With Blackburn with Darwen's diverse communities experiencing lockdown and special measures for longer than almost any other area in the country, creating an effective test and trace system has been at the heart of our public health response.
Breaking the chains of transmission, especially through familial and social contacts is key to stopping the spread of coronavirus. It was clear from early on that the national system was neither robust nor timely and was failing our residents. Keen to increase the number of successful contacts and reduce the time to do so we worked closely and at pace with Public Health England (PHE) and the national NHS Test and Trace team to set up a local enhanced contact tracing service, going live on July 29, just two months after the national service started.
Attendance on PHE's two-day national training programme helped us to understand the national system's digital platform (CTAS). In-house business analysts customised this training, cascaded it to our local contact tracing team and designed a lean end to end process; this learning has been shared with other local authorities to support development of their own systems.
Additional, limited funding isn't sufficient for a dedicated local tracing team, so Blackburn with Darwen has integrated staff, in a business-as-usual model across neighbourhood engagement (community connectors) and wellbeing services (health trainers), with flexibility to scale-up to reflect fluctuating daily case volumes. The team has invaluable local knowledge and experience of supporting individuals' health and wellbeing. Cases are devolved from the national team if they have been unable to contact them within 24 hours. On receipt the data is analysed, duplicates removed and household cases grouped together (so only a single call is required) and then checked against council-held databases. Within an hour each resident on the positive case list is sent a Gov.notify text message, advising them that the local authority needs to speak to them. The text also provides links to COVID-19 guidelines and advice as well as details for Blackburn with Darwen's Help Hub – which offers wrap around advice, information and sign-posting to services to support individuals and families; this includes assistance for the social and economic impact of their self-isolation period.
Experience from the development of the Community Help Hub showed that people appreciated being contacted by a friendly voice, speaking their language, and someone who understands the local area. Operating 8am to 8pm Monday to Friday and 10am to 1pm at weekends our local team does just that. Phone calls are made from a Blackburn area code (01254) not the generic (0300) number used by the national team – we believe this has helped with initial levels of engagement. The tracers carefully talk the individuals through a questionnaire to gather information about their close contacts. These details are inputted back into the same CTAS system used by the national team for their follow-up. Gathering information locally provides important insight about virus spread including workplace, social and education settings. This intelligence, shared with our local public health team, is crucial for wider outbreak management in the borough. If local tracers are not able to make contact with a resident after trying for 48 hours, the case is then referred to colleagues in our public protection service who visit the case's address to check on welfare, reinforce isolation advice and to recommend they engage and speak to a local tracer.
Hard work by our enthusiastic, skilled contact tracing team has demonstrated success; more residents engage locally than a distanced national system is able to achieve. As November 3 we had 1186 devolved cases and been able to contact 89% of residents, providing them with advice, information and support to keep themselves, their families and their communities safe.
It's been a successful three months but with the volume of positive cases continuing to rise rapidly in Blackburn with Darwen there are increasing pressures on the available local tracer resource; more funding is required to strengthen this successful localised public health model. The situation is exacerbated by the poor quality of data from the national system; it is often delayed, inaccurate and incomplete. The local system and local people would gain huge benefits from improvements in data quality, enabling quicker engagement, identification and thus a more effective process to break the flow of transmission.
We will continue to work with national partners to improve collaboration, support local connectivity and make the case for additional resources. The opportunities for further enhancing localised test and trace services when combined with new technology and rapid testing is exciting; creating a leaner and more efficient local tracing system that will be fundamental to the control and management of the virus. Working with local people, supporting them and connecting them to their local communities creates resilience and will contribute to their health and wellbeing for many years to come.
Claire Ramwell is head of leisure, health and wellbeing at Blackburn with Darwen Council
