The role of the public sector in COVID-19 has involved the high-profile activities of the NHS and the community response of local authorities. During recent years, however, as we lay out in Local Authorities and the Social Determinants of Health, local authorities have had a diminishing role in social health outcomes and are at the behest of the UK government, the most centralised government in the Western world.
This issue has been evidenced by the problems in implementing Test and Trace, a centralised strategy, best achieved by local public health experts with local knowledge, but confounded by year-on-year reductions in local and national public health budgets. Conversely, the benefits of centralised control have been effective in the rapid construction and equipping of the large-scale Nightingale hospitals and manufacturing of respirators. There is now a stockpile of 30,000 machines.
The private sector has been pivotal in the provision of PPE, food supply and the development of vaccines, although the concerns of Gareth Davies, Auditor General of the National Audit Office, about the procurement processes and fraud in the Business Interruption Loan Schemes must be noted. The private sector also, however, includes a wide range of businesses which have been negatively impacted by the pandemic. Whole sectors such as airline, hospitality and retail industries have been decimated by major changes in social behaviour. The prospects of mass unemployment, the loss of the high street and major contractions of the economic heart of large cities has led to a major rethink of the economic and workforce structures of the UK, exemplifying the interrelations and interconnectedness of individuals, lifestyles, community agencies and the socio-political environment.
The Kruger Report, commissioned by the Prime Minister, reviews the importance of community and the third sector. This report acknowledges the role of charities, philanthropy and the need to support the role of this heterogeneous range of organisations and agencies which include small and large charities and faith-based organisations. Loss of fundraising income and organisational resilience of some charities has placed them in a precarious state.
Taking all this into account, and examining the research as reviewed in the book, what is clear is the need for trusted partnering between the public, private and third sectors in order to add public value.
An example of such partnering is the response to pandemic-related unemployment funded by the European Social Fund. This involves a partnership between the church and major charity, The Salvation Army, London boroughs and a range of private-sector companies to provide training and employment pathways for unemployed people. This demonstrates that soft structures, provided by a third-sector organisation, are important in complementing the hard structures provided by the public and private sectors in adding and deepening public value.
In the current transforming of society there is a need to develop an objective, evidence-based approach to supporting communication, understanding, research and collaboration between these key drivers of health and social policy in the public, private and third sectors. These are the main aims of the Centre for Partnering which has been developed from a collaboration between academics from five universities with public, private and third sector experts.
As society transforms into new bubbles and economic structures, local and national politicians wrestle with recovery from COVID-19 and adapt to a post-Brexit world, and conspiracy theories abound, we need to ask important questions:
How can levelling up be achieved to reduce the increasing inequalities?
How can we decarbonise capitalism?
How can local authorities develop sustainable budgets which address the real needs of people and communities?
What forms of leadership are needed to navigate through the current and future interrelated wicked issues, that are difficult to solve because of incomplete, contradictory and changing requirements that are often challenging to recognise?
How can relational partnerships deepen and enrich public value?
These questions will be addressed in the third volume in the Social Determinants of Health series, which we are writing as we speak.
Adrian Bonner is Honorary Professor at the University of Stirling, and a consultant in community-based research for The Salvation Army. He was formerly Director of the Addictive Behaviour Group, in the Centre for Health Service Studies at the University of Kent.
Local Authorities and the Social Determinants of Health edited by Adrian Bonner is available to pre-order on the Policy Press website here for £23.99.
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