Letter from Maria Caulfield MP to Professor Dame Jenny Harries, UKHSA chief executive

From:

To:

Dear Jenny,

UK Health Security Agency strategic remit and priorities 2023 to 2024

This letter sets out the priorities for the UK Health Security Agency (UKHSA) for the period April 2023 to March 2024.

I would like to start by thanking everyone at UKHSA for your work this past year to protect the public and develop the core capabilities of the agency. UKHSA continues to make significant achievements in the response to COVID-19 and vital contributions to protecting the public from many other infectious diseases including mpox, seasonal flu and polio.

UKHSA is investing its energies to develop and strengthen its broad range of health security capabilities and making significant efforts in building relationships and partnerships across the health system, government, the UK and internationally.

The purpose of this letter is to set out your core responsibilities for 2023 to 2024 and focus on key deliverables. To complement this letter, UKHSA’s annual business plan will set out the full list of your priorities which will be developed in consultation with the Department of Health and Social Care (DHSC).

UKHSA provides expert public health scientific expertise, data and analysis, surveillance capabilities and operational response to strengthen public health protection and security capability across the UK. You provide the UK with the permanent standing capacity to prepare for, prevent and respond to threats from:

• infectious diseases (covering the main routes of transmission which can give rise to epidemics or pandemics, gastrointestinal, respiratory, sexual, blood-borne, touch and vector-borne)
• chemical, biological, radiological and nuclear hazards
• other environmental hazards, such as extreme weather events
• health hazards that arise from disasters

Your remit and responsibilities relate to England on devolved public health matters and across the UK on reserved matters. Since health hazards do not respect administrative boundaries, it is vital that you work closely with lead agencies in Scotland, Wales and Northern Ireland and thereby contribute to the delivery of high levels of health security throughout the United Kingdom.

This will involve building and sustaining strong, impactful relationships across local and national government, including with local authorities, agencies in the devolved administrations, the Crown Dependencies, UK Overseas Territories and other system partners across the UK to ensure threats are effectively identified, mitigated and addressed at home and abroad.

As an executive agency of DHSC, UKHSA will:

• provide strong national leadership on public health security and health protection
• ensure a cohesive response across England and the UK’s public health functions
• embed effective clinical, scientific and operational functions in the public health system

UKHSA will be expected to align with and, wherever applicable, input to relevant work within the health and social care system, across government and internationally. UKHSA will consider public health disparities across all their work, support delivery of DHSC’s approach to public health disparities and co-ordinate with partners to ensure all members of the community are, as far as possible, equitably protected from exposure to and consequences of public health threats.

UKHSA will work closely with the Chief Medical Officer (CMO), the UK’s most senior medical adviser and head of the public health profession. The CMO will be the ultimate arbiter for advice on scientific and clinical matters, will be formally consulted by UKHSA on wider public health protection strategy and will be the professional lead for UKHSA’s most senior medical professional. The CMO will coordinate closely with UKHSA in support of the Agency’s global public health remit. Additionally, UKHSA will be a trusted source of public health advice and scientific expertise to the public, the NHS and the government, and will also work closely with CMOs for Scotland, Wales and Northern Ireland. UKHSA will synthesise their multiple areas of expertise into a single organisational view, which can be used to advise the public health system, CMOs and relevant ministers.

This letter sets out UKHSA’s enduring core capabilities that you should continue to build as the nation’s expert dedicated public health security agency, as well as key deliverables to focus on during the 2023 to 2024 financial year.

With the creation of UKHSA, there was a requirement to provide clarity on the future division of roles and responsibilities between UKHSA and DHSC across emergency preparedness, health protection and health security policy areas. This is reflected in the core capabilities and key deliverables below.

UKHSA’s core capabilities

As an effective public health agency, UKHSA should continue to provide the following core, enduring public health protection functions:

Pandemic and major epidemics preparedness

UKHSA will:

• prepare its scalable response capabilities in order to facilitate a flexible response to future pandemics and major epidemics. This will include but is not limited to leading on:
  • surveillance
  • diagnostics
  • contact tracing
  • scientific and expert advice
  • emerging and high consequence infectious disease responses
• plan and respond to epidemics and pandemics via the main transmission disease routes (gastrointestinal, respiratory, sexual, blood-borne, touch and vector-borne), with plans to have the capacity and capability to scale up all relevant aspects of a public health response in the event of an emergency until wider state capacity could be deployed, working closely with other bodies
• continue to develop pathogen genomics and surveillance capabilities by investing in efficient and long-lasting data and technology infrastructure, building on the world-leading expertise established during the COVID-19 pandemic while maintaining the ability to ramp up in response to an incident. Build capability to deliver a ‘genomics-first’ approach for epidemic and pandemic preparedness to enable the rapid detection of potential emerging infections and outbreaks, including for those with undiagnosed severe infection

