Defences under strain

by Tim Tonkin

Health protection teams were the first line of defence against COVID. Doctors say that, after years of funding and staffing cuts, the specialty must at last be put on a firm footing

Location: UK
Published: Friday 17 September 2021
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COVID-19 is the greatest public health crisis the world has faced in a century. It has posed an unparalleled challenge to health services around the world, including the NHS.

Among the first parts of the health service in the UK to encounter and react to the pandemic early last year were the HPTs (health protection teams) of PHE (Public Health England).

It was these multidisciplinary and regionalised units which sought to address and counter the ever-rising swell of infections during the early months of 2020.

The existing HPTs became overwhelmed
Public health consultant

Much like the rest of the health service, the effect on staff in these teams during the past 16 months has been enormous, yet for those working in conventional parts of the NHS, the work of HPTs is often poorly understood.

Comprising 18 organisations, each covering different geographical regions of England, HPTs are truly multidisciplinary medical outfits, consisting of doctors, nurses, allied health professionals as well as staff working in administrative and surveillance roles.

Around one third of all public health consultants in England work in health protection, with this area of public health itself divided into three core areas of responsibility.

These include communicable disease control, which in the pre-pandemic era would have seen HPTs undertake contact-tracing work in relation to person-to-person transmissible infections, such as meningococcal disease and blood-borne diseases, such as hepatitis B and human T-cell lymphotropic virus.


Another function is responding to environmental hazards to health including incidents involving the accidental or deliberate release of chemical and radiological materials.

Teams are instrumental in developing emergency plans, improving community resilience and responding to major incidents that affect health, with each of these areas of responsibility seeing HPTs work with a wide range of organisations, such as emergency services, local authorities, Environment Agency and Met Office employers and schools.

However, when COVID-19 began to take hold in the UK at the beginning of last year, HPTs and their staff were among the first parts of the health service to bear the brunt of the new pandemic.

Public health has been really run down in terms of funding and staffing
HPT consultant

Initial work included assisting in the repatriation, and subsequent quarantining, of British citizens from China. Speaking anonymously to The Doctor, one public health consultant explains how the efforts of teams to control the spread of infections through contact tracing of confirmed cases soon became impossible as the virus took hold.

‘Once it [the coronavirus] began to be transmitted within the UK in late February and early March, all of our efforts were diverted into contact tracing and following people up to make sure they acted appropriately, and I think we got advice on self-isolation spot on very early on,’ the consultant says.

‘The big problem came by the second or third week of March 2020 where the existing HPTs, which had been completely repurposed to coronavirus, became overwhelmed.’


The implementation of the first national lock-down in the UK saw the focus of HPTs, working in collaboration with public health services at local authority level, shift from contact tracing to developing guidance and advice on personal protective equipment for NHS staff.

As 2020 progressed, the demands of the pandemic saw the vast majority of public health specialty trainees being deployed to HPT roles.

While redeployments of this kind were not limited to doctors in training, the sole focus of battling COVID has prompted concerns with how some trainees’ experience of working in a public health role will have been narrow in scope.

Speaking truth to power

As if tackling a pandemic was not demanding enough, the revelation, abruptly announced in September last year, that PHE was to undergo a restructuring process has presented a further challenge to staff working in HPTs. With PHE set to be transformed into the UK HSA (Health Security Agency), whatever new form that HPTs take, two important aspects will be how they are funded, staffed and resourced and whether the doctors staffing them will be empowered to be truly independent in the way they operate.

‘The biggest single issue that we’ve had is, as with much else, public health has been really run down in terms of funding and staffing,’ says another HPT consultant speaking anonymously to The Doctor.

‘Next to being properly funded and staffed is [having] the ability to have a professionally led public health response which can be truly independent and speak truth to power, and where individual consultants within the system are free to speak out and advise without political constraint.’

Speaking about the challenges faced by HPTs, BMA public health medicine committee co-chair Penelope Toff says the pandemic had demonstrated how essential the knowledge and experience of these teams were in responding to a health emergency such as COVID.

Back bone

She says: ‘HPTs formed the backbone of the public health response to COVID-19 in England during 2020. This feat is all the more impressive when we consider both the historic under-investment these highly specialised teams have endured, the rapidly escalating scale of the pandemic and the disruption later imposed on them by the Department of Health’s decision to overhaul PHE.

‘The pandemic has shown how coordination at local and national levels is critical to protecting public health and, along with the wider BMA, we would strenuously urge that these teams and their staff are given the resources and support they need to form a central part of the future national HSA.’