Beyond the lockdowns: Lessons learned from Leicester's COVID story

Although the resources and expertise that came with the national COVID response were vital to the Leicester response, it was soon realised that the importance of local knowledge and understanding of communities could not be understated. This was seen with the success of our contact tracing service in Leicester, our local testing programme including door to door team and in the work of the community wellbeing champions around vaccination uptake. It is clear that a ‘one-size-fits-all’ approach for the whole country does not necessarily work for everyone, and in diverse communities like Leicester a more bespoke approach is needed. In the event of future pandemics, or other events of similar magnitude, it is hoped that this will be recognised from the outset, allowing local teams to shape the response according to the needs of their populations. The legacy of this lesson has carried on in our work with our Community Wellbeing Champions Network which allows us to work even more closely with our communities and allow us to respond to needs in the best possible way for our citizens.

During the pandemic, many members of the public health team and the wider council found themselves working hard in roles that were completely new to them. Having stepped up and offered to work as part of the pandemic response, they soon became a vital part of the team, really stepping up to face the challenges they were offered. This willingness to adapt and change, and to learn new skills was so important to the success of things such as the testing and contact tracing programmes, the schools and care home helpdesks and the support with isolation work.

This is also true of the ways of working for many health services; the pandemic forced a seismic change in the way that people accessed healthcare as many aspects were forced online virtually overnight and long steps forward were taken towards more digitised/remote healthcare. Although some of this was out of necessity and will not necessarily stay that way, other aspects have worked well, and people find them more accessible and convenient. The pandemic has taught us that many aspects of health and wellbeing services can be delivered remotely whilst not compromising safety or quality. Digital and online healthcare does not work for everyone, and it is important to remember that, but what has been positive is a widening of options when it comes to ways people can access services and it is likely to stay that way in the future.

It is not just people in the public health and council workforces that have had to be flexible and change the way they work as a result of the pandemic, but something that everyone faced. Those able to work from home were told to do so; in many cases without appropriate or suitable spaces to work from, and many parents also had to become teachers to their children at the same time. For those unable to work from home, workplaces saw incredible amounts of new measures put in place to limit risk and everyone had to find new ways of doing things. The fact that people adapted and carried on is a huge testament to the resilience of the people of the city, and their ability to be flexible in response to challenges.

As many of the examples in this report attest, the Leicester team often found itself having to face challenges and solve problems that no one really had before due to its position as the first in a local lockdown and then an area of ‘enduring transmission’. Consequently, many new ways of working emerged which often went on to become standard practice for other areas in the country. Rapid problem solving became a part of everyone’s life as unprecedented situations cropped up on a regular basis and had to be worked around. This was true for us in public health, but also true for the whole community. Business owners were an excellent example of people finding new and innovative ways to keep their businesses running and keep serving the public in ways that worked with changing restrictions and risks. Locally, the public health team, UKHSA, the council business enforcement team and businesses all worked together to provide on-site testing for many large premises, as well as advice on outbreak management. Schools worked with us to stand up whole-school testing programmes at very short notice, creating and adapting new systems as they went to ensure that the process went smoothly. Residential care providers also had to adapt and create new processes and facilities to ensure that their residents and visitors were safe and cared for, whilst still maintaining as much of regular life as possible. For example, outdoor visiting ‘pods’ in some places enabled their residents to have visitors in a lower risk outdoor setting.

During reflection on the pandemic, members of the public health team spoke of the benefits of this innovative and rapid problem-solving way of working which was new to many as public health projects often traditionally worked on longer timescales. They enjoyed the cross-team working and regular exchanges of ideas and brainstorming sessions between team members that this required and suggested that this should be captured and taken forward into our post-pandemic working. One of the ways in which this learning has been taken forward into our non-COVID work is the formulation of an incident management team structure, similar to that used to manage COVID, to tackle the cost-of-living crisis in the City. This is chaired by public health using the experience gained during the pandemic, but has membership from many partners across the council, health and the community and voluntary sectors. Many of these links were established during COVID times and have been maintained ever since.

