Cuts to public-health funding put “significant” pressure on services and stripped local government of health-protection skills, the head of the UK Health Security Agency has said.
Dame Jenny Harries, who was deputy chief medical officer when coronavirus broke out in 2020, told the Covid Inquiry yesterday that health-protection skills had been “denuded” from local authorities as a result of austerity measures starting in 2010.
Harries was questioned on how funding cuts and structural changes to the public-health system had affected local government services and resilience in the run up to the Covid pandemic.
She described how reforms that began under the coalition government in 2010 had promised to give local government “the freedom, responsibility and funding to innovate and develop their own ways of improving public health in their area”.
She said local authorities had been forced to dip into their public-health funds to make up budget deficits elsewhere as funding was cut further.
Asked if she believed the poorest areas in England had experienced disproportionately high cuts, Harries said it was her “understanding” that this was the case.
The Health and Social Care Act of 2012, championed by then-health secretary Andrew Lansley, transferred key public health functions from the NHS to local councils and underpinned the creation of UKHSA’s predecessor, Public Health England, in 2013.
However, Harries said that following this restructure, “freedom and responsibility had been granted – but funding was often lacking”.
Harries, who was PHE’s regional director for the South of England for six years before being appointed deputy CMO in 2019, said many clinical staff had been “lost in that move” because they were unwilling to transfer to local authorities. Budget cuts had exacerbated this problem as some public-health directors cut “some of the expensive roles”, including clinical staff, she added.
“I'm pretty confident it's evidenced, that some of the health protection skills were denuded… particularly from the smaller local authorities, where you would perhaps have one director of public health, one consultant and one other. Really quite small,” she said.
Among other things, community infection prevention and control became a “declining resource” in local government as a result, she said. Harries said she had “personally persuaded” two infection prevention and control nurses – who help to prevent infections being acquired in healthcare settings, and to minimise spread when infections happen – to transfer to local government.
“Most places were not that lucky; [those nurses] mostly stayed in the NHS, and actually there was a strong need for them in the community,” she said.
Another area that was hit hard by the move to the local authority-led model was emergency preparedness, resilience and response, Harries said. Many EPRR staff who transferred to local councils “moved down a rank rather than stayed in their existing roles”, which she said was “demoralising”.
“I recognise at that time almost all public sector organisations had budget decreases,” Harries said, “But of course the combined effect of that meant that if the local authority also had insufficient [funding] and the NHS had also dropped their numbers of staff, what happened was, when you met round the local resilience forum table, you may not see the person you saw last week because they'd gone to another one… So I think the overall impact was quite significant.”
Harries's testimony contradicted an assertion by former prime minister David Cameron, who told the inquiry earlier this week that the austerity overseen by the coalition and Conservative governments he led from 2010 and 2015 had not left health services in a poorer state.
He said stabilising the UK economy and “having a reasonable debt-to-GDP ratio” could not be separated from funding the NHS or other public services and said he had "protected" the NHS budget.
Ministerial churn 'a major problem'
As her hearing drew to a close, Harries made a point of sounding a “note of caution” about the effect of ministerial turnover on the UK’s resilience to health crises.
“Just like the rest of the system, churn in the system is a major problem: we lose understanding, we lose connections,” she said.
“I've had four different ministers in the Department of Health, and you can start to see the difference of people who understand the problems and then clearly it turns to other things, which is inevitable.
“So I think that minister almost needs to stay with it for the whole of the parliamentary session for it to maintain the infrastructure for the country.”