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Despite being initially hailed as the main way to manage Covid-19, test and trace has proven something of a nightmare for the Government. From technological flaws in its contact tracing app, to u-turns on whether to use Apple and Google’s technology, the papers have been filled with negative stories about progress in this area.

Perhaps it could be said that this week has provided the biggest headache so far for ministers, beginning with the news that 16,000 people who tested positive for Covid-19 between September 25 and October 2 disappeared from official records in England.

This was reportedly due to Public Health England (PHE) using an outdated version of Microsoft Excel to process data. The spreadsheet could only handle a limited amount of information, hence why so many contacts were missed.

The result is that there are potentially tens of thousands of infectious people who have not been contacted; indeed, NHS Test and Trace apparently had to track down an estimated 40,000 Covid-19 cases.

Matters were made worse by the fact that Ring Central, NHS Test and Trace’s call system, allegedly failed to work too – locking workers out of their profiles for prolonged periods.

As if that wasn’t troublesome enough, yesterday it was shown that NHS Test and Trace contact rate figures have reached their lowest rate yet, with 68.6 per cent of close contacts of individuals who’d tested positive for Covid-19 in England reached in the week ending September 30 (the system needs to reach 80 per cent of contacts in order to be considered viable). 

Furthermore, it was shown that fewer than one in four people testing positive for Covid-19 receive their results in 24 hours – a far cry from Boris Johnson’s initial pledge that, by the end of June, results of all in-person tests would be back within that timeframe.

With all of these events, the Government can look forward to even harsher criticisms from Keir Starmer and the opposition on testing, which has repeatedly been called a “shambles”.

No doubt many members of the public, too, are wondering how many more of these problems are to come in test and trace; whether the strategy will ever work, and what it means for their livelihoods in the meantime. So what exactly has gone wrong?

Several hypotheses have been put forward to explain the repeated weaknesses in the contact tracing system.

The first, straightforward one is that the Government simply did not plan enough for a pandemic. Whereas countries like South Korea were able to deploy pre-existing infrastructure for contact tracing, the Government started from scratch – creating NHS Test and Trace, which has had to “learn” on the job.

Even more significantly, NHS Test and Trace highlights an instinct of the Government that has run throughout this crisis; its tendency to create large-scale, centralised solutions to managing Covid-19, rather than utilising existing systems (one of the main examples being its initial desire to build a centralised contact tracing app – instead of going with Apple and Google’s technology).

Many will remember Dido Harding announcing of NHS Test and Trace at its inception: “This is a brand new service which has been launched at incredible speed and scale.” But it is this speed and scale that might explain why there have been so many issues – as rushing something out of this complexity in a pandemic represents huge logistical challenges.

It could be said that the Government has missed a trick by not tapping into local teams and networks to carry out processes such as contact tracing. This is why Germany, Italy and much of Asia have got ahead, using large-scale local investment and resources to do contact tracing.

And indeed, when England started to switch to using local contact tracers, it made a massive difference to success rates. In the week to September 30, for example, these teams were able to reach 97.1 per cent of contacts, much higher than NHS Test and Trace’s rate of 68.6 per cent (done via online messaging or phone calls).

The added advantage of local teams is that they can help ensure compliance in those contacted, some of whom may want to avoid call centres – wary that a number beginning 0300 could mean a tracing team is getting in touch.

It’s not only that devolving responsibilities can enhance the tracing process, but decentralisation can boost testing too – which smaller labs in universities and the private sector initially offered to help the Government with. Instead, it has mostly relied upon PHE labs and NHS trusts to carry out this work.

While the Government should be praised for how quickly it managed to scale up testing, there have been problems with laboratories being too slow to process results (allegedly as a result of over-reliance on post-graduate science students to analyse lab results, who were only there over summer), and incompatibilities between systems – both of which might have been addressed with a more decentralised approach, and flexibility about which labs were used.

Robert Buckland, Secretary of State for Justice, since said that the Government would open 100 more test centres, including a “mega lab” on the way to enhance capacity.

But maybe this brings us back to the initial point – that the Government’s quest for new systems, as opposed to tapping into local and/ or existing solutions, might ultimately hold it back in accelerating testing. Instead of devolving powers, the Government’s instinct has always been to take more responsibility.

Will there be a change to the direction the Government is going in? The shift to using more contact tracing teams is certainly promising – and should be built upon, but given the amount of money, energy and investment that has gone into Test and Trace – along with the Government’s recent plan to merge PHE and NHS Test and Trace into the new “National Institute for Health Protection” – centralisation seems one area it is reticent to u-turn on.

91 comments for: If test and trace is to succeed, a centralised approach won’t work

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