Resilience has potentially become an over-used word in the difficult times over the last couple of years, but in its most basic sense, it can be taken to mean the ability of something or someone to withstand difficulties or physical insults. 2020 and beyond was a time when the population faced unprecedented difficulties and therefore the concept of resilience became suddenly even more important. This was particularly relevant for the teams managing the COVID response at a number of levels:

• Organisational resilience i.e. the ability of the team and wider organisation to adapt to and withstand challenges. A particular challenge for everyone was the fact that because work was progressing at such a pace and so many new workstreams were being established, there was commonly a situation where one person in the team had such a specific remit that there was no one else within the time that had that particular package of knowledge and skills at any one time. This meant that if any team member was missing for any length of time, such as if they were ill or on leave, it was very difficult for someone else to fill in for them. Clearly this wasn’t good for the organisation as it meant that work became stalled if people were off, but also it wasn’t good for the individuals who then felt under pressure to not take time off so as to avoid the situation. The sheer amount of work meant that all hands were needed on deck at all times. Consequently we soon learnt that it was important to have at least two people at any one time who had an oversight of particular work areas (even if not all the detail) so that people could take time off and work could continue. This was particularly true for those in leadership roles for whom the need to be visible for the team was an added responsibility during this time.
• Personal resilience became hugely important. Caring for staff in the workplace and working hard to maintain our feeling of cohesiveness and togetherness as a team became suddenly harder in 2020 when our work moved to our homes and away from communal spaces. All of the informal and formal procedures we had in place to support each other and work together through tough times were no longer able to happen through a combination of logistics and busyness with work. This meant that people’s wellbeing at work was in danger of becoming adversely impacted and so we set out as a department to tackle this. We formed a working group who put together a whole suite of activities and initiatives to support the wellbeing of the team. Initially these were all virtual, but as time went on and restrictions eased, began to include things like walks. The team used the five ways to wellbeing framework to design activities to help bring people together. We also established a peer mentoring system whereby anyone who wanted was assigned a buddy within the team, who was there to check in and chat whenever needed. At an even simpler level, a conscious effort was made by management and leadership to try and promote a culture of not working too long beyond hours, making sure to take leave owed, take breaks when possible and try not to schedule meetings over lunchtime. Although this was sometimes difficult given the workload, the culture has persisted into the post pandemic period.

Workplace wellbeing and team events and activities has remained an important part of the culture in the Leicester City Public Health team even after we are now able to come back to the office. Events have become less frequent now some of the informal support structures have returned, but we have had the occasion to have some full team meetings where we are all in the same room together and it has been absolutely wonderful to see everyone. Somehow the difficulties faced during the last two years have forged a team identity and bond that we are looking to foster and explore into the future.

Finally, but possibly most importantly, it is clear that no Public Health Team is an island! From the first set up of the incident management team when we collaborated with colleagues across the council and health system, to the support received from national organisations to the work done in partnership with communities and education and social care on vaccine confidence, everything we have done has been in partnership and made all the more effective for it. Although traditionally, public health has always worked in partnership with a number of organisations, in the past there have been constraints on this through practical aspects like data sharing arrangements, differing organisational priorities, resourcing, time and capacity constraints. The arrival of a world-altering pandemic brought about a rapid change in many of these circumstances and we were able to collaborate more freely and quickly with partners. It is hoped that the relationships that were formed during the last two years will continue to flourish and evolve and carry over into non-COVID related work. This is already being seen in our close working relationship with the newly formed Integrated Care Board on health inequalities and uptake of vaccines and screening, our collaboration with the other council departments and heads on the cost of living crisis, and in our work with communities. During the pandemic there was a clear demonstration that one of the most important partnerships for us to nurture and develop was the one we have our communities. Without their support, engagement, willingness to share their time and views and collaboration with restrictions and setting up infrastructure, many of the things described in this report could not have happened. However, we also appreciate the need for this partnership to be two-way, and that we must earn and keep the trust that our communities have in us. Our Community Wellbeing Champions Network is growing all the time and build on a foundation of mutual respect and desire to care for the health and wellbeing of the people of Leicester in the best possible way.