The background to this book was a research study that took place in 2021 and 2022. It sought to understand the circumstances surrounding the abolition of the main institution responsible for public health in England – Public Health England (PHE) – and its replacement by the UK Health Security Agency and the Office for Health Improvement and Disparities. As well as collecting data from published reports, national and parliamentary committee meetings and interviews, we also collected information on the structure of public health governmental organisations in the UK. The main study findings can be found here: https://arc-sl.nihr.ac.uk/sites/default/files/uploads/files/public-health-report-sept-2022-final.pdf (Littlejohns et al, 2022c).

The relevant issues that emerged as we described how PHE was closed can be found in a paper we published in Health Economics Policy and Law (Weale et al, 2023).

While the reasons were complex, they could be summarised by two competing interpretations: an ‘official’ explanation, which highlights the failure of PHE to scale up its testing capacity in the early weeks of the COVID-19 pandemic as the fundamental reason for closing it down; and a ‘sceptical’ interpretation, which ascribes the decision to blame-avoidance behaviour on the part of leading government figures. We reviewed crucial claims in these two competing explanations, exploring the arguments for and against each proposition. We concluded that neither was adequate and that the inability to address the problem of testing (which triggered the decision to close PHE) lies deeper, in the absence of the norms of responsible government in UK politics and the state. However, our findings did provide some guidance to the two new organisations established to replace PHE to maximise their impact on public health.

We then continued our thinking of what was required and presented a flavour of it in a Lancet Public Health Viewpoint article by Hunter, Littlejohns and Weale on ‘Reforming the public health system in England’ (Hunter et al, 2022).

We came to the conclusion that a completely new way of thinking about public health was required, and that would only be achieved by establishing a new social contract with the British people.