The announcement in August that Public Health England is to be abolished and replaced by a new body that will focus on protecting the public from future pandemics divided opinion.
Many welcomed the news but others were quick to complain and it was subsequently reported that over 70 health organisations had united 'to raise serious concerns with Government about plans to reorganise the public health system'.
Interestingly a joint statement was announced not by some professional body but via a media release issued by the Smokefree Action Coalition, a campaign group 'committed to ending smoking'.
Coordinated by anti-smoking lobbyists ASH (who else?), Coalition members include the BMA, Fresh North East, ASH Wales, ASH Scotland, UK Centre for Tobacco and Alcohol Studies (UKCTAS), British Heart Foundation, British Lung Foundation, Cancer Research UK and all the usual suspects.
(As an aside it’s worth mentioning too that the tobacco control lead at Public Health England is none other than Martin Dockrell who joined PHE in 2014 after seven years working for ASH. But that’s another story.)
Meanwhile, tucked away at the bottom of the Guardian report (Health leaders warn Boris Johnson over axing of Public Health England), it was also revealed that:
The DHSC has set up a stakeholder advisory group to help it decide who should become responsible for health improvement. It meets for the first time on Wednesday [September 2].
Alerted by this, I immediately sent an FOI request to the DHSC requesting a 'full list of the individuals (and their relevant organisations) that are on the advisory group, and the name of the person who will chair the group.'
The aim was to find out who is in pole position to influence the forthcoming shake-up in England’s public health system and whether we might expect some independent blue sky thinking. (I hate that expression but you know what I mean.)
Just as Dominic Cummings is reported to be attempting to reform the Civil Service, I would love to think that the demise of PHE might herald a completely new approach to public health.
Establishing a new body with the specific remit to 'protect' the public from future pandemics is a good start but we also need a different approach to 'health improvement' that puts education, choice and personal responsibility at the forefront of government policy, not more of the same bullying and coercion under a different name.
The membership of the stakeholder advisory group, I thought, might give us a clue what to expect. Hence my FOI.
Four weeks ago I received this response:
The membership and the relevant organisations of the Population Health Improvement Stakeholder Advisory Group is as follows.
Dr Jeanelle de Gruchy, Association of Directors of Public Health (ADPH), President
Cllr James Jamieson, Local Government Association (LGA), Chair
Seema Kennedy, Former Public Health Minister
Professor Helen Stokes-Lampard, Academy of Medical Royal Colleges, Chair
Matt Fagg, NHS England and Improvement, Director of Prevention
Matthew Winn, NHS England and Improvement, Improvement Director of Community Health
Ed Garratt, Suffolk ICS, Executive Lead for the Suffolk and North East Essex Integrated Care System (ICS)
Professor Maggie Rae, Faculty of Public Health, President
Danny Mortimer, NHS Confederation Chief Executive
Dr Jennifer Dixon, Health Foundation Chief Executive
Paul Najsarek, SOLACE, Chief Executive of Ealing Council
Professor Jo Pritchard MBE, Social Enterprise UK Chief Executive
Professor John Newton, Public Health England (PHE), Director of Health Improvement
Dr Jenny Harries, DHSC Deputy Chief Medical Officer
Professor Paul Cosford, Emeritus Medical Director, Public Health England (PHE), Chief Medical Advisor, NHS Test and Trace (NHSTT)
Professor John Deanfield, Consultant Paediatric Cardiologist and Chair, NHS Health Checks Review
Professor Sir John Bell, Life Sciences Champion
Professor Kevin Fenton, Public Health England (PHE), Regional Director, London
Christina Marriott, Royal Society of Public Health, Chief Executive
Martin Reeves, Coventry City Council, Chief Executive
Paul Farmer, MIND, Chief Executive
Professor Susan Jebb, Nuffield Institute of Primary Health Care Sciences, Professor of Diet and Population Health
Louise Patten, NHS Clinical Commissioners, Chief Executive
Sally Warren, The King’s Fund, Director of Policy
Professor Lord Patel of Bradford OBE
Donna Kinnair, Royal College of Nursing (RCN), Chief Executive/General Secretary
Let's start with the bleeding obvious.
For a 'stakeholder' advisory group on public health there are some glaring omissions. No patient or consumer groups, for example.
No-one from industry either, by which I mean food, alcohol or tobacco – you know, the people and products often blamed for many of the health problems we face in the 21st century (a time in which more people are living longer than ever before in human history).
Are they not stakeholders too?
That aside, let’s have a closer look at the list. You'll recognise one or two names – Deputy Chief Medical Officer Dr Jenny Harries, for example – but what about some of the others?
The first thing to note is the presence of several people from Public Health England, the very body whose axing has led to the formation of this group.
