Public health minister rejects reform threat to independent scientific advice

England's public health minister has rejected concerns that government reforms will jeopardise the independence of scientific advice.

Ms Milton: Public health doctors in PHE will be free to express their view
Ms Milton: Public health doctors in PHE will be free to express their view

Doctors had warned that plans to incorporate Public Health England (PHE), the new national public health body, into the DoH could threaten the impartiality of advice to inform and appraise government policy.

But public health minister Anne Milton defended this move at a session of the Health Select Committee inquiry into the reforms on Tuesday. She insisted public health doctors in PHE would be allowed to criticise government plans if they disagreed.

She told the inquiry: ‘I don't have any doubt that they will be free to express their view.’

It comes after several institutions including the outgoing Health Protection Agency (HPA) had expressed significant concern over the plans.

PHE will replace the HPA, which is independent of Whitehall influence because it exists as an arms-length body known as a special health authority.

NICE currently operates under the same status. This gives both organisations freedom to offer impartial, and sometimes critical, advice on government policy.

But the government has proposed PHE will be an executive agency of the DoH so that its chief executive can be made accountable for public health outcomes to the health secretary.

Critics claim the plans will jeopardise impartiality when judging government policy.

In its response to the public health White Paper, the HPA had warned that maintaining independence of advice was ‘critical’ to public trust.

‘As part of a central government department, as proposed by the white paper, PHE may not be, or may not be perceived by the public, by professional groups or by key stakeholders to be, completely independent and might be thought to be subject to political pressures.

It added: ‘This could affect the public and professional confidence in the scientific and public health advice given nationally and locally by PHE staff and the international reputation of PHE’s evidence and advice.’

The Faculty of Public Health had in its response called on the government to establish PHE as a special health authority ‘to maintain independence and public trust’.

MPs on the inquiry committee asked whether the PHE would be more independent if it was a special health authority instead of part of the DoH.

Ms Milton responded: ‘It's extremely important – particularly in this area where we are treading on people's freedoms sometimes, in cases of health protection, when we're stepping into people's lives a little bit actually – that the foundations for any intervention that we take or any action we take or advice we give has absolute public confidence.

‘It is important that it is independent and I understand an executive agency is the best way to achieve that.’

A DoH spokeswoman told GP: ‘Ministers have been very clear of the importance of a clear line of sight between them and the front line when it comes to health protection issues.

‘The secretary of state is to take on various health protection functions from the HPA which are UK wide (biological substances and radiation). As special health authorities are England-only bodies (or occasionally England and Wales), making PHE a special health authority is not an option.’

MPs on the committee said there was a ‘precedent for people being dismissed if they criticise government policy’.

They referred to the case of Professor David Nutt, who was sacked as chairman of the independent Advisory Council on the Misuse of Drugs (ACMD) in 2009 after he claimed alcohol was more dangerous than illegal drugs such as cannabis.

The committee said the public wanted to know that public health is ‘independent and able to directly criticised policy’ in public.

Ms Milton said the Professor Nutt episode was ‘completely separate’ from the issue over the independence of PHE.

But she added that the independence of advice was ‘critical’. ‘It’s very important that the public have confidence, so it’s not only the case that there is independence, but it is seen to be independent,’ she said.

Professor David Harper, director general of health improvement and protection at the DoH, told MPs that the ‘vast majority of people’ see the MHRA, an executive agency, as an independent regulator.

He added: ‘That perception is vitally important and the governance structure that is set up and the mandate that is given to them ensures, alongside professional requirements and stewardship, that the MHRA is able to act in that independent way as a regulator of those products. The comparison I would draw for the executive agency that will become PHE is exactly with the MHRA.’

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