Reforming the public health system in England

The abolition of Public Health England (PHE) during the COVID-19 pandemic has raised concerns about the future of the public health system in the UK, particularly in England. The two new bodies established in haste to replace PHE prompt reflection on the executive agency's fate and the need to identify any lessons to ensure that a public health system is put in place that is fit for purpose. The UK COVID-19 Inquiry provides an opportunity to make recommendations, but it will need to act quickly to avoid recommendations being ignored. Two areas of concern are highlighted in this Viewpoint: the respective remits of the new bodies and their governance arrangements. Both issues demand urgent attention if the new structures are to succeed and avoid a similar fate to that which befell PHE. But underlying these concerns is a much larger challenge arising from the UK's broken political system. The political system in the UK suffers from several systemic weaknesses, including departmentalism, poor implementation, an inability or unwillingness of those in power to listen to the truth, and chronic short-termism at the expense of long-term planning. Overhauling the UK's dysfunctional political system is a prerequisite for successfully improving the public health system

Introduction: priority setting, equitable access and public involvement in health care

Purpose – The purpose of this paper is to introduce the special issue on improving equitable access to health care through increased public and patient involvement (PPI) in prioritization decisions by discussing the conceptualization, scope and rationales of PPI in priority setting that inform the special issue. Design/methodology/approach – The paper employs a mixed-methods approach in that it provides a literature review and a conceptual discussion of the common themes emerging in the field of PPI and health priority setting. Findings – The special issue focuses on public participation that is collective in character, in the sense that the participation relates to a social, not personal, decision and is relevant to whole groups of people and not single individuals. It is aimed at influencing a decision on public policy or legal rules. The rationales for public participation can be found in democratic theory, especially as they relate to the social and political values of legitimacy and representation. Originality/value – The paper builds on previous definitions of public participation by underlining its collective character. In doing so, it develops the work by Parry, Moyser and Day by arguing that, in light of the empirical evidence presented in this issue, public participatory activities such as protests and demonstrations should no longer be labelled unconventional, but should instead be labelled as “contestatory participation”. This is to better reflect a situation in which these modes of participation have become more conventional in many parts of the world

Dialogue and consultation in higher education policymaking: a critical policy analysis of the tertiary funding review in England, 2017–2019

The UK government’s “Review of Post-18 Education and Funding” (Tertiary Review), 2017–2019, should have been highly influential on the shape of the further and higher education sectors in England. But a period of policy inaction and political turmoil arising from Brexit meant that the policy process, when judged against its own ambition, was a damp squib. I focus in this inquiry on the consultation which formed part of the evidence-gathering approach to support the report from Philip Augar’s expert panel. From this I draw conclusions which have value for practitioners, as the outsiders in the policymaking process, to support their future engagement with policy consultation exercises. This critical policy analysis explores the context of the Tertiary Review and deconstructs its texts following David Hyatt’s (2013a) critical higher education policy discourse analysis framework, adapted to suit this inquiry. I also use elements from the work of Mikhail Bakhtin to consider dialogic aspects of policymaking. The application of Bakhtin provides the epistemic foundation for the thesis, meaning-making through dialogic interanimation, to which I return throughout the analysis. I contextualise the review four ways: medium-term socio-political context; epoch; immediate socio-political context; and contemporary socio-political individuals, organisations and structures. These chapters develop understanding of the Tertiary Review’s position within the political, policy and academic discourses. I then deconstruct the review’s official texts, considering in turn the concepts of authority, consultation and influence. I use the contextualisation and deconstruction to draw conclusions which identify what general lessons can be drawn from the specific case, and I articulate the contribution that this thesis makes to the higher education policy and policymaking literature. I propose a dialogic policy consultation framework as a practitioner tool, and I invite the application and testing of the framework in practice as the natural extension of this practice-oriented, but theoretical, work

Public health by organizational fix?

In August 2020 the UK government announced without warning the abolition of Public Health England (PHE), the principal UK agency for the promotion and protection of public health. We undertook a research programme seeking to understand the factors surrounding this decision. While the underlying issues are complex two competing interpretations have emerged: 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. This paper reviews crucial claims in these two competing explanations exploring the arguments for and against each proposition. It concludes that neither is adequate and that the inability adequately 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 do provide some guidance to the two new organizations established to replace PHE to maximize their impact on public health. We hope that this information will contribute to the independent national COVID inquiry