PUBLIC HEALTH

Putting local resilience under the spotlight

Views are mixed on how local resilience forums have performed during the COVID-19 emergency. Have austerity, Brexit planning and central Government’s original command and control approach taken their toll? Dan Peters reports.

Pandemics took place three times during the 20th century so these were not unheard of events.

The Government's February 2013 pandemic flu guidance stressed that the years in between were a ‘very important opportunity to develop and strengthen our preparations for the potentially devastating impact of an influenza pandemic'.

This brought the Government to simulate a severe flu pandemic in October 2016. A little over three years later and it wasn't flu but a new coronavirus that meant the plans that had been tested by Exercise Cygnus were being put into action for real.

Speaking at the time the final report on Cygnus was published in July 2017, medical director at Public Health England, Professor Paul Cosford, said the lessons identified would help to inform ‘future planning and preparedness at the local and national level'. Those findings included that there was a lack of clarity about arrangements for the distribution and storage of personal protective equipment (PPE) for social care.

A debrief report on Cygnus by the South Yorkshire local resilience forum (LRF) read presciently: ‘In a flu pandemic there may be uncertainties around accessing PPE and its provision for social care including independent care. Demand for PPE may also result in BC [business continuity] issues. More thinking is needed around access to the national stockpile and use of PPE in social care including independent care and potential BCP [business continuity planning] issues.'

It is not fully known what was done in response to Cygnus, but, as of last week, South Yorkshire LRF was still telling the Government that the issue of PPE was having a ‘significant impact' so perhaps the warnings were not heeded.

Experts suggest a combination of Brexit and austerity may have got in the way. Richard Stokoe, who lectures at the University of South Wales on planning for disasters and civil contingencies, said: ‘Brexit's been the only game in town for a while.

‘The other thing is that austerity bites. The longer it goes on for the more it starts to bite into key services. Local resilience stuff is a must-have but it's not right at the top of the list. People will do the best they can in the circumstances they have.'

England's 38 LRFs, which normally work in the background, have had to step up to deal with the emergency.

One council chief executive said: ‘They are an effective way of agencies getting together though often the meetings last longer than they need to. Sometimes they're not particularly strategic and end up talking about minutiae.'

Mr Stokoe added: ‘The whole purpose of them is to be there only in emergencies. They're not huge outfits. They're basically ignored until big stuff happens.'

LRFs had been told by government guidance to develop plans for up to 315,000 additional deaths but very little can prepare you for the real thing.

One council leader said: ‘LRFs have been thrust into the limelight. Some have political oversight, many don't. They're more geared to civil contingencies but have had to make arrangements for PPE distribution and mass body storage.'

Views on how LRFs around the country have performed in the current crisis are mixed.

Prof Martin Green, chief executive of Care England, which represents care home providers, said some LRFs were ‘working fantastically well and some are frankly shambolic'.

One council chief added: ‘A number of us have variable experiences dealing with our LRFs.'

More than 50 million items of PPE have been delivered to LRFs for distribution since the start of April, but councils continue to wait for a new online portal to help primary and social care providers order masks, goggles, hand sanitiser, aprons, gloves and body bags.

Local Government Association chief executive, Mark Lloyd, told a select committee last week: ‘LRFs had to step in to respond to the issue that we had got. They were provided with inadequate levels of supply initially. LRFs are doing their best to plug the gap in the interim, but my fundamental answer is that they should not need to.'

Ministers privately admit they originally took a command and control approach, concentrating decision-making at the centre. The 400-page Coronavirus Act 2020 passed into law a matter of weeks ago included significant and extraordinary centralising powers, including limiting events and gatherings, closing schools, extending notice periods for evictions, postponing elections and suspending requirements under the Children's Act 2014.

Mr Stokoe accepts that things like the lockdown had to come from central government but is scathing about Whitehall's response.‘The only thing that central government is doing is getting in the way,' he said.

‘You've got the local government department trying to micromanage the local authorities. [Local government secretary] Robert Jenrick seems like a slim Eric Pickles who's happy to kick councils for tiny things because it gets him a headline.

‘It's that local working between local organisations that's been more successful. Councils are working behind the scenes making so much happen and, in terms of the main services that need to operate, they still seem to be. That's to the credit of local authorities.'

One thing the UK Government did not do - unlike most countries - was declare a state of emergency.

Robert Pollock, a former senior civil servant at the Treasury who worked across a number of policy areas under four chancellors, said: ‘By not declaring a state of emergency there is currently some confusion, at least from the local areas I have spoken to, about the role of the UK's LRFs.

‘Years of learning about preparedness for a pandemic and the associated decision-making structures aren't being used effectively. There is a lack of local co-ordination between public services, and a lack of co-ordination between the public sector and local communities. We risk muddling through in a very British emergency.'

Mr Stokoe agrees to an extent but thinks that a state of emergency, which has not been declared since 1974, was not the right route.

He added: ‘A state of emergency is not very British. It's never been a cultural and social thing that's been done. I don't think a state of emergency would have helped.'

Emergencies – officially declared or otherwise – eventually come to an end and the UK will soon start to promote a return to normality and the restoration of disrupted services. LRFs have started standing up their recovery coordinating groups, but already there are local government mutterings about overreach, with council bosses keen for councils to resume the lead.

Everyone is keen for the earliest possible return to normality, but the normal that's returned to is likely to be radically different from the normal we knew before.

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