Corporate report

UKHSA Advisory Board: Future of the Health Protection System

Updated 20 November 2025

1. Purpose of the paper

The purpose of the paper is to provide an update on the activity of the Future of the Health Protection System (FHPS) Co-Design Group which promotes the resilience of national, regional and local health protection systems. The paper sets out the group’s future priorities and ask for your advice on how the group can be most effective in supporting the health protection system through upcoming health system changes.

2. Recommendations

The Advisory Board is asked to:

• note the use of the Future of the Health Protection System Co-Design Group as a primary route for UKHSA to engage strategic health protection system partners in England, and collaboratively work to enhance the resilience, effectiveness and scalability of the national, regional and local health protection system.

• comment on how UKHSA, through the Future of the Health Protection Co-Design Group, should position itself in relation to current NHS and local authority reforms to support UKHSA priorities, including in response to cases and incidents, and prevention programmes?

• comment on how can the Future of the Health Protection System Co-Design Group best engage with, maintain and enhance links with Integrated Care Boards (ICBs) and Offices for Pan ICB Commissioning (OPICs)?

3. Overview

The FHPS Co-Design Group was established by UKHSA in 2022 to bring together partners from across the health protection system to collectively enhance the resilience, effectiveness and scalability of the national, regional and local health protection system.

UKHSA co-chairs the group with the Association of Directors of Public Health (ADPH). Members of the group include representatives from Local Government Association, SOLACE, NHS England, Department for Health and Social Care, Ministry of Housing Communities and Local Government, Chartered Institute of Environmental Health, and Faculty of Public Health (full list at Annex A). UKHSA provides secretariat support.

The group  designs, develops, and delivers improvements to the health protection system, based on system need. The remit of the group is advisory, with task and finish groups set up to deliver specific outputs, such as guidance. Member organisations hold decision-making power on the status of outputs delivered by them.

The workplans and priorities for the group are developed based on the needs of the system, through consultation with FHPS group members and the membership bodies they represent. To facilitate this, UKHSA conducted surveys, interviews, workshops and a call for evidence.

This paper summarises the work of the FHPS Co-Design Group, and the progress made since previously attending the Equalities, Ethics and Communities Committee of the Advisory Board in summer 2024. It also sets out the future work planned by the group for 2025/26.

4. Progress

The group has collectively achieved the following:

Improved relationships and trust – After COVID-19 and the 2022 Mpox outbreak, relationships between UKHSA and some senior system stakeholders were strained, and trust needed to be rebuilt. Through working together as a multi-agency, multi-profession group to achieve collective improvements, trust has been re-established and strong working relationships developed. The 2025 survey of FHPS members showed a significant improvement in trust and strengthened relationships.

Memorandum of Understanding Guidance and Templates - This workstream provided a consistent framework to improve the process for developing and agreeing memoranda of understanding (MoUs) between local/ regional health protection system partners. These MoUs improve effectiveness of the health protection system and more efficiently ensure clarity of roles and responsibilities, funding and accountabilities at a local level. Agreeing local interoperability arrangements and clarifying organisational roles and responsibilities also contributes towards risk identification and mitigation. Working together with representatives from across national, regional and local health protection systems, UKHSA developed an MoU Guidance Framework and MoU Template which was published in July 2024. Currently half of LAs have developed or are developing MoUs, with regional/ local health protection system partners including UKHSA, NHS England and ICBs, using these products.

Health Protection Assurance Framework and What Good Local Health Protection Systems Look Like tools and guidance - Directors of Public Health (DsPH) have a statutory function to be assured that adequate local health protection functions are in place in their local system, are being appropriately implemented and identify/ agree mitigation measures with partners where elements may be perceived to be inadequate. Working in collaboration with UKHSA, the East Midlands Health Protection Community of Improvement and the ADPH, existing products were adapted and updated. These support DsPH to provide a positive declaration (intended to give confidence) that the areas of health protection are being commissioned and provided in a manner which meets the needs of the population or, if this is not the case, to identify gaps in the system so that measures can be taken to resolve these. The Health Protection Assurance Framework and What good local health protection systems look like were published in January 2025. A national webinar was co-delivered in March 2025 to launch the products.

