International lessons for Welsh public bodies in responding to and recovering from COVID-19

Thursday, August 20, 2020 - 6:51pm

Recovering from the global pandemic will take time. The public bodies who keep us safe, well and healthy will find themselves in a changed operating environment, with financial issues to address, a change in citizen and visitor behaviour and expectations, and workforces that need to adapt to new ways of working. We will all have to deal with additional risks and getting back to what we remember as ‘normal’ may take a long time, if it happens at all.

The consequences are likely to last for several years for most organisations. But there will also be opportunities to consider:

  • what worked well;
  • what needs to change; and
  • what needs to be stopped.

As part of this reflection, there are opportunities to learn from other countries who may have dealt with major emergencies or disasters and draw on their experiences.

As Audit Wales begins its work looking at how public bodies in Wales are undertaking their recovery planning, we have pulled together some key messages from across the globe that show some key learning on how countries have been successful, or not, in responding to the pandemic.

This learning can be applied to any tier of government – national, regional or local – and any public service which provides services to people.

Responding to and recovering from a pandemic is cyclical – each cycle presents an opportunity to address long standing problems

Emerging definitions of recovery are not universal, nor is its timing or focus. In Wales, the message from the top has been to consider the pandemic as a catalyst for change, and recovery is the opportunity to get rid of or alter practices that for too long have held public bodies back. Recovery is therefore a chance for ‘renewal’ rather than a ‘return’ to pre-COVID-19 business-as-usual.

This thinking is reflected in the work of the RSA Lab[1] on understanding crisis-response measures. They concluded that recovery during a pandemic is different to recovery after a single-event disaster, happening alongside the response and is a continuous exercise of trial-and-error. They are not linear with one following the other. Pandemics work in cycles and you move between response and recovery frequently.

The Committee on Data of the International Science Council (CODATA[2]) represent this ‘ebb and flow’ as a corkscrew – figure 1.


Figure 1


Importantly, CODATA note that thinking of a pandemic as ‘cycles of activity’ reinforces the need to learn, change and adapt. For them COVID-19 has been a catalyst to discard obsolete practice and prioritise innovation – the reasons why you could not change that often stymied progress in the past now have less relevance, and problems that were previously thought intractable are solvable. Public bodies need to take advantage of these unprecedented times and make bold decisions.

Influencing how you want people to behave is critical

The World Health Organisation research on pandemics and major emergencies highlight valuable learning for public bodies about informing and influencing how people behave to prevent unnecessary demand[3]. These are important principles that can be applied to any public body responding to an emergency, reopening or revising a service. They can be summarised into the following key messages:

  1. Targeted information and constant reassurance prevent unnecessary and unwanted demand for services. From red and pink posters in public squares to ministers’ frequent appearances on the nightly news, officials in Switzerland have worked hard to gain control of communication about the pandemic. Using the statement “we must act as quickly as possible, but as slowly as necessary” was a perfect example of the clear, measured and earnest tone that the country’s authorities have tried to strike publicly from the start of the outbreak. The Government’s messaging was received positively across Switzerland and helped manage demand and enabled the Swiss Health system to cope with impact of the virus[4].
  2. People’s compliance with laws and regulations is heavily conditioned by how fair we perceive our required action to be. Getting people to accept and comply with safety messages, restrictions and changes in the services they use and receive will only work if people believe the change is right and fair. People need to trust that the decisions taken by government at all levels are based on the right motives and have been developed in an unbiased way. Being transparent and clear why things must stop or change, and the new priorities that need to be implemented can influence acceptance and buy in.
  3. Guidance works best when it is developed and agreed jointly. Citizens need a ‘voice’ or ability to give their concerns and feel listened to. The opportunity to express fears or seek clarification is critical and dealing with such queries promptly and consistently is essential. People need to feel that the guidance is for everyone.
  4. Trust in authority is vital. If people can see the rationale for doing this, they are more likely to accept the impact however difficult it can make their lives. Trust has become a vital issue. Confidence both in expertise and in public institutions to do what is needed can help get buy in and cooperation. If people do not trust the motives or decisions of government or public bodies, then the legitimacy of their actions and acceptance of them is weakened.
  5. Witnessing bad behaviour and seeing people ‘get away with it’ saps trust and confidence. Not dealing with people who break regulations quickly and consistently undermines faith in the system. It encourages people to do what they want because compliance is no longer seen as essential or relevant.
  6. Public bodies need to reassure people that things will get better. All of us need to hold on to the belief that sacrificing now will lead to a better result for us, our family, friends, colleagues and communities. Messaging that emphasises putting in effort now will lead to a reward later can help condition our buy in.

