It is no surprise that the prime minister can’t remember the details of the latest social restrictions introduced in the north-east of England. I doubt whether very many people could be entirely sure what they should or should not be doing, except in their local area, and maybe not even then.
The messages emanating from Downing Street have been unclear and inconsistent for some time. The government’s financial and political commitment to the eat out to help out scheme, as well as its exhortations to bosses and workers to repopulate city-centre offices, were part of an over-optimistic effort to return to an illusory normality that ignored the continuing presence of the virus. Lifting measures such as the two-metre social distancing rule before the virus was adequately suppressed has done us no favours.
Whitehall’s reliance on tweaking social restrictions in response to upsurges in the virus will only ever be partially and temporarily successful. Of course, the virus isn’t present at a consistent level across communities, and the patchwork of local restrictions is a response to this reality. But a situation where there were four different sets of restrictions in operation in the Greater Manchester area, for example, will only breed confusion and non-adherence. Particularly when national announcements are made that contradict those local arrangements.
It’s clear that transmission of the virus is highest in communities that have high levels of deprivation, overcrowded housing and a very significant proportion of residents from ethnic minority populations. Leaked information from Public Health England reported in the Observer showed that the national “lockdown” failed to control the virus in some of these communities, and that Covid-19 was still continuing to spread in local authority areas such as Bolton, Manchester, Oldham and Rochdale. Why should we expect that less rigorous local measures would work in areas where the national lockdown failed to bring the virus under control?
There are two glaring deficiencies in the government’s approach. First, it fails to understand that coronavirus cannot be beaten unless resources and powers are devolved to England’s regional and local authorities. It’s local people, at home and in their workplaces, health services, businesses, or as leaders in local neighbourhoods and communities, who will be key to suppressing transmission.
One size definitely will not fit all, but neither will a medley of approaches decided upon in Whitehall. Local authorities tend to have more knowledge and expertise than Westminster about the places and people they govern. And a truly localised approach would also allow local directors of public health to play a more prominent leadership role and do what they’re trained to do, which is to protect and restore the health of their local populations.
The second gaping hole in England’s Covid-19 response is the government’s complete failure to organise an effective system for testing, contact tracing and isolating. Local restrictions will come to nothing, no matter their number, unless authorities are able to rapidly chase down the virus and prevent it from spreading further.
To any objective observer, it’s completely inexplicable why the government hasn’t acknowledged the failures of its hugely expensive and centralised test-and-trace system. An urgent rethink is long overdue: again, the answer is undoubtedly to go local. We need to give the local NHS, public health teams and authorities the money and staffing they need to deal not just with the current upsurge but also build the capacity to respond to future flare-ups when they occur, as they inevitably will.
Instead of delivering a proper strategy for how to suppress Covid-19 across the country, the government has opted for reactive half-measures, tweaking a complicated set of lockdown restrictions in response to every spike. It’s difficult to believe that the last time anything resembling a coherent programme to control the virus was published on 3 March.
That “action plan” did not survive long before it was overwhelmed by events. Since then, we have had a plan to lift the restrictions but no sight of a strategy defining the goals we’re seeking to achieve, and the methods that will get us there. Neither have we seen a convincing, thought-through approach to tackling this deadly virus that has already killed tens of thousands of people, and left countless others with serious, continuing health problems.
• Gabriel Scally is a former regional director of public health and honorary professor of public health at the University of Bristol