £760M p.a. that PHE gave them.”

“I think the word is Protection, Minister, but I take your point.  It is confusing. When we announced the dissolution of Public Health in August last year, we said its replacement would 'be operational from Spring 2021, to prevent any disruption to ongoing vital work'.  On 13th July this year, however, we described the UK Health Security Agency as ‘the new organisation responsible for preparing, preventing and responding to threats to the nation’s health’[6], which obviously includes Public Health England. As you can see, Minister, we are keeping up with the times.” 

“I can? So what has become of Health Protection?” 

“Our late Secretary of State intended to make Lady Harding Chief Executive of the NHS Commissioning Board, which you may know as NHS England. He freed her up by rolling the Health Protection into Health Security.  Alas, Protection is no more, Minister. Prevention is the name of the game and that is better than cure.” 

“Absolutely. I thought putting Lady Harding in charge of Health Prevention was rather a good idea but maybe not NHS England . “ 

“Indeed not.  But all is not lost. In Whitehall when one arm’s length body closes, two more will open. On 29th March, we announced the Office for Health Promotion ‘will combine Public Health England’s health improvement expertise with existing DHSC health policy capabilities, in order to promote and deliver better health to communities nationwide. By combining and enhancing these functions, the Office will play a vital role in helping the public lead healthier lives.’”

“Jolly impressive, Humphrey, barring one little snag.  It was all going to be formalised in the Health and Care Bill. I’ve been through the Bill with a fine-tooth comb and I can’t see a word about this Office. The Bill just says the locals will have to sort it out but local authorities are always a bit strapped for cash. Is this the Ministry of Sound again?” 

“Minister, if I may say so, that is unworthy of someone holding one of the great offices of state. Though I would not do so myself, others might describe it as cheap. We are doing our best. The new Health Security Agency is a very exciting development. Lord Bethell, in his letter, sets out its main role as being to ‘anticipate threats to health and help build the nation’s readiness, defences and health security.’” 

“Yes, that is jolly good, Humphrey. Jenny Harries will divine new diseases that no one has ever heard of and manufacture millions of vaccines for each one before anyone has copped the first dose?” 

“You could put it like that, I suppose.” 

“Wow! Would Jenny like to accompany me to Goodwood next month?”