The Times view on No 10’s handling of coronavirus: Failed Test

An investigation into the strains on the test and trace programme strengthens the case for a minister to take charge.

www.thetimes.co.uk

Three weeks ago the health secretary Matt Hancock said that the problems in the test and trace programme would be fixed within a fortnight. Two weeks ago he said they would be fixed “within weeks”. Yet here we are at the start of October and the problems are unfixed. An investigation by an undercover Times reporter who spent last week working at a large testing centre near Stoke reveals a system in trouble. Faced with a backlog of unprocessed tests at laboratories, the government has introduced strict new daily limits on testing. As a result, on one day this week a facility that just weeks ago was testing up to 500 people a day had tested only 100 by 5pm, a few hours before it closed. Staff were being told to turn away those with symptoms or who had been referred by their GPs unless they had made a booking online.

It does not seem likely that these problems will be resolved in anything like the timescale suggested by Mr Hancock. A new so-called Lighthouse laboratory near Loughborough, which is supposed to provide capacity for 50,000 more tests a day by the end of the year, was meant to come on stream at the end of last month. That has now been delayed by at least a month. Another lab in Newport, due to come on stream in August, has been delayed until November. The government insists the backlog reflects unexpectedly high demand for tests, though why a surge in demand as schools and universities reopened was not anticipated is not clear. A bigger problem appears to be a shortage of laboratory staff as students employed over the summer return to university. Again, it is hard to understand why this was not foreseen.

That is not to deny the impressive progress that has been made in building up Britain’s testing capacity over the past six months. From what was effectively a standing start in April, just under 265,000 tests were carried out on Thursday. That’s more per head of the population than almost any other country. Official data shows that NHS Test and Trace now has capacity for 1.8 million swab tests a week across five Lighthouse labs and NHS-run facilities. The government’s target is to hit 500,000 tests a day by the end of this month.

The problem is that too often this capacity is in the wrong places, or not available to those who need it, while the results themselves are taking too long to arrive. Many people are still having to travel long distances to take tests, if they can book one at all.

A Times data analysis which sought to book a test using 50 nearby postcodes every hour for 48 hours found that appointments were only available 17 per cent of the time. The result is that some people may be forced to isolate unnecessarily, while others who may be infected are continuing to spread the virus and their contacts are going untraced. Perhaps most troublingly, the promised weekly testing of NHS staff in hotspot areas is still not being delivered. That risks further disruption of non-Covid healthcare, longer waiting lists and increased deaths from other causes.

These latest disclosures only strengthen the case for Boris Johnson to appoint a minister with specific responsibility for the pandemic response. Too often the government’s reaction appears to be driven by the need to hit arbitrary political targets rather than a strategy to ensure tests are available where and when they are most needed. The pressures are likely only to intensify over the winter. Indeed the roll-out of a vaccine, should one materialise, will pose an even greater logistical challenge. Mr Hancock already has his hands full dealing with the NHS and tackling the crisis in social care. This challenge is too important to be left to an unelected figure such as Baroness Harding of Winscombe, the chief of NHS Test and Trace, who is also overseeing a Whitehall reorganisation. There is no greater priority facing the country. That requires a minister able to give it their full attention.

Improving local bus services in England outside London – National Audit Office (NAO)

www.nao.org.uk

Today’s report [2 October] from the National Audit Office (NAO) finds that, despite the Department for Transport’s long stated aim to increase bus use, passenger numbers have fallen. The Department will need greater clarity on what it wants to achieve and how it will measure success, if its forthcoming national strategy for improving bus services is to succeed.

Between 2010-11 and 2018-19 the number of bus journeys fell in 65 of 88 English local transport authorities outside London and by 10% overall.1 The COVID-19 pandemic led to a drastic reduction in bus travel across the country and created uncertainties about future travel habits. However, bus travel will likely remain the primary and essential mode of transport for many, especially the most disadvantaged.

The Department considers that good quality bus services support local economies, help ease congestion, reduce greenhouse gas emissions and better connect communities. In September 2019, it announced that it would develop the first National Bus Strategy for England and in February 2020 committed £5 billion over the next five years to promote buses, walking and cycling. Progress with the strategy has been delayed due to COVID-19. However, the Department told the NAO that during the pandemic it had been able to work with local authorities and operators to understand areas of critical need and target support.