Communicable Disease Outbreak Management guidance - The group provided extensive input into the UKHSA-led revision of the Communicable Disease Outbreak Management (CDOM) guidance, providing the primary route for cross-system engagement throughout development and implementation. This guidance provides health protection organisations in England with principles to support local health protection system responses to outbreaks of communicable disease, aiming to prevent related harm. The revised CDOM guidance was published in January 2025.

Clinical commissioning guidance for ICBs – Response to incidents and outbreaks of infectious disease - An FHPS Task & Finish Group was convened to support the development of NHS England’s Clinical response to local incidents and outbreaks of infectious disease: Commissioning guidance for ICBs. The guidance supports ICBs in planning and commissioning services to manage infectious disease outbreaks. The guidance was published in March 2025.

As the majority of outputs produced by the group were published in 2025, we don’t yet have an assessment of impact on health protection outcomes. Plans are in place to do so and assessment of impact of the Health Protection Assurance Framework and What Good Local Health Protection Systems Look Like tools and guidance has started.

Alongside delivering its workplan, the FHPS Co-Design Group co-hosted sessions with the Faculty of Public Health (FPH) at the UKHSA Conference in 2023 (Changing Landscape of the Health Protection System) and 2025 (The Future of the Health Protection System in England). The 2025 conference session had at-capacity attendance and was extremely well received.

FHPS has become a recognised strategic forum to enable national programmes and projects to engage system partners and obtain advice and expertise from across the health protection system in England (Annex C).

5. Managing the impact of health system changes on health protection

The board will be aware that significant structural changes within the health system are in train, with the merger of NHS England and DHSC, the restructuring of ICBs, the transfer of immunisation and specialised commissioning responsibility to ICBs, the formation of new pan-ICB commissioning structures – Offices of Pan-ICB Commissioning (OPICs) (to support at scale commissioning) and the reorganisation of local authorities (through the English Devolution and Community Empowerment Bill) (see Annex D for detail).

The health protection system - locally, regionally and nationally - is inter and co-dependent. These changes therefore present both risks and opportunities to innovate. For example, vaccination commissioning responsibilities transitioning from NHS England to ICBs has the potential to lead to uncertainty on responsibilities at the system level, whereas the introduction of a new duty on regional mayors to improve health and reduce health inequalities has the potential to strategically enhance health protection and support focus and action on health equity for health security.

Maintaining engagement and participation with system partners throughout the duration of health system changes is crucial to ensure that health protection is not overlooked in system re-design.

The board is asked to consider:

• How should UKHSA through the FHPS Co-Design Group position itself in relation to current NHS and local authority reforms to support UKHSA priorities, including in response to cases and incidents, and prevention programmes?

• How can the FHPS Co-Design Group best engage with, maintain and enhance links with Integrated Care Boards (ICBs) and Offices for Pan ICB Commissioning (OPICs)?

6. Future Plans

In March 2025, the FHPS Co-Design Group met in-person and re-affirmed their joint ambition to design, develop, and deliver improvements together, to achieve having the best possible health protection system for England that is sustainable into the future. The group agreed their priorities for 2025/26, as set out in Annex E.

7. Conclusion

The FHPS Co-Design Group has made significant progress over the last three years. The ambition to enhance the resilience, effectiveness and scalability of the national, regional and local health protection system is being achieved via co-design and collaboration, and the group has identified its shared future priorities for the coming year through its 2025/26 workplan.

The FHPS Co-Design Group is increasingly used as a primary route for engagement across the health protection system in England. Maintaining engagement throughout health system changes, reorganisations and restructuring is crucial to ensure that health protection is not overlooked in system re-design.

The FHPS Co-Design Group will continue to develop joint cohesive and comprehensive responses to the issues affecting the health protection system. This will include how to maximise and increase opportunities as health system changes progress, and mitigating risks.

