‘This isn’t over, but I’m cautiously optimistic as I retire’

An interview with Dr Liz Robin, Director of Public Health, Cambridgeshire County Council and Peterborough City Council

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This is part of a series of interviews with public health directors, published on 30 March 2021.

After three decades working in public health – nearly 20 years of which have been as a director of public health – Dr Liz Robin will retire at the end of April. It is a retirement she delayed because of the pandemic – but one that she feels she can now take because of the progress that has been made.

“I was due to retire at the start of the year, but we were in the middle of the second wave. It was a difficult time. I could not have left then, but now feels right. We should be cautiously optimistic where we are now. There are challenges ahead, but we are on the right path. 

This has been unlike any year I have experienced. I was a director of public health during the Swine Flu pandemic. I was involved in emergency planning then and that experience has obviously helped me, but what we have faced with COVID has been on a different level all together.

“Being in local government has been a real strength – back in 2009 directors were part of the NHS. It has allowed us to work with the community in a way that would not have been possible a decade ago. That has made a big difference.”

The vital role played by community leaders

In fact, working with the community has been one of the key foundations of Cambridgeshire and Peterborough’s approach to the pandemic, Dr Robin said.

“We have 130 languages spoken in Peterborough alone so engaging and connecting with our communities in different ways has been vital. We have worked with community leaders very closely – they have done videos and translated things into different languages.

“Those videos have then been posted on social media and used in other ways. Right at the start of the pandemic we did some videos on the lockdown rules and need for social distancing. The police even used these – they had them on their phones so they could show people they came into contact with and encourage them to follow the rules. It is important to remember not everyone is following mainstream media.”

This approach has also been crucial during the vaccination programme, said Dr Robin. There are now a network of community champions who are promoting vaccination in their communities. Videos have again been used, while scripts have been supplied to help the champions explain the importance of vaccinations.

Dr Robin said: “The communications team have been really vital in this, ensuring simple and easy-to-understand messages are given. Throughout they have been supporting the public health team with this.

“Others have played their part too. We have worked with local GP who had a weekly health programme on local BBC radio. She helped explain all sorts of things as the pandemic was starting, such as social distancing. You have to connect with people in different ways.”

Learning from the first wave

Looking back to the start of the pandemic, Dr Robin said it is noticeable how much has been learnt. “Everything happened very quickly once March came. But in the early stages I remember it was quite incremental. We started with a multi-agency teleconference for LRF emergency planning leads in January which we had weekly, and it gradually built up from there.”

“We were not hit as badly as London, but we still saw a lot of cases. It has been similar in the second wave. We have all learnt a lot from those first few months. The most important thing is that we now have more knowledge and understanding about the virus and how it spreads, as well as better availability of PPE and lots more testing in place. 

That learning continued in the summer. While many areas saw infection levels drop significantly, Dr Robin was battling above average rates in Peterborough. The city was on the government’s watch list after being in the top 10 areas for infection at the start of the summer, when the country came out of lockdown. 

“Many local people had continued working through lockdown in essential industries, particularly food packing and distribution, and some were sharing cars and sometimes minibuses to get to work. We worked with our environmental health, transport and communications colleagues to help address that  - and as rapid testing became available we have helped them with that too.”

“Peterborough was an area of concern last summer - we didn’t have extra restrictions imposed - but we did need to do a lot of work. That has subsequently stood us in good stead. We’re now seeing some of the same issues - with people having to go out to work during lockdown and higher case rates in Peterborough and Fenland - but have a better understanding of the root causes.” 

The experience paved the way for what has become a key element of Dr Robin’s approach to working at local level. As well as regular county-wide Covid-19 gold meetings, we now have district/city-level gold meetings set up and run every week which focus on a rapid local response.  

“We bring together all the intelligence we have and discuss it at these meetings, which involve public health, district and city council staff and other local partners. It has helped us be proactive. For example, in one area we saw infection rates climbing quicker among people in their 60s so we wrote a letter to all households in that age bracket to warn them of what was happening. 

“It was a prompt to remind them to be even more vigilant. Being able to respond like that on a really local level can make a big difference.” 

‘Most difficult times should be over - but still a way to go’

But, of course, it is the vaccination programme that has really changed the landscape, said Dr Robin. “It is breaking the relationship between case rates, deaths and hospitalisations, particularly in the over 70s. That should reduce the pressure on hospitals. But we have to remember the middle aged are still vulnerable. There are still challenges ahead.  

“The vaccines are good, but they are not 100% effective and not everyone is getting vaccinated.

“I think communication is going to be key in the coming months. People are desperate for good news and it is important we keep spirits up and improve wellbeing. But we have to be clear about what precautions people still need to take.

“We have had some incredibly difficult times – I know all directors of public health feel the same. Not getting the information from the pillar two testing in the early days was really frustrating. It is much better now. We have lots of information.

“The biggest issue now is fatigue. As directors of public health, we are worried about our staff. The workloads are not manageable in the long-term.

“But the vaccination programme is a game-changer. Together with other measures it is our way forward, and has given everyone a boost just when we needed it. I know it is not going to be easy from here, but I think we are getting there.”