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September 17, 2020
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ADPH Presidential Blog: The Path Ahead

Dr Jeanelle de Gruchy, President, Association of Directors of Public Health

It is now abundantly clear that we are experiencing an exponential rise in COVID-19 cases and we, as a nation, face an incredibly testing few months. We all have a role to play and responsibilities to shoulder as we strive to overcome this deadly, devastating virus and, over time, I hope, address the economic and health inequalities – and undervalued public services – that have left us more exposed than we should have been to COVID-19.

This blog is about where we are, the challenges ahead and what should happen next.

I want to start by directly addressing and thanking Directors of Public Health, public health consultants and all those who work in our teams – as well as our local partners - for their commitment, dedication, skill and leadership. You are an inspirational group of people and by drawing on our collective strengths we can, and will, continue to fulfil our statutory duty to protect the health of the communities we serve as we live with COVID-19. Our valued colleagues in local government, the NHS, Public Health England, the National Institute for Health Protection, the police and many others – including lots of people without ‘public health’ in their job title – are going above and beyond the call of duty day in and day out

I know half a year of lost evenings, weekends and holidays takes its toll – and we are all missing spending time with loved ones and friends. We must remember that we are human beings and, like everyone else, struggle to juggle what sometimes seems like a hundred balls at once. The reality is that the resources available fall woefully short of the scale of the task. I will return to the issue of pressures and capacity.

For the country, the path ahead of us looks rocky. We have learnt an enormous amount about what works and the improvements that are still necessary. Let us be clear what the task is: to do everything we can do to limit the transmission – and impact - of COVID-19. The pressing issues which require focus are consistent public communications, an effective Test and Trace Service and enough funding for every part of the system, including local government.

On public communications, the new ‘rule of 6’ is at least a simple universal instruction, but we know on a human level it raises all kinds of dilemmas in our personal lives and the political conversation should reflect this reality. There is certainly a case for more frequent national press conferences like we saw all those months ago with the Prime Minister, the Chief Medical Officer, the Chief Scientific Advisor and NHS leaders. Mixed national messaging and a complex labyrinth of measures and restrictions have left the public confused when what we need is clarity and consistency. The basics warrant repeating again and again: regular handwashing, wearing face coverings, maintaining social distancing and self-isolating if you’re symptomatic.

Of course, the messenger is just as important as the message. A key aspect of the Local Outbreak Plans, which Directors of Public Health are responsible for, is community engagement. Directors of Public Health have really made this a priority, working with Councillors, charity, faith and business leaders and community groups. Many councils have established local COVID-19 Community Champions schemes – networks of residents who share advice and information within their neighbourhoods and communities. It is not for Directors of Public Health or councils to enforce rules or regulations on residents, but rather to engage, encourage and enable everyone to protect each other. 

In June, we were told that the Test and Trace Service would not be “fully operational until September”. When schools, universities, workplaces and other parts of the economy reopened their doors, we were told the system would be ready to test, trace and support cases. Across the country, Directors of Public Health are saying that this is not where things stand; and it is not acceptable. Rather than aiming for the moon, the priority must be getting the Test and Trace Service working as comprehensively, effectively and quickly as possible. Without that, the virus will pass unchecked through our communities as it did in spring and early summer. There are already strong warning signs that this is happening. We know only too well the tragic consequences that follow.

So, what are the challenges? Directors of Public Health are reporting a range of shortcomings including limited or no testing capacity in their areas; requests for Mobile Testing Units being delayed; cases and outbreaks being missed by the system; poor quality and missing data; and slow or inadequate contact tracing. We all want and need it to improve fast.

That means increasing and targeting testing capacity so that all those with symptoms can get tested, minimising delays in processing and providing test results, optimising contact tracing coverage and supporting people to isolate – including by providing the right level of income to mitigate potential losses.

Finally, it means directing resources to where they are needed most. I want to come back to long hours and stretched local public health teams. The surge in cases represents a shift from a small number of outbreaks in a few parts of the country to a larger number of outbreaks and widespread community transmission in most parts of the country.

A decade of cuts has seriously compromised the capacity of local authority public health teams, other council departments and vital regional Public Health England teams. ONS figures analysed by the LGA show that the local government workforce has been reduced by 26.2% since 2012. Institute for Government analysis reveals that in the last year, the overall number of civil servants has increased by 2%.

Whilst funding of £10 billion has been allocated to the Test and Trace Service nationally for the work it is undertaking on COVID-19, the local response has been provided with only £300m. Despite talk of ‘local by default’ and ‘locally supported contact tracing’ there has been no additional funding package to meet growing expectations and additional responsibilities.

The situation is simply unsustainable. We cannot keep our communities safe on a shoestring.

As ADPH has repeatedly said throughout this crisis, the most effective culture is a ‘team of teams approach’ – for this to happen every part of the system should be funded properly to do its bit. There is a tipping point on the horizon for councils. An emergency funding package for local outbreak prevention and management is now urgent – we need more people in our places and money into our councils to get the work done.

Beyond the immediate funding and capacity emergency, the Spending Review offers a chance to reset the course of public health funding for the next three years and beyond. The profile and importance of public health – and all of us who work in it – has grown rapidly, as have our responsibilities. ADPH is calling for the upcoming Spending Review to reduce health inequalities through cross-government action, resource the health protection system – including local councils – to manage COVID-19 and prepare for future outbreaks and value the role of place and local public health leadership. There has never been a more compelling case for this agenda.

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