'I have tried to be a visible, trusted face'

Interview with Dr Justin Varney, Director of Public Health, Birmingham City Council.

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

Engagement and communication has been a big priority for Birmingham City Council Director of Public Health Dr Justin Varney.  So much so that he has been spending at least seven hours a week answering questions from the public in different spaces and formats.

In the last week alone, Dr Varney has held online discussions with local mosques, black churches, an inter-faith group and a Bangledeshi women’s group and Bangledeshi men’s group. This is on top of his weekly slot on BBC West Midlands radio on a Tuesday morning and a Wednesday lunchtime all-staff session for council staff.

Dr Varney said: “Right from the start, I’ve made sure we have done as much engagement as possible. Pre-lockdown it was face-to-face, but since lockdown it has obviously had to be done remotely. We’ve done regular Q&A sessions including sessions with local media such as Birmingham Live and New Style Radio as well as live sessions on digital platforms like Facebook and Instagram with local influencers.

“We’re all scared. We’re all worried. I’ve tried to be a visible, trusted face and voice. I come from a medical background so have been able to answer some of the clinical questions too which also helps.

“You have to be authentic and honest - sometimes it’s not about providing the perfect answers, as so much is uncertain and unknown, but rather trying to explain and engage with people.”

Engage on a range of platforms

Alongside, these regular engagement exercises, Dr Varney has held digital meetings with the local Chamber of Commerce, the creative arts sector and the WM LGBT Alliance, joining existing networks of businesses and professional groups to listen to concerns and answer questions as people try to navigate national guidelines and what it means to them.

“It’s important to try a range of different forums to reach out to as many people as possible. I am aware I have not reached everyone. I would have liked to have done something specifically for children – I think Jacinda Ardern in New Zealand did this very well.

“The digital divide also concerns me, not everyone is online and so much communication has been done via online one way or other. That’s why the radio is important as it does engage a different demographic.

“The sort of questions people ask has changed over time. People ask very practical questions – they want to know how it applies to their lives. Recently we have had a lot of questions about the social bubbling guidance.”

The risk to BAME community ‘concerning’

Dr Varney said he had tried out some different social media platforms too. “I’ve done Instagram live Q&As with younger people. It is a very different way of communicating. Questions stream up on the screen alongside various emojis and clouds of hearts and thumbs when people agree or like your response. It’s a very fast paced engagement space and working with people who already have an audience it has been a good way of reaching out.

“We also did a bilingual Q&A sessions, before lockdown with Sikh Channel KTV and during lockdown through online Mirpuri channels. If you speak English it is fairly easy to get advice and understand guidance if you want. But the national information has not always been disseminated in different languages.

“I think the assumption is you can use Google translate. But you can’t always do that – we have over 100 languages spoken in Birmingham and we really wanted to provide opportunities for people who don’t have great English.”

Indeed, what coronavirus means for different ethnic groups has been a big focus for Dr Varney.  A risk analysis by Public Health England published in early June showed the BAME community were at higher risk of dying with coronavirus and before this the city had identified concerns and convened a special meeting of the health and wellbeing board to discuss these with local NHS leaders.

“As the pandemic has progressed, the inequalities of impact on ethnic communities has become ever more clear although we still don’t fully understand why and what needs to change before the next wave. Our cabinet member, Councillor Paulette Hamilton, heard these concerns directly from the community early on and convened a special meeting of our board. We put out a call for questions from the public and over 600 came in.

“We ended up splitting them into different themes and, as well as broadcasting the meeting live, we also recorded it and put it online so people could listen back. Everyone who submitted a question got a written answer from Councillor Hamilton, which took a while but it was the right thing to do.”

‘Connecting up the dots has been a weakness’

The debate over risk to BAME communities has also demonstrated what has emerged as one of the key weaknesses in the UK’s approach, according to Dr Varney.

“The system is not very good at connecting dots. As directors of public health, we’ve really suffered from a lack of local information. If we had ethnicity data in February it would not have taken us two months to spot the link. But ethnicity is not included on death certificates, nor has it been part of the data on cases in hospital shared with us from the NHS.

“We will learn from this – and there are already signs this is getting better. We are beginning to get more information about who is testing positive. There is now a dashboard giving us a breakdown of pillar two testing.

“But I am still worried we may miss things. For example, we have a lot of people commuting in from outside Birmingham to work, from places such as Solihull, so we have to have approaches which connect across neighbouring authorities and look to connect the dots from the way people live their lives and their social and professional interactions. Fortunately I have a great relationship with my other DPH colleagues across the West Midlands – this is really a team effort.

“If we don’t spot the signs early, we will be in trouble. The government has talked about local lockdowns, but I am not sure how they will work. I’m not convinced it’s the important bit of the solution, rather it should be last resort.”

 ‘This is a war’

Unsurprisingly, Dr Varney said dealing with the pandemic has taken a toll. “Like all DPHs, I‘ve hit a wall at points. It has been relentless – we set up Covid cells in February and went to our public health business continuity response in early March - in these first three months I had virtually no time off. I was working weekends and late into the evening.

“I’m now trying to reserve one day a week as a rest day. The team can still call me if there is a problem. It is important we look after each other. I have received fantastic support from my deputy and from the council at every level, including from local elected members, especially my cabinet portfolio holder.”

He says he has also taken inspiration from the writings of Maya Angelou and Sun Tzu, highlighting a quote from each.

“Victory comes from finding opportunities in problems”  – Sun Tzu

“It is sad but true that sometimes we need the tragedy to help us to see how human we are and how we are more alike than we are different” – Maya Angelou

It is, Dr Varney said, like a war. “We’re in it for the long-haul. There’s lots of strategy, you have to be prepared to pivot and deal with things as they arise. But you have to keep the long-term objective in mind. You can’t keep analysing the battle you have just had, otherwise you miss what’s coming over the horizon.”