Infectious disease threats

UKHSA will:

• continue to provide effective nationwide health protection services to detect and contain infectious disease outbreaks, minimising harmful health impacts and protecting functionality of the NHS and its users
• prevent antimicrobial resistance (AMR)-related infections and prepare, plan and respond to AMR-related infections at local, regional and national levels (through public health protection teams) and support delivery of the UK’s national action plan to reduce the impact of AMR domestically and globally
• provide overseas public health protection and support in the event of outbreaks, epidemic threats and humanitarian crises in partnership with other organisations and government departments, including fulfilling international responsibilities and World Health Organisation commitments

Emergency preparedness, resilience and response

UKHSA will:

• take lead responsibility for infectious and endemic diseases in incident planning and response. This includes leading the response across government and the health and care system (including with NHS England and bodies in devolved administrations)
• prepare, plan and respond robustly and rapidly to the public health impacts of all non-infectious disease incidents including any chemical, biological, radiological, nuclear (CBRN) events. This includes leading the identification and assessment of public health impacts for threats related to CBRN and providing technical, scientific and clinical advice to inform planning and during incident response. Provide expert scientific advice to ensure the impact on public health and public health delivery of environmental incidents and emergencies, including flooding, meteorological hazards and terrorism is considered as part of the response
• provide expert advice on, and as appropriate undertake, public health activities at the borders including seaports, airports and rail crossings to aid the local detection and management of outbreaks and help prevent wider community transmission
• establish a routine UKHSA emergency response exercise programme to test their preparedness on the key public health threats and hazards, that are identified in the National Security Risk Assessment and through UKHSA’s All Hazards Intelligence horizon scanning programme, including on avian influenza. In addition, for those programmes outside UKHSA’s own internal organisational preparedness remit, UKHSA will continue to provide a training and exercising programme which will be agreed by DHSC and support emergency preparedness, resilience and response capability in UKHSA, DHSC and NHSE. Through this, relevant organisations can and should jointly and individually assess their own readiness against, and implement, recommended actions

Vaccinations, immunisations and treatments

UKHSA will:

• manage procurement, storage, and distribution for national immunisation programmes given to over 5 million children and adults each year, as well as vaccinations for childhood influenza, COVID-19 and emergency clinical countermeasures
• systematically assess and drive forward the epidemiological and scientific evidence base for new opportunities for existing or novel vaccine development programmes, including the potential use of new vaccine platforms, working closely with the department and across Whitehall
• establish a Vaccine Development and Evaluation Centre to strengthen preparedness for priority infectious diseases threats through laboratory-based studies to support the development and evaluation of vaccines and therapeutics
• support DHSC and NHSE to reduce the impact of vaccine preventable diseases including polio and measles, in line with elimination and eradication strategies in particular where coverage has significantly diminished or elimination status has been lost. This includes efforts to reduce disparities in vaccination coverage that may put specific regions and communities at higher risk
• continue to provide secretariat and modelling support to the Joint Committee on Vaccination and Immunisation

Scientific infrastructure

UKHSA will:

• develop a digital infrastructure which enables UKHSA to securely and at pace share data with partners in the event of a large number of cases for a public health threat or incident
• maintain a network of specialist reference and high containment laboratories and the capability to be pre-warned and prepared for public health threats to the UK that may arise outside its borders or domestically, including ability to detect rare, serious infections. These laboratories need to be able to handle serious consequence human and animal pathogens, as well as radiation, chemical, toxicological and environmental hazards, provide specialist diagnostics and public health microbiology services to the NHS and others, deliver infectious disease surveillance control and reporting to enable testing to be scaled up at pace

Working with academia and industry

By implementing its science strategy, UKHSA will:

• enable health and prosperity through its scientific work and assets, building on existing dynamic and productive relationships with a range of partners
• as part of this strategy, UKHSA will continue to work with academia to support innovative science to better understand hazards to public health and develop practical ways to prevent and control them; and work with industry, in particular in the life sciences, to prevent and mitigate public health hazards through innovative approaches and collaboration such as with pharmaceutical companies on vaccine research and development of diagnostics

Parliamentary and public accountability

UKHSA will:

• fulfil all parliamentary and public accountability functions which are expected of an executive agency, for example answering and contributing to parliamentary questions and freedom of information requests

Key deliverables for UKHSA in 2023 to 2024

In 2023 to 2024, the government expects UKHSA to undertake the following activities, underpinning these with smart deliverables in line with the Cabinet Office’s Arm’s length body sponsorship code of good practice.

