It's not that we've become entirely conspirazoid, not entirely

We note two pieces of news, one a day after the other:

Great Britain faces its greatest risk of blackouts for six years this winter as old coal plants and nuclear reactors shut down and energy demand rises as the economy emerges from Covid-19 restrictions.

National Grid’s electricity system operator, which is responsible for keeping the lights on, said it expected the country’s demand for electricity to return to normal levels this winter, and would be braced for “some tight periods”.

That planned transition from secure baseload to reliance upon variable renewables might not work all that wonderfully. Perhaps, that’s the word from the engineers who currently run the system. The other piece of news, from the day before:

The government plans to strip National Grid of its role keeping Great Britain’s lights on as part of a proposed “revolution’” in the electricity network driven by smart digital technologies.

The FTSE 100 company has played a role in managing the energy system of England, Scotland and Wales for more than 30 years (Northern Ireland has its own network). It is the electricity system operator, balancing supply and demand to ensure the electricity supply. But it will lose its place at the heart of the industry after government officials put forward plans to replace it with an independent “future system operator”.

The engineers who run the grid will be stripped of their responsibility to do so and be replaced by political appointees. Who, one must presume, will be more politically reliable than to insist that there might be problems with the planned change in the national electricity system.

We are not diving headlong into conspiracy theories here but we do think that it’s incumbent upon those proposing the change to assuage, even refute, such concerns.

Because it’s not exactly unknown in politics that bearers of bad news get replaced by those willing to affirm now, is it? Even if the affirmation doesn’t in fact coalesce around reality.

It’s possible that the correct response here is just for us to go and have a little lie down ad some deep breathing exercises. And yet, well, if there were things likely to go wrong what would the political reaction be? What is happening, no?

The real test is going to be who gets appointed to that “future systems operator” and if it’s the people we think it will be then deep breathing exercises just aren’t going to be enough.

Perhaps we shouldn't have social housing at all?

We think this is interesting:

A Labour MP defrauded her local council out of nearly £64,000 by “dishonestly” obtaining social housing over three years, a court heard.

Apsana Begum appeared at Snaresbrook Crown Court on Wednesday charged with three counts of fraud that allegedly took place over three separate periods between 2013 and 2016.

Ms Begum, who denies all charges,

We have no view on the case. However, the number claimed does interest - £64,000 is real money even by local council standards.

It’s a standard claim that social housing - and council housing even more so - makes a profit. There’s an excess of income over costs, this is a profit, right? Except that’s not true, this £64,000 number is correct. For this includes the opportunity costs - what else could have been done with these resources? Like, here, housing someone else perhaps. Or, in the more general case housing provided at less than market price clearly leaves money on the table - exactly that difference between market price and the rent actually being charged.

That is, the entire system of social, affordable, council, housing is wildly expensive. Our proof being the claim that three years’ worth of it has this value of £64,000. Meaning that it might well be better to not have said system at all. Instead, work to lower the cost of all housing by increasing the supply.

By, say, blowing up the Town and Country Planning Act 1947 and successors?

We’d also note that if said social housing has a value of £21,000 a year then don’t we have to rather change our estimations of the wealth distribution? For currently we assign value to equity in owner occupied housing and yet value that £21,000 a year as having no value to the recipient at all. It might not be worth, to that recipient, that much but it most certainly has a value and therefore a capital value.

What would Cuba have been without the revolution?

Given that we are seeing at least stirrings of the counterrevolution in Cuba it’s worth pondering what the place would have been without that revolution itself.

One problem we have is that the usual numbers we’re presented with are entirely and wholly unbelievable. The idea that Cuba’s GDP is $100 billion is absurd. The population is about the same as that of the Dominican Republic (GDP $88 billion) and it would indeed be insane to claim that living standards are higher in Cuba than that Republic. No one in Cuba outside the senior ranks of the Communist Party is living as if GDP per capita is approaching $9,000 a year so therefore GDP per capita isn’t approaching that - GDP is the value of all consumption in one of the calculation methods after all.

That isn’t usually the claim though. Rather, that while the socialist revolution hasn’t brought mass hyperconsumerism (to adopt the usual language) it has brought two much more valuable things. Free health care and freedom from the regional hegemon, the United States. Well, OK, so our counterfactual needs to be - by preference Spanish speaking just to reduce alternative possible influences - a Caribbean island that did remain subject to that hegemonic power of Uncle Sam.

