Christopher Snowdon

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.

It is not exactly clear what PHE is meant to be doing at the moment

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.

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