Covid-19: the national and local responses
2 Nov 2020 03:23 PM
In March, at the beginning of the coronavirus pandemic, the Government’s prevailing narrative was that of a colossal national effort led centrally from Westminster and supported by the scientific evidence from experts appointed to SAGE.
During that first stage of the crisis, as national lockdown was enforced, little emphasis was placed on local expertise or decision making in matters such as the extent of lockdown. This centralised model is illustrated by the early failure to empower meaningful local action through sharing comprehensive test results data with councils.
The nationwide lockdown did have the advantage of equity, placing everyone in the same boat. Initially, lockdown did reduce infection rates, preventing the NHS from being overwhelmed. This bought time to implement other strategies such as Test, track and trace.
Unfortunately, the unwillingness to engage councils in managing the crisis represents a failure to mobilise highly experienced allies. By surviving austerity, local government has honed many of the skills necessary to survive the pandemic:
- partnership building
- risk management
- cross-agency working.
Lockdown was a blunt instrument that took little notice of local variations of infection, either at the point of locking down or crucially when unlocking. Andy Burnham, the Mayor of Greater Manchester, has been a particularly outspoken critic of government interventions. Burnham was critical of what he termed the “illogical approach” to releasing lockdown measures in the Greater Manchester boroughs of Bolton and Trafford, an announcement criticised by local council leaders. It emerged that Bolton had one of the highest infection rates in the UK. Subsequent to announcing a lifting of measures, the government announced a further tightening of measures specifically for Bolton.
Comments from councillors
- Manchester City Council
Westminster now finds itself in another wrangle with Greater Manchester leaders regarding tightening restrictions in the city region. In a recent blog, the leader of Manchester City Council, Councillor Richard Leese, makes a case for a targeted funding programme to shield the groups known to be most at risk of hospitalisation and death. This argument is based on evidence of transmission in the Manchester locality.
Leese believes that the closedown of bars and restaurants may well make transmission levels worse by closing well-regulated meeting places and giving citizens little choice but to meet at home in a non-regulated space.
There is a widespread sense of frustration amongst local leaders in the North that government will not listen to local knowledge and consider rethinking the strategy of lockdown.
- Cheshire West and Chester Council
Louise Gittins, the leader of Cheshire West and Chester Council explained that council leaders are very concerned about the availability of sufficiently granular data. Initially, data was not released in a timely way and anonymised, making it challenging to identify and act on the sources of infection hotspots in a locality. For example, postcode data was not made available to public health officials, making it difficult for public health to trace those tested positive for Covid.
Cllr Gittins now believes that the situation has improved:
“It is 100% better than in June. It was desperate in June. It took a long time for data to come through. I don’t know if it was the Government not listening or not wanting to give that information.”
In answer to a question from Stella Creasey MP Health Department Minister Nadine Dorries revealed that testing contracts require Deloitte, as the provider for Pillar 2 , to set up testing facilities but not to share data related to test results. While these contracts were almost certainly drawn up in haste, some lack of attention to detail is perhaps inevitable.
As case numbers are now rising again, it is undoubtedly now the time to get this right and give councils the data and financial support necessary to respond locally.
Local authorities have now demonstrated that they can co-ordinate and provide services to manage outbreaks of the virus more effectively than a one-size fits all national solution:
- In Blackburn and Darwen, a local approach quickly proved its value; contacts are called from a local number, and if, after 48 hours, it is not possible to make contact by telephone, a visit from a contract tracer is arranged. Significantly, the community-based service can address crucial language issues in an area with a sizable minority ethnic population. The council reported that after one week of operation, they managed to contact 9/10 of the cases the national system had been unable to reach.
- In Cheshire West, located on the highly porous border with Wales, there is the added complexity of sharing data with devolved governments. It seems that in early July, Dido Harding, head of NHS Test and Trace, promised councils that there would be a deal on data sharing between England, Scotland, and Wales. This issue is yet to be settled.
Central vs. local
Throughout the long spring and summer, it has appeared that devolved and Westminster governments have been engaged in a competition, resulting in confusing messages about travel, social gatherings, and face coverings. Fortunately, this situation is being mitigated by positive working relations locally; for example efforts made by officials on both sides of the England-Wales border to agree on joint communications clarifying the differences in approach between the Cardiff and Westminster governments and its implications for residents.
The everyday practicalities of operations where organisations co-operate on a regular basis ensure that critical information is exchanged appropriately. Cara Williams, Chief Digital Information Officer at the Countess of Chester NHS Trust, highlights data sharing driven by existing operational imperatives. Trusts on either side of the England-Wales border regularly care for patients resident in each other’s area, thus establishing procedures for data sharing.
Although the Westminster government would appear to wish to engage in battling the virus without allies, effective partnerships are a significant asset in the local government and health sectors, never more so than when dealing with complex matters such as a pandemic.
CIPHA COVID-19 Response (Combined Intelligence for Public Health Action) is an excellent example of partnerships innovating at this time. CIPHA is a data dashboard commissioned by the Cheshire and Merseyside Hospital and Out of Hospital Cells.
It integrates a range of data sources to help public health departments:
- identify geographical hotspots of infection
- monitor changing healthcare demands
- determine if sufficient capacity is available to respond to any surge second wave of infections.
In Greater Manchester, a digital platform has been developed which provides situation reporting essential information such as:
- staffing availability
- infection rates
- PPE stock levels
- staffing availability
The platform connects 10 local authorities, 445 GP practices and 681 pharmacies, giving visibility of pressures and issues during the outbreak.
Local government is enormously innovative and energetic when promoting the best interests of citizens. Given the right tools to work through the pandemic, the sector can be a valuable support and ally for the central government. Of course, financial aid is essential. But, in the time of coronavirus, councils can be empowered with the right tools, consistent messaging, open and anonymised data, fit for purpose contracts and data sharing agreements, supported by a real commitment to collaboration across the different levels and sectors of government.
 Note: Coronavirus testing in the UK is divided into two groups: Pillar 1 (swab tests for COVID-19 processed by NHS and Public Health England labs) and Pillar 2 (swab tests for COVID-19 processed by commercial providers such as Deloitte.) During the first months of the pandemic before early August, only limited data was shared with councils.
This is a guest blog post written by Graham Catlin.
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