Fortunately we have one of these to compare with - Puerto Rico. Where GDP per capita is, even at those unbelievable about Cuba official numbers, three to four times higher (about a quarter of the population with roughly the same total GDP). They also have free healthcare, or at least a system that provides it for free to those who cannot pay themselves. Just as we also have a system of free healthcare even though we didn’t have a bloody revolution and generations of penury to get it.

We do not argue that Puerto Rico is some nirvana, some perfection upon the Earth. We would argue that it’s a better outcome than that which Cuba suffers.

Or, more simply, as 1989 showed us, socialist revolutions don’t achieve their claimed goals let alone actually work. As with the Soviet one, after 70 years plus or minus some change the Cuban revolution has produced a result worse than not having that revolution. Even when we do consider the health care thing.

Here’s hoping that the people will soon be free of this dreadful error…..

This is to be on a hiding to nothing

It’s entirely reasonable - effective even - to demand that the world be different than it is. We do it ourselves all the time, demanding that greater liberty, more freedom and less government as we do. However, to demand that the world be different than it can be is to be on that proverbial hiding to nothing.

Politicians around the world have been promoting responses to the Covid-19 pandemic with statements such as: “we must open up”, “we have to learn to live with the virus”, and “freedom day”.

But to us epidemiologists these are almost meaningless political slogans that cover a vast array of possible scenarios, some of which are potentially very harmful, especially for the most vulnerable.

The approach of Boris Johnson’s government in the UK provides a particularly egregious example of how political rhetoric is damaging our ability to discuss pandemic responses in an open and transparent way. Framing our global response to Covid-19 with slogans starts to narrow the range of options in ways that may stifle thoughtful discussion of alternatives.

Things that are politically decided will be decided by politics. Which means the deployment of political rhetoric. That’s just how any such system will work because that’s how the mechanism being employed does work.

It will never be possible to have “scientific” decisions from the political system. Nor will it be possible to jury rig matters so that we do.

The very best that it is possible to do is to get government out of the decision cycle upon scientific matters thereby allowing the room for science to take place.

No, we do not therefore mean that there should have been no political decisions about Covid. Given those events there clearly was going to be more than the one political decision - to do nothing would have been one of those, as would doing anything. The point is, rather, that once something has been subsumed into the political decision making process then it is politics - along with that rhetoric - which will make the decisions.

Our favourite example of this is the, possibly apocryphal, story of Jim Callaghan and the steel plants. The science, the business logic, insisted that the British steel industry needed to be operating at scale. There are economies of such in this industry. So much so that the UK could only have a usefully effective steel industry if it had the one large and fully integrated plant. This logic was accepted in what was at the time a nationalised industry.

At which point half the single integrated plant was allocated to Wales and half to Scotland. For, obviously, political reasons.

Anything run by politics will be run by politics - why is that so hard to grasp?

Would anyone daft enough to want to be CEO of the NHS be up to the job?

The new Health and Care Bill is a veritable curate’s egg. We do need to link the NHS and social care to achieve a smooth transition between the two.  We do need to remove the close to a decade old burdensome bureaucracy when outsourcing work to the private sector.  We do need to remove the ambiguity of NHS England; as a Non-Departmental Public Body it is both answerable and not answerable to the Secretary of State at the same time. 

It should either become an independent public corporation, like the Bank of England, or an Executive Agency which would be a separate organisation within the Department of Health and Social Care.  NHS England staff would become civil, rather than public, servants.  Given that “the Bill also includes proposals from the February 2021 White Paper to give the Secretary of State for Health and Social Care powers to direct NHS England”, it appears the Executive Agency option is being taken.  It would have been sensible for the Bill to say so. 

The addition to the powers of the Secretary of State, however, is a worrying feature of the Bill. According to the Commons Library briefing (p.8) the Health Foundation, NHS Providers and the NHS Confederation have all expressed concerns on that score. No ground rules are set for when the Secretary of State can move in to direct NHS England matters. The House of Lords may also be concerned with Clause 130 which “gives the Secretary of State some general regulation making powers consequential on the Bill. In particular, the power may be used to amend, repeal, revoke or otherwise modify any provision within this Bill or any provision made by or under primary legislation passed or made either before this Act is passed or later in the same Parliamentary session.” The worry is that a politician playing to the media may conflict with a CEO trying to run the NHS the country needs. 

