1/23 This week has seen the first data release from NHS Test and Trace so a good point to assess its progress so far and look at what now needs to be done. Thread follows. Usual basis, we're not Government or @NHSEngland, we're the voice of NHS trusts: nhsproviders.org/news-blogs/pre…
2/23 Rapid, good, progress has been made since early May to establish a working, national level, phone and online based, contact tracing service, linked to the national testing regime. This is a significant achievement, given the context, and deserves appropriate recognition.
3/23 However it’s clear that, as a nation, we are coming to this very late - much later than other countries. We would be in a much better position had this work been started, with this team, in March not early May. Public inquiry will need to identify why this didn’t happen.
4/23 It’s difficult to assess how well NHS Test and Trace is doing at this point in its life because it’s only just been created & there are few comparison points. But initial statistics suggest it does have confidence and trust of public – vital. And no mean feat, given context.
5/23 It's also worth recognising the good work that has been done to get a rigorous and credible set of initial, experimental, performance statistics. There's been no public noise on the reliability or credibility of those stats. Very stark, and welcome, contrast to end of April!
6/23 Important to recognise that the volumes of work at this point are likely to be small as the country is only starting to come out of lockdown. The first key test was could NHS Test and Trace get a functioning system up and running by early June? That test has been passed.
7/23 Colleagues at NHS Test and Trace tell us they are confident that, on the assumption that any outbreak at this point is likely to be relatively small and localised, they think the system as currently operating will be sufficient and robust. But there is clearly some risk.
8/23 The problem is we simply don’t know whether there will be a second spike, when, how big and how widespread. There is lots of speculation that the worst case scenario is a second big, widespread, spike coinciding with winter. This seems a sensible planning assumption...
9/23 ...So, another key test for NHS Test & Trace will be its ability to deal with this kind of work volume - a very different scenario to the current situation. Still a huge amount of work to do to get a fit for purpose, let alone world class, service to deal with this scenario.
10/23 In looking at the work that NHS Test and Trace now needs to do, it may be best to think of two different buckets of work – its core testing work and its test and trace work. It’s important to remember that NHS Test and Trace, as an organisation, has responsibility for both.
11/23 On core testing, three big gaps that need rapid filling. 1. We still need clarity on overall strategy – who to test, why, when, where and how frequently, in this next phase. Each test must have a value and purpose, driven by the strategy. No tests for testing numbers' sake.
12/23 Testing gap 2. NHS trusts, care homes and the general public need all tests of those with symptoms to be returned with 24 hours. This is international standard for good clinical reasons. Lots of anecdotal evidence that there is still a significant patchwork quilt here….
13/23 …Still too many places without consistent 24 hour test turnaround. We need to know how many places, where, why, and then reliably fill those gaps, with public data showing this has been done. We think this will require more local control of testing and much better data.
14/23 Testing gap 3. There are still no clear plans for regular testing of relevant NHS/care staff and patients/residents, to ensure effective infection control. This is required for the NHS to fully restart services. It’s also a huge operational and testing capacity challenge...
15/23 ...This would need to sit within a wider approach to testing those in high contact, high risk of virus spread, roles like taxi drivers, security guards etc. Don’t forget that covid-19 is here to stay for some time yet – testing helps manage the risk of virus spread.
16/23 But, and this is also crucial, testing is only one weapon in the virus spread, risk management, armoury. It's vital that good hand hygiene, appropriate social distancing and protection of the most vulnerable stay in place. Testing is not a silver bullet by itself.
17/23 Test and trace gaps. 1. Local surge plans to deal with any larger scale outbreaks – how to locally surge test, trace & isolate capacity if needed - still being developed. These need to be in place, tested, and robustly assured. This feels like it is still 4-6 weeks away.
18/23 Test and trace gap 2. This week’s data shows that, whilst a good start, there is a lot of hard work needed to improve performance at each of the stages in the end to end process. It would be good to see targets for each of these over time. These stages / measures are:
19/23 Percentage of those with positive tests coming in to test and trace system (though duplicate tests likely to be skewing stats). %age contacted within 24 hours to get contacts. %age of those contacts contacted within 24 hours. %age of those contacted willing to self isolate.
20/23 It's also clear that work will be needed on other related issues. Assurance on compliance (including data), recognising UK is not a police state. Financial support for those who are required to self isolate and need such support to do so (e.g. gig economy workers).
21/23 Test and trace gap 3. We need right data reliably and rapidly flowing to NHS organisations, patient records and local authorities. NHS trusts reporting that data flow from NHS/PHE testing much more reliable than data flowing from ‘Pillar 2’ commercial testing labs.
22/23 @CommonsHealth and @CommonsSTC have important role in ensuring appropriate scrutiny of NHS Test and Trace performance over next few months given how vital its role is. Good to see the high quality of work that @Jeremy_Hunt and @GregClarkMP are already leading here.
23/23 In summary, NHS Test and Trace has made good, rapid, progress over the last six weeks. But the Government should have ensured this work started a lot earlier. And there is a huge amount still to do to get to a fit for purpose, let alone world class, service.
