‘It feels like we are impotent at times – we need the power to do our jobs’

This is part of a series of interviews with public health directors, published on 23 October 2020.

Summer presented a little respite for many when it came to coronavirus. But not for Northamptonshire Director of Public Health Lucy Wightman - she has had to deal with one of the biggest workplace outbreaks of the pandemic so far and has seen three of the main towns in the country placed on the government’s watchlist.

The workplace outbreak was at Greencore, the sandwich-making factory for Marks and Spencer. The first cases started emerging in late July – and soon the health secretary himself had got involved.

“We were alerted by Public Health England when they had two linked cases. We knew immediately it was a large employer and went in straightaway. Soon another four cases were confirmed, then another four.

“The employer was really co-operative – and that made it much easier. I know from other director of public health colleagues that is not always the case. They actually paid for private testing to done and paid all the workers who were isolating 80 per cent of their pay when all that was actually required for many was statutory sick pay.”

Hundreds of workers tested positive

Eventually more than 1,000 staff were tested with more than 250 positive cases confirmed. Ms Wightman said: “One of the biggest challenges was language – 35 different languages were spoken by staff so we had to translate the literature detailing what was expected in terms of isolation and testing.

“There were cases of transmission on to other members of the household who did not work at the factory too that we had to contend with. But it did not spread to the wider community.

“Greencore staff form a very close-knit community. Many had been recruited from abroad to work at the factory. They lived and socialised together – and that is where the transmission happened.

“The factory was very COVID-secure. It had taken all the steps expected. There were some extra things we recommended, but our main focus was on getting across the importance of social distancing outside of work. We now run a campaign ‘Don’t leave COVID-secure at the door’.”

Government action ‘had unintended negative consequences'

But Ms Wightman said perhaps the most challenging aspects of the local response was the direct involvement of government. Northampton was declared an area for intervention off the back of the outbreak, which gave the government powers to close the factory and force every worker to self-isolate.

“That hampered our ability to communicate with the workforce. We had 800 workers who had tested negative twice. They had been coming into work and we had been talking to them face-to-face about what needed to be done to reduce any on-going risk to them, their families and the wider community.

“But that stopped when the government intervened and it created some mistrust in the workforce that we had to work hard to overcome as well as having a big financial impact on the factory.”

Ms Wightman said this is symbolic of a wider issue that has defined the pandemic so far for her. “As directors of public health we are responsible for the health of our population. But we do not and have not been given the powers to fulfil that role. It has felt at times like we are impotent and unable to do our jobs.

“It is really hard for central government – they are dealing with something we have never had to deal with before so of course they are not going to get everything right. But central government really needs to trust local government and their partners more. There is so much expertise – not just among directors of public health, their teams and lower tier local authority environmental health officers, but regional Public Health England officials and at Porton Down.”

She said another example of this tendency was the period when councils were not given information about who was testing positive in their area. “It was so frustrating. We knew PHE had the information, but they could not give it to us and that meant we could not target our response on areas where there was the most infections. It meant we had to rely on blanket communication methods, which we know do not work.

“Now we are dong leaflet drops in certain neighbourhoods and targeted social media campaigns at certain demographics – it is a much more effective way of encouraging people to adhere to the rules.”

Success in curbing spread in community

The impact of this can be seen in how infection rates have been reduced in the  main towns of Kettering, Northampton and Corby. All three have been on the government’s watchlist, but have since come off after rates were brought down. At one point Corby had the highest rates nationally.

“We have been careful not to shout about it too much as we don’t want people becoming complacent, but it is a real achievement and is a testament to how local people have reacted and followed to the advice we have provided.

“But again we did not have the powers to do what we thought was necessary. We wanted to introduce the 10pm curfew locally weeks ago, but could not. The government has gone for that now and I am pleased, but we would have chosen to act sooner. It’s not universally popular and will have some unintended consequences – people may go back and drink and people’s homes. But that doesn’t mean it will not have an impact.”

Ms Wightman is worried about what the coming months will bring. “We are seeing infection rates rise and that translate to more people being admitted to hospital. I hope we will avoid the peak in hospitalisations and deaths we saw in the spring as we have better treatments, more vulnerable groups will naturally be taking more precautions and we are in a stronger position to protect care home residents.

“But it’s still going to be very difficult. We’re currently having a problem with Test and Trace. We have set up our own team of local contact tracers – we have used the police, environmental health officers, licensing officers and community wardens to help reinforce compliance too. They have done a really good job, but now because of the delays in testing we are not able to start the tracing sometimes for up to eight days after the case tested positive. That is about as useful as a chocolate teapot. It is not helping us keep on top of infections.

“I know locally we will keep doing our best. The response of all our partners has been magnificent. But I must give particular praise to the environmental health officers working for the district councils. Alongside the contact tracing, they have provided invaluable support on the ground, working with businesses to get the compliance we need to minimise risk in Northamptonshire. It has been a real team effort.”