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.

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