In 2019 central and local government subsidies and support made up around 24% of bus operators’ revenue income from bus services. However, increasing congestion means bus operators need to put on more buses to maintain frequency, which, when combined with falls in paying passengers, puts pressure on operator profit. The Department pays a subsidy to operators to keep services running and fares down, but between 2010-11 and 2018-19, estimated operator revenue fell by 11% and bus fares increased by 18% on average.

Between 2010-11 and 2018-19, 72 local authorities reduced spending on those bus services which operators would otherwise see as not commercially viable (supported services) and which often serve rural and disadvantaged bus passengers. Of these, 42 reduced funding by over 50%. The Department does not know how passengers have been affected by the loss of supported bus services.

New powers for local authorities to partner with operators and improve services have made little difference as the wider funding pressures on local authorities have increased. The 2017 Bus Services Act (the Act) aimed to strengthen operator-local authority partnership working and gave authorities the power to take control of services under a franchising arrangement.2 However, since 2010-11, local authorities have reduced spending on local transport by around 40%, which is likely to have had an impact on their ability to work in partnership with local bus operators. It was not until April 2020 that the first partnership using the Act was agreed,3 and no local authority has yet agreed a franchising arrangement – the Greater Manchester Combined Authority has made the most progress.

The Department does not know if it is getting the best value from its short-term capital funding to local authorities and bus operators. Some funds are bus-specific, for example to support investment in zero emission vehicles or bus infrastructure. The Department’s evaluations show that it has funded schemes that have delivered valuable improvements, although some schemes go wider than bus improvements. However, local authorities told the NAO that the resources needed to bid and account for this funding can be too great. The Department is concerned about local authorities with potentially viable projects that are not accessing funding, because they do not have the resources.

“Despite the Department for Transport’s long-stated aim to increase bus use, passenger numbers have fallen since 2010. The Department has funded some valuable local enhancements to bus services but these do not constitute systemic improvement.”

“To meet the needs of local people, especially those in rural and disadvantaged communities, the Department’s future bus strategy should match the funding provided to its objectives, and better enable local authorities and operators to work together.”,

Gareth Davies, head of the NAO

  1. Government deregulated the local bus market in 1986. Today, more than 500 companies operate bus routes, ranging from small, family-run businesses to multi-national firms.
  2. Local partnerships are designed to help authorities work with operators to decide which arrangements will advance local bus services. Franchising is a more ambitious approach, involving local authorities taking on some of the financial risks and rewards of running local bus services, and allowing them to set route frequencies and running hours of bus services.
  3. It was not until April 2020 that the first Enhanced Bus Partnership using the 2017 Act was agreed between Hertfordshire County Council and over 20 local bus operators

Ottery St Mary Creative Writing Competition

The Ottery St Mary Writers’ Group were delighted at the excellent response they had received to their Creative Writing Competition. They received over 300 entries which came from all over Britain.  After considerable reflection, the judges thought that Helen Gaen’s poem skilfully tackled the distressing subject of dementia with a touch of humour. She was awarded first prize in the poetry category.

Helen is a former civil servant and editor. She is currently working on her own collection of poems and short stories, alongside  a children’s novel. She has previously has some of her work published in the small press. Helen is a young, very active retiree, who loves reading, the cinema, walking and swimming.

First Prize winner- Memory Tricks by Helen Gaen

Most of Boris Johnson’s promised 40 new hospitals will not be totally new

Ministers have set out more details of Boris Johnson’s much-scrutinised election promise to build 40 new hospitals in England, revealing that the bulk of the projects involve rebuilding or consolidation, and that only four have been started.

Denis Campbell www.theguardian.com 

The scheme comes with a promised spending package of £3.7bn. However, NHS Providers, which represents hospital trusts, said the real cost of building 40 new hospitals would be more like £20bn.