In New Zealand the Prime Minister and senior cabinet members effectively communicated to the nation with clear, concise daily statements about the situation. The Prime Minister gave updates nearly every day at lunch, reminiscent of old wartime radio broadcasts, but via social media. Government messaging was clear and coordinated by the ‘All of Government Response Group’ which laid out four phases of lockdown and the conditions that had to be met to proceed from one to the next. The Group leaned heavily on scientific knowledge[5]. The Government also involved and trusted citizens encouraging the behaviour they wanted and needed from them using a series of posters[6] under the slogan of ‘a team of five million’ to describe their collective efforts. People trusted their government to do the right thing. People bought in to the approach and saw it as the nation as one responding to fight and beat the virus.

Public bodies must respond quickly and decisively

Singapore’s approach to the pandemic has benefitted from the country’s experience of having to manage a quick succession of recent public health challenges. COVID-19 is the fourth major public health outbreak the country has had to deal with in the last two decades[7].

In 2000 the country experienced foot-and-mouth disease which resulted in 3,000 infections and three deaths. This was followed by the ‘Severe Acute Respiratory Syndrome’ or SARS epidemic in 2003 that saw 238 people becoming infected and 33 people dying. In 2009 the country was infected by the avian influenza H1N1 outbreak which led to 1,348 people being infected and 18 people dying. And finally, in 2020, COVID-19, which has seen 42,995 infections and 26 deaths[8].

Singapore was one of the earliest countries to detect Coronavirus and in early February was near the top of the confirmed cases list by territory. Yet there was no exponential rise in cases. Some of the reasons for these are unique to the Singapore system, which has invested heavily in outbreak preparation and building health care infrastructure capacity building after the SARS wake-up call in 2003. Singapore built a task force across multiple government agencies to coordinate interventions and messaging during any future pandemics. This task force was tested in 2009 during the H1N1 pandemic. It was reassembled by January 2020 for COVID-19[9].

One of the most important lessons for the Singapore Government in dealing with earlier outbreaks was to act quickly and decisively. Singapore proactively implemented travel restrictions on passengers coming from mainland China contravening the World Health Organization’s insistence that travel bans were not necessary. The precautions came at a significant economic cost to the international hub, which relies on mainland China as their biggest trading partner and source of tourists. Through experience the Government had learnt that its decision making had to be agile and quick to be able to effectively respond to the challenging situation.

Similarly, the reason the New Zealand Government has been the most successful in tackling COVID-19 is because it took decisive action. Though the country did not ban travel from China until February 3 (a day after the United States) and its trajectory of new cases looked out of control in mid-March, decisive action helped the Government manage and control the spread of the virus.

The key to New Zealand’s success is an approach that could be applied anywhere – moving swiftly, testing widely, and relying heavily on good science. Like many countries, New Zealand had models that showed that a potential pandemic could be devastating if no action was taken. Unlike some other countries, New Zealand responded relatively fast[10].

On March 14 the Government announced that anyone entering the country would need to self-isolate for two weeks, it was among the toughest border restrictions in the world. At the time, the country had six cases. And on March 23, when the country went into lockdown, there were 102 confirmed cases – and no deaths. Decisive action, going hard and going early, helped the New Zealand Government to stamp out the worst of virus.

All parts of the public sector pulled together to deliver the intended goal of eradicating COVID-19, and the creation and promotion of transparent governance and collaborative structures helped get buy in and trust. This resulted in a return to normality for the country three months after entering a severe lockdown.

Compare the decisive actions in New Zealand with the response in Europe, where the severity of the outbreak has been attributed to slow Government responses. For example, allowing sports events, conferences and demonstrations to mark International Women’s Day to take place despite seeing the impact and spread of COVID-19 across the globe.

Data driven decision making and evaluating what and why things work, or fail, is essential

Data plays a central role in the global efforts to combat COVID-19 through virus detection, mitigation of spread, treatments, and vaccines. Public policy responses are equally informed by and reliant on data analytics. Access to data in real-time is vital to understanding the virus, adjusting public policy countermeasures such as social distancing and contact-tracing, and accelerating research and development on diagnostics, treatments, and vaccines. People also need to trust government and public bodies to use data only for the purposes intended.

Key to demystifying the virus in New Zealand was the support decision makers got from a team of scientists and health professionals who collated, interpreted and published data to drive decision-making[11]. Data was given high currency and recognised as essential in containing the virus but also in understanding the consequences of the pandemic. Through its COVID-19 dashboard [opens in new window], data was shared openly, trusted and drove the country’s successful easing of lockdown.

Smartphone data has been used in Singapore, China, Taiwan, South Korea and Australia, to track the location and contacts of individuals who have tested positive for COVID-19 or to enforce quarantine orders. For example, over 1 million people downloaded the Australian Governments App – COVIDsafe [opens in new window] – within 12 hours of its release. Analysing the data collected is seen as crucial in capturing helpful insights to stem the flow of the pandemic.

For public bodies to successfully reopen or reconfigure facilities or amenities hinges on the tricky task of collecting the right data, using it to help understand their services and harness the insights in the data to determine what to do and when. This approach is no different for any aspect of public service – reopening leisure facilities, recycling sites or when to restart routine operations. Data can be the driver of decisions. It needs to be analysed frequently; revisited, pored over and challenged to ensure the decisions taken are based on the best evidence available.

