Corporate report

UKHSA Advisory Board: Chief Executive's report

Updated 25 November 2024

Date: 19 November 2024

Sponsor: Dame Jenny Harries

1. Purpose of the paper

The purpose of the paper is to provide a forward look of priorities and brief overview of the recent operational and response status of the UK Health Security Agency (UKHSA) since the last Advisory Board.

2. Recommendations

The Advisory Board is asked to note the update.

3. Overview

On 30 October, the Chancellor set out the Government’s financial and economic priorities in the first budget statement of the new administration. This placed a focus on “fixing the foundations”, with the NHS and the health system more widely marked out as a cornerstone of this ambition.

The budget sets out the plans for total Departmental Expenditure Limits for 2025/2026, following the first phase of the Spending Review. As part of this the Chancellor confirmed that the Department of Health and Social Care (DHSC) would receive an additional £22.6 billion for day-to-day health spending over two years to support delivery of the Health Mission. Responding to the recommendations in Lord Darzi’s Independent Investigation of the NHS in England, which found the NHS had been “starved of capital”, she also announced a £3.1 billion uplift in capital funding in 2025/26. Department budgets for 2026/27 and beyond will be determined in the second phase of the Spending Review.

Of most direct relevance to UKHSA is the announcement of a £460 million capital investment for pandemic preparedness and health protection.

“£460 million will be invested in strengthening the UK’s pandemic preparedness and health protection to address the risk posed by future health emergencies and implement the lessons learnt from COVID-19. This includes replenishing personal protective equipment, vaccine and medicines stockpiles, and investing in critical health protection infrastructure such as high-containment laboratories. ” Autumn Budget 2024, p.52-53

This is a positive outcome and includes funding for both DHSC and UKHSA-led elements of pandemic and wider emergency preparedness. We are engaging with DHSC on the precise details of the allocation of this funding and will be able to update further once this has been finalised. Further work will also be required to develop business cases for the capital funding ahead of next financial year. Regarding UKHSA’s core resource funding, the Health Secretary has initiated a zero-based budget review across the whole health group allocation to finalise budgets for next year. This is expected to conclude by the end of November.

More broadly, there are several other elements of the announcement that have direct relevance to UKHSA over the next financial year and beyond.

• The Chancellor has set all government departments a 2% productivity, efficiency and savings target. The target is at departmental level so we will need to work closely with DHSC on their plans for delivering this across the wider health budget, of which UKHSA is one small component.

• The increase in Class 1 Employer National Insurance Contributions from 13.8% to 15% will have an impact on UKHSA’s overall pay bill. We will factor this into our budget and business planning as a risk, while also considering what additional funding HMT may make available to departments to fund this pressure.

While all eyes may have been on the budget, on 30 October we also reported the first case of mpox clade Ib detected in the UK. This clade is the cause of the significant outbreak that has been ongoing in the Democratic Republic of Congo and some nearby countries since late last year and is different from mpox Clade II that has been circulating at low levels in the UK since 2022.

The initial clade 1b case was detected in London and the individual managed through the High Consequence Infectious Diseases (HCID) pathway with an initial enhanced response level. The individual had a recent travel history to countries in Africa that are affected by the Clade Ib outbreak.

Since this initial detection and within expectations for contact transmission, three further cases have been confirmed, who are high-risk household contact of the first case. Contact categorisation, clinical assessment, and monitoring of contacts continues and offers of ring vaccination is being offered where appropriate.

The identification of individual imported cases, most likely acquired in one of the countries where the disease is known to be circulating, was predicted. Similar, isolated detections have already been confirmed in Sweden and in Singapore earlier this year, both with no identified spillover into the wider community. The overall assessment of the risk to the general public in the UK of contracting mpox Clade Ib remains low.

We have been closely monitoring the global situation regarding mpox Clade Ib since the outbreak began and we have been running enhanced pre-incident arrangements to prepare for the possibility of a case or cases being identified in the UK since transmission of the virus within countries outside of DRC became evident.

This has included acting as lead Government department, working closely with Cabinet Office, other UK Government departments, and the devolved Public Health administrations and health departments, to prepare for a range of potential scenarios. In September, we announced the purchase of more than 150,000 vials of mpox vaccine from Bavarian Nordic, both to support the routine vaccination programme for mpox Clade II recommended by the Joint Committee on Vaccination and Immunisation and to as a contingency for responding to cases of Clade Ib in the UK.

Alongside wider work across Government with international partners, UKHSA is supporting the global response to the management of the outbreak in central Africa. This includes the deployment of two specialists via the Public Health Rapid Support Team to provide Infection Prevention and Control and epidemiological assistance to the World Health Organization and Africa Centres of Disease Control joint incident management team.

4. Strategic Forward Look

On 21 October, the Health Secretary announced the beginning of wide-ranging consultation to support the development of the NHS 10 year plan, to be published in Spring 2025. This work will build on the findings of the Darzi Review and inform how Government and the NHS will deliver the ambitions set out in the Health Mission. Central to the plan are three “shifts” in underlying approach:

• hospital to community;
• analogue to digital;
• sickness to prevention.