The plan for 40 hospitals to be built by 2030, first made by the health secretary, Matt Hancock, at last year’s Conservative party conference, and repeated many times by Johnson during the subsequent election campaign, was criticised at the time for being based more on aspiration than definite plans.

Experts said that the initial programme involved the bulk of money going to just six sites, with a much smaller pot of £100m set aside for seed funding among 34 hospitals, with few signs of how much money would be available overall.

The details set out on Friday by the health department list 40 projects due to be completed by 2030 under the government’s health infrastructure plan, with eight other sites invited to bid for funding.

Of the 40, 26 form part of the second phase of the infrastructure plan, due to take place between 2025 and 2030. Six more are planned under the first stage, by 2025. Of the other eight, four are already being built, and four more are awaiting final approval.

Additionally, more than half the projects are not new hospitals as such, but comprise rebuilding projects on existing sites, consolidations of other hospitals, or extra units.

The four already being built are in Sandwell in the West Midlands, north Cumbria, Liverpool and Brighton. Those awaiting approval are in London, Morpeth in Northumberland, Manchester and Nottingham.

Johnson said: “The dedication and tireless efforts of our nurses, doctors and all healthcare workers have kept the NHS open throughout this pandemic. But no matter what this virus throws at us we are determined to build back better and deliver the biggest hospital building programme in a generation.”

Saffron Cordery, deputy chief executive of NHS Providers, welcomed the announcement but warned that the 40 new hospitals would cost about £20bn, most of which would need to be found in the next few years: “Building a new, average mid-sized hospital costs around £500m, so this [£3.7bn] is just an initial downpayment.”

She added: “If the government wants these hospitals built in the time it is specifying, trusts will need the rest of the capital allocated as soon as possible.”

The announcement also lacked “any meaningful investment in our mental health estate”, she said.

Cordery said: “Any additional funding to address long-neglected infrastructure and facilities to ensure safe, high-quality care is welcome and a number of trusts have well-developed plans to get this important work under way.”

The shadow mental health minister, Rosena Allin-Khan, said the announcement was “a missed opportunity and extremely disappointing”.

She said: “It is an insult that mental health – which represents one-quarter of all health needs – has again lost out. The government must take mental health seriously and provide the resources and facilities it needs.”

Nigel Edwards, the chief executive of the Nuffield Trust health thinktank, said the £3.7bn reflected the “feast after famine” approach that recent governments had taken to NHS capital funding – the money it uses to build and modernise facilities and buy equipment such as scanners and IT – and which had made planning new projects difficult.

“This funding does not make up for the fact that the health service has not had a proper strategic view of capital investment for many years,” he said.

The Royal College of Nursing also warned that, however significant any spending on hospitals, this would not make up for a shortage of nursing staff. Donna Kinnair, its general secretary, said: “Whether hospitals are rebuilt or wholly new, they will struggle to provide safe patient care without enough nurses. Unfair salaries are pushing nursing staff out of jobs they love when England’s NHS is already missing tens of thousands.”

Care homes ‘left with empty rooms’ as families avoid them

Care homes across Devon are facing increasing numbers of empty rooms as families are reluctant to place relatives within them.

Daniel Clark www.devonlive.com 

Cllr Andrew Leadbetter, cabinet member for Adult Social Care, said at Thursday’s full council meeting there have not been any unplanned care home closures across Devon as a result of the pandemic, but concerns have been raised nationally around this potential.

He said that to support care homes in Devon, a number of elements have been put in place, including weekly monitoring via the care homes capacity tracker, voids being funded with PPE costs and additional staff costs covered, and funding to support client isolation costs for 14 days post placement.

Cllr Leadbetter confirmed that the policy across Devon for hospital discharges into care homes was that testing takes place, and the result is known prior to discharge, with care homes to receive funding to be able to put in place arrangement to support 14 days of isolation within care homes for new placements, if needed.

But we added: “What we are seeing in Devon is a rising numbers of voids as individuals and families are reluctant to place them into care homes.”

He had been asked to report by Cllr Martin Shaw on the Covid situation, especially outbreaks in care homes, and the measures taken, and in his report, Cllr Leadbetter said that Devon is one of the areas of the country so far least impacted by COVID-19 related cases and fatalities.

