July 14. Here’s an idea. The health of an area is a complex matter, interacting with a wide range of public services and private behaviours. Why not appoint a senior figure in each local authority who can work across the three connected fields of protection, improvement and health care. The role would advise elected members and senior officers and liaise with national bodies such as Public Health England and NHS England.
It has taken a long time for Matt Hancock, the Minister of Health, finally to accept that 134 such figures already exist. The post of Director of Public Health (DPH) was created as part of the Lansley reforms of the Cameron government in a creative attempt to compensate for the damage caused by the abolition of regional health authorities. According to NHS England, “Directors are responsible for ensuring that public health is at the heart of their local authority’s agenda. Using the best and most appropriate evidence, they determine the overall vision and aims for public health in their locality. They then manage the delivery of those objectives and report annually on their activities.” As the Department of Health’s own website puts it, their role embraces both long-term issues such as obesity and health inequalities and short-term reactions to “outbreaks of disease and emergency community and emergency preparedness.”
The turning point in the deployment of the DPH’s in came in the second week of May, two months after the country began to grapple with the coronavirus outbreak. The scandal of the infection and mortality rates in care homes forced central government to recognise that it simply did not have the capacity to determine how to prioritise a testing programme. It turned to the DPHs because of their familiarity with provisions for the elderly in their areas, and their connections with other community agencies. A DPH was quoted at the time as saying, “We’ve been pushing and pushing government to realise that we exist and that we are best placed to organise things like testing, alongside directors of adult social services, because we know our patch.”
Now, in an article in the Telegraph last Sunday, with the official UK death rate approaching 45,000, Hancock finally recognised that the coronavirus was a local event requiring interventions tailored to local circumstances. He wrote that “now we can take more targeted local action and less national lockdown, to restore the freedom of the majority while controlling the virus wherever we can find it.” The much delayed track and trace system can only work if the Directors of Public Health are supplied with all the so-called ‘Pillar 1’ and ‘Pillar 2’ returns so they can fully understand the conditions in communities or workplaces that are giving rise to anomalies, and develop tailored actions for dealing with them.
With power comes responsibility. Central government has not lost its appetite for intervention and it was reported over the weekend as threatening to take over running Leicester council if it failed to deal with the crisis in the city. The Directors of Public Health are finding that their new powers are bringing with them an immense body of work, and an unwelcome exposure to the media. The Herefordshire Director did not appear at all comfortable yesterday answering questions about the outbreak in a farm, particularly why three of the workers had managed to abscond from the lockdown she had imposed.
Nothing will be easy, and it remains to be seen how permanent is the shift of authority from the centre to the periphery. But after so much confusion, wasted resources and unnecessary deaths, the belated change in policy can only be welcomed.
As the far-seeing Dominic Cummings almost said, ‘Take back local control!’ Just now I live not in the United Kingdom, nor in England, but in Shropshire. Home rule cannot come too soon.