A new report based on research undertaken by the Local Government Association with a sample of health and wellbeing board chairs from across the country also revealed widespread concerns over data flow and personal protective equipment supplies.
It claimed that although some health and wellbeing boards have been “struggling” in recent months, the crisis has presented an opportunity to “reset” their purpose and “cement their place in a new normal”.
As part of the research, 15 chairs of health and wellbeing boards – the bodies bringing together representatives of all parts of the care system locally – participated in hour-long telephone interviews in the week commencing 11 May.
The chairs, who are elected members, all identified the community and volunteer response as one of the key positives to emerge from the pandemic.
One chair commented that testing and contact tracing has been “a dog’s breakfast” and “the expectation for local authorities to be responsible has suddenly appeared out of nowhere”.
On the thorny issue of PPE, respondents were typically critical of a perceived failure of national government-led activity and several commented that making rapid local procurement decisions meant they had been able to buy PPE in bulk and achieve acceptable supply level in their own area.
There was also a widely held perception that transfer of care from A&E and other acute settings back into care homes had been done without individuals testing negative or, in most cases, being tested at all.
“We’ve been unable to transfer terminally ill people to a hospice setting so we are inappropriately receiving palliative care in a care setting, and there has been a shortage of end of life medication,” commented one chair.
Health and wellbeing board chairs are senior elected members, and the report found that chairs who are also leaders or deputy leaders are more engaged in the emergency response. Some portfolio holders on the other hand have reported frustration about not being involved.
Chairs in places where delivery footprints are more complex reported frustration, notably where the local NHS arrangements cover multiple local authority areas.
One chair raised “deep frustration” over how “the NHS sees this as an NHS crisis and not a public health crisis in the community”.
“The controlled national approach has been clinical and not about care homes and people in their own homes,” they added.
The research also revealed the emotional impact the crisis has had on councillors.
One described the new virtual set up with meetings held remotely as “weird” and another referred to the crisis as “scary”, raising particular concerns about their council’s financial plight.
There were mixed reviews about the £600m infection control fund, with some believing it helpful and others worried that it might undermine previously well-managed markets.
All interviewees were concerned about whether this fund and others that had been pledged were recurrent or not.
Concerns were also raised about the quality of the data coming from Care Quality Commission and Public Health England, and the timeliness of communication from Whitehall.
“Very poor data” about shielded individuals was a shared concern, and there was a perceived disconnect between the national volunteering initiative and local need.
One chair said: “It’s been frustrating. It took time for various bodies to get into gear. Local community groups were up and running two weeks before the local resilience forum.”
More positively, chairs said there had been an emergence of a new cohort of community volunteers which now needs to be “recognised, cherished and nurtured”.
A general view was shared by chairs from all political affiliations that national government has been implementing top-down solutions and then later handing over to local government.
“The centre hasn’t shared appropriate information,” said one chair, who lamented that their director of public health had been unable to get information on a local level on exactly where the outbreaks are.
Another said the “top-down approach” has been “frustrating”. “I naively assumed that we would… implement strong testing and contact tracing, but it’s been impossible to do when it’s been directed by Whitehall,” they added.
Many positive experiences were also shared. Chairs reported step changes in processes such as discharge, day-centre provision and food bank provision catalysed by the emergency which should now be “embedded in the new normal”.