This pen portrait is an imagined experience, based on the interaction between residents and councils and councillors across the country.
Mary, 57, and Keith, 59 are a married couple and live together
The past year or so has been a bit of a struggle. Keith and I always kept ourselves to ourselves. When COVID first came in March I was really scared. Keith used to laugh at me. But I was worried because I’m the main carer for my 85-year-old mum who lives near us on the estate. I wasn’t sure if I’d be allowed to carry on seeing her. I do everything for her. Her shopping, her cooking – and she likes the company. But the council was really good. Someone phoned my mum and offered to send her a food parcel and checked to see if she needed any other help. In the end we didn’t need it as I just did everything for her. But it was nice to know that the housing officer knew that mum was alone and might need help.
Then things seemed to get better and we even went out in the summer, but then in the early part of 2021 we both got COVID pretty nastily. The doctor said that in the future we need to think about quitting smoking and getting fitter. I was worried about my mum as I couldn’t go and see her. I got in touch with the council again and they were really helpful. Firstly, they said we qualified for test and trace self-isolation payments. Secondly, they got mum some help with her shopping and arranged for her medicines to be sent directly to her home.
After having COVID I decided I wanted to get my vaccination done as soon as possible. Keith wouldn’t go, said he wasn’t going to be told to have a jab. I got really upset and spoke to the doctor. Then this community champion man came to our house. He had a long chat with Keith and left these leaflets. In the end Keith came round and decided to get his vaccinations done.
We are all vaccinated now. But I’ve been thinking about what the doctor said about us stopping smoking and getting fitter. It’s just all really hard to do at our age and we can’t afford any of those expensive slimming programmes or ‘quit smoking’ courses. I’m hoping this local ‘healthy lifestyle service’ that the GP mentioned will be able to offer me and Keith some help.
Delivering during COVID
Throughout the pandemic public health services commissioned by local councils have worked quickly, efficiently, and creatively. Public health has used its experience in communications, behavioural insight and health campaigns to engage with local people to tackle outbreaks and maintain safety. Councils have been flexible and innovative in keeping health and wellbeing services running through digital options and has sought to tackle the impact of the pandemic on health inequalities.
Significant work has been undertaken to establish mechanisms for supporting vulnerable people during the pandemic. This work cuts across a number of key stakeholders from local government to the NHS, local resilience forums (LRFs), food distributors, food charities and the wider VCS. This work meant that collectively millions of vulnerable people – like Mary’s mother, were shielded and received food and medicine parcels, additional support was provided for surge testing and outbreak management, special programmes were delivered to increase the uptake of the vaccine in difficult to reach communities and other essential public health services, such as sexual health and mental health support, moved online so that people still got the help they needed.
Public health in local government is at the heart of local work to tackle the virus. It provides the leadership, expertise, partnership-working and access to local resources that are fundamental to the strong place-based coordination of health protection and health improvement.
From a local perspective, getting the right balance between national and local measures to tackle the pandemic has been an ongoing challenge. There is appreciation for the hugely difficult job national government had in responding to the pandemic, and an understanding that some measures are most effective when coordinated and delivered on a national basis. Not least of these was the vital national decision to prioritise the development, purchase and speedy roll-out of vaccinations.
However, throughout the pandemic, council leaders have called for greater involvement in decision-making and better dialogue before national announcements about measures with implications for local areas. Moving forward, it is essential that there is greater recognition that public health, wider local government, and local partners have the skills, expertise, local knowledge and infrastructure to play a major role in combatting local outbreaks.
Directors of public health feel personally responsible for protecting the health of people in their areas and need the tools to do this well. Two key areas of concern were restricted access to nationally collected data and an initial lack of local involvement in contact tracing. As a result of shared experience and learning between national and local organisations there have been improvements throughout the year, but this took time.
Moving forward, public health cannot be in a position where it faces restricted access to nationally collected data, particularly information about the locations of people testing positive at postcode level, as this hampers the ability of the service to monitor, analyse, model and take action on local virus patterns and outbreaks.
There is a strong view in local government and public health that if sufficient data had been shared more quickly then contact tracing could have been localised sooner. This would have led to a more affordable, swift and effective system. For this to work, a ‘team of teams’ approach is needed with the responsibilities of each part of the system clearly articulated and properly resourced.
Research is taking place into the effects of people experiencing long COVID symptoms. Less is known about the longer-term impact of living through the pandemic on the general public – their mental wellbeing and resilience, for instance – more information will emerge in time. The pandemic has had a major impact on the health and wellbeing of our society and recovery will be a priority for public health for many years.
As we come to live with COVID, services will need to be on constant high alert, to be responsive to new variants of concern and act swiftly to get on top of areas with enduring transmission.
