Together, big state and big business ruined our Covid response. Local communities can take it from here.
A ‘marriage from hell’ between big state and big business birthed a litany of failures during Covid-19. Meanwhile, councils and communities have proved themselves far more equipped to cope. As a parliamentary debate on Covid-19 looms, Jessica Studdert argues that it’s not too late to devolve power to local areas to deal with a second wave.
When we went into national lockdown six months ago, the future was uncertain. Of all the places we might have predicted we would be half a year on, back at square one probably wasn’t one of them. Yet that is where we find ourselves. The testing system has collapsed and contact tracing is falling short. Community transmission is growing, the graph lines are rising, and another national lockdown beckons.
Two habits of government carried over from before the pandemic have been holding back our Covid response: a combined blind faith in the big state and big business as the prime routes of action.
Government strategy involves a mix of state control and large-scale outsourced contracts. As set out in NLGN’s The Community Paradigm this model has diminishing returns at the best of times, but its failings during the pandemic have reached a nadir.
Next week MPs are finally due to scrutinise the Government’s handling of the pandemic at the six month review debate of the Coronavirus Act, which granted Government extraordinary new powers. The shortcomings of the approach to date need to be recognised and a more resilient response built from the ground up. One focussed on building local capacity, community trust and individual responsibility.
But let’s start with what’s gone wrong so far. The decision to empower the executive rather than use existing emergency legislation that would have worked through Local Resilience Forums, began an approach that has consistently favoured a big blunt state response over smaller, local level interventions.
So shiny new Nightingale hospitals were built just to be mothballed, while care homes went without basic protections. The NHS volunteer scheme fell flat because it wasn’t linked in to local needs, while community mutual aid groups flourished – practically unnoticed by the centre. Big Lighthouse Laboratories were set up from scratch to process tests, bypassing capacity in smaller NHS and university labs – but are now causing bottlenecks that are reported to be responsible for recent testing chaos. These strategic schemes with fancy names attracted press coverage but they haven’t actually created a more resilient system.
The Government has only been prepared to let go of responsibility when it has handed it – largely unchecked – to the private sector. The details of contracts are shrouded in secrecy, but we know that this combination of generalist private contractors and blanket national schemes has persistently bypassed local insight and capacity, to the detriment of an effective response.
Deloitte has been contracted to oversee testing sites, and it has subcontracted the management of these to smaller companies including events management operators. Public health expertise has not been a prerequisite.
This has been to the utter frustration of local government, which has been side-lined in how testing is conducted, to the detriment of the ability to target high risk groups. Sites have too often been unilaterally plonked on large out of town carparks, which may look logical on a map but don’t work with the patterns of movement on the ground, limiting access for some at-risk communities. Staff contracts are fixed, so the sites run for designated hours, making them less accessible for groups such as night shift workers.
Hidden by its title NHS Test and Trace, contact tracing has largely been outsourced to Serco and other generalist providers with no public health experience. They run call centres in which inexperienced call handlers manage most cases, with the more complex ones handed to local public health teams.
The national scheme is only picking up only 60 per cent of identified contacts, well short of the 80 per cent deemed necessary for effective virus control. Locally-run public health teams are thought to be picking up eight times as much – their local knowledge means they can better identify the source of outbreaks and links based on local patterns of behaviour and footfalls. And their community connection means they are more like to persuade someone to take a test and, if necessary, self -isolate.
The apex of the terrible marriage between the big state and big business is the new National Institute for Health Protection, set to replace Public Health England. In a triumph of generalist commercial expertise over specialist public health understanding, the person responsible for the underwhelming test and trace scheme – Dido Harding – will also run it. The links into local public health teams remain unclear.
This all bodes ill for plans to disseminate any potential future vaccines. Reports suggest the current plans replicate the big state and outsourced model of test and trace – privately run large drive-through sites with the army drafted in for support. If this is the case, the same mistakes risk being repeated – a crude blanket approach with no targeting or persuasion built in. How, in the context of tough anti-immigrant rhetoric from the government, will some higher-risk minority groups feel confident in attending sites run by the British Army? With the rise in anti-vax conspiracies, how will remote non-specialists work with communities and individuals to persuade them of safety? The enterprise certainly won’t be as simple as ‘if we build it, they will come’.
It isn’t too late to shift gear. Local government capacity is currently under-resourced and under-used, but making headway nonetheless. Many councils are building their own contact tracing schemes anyway – currently diverting precious existing resource, so they should be funded to make this mainstream.
Their logistical expertise is underrated: if councils can run general elections with a few weeks’ notice they can certainly play a greater role in managing testing sites and future vaccine delivery plans. Every locality now has a health protection board drawing in expertise from Clinical Commissioning Groups, social care, primary and secondary care. These partnerships have the expertise and capability to lead any future uptake of vaccinations, and should play a stronger role overseeing testing and contact tracing efforts in the meantime.
Living with the virus is reliant on everyone playing their part, and councils have an important role working with their communities across the board to foster consent. The recent groundswell of mutual aid action shows the mobilising force of neighbours helping neighbours. This can’t be mandated by national government but it can be supported locally to thrive as we face down a potential second wave and beyond.
So instead of the Government lurching from one local crisis to another with a reactive and pejorative “whack-a-mole” strategy, it is time to signal that local partners are at the core of an effective approach. The big state and big business have both reached the limits of their effectiveness in our Covid response – local communities can take it from here.