Increasing community vulnerability to gastrointestinal infections in austerity’s shadow: a comparative study of two English local authorities

BACKGROUND: Gastrointestinal (GI) infections are spread through food, water and the environment. They cause significant morbidity and mortality worldwide and are a UK public health priority. In England, local authority (local government) Environmental and Regulatory Services (ERS) play a crucial role in GI infection services. During the period of UK government ‘austerity’ policies in the 2010s there were significant cuts to national spending, including reductions to ERS budgets which may have compromised GI infection prevention and control. In this paper, we examine how reductions in ERS spending across contrasting local authorities in England have shaped the lived experience of staff providing GI infection work, within the context of the COVID-19 pandemic. METHODS: Data were collected between June 2021—March 2022 from staff linked to ERS across two urban English local authorities with contrasting ERS budget cuts, contrasting socio-economic deprivation and different local authority structures. Data consisted of observations (14 h) and semi-structured interviews (n = 17) collected from staff from the following teams: regional UK Health Security Agency teams (n = 6); local authority public health teams (n = 2); public protection teams (including Environmental Health Officers (EHOs)) (n = 6); and local authority-commissioned infection prevention and control teams (n = 2). Data were analysed using a reflexive thematic analysis. RESULTS: Our analysis showed more significant impacts on GI infection prevention and control in our socio-economically ‘disadvantaged’ local authority, underpinned by a greater loss of EHO staff. Budget cuts in our ‘disadvantaged’ area have reduced the capacity for on-the-ground GI infection work in communities, hampered collaborative working across local health protection systems, and forced staff to ration and prioritise their work according to risk, reducing or discontinuing crucial preventative functions. Our ‘advantaged’ area was less affected. CONCLUSION: Contrasting levels of cuts have created socio-spatial inequalities in the experience of delivering GI infection prevention and control. Austerity may therefore be contributing to geographical inequalities in community vulnerability to GI infections. Staff should be supported in using risk assessment tools as they adapt their work practices to accommodate the impact of cuts. Illuminating these inequalities allows community vulnerability to GI infections to be more effectively targeted through policy measures.