Written evidence submitted by the Local Government Association (CLL0005)

Jeremy Hunt MP and Greg Clark MP

Chair, Health and Social Care Committee

Chair, Science and Technology Committee

House of Commons

London

SW1A 0AA

19th October 2020

Dear Jeremy and Greg,

Coronavirus: lessons learnt inquiry

I am writing as the Chair of the Local Government Association’s (LGA) Community Wellbeing Board to share our views ahead of your Committee’s inquiry into Coronavirus: lessons learnt. Local government’s delivery of vital public services during this critical time highlights the value of place-based local leadership. The pandemic has demonstrated that a solely centralised design and control of public services from Whitehall does not work as effectively as an approach that fully incorporates councils’ ability to innovate and create services that are tailored to their communities and localities, with government departments supporting councils as equal partners instead of looking to them simply as delivery agents. 

As we enter the next phase of the pandemic, there is an important opportunity to address the health inequalities the pandemic has exposed. I would like to take this opportunity to share the lessons and insights from the LGA and local government.

The deployment of non-pharmaceutical interventions like lockdown and social distancing rules to manage the pandemic

Councils have been working extremely hard to deliver and support the nation’s response to the COVID-19 emergency. Alongside the police, councils have played a key role in enforcing new coronavirus regulations and have worked hard to support businesses to comply with new legislation both around business closures and safe re-opening.

The LGA has called for the introduction of a temporary public health (or COVID-19) objective in the Licensing Act which would enable councils to take action where licenced premises like pubs, bars and restaurants are not protecting the public during the pandemic – such as maintaining social distancing. Whilst the vast majority of businesses are working hard to implement the necessary measures to protect people’s safety, there have been examples of  guidelines not being followed by some licensed premises and councils have told us that they do not feel they have the powers they need to stop this, putting people at risk of infection. Extending licensing powers would mean they can act quickly and proactively in cracking down on places that do not follow the guidance, to prevent problems in the first place instead of only being able to act when it is too late. Sanctions available under the Licensing Act – such as requiring a business to apply new conditions to operate safely, or in the worst cases revoking a licence – would be better suited to preventing the risk of infection spreading than the tools available under health and safety laws.

As always, the importance of close engagement between central and local government is crucial. In recent months, councils have demonstrated that local can deliver where a centralised design and control of public services from Whitehall simply cannot. We now need to be empowered to be allowed to innovate and create services that are tailored to communities and localities. Where new regulations are implemented, councils also need sufficient lead time to prepare for these to allow them to be adequately resourced and undertake the necessary engagement with businesses and residents.

The impact on the social care sector

Adult social care has been severely affected by the COVID-19 pandemic. Tragically, thousands of care home residents passed away during the first wave of the pandemic. An already fragile workforce has also been severely impacted, with care workers dying at twice the rate of health care workers. 

Local authorities faced huge costs to provide PPE and support providers. They also faced increased cost and demand pressures, whilst seeing a significant drop in income. The LGA has used its submission to the Comprehensive Spending Review (CSR) to call on Government to provide an additional £10.1 billion per year in core funding to councils in England by 2023/24. This additional funding would, firstly, cover the funding gap facing councils in England of £5.3 billion by 2023/24. This funding gap figure is based on analysis we commissioned from the Institute for Fiscal Studies and is just to maintain services at today’s level – their upper estimate of the funding gap figure is as high as £9.8 billion. £1.9 billion is for services struggling under increased demand, such as adult social care. Finally, the LGA’s submission sets out how a further £2.9 billion could be used by councils to help improve services and reduce inequalities, such as investment in early intervention and prevention and reforming adult social care worker pay.

During the first wave of the pandemic, there were a number of issues that councils had to resolve with Government. Councils welcomed the Enhanced Discharge Arrangements, which built on the evidence that going home is the best place for most people after a spell in hospital. The implementation of the guidance, however, in prioritising the NHS’ capacity had a significant effect on individuals in the care sector, most particularly with the increased flow of discharges to care homes without an adequate testing regime in place. It is also important to note that the Government’s ‘COVID-19: Our action plan for adult social care’ was not published until mid-April.

Access to PPE and testing continue to be a concern to the sector and need to be addressed by national government. It is vital that the adult social care workforce, and local government workforce more broadly, is able to access the tests and PPE it requires to care for our communities and keep people safe.

The Care Home Support Plans submitted on 29 May 2020 also demonstrate the leadership of councils, with their NHS partners, in promptly establishing effective wrap-around support to the care sector, including across the provision of infection control, PPE and testing kits. The administration of the planning process, however, was chaotic, piecemeal and late, with councils given two weeks to respond to this Government consultation. Similarly, the £600 million fund for infection control was welcomed as much-needed investment. Providers and councils, however, were frustrated at the overly narrow access criteria. As we enter the next phase of the pandemic, Government should work with councils and care providers on national support that is well-planned and co-ordinated.

