'Councils are at the forefront of this now'

Interview with Helen Atkinson, Director of Public Health, Portsmouth City Council.

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This is the twelfth in a series of interviews with public health directors, published on 22 June 2020.

Helen Atkinson only became Director of Public Health at Portsmouth City Council at the start of February after seven years at Surrey.

It was, of course, a baptism of fire as the first cases of coronavirus had begun to emerge. But it was made so much easier by the level of integration in the city – the council and CCG share the same building, while a number of posts, including the director of adult social care, are joint appointments.

“It’s not just partnership work, it’s true integration,” said Ms Atkinson. “One of the real advantages I have found working in a unitary authority, especially one that is in a relatively condensed area like Portsmouth, is this level of integration. You don’t get that in two-tier areas.”

How integration helped support care homes

That has been of particular benefit in the work that Portsmouth has done to support its 39 care homes. Every Thursday throughout the pandemic Ms Atkinson, the director of adult social care, who also acts as the CCG chief operating officer, and the CCG director of infection prevention and control have met virtually to discuss the situation in care homes with their teams.

Ms Atkinson said: “We can, of course, meet and talk through things at other times – and we do – but this is the opportunity to really go through the data with a fine toothcomb and check we are doing everything we can.

“We look at the national data on confirmed cases and weave that together with our local intelligence from hospitals, care homes and Public Health England intelligence. We can quickly pull things together and react in a timely way where needed.”

There are several examples of how this has helped. In the early days the close relationship meant the provider infection prevention control team was able to visit each care home and provide training and advice on how to prepare, manage and prevent outbreaks ahead of lockdown.

As the pandemic has proceeded, the approach has also provided the intelligence needed to decide which care homes should be prioritised first for whole home testing, while national guidance on everything from PPE to cohorting residents for isolation advice has been quickly interpreted and disseminated.

Portsmouth City Council also sourced its own stockpile of PPE to supplement the supply routes for care homes and the supply coming from the local resilience forum, which covers Hampshire, Southampton and the Isle of Wight as well as Portsmouth. It meant care homes have been well supplied with the protective kit they have needed.

The results of this approach can also be seen in the way outbreaks have been prevented and controlled. Thirteen care homes have had cases, including two in-house homes that specialise in dementia. There have been no new outbreaks in care homes in Portsmouth for just over five weeks.

Ms Atkinson said: “There is always the risk of future outbreaks, but it is really pleasing that we seem to have been able to prevent Covid  spreading. It shows the positive impact the joint working has had. Protecting our care homes has been a key priority.”

There are still frustrations

But alongside the successes, Ms Atkinson said there has been some frustrations. “It’s amazing to think this pandemic has only been going on since February. So much has happened – it seems like a lifetime. We are all learning a lot.

“Like many other DPHs I have been frustrated by the lack of data coming from the national testing programme initially. We were having to look at the national dashboard to see how many confirmed cases there were in our area.

“That information is coming down to us now, but we are not yet getting postcode level data. It means we are only getting part of the picture.

“As we develop test and trace, we will need geographic data on where our confirmed cases are to ensure we can do the outbreak control work and getting up-to-date information will be crucial to that.”

Local government ‘has crucial role now’

Schools have become a major focus for Ms Atkinson in recent weeks. She chairs a local infection, prevention and control group with head teachers, which has played a vital role in advising schools as they open to more children. 

“We have had low levels of infection in Portsmouth which has allowed me to provide reassurance to all the schools and they have all opened. We have provided advice and support to them on social distancing, PPE, face coverings and setting up bubbles for staff and class groups.

“This goes to the heart of what we do as DPHs. We are there to provide confidence as well as warning about risks. As the government relaxes restrictions and tries to get the economy back, people will be worried. We have to mitigate against a rise in the R number and an increase in new infections. 

“Councils are going to be at the forefront of this - through our work alongside the national test and trace system with our outbreak control plans. But it is not just about preventing the virus, it’s about the indirect costs too.

“I am concerned about health inequalities which are widening – we are going to see worsening mental health issues and rises in child and domestic abuse. We are going to need to support our residents with these critical issues and help them deal with the consequences of lockdown.

“To date, the NHS has been rightly centre-stage and has received a lot of plaudits as they rightly deserve, while councils have been working hard behind the scenes. But I think we will now be leading this alongside them and people are looking to local government. We look forward to delivering for them.”