Local response to COVID and its effectiveness

By Peter Warrington

You may also want to look at Mayoral response and notes.

Local public health efforts often have a key role on battling health crises. This document will explore the actions in this region, and the extent to which local authorities were able to take a crucial role in the region, or whether much of this was taken out of their hands by central government.

Council-lead efforts

On the 10^{th of} March 2020, Cambridgeshire recorded its first Coronavirus case in the region¹. On the same day, Cambridgeshire County Council’s director of public health Dr Liz Robin said that the development was “not expected” and that “our services have planned for, and are ready for this situation”.²

Later, on the 20^{th of} March 2020, the same day as schools and public venues closed, Cambridgeshire country council announced the launch of its COVID-19 coordination hub, under the advice of national government, aiming to help those most affected by the outbreak. It called for offers of help to communities and managed a coordinated volunteer response working alongside community organisations³.

Question: How many people signed up to help? How many individuals did they support?

Local councils have also been administering local grants to businesses, for example those that have closed, and a Christmas support scheme for pubs, although this was led by the government and managed locally by councils.⁴

Question: What other measures did councils put in place? It can be difficult to find information online

Throughout the pandemic, councils and other local authorities have also played a role in communicating with the public, for example where local case numbers cause room for concern. On the 26^{th of} April 2021 for instance, Cambridgeshire County Council urged people in Cambridge to follow guidance and self-isolate if they have COVID symptoms after the area recorded an increase in new cases per 100,000 people to 58.5 from 44.9 the week before⁵, above the UK average of 25.⁶

The director of Public Health on the county council, Dr Liz Robin, has also been posting videos to Cambridgeshire residents communicating information about COVID-19. In one from November 2020, they remind Peterborough residents to keep to restrictions after the area’s case rate increases to over 200 per 100,000 people.⁷

Councils in Cambridgeshire have also been employing COVID marshals to help enforce restrictions, especially in hotspots where case rates are higher. For example, Peterborough City Council announced the rollout of its 30 person COVID Marshall team in November⁸ as its case rate increased to the worst in Cambridgeshire⁹. Other areas in Cambridgeshire, such as in Cambridge, have also employed people for the same purpose.¹⁰

They have however also been criticised for their effectiveness, a Peterborough councillor claiming that they have not seen marshals “challenging people” instead “letting them go past”. The conservative group on the council however responded by saying that the response has been “very positive” and that while there have been issues with marshals adhering to social distancing, “COVID marshals actually do their job”.¹¹ In addition, they have come under criticism nationally for being “disproportionate” in their powers, where authorities may not be able to deliver the marshals¹².

Combined authority (mayoral) efforts

The combined authority ran the COVID-19 Capital Grant Scheme which provided a “flexible capital subsidy to help Registered Limited Companies”. This was available to small to medium sized enterprises.¹³

The following was added in response to the mayor’s email

The Combined Authority claims that the grant scheme saw £5.25 million of grant funding awarded to small to medium businesses which the mayor claims is “due to create 287 new jobs and protect a further 522 in the process”.

In addition to the Capital Grant Scheme, the Combined Authority also opened a Micro Grant Scheme providing grants to businesses with five employees or fewer, totalling a £500,000 fund.¹⁴

The authority also continued to run its “business growth hub” throughout the pandemic, providing business advice to businesses in areas across East Anglia, especially in response to Brexit and COVID-19.¹⁵ As part of this, the “Business Triage Service” was established to handle the significant increase in requests for support and advice.¹⁶

In his response, the mayor points to its Economic Recovery Strategy it produced in collaboration with local councils, claiming it provided “sector analysis from across our county with information relating to the status of businesses, employment levels, and income throughout the pandemic” and that while it has been useful it will also help him to “deliver a more effective agenda going forward”.¹⁷

The mayor also pointed out the City Centre Exit Strategy group which has been “working with enterprise and council leaders to open up our high streets as safely as possible”, a group that looked at among other things possible funding for “projects seeking short-term capital investment to support the visitor economy in the city centres” and targeting businesses with support to “aid safe adaption” as per the business boards meeting minutes.¹⁸

Critisism of local response

In August, the combined authority came under criticism for claiming that bus stops it had cleaned had “a 30 day guarantee against all viruses”.¹⁹