Public health teams in councils have been at the forefront of this tremendous local response to the pandemic and are ready to work closely with the new UK Health Security Agency (UKHSA) and the Office for Health Promotion. It is more than evident that responding to and recovering from an outbreak of this scale should start at the local level, working closely with national agencies.
The UKHSA needs to be able to operate nationally as a global player to major health threats. This should then be aligned with councils’ ability to react swiftly on the ground, using their local knowledge, expertise and skills. It is vitally important that we clearly define the role and accountability of each, as well as devolve more leadership, control and resources to councils. Health inequalities between the most and least deprived have been exacerbated by the pandemic, so it is essential that any future model for health protection be intrinsically linked with health improvement, if we are to realise real improvements for our residents.
It is widely accepted that prevention is better than cure. The Office for Health Promotion has an opportunity to enhance this focus on prevention. All parts of the public health system – including councils’ public health services – have a role to play in promoting healthier choices, preventing sickness and intervening early, to reduce the need for costly hospital treatment and social care. By embedding prevention as a core focus of its strategy, the Office for Health Promotion will ensure the best outcomes are achieved for people.
How can we empower local public health to improve the health and wellbeing of local communities?
The Government’s levelling-up agenda was important before the pandemic and is now even more essential for a stable and prosperous future. A comprehensive, ambitious and energetic drive to tackle the social determinants of health at national, regional and system level must take place and be properly funded.
Local government and public health should work with national and system partners to develop a new model for health protection – one which does not just tackle outbreaks or incidents, but responds to the impact on individuals, and harnesses the power of communities.
A full evaluation of the pandemic response is needed, but early suggestions from local public health is that there should be a shift to emphasising the impact on individuals and communities affected. A key example is the issue of people on low incomes with unstable employment finding it difficult to self-isolate for financial reasons, and the Government’s provision of £500 funding to support isolation. The role of voluntary and community organisations in the pandemic also suggests a greater role for that sector in emergency response.
Using online and digital communication has been the cornerstone of making services more flexible. Many were already increasing their digital offers with new contracts for services like sexual health and stop smoking. Some, not traditionally associated with digital communication, like health visiting and drug and alcohol support groups, have developed online offers, which are being evaluated for effectiveness.
While digital communication will never replace one-to-one contact or groupwork, it can be highly effective, provides good value for money, and is popular with many participants who find it more convenient, more relaxing at home, and more environmentally sound.
There are big questions over the longer-term impact on the general population that need to be better understood – for example, will there be longer-term impacts on the mental health of young people, on drinking patterns, on obesity? Public health will be working on these issues in the coming years.
The health, wellbeing and prospects of children and young people, particularly in deprived areas, have been damaged in the pandemic. Early years support forms the basis for future healthy lives, but important services with proven effectiveness, such as support for the first years in life, have often been the victim of economic austerity. Redeploying updated models of support, with enhanced digital offers and a focus on community assets, peer support and positive mental health in families, should be a priority.
At various stages in the pandemic there have been opportunities for local areas to be involved in national/local partnerships to trial new initiatives. Local government is ideally placed to do this because of its reach across infrastructure and communities, while partnerships between public health and academic institutions provides a good basis to pilot and evaluate new measures.
During the pandemic, many councils have reported issues with the availability of sufficiently qualified staff, leading to high levels of service disruption. With a fully funded and resourced workforce, councils can do much more to deliver public health services.
The public’s increased understanding of, and personal involvement in, health, and the upswell of community support during the pandemic are important opportunities which public health can capitalise on when the pandemic recedes. Models previously developed by public health, such as health champions, making every contact count (MECC) and asset-based community development have proved their worth. All of this provides a window of opportunity for the future.
If we build back local now, we can give people like Mary and Keith the support they need to be healthier, safer and happier.
Local areas need to be given the tools and support to understand and address the economic, social and psychological impacts of the pandemic, and the serious health inequalities that have been highlighted and deepened. If this can happen we can start to build an approach which finally addresses deep rooted issues and has a chance of delivering genuine levelling up across the country.
Public health: sector support at a glance
COVID-19 response support
The COVID-19 Response and Coordination programme supported councils with local contact tracing, community testing, surge testing, shielding and the clinically extremely vulnerable (CEV). In collaboration with the Ministry of Housing, Communities and Local Government’s (MHCLG) National Vaccine Deployment Group, we also developed a think piece to support councils in using behavioural insights techniques to encourage greater vaccine take up. Cross-body working has remained an ongoing feature of this work, with coordination between government, council leaders and chief executives, and councils to prepare for and manage outbreak planning in support of local communities.
The Test, Trace and Outbreak Management programme created further tools and resources to address and share leadership challenges, including dedicated sessions and top tips for chief executives and leaders – as well as the establishment of a Local Outbreak Control Plans Advisory Board, which brought together expertise from across local government to support councils to manage outbreaks more effectively.