The power of local systems to save lives

By Donna Hall | 21 May 2020

We are really proud and privileged at the New Local Government Network (NLGN) to work with 70 of the most amazing forward-thinking councils in the UK. All of them are trying their hardest to work seamlessly with their partners in the NHS, police, housing, community and voluntary sector to face one of the biggest challenges of a generation.

COVID-19 has had a devastating impact on communities, particularly poor communities, and we now know that we will be dealing with the effects of this new virus for many months, possibly years ahead. There is a distinct possibility that without a strong and harmonious national and local strategy this hidden danger will destroy economies, local infrastructure and even communities.

It is really reassuring to our sector that Tom Riordan, CEO of Leeds City Council has been drafted in to support Baroness Dido Harding to resolve the nightmare that is testing and contact tracing in order to develop a coherent, robust and hopefully localised and resourced response.

I’m sure Tom will be making everyone in Government aware that councils and their local partners have been absolutely critical to tackling the spread of coronavirus; maintaining crucial services, setting up community hubs or building on their already established integrated place-based teams. They have been described as the ‘unsung heroes’ on the pandemic along with other vital front line teams.

However local councils and their partners could do even more to contain the spread of  COVID-19 if properly funded to undertake the testing and tracing of people who are known to have had the virus and their potential contacts.

I have seen first-hand the incredible work of public health and environmental health teams who work to test, track, trace and treat people with sexually transmitted diseases, hepatitis and HIV. They involve GPs, local NHS trusts and the local community to ensure no stone goes unturned.

I’ve been out and accompanied these highly skilled impressive multi-agency frontline teams and witnessed the supportive conversations they have with sex workers, homeless people and recent migrants to the UK in order to track and trace HIV, hepatitis and other infectious diseases. The systems are already in place locally to do this. We can do the testing and tracing with the right resources. The staff have had the right training and have local knowledge about which GPs to speak to, which classroom assistants, and who in the local community centre will know where a person lives so they can receive lifesaving treatment.

As in Germany, where local health staff tracked and traced the single canteen salt pot that had spread COVID-19 around the entire factory, local staff have the existing contacts and community knowledge as well as expertise. The success of the localised German approach speaks for itself.

Sometimes it isn’t just algorithms and apps - the tools of a campaign - that solve global issues; it’s about concerted local intelligence and anthropology followed up by local action.

How was the 1854 catastrophic cholera outbreak in London stopped? It was when local physician John Snow observed exactly how it was spreading. Similarly to the salt pot in the canteen, the source of infection in London in 1854 was the water in a particular water pump where people gathered their daily supply. The best course of action was to remove the pump handle so that people couldn’t use it and had to find an alternative supply. It worked!

Instead in the first vital months of the pandemic unlike other nations our Government seems to have opted for a tactical national but fragmented approach, rather than one that is  strategic and localised. A new national contact centre managed by the private sector would be a disaster. It removes the ability to link into local knowledge and existing tracking and tracing systems already in place in experienced public health and environmental health teams. Staff would need to be trained and then probably just send the information to the local NHS or council or Strategic Transformation Partnership. We simply haven’t got the time to do this.

The Government have announced that everyone over the age of  five years old demonstrating symptoms will qualify for a test. This is both vague and meaningless. When will they be able to receive a test? There is a real problem with the availability of testing and delays in the tests being returned. Currently the results go back only to the person having the test and not into the local system who can help them: their GP, council, etc. This information is effectively lost to the system.

Testing in isolation from a robust localised tracking and tracing system is also meaningless as it will only tell you if you have Covid-19 on the day upon which you take the test. This means you could go to the supermarket the following day and become infected. Therefore without a follow up tracing of the contacts of those who have tested positive and isolating with support, it is operating within a vacuum and virtually pointless. The random numbers of tests, achieved or not achieved do not tell us the real story of infections and future infections.

If we are to eradicate COVID-19, and this will take time, we need to learn from the way Ebola was tackled. Local solutions were deployed  - and deployed quickly and boldly.

In places like Greater Manchester and West Yorkshire and Harrogate Strategic Transformation Partnerships a more joined up approach to testing, tracing and isolating is being developed with the local resilience forum approach set out in the Civil Contingencies Act 2004.

Galvanising the existing resources and local expertise working in environmental health, regulatory services, public health, sexual health, infection control and TB teams to start testing and tracing is essential, using the already established infrastructure of the local resilience forums.

Similarly, the expertise in local laboratories in NHS Trusts could be used to provide a quicker and more localised response to testing. This capacity has been largely ignored as private sector contractors drive tests results past these state of the art facilities down to their privately owned laboratories in Milton Keynes.

We in local government and in our localised health and care systems are critical to preventing the unnecessary loss of life and we will be managing COVID-19 over a long time period so it is vitally important that we get this right and embedded as soon as possible. We believe in local government, in local systems and in communities. If we invest in them and believe in them they work wonders.

They have the ability and power to find the salt pot, remove the handle of the pump and can get to where an app or a person in a contact centre hundreds of miles away can’t. We have been doing it for hundreds of years. Now is the time for Government to really believe in its partnership with local government.

Professor Donna Hall CBE is chair of the New Local Government Network and chair of Bolton NHS Foundation Trust

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