Statues and Coronavirus

June 25, 2020 in ADPH Updates, Blog, Covid-19 by Nicola Close

Nicola Close, Chief Executive, Association of Directors of Public Health

I was reminded last weekend of the conundrum: how tolerant should we be of intolerance? I am a ‘takes all sorts’, ‘live and let live’ kind of person but I cracked. We have a neighbourhood WhatsApp group. What started as a chat about food trucks on the community garden (we know how to live round here!) led on to Mr S (let’s call him) having a rant including mention of “undesirables” and “too much freedom of choice leads to anarchy and graffiti on the statue of Churchill”. This I found hilarious until, in response to someone leaving the group in protest, Mr S raised the bar by quoting Edmund Burke (‘All that is necessary for the triumph of evil is for good men to do nothing’.) and saying he ‘could not stand by when the extremist minority (meaning Black Lives Matter) tried to tell the majority they were wrong’. This is unacceptable in my eyes for so many reasons.

Back to statues. What do we think of Churchill? Hero? Arguably. Saint? Absolutely not! – But the point of the Black Lives Matter protests was, I think, not to denigrate him as a war leader per se (he was undoubtedly effective) but to highlight his treatment of Bengalis and his other racist policies. Should statues only be of saints? Do heroes have to be saints? Questions for another time.

So, who are the heroes of the COVID-19 emergency? Captain Tom, Marcus Rashford? How will we look back and decide who deserves a statue? Statues are a tangible symbol of the spirit of a time – a milestone in what is always a curated view of history. The narrative of COVID-19 has been framed to put the NHS up as the hero. This has led to some unfortunate consequences.

From the start, COVID-19 has been treated as an NHS crisis rather than a public health emergency. From the “save the NHS” slogan through “clap for the NHS” to the fifth test for easing lockdown (avoid overwhelming the NHS) the main message has not been about mitigating the impact on people’s lives but about saving the NHS. This consequentially required national, large-scale, one-size-fits-all solutions (e.g. drive-in testing centres) rather than boosting existing local systems. It has meant an emphasis on the acute response (e.g. Nightingale Hospitals) rather than using Primary Care and local public health and the neglect (at least initially) of the care sector and rehabilitation needs. What’s more it has had the consequence of downplaying the role of other health and care workers not based in the NHS.

The irony of local authority Directors of Public Health (DsPH) leading the NHS Test & Trace system has been lost to most commentators, but it could have dire consequences in terms of creating a sustainable future-proofed public health system and future funding for public health. The message we are expected to receive is that the NHS has done it all.

Don’t get me wrong. The NHS has done an incredible job reorganising and re-purposing to cope with the peak and this has undoubtedly had an horrific impact on hospitals and their staff. I also see absolutely why this approach has been taken. The NHS brand is incredibly strong and it holds a unique place in the British psyche. It was essential to persuade the public to accept what were indeed unprecedented and (for the UK) draconian restrictions and putting everything under the NHS banner helped to do that. I get it – but nothing has been done to mitigate the effects of that framing. The messaging has not been an add on; it has been the whole plan.

My hope is that the historians who curate the history of COVID-19 will see behind the message and understand that there are millions of heroes who have worked their socks off in many different organisations – not least the local and regional public health teams. ‘The Salisbury Poisonings’ (unmissable and currently available on BBC iPlayer – other dramas with a UK DPH as main character are not available) showed what a good Director of Public Health can achieve through collaboration and with the support of other agencies. DsPH late arrival in the national plan for COVID-19 is very welcome but has made life difficult, particularly attempting to tie in with those new top-down systems.

We all have our heroes and very few, if any, will be saints. But for the nation to pick out one for a statue tends to be divisive. I prefer the Unknown Hero model reflecting the many and various roles they have played. I don’t know if our COVID-19 heroes are a minority or the majority but I do know that the views of the minority count even if they do oppose the majority. I left the WhatsApp group – as did many of my neighbours.