“Even relative to its low level of community-based transmission of COVID-19, Devon has experienced significantly fewer outbreaks and fatalities in its care homes than is typical elsewhere,” he added.

He continued: “National testing challenges continue, but work locally is taking place to support care homes, and the national testing strategy is that all care home staff (including bank and agency staff), including those without symptoms, should be tested every week.

“We are taking part in a Department of Health and Social Care COVID-19 testing pilot within Extra Care Housing (ECH) and Supported Living (SL) to inform future national testing requirements and testing strategy for people living in ECH and SL, of which there are 324 properties in Devon.

“People living in these properties, their homes, have a range of needs including mental health needs, physical disability needs, learning disability or autism needs. They also have a greater level of independence than people in care homes and subsequently can play a more active role in the community and therefore have different infection risks to manage, this can be challenging for those who have more risky behaviours and for the staff that support them.”

Cllr Leadbetter added: “To support care homes in Devon we have put a number of elements in place. These include weekly monitoring via the care homes capacity tracker enable is to have oversight of risks to business continuity and viability, and for those identified with 15 per cent voids to receive weekly phone calls providing the opportunity for care homes to raise concerns including viability concerns.

“There has been £3.9m additional and targeted funding to care homes, a £10.5m Infection Control Fund for Devon of £950 per bed and a second additional payment from unallocated funds, and funding to support client isolation costs for 14 days post placement.

“It is policy across Devon that testing takes place, and the result is known prior to discharge. Care homes receive funding to be able to put in place arrangement to support 14 days of isolation within care homes for new placements.”

Earlier this year, he Devon STP health and care organisations worked jointly in the recruitment, training and deployment of staff, which result in 209 extra people, who were employed in front-line healthcare assistant roles across the Devon STP health and care organisations

The majority were recruited into permanent roles, with 74 people employed in permanent care worker roles with adult social care providers, including 49 in domiciliary care and 25 in residential care in Devon County Council’s geographical area, with 17 people were employed on a temporary basis in Social Care Reablement and the Durrant Care Hotel, via Temp Solutions.

A new STP Proud to Care campaign in Autumn/Winter 2020 will attract new people to important health and care vacancies in Devon. The aim is to support winter pressures, to support recruitment in anticipation of a local or national resurgence of COVID-19, to fill vacant posts, to support hospital discharge and encourage people to remain independent at home, where possible, and residential homes, and to benefit from government’s Plan for Jobs including the Kickstart Scheme, apprenticeships (including nursing apprenticeships) and traineeships at a time of high unemployment.

Providing infection control guidance is followed, care homes can continue with their own visiting policies.

But Cllr Leadbetter added: “However, this situation is subject to an ongoing dynamic risk assessment and may change in the future, at which point care settings will be notified. Our priority is to ensure that everyone is as safe as possible, should we see an increase in local coronavirus cases.”

Coronavirus cases rise overall in Devon and fall in Cornwall

The total number of new coronavirus cases confirmed in the last seven days across Devon has risen – but with falls in Plymouth and Cornwall.

Daniel Clark www.devonlive.com 

Government statistics show that 381 new cases have been confirmed across the region in the past seven days in both pillar 1 data from tests carried out by the NHS and pillar 2 data from commercial partners, compared to 365 new cases confirmed last week.

The number of new cases confirmed in Cornwall has fallen, going from 179 to 132 in the latest seven days, while Plymouth has seen cases more than half, dropping from 74 to 36.

But in Torbay, cases have more than doubled, from 18 to 39 – partially linked to an outbreak at a care home. And in the Devon County Council area, they have nearly doubled, from 96 to 178, although 60 per cent of those cases are in Exeter, primarily linked to the University.

Of the 381 new cases, 132 were in Cornwall, with 11 in East Devon, 107 in Exeter, 8 in Mid Devon, 13 in North Devon, 36 in Plymouth, 9 in the South Hams, 20 in Teignbridge, 39 in Torbay, 5 in Torridge, and 4 in West Devon.

