The Struggles That Led to the Unwise Demise of the Public Health Laboratory Service, 1979-2003, in the Context of Changing Economic Policy.

The Public Health Laboratory Service (PHLS) was an integral part of England's post-war communicable disease control. Its central reference and surveillance facilities and network of laboratories in NHS hospitals was an international exemplar. Under neoliberal economic policy from the 1980s it faced intense scrutiny and expenditure constraints. Attempts to transfer its peripheral laboratories to the NHS were successfully opposed by arguing that public health needs would not be prioritised. The 1990s introduction of the internal market and capital charging fractured the complex relationships that had developed between the PHLS and NHS. Required to enter market-like contractual arrangements with NHS bodies, it found most of its funding switched from government grant to contract-generated income. This was unsustainable. The PHLS was dismantled in 2003 without a clear rationale, ostensibly because of complexity, preferential financial treatment, and professional rivalries. When Covid-19 arrived, England lacked an established and extensive public health laboratory network.