Local public health proves its worth in a crisis

COVID has emphasised the importance of public health teams being part of local government, says Professor Maggie Rae. But councils need the resources to address the fallout from this pandemic and prepare for the next one.

COVID has emphasised the importance of public health teams being part of local government, says Professor Maggie Rae. But councils need the resources to address the fallout from this pandemic and prepare for the next one

Local government public health teams, working as partners at the heart of their communities, have played a major role in the national pandemic response. Now our thoughts are turning to building resilience against future pandemics and addressing the health inequalities laid bare by COVID-19.

Partnership has underpinned everything we are doing. Public health directors have been part of the corporate leadership advising members and officers on everything from managing an outbreak to interpreting the myriad of often conflicting guidance and requirements coming down from government.

We have been working alongside schools, colleges, universities, care homes, shops, businesses, community organisations, the police and many more, advising on how to minimise and manage risks and operate within the fast-changing rules, tracing infection contacts, supporting the shielding and the vulnerable and helping with access to personal protective equipment.

Time and again, the pandemic has underscored the vital importance of public health teams being part of local government. To take just one example, environmental health and public health teams have been working together to help businesses ensure they are COVID-safe, drawing up local outbreak control plans and tracing contacts.

Nationally it has been a struggle to get ministers to hear the public health voice. Success in finally getting our role and skills recognised has been immeasurably helped by some outstanding leaders.

Among many others, Association of Directors of Public Health (ADPH) president Dr Jeanelle de Gruchy has been a brilliant advocate for local government's public health role. Leeds City Council chief executive Tom Riordan finally persuaded the Government to have a strong local element in the test and trace system. That was taken up by Oldham Council chief executive Carolyn Wilkins as ‘contain' director for NHS Test and Trace.

Peter Wright at Gateshead MBC has played a leading role in highlighting the important work of environmental health officers. Ealing LBC chief executive Paul Najsarek, who leads on wellbeing for senior managers' organisation Solace, worked on getting the right design in place for the local pandemic response. The Local Government Association has worked tirelessly, and chairman James Jamieson, who sits alongside me on the Secretary of State for Health and Social Care's advisory group, has been highly effective in putting councils' case to ministers.

The biggest lesson from COVID-19, along with the SARS and MERS outbreaks, is that pandemics can no longer be treated as once in a century phenomena. As well as supporting our communities to live with coronavirus long-term, it is vital that we build resilience locally and nationally to cope with future infectious diseases.

Central to those preparations is hardwiring cooperation between national and local government and between the NHS and councils. We must never again lose vital weeks arguing about access to data while our communities succumb to infection outbreaks, or have ministers failing to understand the role of public health, environmental health and trading standards teams in supporting care homes, schools and businesses, finding and isolating infections and contacts and working with minority and deprived communities to boost the uptake of vaccinations.

We hope that the welcome acknowledgement of public health as an essential part of the health and social care system in the Government's recently released White Paper for Health and Social Care will help cement this cooperation.

As well as responding to the crisis, we need to confront the underlying reasons why the UK has suffered so badly.

This means renewing our determination to address health inequalities such as obesity and poor housing, and matching that determination with resources.

To do all this vital work, the Government must fund local public health services properly. Since 2013 the like-for-like public health grant has been cut by 15% to £2.4bn, before the transfer of some children's services.

After all the country has been through, the Faculty of Public Health was shocked at the Government's failure to announce investment in public health in the last Spending Review. We stand by our call for an additional £1bn of public health funding, and have joined with the ADPH in calling for a multi-year funding settlement.

Adding to the difficulties of strengthening public health services is the uncertainty created by the abolition of Public Health England, to be replaced in part by the National Institute for Health Protection. I must thank Public Health England colleagues for their professionalism in the face of this uncertainty, and for continuing to deliver excellent work to tackle the current pandemic whilst under extreme pressure.

While the new institute will formally exist from April, the Government has admitted it will not be functioning properly until the autumn. Meanwhile it is still unclear who will assume national responsibility for health inequalities and issues such as obesity and smoking cessation.

The institute will have a much bigger budget than Public Health England, but more capacity at the centre needs to be matched with additional local funding.

So, reflecting on our experiences a year after lockdown, local government can be immensely proud of its contribution to the pandemic response. But as we look to the future, councils need the resources to address the fallout from this pandemic and to make sure we are ready for the next one.

Professor Maggie Rae is president of the Faculty of Public Health



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