This has considerable relevance to the work of UKHSA, and there are important opportunities for UKHSA to support both the development of this plan and the outcomes it aims to deliver. The mitigation, limitation and prevention of exposure to health hazards to avoid illness, health service demands, and subsequent economic sequelae is a critical component of our routine work. However, there will be important learning to be shared and intersection of activities between UKHSA and the NHS across all three of these areas, including for example use of the rich data that we have available to inform NHS planning and the community focused approaches taken to many health protection interventions such as vaccination.

The Executive Committee are currently considering the most effective ways that UKHSA can contribute to the consultation and assist DHSC and NHSE in the wider work to develop and deliver this plan. We will also want to ensure our own strategic goals, which we will be refreshing next year as the current three-year strategy comes to an end, both compliment and are complimented by the plan. Once more detail is available, I would welcome the Board’s suggestions at a future meeting.

The reorganisation of Senior Civil Servants posts within UKHSA continues, with staff now in the stage of individual consultation. We anticipate most staff eligible will be confirmed in roles by 1 December; however, some roles will take longer to confirm and others will require open recruitment. We are also at the longlisting stage for the new Director General role of Chief Operating Officer, which I hope to be able to update the board on shortly.

As winter fast approaches, we have once again stood up close monitoring of seasonal infections. We are working with DHSC and NHSE to ensure that our surveillance and analytical modelling can best be used by the NHS to inform their resource and capacity planning and management. This includes support for the Minister of State for Health, Karin Smyth’s, regular urgent and emergency care winter planning meetings.

Seasonal infection prevalence, including flu, is currently trending at relatively low levels with minimal impact on health service demand. COVID-19 prevalence continues to maintain an unsettled and largely non seasonal pattern and COVID-19 rates are currently in decline. We are beginning to see norovirus and respiratory syncytial virus (RSV) increase in line with typical trends (albeit a few weeks early for norovirus).

Looking further ahead to 2025, on 25 and 26 March we will hold the third UKHSA Conference. This has grown from an initial gathering of just over 1,000 colleagues and external partners in 2022 to a significant fixture in the health protection calendar. We have an exciting line-up of keynote speakers, including the new Minister for Public Health, Andrew Gwynne MP, science writer and broadcaster Vivienne Parry, and Faculty of Public Health President, Professor Kevin Fenton. We will have further speakers to announce nearer the time.

For 2025, we are moving to a larger venue, Manchester Central, so that we can meet ticket demand from colleagues in academia, pharma, biotech and our own scientists and colleagues, both from the UK and worldwide. The selection of Manchester to host this year’s conference continues our ambition to ground discussions in different perspectives from across the country and to recognise the different regional and community challenges to be addressed in reducing health inequalities across the UK.

Indeed, tackling inequalities in health outcomes is the main theme for our conference presentations and discussions this year. The conference programme will also explore the latest advancements, strategies and innovations in health protection and demonstrate the unique impact of UKHSA through our scientific, academic and commercial offer, and the power of our collective endeavour through partnership.

We will also build on the successful partnership established with the Faculty of Public Health last year, to ensure that our conference programme speaks to the interests of all of our valued public health colleagues.

5. Update on Activities

The rollout of the new maternal and older adult RSV vaccination campaigns continues, alongside commencement of the Autumn/Winter flu and COVID campaigns. UKHSA is working closely with NHSE to ensure these run smoothly and effectively. This includes a strong marketing push to drive awareness and uptake.

As of 27 October, through these campaigns the NHS in England has administered:

• 780,024 RSV vaccines to older adults;
• 59,369 RSV vaccines to pregnant women;
• 6,363,851 flu vaccines to adults over 65;
• 2,014,230 flu vaccines to children;
• 5,730,126 older adults, including care home residents;
• 1,320,886 people in a clinical risk group; and
• 6,896,290 COVID-19 vaccines to frontline health care workers.

The public hearings for Module 3 of the COVID -19 Public inquiry (the impact of Covid-19 pandemic on healthcare systems in the 4 nations of the UK) are now well underway. I myself gave evidence to the Inquiry on Wednesday 6 November, predominantly on matters relating to the Shielding Programme and Infection, Prevention and Control, and our Chief Medical Adviser, Prof Susan Hopkins, gave evidence on 18 September. We are also supporting the Inquiry into the Death of Dawn Sturgess, for which public hearings have now begun.

In September, the Government of Rwanda declared an outbreak of Marburg Virus Disease (MVD); the first in the country. As of 24 October, 64 cases of MVD have been confirmed, of which 15 have sadly died. We are closely monitoring the situation and have taken proportionate precautionary steps to manage the, albeit small, risk of importation to the UK. We already have enhanced public health messaging to direct arrivals from Rwanda in place for clade Ib mpox, and we have extended this to cover MVD as well.

To support the Government of Rwanda in their management of the outbreak, we have also deployed three members of the UK Public Health Rapid Support Team to the country. The deployment began on 20 October for an initial period of 8 weeks.

Alongside the responses to mpox clade Ib and MVD, we are continuing to manage a range of standard incidents. This includes continuing high levels of measles and pertussis, though in both instances cases are declining.

Professor Dame Jenny Harries

Chief Executive

November 2024