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.
The Advisory Board is asked to:
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.
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).
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:
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.
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.
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
Health System Changes – NHS England Integration into DHSC
English Devolution and Local Government Reform
