While central government eases lockdown, councils have the difficult task of developing plans to support their communities who may be forced back into stricter measures in the event of a local spike in COVID-19 cases.
EHN Extra spoke to Eugene Milne, director of public health for Newcastle upon Tyne, which is one of 11 council areas helping to develop and share best practice around local endeavours to contain the virus.
Alongside the selection of pilot councils, the government pledged a £300m support package for local councils nationally, with £29m for Scotland, £18m for Wales and £10m for Northern Ireland.
This was widely reported as allocated for local contact tracing but in reality, while local contact tracing is a vital part, the task is more complex, Milne argued. “[If we’re] taking a chunk of the population and plunging them instantly back into isolation then a lot of the mechanisms that we've put in place in order to provide support to people during lockdown need to be continued,” he said.
These mechanisms include local food and medicine distribution, while continuing to reinforce social distancing and hygiene as a means of keeping safe. Milne said: “We want to reinforce those messages as we start to remove bits of lockdown. We want people to understand that the deal is if they're able to carry on doing these things, it will keep them safe and then we don't have to move back in the other direction.
“It surprises me when people keep asking me about compulsory powers. I think the use of compulsory powers is a sign of failure. If we're compelled to do that, it's because we haven't actually explained and supported, and put in place arrangements to do this properly.
“There are there are lots of unknowns. We still won't know whether overall that's sufficient because we don't know yet what any resurgence might look like.”
Milne said the focus is on prevention, and on the local response in the event of an outbreak – especially among the homeless, people with drug and alcohol problems, care homes, schools and other vulnerable communities. His teams are preparing for different scenarios so that they have the protocols ready to go. “And [so] that we've built confidence and communication with those groups so that they know what we're going to be asking for, in those circumstances – and that we can support them in doing that,” he added.
Developing the system while lockdown is being rapidly dismantled has not been helpful. “There is a slight ‘one-eyed man in the land of the blind’ thing about it because we are still designing the systems. One of the things we really would have wished for was to have the whole system up and running and be able to run it in parallel with lockdown to begin with.”
While council spending has risen, income has dramatically declined, and it’s not clear how far the £300m will go. The size of the task is still unclear and it is not known how much track, test and isolate work will be escalated to the local level.
The national contact tracing system is divided into three levels (also called tiers). Level one contact tracing is handled by Public Health England working on a local level with councils and involve the most complex cases. Level two is a specialised remote service run by NHS Professionals. The third level is the home-working call centre run by Serco dealing with the most straightforward cases. Concerns have been raised that if a very large number of cases are escalated to the local authority, they could quickly become overwhelmed.
An area of concern Milne highlighted is information sharing. “One of the problems at the moment, is that all of the information as I understand it is going from levels two and three to level one. So the only information that's getting to level one are the escalated complex cases.
“As far as I know, I don't think there's anybody at the local level who's got a complete overview of all of the testing that's going on in the local area right now. I think that's problematic.
“If we could get all of this data at a local level, it would mean the different groups involved could get access at an appropriate level to be able to enable them to do the job really effectively. And it would allow us to do appropriate surveillance on the local system.
“I'd be very happy for it to sit with, in our instance, the north east commissioning support service because they're used to handling data for the NHS, it's behind appropriate barriers and the GDPR safeguards are all in place.”
Turnaround in tests is also still an issue. Pillar one testing done by local hospitals has a quick turnaround so the preference is to expand that service. The national pillar two system, while getting better, is not quick enough. Milne added: “We're increasingly going to want to target prevention. And part of my ideal in all of this is that – particularly for the likes of care home staff – we get to the point where we can do regular screening, in order to get people out quickly [who test positive for COVID-19], because we know that pre-symptomatic viral spread is a key factor.”