This week the Government formally announced the scrapping of Public Health England and the creation of the National Institute for Health Protection. The Government contends that this is a necessary merger of functions of PHE, NHS Track and Trace and the Joint Biosecurity Centre. The criticism of the announcement from medical professionals, academics, policy experts and opposition politicians started even before the announcement had been made, more or less the moment that it leaked. Was it they asked, really the time, in the middle of the largest global pandemic for almost a century, to be getting rid of the major public health body? Certain comparisons to seating arrangements on large and doomed ocean liners might have been made.

One of the interesting things about the merger is that it is another major structural change that seems to have been undertaken without any significant consultation. It’s not the first time that this has happened. A few weeks ago, the Department for International Development was unexpectedly merged into the Foreign and Commonwealth Office, without consultation, causing uproar amongst MPs and NGOs involved in International development. Last week, the Chair of the Defence Select Committee sent a letter to the PM requesting more information about the ongoing comprehensive defence and foreign policy review and complaining that it does not yet appear to have involved any external stakeholders.

So should the Government have consulted on the merger? Many decisions have been made recently to tackle the coronavirus that have had little to no consultation, and have been generally accepted as a necessary move. How is this one any different? There are several reasons that it might be.

Firstly and most obviously, the abolition and restructuring of the major public health infrastructure for England in the middle of a period where that infrastructure is most under strain is not the same as a temporary and minor regulatory derogation. A change of the rules, even if it goes disastrously wrong, is unlikely to have a massive systemic impact on the ability to tackle the coronavirus. If the PHE reorganisation goes wrong, it could have disastrous impacts on our capacity to fight the immediate infection, and not only that, but our ability to predict and tackle illnesses going forward.

Secondly, one of the major problems that has been identified by health think tanks is that it’s not clear what problem the reorganisation is actually meant to solve, or indeed, how the reorganisation is meant to solve it. The Government claims it is to unify the different strands of the response to the coronavirus pandemic, but why this unification is so important when they seem to be working well enough right now is not as clear. If you don’t have a defined problem to solve, then you are likely to end up causing yourself more trouble down the line. In this case, that may be doubly the case. PHE does not only deal with pandemics, but also handles a wide variety of other public health issues and campaigns. Where do they sit within the new infrastructure? A consultation could help clarify these issues, not only because they would have to be somewhat clarified for the Government to make their pitch for support in the consultation, but also because if it wasn’t clear, then consultees could identify that and respond to it.

The lack of consultation also cuts out those with more experience on the subject area. A fundamental reorganisation of public healthcare should necessarily carry with it (at the best of times, let alone now) a need for a better evidential base than a minor change of rules, a base that can best come from the doctors, nurses and academics doing the work. With no real knowledge of how this new policy has been arrived at, how can we be sure that the Government has taken into account all the major and minor considerations? If the public does not have the reassurance, that a consultation could provide, then will they have confidence in the change?

Fourthly, it removes important democratic safeguards. The announcement was made to a thinktank and not before Parliament, something which is bound to ruffle feathers. Sir Lindsay Hoyle, the Speaker of the House of Commons has already given the Government short shrift several times for making major policy announcements before Parliament has the opportunity to even debate them. Parliament is presently in recess, and due to return on 1st September, but it seems difficult to believe that the change is sufficiently necessary that it couldn’t have waited until then. There has already been protest amongst both MPs and Peers that the Government is cutting them out of decision-making by publishing regulations so that they cannot be debated. Sparks are surely going to fly over this.

Perhaps the most stark reason that this decision should probably have been made with consultation is that we cannot afford to get this wrong. Coronavirus is not gone. Although it has been pushed back, local lockdowns are still in place, with more in the offing. If we trip up now, then all the good work and hard times that have passed over the last five months could be for nothing. Consultation is not a panacea. But it could help to reduce the risk of a policy going horribly wrong. I do realise that the tone around this decision has been very negative. It is entirely possible that this won’t go wrong, that the reorganisation will happen and everything will run smoothly. But it’s a big risk. Restructuring of major public infrastructure always is. All hands are very much still needed at the coronavirus pumps.

One of the key reasons we consult is to make better decisions. This is particularly pertinent when it comes to big decisions that could have far ranging impacts upon a large number of people. At this moment in time, it is perhaps hard to think of a bigger decision than the protection of public health, or one that affects so many people. In light of that, it would perhaps have been desirable for this decision not to have been taken in the manner that it has, but rather to have been arrived at and developed after consultation, in order to ensure that it was being taken for the right reasons, in a manner that maintained public and professional confidence, and that, if it were to go wrong, would have the minimum possible negative impact.