Interview with Rachel Flowers, Director of Public Health, The London Borough of Croydon.
This is part of a series of interviews with public health directors, published on 9 November 2020.
The London borough of Croydon, like much of the rest of the capital, was badly hit early on. “It happened so quickly,” said Rachel Flowers, the council’s Director of Public Health.
“The hospital started filling up and the number of deaths were rising. It was alike a disaster movie. We have a lot of care homes and so had a lot of patients discharged from hospital and there was no testing. Covid got in and we saw a lot of deaths.
“It was really distressing. I remember crying the first time that there were so many deaths on one day that I could not remember the name of all those who died. As directors of public health, we have trained for this, but nothing could really prepare us for what has happened in those early weeks of the pandemic.”
‘Clear messaging has been crucial’
The surge in cases did though end and the numbers came down and remained low. In fact, all through summer and into early autumn Croydon had one of the lowest levels of infection in the capital and was well below the national average.
“We worked really hard alongside the local community to get a clear message across – hands, face, space to keep Croydon safe. We have tried to create a clear narrative as we know people have been confused with all the changes in regulation. My key message has been that this is a virus that loves human contact and to keep our loved ones safe we have to reduce the amount of contact we have.”
Ms Flowers said as well as what you are saying, how you say it and who you get to say it is just as important. “We have tailored those messages to reach out to different parts of the community. We have used social media, translated materials and worked with community partners. Our deputy young mayor did a You Tube video. You have to work with the community.
“I have done countless online meetings with faith groups, voluntary sector bodies, head teachers and local politicians to get messages out into all our different communities. Some of it is simply about combatting the misinformation that is out there.”
One technique that has proved particularly popular and effective is the use of flow charts. A series of different charts have been used advising people what they need to do if they test positive or how contact tracing works. “We’ve done a lot of this for schools – really easy to understand charts that take people through everything step-by-step.”
‘We’re entering our third marathon’
Ms Flowers said: “One of the benefits of the pattern of the spread we have seen in Croydon is that it did allow us to regroup over the summer, build up some of the resilience and a chance to rest.
“I hope that will stand us in good stead now. I realise not all areas and my director of public health colleagues have had that.”
As autumn progressed, Croydon did start to see a rapid increase in cases although the rates were still below the national average. By the last week of October 117 cases per 100,000 were recorded.
“We are now in the second lockdown. I think of it as the third marathon – and it is exhausting for everyone. People are frustrated and tried, but we have to keep going and believing it will be better in the spring. That the vaccines will make a difference and the seasons will be with us.”
‘We can do things better in second lockdown’
Ms Flowers is determined to avoid some of the most damaging elements of the first lockdown. “I think we need to do better in encouraging people to seek care for other problems. The NHS is trying to keep other services going much more, but the problem is people are scared and we have to communicate to them better that they must seek help if they need it – the NHS is there for them.”
Another ambition for Ms Flowers is to allow some form of care home visiting to continue during the winter. “Loneliness and isolation is really distressing. We were able to get back to allowing visitors in the summer for care homes through the use of risk assessment, good infection control and regular testing within the home - I am hoping we can get this for visitors soon.
“We may have to be quite creative going forward – allowing people to meet and talk through windows or setting up gazebos. I don’t want to get to the situation where people are spending all winter without getting any visitors. That would be devastating. We have to learn from what happened first time round and ensure we are in a stronger position.
“In fact, I would like people in all sorts of situations to think of new ways to stay connected and supportive to people. I know of people who used to say ‘I can’t use Zoom or Microsoft Teams’ but are now experts.
“It has changed the way we do things. I know in many ways for the worst, but there are also some things that are different in a good way.
“In some ways relationships have got stronger. I have certainly got to know my fellow directors of public health better. I have seen the inside décor of people’s homes, their cats, dogs and children. We are learning from each other and supporting each other.
“We are going to need that in the coming months. And when we get through them we will need to work on recovery. Covid is going to make inequalities worse. It distresses me to think of the life changes that have been disrupted and that will be a challenge we have to rise to.”