Professor John Newton is director of health improvement at PHE and it was he who was quoted back in April when it was reported that:
Smokers face a greater risk from coronavirus and may also be jeopardising the welfare of their loved ones, Public Health England (PHE) has warned.
Professor John Newton, Public Health England’s director of health, said that in light of the “unprecedented” pandemic sweeping the globe, “there has never been a more important time to stop smoking, not only for your own health but to protect those around you”.
He adds that giving up smoking “will also help alleviate the huge pressures on the NHS.”
PHE's claim that 'Emerging evidence from China shows smokers with Covid-19 are 14 times more likely to develop severe respiratory disease' was, as we know, based a single study from China that looked at just 78 people, only five of whom were smokers (or ex-smokers).
It has since been debunked and ridiculed yet PHE’s statement, effectively endorsing the study and its dubious findings, together with Prof Newton’s partisan comments, are still on the government website.
Also on the advisory group is one of PHE's regional directors, Professor Kevin Fenton.
Fenton joined PHE in November 2012 and wasted no time highlighting the so-called ‘hidden’ dangers of secondhand smoke.
“We must do more to protect the health of our children and making your home and car smokefree will reduce this unnecessary harm to children’s health,” he said.
A third member of the group with a connection to Public Health England is Sally Warren, director of policy at The King’s Fund. Warren previously worked at the Department for Health and Social Care and PHE where she was director of programmes.
Another member of the advisory group whose name stands out is former public health minister Seema Kennedy.
Elected to parliament in 2015, Kennedy replaced Steve Brine at the DHSC in April 2019 before standing down as an MP at the last election.
During her extremely brief tenure in office she declared herself "determined" to see a smoke-free NHS by 2020.
Responding to a PHE report, she added:
"No-one should have to walk past a cloud of smoke in order to enter or leave their local hospital.
"I am encouraged by this new survey, which shows great strides have already been made towards a smoke-free NHS, I strongly urge all trusts to follow suit."
After the publication of the Government's Prevention Green Paper last July she added that the government’s plans would help the NHS change from being a treatment-based service to “a national wellness service”, more focused on prevention of illness.
Another name - Professor Maggie Rae, president of the Faculty of Health - rang a bell but it took me a while to make the connection. Then I remembered.
Rae was one of the signatories on the statement issued by the Smokefree Action Coalition complaining about the abolition of PHE and changes to the public health system.
Further inspection revealed that the advisory group includes two more signatories to that letter. One of them, Dr Jennifer Dixon, chief executive of the Health Foundation, said:
“The reorganisation will be a distraction at the worst possible time. Setting up and abolishing or merging national agencies like PHE is all too common and frequently demoralising, wasteful and lacking justification.”
See Health chiefs attack 'risky and unjust' decision to scrap PHE (Guardian).
In a separate press release issued by the Royal Society of Public Health, chief executive Christina Marriott – another member of the stakeholder advisory group – said:
“While we welcome the commitment to bolster capacity and capabilities in health protection, the unanswered question is what happens to health improvement. We know that one thing that marked England out as Covid-19 hit was our poor public health including our high rates of inequalities, of smoking, and of overweight people and obesity. So Covid-19 makes it vitally important that prevention is not side-lined – but so does every year when 40% of avoidable deaths are as a result of tobacco, obesity, inactivity and alcohol harm. Clear national leadership on this is critical for the public’s health. The uncertainty created by today’s announcement is not acceptable.”
Also on the advisory group is Cllr James Jamieson, chairman of the Local Government Association (LGA), a body that recently supported a last minute amendment to the Government's Business & Planning Bill that would have banned smoking in all new licensed pavement areas.
The bid failed but it’s pretty clear what the LGA’s position is - further intervention.
But the four members of the advisory group who really stand out – for me at least – are Lord Patel of Bradford, Professor Helen Stokes-Lampard, Professor Susan Jebb and Dr Jeanelle de Gruchy.
You may not have heard of them but bear with me.
In 2009 Lord Patel was one of the first politicians to champion standardised packaging of tobacco (Lords’ move reignites debate on plain cigarette packaging):
Lord Patel of Bradford, Baroness O’Cathain, Lord Walton of Detchant and Lord Faulkner of Worcester have tabled amendments to the Health Bill at the committee stage in the House of Lords that would allow the Health Secretary to ban or restrict the sale or supply of tobacco products if they are sold in packs that do not comply with the regulations.
The Health Secretary would also be allowed to impose restrictions on the colour of cigarette packs, their shape and material, the trademarks displayed on them and any labelling used, if the amendments are agreed.”
Professor Helen Stokes-Lampard is a GP and chairman of the Academy of Medical Royal Colleges. In January 2017, when she was chairman of the Royal College of GPs, it was reported that:
... she had “profound concerns” about campaigns that suggest vaping is a positive thing and calls for rules to stop e-cigs becoming socially acceptable.
