1/22 Lots over last 24 hours on staff testing so thought I’d do one of my threads. Usual basis: we are not Government or @NHSEngland, we are voice of NHS trusts. Full detail of the basis of our public coronavirus comment here: nhsproviders.org/news-blogs/pre….
2/22 My first thread on testing gave a lot of the background. It’s worth a read if you are new to the topic, e.g. the different types of test and the challenge of balancing enough staff and patient testing: threadreaderapp.com/thread/1242142…
3/22 Everyone is working very hard to expand coronavirus testing capacity as fast as possible – Government, central NHS leaders, procurement chain, trusts, their pathology labs and new “alliance”: gov.uk/government/new….
4/22 It's important to understand the constraints. Recognise view of chemical industry but trust leaders tell us major shortages of swabs and chemicals / reagents needed to complete tests. There is a global shortage. But everyone is doing everything they can to maximise supply.
5/22 Two anecdotes on trust resourcefulness: trust sourced reagent from local vet research laboratory to allow one day’s further testing (same reagent usable across different tests). Serious effort going on to see if NHS path labs can make their own reagent - told working well.
6/22 We understand that if existing NHS pathology labs had unlimited swabs and reagent there is enough test machine capacity to process c100,000 tests a day but reagent and swab shortage is currently limiting this to c13k a day. Shows impact of shortages on current test capacity.
7/22 Frustrating, not fully understood, constraint is mismatched demand & capacity – some labs not working at full capacity, others struggling with high volumes. But number of different testing platforms in use, each needing own swabs/reagent, so there are compatibility issues...
8/22 …If a London trust wants to use spare capacity in a Newcastle lab, the test swabs have to be transported down to London and then the swabs from the completed tests have to go back to Newcastle. This makes matching capacity and demand like a Rubik’s cube....
9/22 ...as, given swab shortage and transport distances, a trust short of testing capacity would ideally want to use its regular swab type but then has to find another lab using the same testing platform with spare capacity. National level demand/spare capacity matching complex!
10/22 This explains the obviously frustrating difference between the potential testing capacity, i.e. the number of tests that could be done each day and actual tests completed i.e. number of tests actually done. And the fact that some labs are currently running under capacity.
11/22 We understand that new “alliance” testing capacity is not on stream yet but is likely to come on stream shortly. It will build up over time but is likely to start at c500 tests a day hopefully later this week/ early next. When this new capacity arrives it will be welcome.
12/22 What about who is tested? Constrained capacity means potentially difficult prioritisation decisions on the balance between staff and patient testing (see my earlier thread). Up until last Friday, the instruction to trusts was no staff testing, just test patients.
13/22 Trusts told at the weekend that they can start staff testing (england.nhs.uk/coronavirus/wp…). But testing capacity is so constrained that they were asked to only allocate 15% of their testing capacity to staff testing and keep the rest for patient testing.
14/22 Some of first systematic staff tests therefore done over weekend, but not a huge number. Intriguing data from v small sample size...only around 15% of those in 14 day isolation tested positive so other 85% could come back to work. If anything like right, a huge opportunity.
15/22 We are expecting more good news this morning. We understand that trusts, as we have asked for, will be allowed to set their own priority balance between how much staff and how much patient testing. Good and sensible piece of delegation of decision making.
16/22 Lots of CEOs we’ve spoken to in last 24 hours clear they’ll rapidly expand staff testing. As one CEO put it to me: “Our clinicians usually pretty clear on who has covid19 and who doesn’t. The test provides confirmation but we could concentrate testing on cases with doubt...
17/22 ...But we have no idea which of our staff can return to work and the test can tell us that in a way nothing else can. We’re massively short of staff so logical to give greater priority to staff testing, particularly in vital areas where pressure on staffing is greatest”.
18/22 However, before getting carried away, remember testing capacity is still v constrained (currently 13k/day) and there are 1.2 million NHS staff. So no immediate prospect of mass staff testing. Testing will have to be tightly targeted where most needed whilst capacity grows..
19/22 ...So we expect today's new guidance to focus staff testing on ambulance and hospital critical care/emergency dept staff. Obviously very frustrating for all other trusts & staff. But at least we can now start ramping up staff testing as @NHSProviders has been calling for.
20/22 We are asking Government / national NHS leaders to give a public estimate of how rapidly testing capacity will ramp up so trusts can start making sensible plans on how rapidly staff testing will grow. This is important to reassure trust leaders and frontline staff.
21/22 Lots of recent focus on "have you had it" antibody testing (2.5m kits, Amazon ordering, use the post etc). We understand still very much in the test phase and no prospect of the tests being available any time particularly soon. Though v welcome when they do arrive!
22/22 Also recognise that some want to debate "did Government move fast enough, what was happening in January/February etc". Trust leaders, who would want to contribute to that debate, as they run the pathology testing labs, don't have time for that at this point.
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