1/21 Following yesterday’s post about access to personal protection equipment (PPE), I thought it would help to post a thread about staff testing for coronavirus. We know this is another source of frontline concern. From where we sit, this is complex so bear with me....
2/21 Again, our perspective is of the membership organisation for frontline trust leaders – our job is to articulate their views. We now have a detailed statement of the basis on which we are making all our coronavirus public comment, here: nhsproviders.org/news-blogs/pre…
3/21 Trust leaders tell us that being able to test staff is important for a number of different reasons, recognising the need to distinguish between two types of test – “have you got covid?” and “have you had covid?” (presence of antibodies).
4/21 Trusts are losing a lot of staff due to numbers in vulnerable groups (e.g. pregnancy and over 70) and those with household cases having to self isolate. This is having a significant impact on trusts’ ability to provide the right quality of care at the frontline.
5/21 Trusts are doing all they can to work round this – e.g. putting up staff who haven’t actually been in contact with covid family members in hotels; and reassigning vulnerable groups to other work. But maximising the numbers of staff on the frontline is vital.
6/21 Staff testing allows trusts to identify who is able to return to work before end of potentially long isolation period, making a significant difference to staff numbers. Staff testing also enables trusts to test key staff (e.g. lead ICU nurse) with potential symptoms.
7/21 Trust leaders also tell us that they know that staff testing is important to frontline staff as those who may be unnecessarily self isolating are keen to help out their hard pressed colleagues on the front line and want to be back at work as quickly as possible.
8/21 There’s also very understandable anxiety amongst staff that if they fear they have covid 19 (e.g. from contact with a covid 19 patient) they want to know if they have the virus as quickly as possible. If it’s important to staff, it’s important to their trust leaders.
9/21 It’s striking how many trust CEOs are telling us today that staff testing is vital and they feel that it’s now one of the biggest issues that needs resolution if they are to properly support staff in the way they want to, and they believe is appropriate.
10/21 On the other hand, though, trust leaders also tell us that testing patients is important because it can genuinely save lives. Identifying whether a high risk group patient has covid 19, or not, is important to being able to provide the right quality of timely care…
11/21 ...Trust leaders also tell us that testing patients is key to maintaining vital patient flow. At the moment, for example, hospitals are having to keep patients on wards until test results come back. The longer the delay on testing, the more congested the hospital becomes.
12/21 Also important to remember that national and regional data about the spread of the virus is vital. Key decisions are made on the back of it – e.g. whether to speed up / tighten up social distancing measures and where to allocate vital extra NHS ventilator capacity.
13/21 However, testing capacity is limited. The NHS is growing this capacity as fast as possible. The “have you got it” test capacity has grown from 1,500 tests a day a few weeks ago to 8,000 at the weekend. The NHS should hit 10,000 daily tests this week.
14/21 We understand that the “have you had it” test is also being developed as fast as possible. But there are some big constraints to expanding capacity. EG There is a global rush to maximise "have you got it" test capacity and real pressure on procuring vital testing reagents
15/21 National leaders tell us there is therefore a very important call to make between how much testing capacity is allocated to patient testing and how much to staff testing. They say block testing large numbers of NHS’s 1.2m staff not feasible given current testing capacity…
16/21 So given limited, but growing, capacity, who should be prioritised when it comes to testing? This feels like a very good example of the prioritisation dilemmas the NHS is going to face in addressing this unprecedented challenge.
17/21 We believe it would help if national leaders made these dilemmas, and the constraints, clearer so there’s proper open discussion of available choices. It's vital the voice of trust leaders is prominent in any prioritisation decisions as they have to lead & support staff.
18/21 We therefore think it’s important for national NHS leaders to be clear about three things. A. They should give a regular, honest, best guess of the speed at which capacity for both tests will grow so we can see what will be available when…
19/21 B. National NHS leaders should be clear about the relative priority, within this capacity, that should be given to patient and staff testing and the reasons why, including how we adjust these priorities as testing capacity grows.
20/21 C. National NHS leaders should be clear about what prioritisation decisions mean for the availability of staff testing when, so that everyone knows when we can expect serious staff testing to start and how we can expedite this as rapidly as possible.
21/21 Trust leaders tell us that maintaining the confidence of frontline clinical staff in the NHS and its decision making is important and that this issue, along with PPE, is top of staff concerns. They therefore feel they need clarity as quickly as possible. Hope helpful.
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