Public Health England (PHE) was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as a result of the reorganisation of the National Health Service (NHS) in England outlined in the Health and Social Care Act 2012. It took on the role of the Health Protection Agency, the National Treatment Agency for Substance Misuse and a number of other health bodies. It was an executive agency of the Department of Health and Social Care, and a distinct delivery organisation with operational autonomy.On 29 March 2021, the UK Government announced that PHE would be disbanded and that its public health functions would be transferred, in proposals to reforms public health structures. From 1 October 2021, PHE's health protection functions were formally transferred into the UK Health Security Agency (UKHSA), while its health improvement functions were transferred to the Office for Health Improvement and Disparities (DHSC), NHS England, and NHS Digital.
Integrated care for children and young people in England represents a transformative shift towards holistic, person-centred health services tailored to the needs of local communities. In this first part of a series of three, we describe what we mean by integrated care, and why it is needed now, setting the context for the subsequent parts that detail integrated care's core components and practical implementation.Integrated care addresses multidimensional needs-physical health, mental wellbeing, education and social development-while reducing fragmentation and inefficiency. This approach enables early intervention and improves health equity. Key benefits include streamlined access for families, reduced hospital admissions and better outcomes for vulnerable groups, such as children with complex conditions or those facing social and economic challenges.The evolution of UK child health policy, from the 1959 Platt Report to the 2025 National Health Service 10-Year Health Plan for England, underscores the growing emphasis on multidisciplinary, community-based models. By adopting a whole-population approach-segmenting children by health and social needs rather than rigid pathways-integrated care enables every child to be supported and cared for.Ultimately, integrated care is not just an improvement but a necessity, addressing rising demand, workforce pressures and persistent inequities. It fosters proactive, collaborative systems that prioritise children's wellbeing, offering a sustainable future for child health and care services in England.
Background:National Institute for Health and Care Excellence technology appraisals assess the effectiveness and cost-effectiveness of medicines at a single point in the treatment pathway. However, for some disease areas, such as non-small cell lung cancer, there are many recommendations, making it difficult to use National Institute for Health and Care Excellence guidance. The treatment pathway for metastatic stage 4 non-small cell lung cancer can be divided into decision points (nodes) based on histology (squamous or non-squamous), programmed death-ligand 1 expression, presence of tumour mutations and line of therapy. The National Institute for Health and Care Excellence commissioned this pilot to assess the potential of taking a 'pathways approach' to technology appraisals. The aim was to build a single disease-specific cost-effectiveness model for metastatic stage 4 non-small cell lung cancer patients not eligible for targeted therapies at first line, that can be updated with economic and clinical data as required. Methods:We conducted a systematic review (searches last updated 11 July 2025) and network meta-analysis of treatment efficacy and safety at each decision node in the pathway. We used flexible fractional polynomial models for primary outcome progression-free survival, required for a model of treatment sequences. We built a novel cost-effectiveness model that compared sequences of treatments, and was populated using network meta-analyses for progression-free survival, data on overall survival after last-line therapy, evidence on treatment sequences from an analysis of systemic anticancer therapy data, and quality of life, cost and resource use estimates from previous technology appraisals. Drug list prices were used, but confidential discounts are available. Results:We included 15 randomised controlled trials and 1 single-arm study in the review, judged as some concerns or low risk of bias. Immunotherapies, in combination with doublet platinum chemotherapy, were most effective first-line treatments, although with higher adverse event rates. Immunotherapy monotherapies were most effective at second line, unless patients were suitable for targeted therapies. Sequences starting with atezolizumab + bevacizumab + doublet platinum chemotherapy had similar costs and quality-adjusted life-years to sequences starting with pembrolizumab + doublet platinum chemotherapy. Sequences starting with pemetrexed + platinum chemotherapy had the lowest costs but also the lowest total quality-adjusted life-years. Sequences for non-squamous non-small cell lung cancer, programmed death-ligand 1 ≥ 50%:Sequences starting with pembrolizumab + doublet platinum chemotherapy had highest quality-adjusted life-years, but higher costs compared to other sequences. Sequences starting with pemetrexed + platinum chemotherapy had the lowest cost and the lowest number of quality-adjusted life-years. Sequences for squamous non-small cell lung cancer, programmed death-ligand 1 < 50%:Sequences starting with pembrolizumab + doublet platinum chemotherapy had higher quality-adjusted life-years and higher costs than sequences starting with platinum chemotherapy. Sequences for squamous non-small cell lung cancer, programmed death-ligand 1 ≥ 50%:Sequences starting with atezolizumab had the highest predicted quality-adjusted life-year gains, slightly higher than for sequences starting with pembrolizumab. Sequences starting with platinum chemotherapy had the lowest quality-adjusted life-years, but the lowest total costs. Patients in the systemic anticancer therapy analysis had a shorter time on treatment than those in trials, resulting in lower treatment costs and causing the immunotherapy sequences to appear more cost effective. Conclusions:Our model can be used to estimate either the most cost-effective sequence of treatments or the most cost-effective treatment at a given point in the pathway, although our results are based on drug list prices and these would need to be updated to draw conclusions about the relative cost-effectiveness of different treatment sequences. We were able to use real-world data from systemic anticancer therapy to estimate model parameters and sequences that reflect clinical practice. Our model can readily be updated and used as a reference model for metastatic non-small cell lung cancer. Study registration:The study is registered as PROSPERO CRD42023470119. Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR136097) and is published in full in Health Technology Assessment; Vol. 30, No. 46. See the NIHR Funding and Awards website for further award information.
Rogwe Clarke, CBE, passed away 9 April 2026 at an age of 82 years following a short illness. He is survived by his wife and a son and a daughter and their families. His distinguished career as Directif of the UK National Radioloogical Protection Board (NRPB) and Chairman of the International Commission on Radiological Protection (ICRP) is outlined.
The antigenic drift of viral glycoproteins must be balanced by purifying selection pressure to maintain functionality. Understanding these evolutionary processes is key to predicting and combating viral evolution but is primarily based on influenza A(H3N2), which may limit generalisability. By characterising the influenza B virus haemagglutinin (HA) over 8 decades of circulation in humans, we found continuous genetic diversification, punctuated with antigenic changes that did not follow a linear path in antigenic space. Antigenic change is primarily underpinned by re-occurring mutations and deletions at positions 136, 150, 162-165, 197 and 203. These residues form complex epistatic networks that modulate the antigenic impact of mutation recycling. They also generate permissive backbones on which immune escape can emerge with limited replicative fitness cost. Our study identifies critical similarities and differences with A(H3N2) evolution and demonstrates the role of epistasis in balancing antigenic novelty with viral fitness. Our findings and genetic, antigenic and phenotypic datasets support the development of genotype-to-phenotype prediction tools, but such predictions need to capture the complex outcomes of epistasis.