The Bill is a curious mixture of strategy and technical detail with some of the most important strategic issues omitted altogether. For example, there is no word on how the chronic shortage of doctors, nurses and care workers will be corrected.  This problem has been exacerbated by the pandemic backlog and new immigration controls. Too many, maybe all, of the changes lack precision or justification in the explanatory notes. Integrating health and social care would be fine if the long-awaited social care Green (or White) Paper had appeared and given us any idea on what social care will look like.  The Nuffield Trust put it this way “the hope that the NHS will cooperate more with social care services will also come to nothing without proper reform so that more people receive help, more staff join the sector, and stability is restored after years of desperation.” 

42 Integrated Care Systems (ICSs) now cover England but they have grown like Topsy, each in it’s own way with no standard pattern. “As a result, there are significant differences in the size of systems and the arrangements they have put in place, as well as wide variation in the maturity of partnership working across systems.” Whilst the objective of a joined-up health care interface is incontestable, they involve a plethora of meetings.  Taking GPs away from dealing with patients, as the 2012 Act did, may help some patients but harm others.  

The boundaries for ICS responsibilities vary; some include housing, some do not.  In short, we have no idea, and nor does the DHSC, which ISC models are better than others?  Devolution has its merits but the Bill should define what will be devolved to ICSs and what will not be. Nor is the national versus local logic trap addressed. ICSs move decision-making, e.g. on how budgets are spent, from national to local. Tailoring the provision to local needs makes sense but it also means that some benefits with be available in some localities but not others, at which point the tabloids will cry “post-code lottery”. What is the answer? 

The Bill sets a very broad remit for NHS England, namely the “Triple Aim” of “better health and wellbeing, better quality health care and ensuring financial sustainability”. No one will argue with the NHS living within its means, topped up in time of emergency.  If the NHS is really responsible for our individual health, rather than us, the government should adopt the Chinese model and resource the NHS when we are fit and not when we are sick.  If the aim refers to public health in general, why should the NHS do that when we have a plethora of other public health bodies at national and local government levels?  

“Well-being” should only be a matter for the NHS when we are ill or at risk of becoming ill.  The dictionary defines well-being as good spiritual and human relationships, having a (financially) comfortable way of life and being happy. That’s a tall order for the NHS.  “Better quality health care” is not just a matter for the NHS: it is a matter for the ICSs.  

With the cost of the NHS soaring to heights that will become unaffordable, we should be thinking about trimming, not adding, responsibilities. Should it simply be concerned with the treatment and cure of physical and mental health conditions, i.e. the sick, or should it be responsible for wider user demands, e.g. fertility and cosmetic surgery? Or for primary research, and reduce over-treatment of the dying, tonsillectomies, over-prescription of antibiotics and over-testing?The Taxpayers Alliance reported one Foundation Trust spending £360,000 on a failed music festival,  No doubt it would have been good for the wellbeing of the citizens of Derby. 

Hospital Foundation Trusts, with their layers of governance, are both independent and not independent of the NHS and DHSC at the same time. In 2003, NHS Foundation Trusts were “established in law as new legally independent organisations called Public Benefit Corporations.” The Boards were to “be made up of local people, patients and carers and staff.” Has anyone investigated whether this local democracy is worthwhile or whether it just distracts the CEOs from running their hospitals? The 2012 Act encouraged all Hospital Trusts to shift to Foundation status but one third have not done so.  The current Bill affirms all this, stopping NHS England from limiting Foundation Trust capital, but not revenue, spending if NHS England thinks the Foundation Trust is about to spend more than its fair share of ICS capital money. 

Many of the changes in this long and complex Bill are to be applauded, notably those which tidy up the 2012 Act.  No doubt there will be another before long as a future Secretary of State makes his mark. As one wit put it “What changes all the time but stays the same? The NHS.” The central issue of this Bill is the redistribution of responsibility. We all know who will take the credit or blame when things go right or wrong. Do we really want a politician, without relevant experience and changing with every reshuffle and election, to direct NHS England rather than a seasoned executive from that sector?  

Now look at it with the perspective of an incoming CEO once this Bill is enacted.  On paper, one has charge of the largest organisation in the UK, 1.5M people, and the fifth largest in the world. As the staff are now civil servants, you do not set the wages nor even negotiate them. The 2019/20 NHS England budget was £139 billion and the Trusts, mostly Foundation Trusts, had £92 billion of that. But they do not report to you. GPs’ surgeries cost about £13 billion, and probably should be double that, but GPs do not report to you either. The only parts of NHS England that do report to you are the parts that do not actually treat or cure people.  

