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NHS Test and Trace

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Not to be confused with the NHS contact-tracing app.

NHS Test and Trace
Agency overview
Formed28 May 2020
JurisdictionEngland
Employees25,000
Agency executive
Parent departmentDepartment of Health and Social Care

NHS Test and Trace is an outsourced service provided to the National Health Service in England, established in May 2020 to track and help prevent the spread of COVID-19. It is part of the National Institute for Health Protection; the service and the institute are both headed by Baroness Dido Harding.

The service provides temporary sites where samples are taken from individuals, processes the samples at a newly created network of laboratories, and communicates the results; infected people are instructed to isolate themselves from others and asked to provide details of their recent close contacts, who are also told to isolate.

Background

During the early stages of the pandemic, contact tracing was carried out by Public Health England, working with local authorities; PHE is an agency of the Department of Health and Social Care and is not part of the NHS. Tracing efforts largely ceased on 12 March 2020 in view of the wide spread of infection in the population,[1] and as the UK government changed its strategy for dealing with the virus. This decision led to criticism.[2]

Overview

NHS Test and Trace's remit is to find people who have come into close contact with those infected by the virus, thus enabling the lifting of blanket lockdown restrictions and a potential shift towards more localised measures should they be required.[3] The organisation employs a team of (initially) 25,000 contact tracers who contact people who have newly tested positive for COVID-19 and ask them about their recent movements, before identifying others they may have come into contact with. Those people are then asked to go into self-isolation for two weeks.[4] The contact tracers are employed by Serco, who were paid £108 million for the first phase of the work, up to late August.[5] The call centre is operated by American specialists Sitel, who were paid £84m for a similar period.[6]

All components – administering tests, processing samples in laboratories, and contact tracing – are contracted to private companies. Multinational consultants Deloitte handle testing logistics, including collection of statistics, and in turn appointed outsourcing companies Serco, Mitie, G4S and Sodexo, together with the Boots pharmacy chain, to run drive-through or walk-in test centres.

Mobile testing units (MTUs) were designed, prototyped, bought and operated by the army in April.[7] By 20 July there were 218 in operation in England, Wales and Scotland, and the units were then handed over to undisclosed civilian contractors.[8][9] Mobile units in Northern Ireland were operated by civilians from the outset.[8]

Deloitte also coordinates the centres known as Lighthouse Labs where samples are processed.[10] Test kits for use at home (and at some test centres) are provided and processed by Randox under a £133m contract,[11] with logistics by Amazon[12] and some identity checking by American consumer credit agency TransUnion.[13] Randox has a lab in Northern Ireland, although in May some samples were processed in the United States owing to lack of capacity.[14]

The system works in parallel with Public Health England's local health protection teams, who in turn work with local authority staff. Cases involving institutions such as hospitals, care homes and prisons are handed off to the local teams, who give advice to the institution rather than the affected individuals. Less complex cases are handled by NHS Test and Trace: the infected person is contacted by text, email or phone, and asked to give details of their recent close contacts. They may either enter these contact details into the Test and Trace website, or give them over the phone to a contact tracer.[15] If they do not respond, in some areas NHS Test and Trace passes their details to a team employed by the local authority, who make further attempts by phone or text and in some cases by home visit.[16]

Since early July 2020, establishments where people come into prolonged contact with those from other households are asked to collect and keep for 21 days records of staff, customers, and visitors, although this is voluntary and no check for accuracy is required. Contact-tracers request these records if the premises are suspected to be the site of a COVID-19 outbreak. Applicable establishments include all hospitality outlets except takeaway food and drink, tourism and leisure, community facilities, places of worship, and close contact services such as hairdressers.[17]

Geographic scope

The scope of the NHS Test and Trace contact-tracing service is England only, the other United Kingdom administrations making their own arrangements. However, the laboratory network operates UK-wide.[18]

Lighthouse labs

Before the COVID-19 pandemic, tests for infections in England were carried out at laboratories within either Public Health England or the NHS (the latter often sited at hospitals, and reporting results to PHE's surveillance system).[12] In early April 2020, the government reserved the capacity of these labs for testing NHS patients and staff, calling this "pillar one" of their testing strategy.[19]