Governance and accountability

UKHSA will:

• continue to strengthen solid corporate foundations for the organisation. This includes developing organisational structures which:
  • allow UKHSA to prepare and flex all aspects of the agency to respond to public health threats and incidents
  • enable the agency to operate at optimal effectiveness and efficiency, and provide value for money
• work through the finance and control improvement plan and develop further processes to address the historic and transferred issues that have resulted in a disclaimed audit opinion in 2021 to 2022 for the new organisation, to enable an improved audit opinion for the organisation to be secured as rapidly as possible and ensure accounts can be laid pre-summer recess. More broadly, ensure robust financial management and adherence to Managing Public Money, in line with the HM Treasury target for actual outturn within 1% of the M6 forecast position
• continue to embed good governance, risk management and accountability structures throughout the organisation, in line with those expected in Executive Agencies: A guide for departments and drive efficiencies and effectiveness through shared services where there is evidence of likely improvements. Plan and use the organisation’s resources in an affordable and sustainable manner, within agreed limits and delegations, as set out in the Framework document and schedule of delegations
• seek agreement from DHSC ministers and finalise UKHSA’s 2023 to 2026 strategic plan. The strategic plan should reflect UKHSA’s core capabilities and priorities, including how the organisation contributes to the achievement of DHSC’s medium-term plan and priorities, in line with the remit letter and performance metrics and milestones
• continue the transition away from contingent labour to a sustainable, resilient permanent workforce that is able to deliver its functions and can adapt to changing public health threats and demands in line with ministerial targets, developing and utilising cross-government and/or specialist clinical and scientific professional recruitment frameworks to enable strong recruitment and retention in support. Additionally, continue to focus on developing a culture that invests in people and nurtures talent, enabling UKHSA to attract and retain individuals with crucial scientific, public health and technical skills
• deliver the Living with COVID-19 strategy to agreed budgets by decommissioning COVID-19 testing and tracing infrastructure whilst retaining capacity and capability to scale up a response consistent with the agreed living with COVID-19 strategy and financial envelope. Continue to provide COVID-19 test stock and access to tests through UKHSA’s home channel for COVID-19 treatments to an eligible ‘highest risk’ cohort of people in the UK from April to September 2023. Additionally, UKHSA should have plans in place to hand over responsibility for testing for COVID-19 treatment to NHSE on 1 October 2023

Preparation and response to COVID-19 inquiry

UKHSA will put in place capabilities and resources to enable the organisation to respond to requests from the COVID-19 Inquiry as required as a core participant to the Inquiry and as an executive agency of a government department.

Vaccine technology and innovation

UKHSA will proactively anticipate and encourage advancements and innovation in vaccine technology. Explore opportunities related to research and development, manufacturing, supply chains, and delivery methods. Close collaboration with vaccine developers and clinical experts is essential in this process and will include horizon-scanning and assessment of emerging health threats that could potentially be addressed through vaccination.

Critical national infrastructure

UKHSA will finalise and seek ministerial agreement on plans to keep critical national public health protection infrastructure secure, including agreement on the strategic direction for UKHSA’s future estate contained within UKHSA’s science strategy. Such plans should prioritise UKHSA’s critical response and public health capability needs and value for money. Following approval of strategic direction from ministers and the Major Projects Review Group, UKHSA should deliver agreed plans as per the timelines set out in the programme business case.

Border health strategy

UKHSA will develop a strategic work programme to deliver border health security, which with the cooperation of the devolved governments, will deliver a UK-wide strengthening of border health capabilities. The programme aims to advise key partners across government and the wider sector on capabilities at ports of entry to meet obligations under international agreements, including the international health regulations, and supports delivery of existing work on border health security in response to risks to public health from both goods and people entering the UK.