The DHSC has 14 arm’s length bodies apart from NHS England, though they come and go so fast it is hard to keep track. The new Bill gives powers to the Secretary of State to change any of them whenever, but that is probably a good idea. Nowadays, IT is an integral part of any large organisation with the rare exception of NHS England. NHS Digital and NHS Business Services are separate arm’s length bodies reporting directly to the Secretary of State. No wonder major NHS IT initiatives have such a chequered history. Social care has no arm’s length bodies at all. These bodies will all keep the Secretary of State well versed on the NHS matters he can micro-manage, even when the media are quiet. ICSs will be taking care of dealing with all the people who actually need health care and they will be run by hospital Trusts, GPs and local authorities, none of whom answer to the NHS CEO. Overruled and unsupported, one has to question the wisdom of anyone who wants the job.

Well, if you're going to be wholly ignorant about it....

At least 21 - yes, count ‘em, 21! (over 20 is at least 21, no?) - politicians have signed up to be rulers of the world. Sorry, that’s not quite right, have demanded the power to create a Global Green New Deal in which all our lives are lived according to their precepts.

One of whom tells us this concerning what must be done:

Manon Aubry, a French MEP, said governments must focus on social justice and the climate. “As the consequences of the climate crisis become more and more alarming, inequalities are growing and the poorest are hit hardest by the impacts of a changing climate. If we want fair, systematic and effective climate policies, we need a radical shift away from free trade and free-market ideology.”

It’s OK, we do grasp that some people just don’t like trade. Who are these filthy foreigners who do things better than our own folks at home? And why should they be allowed to? Poujadism has not been entirely unknown in France in the past after all.

We are also aware of Polanyi and his insistence that it is the local web of personal interaction which gives meaning to economic life. We disagree but accept that some don’t.

Opposition to free trade can thus run on that spectrum from rampant xenophobia to a principled moral stance, however wrong either or both might be.

However, the one thing that isn’t going to work is killing trade to beat climate change. This was tested in the economic models which underpin all discussions of climate change, the SRES (and still do underpin, the RCP and so on models are all derived from the same place). Whatever our views on free markets red in tooth and claw - as opposed to a more comfy social democracy - it’s an explicit insistence in those models that a more globalised, free trading, world produces a better outcome than a more regionalised and fragmented one.

In the jargon, A1 is better than A2, B1 better than B2. A standing, roughly, for free market capitalism, B for something more kumbaya. But 1 for that globalised and trading world, 2 for one less so than we currently have.

The better being defined by fewer and richer people, which is nice enough. But more importantly for the argument here, with less climate change because lower emissions.

The why should be easy enough to understand. Trade just means that things are done where it is most efficient to do them. Therefore, for any level of living standard to be enjoyed by a population of whatever size, trade will lead to the use of fewer resources to achieve that economic wealth. Or, the same statement moved around a bit, for any given level of resource use the living standard to be enjoyed will be higher.

Trade means, holding other things equal, less climate change. Therefore the one thing we don’t want to do as part of our actions against climate change is to restrict trade.

As Ms. Aubry is entirely ignorant of this obvious point then we’ve not got to pay much more attention to her demands to rule the world, do we? Well, other than to just reject the idea as being ludicrous. But then Caroline Lucas is involved so that last point should be obvious anyway.

Just say no to The Smart Fund

The Smart Fund is the idea that those who sell the gizmos upon which digital art is appreciated could chip in some sum from those sales to subsidise the digital art.

The Smart Fund is proposed as a collaboration between creators and performers, technology companies and the Government. It provides a direct way for tech manufacturers to invest in, grow, empower, and enrich the cultural DNA of our society, by supporting the creativity for which the UK is globally renowned.

The Smart Fund places a small one-off levy on to mobiles, laptops, PCs and devices that are built to allow people to store and download content.

These small payments, the equivalent of 1-3% of the sales value, are paid into a central fund that is then distributed to creators to help them sustain a living from their content, support and bring together communities, and put different parts of the UK on an equal footing.

If the hardware manufacturers wish to do this then good luck to them and all who sail in the scheme.