Cambridge city council also came under scrutiny over it’s closing of Cambridge Market on December 30^th as a result of concerns of overcrowding, despite them being allowed to operate under national Government guidance, leading to a petition by the local liberal democrats and their subsequent reopening on the 18^th January.²⁰

Critisism of national government locally

In January 2021, Cambridge News published an article claiming that the Government had failed to deliver 1,000 laptops that it had said it would deliver to school children in Cambridgeshire.²¹

Other problems

On the 25^th November 2020, a leaked memo from staff at Addenbrooke’s hospital revealed that they considered patients to be ‘at risk of harm’ as waiting times reached the second worst in England. It describes the situation as “unsafe” and that it could cause “significant harm” to patients.²²

Question: What led to this? Was it an issue of funding, or perhaps management?

Did Local government even have the power to respond?

National government has come under criticism of having an over-centralised response to COVID-19, where local government only has a limited role. For example, the BMJ in May said that a track and trace system “must be adequately resourced, decentralised, and led by local public health teams who know their communities and the nature of the outbreaks in their localities.”²³ Instead, contact tracing schemes were led centrally through the national government NHS Test and Trace, who ran testing sites, notified individuals and contacts of those who have tested positive.²⁴

The nationally led system has come under widespread criticism, for example, the Director of the Institute of Health and Society at Newcastle University, Professor Allyson Pollock, wrote that the system was “about as far from integrated or effective as you can get"²⁵, and in a SAGE endorsed paper in September was described as “having a marginal impact on transmission at the moment”.²⁶

The British Medical association was one of the groups that called for a higher budget for local public health teams, and greater integration between local teams and NHS test and trace.²⁷ The House of Lords public services committee report into the Government response echoed this, saying that their response was “hampered by overcentralised, poorly coordinated, and poorly communicated policies”.²⁸

Opposition parties have echoed calls for a locally led testing and tracing system, including Labour²⁹ and the Liberal Democrats³⁰.

The introduction of Community testing and contact tracing

In December 2020, the Government announced its “Community Testing Programme” to help “Identify asymptomatic cases through local testing and supporting them to isolate”. It offers asymptomatic testing managed by local authorities, mostly using Lateral Flow devices, focusing on those who “leave home for essential reasons and are unable to access asymptomatic testing through other routes”. Local authorities are able to decide where testing is targeted, something that is useful given their understanding of communities, and Local Government is expected to work with local groups to encourage engagement.

Local Contact Tracing Partnerships have been made between the national test and trace system and Local Authorities. These enable “quicker and more efficient public health interventions locally” according to the Government, where Local Authorities are able to use their own contact details and information to better reach residents and trace contacts, while working with local groups such as schools, businesses and organisations.³¹, ³²

Councils normally take on those cases that national test and trace have been unable to reach, areas such as Birmingham reaching 48% of cases that the national team were not able to contact. Birmingham council also said that this enabled them to better communicate with local groups, such as the university where they were able to use new data to alert them to how COVID transmission was occurring among students. The council however adds that as of October 2020 they have had to pause their tracing team due to a lack of quality data from the national team.³³

Blackpool council mentions that they are able to build a “rapport” with people they contact in a way national teams are unable to, where they know the areas the people they contact mention. They were able to reach 71% of cases.³⁴

The House of Commons Public Accounts Committee published a report in March 2021 stating that

“The introduction of rapid-results testing was supposed to be a ‘gamechanger’ but confusion persists over why and how it should be used in different community settings”, pointing to the lack of clarity over their use in schools.

“Laboratories processing community swab tests were unable to keep up with demand, leading to large backlogs, limits on the number of tests available, longer turnaround times and some people having to travel hundreds of miles to get a test”

“NHST&T [NHS Test and Trace] claims to be a learning organisation, but since last May many important stakeholders [such as local authorities] have at times felt ignored by it.”³⁵

I believe the introduction of community testing and local contact tracing is an effective way of reducing COVID transmission which has seen success in comparison to some of the failings of the national system, improving based on some of the widespread criticisms seen. I however add that it should have ideally been locally-led from the start and that there still are problems with the system that could be prevented with further suitable devolution of power to local authorities to engage in testing and contact tracing.