"Pillar two" provides mass testing – at first to key workers, later to the general public – using a new network of large processing centres operated by commercial companies and universities.[19] Initially three of these sites were planned, collectively named "lighthouse labs" since they employ the PCR test which uses fluorescent dye to detect the virus.[18] As of August 2020, five sites were in operation:[20]

Another lab near Loughborough, Leicestershire is due to open by the end of September.[21]

Phone app

The system was designed to work in conjunction with the NHS COVID-19 app, which was originally announced for mid-May but subsequently delayed due to technical issues during its testing phase.[22] Once the app is launched, it would enable those who have been in close contact with a person with COVID to be identified using their mobile phone. Prior to this, information would be gathered by questioning people about their recent movements.[23]

Following a further delay, Liberal Democrat MP Daisy Cooper tweeted on 28 May: "Dido Harding just told me that the #NHSX app described by PM a week ago as 'world-beating' is in fact just a 'cherry on top' of the tracing system: which itself won’t be fully operational until end June... 4 weeks after lockdown restrictions ease. This is a high risk strategy."[24] Replying to a question at the government's daily briefing on 11 June, Hancock was unable to give any date for rollout of the app, saying it would be brought in "when it's right to do so".[25] On 18 June, development of the app was abandoned in favour of a different design using the Apple/Google Exposure Notification system.[26]

More details of the second app were published on 30 July.[27] Public trials of the app began on 13 August,[28] with residents of the Isle of Wight, the London Borough of Newham, and NHS volunteer responders being the first to test it.[29]

History

The programme was outlined by Matt Hancock, the Secretary of State for Health and Social Care, at the UK government's daily briefing on 23 April, when he stated that 18,000 contract tracers would be hired; at that time the name given to the programme was 'test, track and trace'.[30] At the 4 May briefing, Hancock said he hoped to have the system in place by the middle of the month, and that 3,000 of the recruits would be medical staff.[31] It was reported that Serco and Sitel had been contracted to supply 15,000 call centre workers, who would have a short training period, and Hancock was criticised for not making use of around 5,000 environmental health workers in local authorities.[32]

On 7 May, Hancock appointed Baroness Dido Harding to lead the contact tracing programme for England, with a remit to oversee the implementation of the programme itself, and a contact tracing app.[33] On 18 May, Hancock said 21,000 tracers had been hired.[34] On 20 May, Prime Minister Boris Johnson told Prime Minister's Questions that a team of 25,000 contact tracers would be ready to begin work on 1 June.[35] The launch of the contact tracing service for England began on 22 May, when the government announced eleven pilot areas, including Norfolk, where the service would be initially rolled out. A £300 million investment package was also announced to help local authorities support the service.[36]

Deployment

The launch of the system in England – branded for the first time as NHS Test and Trace – was announced by Boris Johnson, the Prime Minister on 27 May 2020, and it went live the next day,[37] before it was fully ready.[38] Initially officials believed it would have the capacity to identify 10,000 people a day.[4] News that the service would be established without the phone app led to concerns manual tracing alone would not be effective enough to slow the spread of the virus.[39]

On the day of its launch, contact tracers began the process by contacting the 2,013 people who had tested positive for COVID-19 the previous day. Some tracers initially reported difficulties in accessing the system, but the UK government said it had not crashed and the problems were being resolved.[3]

On 28 May, Harding told MPs that the system would not be "fully operational at a local level" until the end of June.[40][41] Contractor Serco stated in internal communications that they believed it would not be fully operational until September.[42]

By 1 June, Hancock described the system as "up and running" but was unable to say how many cases had been handled.[43] On 3 June Channel 4 News reported that 4,456 confirmed cases of COVID-19 were reported to Test and Trace between 28 and 31 May, with those people passing on 4,634 contacts, and of those it said 1,749 had been contacted by tracers. The government described the data as outdated. On the same day a contact tracer claimed in a BBC interview that although she had worked for 38 hours she had not been asked to speak to anyone since beginning work, and had spent her time watching Netflix. In response the government said her story did not reflect the work taking place.[44]

