Are public health cuts to blame for the UK’s pandemic response?

As we begin to learn best practice in the fight against Covid-19, it is notable that the handful of countries that have reduced the number of new cases to zero have used diagnostic testing and contact tracing on a large scale and have recommended the use of face masks. After two frantic months, the UK has just about got a handle on testing, but its embryonic contact tracing app has the hallmarks of every government IT fiasco, and there are barely has enough face masks for health workers, let alone the general public.

No country can prepare perfectly for a new viral pandemic, but Britain’s public health system has fallen conspicuously short. Why? The stock answer from many is ‘under-funding’ – but the NHS budget has continued to rise since 2010, albeit not at the unsustainable pace seen during the New Labour splurge.

Public Health England (PHE), whose ‘primary duty is to protect the public from infectious diseases’, was created in 2013 and spent over £4 billion in 2018/19, of which around £3 billion was handed to local authorities in ring-fenced grants. Local authorities have seen their budgets cut in recent years, but this has little bearing on Covid-19 since the responsibility for dealing with pandemics lies with PHE, the NHS and the Department of Health.

PHE’s budget for ‘protection from infectious diseases’ rose from £52 million in 2014/15 to £86.9 million in 2018/19. There have been no cuts in this crucial area. Still, £86.9 million is only 2 per cent of the public health budget. If you include routine vaccination programmes, the amount spent protecting the public from infectious diseases rises to 13 per cent. With the benefit of hindsight – and arguably without it – it could be argued that this was not enough, but that does not necessarily imply that the overall public health budget was too small. The real question is what happened to the other 87 per cent.

In 2018/19, £220 million of the public health budget was spent on anti-obesity schemes – more than twice the budget for infectious diseases. More was spent on ‘tobacco control’ than on infectious diseases. One of Public Health England’s big-ticket projects has been its quixotic, multi-million pound attempt to take sugar, fat and calories out of food. If infectious disease prevention has been under-funded in recent years, it is because money has been diverted towards such nanny state schemes.

There is no wider shortage of cash in public health. The amount of money spent on tenuous, policy-driven research alone is staggering. Public health academics were recently given £400,000 to study the drinking habits of football fans. You can buy a lot of face masks with that kind of money. £795,463 has been spent training Imams in Bangladesh to preach about second-hand smoke in mosques. Even local councils, which have seen real cuts to their budgets, still find money to fund pressure groups to lobby for higher alcohol taxes and protest about fizzy drinks.

If you believe that Public Health England would have stockpiled plenty of personal protective equipment if it had been given £5 billion, rather than a mere £4 billion, I have a nice bit of swampland you might be interested in. Aside from anything else, neither PHE nor the local directors of public health are responsible for such stockpiling.

Indeed, it is not exactly clear what PHE is meant to be doing at the moment. Covid-19 is, quite obviously, a public health issue and should have been PHE’s time to shine. Instead, it was Imperial College that developed the scientific modelling and it is NHSX that is developing the contact tracing app. PHE boss Duncan Selbie has been the invisible man while the Chief Medical Officer and his deputy have become household names. Local directors of public health have spent the crisis complaining about being left out of the loop while PHE has been reduced to retweeting messages from the Department of Health. Its only memorable contribution has been hindering the roll-out of diagnostic tests with its overly centralised bureaucracy.

Perhaps a future inquiry will ask why an agency whose ‘primary duty is to protect the public from infectious diseases’ was not expected to lead from the front during the coronavirus pandemic. Perhaps it will find that it was a mistake to spread responsibility for tackling the disease across so many organisations: the NHS, PHE, the Department of Health and local authorities. In practice, it will probably conclude that public health was under-funded in 2020 and recommend bigger budgets for all. Anyone who has witnessed the way in which our money has been squandered by the public health establishment for years will beg to differ.