Does Wales have an advantage in how public bodies can respond to COVID-19?

Wales already has a framework in place that can help drive public bodies choices in responding to the Coronavirus – the Wellbeing of Future Generations Act. The recommendations from international good practice we have noted above fit naturally against the five ‘Ways of Working’ and can help shape a distinctly Welsh response-recovery to COVID-19. Looking at some of the lessons from abroad and considering the changes we have seen in Wales in public services have designed their response draws this out – Figure 2.

 

Ways of working Lessons from Abroad What’s working well in Wales
Long term Learn lessons for climate change



Rethink capital spending and procurement programmes
Flintshire County Councils long-term procurement of Personal Protective Equipment



Wrexham County Borough Councils inclusion of climate change mitigation in new action plans



Conwy County Borough Council’s fleet management planning and move to electric vehicles as default
Prevention Change mindset from ‘if’ to ‘when’



Address any inequity in service delivery and balance with prevention services



Learn prevention lessons from disaster risk management
Dyfed Powys Police’s ‘At Home [opens in new window]’ tailored online information community safety information



Ceredigion County Council’s track, trace and protect [opens in new window] system



Broader and enhanced fire and rescue service Safe and Well visits [opens in new window]



Cardiff Council’s Cardiff.Gov app [opens in new window]​ which is full of advice and prevention information
Involvement Participation Cymru’s well established principles for involvement [opens in new window]



Ensure involvement of younger people as they have the most to gain or lose
Bridgend County Borough Council’s COVID-19 updates [opens in new window] to help inform and engage with citizens



Monmouthshire County Council’s volunteering hub [opens in new window]



Rhondda Cynon Taf County Borough Council’s Financial Support Guidance [opens in new window] developed with local businesses



Powys County Council’s interactive social media pages – Facebook [opens in new window]Twitter [opens in new window]Flickr [opens in new window], YouTube [opens in new window]LinkedIn [opens in new window] and Instagram [opens in new window]
Integration Move towards an integrated approach to pandemics



Build on what is working – don’t ‘reinvent the wheel’ – take the best from all



Build recovery on existing frameworks
Blaenau Gwent County Borough Council’s Business Continuity guidance and support [opens in new window]



Powys County  Emergency Childcare hubs [opens in new window] integrated with local nurseries



Denbighshire’s support for business information [opens in new window]
Collaboration Strengthen collaboration



Design an appropriate information and risk communication system



Collaborate with private sector and wider range of partners as appropriate
The Vale of Glamorgan Council’s formal collaboration arrangements through the Public Services Board and its role as the regional lead on the Local Resilience Forum



Newport City Council’s public service Information Station [opens in new window]Welsh Police Force specialist services

 

 

Figure 2

 


Wales is already learning its way through how to respond effectively to the pandemic. Building upon and using the established language and processes of WFG can help support this transformational change. Similarly, the established learning approaches found in national public service and sector specific forums is helping councils, Police forces and Fire and Rescue services to use peer learning to drive improvement.

Next steps

In the next few months Audit Wales will be supporting and feeding back on how public services in Wales are continuing to shape their response and recovery and keeping us all safe and well. We have pulled this paper together to provide some useful information from our review of how other countries and governments, emergency services and specialist agencies have responded to pandemics to support this work.

Authors: Nick Selwyn, Steve Frank and Bob Lloyd


[1] The Royal Society for the Arts undertakes research on a range of areas including public services and communities, Creative learning and development and Economy, enterprise and commerce.

[2] CODATA exists to promote global collaboration to improve the availability and usability of data for all areas of research.  CODATA supports the principle that data produced by research and susceptible to be used for research should be as open as possible and as closed as necessary. This is taken from the Progress in Disaster Science [opens in new window] journal published in May 2020.

[3] https://www.who.int/publications/i/item/risk-communication-and-community-engagement-readiness-and-initial-response-for-novel-coronaviruses-(-ncov) and https://covid-19-response.org/pillar/2

[4] https://www.swissinfo.ch/eng/covid-19_coronavirus–the-situation-in-switzerland/45592192

[5] https://covid19.govt.nz/covid-19/covid-19-all-of-government-response-group/#mission

[6] https://covid19.govt.nz/updates-and-resources/posters/

[7] https://www.moh.gov.sg/diseases-updates/being-prepared-for-a-pandemic

[8] https://www.moh.gov.sg/diseases-updates

[9] https://www.moh.gov.sg/docs/librariesprovider5/default-document-library/multi-ministry-taskforce-on-wuhan-coronavirus-and-tor—final.pdf and  https://www.moh.gov.sg/news-highlights/details/ministerial-statement-on-whole-of-government-response-to-the-2019-novel-coronavirus-(2019-ncov)

[10] https://covid19.govt.nz/updates-and-resources/data-and-statistics/

[11] https://www.health.govt.nz/publication/covid-19-modelling-and-other-commissioned-reports