Evolution

A reorganisation of the contact tracing element was announced on 10 August, following criticism that the service was not making use of local knowledge. The number of tracers in national teams would soon be reduced from 18,000 to 12,000,[45] and some staff would work in teams linked to local authorities, at first in areas with high prevalence;[46] the number of clinically trained advisors would not change.[47] However, Andy Burnham, Mayor of Greater Manchester, claimed on 2 September that resources from the national test and trace system had not yet been released to local authorities.[48] Earlier, authorities including Blackburn and Oldham set up local systems involving GPs and Public Health England, as it was taking up to 96 hours for cases to be transferred from the national system.[49][50]

By 21 August there were over 130 testing sites, of which 38 were "walk-in", and there were 236 mobile test units.[46]

August 2020 restructure

An announcement by Hancock on 18 August established the National Institute for Health Protection by combining NHS Test and Trace with parts of Public Health England. The new body is chaired by Harding on an interim basis.[51][52]

Key people

Conservative peer Dido Harding, the chair of NHS Improvement, has led Test and Trace since its formation.[33]

Tom Riordan was appointed to lead contact tracing for three months in mid-May 2020, alongside his role as CEO of Leeds City Council.[53][54] At the same time Sarah-Jane Marsh, chief executive of Birmingham Women's and Children's NHS Foundation Trust, was appointed to lead testing.[54] Susan Hopkins, a director in Public Health England's National Infection Service,[55] held the position of Interim Chief Medical Adviser in September 2020.[56]

Test capacity

In late August 2020, the Lighthouse labs were overstretched and sought assistance from NHS labs.[57] A rapid increase in COVID-19 cases in early September led to the demand for tests outstripping supply in some areas[58] which caused delays in accessing the appointment system, and in some cases, people were being asked to travel longer distances to get tests.[58]

The leader of the testing programme, Sarah-Jane Marsh, apologised on 8 September 2020, saying the "pinch-point" was laboratory processing.[59] The following day the senior director of public health in a local authority was quoted as saying "I am not interested in an apology. I want them to pull their finger out and sort this mess out or hand it over to us and get out of the way."[60]

Matt Hancock, commenting on the same issue, suggested that the reason people were unable to book tests was that the proportion being booked by people who were not eligible to have them had risen to 25%. He said "[w]e have seen an increase in demand including from people who are not eligible for tests, people who don't have symptoms".[61]

In mid-September, the Independent reported that the Lighthouse labs had been partly staffed by university technicians and students, who had since returned to their universities; there were also logistical difficulties with movement of test samples.[62] A report by The Guardian described testing sites attended by hardly any people, staffed by personnel frustrated at not being permitted to test people from nearby who turn up without an appointment. It was reported that people attending a site without appointment were advised informally to get an appointment anywhere using a false postcode, and download the QR code for it; with such an appointment they can be tested.[63]

Contact tracing statistics

The Department of Health & Social Care publishes weekly statistics on contact tracing. Numbers shown below include the complex cases handled by local health protection teams as well as those handled online and by the call centre; the first week's report stated that a "high number" of contacts were managed by the local teams.[64]

By the end of July the percentage of contacts reached had decreased, which was said to be primarily due to a decrease in the number of complex cases handled by local teams, where the success rate is higher. Of the 3,688 cases handled in the week to 29 July, only 249 (7%) were classed as complex. After their close contacts were identified, in complex cases 93% were reached, while in non-complex cases 61% were reached.[65] Following more targets not being met and the percentage of close contacts traced being at a record low of 69.2%,[66] Dido Harding said "NHS Test and Trace is working and every week we consistently reach the majority of people testing positive and their contacts".[67]

Dates Positive COVID-19 tests

referred to Test and Trace

People reached Contacts identified Contacts reached
28 May to 3 June 2020

(revised 18 June)[68]

8,096 5,826 (72%) 51,851 46,949 (91%)
4–10 June[68] 5,949 4,366 (73%) 44,895 40,690 (91%)
11–17 June[69] 6,923 4,869 (70%) 30,286 24,734 (82%)
18–24 June[70] 6,183 4,639 (75%) 23,028 16,804 (73%)
25 June to 1 July[71] 4,347 3,366 (77%) 14,892 10,547 (71%)
2–8 July[72] 3,579 2,815 (79%) 13,807 9,811 (71%)
9–15 July[73] 3,887 3,098 (80%) 16,742 13,034 (78%)
16–22 July[74] 4,242 3,455 (81%) 18,598 13,974 (75%)
23–29 July[65] 4,642 3,688 (79%) 19,150 13,866 (72%)
30 July to 5 August[75] 4,973 3,962 (80%) 20,638 15,308 (74%)
6–12 August[76] 4,803 3,787 (79%) 16,897 12,053 (71%)
13–19 August[77] 7,941