Cases in Cornwall, the South Hams, Plymouth have fallen compared to the previous week, with East Devon remaining the same

Of the 381 new cases confirmed, 280 of the cases have a specimen date of between September 25 and October 1, with the majority of the other 101 cases dated occurring between September 21 and 24, although some dated back to the start of the month.

Of the 303 of the cases had a specimen date of between September 25 and October 1, 91 of Cornwall cases occurred in that period, with 10 in East Devon, 72 in Exeter, 5 in Mid Devon, 12 in North Devon, 17 in the South Hams, 14 in Teignbridge, 31 in Plymouth, 32 in Torbay, 2 in Torridge, and 4 in West Devon.

By specimen date, the most recent case in Teignbridge is October 1, for Cornwall, Exeter, North Devon, Mid Devon, Plymouth, the South Hams, Torbay and West Devon is September 30, is September 29 for East Devon, and September 28 for Torridge.

While the number of cases in Devon have significantly risen, more than half of the cases are linked to students at the University of Exeter.

It is understood that at least 60 households within the City are self-isolating and following public health advice, and there is no evidence at this stage of the virus spreading into the wider community, say Public Health teams.

But as demand for tests is rising at the University, they have invited the national Test and Trace scheme to set up a temporary Testing Centre on the Streatham campus dedicated to Exeter students and staff, which will enable them to focus their Halo resources on some targeted testing, and to develop a process to enable staff family testing.

Of the cases with a specimen date of between September 22 to 28, there are currently 33 clusters where three of more cases have been confirmed in a Middle Super Output Area – seven in Devon, five in Torbay, five in Plymouth, and 16 in Cornwall.

There is a cluster of three cases in Ivybridge in the South Hams and four in Roundswell and Landkey in North Devon, with five clusters in Exeter – St Leonard’s with four, Central Exeter with five, St James Park and Hoopern with nine, Middlemoor and Sowton with seven, and 52 in Pennsylvania and University.

In Torbay, Shiphay & the Willows, Babbacombe & Plainmoor, Upton & Hele, Chelston, Cockington & Livermead and Clifton & Maidenway all have clusters of three.

In Plymouth, Mutley and Plymstock Elburton have a cluster of three, Honicknowle & Manadon four, Plymstock Hooe & Oreston five, and Keyham seven.

In Cornwall, there is a cluster of three in Newquay East and Penzance North, Penzance Quay, Bodmin North, Illogan & Portreath and St Columb Minor & Porth of four, Redruth North and St Agnes & Mount Hawke of five, Redruth South six, Camborne South of seven, Lanreath, Pelynt & Polraun of nine, Camborne West and Roche & Goss Moor of 11, Camborne East of 14, Kingsand, Antony & Maryfield of 16, and Pool & Illogan Highway of 26.

And while there has been a rise in cases across the region from previous figures, the number of people in hospital with coronavirus has continued to remain relatively low compared to the rest of the country, and has even fallen in the South West.

In the South West, there are currently 33 people in hospital and two on ventilation, compared to 34 and three respectively last Friday. There has not been a hospital death since September 20, and were only three deaths in the South West in hospital in September.

A person walks passed a COVID-19 test centre sign at a new walk-through testing centre (Image: Andrew Milligan/PA Wire)

The R Rate for the South West is now being estimated as between 1.1 and 1.4, the same figures as last week, with the ONS survey estimating that 0.08 per cent of the population in the South West would test positive at any one time, up from 0.07 per cent as of last week.

NHS 111 data for both Devon and Cornwall has fallen significantly in the past seven days, with the figures down 50 per cent on last Friday.

In total, Torridge has had 76 positive cases, West Devon 87, with 151 in the South Hams, 168 in North Devon, 249 in Mid Devon, 272 in Teignbridge, 305 in East Devon, 377 in Torbay, 460 in Exeter, 948 in Plymouth and 1397 in Cornwall and the Isles of Scilly.

The COVID-19 cases are identified by taking specimens from people and sending these specimens to laboratories around the UK to be tested. If the test is positive, this is a referred to as a lab-confirmed case.

Confirmed positive cases are matched to ONS geographical area codes using the home postcode of the person tested.

