Building trust in test and trace

By Martin Ford | 10 November 2020

The country is once again in lockdown as the Prime Minister deploys the bluntest weapon in his arsenal to tackle COVID-19.

One could be forgiven for assuming Boris Johnson’s cherished approach of regional restrictions backed by testing and tracing has been a failure – but was the strategy at fault, or its execution?

Many experts agree that while a lockdown may be required in the event of surges such as those seen in the spring and recent weeks, test and trace should be the tactic of choice for keeping the coronavirus contained.

The World Health Organisation’s special envoy on COVID-19, David Nabarro said: ‘Dealing with this virus involves local capacity to find where it is and interrupt transmission. That is the mainstay.’

Questions must then be raised over how the theory has been put into practice.

In the last week of October, the national NHS test and trace system managed to reach just 59.9% of people who had been in contact with someone infected with COVID-19.

The Scientific Advisory Group For Emergencies (SAGE) has said that 80% must be contacted and, furthermore, must self-isolate as instructed for a system to be effective.

There is hope for the future, as more and more local authorities establish local systems to complement the national version, with areas such as Reading and Leicester recording success rates of 80% to 90%.

Director of public health at Newham LBC, Jason Strelitz, is clear that beyond tracking down contacts, people were then more likely to comply with self-isolation if they trusted the system and had access to the right support.

He said: ‘We could see there were a number of people not being reached by the national system.

‘Conversations with local people is a more positive way of building trust in the model. People want to engage because we are local and understand the local context.’

He said there were remainng issues around eligibility for the national system of isolation payments, but the council was able to assist with hardship payments and already had a system of support in place for people who had been shielding.

‘They are doing it for the benefit of other people, not themselves – we need to compensate people for that,’ Mr Strelitz added.

With the lacklustre rate of the expensive NHS scheme and success enjoyed by its local counterparts, debate has emerged whether the funds would be better spent on councils.

There has certainly been a political divide over the issue between local Labour administrations and the Conservative government in Westminster.

Hackney LBC is among those to have gone on the offensive over test and trace.

Cabinet member for health, Cllr Chris Kennedy, has spoken of his ‘frustration’ at the time taken for test results to be returned and allowing police to access NHS test and trace records, citing them as examples of ‘great work at a local level undone by two more Government failures’.

The stand-off between the Prime Minister and Greater Manchester Mayor Andy Burnham stole headlines some weeks back, but the North East has been a battleground for even longer.

The leader of Newcastle Cllr Nick Forbes issued yet another call for ‘greater local control over the essential track and trace system’ as the UK entered another lockdown.

His frustration is shared in another Labour stronghold, Gateshead MBC.

A spokesperson told The MJ: ‘We have said right from the start that we want to have a localised test and trace system in place in Gateshead and we put a proposal to Government back in May.

‘Our ask from Government is that resources are made available to support a localised track and trace system and to support us in the development of information systems. We are doing this despite the lack of resources and our ask is simply that Government supports us.’

A Government spokesperson said: ‘We have worked closely with local leaders and public health teams in the North East to inform decisions on local interventions – including several recent meetings with council chief executives and MPs.

‘This is a crucial moment and we are providing nearly £14m to the seven local authorities to support their efforts in tackling COVID.’

But is test and trace just a political football? Not exactly.

Labour-controlled Calderdale MBC was among the trailblazers in establishing a local system in August and tracked 95% of the cases it has been allocated.

The council’s public health consultant, Ben Leaman, said: ‘We had some really good compliance in Calderdale compared to our neighbours – [then] our rates started going up.’

Mr Leaman said ‘people were doing what they were told’ by the Government, but as lockdown restrictions were lifted, the number of cases rose and the national test and trace system could not keep up.

‘It became clear they couldn’t get hold of everyone.

‘We needed to make this happen. It’s hard to know how much it’s going to cost [but] it’s about doing the right thing first and foremost.’

The council learned from the experience of counterparts in Leicester and Blackburn with Darwen to create a hybrid system.

‘We’ve adapted things along the way. What we were doing in August is certainly not what we are doing now,’ Mr Leaman said.

Calderdale was able to cross-reference the phone numbers used at a national level and saw higher response rates when using a local area code to call contacts.

It was also able to physically go out and knock on doors where necessary. On top of that the local team were able to help people self-isolating access support, down to the level of help to walk their dogs and bring them groceries.

But Calderdale has not been immune from difficulties shared by many other authorities.

‘There have been some data challenges, mostly with the time taken – six days on average,’ Mr Leaman said. ‘We would like to speed that up.’

He also explained that where new contacts are discovered by the team in Calderdale, they must be passed back to the national system – even if they are in the same household the local tracer has called.

Notwithstanding those issues, and for all that Calderdale is an example of the success had by local teams, Mr Leaman said the contribution of the national system was vital.

‘We couldn’t do all this on our own,’ he said. ‘The numbers would be too big for us to handle.

‘They are really good at getting hold of most people, but they might not be able to get hold of everyone.

‘For this to work really well, we have to have a partnership approach.’

Conversely, Adam Briggs, consultant in public health at Conservative-run Oxfordshire CC has concluded in a paper for The Health Foundation that test and trace’s impact ‘is likely to remain marginal without additional resources’ for local authorities.

Perhaps unsurprisingly We Own It, a campaign group opposing the outsourcing of public services to the private sector, has called for the service to be handed over to councils.

Campaigns officer Pascale Robinson told The MJ: ‘At the heart of the failure of the national system is the privatised, disjointed approach adopted by the Government.

‘We should be scrapping the failing private companies and building a local, public system which will deliver results.’

But the call is echoed by the Association of Directors of Public Health.

It has claimed ‘vast sums of money are being paid to consultancy firms with no prior experience of public health’ and has pushed for an ‘ambitious overhaul’ to produce ‘a more human and local system that is closely rooted in the daily lives of people and communities’.

Asked about calls to localise the service, a Government spokesperson said: ‘NHS Test and Trace is helping to reduce the spread of COVID-19, and over 1.4 million people who may otherwise have been unknowingly at risk of spreading coronavirus have been contacted and told to isolate.’

News - National delays hold back local test and trace

Opinion - The clock is ticking

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