7.1 Annex A – FHPS Co-Design Group Members

Organisations

• Association of Chief Environmental Health Officers
• Association of Directors of Public Health UK (ADPH)
• Association of Port Health Authorities
• Chartered Institute of Environmental Health (CIEH)
• Department of Health and Social Care (DHSC)
• Faculty of Public Health
• Local Government Association
• Ministry of Housing, Communities and Local Government (MHCLG)
• NHS Confederation
• NHS England
• Office of Health Inequalities and Disparities (OHID)
• Society of Local Authority Chief Executives (SOLACE)

Representatives of Member Organisations

Name	Role	Organisation
Association of Chief Environmental Health Officers
Fiona Inston	Public Health Associate	Association of Chief Environmental Health Officers
Association of Directors of Public Health (UK)
Deborah Harkins	Director of Public Health, Calderdale	Association of Directors of Public Health UK
Gillian McLauchlan	Director of PH Commissioning and Protection, Salford	Association of Directors of Public Health UK
Rachel Flowers	ADPH alumni	Association of Directors of Public Health UK
Sangeeta Leahy	Director of Public Health, London Borough of Southwark and ADPH Health Protection Lead	Association of Directors of Public Health UK
Faculty of Public Health
Dominic Mellon	Chair Health Protection Committee	Faculty of Public Health
Association of Port Health Authorities
Louis Franks	Executive Lead	Association of Port Health Authorities
Chartered Institute of Environmental Heath (CIEH)
Ian Andrews	Head of Environmental Health	CIEH
Department of Health and Social Care
Helen Beazer	Deputy Director – National Immunisations Policy	DHSC
Simon Reeve	Deputy Director - Public Health Systems	DHSC
Morwenna Carrington	Deputy Director – UK Health Security	DHSC
Local Government Association
Paul Ogden	Senior Advisor (public health)	Local Government Association
Ministry of Housing, Communities and Local Government (MHCLG)
MHCLG representative	Resilience & Recovery Directorate (RED)	MHCLG
NHS Confederation
John Patterson	Associate Medical Director, NHS Greater Manchester	NHS Confederation
Michael Smith	Chief Officer, Bolton GP Federation	NHS Confederation
NHS England
Sarah Price	Director for Public Health	NHS England
Office of Health Inequalities and Disparities (OHID)
Mike Wade	Regional Director of Public Health	OHID/NHSE
Society of Local Authority Chief Executives
Tom Stannard	Heath and Social Care Spokesperson at Solace and Chief Executive Salford City Council	Society of Local Authority Chief Executives
UK Health Security Agency
Sarah Fisher-Mackey	Deputy Director, Health Protection Policy	UKHSA
William Welfare	Director of Regions	UKHSA
Yimmy Chow	Regional Deputy Director- London	UKHSA

7.2 Annex B – Links to documents produced through FHPS

Communicable disease outbreak management guidance and document suite. - Communicable disease outbreak management guidance: principles to support local health protection systems - GOV.UK

Clinical commissioning guidance for ICBs – Response to incidents and outbreaks of infectious disease. - NHS England » Clinical response to local incidents and outbreaks of infectious disease: Commissioning guidance for ICBs

What Good Looks Like For Health Protection and Health Protection Assurance Framework - What-Good-Local-Health-Protection-Systems-Look-Like-Updated.pdf - FINAL-Health-Protection-Assurance-Framework-v2.0.pdf - WGLL-Quality-Improvement-Framework-v1.0-FINAL.pdf

7.3 Annex C – FHPS stakeholder engagement for national programmes and projects

• Pandemic Preparedness – UKHSA Centre for Pandemic Preparedness
• Respiratory Pandemic Response Plan for UK Health and Social Care – DHSC
• Changes to the Health Protection (Notification) Regulations 2010 – DHSC
• NHSE Vaccination Strategy implementation – NHS England
• eNOIDs pilot – UKHSA Programmed Delivery Unit
• Post-election and Covid-19 Public Inquiry – UKHSA Policy
• Mpox 2024 response – UKHSA Health Protection in Regions
• Review and update of the ‘What Good Looks Like’ suite of products – Association of Directors of Public Health
• Impacts of wider changes to NHS and Local Government on the Health Protection system – UKHSA Policy
• National Contingency Plan for Invasive Mosquitos – UKHSA Centre for Climate Health Security
• Future Outbreak Pathways – NHS England
• Pandemic Preparedness Strategy – UKHSA Centre for Pandemic Preparedness and DHSC
• UKHSA Public Health Social Measures in a respiratory pandemic – UKHSA Guidance
• English Devolution and Local Government reform – Ministry of Housing Communities and Local Government (MHCLG)

7.4 Annex D – Summary of wider system changes impacting health protection system

Health System Changes – NHS England Integration into DHSC

• On 13 March 2025, the Secretary of State for Health and Social Care announced that NHS England will be brought back under direct government control, ending its operational independence established by the 2012 Health and Social Care Act. The stated aims are to streamline governance, reduce bureaucracy, and cut administrative costs, including a planned 50% reduction in staff across both NHS England and DHSC.