But that, of course, is not what is actually being proposed. Based on the French scheme this is in fact a tax. That is, it’s not a cooperation at all, it’s a forcing.

At which point just a couple of problems. One is that usual one of the hypothecation of tax revenue. If we can tax hardware then why should the tax be spent upon the arts? Why not upon saving babbies in the NHS from the midwives? Say, just for one example. Gaining tax revenue is one thing, disposing of it another, the ability to tax one issue is not proof of where that revenue should be spent.

There’s also the point that we’ve already got tax spent upon the arts. The Arts Council, the lottery, there is already considerable subsidy out there. What’s the case for more?

But the big issue here is the very idea itself. For that hardware itself is indeed what we all consume digital products upon. We spend vast amounts too. Apparently some £2.1 billion on “over the top video”, £5.4 billion on esports and video games. The sector as a whole is worth £60 billion and change including advertising - which does support a significant amount of digital production.

It appears that it’s now easier than ever to gain revenue from producing digital products, art even. Well, assuming that one is producing art that anyone is willing to pay for that is. And, if people are producing art that no sentient being wishes to pay for then why should those same sentient beings be taxed to pay for it?

They shouldn’t of course. So, just say no to The Smart Fund. It’s merely another attempt by the arts establishment to force you to pay for what they - but not you - desire. The correct response to which is pay for your own art desires, Matey.

An exercise in entirely missing the point

Following on from that ludicrous National Food Strategy we are berated with this in The Guardian:

The Food Strategy review itself makes this very clear; it cites the eye-opening statistic that 85% of the land used to feed the UK population is devoted to rearing animals, even though animal products provide only 32% of our calories. Given the need to act quickly before it’s too late, the report’s suggestions are often frustratingly mild.

The mental image of someone observing us with folded arms, foot tapping, awaiting our mumbled response to this clear and obvious fact is difficult to clear from the mind.

Yet the correct response is “Yes, and?”

For the base point of our having an economy, even a civilisation, is being ignored. That base point being that we humans should gain as much of whatever it is we desire from the assets available to us. The rational - omniscient, benevolent etc - planner and the chaos of the free market are not at odds here. The aim is to maximise human utility over time.

There’s a certain free gift of nature in the amount of land out there. Depending on how we count it 30 to 50% isn’t - or hardly is - used by humans. The amount we use for any intensive form of agriculture is falling - when measured per capita it’s near halved in recent decades.

That land is an asset. Gaining a higher return from an asset is also known as “getting richer.” If it is true, and it seems to be, that we humans value meat and dairy more than the alternative starchy stodge crop then we are being made richer by gaining access to that meat and dairy.

That is, this statement that lots of land is used for meat and dairy.

And?

Opposition to this idea - that we are aiming to maximise human utility - clearly calls into question the idea that the would be planners are benevolent. Or even omniscient, given that they’re failing to even ask the right question.

One more little point about the report itself. We are told in it, as proof absolute that something is wrong, that the UK has 28 types of KitKat bar available. We’ve not checked this, not counted, although it has been pointed out to us that Japan has 200. But if Mr. Dimbleby, as he does, presents this as an obvious indication of some problem then he’d better have an answer to this next question. How many types of KitKat should there be?

And why?

A word of advice

We’re not saying that we agree with this specific critique, even as we hold the general opinion about those who rule us. It’s the next stage in the argument that interests us here:

Having read that lot I despaired, more than a little. How is it that the House of Lords, which is supposed to be a repository of wisdom, seems to know so little on something as important as economics?

As Hayek explained to us all it’s actually impossible for that centre to gain data, let alone process it into information, to be able to plan matters in any detail. We are also not wholly surprised, to put it mildly, that the usual run of PPE graduates are not all that up with the technical details of this and that.

So the idea that a parliamentary report, whether Lords or Commons - or, indeed, any set of deep thinking from the Man in Whitehall - misses a little to much of the necessary understanding doesn’t shock nor surprise us.

Which is why the next stage of the argument is, to us, that those in parliament, Whitehall, should have little and certainly less power over the lives of the rest of us. Simply because they do not grasp the detail.

Where we fail to understand Professor Murphy is in his dual insistence that the rulers don’t kno’ nuttin’ and also that they should have ever greater power and intervene in life to ever greater levels of detail.

Perhaps it’s some special code in academia, even some special insight. But the demand that incompetents and know nothings be given more power strikes us as illogical.

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?”