In a speech today (“The future of public health”) Matt Hancock confirmed reports in the Sunday Telegraph that he plans to scrap Public Heath England (PHE) and replace it by early-September with a new National Institute for Health Protection modelled on the German Robert Koch Institute (but operating in a very different political system). This comes as no surprise, and may well be a good idea, but the lead-up to this decision tells us a lot about the lack of understanding amongst ministers and their political advisers about how government works in the UK. It also suggests that the government risks repeating mistakes made in the past.
Almost everyone agrees that PHE has had a bad Covid-19 war. The question that has yet to be addressed is why? Is its failure simply a product of bad decision making within this executive agency, and poor coordination between it and other national, regional, and local government institutions, or is it the product of mistakes made by ministers and their advisers, or perhaps a combination of the two?
Without all the evidence it is hard to answer these questions. But what is clear is that we can deduce three things from the sorry saga that has unfolded over the past few months.
First, ministers and advisers seem to have had a worryingly hazy notion of how government actually works in the UK, and in England.
We can see this because the abolition of PHE was heralded by Dominic Cummings in June when (as the Times reported) he canvassed bringing forward a planned Bill to assert more direct Whitehall control over the NHS as a way of allowing No.10 to impose its will on PHE – only to find out that no such Bill was needed. Whereas he had assumed PHE operated largely autonomously he had discovered that it was in fact directly controlled by the Department for Health and Social Care (DHSC). Indeed it was, for PHE was an ‘Executive Agency’ of DHSC. It worked at arms-length from DHSC in its day-to-day management certainly, but within an operating framework set by that department’s ministers.
Second, the evident ignorance demonstrated by both special advisers and ministers about PHE’s status has wider implications.
The prime minister’s principal political adviser has had eight years in government, seven as Michael Gove’s main special political adviser at the Department of Education, and a whole year at the heart of government in No.10. How on earth can Mr Cummings have been so unaware of a key aspect of how UK government has worked for the past thirty years? Perhaps he should familiarise himself with the government’s web page “How Government Works”, a guide for the uninitiated which amongst other things concisely explains what an executive agency is.
However, the issue raised by Dominic Cummings’ ignorance of the executive agency model is a bigger one than that raised by PHE’s abolition – important as that is. How can Cummings, have been tasked by the prime minister with fundamental reform of the Civil Service when he displays such an astonishing misunderstanding of the institutional model within which over a quarter of all civil servants work? That number may be down from the three-quarters who worked in executive agencies in the late-1990s, but it still represents a very large chunk of UK government officials.
Third, anyone who knows the history of executive agencies will be unsurprised by the unfolding imbroglio over PHE – and ministers and advisers badly need to learn from past mistakes. Perhaps they should “read the research” on UK government failures over the years, as recommended by the editor of the Understanding Government website, Martin Stanley.
From the start, there was a profound tension between the agencies and the ministers who directed them. The intention of the 1988-97 Next Steps programme which created them was to delegate responsibility for day-to-day policy implementation to managers closer to the front line. The intention thereby was to break with the “Whitehall knows best” model that had hitherto dominated UK government. With the new agencies, ministers would ‘steer not row’ – in the words of Osborne and Gaebler, two academics closely associated with what came to be termed the ‘New Public Management’, of which the UK was in the vanguard in the 1990s – focusing on strategic policy making and leaving delivery to the agency.
Ironically, this is almost exactly the model proposed by Mr Cummings in June (as reported by Conservative Home).
The tension that this new model of governance created had two main dimensions. First, it required central government departments to “let go”, something they felt deeply uncomfortable with for it required a revolution in their thinking. Peter Kemp, the civil servant who drove the implementation of Next Steps was constantly exasperated by this, complaining in his valedictory letter to John Major in July 1992 that “the forces of darkness” in departments were ever-present and eager to re-establish direct day-to-day control.
There was a good reason why Whitehall was troubled by devolving decisions over day-to-day policy delivery to agencies: it raised the prospect of an agency taking decisions without consideration of their potential wider political consequences. That in turn raised difficult constitutional questions about who should be held responsible for failure in the context of the UK’s highly centralised polity. To address the problem, the then Cabinet Secretary Robin Butler sought subtly to recast the historic convention whereby ministers were held responsible for the failings of their departments – arguing that responsibility and accountability did not necessarily have to be vested in the same person or institution.
It was easier to enunciate the distinction between responsibility and accountability than to make it work in practice. Both MPs and the media, for example, proved highly resistant to the idea. A case in point is the furore over the assigning of blame for the escape of IRA prisoners in 1994 and 1995. Formally, day-to-day responsibility for the running of prisons lay with an executive agency – the Prison Service. As far as its chief executive was concerned it had been set objectives by ministers that had been met – mainly to do with improving prisoners’ welfare, then a pressing concern, but also a target for limiting escapes. The then Home Secretary, Michael Howard, however was widely seen by MPs and the media as the man responsible for the failure to prevent the escape of such high-profile prisoners (with some justification since if the Home Secretary had paid more attention to the traditional custodial function in setting the Prison Service’s objectives, and less to issues of prisoner welfare, the issue might never have arisen). Howard’s solution to the problem was to sack Lewis. But the tension between devolving responsibility for day-to-day administrative decision-making and preserving ministerial accountability was never resolved.
Plainly, it is this tension that lies at the heart of the present debate about PHE.
For example, despite obvious failures and the opprobrium heaped by ministers and advisers on PHE it might actually be argued that it has performed reasonably well within the parameters of the objectives set for it by DHSC ministers, and against a background of many years of cuts to its budget as ministers sought to divert spending on public health to the NHS. That may seem an odd claim, but inspection of the ministerial operating framework set for PHE in 2019-20 by Steve Brine (then Parliamentary Under-Secretary of State for Public Health and Public Care) shows that PHE entered the Covid-19 crisis with a series of ministerial priorities defined for it that made no reference at all to pandemic control.
Ministers’ number one objective for PHE in 2019-20 was for it to support the country’s exit from the EU. Other objectives ranged from a green paper on interventions to improve the country’s health and reduce health inequalities; via objectives such as improved “predictive prevention interventions” and the campaign to reduce childhood obesity, to action to improve sexual and reproductive health, and improve mental health.
The failure of ministers to even mention pandemic control as one of PHE’s operational objectives was startling given the long-standing concern about a potential flu pandemic. As we now know, it had fatal consequences.
Not surprisingly, by the time PHE’s operating framework for 2020-21 appeared in April ministers had decided that dealing with the Covid-19 pandemic must be PHE’s ‘top priority’, as it now was for the government more broadly. But that was simply shutting the stable door after the Covid horse had already bolted.
In short, ministers and their advisers seem to have been woefully ignorant of how the government they are running actually works, and it might well be argued that a product of that ignorance was an underfunded PHE operating within a ministerial operating framework that was poorly defined, fatally so as it turned out.
As with Michael Howard and the Prison Service in 1995, perhaps it suits ministers to lay the blame at the door of PHE and its chief executive rather than face the political music themselves. But that rather cuts against Mr Cummings’ evident distain for Whitehall departments, and his expressed desire to decentralise. Personally, I have sympathy with that objective. But if the government is to succeed in such reform, it badly needs to look back at the past failure to resolve the tension between responsibility and accountability or risk being derailed by it all over again.
 A usefully concise definition of an executive agency and its relationship to its owning Whitehall department can be found in this Cabinet Office guidance document.
This blog post draws on research conducted during the writing of The Official History of the Civil Service, Vol. 2 (R. Lowe and H. Pemberton (Routledge 2020).