NHS and care workers have gripped public attention as the country responds to the Covid-19 pandemic. But the one million people who work in local government have also been working flat-out – work that will continue well past the present crisis, that has been made much harder by 10 years of austerity, and that is not being helped by some parts of Whitehall trying to micromanage the local response, writes:
Richard Vize, a public policy commentator and analyst www.theguardian.com
As councils cope with a huge wave of demand on every front, from social care to refuse collection, they are taking daily instructions from ministers and officials across Whitehall, themselves under pressure and struggling to keep pace with directions from Downing Street.
Ironically perhaps after years of cuts, the tensions aren’t about money, but about communication and coordination. There have been delays, confusion and aborted work, such as changes of policy about whether central or local government is managing the assembly and distribution of food parcels, and local preparations for additional mortuary capacity being put on hold in favour of a national response.
While some difficulties are inevitable, the fundamental problem is ministers persisting in the fantasy that everything works best when it is run from the centre.
Limited understanding about the practicalities of local delivery has affected everything from identifying which vulnerable people need help to supporting local businesses.
In some places food parcels have arrived stuffed with biscuits and chocolate, which then need to be supplemented with something nutritious.
Meanwhile, public health directors are frustrated at being excluded from key communications and the development of guidance by NHS England and government departments.
Responsibility for commissioning public health policies was moved out of central government in 2013. As former public health director Gabriel Scally said earlier this week, public health budgets have since been systematically raided in the face of massive cuts to council funding. The heart of the local response to the virus now lies with a small number of council public health specialists – about 500 across England.
As the first wave of infections hit, these specialists played a crucial role in the containment phase, chasing infection contacts and coordinating the local response.
Among a torrent of other responsibilities, highlighted via the hashtag #adayinthelifeofadph, local public health staff are collating and analysing data, giving advice on everything from protection equipment to homelessness, managing the implementation of social distancing, supporting vulnerable people, and working with the NHS, voluntary groups and government.
All councils depend on these specialists to help implement the blizzard of guidance on infection control and safe working, as they work with GPs, volunteers, community groups, local businesses and government during the lockdown.
Those who may need help are being identified from numerous sources, including responses to a government letter asking 1.5 million people judged at risk if they need help. Many people have contacted councils directly. Staff and voluntary workers – all trained in infection control – are making personal visits and keep in touch online and by phone, as well as delivering food and medicines and checking on social care and other welfare needs. Some support will come from the £500m government hardship fund.
Two weeks ago the NHS and the government instituted a new patient discharge regime, which amounted to an order to do whatever it takes to clear patients out of 15,000 beds. Councils are working with the NHS, care homes and voluntary groups to ensure residents being moved out of hospitals have somewhere to go and have the right support in place.
The government has allocated councils in England £1.6bn of additional funds to cope with Covid-19 pressures, such as buying support from care providers, but the guidance did not mandate the testing of patients before discharge, leading some care homes, such as in Liverpool, to refuse to take them. Continuing difficulties in getting personal protection equipment (PPE) to care staff are also hindering discharges, and infections in care homes will put a huge additional strain on adult social care.
Social care staff continue to go to people’s homes despite the lack of PPE. The British Association of Social Workers has warned (pdf) that staff are often seeing a dozen or more service users a day without even hand sanitiser as protection. Social workers are also scrambling to keep in touch with children who may be put at additional risk by the lockdown.
Councils and their contractors are trying to keep other vital services running, particularly refuse collections, knowing that any deterioration in the environment will exacerbate people’s sense of fear. It’s a growing problem. Some council recycling centres have closed and the volume of waste is increasing just as sickness among refuse crews increases.
Huge efforts have been made to get rough sleepers off the streets, including working with volunteers and businesses to get people into hotels and revamp empty properties. And councils are gearing up to help an expected surge in domestic abuse victims.
Local authorities also have to handle the emotionally-charged practicalities around funerals. Guidance from Public Health England now says only immediate family are allowed to attend and social distancing rules must be maintained.
Some families are waiting to remove bodies from hospital mortuaries in the hope that the rules might be relaxed in a few weeks, while many undertakers are not working as normal. As a result, mortuary capacity is rapidly running out, and emergency facilities are being built.
Under intense pressure, local government’s role has been a mix of community leadership, implementing national plans in ways that are sensitive to local needs, and providing support for everyone from rough sleepers to businesses.
When the immediate crisis is over, councils need to ram home the message that while national guidance has often been essential in fighting Covid-19, local government is at its best when it has maximum freedom to meet local needs. When the plaudits are being handed out, councils will deserve huge credit for the energy and innovation they have brought to leading their communities.