There is also some important learning from the Care Act easements. Councils understand the concerns of people who use social care services, as well as unpaid carers, their families and friends, about the easements. Councils and the adult social care workforce worked hard to ensure that most services were unaffected by easements, and most people continued to receive care and support despite the challenging circumstances.

Only eight councils out of 152 enacted easements, and most of those for a very short time, or for only a single specific service. Councils remained under a duty to meet needs where a failure to do so would breach a person’s human rights under the European Convention on Human Rights and observed the Ethical Framework on adult social care when making decisions about prioritising those most in need of urgent care and support. Other important Care Act duties, such as on wellbeing, prevention, information and advice, adult safeguarding and advocacy have been unaffected.

Moving forwards, there needs to be greater clarity on the purpose of the easements. Providing councils with more support for stage two of the easement guidance may be a better future focus. It is also important to recognise that the Care Act and associated guidance has stood up well given how few councils needed to enact easements. This suggests that there is enough flexibility already within the Care Act to enable councils to meet their duties, albeit in different ways. A positive legacy would be for this flexibility to continue. 

One of the only positives to come out of the COVID-19 pandemic is that it has put adult social care firmly in the public, political and media spotlight. It has also shone an important light on the tireless work of our invaluable social care workforce who are providing care and support to all who need it in the most challenging of circumstances. This emergency has begun to highlight the essential value of social care in its own right to the wider public; this debate needs to be harnessed in thinking about the future of care and support.

The legacy of COVID-19 for social care – and most importantly the people who use social care services – must be a reset, not simply a restart. This impetus should spur our thinking around long-term reform of care and support, which we have always said should be built on cross-party cooperation. We are committed to working with Government and all parts of the social care world – particularly people with lived experience – on a way forward that is informed by the many valuable lessons from the pandemic on the role and value of social care in all our lives.

The LGA’s submission to the CSR called for action from Government on three fronts:

• provide additional funding to shore up social care ahead of winter and a likely second wave of the virus, with a look to this continuing in future years;

• provide additional funding for the medium term to help address the long-standing challenges that have faced social care, many of which have been exacerbated by the pandemic; and

• use the above funding as a ‘down-payment on reform’ and to pave the way for changes that will finally put the funding of social care on a sustainable footing for the long-term.

We would welcome the support of your Committees in driving these points forward.

The impact on BAME communities

Fairness, equality and social justice flows through everything local government does and councils are wholly committed to ensuring that no one in their community is left behind or cannot be supported to combat the effects of this dreadful disease.

There is clearly an increased risk to people from different BAME groups of being infected and dying from COVID-19 and there are many factors involved in this. Some of these are long-term, fundamental issues around health and society which need to be addressed, including housing and occupation.

Specific actions which can be taken in the short term include improving public messaging around the risk of acquiring COVID-19; improving messaging about health-seeking behaviour, such as encouraging people from Black British heritage to go into hospital if they need to; and greater consideration of underlying risks once a person is in hospital. This includes important questions around the care for individuals and whether different treatments are needed to reflect these underlying risks.

Building cohesive communities is a vital part of councils work over the coming weeks. The social impact of the pandemic and the Black Lives Matter movement have shown us the need for councils to build communities where everyone feels valued and equal. Councils must be given the backing and tools to do this – to ensure that everyone can lead a healthy, safe and productive life supported by their community.

Testing and contact tracing

Since the COVID-19 pandemic took hold earlier in the year, the LGA has been consistently making the case for councils to have necessary powers, resources and authority to be able to lead the response locally and tackle outbreaks swiftly and effectively. 

Experience of the test and trace system to date has shown the advantages local authorities have over national systems in being able to identify those who have been exposed to COVID-19 and working with their communities to slow and stop community transmission. The most recent test and trace figures prove again that councils’ public health teams, with their unique expertise and understanding of their communities, have more success in reaching complex close contacts of positive cases, where NHS Test and Trace has been unable to do so. We estimate that local contact tracing systems have a 97.1 per cent success rate at finding close contacts and advising them to self-isolate, compared to 68.6 per cent of close contacts reached by national Test and Trace. The Government is right to recognise the urgent need to build upon these successful local efforts to address the current inadequacies of the national scheme.

Many councils have or will shortly launch their own locally supported contact tracing arrangements. To build upon these local efforts and reduce the spread of infection, councils need clearer, more precise information on who they should be trying to contact as soon as possible. This should include details such as occupation and workplace, working with police and others to share local intelligence, alongside the right resources including funding and recruiting extra personnel to work on the ground and respond quickly to outbreaks.

Driving strong local action and effective contact tracing will add further pressure to already over-stretched council budgets. While we are pleased Government will provide much-needed additional funding for areas at alert level 3 and that councils will also benefit from a further £1 billion relating to wider COVID-19 cost pressures, it is not clear whether the savings made in the last two months by reducing the number of contact tracers in the national arrangements from 18,000 to 10,000 will be passed on to councils. We await further details on whether the additional funding for areas on alert level 3 is expected to cover local contact tracing activity, and what funding might be available to councils outside alert level 3 for contact tracing so they prevent their areas being classified at alert level 3.

