Our response to Covid-19

Matt Ashton is the new Director of Public Health for Liverpool City Council. Matt lives in the city and takes up the role at a time of unprecedented challenge. Matt was previously the Director of Public Health at the neighbouring Merseyside borough of Sefton Council. Liverpool was the first council in the country to appoint a Director of Public Health — the famous Dr Duncan — reflecting the importance of reducing health inequalities and health protection in the city. In a ground breaking partnership, Matt will also be working jointly with the University of Liverpool and holds the position of Honorary Professor, Department of Public Health and Policy.

Throughout history, nothing has killed more human beings than infectious disease. Covid-19 shows how vulnerable we remain. In Public Health we have spent our careers training and preparing for outbreaks of infectious disease. However, it is fair to say I wasn’t expecting my first priority as Director of Public Health for Liverpool to be dealing with the biggest pandemic for 100 years.

I feel humbled to work alongside my Public Health and council colleagues, and with our brilliant partners across the city, to take on this challenge and serve the people of Liverpool striving to keep every single one of them as safe as we possibly can. Having only been here a week I am blown away by the sheer dedication and determination I have witnessed by so many people keeping this City going. A special mention has to be given to the amazing work that our NHS and Care colleagues are doing, putting their own lives at risk to save others.

Having grown up in Liverpool and having worked as Director of Public Health in Sefton for the last 4 years, I am delighted to be given this opportunity to work in the City I call home.

As we all know, Liverpool is an incredible place with fantastic people who always amaze us with their generosity. It does though have some very poor health outcomes, and some large health inequalities, issues that must be addressed if we are going to survive and thrive as a city, and indeed a city region. Once life returns to normal (whatever that means) after COVID-19 my priorities will centre on using our biggest assets, our communities and people of Liverpool, to help rebuild, return life back to normal and make this City even stronger than before.

So what is the job of being a Director of Public Health all about? In more normal times, my role is to be the chief advisor on all health and wellbeing issues to the city. This is obviously a very broad remit, and covers everything from health improvement advice around smoking, alcohol, and diet, through to health care public health (for example screening & immunisation programmes), health protection (outbreaks of infectious disease!) and of course the wider, or social determinants of health, things like housing, employment, education, and the environment. Arguably the wider determinants of health are the things that usually have the biggest impact on both individual and population level health outcomes, which is why it is absolutely essential that we embed health & wellbeing into everything we do. No easy task!

But in the middle of a pandemic, our focus has naturally shifted almost entirely towards responding to Covid-19. There are a couple of key areas we are actively involved in at the moment, as we try to minimise the impact of this truly horrendous situation on our city:-

Data, intelligence, and modelling — making sure we and the rest of the system understand to the best of our ability, the level of infections in the city, the number of deaths occurring, likely hot spots of activity, and any implications on overall levels of health & wellbeing both now and in the future. We are undertaking modelling activity with our fantastic academic partners to try and predict the course this outbreak will take, to help inform planning around hospital care, out of hospital care, death management, and what recovery activity we will need to undertake to get the city back on its feet.

Communication — we are working really hard with partners and with the general public to be clear about some of the key messages that we all need to be taking on board, whether that be the difference between self-isolation, and social distancing, around the appropriate use of Personal

Protective Equipment (PPE), or around the modelling work we are doing, the strength of our communications are a vital part of our overarching response.

Here are some of the messages we are sharing:

Vulnerable Groups — Whilst the pandemic is affecting everybody, we know it is going to adversely affect some of our vulnerable groups much more seriously. We are working with partners to identify the various cohorts of vulnerable people in our city, and make sure they get access to essential supplies like food, medicine, and health advice as required. This is difficult because there are lots of different lists, so careful coordination is required, but it is essential we get this right in order to protect people’s lives and wellbeing.

Care homes — one of the areas we are putting a lot of effort into is keeping the residents of our care homes safe. Clearly this is a very vulnerable cohort of people, so working alongside our brilliant social care colleagues we are working hard to ensure the care homes receive the advice, guidance and support they need from our infection control service, and also are able to draw on the specialist technical support of Public Health England when they have outbreaks within the care home itself. This will all help to keep many of our care home residents as safe as possible.

Public Health Commissioned Services — whilst all this is happening, we are also keeping our core services operating to help protect people in the City, such as our Smoking Cessation services; Smokers have an increased risk of more severe symptoms of COVID-19 should they become infected. Our Sexual Health leads have worked with providers to establish an online/digital offer to residents wishing to access STI testing and contraception during this challenging period so that patients can still receive this service remotely. With the support of Commissioners, Substance Misuse services are re-configuring service delivery to minimise or eliminate face-to-face contact while maintaining contact with service users to minimise risk of them falling out of treatment. In addition, work is under way to prepare for the release of short-term sentence prisoners who are in receipt of opiate substitution treatment. We are even using our ‘nudge’ expertise to help in

extraordinary circumstances such as nudging the bereaved to hold funerals now rather than put off until the pandemic is over. This is all helping to take the strain off mortuaries and the NHS.

Recovery — When the pandemic is over and the immediate health crisis has been dealt with, we will start to deal with the wider impact of COVID-19 such as the impact on the mental health & wellbeing of our children and young people, as a result of the downturn in the economy we are experiencing. We have started to think about what this means already, however it is a much longer piece of work, and will likely inform our priorities for action for many years to come.

Of course, we don’t do any of the above by ourselves, public health is all about really strong partnership working and first class systems leadership. And we must also always remember that communities are at the heart of everything we do, our mission is to make the world (starting with Liverpool) a better place, and I am proud to be able to do that in the best city in the world.

In these unprecedented times, I know that we won’t get it all right but I am certain that we are all working incredibly hard to do our best for Liverpool. We have always put Liverpool residents at the heart of the decisions we are making to ensure they stay healthy now and in the future, and that isn’t going to change.