She also calls for vaping to banned in public places saying they should not been seen as a lifestyle choice.
Dr Stokes-Lampard’s branded allowed vaping in public as a “retrograde step”.
“The only place that I see vaping has is for people cutting down from smoking on their way to quitting, and therefore the appropriate thing is to treat it like smoking,” Dr Stokes-Lampard said in an interview.
Leaving smoking and vaping aside, what are we to deduce from the presence of another advisory group member, Professor Susan Jebb. According to the Daily Mail (March 16, 2016):
All meals should be served with vegetables, snacking should be socially unacceptable and a fizzy drinks tax must be introduced if the obesity epidemic is to be tackled, an expert said today.
The Government's anti-obesity adviser said she wants food policy to be subjected to the same tough regulations as the tobacco industry.
Professor Susan Jebb, from Oxford University, said social norms are 'terribly important', and as such, grazing on unhealthy snacks should be frowned upon.
Expect mental health to be high on the agenda too.
Paul Farmer, chief executive of Mind, is a member of the advisory group and in 2016 it was reported that a 'new report created by Action on Smoking and Health (ASH) and endorsed by 27 health and mental health organisations, highlights that around one third of adult tobacco consumption is by people with a current mental health condition.'
Commenting on the findings, Paul Farmer, chief executive of the mental health charity Mind, told The Huffington Post UK: "The relationship between smoking and mental ill health is an issue that we’ve long known about.
"Mental health services are on the path to becoming smoke-free by 2018, a move which will bring them in line with physical health services.
"For this process to be effective, however, it has to be done in the right way with proper support given to all those affected by the changes. We welcome the emphasis in the report on how to do this."
But I've kept the best to last.
Dr Jeanelle de Gruchy is currently president of the Association of Directors of Public Health but here's what she had to say in January 2016 when she wrote about the death of David Bowie in her then role as director of Public Health at the London Borough of Haringey:
David Bowie has died. From cancer. So much outpouring of grief. And yes I participated, posting #RIPBowie tweets and reminiscing about seeing him in concert in Montreal as an 18 year old with all who would listen, shedding a tear listening to the day long radio tributes as I felt my youth slipping away with his passing. And yet everything I watched, on TV, on YouTube, on Facebook and in the many pictures, there it was, revelling in its strong silent presence and mocking us for our complicity, the killer that took him away from us aged only 69. The swell of adulation for one of the greatest musicians, pop stars, cultural icons, and boundary pushers was wonderful; the lack of comment on what killed him prematurely was pitifully duplicitous.
I normally hold my tobacco industry genocide outrage in check in social settings … until my friend said what a wonderful, quiet, dignified death he had had. Actually no I opined, not acceptable — why did he go quietly, why didn’t he use his celebrity status to speak out about the epidemic caused by smoking? I questioned how, when well-known people have died from AIDS, this is foregrounded, and if they had spoken out about the epidemic, we were pleased, and if they denied they had it, we disapproved. Yes Bowie stopped smoking some years ago, but those who were HIV positive are likely to have changed their behaviour too. For them both, the extra bullets had already been loaded in the gun for the Russian roulette of diseases that would kill them ...
Yet, the tobacco industry did very well from their product placement through Bowie - even more so following the wide coverage of his death and surge in viewing of Bowie smoking footage. It makes me angry, angry that he died so young - and angry that no one is lamenting this, as if death from cancer is random and unpredictable, and no-one is responsible. It makes me angry that my hero has allowed this to happen, to influence so many more to start or continue smoking, and to die quietly, without speaking out in rage about this needless, profit-making killer.
I feel lucky I can do my bit to reduce tobacco use through my work. For social occasions however, I think I’m going to have to tone the old outrage down, and turn Bowie up.
See Should David Bowie have spoken out about the cause of his cancer?
With people like Dr de Gruchy on the advisory group I don’t think it takes a genius to deduce the likely direction of travel post PHE. Oh, to be a fly on the wall during their meetings.
Talking of which, as part of my FOI I also requested the minutes of the group's first meeting. The DHSC replied:
We are withholding the minutes of this meeting under section 22 of the FOIA, which states that public bodies are not obliged to disclose information that is intended for future publication ...
The Department takes the view that the public interest in the disclosure of this information will be satisfied by its publication in the future on the GOV.UK website.
Make of that what you will.
PS. I submitted my FOI concerning the membership of the advisory group on September 3 and received the response from the DHSC on October 1.
Sometime between then and now the Population Health Improvement Stakeholder Advisory Group was posted online.
I have no idea if my FOI prompted the DHSC to make the list public but it does seem a bit of a coincidence.