Bishop of London – need to invest in local public health responses to coronavirus and offer right financial support for most restricted areas

On 20th October 2020 the House of Lords heard the repeat of a Government statement on Covid-19, and also considered the Government’s Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 5) Regulations 2020. The Bishop of London spoke in response to both:

In response to the Motion to approve the Regulations, she said:

The Lord Bishop of London: My Lords, I am grateful to the Minister for the work that he and others are doing to make decisions at this very challenging time. The regulations we are debating relate to health protection restrictions and fines. However, I wonder whether our approach to public health protection and restrictions during the pandemic needs to pay more attention to a bottom-up approach of wisdom, rather than simply relying on top-down pragmatism and the push and pull of financial incentives. Last week, the right reverend Prelate the Bishop of Manchester highlighted how policies, such as fines, are out of touch with many. It has led to frustration and resentment nationwide.

Our current crisis highlights the need for a whole-systems approach to public health. We need to reinvest in our public health practitioners on the ground, working in and with communities, such as public health nurses, who understand and work with their community to ensure that health and well-being are maintained. They can provide grass-roots insights, learning the needs of local people and business owners and, therefore, how to bring about change in behaviour. In this way, rules that come down from the top are informed by real experiences from those on the ground, from the bottom up—public health professionals, with their knowledge, skills and relationships, working with people and the population to promote well-being. This approach is often seen in those countries doing far better with Covid-19 than we are.

In times as fractured as these, we must extend trust and power to those most familiar with their situations and best equipped to bring about change and rely less on disengaged push-and-pull financial incentives to influence behavioural responses. What is being done to ensure that future restrictions are better informed by local wisdom as well as science?

In response to the statement on Covid-19, she said:

The Lord Bishop of London: My Lords, from my background as a former Chief Nursing Officer, I am aware of the difficult decisions that Her Majesty’s Government are required to make, as well as of the importance at this specific time of good public health action. However, I have heard the concerns expressed by my colleagues in the north-east and the north-west of England, including some of my right reverend friends in your Lordships’ House: Covid-19 is disproportionately affecting the vulnerable and, unfortunately, so are the restrictions. There are significant concerns about their compliance with regulations that they do not feel are fair. The Government have frequently made assertions about public health behaviour and science without publishing the evidence or properly engaging with people in the communities affected. The interventions may well be right but the implementation seems to be failing. The Government must genuinely engage with, listen to and learn from people affected at a local level. Without such local buy-in, public health actions will not happen.

There is also some concern that the restrictions are impacting on those least able to manage the health and economic impact. There are concerns that movement into tier 3 will continue to exacerbate matters such as child poverty, deprivation, economic and health inequalities and poor mental health. If the perception is allowed to grow that certain sections of the economy or society can be allowed to bear the substantive weight of fresh regulations without levels of financial support, the consensus will not hold. Will the Minister reassure your Lordships’ House that, as areas move to tier 3, local voices will be listened to and everything will be done to ensure that the risk to the most vulnerable is minimised?

As I have already said in your Lordships’ House, the local public health nurse can inform top-down rules with local experience. What is being done to ensure that when the ring-fencing of funding that was passed to local government for public health comes to an end at the end of this financial year, it does not lead to further disinvestment in public health?​

Lastly, faith communities, like public health nurses, are part of local populations and areas, and should be used more as experts to help leverage insights that they gain on the ground to support the public health action and interventions needed. I again encourage the Government not to neglect the whole-system approach to public health, as we work together on the challenge of Covid-19.

Lord Bethell (Con, Minister): The right reverend Prelate puts it extremely well. We completely recognise that not only does the virus attack the most vulnerable, but those who are least fortunate bear the huge brunt of the lockdown and the measures needed to crack down on the virus. In these matters, I emphasise that it is worth stepping back and reminding ourselves that the Government are not the source of the problem; the virus is. All the Government can do is take measures to save lives, protect our healthcare service and keep our schools open. In that way, it is not right to demonise central government for taking measures.

Central government can take measures to help protect the vulnerable, and I acknowledge the right reverend Prelate’s point on this. I reassure her that we have put in place the Job Support Scheme to ensure that those affected by business closure are still paid; we have made £465 million available to help local authorities implement and enforce restrictions; we have provided £1 billion of extra funding to local authorities across the country; and we are committed to working with local authorities to allocate testing and tracing locally.

On the message the Government deliver, I recognise the phenomenon described by the right reverend Prelate, but I reassure her that there is no intent by government to make an association between poor behaviours and results. The data is there. We have published every piece of data we can and, to an extent, it does not lie. It is an uncomfortable truth, but some communities have consistently higher prevalence and infection rates. There is some responsibility on those communities to address the causes of that. It is an intent shared by government, local authorities, communities and individuals. There is no avoiding the fact that you cannot pin responsibility on any one of those four pillars.

Lastly, the right reverend Prelate is entirely right that faith communities pay an important role. I pay testimony to those faith communities in cities such as Leicester and Bolton, which have worked with us to great effect. We continue to put our relations with faith communities at the centre of our outreach to communities.

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