Public health

The LGA was surprised to learn of the dismantling of Public Health England. Some councils expressed concern about this decision, at a time when we need absolute stability, clarity and consistency in our public health services. Nevertheless, what matters now is ensuring that the new National Institute for Health Protection works, and local government is ready to work with this new agency to make it a success.

The Government should use this opportunity to ensure the National Institute for Health Protection has the local expertise and resource to ensure its success. This should be embedded in local authorities, who have the detailed knowledge of local systems and partners. The Government should also use this opportunity to transfer oversight and coordination for local immunisation programmes to Directors of Public Health. Local authority public health teams already have access to community level data on hard to reach areas and can use a wide range of commissioned services - such as health visitors and school nurses - to reach the most vulnerable and improve vaccination rates.

In the LGA’s submission to the CSR, we called on the Government to work with us to deliver a four-sided strategy to strengthen public health services.

• Our first ask was for sustainable core funding. We know that one thing that made England vulnerable to COVID-19 was our poor public health, particularly our high rates of inequalities, of smoking, and of overweight people and obesity. One of our learnings from this pandemic should be the importance of prevention. The LGA would like to see increases in the public health grant to enable councils to do more to keep our communities healthy.

• Our second call was for Government to invest in transformation. In order to arm our population against this virus, we will need to turbocharge public health programmes that can reverse chronic conditions such as type 2 diabetes. The Government should work with councils to introduce a new Prevention Transformation Fund, underpinned by a sector-led transformation programme, to help deliver on this shared ambition.

• Our third ask was for Government to strengthen local leadership through devolution. Local authority directors of public health have demonstrated the value of local public health teams being able to respond effectively to the pandemic based on a detailed understanding of their community. ‘Local by default’ should be the approach to addressing public health in the COVID-era.

• Finally, we also called on Government to consider rewiring behavioural incentives to raise revenue to fund these initiatives. Levies on alcohol, smoking and sugary products can discourage consumption of harmful products while also raising income to invest in vital public health services.

Government communications and public health messaging

Some councils have found it challenging to review the large amount of new evidence and consider its impact locally, regionally and nationally. It is essential that councils are provided with trusted sources of information and are empowered to think laterally on how action based on new or emerging evidence can be optimised.

The public wants to be able to follow evidence-based guidance from trusted sources. Local authorities know their communities. In many places’ councils have localised the national messages for a local audience and delivered it through trusted advisers like the Director of Public Health. Sound health communication will serve the public well, but it needs to be clear, concise and continually reinforcing.

The UK's prior preparedness for a pandemic

Years of significant underfunding coupled with rising demand and costs for care and support, have combined to push adult social care services to breaking point. This has been exacerbated by the COVID-19 pandemic. The significant pressure on councils’ adult social care budgets means that funding is having to be prioritised on supporting people with the highest level of needs. This puts the workforce and unpaid family carers under further strain, creating unmet and under-met need and impacting on social care’s ability to help mitigate demand pressures on the NHS. Long term reform of adult social care is urgently needed.

Since the transfer of public health to local government, councils across England have seized new opportunities to make health everybody’s business. They have done this despite public health grant funding being reduced by over £700 million in real terms between 2015/16 and 2019/20. The ability for local authorities to innovate and increase efficiency is nearing its end. Investment in public health must be increased. Reductions to public health budgets must be reversed and public health needs to be put on a sustainable footing. This will help avert the onset of disease and reduce the burden on NHS and social care.

The development of treatments and vaccines

Should there be a roll out of a COVID-19 vaccine, this will bring with it a further set of challenges both in terms of logistics and ensuring the vaccine is available to those who need it, including our critical social care staff and others providing essential local services.

It is essential that NHS England colleagues engage with local system leaders, particularly Directors of Public Health, Chief Executives and others within local government such as Local Resilience Forums, about the roll out of a potential COVID-19 vaccine.

Government must recognise that local councils have an in depth understanding of their communities, strong partnerships with community organisations, extensive local assets (familiar to the local community) and a significant reach into volunteers and others that could support local initiatives. Local government also employs and commissions nursing staff, school nurses, health visitors, and occupational health teams. In the same way these resources have been hugely effective in establishing local test and trace systems, they can be deployed to equal success in the roll out of a future vaccine. However, to do this, timely and constructive engagement with local government will be essential.

I hope the information outlined above is useful. We would be very happy to provide oral evidence to your inquiry if that would be helpful to your Committees. If we can help with anything else, please do not hesitate to get in touch with my colleague jade.hall@local.gov.uk.

Yours sincerely,

Cllr Ian Hudspeth

Chair, Local Government Association’s Community Wellbeing Board

Nov 2020