Cases received from laboratories by 12:30am are included in the counts published that day. While there may have been new cases of coronavirus confirmed or people having tested positive, those test results either yet to reach PHE for adding to the dataset or were not received in time for the latest daily figures to be published.

The latest available figures show that 10,900 tests (Pillar 2) were carried out in Devon during the week ending 25 September, a significant rise on the 7,600 test carried out during the previous week.

Steve Brown, the Deputy Director for Public Health Devon, said: “The latest numbers show another rise in the number of tests carried out in Devon, and we are hearing fewer reports of delay or having to travel distances to attend a test.

“Overall, the county is still comparably very low down the table for the number of confirmed coronavirus cases. We have the immediate increase in cases in Exeter for which there is no evidence of spread within the community, but confirmed cases in our seven other District areas are still low,

“Testing resources in the main are keeping up with demand in Devon, and I ask anyone who is showing symptoms – the high temperature, new and continuous cough, or change in their sense of taste or smell – to self-isolate immediately and book a test.”

NHS considering plans for 160 one-stop shop High Street cancer test centres

Patients needing a scan to diagnose conditions such as cancer will be able to get them on the high street under new plans being considered by the NHS.

Ryan Merrifield www.mirror.co.uk 

Health Service chiefs are drawing up plans for a reported 160 one-stop shops to provide routine checks and increase the likelihood of early diagnosis for cancer, heart disease and dementia.

They want to “radically overhaul” the way X-rays, MRI and CT scans are delivered with the innovative new set ups.

The hubs could also provide people with blood tests six days a week, lung function tests and endoscopy, without the need to go to hospital.

Bigger centres could offer mammograms, eye services, scans for pregnant women, hearing tests and gynaecological services.

CT scanning capacity would double in five years, while an extra 6,000 specialist imaging staff would be hired, reports the Sun.

The newspaper also reports figures for sick people facing long waits for diagnostic tests rose 20-fold in lockdown.

By June, there were 580,000 waiting, compared with just 30,000 in February.

In a report presented to NHS England, former cancer tsar Professor Sir Mike Richards set out how the hubs could work, particularly while the Covid-19 pandemic continues.

His study said patients may prefer to be treated away from hospitals “in a Covid-19 minimal hub”, with the centres set up on the high street or retail parks.

Children’s investigations could also be carried out in the community hubs as long as there was proper staff training, including blood tests, ultrasound, X-rays and heart monitoring.

Investigations for patients presenting with blood in the urine or who need tests for prostate cancer could also be undertaken in the hubs, the report said.

Staff working at the centres could be called upon to support the delivery of some tests (such as mobile X-rays) in patients’ homes or in care homes.

Sir Mike was commissioned by NHS chief executive Sir Simon Stevens to review diagnostic services as part of the NHS Long Term Plan.

The report said emergency diagnostic services in hospitals should be separated from planned services wherever possible to increase efficiency.

It added: “Acute diagnostic services (for A&E and inpatient care) should be improved so that patients who require CT scanning or ultrasound from A&E can be imaged without delay.

“Inpatients needing CT or MRI should be able to be scanned on the day of request.”

The study said that before the pandemic, “the need for radical improvement in diagnostic services was already clear-cut”, amid rising demand.

Diagnostic services in the NHS were already “reaching a tipping point”, with fewer people seen within NHS targets and more work being outsourced to private firms.

The study said: “The Covid-19 pandemic has exacerbated the pre-existing problems in diagnostics.

“The risk of infection to and from patients attending for diagnostic tests has slowed throughput in all aspects of diagnostics, but particularly in CT scanning and endoscopy.

“This is due to the need to deep clean equipment and facilities if a patient’s Covid-19 status is positive or unknown.

“The backlog of patients waiting more than six weeks for diagnostics has increased very significantly since the start of the pandemic and now needs to be tackled as quickly as possible.”

The report said that, to help this problem, community diagnostic hubs “should be rapidly established to provide Covid-19 minimal, highly productive elective diagnostic centres for cancer, cardiac, respiratory and other conditions”.

And it says CT scanning capacity should be expanded by 100% over the next five years “to meet increasing demand and to match other developed countries”.

