Interview with Matthew Ashton, Liverpool City Council Director of Public Health.
This is the seventh in a series of interviews with public health directors, published on 29 May 2020.
Matthew Ashton was appointed Liverpool’s Director of Public Health at the end of last year. But with a three-month notice period to work for Sefton Council, he could only start the job on 1 April – in the middle of the coronavirus pandemic.
“It was hard. I liken it to jumping into a freezing lake – there is shock at first but they you start swimming. I’ve had to learn the ropes, meet the people and build relationships very quickly. It was certainly not what I had envisaged when I got the job.”
With Sefton being part of the Merseyside group of councils, Mr Ashton was able to keep across what was happening in Liverpool and the wider region. He also grew up in the city so knew it well.
“I have never worked so hard as I did when I first started, and it isn’t much different now – but I know lots of people can say that during the pandemic. I think for all of us involved in public health it has felt natural to step up. It is what we have been trained for. We want to bring our skills to the job and make a difference.
“The Liverpool public health team has gone above and beyond in responding to COVID, while maintaining services. All core services were quickly adapted to ensure they were still able to operate in the current climate
“This includes a city-wide digital offer for sexual health services, the provision of weekly prescriptions for people getting methadone and telephone-based smoking cessation services.”
‘Local decision-making may become more important’
But alongside this, of course, new practices have been developed to respond to coronavirus. At the heart of the work is the intelligence cell that was set up by Mr Ashton and reports into the Merseyside local resilience forum. The University of Liverpool also has crucial input – Mr Ashton holds the position of honorary professor in the department of public health and policy ensuring a joined up approach between academics and those on the front-line.
“I set up the information cell to analyse the epidemiology on a daily basis. We know the flow of information from national bodies has been a problem so we have been able to provide some information and evidence to help our officers and politicians in their decision-making.
“We have the second highest level of excess mortality in the country outside of London. It has been a big focus for us. We’ve worked with our NHS and Public Health England partners to ensure that this wasn’t about service availability or quality, rather than more obvious links to the long-standing deprivation issues.
“It is also noticeable we have been coming down from the peak more slowly perhaps another areas and that of course cause problems. We don’t get the R-value for Liverpool. You just get that regionally so you have to make local judgements.”
He believes this may mean a “bigger role for local decision-making” as the country eases out of lockdown. “Nationally the government will probably put pressure on local areas, but as we see with schools will have to look at what is happening locally and that is why the mayor has warned we may move more slowly here on expanding opening. Schools are of course doing their own risks assessments and we are helping to provide advice on that.”
How Liverpool has led the way on care homes
Mr Ashton is particularly proud of the work done with care homes. Liverpool was part of a pilot with Public Health England that saw testing of all residents and staff introduced to capture asymptomatic cases – the success prompted ministers to agree to the policy nationwide.
“We prevented a number of outbreaks. We tested everyone in care homes where there was no outbreaks and then re-tested a few weeks ago. We probably helped prevent cases at four or five care homes and I’m very pleased with that piece of work.”
Alongside that, the public health team has also been providing regular infection-control advice and helping with PPE, which has been particularly challenging. “It has settled down now. But one of the problems we faced has been that the guidance was being constantly updated and we’ve had to explain that. We have also had to source PPE and supplement peoples own supply chains.
“And then when the face-coverings announcement was made I did media interviews explaining the need not to take up the clinical masks that would be needed by the front line and that instead it was about making face coverings.”
But while care homes were always going to be a major focus, the pandemic has also thrown up some surprising, unforeseen challenges. “We also did some work with the faith sector about mortuary capacity. In the early days mortuaries were filling up due to people not claiming the bodies of their loved ones. They were waiting for when the pandemic was over so they could have a proper funeral.
“We have a behavioural insights lead within the team, and they did some fantastic work with the faith sector utilising nudge techniques to encourage families to come forward. You would never expect you would be working on something that. But it was a really important piece of work – and illustrates how in this pandemic you have to be prepared for everything.”
‘Think long-term too – recovery and capitalising on opportunities’
Looking ahead, Mr Ashton said developing the test, track and trace system is clearly going to be crucial. “It is going to have to evolve, once it goes live we will have to learn and adapt. It is a very complicated piece of work – and local government will have an important role to play.”
But despite the daily problems that coronavirus throws up, Mr Ashton said it is important not to lose sight of longer-term challenges. “You cannot just keep dealing with what is immediately in front of you. There is still an element of business as usual. We are having to make commissioning decisions about services and developing savings plans at the same time
“We also have to start planning for recovery now. Unlike a flood or fire or outbreak of measles, the critical event for coronavirus is not short. It has been going on for two months - and recovery could take two years or more. We have been meeting with the visitor economy and restaurant trade. We have to re-launch the city at some point, but how we do that is going to be crucial.”
There are opportunities too that should not be missed, be believes. “We are seeing more people use local open spaces for physical activity, increased community cohesion and benefits for climate change. We are also encouraging more active travel and use of pop-up cycle lanes, coronavirus could be used to reshape the way we live our lives – maximising that potential is an important consideration.”