The value of local leadership

By Professor Jim McManus | 12 June 2020

In recent weeks, there has been increasing recognition about the value of local leadership as a vital component of an effective response to COVID-19. This is a positive sign and is symbolised by widespread interest in Local Outbreak Plans. Announced just two weeks ago and due to be in place by the end of June, these are being developed at pace by directors of public health and their teams in collaboration with local partners. So, what are they and how are they shaping up?

Local Outbreak Plans are designed to clarify how local government works with the NHS Test and Trace service, so that the whole local system is geared up to contain the virus. The plans build on existing health protection roles and responsibilities as well as the specific work councils have been undertaking to stop the spread of COVID-19. The plans should consider themes such as: planning for local outbreaks in care homes and schools; identifying and planning how to manage other high risk places, locations and communities of interest (i.e. rough sleepers, dormitories for migrant workers, transport access points); supporting vulnerable people to get help to self-isolate and ensuring services meet the needs of diverse communities.

One key lesson we need to learn from this pandemic is that maintaining a well-resourced public health system is not a nice-to-have but a must-have.

The Association of Directors of Public Health (ADPH) has worked collaboratively with Public Health England, the Local Government Association, the Faculty of Public Health, the Society of Local Authority Chief Executives and Senior Managers and the UK Chief Environmental Health Officers to develop ‘Public Health Leadership, Multi-Agency Capability: Guiding Principles for Effective Management of COVID-19 at a Local Level’. It captures our collective view about the form Local Outbreak Plans should take and how to make them happen in practice.

A good Local Outbreak Plan should be defined by four principles:

Firstly, it must be rooted in public health systems and leadership. The expert scientific and leadership capabilities of the local public health system – including the Director of Public Health, their team, other colleagues across local government and PHE regional health protection functions - will be central to the design and implementation of the plan. Existing roles, responsibilities and governance structures should be built upon wherever possible.

Secondly, the capabilities of the whole system need to be mobilised in preventing and managing outbreaks. Each agency should be clear on its role and responsibilities. Local police forces, the voluntary sector, the NHS and many other bodies all need to play to their strengths to, for example, ensure vulnerable people are supported to self-isolate. Strong public engagement is also crucial to building confidence and trust and maintaining compliance with public health. Councillors have an essential role here.

Thirdly, it will ensure that the system is designed to run efficiently at a local and regional level. This includes timely access to - and sharing of - information, data and intelligence to inform action, monitor outcomes and deliver clear arrangements for rapid and proactive management of outbreaks.

Finally, it will be properly resourced – each agency will have the necessary capability, both financial and in respect of skills and expertise, to carry out their responsibilities.

While the additional funding of £300 million for local councils is welcome, delivering these plans will require much more than money – a fully operational NHS Test and Trace Service, high quality and timely data flows, the right levels of capacity in all parts of local government and the health and care system, and strong national impetus to promote the public health messages that we all know save lives.

There has been much focus on the idea of ‘local lockdowns’ but the Government has not yet defined what the term means, how, where and when they could be applied or considered the question of whether they would be either desirable or practical. Proactive promotion of public health messages combined with targeted outbreak management in specific settings and support for vulnerable people should be the priorities.

Local government is getting on with the job in hand to deliver robust and integrated plans at the end of the month, guided by the four principles above. The task is huge but Directors of Public Health are stepping up and determined to discharge their duties as effectively as possible. This work will need to be championed and supported at a national level.

As we have been advocating throughout the pandemic; recognising, understanding and valuing the role of all partners is key to containing COVID-19. This matters more than ever.

Professor Jim McManus, Vice President, Association of Directors of Public Health

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