Meanwhile, hospitals with an A&E should have access to a minimum of two CT scanners so patients known to be Covid-19 negative can be kept separate from those who are Covid-19 uncertain or Covid-19 positive.

This would help clear the screening backlog, while further demand is expected to come from patients recovering from Covid-19 with respiratory and cardiac problems.

To support the key plan, Sir Mike calls for a “major expansion” in the workforce, with an extra 2,000 radiologists and 4,000 radiographers as well as other support staff.

Sir Mike said: “The pandemic has brought into sharper focus the need to overhaul the way our diagnostic services are delivered.

“While these changes will take time and investment in facilities and more staff, it is the right moment to seize the opportunities to assist recovery and renewal of the NHS.

“Not only will these changes make services more accessible and convenient for patients but they will help improve outcomes for patients with cancer and other serious conditions.”

Health officials fear de-prioritising of Covid testing in care homes in England

Covid-19 testing in care homes in England could be de-prioritised to save scarce laboratory capacity for the NHS, public health officials fear.

Robert Booth www.theguardian.com 

The prioritisation of testing capacity to speed up results from hospitals has been raised in meetings between the NHS and local authorities, sources said. Delays in hospital testing are reportedly slowing down patient discharge and have caused some elective surgery to be postponed.

“There are moves afoot to keep testing capacity for the NHS,” one local health official said after meetings with NHS colleagues. “It has been mooted in our area that the NHS has to come first and it is having real difficulties.”

In an email seen by the Guardian, another senior local official urged colleagues to help head off a “concerning” proposal to prioritise NHS testing above care homes. They warned any reduction in care home testing could delay the identification of outbreaks. Concern about a potential move to switch test capacity away from care homes is said to have been raised by several local authorities in England.

Dido Harding, the head of the NHS test-and-trace programme and the newly created National Institute for Health Protection, set out her testing priorities two weeks ago. She told MPs the first priority for testing was hospital patients, followed by care home workers, care home residents and then NHS staff.

The Department of Health and Social Care denied any change was on the horizon. A spokesperson said: “There has been no change to our prioritisation of tests for care homes and there are no plans to change this in the future.”

It said the government was issuing more than 120,000 tests a day to care homes, prioritising outbreak areas.

However, concerns over the availability of testing in the NHS are growing. In a letter seen by the Guardian, one health authority warned that a shortage of reagent chemicals used to process tests meant some results were taking three days to come back in some hospital settings putting patient safety at risk.

Jeremy Hunt, the Commons health select committee chairman, said on Thursday that community testing – the type relied on by care homes – should be deployed to support the NHS.

“Some of those hospitals are trying really hard to test all their staff using their own laboratories, but to do that on a weekly basis they need support from NHS test and trace, they need additional reagents,” he told BBC Radio 4’s Today programme.

“What we really need is for the government to say, ‘You need to make this happen at least in areas where there is high prevalence and we will help you if you can’t do it yourself’.”

By the end of this month, the NHS is aiming to increase in-house testing capacity to 100,000 a day while NHS test and trace community testing is due to expand to 500,000 a day. In the week to 23 September, about 260,000 tests of all kinds were processed daily, latest figures show.

Care homes have been clamouring for more rapid testing for staff who are supposed to be tested weekly, but in thousands of cases the results are taking more than a week to come back. This leaves residents at risk of infection by potentially asymptomatic care workers and means more care workers having to self-isolate unnecessarily.

Portsmouth council this week complained it was not receiving a result for 30% of care home tests. The leader of the council, Gerald Vernon-Jackson, said it was an “impossible situation” for care managers.

Such is the concern at the national system that Care England, which represents the care home chains providers, is trialling private testing with the potential to deliver results in 45 minutes from nostril swabs. The hope is that it could be used before staff begin their shifts and enable the return of family visitors.

The devices are provided by VMD, a Leicester-based company, whose director, Anoop Maini, cautioned that trials were at an early stage.

The machines, obtained from a Californian supplier, operate using a direct test of virus genetic material (RNA) similar to the PCR tests relied on by care homes, Maini said. He wants to make the equipment widely available this winter.