Test and trace needs radical reform in England, health experts say

The government faces renewed calls for the central NHS test and trace system to be scrapped in favour of handing responsibility for contact tracing to local public health teams.

Mattha Busby www.theguardian.com 

Weekly test and trace figures for England show it reached just under 60% of close contacts of people testing positive, the lowest since the service began. It comes as the Office for National Statistics indicated the steep rise in new infections was levelling off in England and stabilising at about 50,000 a day.

Sir John Oldham, adjunct professor in global health innovation at Imperial College London and former leader of large-scale change at the Department of Health, said “lockdown will be a letdown” unless trust was increased through radical reform of test and trace.

“I think this probably includes increasing the number of small labs to decrease turnaround time and, crucially, the results to go to local directors of health and for them to have teams to undertake the contact tracing,” he told BBC Radio 4’s Today programme.

“I’d probably get the resources for that by scrapping the failing central call centres. I think the whole system should be under the purview of public health, which gets us as close to the effective system we had before 2012 NHS reforms. I think they have demonstrated that they have the capability and effectiveness – they are running at 95% contact tracing; the national call centre is at 60%.”

Oldham suggested lockdown could be futile unless there was an effective test and trace system – “such as in South Korea, New Zealand, and Germany” – to keep numbers down after restrictions were relaxed. “This we’ve been continually promised but there has been a failure to deliver,” he said.

He added that trust was paramount as he advocated the use of local contact tracers. “The pandemic is seen as a political campaign with huge promises and slogans. The virus does not tweet back or send out press releases. We just need some truthfulness, transparency about the data and the outcomes and decision making … Greater understanding gives greater trust and greater adherence for what we want people to do.”

Thousands of people were tested in Liverpool on the first day of the mass pilot scheme on Friday. The programme aims to test up to 50,000 people a day once fully operational, said Matt Ashton, the city’s director of public health.

He said: “We are still working on the numbers but we think [there were] about 1,500-2,000 people per testing centre, so really good numbers and really good interest, so it was very encouraging.”

The scheme has drawn criticism from health experts, however, who have described it as not fit for purpose. Allyson Pollock, professor of public health at Newcastle University, said plans to test asymptomatic people went against advice from the Scientific Advisory Group for Emergencies to prioritise testing for those who were displaying symptoms.

Meanwhile, Chris Lovett, the deputy director of public health for the City of London and Hackney, said his team of six were being asked to reach people in their area whom NHS test and trace had not been able to contact. Of 700 cases transferred in the past six weeks, just under half were reached and brought into the scheme, he said.

“Right at the beginning of the pandemic, our local mayor and many others did ask for local systems to take control of test and trace,” he said.

“At this stage, its going to be very difficult for us to mobilise all the resources necessary to take on the full contact tracing, but certainly working in much closer partnership with local organisations, the councils, the NHS, so we can ensure this important control measure works is what we’re committed to do.

“Our local residents have often said how important it has been to have that local contact, local knowledge and knowledge of what works for our communities.”

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