Public Health during Covid-19

Registrars in Yorkshire and the Humber rise to the challenge

HEE supports the development of public health specialists across England through the Schools of Public Health, which is why we thought we would share information on the vital role registrars in public health in Yorkshire and the Humber have played during the Covid-19 pandemic.

From the start the School of Public Health in Yorkshire and the Humber was readying itself to respond to this immense public health challenge. The school has an excellent and long-standing relationship with colleagues at Public Health England (PHE) and made early offers of support in relation to on-call and additional sessions to bolster capacity in the Acute Response Centre (ARC). Several registrars were on placement with the Health Protection Team at PHE and others were quickly recruited to provide additional back up.

Currently 12/40 registrars are qualified to work on-call and have been doing so and working additional in-hours shifts since February 2020. They are now planning cover until the end of August 2020 at least.

Other registrars are located with local authorities, universities, and partner agencies. All have, to varying degrees, been involved in the response to the pandemic. Registrars have undertaken additional work with the PHE Health and Wellbeing Team, they have lead work in local councils responding to the crisis in care homes, with PPE and testing, and they have also been able to act quickly and respond to rapidly-changing situations across the board.

Below are a couple of stories from registrars on the frontline in the region.

Helen Christmas, Specialty Registrar in Public Health - currently working with Hull City Council and on the national Public Health Approach to Policing initiative

What is the same?

Even though it is an emergency, I still take a public health approach to whatever work I happen to be doing. That means seeing the bigger picture and recognising actions to reduce the impact of Covid-19 have other consequences for families and communities who are poor and don’t have a financial safety-net. There are also those who live with dangers like domestic abuse or child abuse and how we try to mitigate that.

I have to be able to interpret and explain complicated data to a wide range of people and make it meaningful. I work on adapting services to recognise the changing need. I also use the evidence we have on the causes of violence to predict patterns and prevent harm.

My work sees me combining technical knowledge with empathy and communication skills to help headteachers interpret guidance and work out how best to reassure scared parents and staff.

None of this is done alone: it’s all a team effort with and across organisational boundaries.

What has changed?

I spend my day on Microsoft Teams, Zoom, Skype and Webex instead of in meeting rooms, it’s easier to get hold of people, because they are desk-bound too and ‘not urgent’ now means by the end of the day, rather than in a week or two.

I no longer have to explain what epidemiology is to anyone, but my working life now includes helping colleagues to source £5,000 worth of sanitary products and nappies in a weekend to fill gaps in care parcels, and listening to a care home manager explain, in tears, why he feels abandoned by broken promises on PPE and testing and is moving into his workplace to support dying residents and protect his family.

We know there will be no going back to normal, because the levels of poverty and inequality in our communities will have changed beyond recognition.

What is special about being a registrar?

Every day since the outbreak began, I’ve used the full range of my public health skills across health protection, health improvement, healthcare and academia. As a registrar, my knowledge in them all is current, as are my skills working across local authorities, PHE, provider trusts, Clinical Commissioning Groups, police forces and voluntary agencies. I speak all their languages! As registrars we are used to picking up new roles, hitting the ground running and gaining the trust of new colleagues quickly. Reflective learning is our second nature, invaluable as we begin to learn the lessons of the pandemic and move forward.

Ben Holden, Specialty Registrar in Public Health – previously on placement with the Health Protection Team at Public Health England (PHE), now based at Barnsley Metropolitan Borough Council (BMBC)

What is the aim of your placement?

The key objective of the Health Protection Team (HPT) placement is to gain experience of acute response work to start working on the out-of-hours health protection on-call rota. In addition, Public Health England (PHE) provides opportunities for registrars to undertake projects to manage longer-term health protection issues.

I started my placement with PHE in December 2019 and early in the pandemic took the first notification of a possible Covid-19 infection in the UK. This meant I followed-up the case before it was confirmed as Covid-19 positive. Once diagnosis was confirmed I was heavily involved in identifying anybody that they had been in contact with (contact-tracing).

What has your work involved since then?

It has been varied, but largely falls into three categories:

Acute Response Centre (ARC) duties:

Contributing to the day-to-day running of the acute response function and delivery of the regional PHE health protection service (daytime and on-call shifts). All work is now undertaken remotely (from home).

Providing first point of contact for specialist knowledge, support and advice to health professionals on health protection matters (e.g. a GP requesting guidance on decontamination of a clinical environment after treating a suspected Covid-19 patient, a care home manager requesting guidance on self-isolation of staff.

Undertaking initial assessment and management of disease notifications and health protection incidents (e.g. a new outbreak of Covid-19 in a high-risk setting – such as a care home or prison).

Supporting the management of complex incidents and outbreaks of infectious diseases and non-infectious environmental hazards (e.g. advising on health protection response to chemical spills, fires or flooding).

Development of national guidance:

I lead the development of internal national PHE guidance to aid the risk assessment and identification of contacts of confirmed Covid-19 cases. This was used by health protection teams across the UK to support large-scale contact tracing efforts at the start of the epidemic.

Additional out-of-hours shifts:

Along with all other public health registrars currently on the on-call rota, I am picking up additional shifts as the health protection team moves to surge capacity. This is to support PHE with additional capacity to manage the resource-intensive Covid-19 response, in addition to on-going routine health protection work.

How do you think life will change for registrars because of coronavirus?

The response to Covid-19 has transformed the health and social care landscape, reinforcing the need for a public health specialist presence in local, regional and national settings. There is a huge amount of work to be done to continue the response, in addition to restoring, re-invigorating, and strengthening the public health system. The workload is vast and will require support from (and provide great training opportunities too) public health registrars across the UK.

Key areas of work include:

The pandemic has had a disproportionate effect on disadvantaged communities and has highlighted the widening inequalities that exist in our society. Research into the reasons for the disproportionate impact of Covid-19 on some groups, and action to tackle these issues is required.

The suspension of established pathways of health care has prevented individuals at risk of other health conditions, most notably cancer, from accessing interventions that are proven to improve outcomes. At an individual level this imposes a risk to health and wellbeing which may outweigh the risk from Covid-19. Restoration of services needs to be addressed as a priority.

Support to the testing and contact tracing of suspected and confirmed Covid-19 cases. Ensuring integration of systems with linking up with local communities and public health teams.