I would be lying if I started this article with a reference to the England testing strategy for adult social care. On the ground, it has felt anything but strategic. On occasion it has felt like a knee-jerk response to a crisis combined with an opportunistic land grab as testing capacity increased. All of which has been run through a communications office that has wanted the good news stories out before the notion of operational implementation has hit the desk.
Unfair, I hear you cry. We have been in the midst of the largest global health pandemic that any of us have experienced. Yet, the local and national response has been hugely frustrating for the care sector that has been calling for regular and repeat testing for both those receiving care and support and the workforce.
Over the last four months, the National Care Forum has run a series of surveys and engagements with our membership to find out what was happening on the ground in relation to testing. These surveys coincided with the significant shifts in approach to testing. They have been critical in determining how national policy is translated in practice, and have also uncovered some of the significant variations that have emerged in relation to how providers access testing, who gets tested and how quickly results are returned.
In one survey in May it emerged there were at least five different ways to access testing as a resident and at least six different ways as a member of staff, leading to huge confusion and lack of consistency. There was a significant connection between the testing route and how quickly you received the result, with localised Public Health England (PHE) team testing taking the longest to return results and self-testing being the quickest. In other words, testing, the central pillar supporting us to emerge from this pandemic, felt like engaging in a lottery.
On 6 July the Government started the roll out of regular and repeat whole care home testing. This new approach is initially being carried out across all care homes supporting older people and people living with dementia. Then, from early August, across all care homes.
This seemed to be clear, but within a week of that announcement, there was a new approach which runs in parallel relating to outbreak management. Here, on notification of an outbreak, which is two or more confirmed cases within a seven day period, local PHE teams are rapidly deployed to carry out whole home testing of residents and staff, and then return four to seven days later to test again those who tested negative on the first wave to see if there has been any change.
The team return at the end of 28 days to do a further complete test to determine whether or not the service has moved into ‘recovery’ – that is, COVID-19 free. How the two systems knit together is unclear, and we await a matrix which will tell us which testing approach trumps, or indeed whether homes are expected to run them concurrently.
Of equal importance is the logistics and resources required to actually operate weekly testing. For many providers it has meant a dedicated member of staff doing the ordering, administering, recording, sending off, receiving results and monitoring/interpreting and logging those results. These additional costs must be met as the regime of testing continues, but the £600m infection control fund only runs until September and so ongoing funding must be available.
The ability to utilise testing data interchangeably between national and local programmes seems elusive, leaving local PHE teams to rely on care homes to manually update them on the presence of positive cases preventing the seamless sharing and learning from data in a meaningful way. Local approaches to interpreting policy and guidance also vary considerably. It is essential that care providers receive clear and consistent guidance and practical support to put guidance into practice.
Testing outside of care homes has not been sufficient. Symptomatic staff have been able to access testing through a variety of arrangements. However, the testing of asymptomatic staff and those receiving care based in the community in supported living, shared lives, home care or employing their own carers has been hugely challenging. Repeated requests to government to clarify the timetable for when this will be available have not yet resulted in the kind of assurances that care providers need and want.
Testing therefore must be suitable for a wide range of people, particularly those living with dementia. Saliva testing holds much promise, both from the perspective of the individual and the provider. We need to protect these individuals and those around them, so making tests less invasive and faster will help those who find the experience a challenge.
Vic Rayner is executive director at the National Care Forum, the leading representative body for the not-for-profit social care sector