• These reforms will have significant implications for Integrated Care Boards (ICBs) and Integrated Care Systems (ICSs). From April 2026, ICBs will undergo mergers and boundary realignments to achieve coterminousity with strategic authorities such as mayoral or unitary councils. This aligns with the 10-Year Health Plan, which emphasises place-based commissioning and community-focused care.

• The restructuring includes a mandated 50% reduction in ICB running costs, to be achieved through clustering, shared services, and eventual mergers. Of the current 42 ICBs, it is anticipated that 28 will consolidate into 13 larger entities, pending ministerial approval. ICBs will shift toward a more strategic commissioning role (including for immunisation), with a focus on population health management, digital transformation, and preventative care models.

• These changes are alongside NHS England’s existing plan to delegate commissioning responsibility for immunisation, screening and specialist services to ICBs. The transfer of full commissioning accountability to ICBs will take place from April 2027.

• In addition, NHS England plan to establish new Offices of Pan-ICB Commissioning (OPICs) to support at-scale commissioning where appropriate. These structures will operate at the regional level, with one per NHS Region. The offices will support all ICBs equally and collectively across a region in discharging their new responsibilities and future accountabilities.

English Devolution and Local Government Reform

• The English Devolution White Paper (Dec 2024) sets out a programme of devolution and Local Government Reorganisation (LGR) across England. The vision is for all regions to be part of Strategic Authorities led by elected Mayors, empowered through the English Devolution and Community Empowerment Bill. The bill, which is currently going through Parliament, includes a new statutory duty for Mayors to improve health and reduce inequalities.

• LGR aims to simplify England’s local government structure by replacing two-tier systems (county and district councils) with unitary authorities. Councils in scope are grouped into three cohorts with staggered implementation timelines: Surrey (fast-track, live by April 2027), six Devolution Priority areas (live by April 2028), and 14 remaining two-tier areas (live by April 2029). The transition period includes statutory consultations, elections, and secondary legislation, with full operational handover planned from Spring 2028.

• These structural changes intersect with the health system reforms. UKHSA and FHPS must remain engaged throughout to mitigate risks to health protection continuity. Potential impacts include disruption to coordination mechanisms (Local Resilience Forums & Local Health Resilience Partnerships), disruption functions that sit at the lower tier (environmental health), loss of clarity over public health duties, and delayed visibility of health-specific details in LGR plans.

7.5 Annex E – 2025/2026 Priorities

Workstream	Objectives
General
Advocacy / developing one voice into the centre	- When/where required, identify how to maximise resource and increase benefits (“how to do more with less”). - Create a single shared view and develop joint, cohesive, and comprehensive responses to issues affecting the health protection system.
Assurance	- Enhance clarity and understanding across the health protection system regarding assurance roles, responsibilities, and statutory duties of organisations (including LAs and ICBs). - Reduce confusion and delays at a local level. - Provide a mechanism for practitioners and front-line colleagues to share their views on the health protection system.
Topic Specific
Influencing Policy / Strategy – ensuring engagement across the health protection system	- Promote and strengthen the principle of co-design across the health protection system. - Provide a forum for engagement across the health protection system and at all levels (local, regional, national) during policy development.
Vaccinations	- Ensure clarity and increase understanding across the health protection system regarding vaccination roles, responsibilities, and accountabilities—including statutory duties on LAs and ICBs. - Ensure system-level perspectives are articulated, collated, and raised to influence the shaping of the future system and optimise vaccination delivery.
Part 2A Orders of the Health Protection Regulations (2010)	- Understand the full range of challenges encountered when applying Part 2A Orders. - Identify whether each challenge can be resolved by more comprehensive/supportive guidance or whether legislative/regulatory change is required. - Reduce confusion and delays at a local level. - Create more clarity and better understanding across the health protection system regarding Part 2A Orders. - Address the timeliness issues associated with Part 2A Orders.
Environmental Health / Aesthetics Industry	- Understand the full range of challenges encountered across the health protection system around the cosmetics and aesthetics industry. - Support DHSC, UKHSA, and CIEH in the development and delivery of a new regulatory system for the non-surgical cosmetic industry and guidance on tattoos and piercings.