(incl. some tested in previous week)

5,767 (73%) 24,197 18,274 (76%)
20–26 August[78] 7,683 6,257 (81%) 31,388 21,773 (69%)
27 August to 2 September[79] 8,908 7,367 (83%) 32,359 22,381 (69%)
Cumulative[78]

(not exact sum due to retrospective revisions)

81,989 64,842 (79%) 372,493 293,452 (79%)

Appraisal

Potential impersonation of contract tracers

Concerns were raised by members of the public and the media about how someone receiving a call from a contact tracer could be sure of it not being a scam. Speaking at the UK government's daily coronavirus briefing on 31 May, Dr Jenny Harries, the Deputy Chief Medical Officer for England, acknowledged those concerns but said it would quickly become apparent the call came from a professional, who "will make it very clear to you that they are calling for a particular reason. I think it will be very evident, when somebody rings you, these are professionally trained individuals and sitting over them are a group of senior clinical professionals."[80]

Data protection

Concerns over data security and data protection have been raised. At launch, the programme did not have a Data Protection Impact Assessment, which is required by law.[81] In July, it was reported that workers on contract were sharing patients’ confidential information on social media support groups, due to a lack of alternative means to solve problems within their teams.[82]

On 20 July, privacy campaigners the Open Rights Group claimed that NHS Test and Trace was unlawful and breached General Data Protection Regulations (GDPR) because sensitive information could be shared with third parties. In response the UK Government conceded an assessment of its impact on data privacy had not been carried out before the system was launched, but there was no evidence that data had been shared with third parties.[83]

Effectiveness

In July 2020, medical academic Prof Allyson Pollock wrote that the programme was "about as far from integrated or effective as you can get" and called on the government to publish details of its contracts with outsourcing companies.[84]

BMA opinion poll

The British Medical Association (BMA) asked 8,190 doctors and medical students in England about their concerns about COVID-19; the results were published on 14 September 2020. 86% of respondents expected a second peak, and it was the main concern for 30%. 89% of respondents agreed or strongly agreed that the failure of test and trace risked causing a second wave.[85][86]

International comparisons

Although different countries keep records in different ways, the Our World in Data research team from the University of Oxford say that the UK is performing more tests than many other countries.[58] As of 14 September 2020, they show that at 2.76 tests per 1,000 people, the UK rate was ahead of most countries in the world, including the major European countries: Belgium (2.3), Russia (2.1), France (2.07), Ireland (2.07), Norway (2.03), Germany (1.79), Sweden (1.78), Spain (1.77), Switzerland (1.42), Netherlands (1.36), Austria (1.35), Italy (0.91) and Poland (0.46).[87]

Testing and tracing in other UK countries

NHS Test and Trace as such is an English programme, but testing and tracing is carried out by programmes in the other countries of the UK. Northern Ireland became the first constituent country of the UK to reintroduce contact tracing when, on 23 April, its Chief Medical Officer, Michael McBride, announced that a scheme was "active".[88] Following a pilot, the system became fully operational in Northern Ireland on Monday 18 May.[89] On 23 July, Northern Ireland's Department of Health confirmed the release of the contact-tracing app, StopCOVID NI, for as early as 29 July. Northern Ireland was the first part of the UK to launch a contact-tracing app,[90] which was launched on 30 July.[91] The app runs on both the IOS and Android operating systems, but the developer said that it would not work on iPhone 6 or older Apple devices.[92]

Plans for Test and Protect, a contact tracing service in Scotland, were published by the Scottish Government on 26 May,[93] and it was launched on 28 May, shortly after NHS Test and Trace went live;[3] a companion app "Protect Scotland" was launched to the public on 10 September.[94][95]

The Welsh Government began a pilot scheme in some health board areas on 18 May. On 27 May, Wales announced that its contact tracing service would launch on 1 June.[96]

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