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November 10, 2020
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ADPH Presidential blog: Time to reset the strategy

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

We are, once again, being called upon to take firmer individual and collective action to keep each other safe. The national lockdown is necessary to control advancing infection, increasing hospitalisation and COVID-19 deaths. In this blog I consider how we must use this reset moment to forge a new consensus, reset our strategy and set out a national plan for controlling COVID-19 over the winter and lay the foundations for a more hopeful spring. 

Lockdowns and circuit-breakers serve a valuable purpose, as we learnt earlier in the year. A concerted effort to push the R value to as low a level as possible is the right thing to do. Reducing the rate of transmission and the number of infections will prevent unnecessary illness, stop our hospitals being overwhelmed and save lives. It is also the case that there is no path to economic recovery that does not involve controlling COVID-19.  

Polling shows the majority of the public support this intensive four-week mission, which is a testament to the kindness and character of the nation. However, these periods of severe limitations on personal, social and economic life can only ever be short, sharp shocks on the way to a better destination. And as we set off on this journey, we all should know where we are heading. We must use November wisely. 

As we pointed out in May, easing restrictions too quickly and without putting a sustainable approach in place is a mistake that will cost lives and livelihoods. As such we are calling for a road map to be developed collaboratively and put in place in early December ready for when the current restrictions are lifted (of course we can, and should, make progress on all these fronts in the meantime). The Government has previously set out plans at crucial points during the response to COVID-19, in March and May. A new phase requires a new plan – here is what should be in it.  

The month ahead

Firstly, a clear commitment to a “combination strategy” as set out in ADPH’s Protecting our communities guidance. After months of jumping from magic bullet to magic bullet, it must articulate the strength of a mix of measures and interventions in totality. No one thing will be our saviour. If we maximise the potential of adherence to the basics, like social distancing, face coverings and handwashing, behaviour change, the Test and Trace Service, treatments and vaccines then we will make significant progress together.  

Secondly, a focus on winning hearts and minds. The public are not naïve, they know COVID-19 will be with us for some time and want an honest conversation about the longer-term implications of this. In Protecting our communities we outline how the confidence of the public, and indeed all actors in the system, is crucial in any major health protection challenge.  

Trust, goodwill and collaboration between the public, service providers and system leaders are all critical components of the response to a pandemic. When they are undermined, the public may disengage from the behaviours needed – and understandably so. Rather than talking about a lack of compliance and talking up enforcement and fines, we should put our energy into engaging, informing and enabling, especially in relation to supporting self-isolation. 

As Directors of Public Health, we can support this locally through: greater and consistent use of psychological and behavioural sciences; clear and consistent local communications; and working in strong partnership with locally elected members and communities. 

Thirdly, a level of funding and resources which support individuals, businesses and public services to make the contribution being asked of them.  

Of course, the public finances and the ability of businesses to operate are of deep concern. Directors of Public Health are passionate about a thriving economy and good jobs because they are vital to healthy lives and healthy communities. Fundamentally, there can be no recovery if we don’t control the virus. The countries that have got a grip of transmission are finding their economies are recovering stronger and faster.  

In respect of funding for the local public health response, as I set out in my last blog, we cannot protect our communities on a shoestring. Local public health teams are stretched to breaking point and burdens continue to grow without the funding, capacity or resources to meet them, not least in relation to the Test and Trace Service. The plan we are urging the Government to develop for December, must identify and allocate the resources and capacity that local councils need to carry out their responsibilities during this pandemic; and indeed, build longer-term capacity across the public health system for this pandemic, and the next. 

I know Directors of Public Health – and our colleagues in local authorities, PHE, the NHS, national government and the third sector – are very, very tired. Our businesses and communities have been sorely challenged and we all long for an end. We have found resources and reserves we didn’t know existed, created deeper connections, built new relationships and we can all be proud of our contribution to the COVID-19 response. 

As Directors of Public Health, we must preserve and continue to draw on our knowledge, skills, experience and partnerships to help the communities we serve through what will be a tough winter.  

Over the next four weeks, we need to see a much clearer approach emerge so that we can exit these tighter restrictions in a better state than the one we entered them in. The clock is ticking, there is no time to waste. Let’s pull together.  

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