Since July 2020, in partnership with the Health Foundation, The King’s Fund has been exploring the role of directors of public health and other key stakeholders in the response to the biggest public health challenge for a generation. The aim of our research is to give directors of public health the chance to share their stories and reflect on the lessons they’re learning as the Covid-19 pandemic progresses. We initially spoke to 12 directors in September 2020, and are following up with a further 8 until May 2021. As well as their generosity with their time during this unrelentingly busy period, we’ve been struck by their honesty and reflectiveness throughout. We will publish our full findings in the summer. For now, following our first round of interviews, we want to share some insights about some of the ways directors of public health have worked together with their local systems in responding to the pandemic.
I think one of the benefits for me is, actually I’ve been in [my area] quite some time and I had very well-established relationships … I know the people, I know the strengths, I know the weaknesses.
Alongside the directors’ routine public health responsibilities around health protection and prevention, the pandemic revealed the range and diversity of their roles and responsibilities. Working with colleagues in their local area, directors’ roles included tasks as diverse as chairing the local emergency response, managing the delivery of personal protective equipment (PPE) to hospitals and care homes, co-ordinating emergency support to people shielding, setting up local test and trace programmes and communicating public health messages to their local communities, schools and local businesses, as well as addressing the wider health inequalities laid bare by Covid-19.
Directors of public health with well-developed local networks demonstrated the power of strong local relationships in enabling this work with a broad range of partners. One described managing a local outbreak linked to a commercial site by building agreement rather than forcing the company to act through use of powers. Others described diffusing difficult interactions with colleagues and members of the public by getting to the bottom of their concerns to address the underlying issue – for example reassuring people whose concerns were motivated by fear of the virus rather than fundamental objection to the director’s actions.
[I’m] in a place as DPH [director of public health] where I can mobilise others very quickly now. That sense that this is a collective effort, not just of a public health team but of a whole local authority … In a way that would have been truly impossible if I’d wanted to do something like that a year ago.
For directors of public health newer to their systems, they had to work quickly to develop these positive relationships. Focusing on building their own networks was key to this, as was developing the skills of their public health teams and building relationships with different teams and organisations through their team members. One described seconding a member of staff to an NHS organisation – which both developed their skills and embedded public health thinking early in that organisation’s planning.
If you want people to comply and respond to Covid, it’s not done from a call centre, it’s done by people who have already got those really good and trusted relationships. People will open up to people they trust, they’re not going to open up to a stranger.
Engagement with local communities has been a priority for directors of public health to ensure their populations understand and receive the support they need to comply with public health messages. From live Q&As, radio broadcasts and WhatsApp messaging, directors have explored new and innovative ways of bringing their local community on board with ‘real authenticity’, often plunging the directors themselves into the limelight. Regardless of the methods, the key to getting to the heart of the community has been collaboration, respect and humility. This multi-pronged approach has enabled some to support groups in the community who would not have been reached before. Trailblazing this is the Covid Community Champions programme running in many areas across the country, which uses community connections to better support local needs.
It’s great to see the rising profile of directors of public health in their local systems, in the media and more widely. This increased recognition of their role brings the potential for greater opportunities to influence public health going forward: the health of their local populations, as well as the future of their profession and of the wider public health system. But it also means directors face increased exposure, particularly when being held to account locally for decisions made by national politicians. This highlights a need for greater collaboration between national and local systems to support the local relationships that directors of public health rely on.
As we have highlighted elsewhere, these are uncertain times for public health. In continuing to follow the experiences of our directors, we will explore these developing opportunities and challenges, and their implications for local population health and the response and recovery from Covid-19 in their local systems.