Min­is­ters set to miss 500,000 tests target

It was trum­peted as a key way of keep­ing Covid at bay but now sci­en­tists say it has a ‘mar­ginal im­pact on trans­mis­sion’

The Daily Telegraph - - Front Page - By Bill Gard­ner, Tony Diver and Mike Wright

The Gov­ern­ment will miss its 500,000 daily tests target in two weeks un­less min­is­ters “mas­sage the fig­ures”, the body rep­re­sent­ing NHS lab­o­ra­to­ries warned. The Prime Min­is­ter pledged to in­crease test­ing ca­pac­ity to half a mil­lion by Oct 30. How­ever, with daily ca­pac­ity at 345,135 tests with 295,690 pro­cessed, a 45 per cent pro­duc­tiv­ity rise is needed in two weeks. Yet, data from NHS Eng­land showed that the num­ber of tests com­pleted last week rose by only 5 per cent over seven days.

IT WAS sold to the coun­try as a vi­tal line of de­fence against Covid-19: a state-ofthe-art op­er­a­tion to catch and stop the virus be­fore it had a chance to spread.

Min­is­ters promised the £12 bil­lion NHS Test and Trace pro­gramme would keep coro­n­avirus at bay over the win­ter.

“We have grow­ing con­fi­dence that we will have a test, track and trace op­er­a­tion that will be world-beat­ing and, yes, it will be in place by June 1,” Boris Johnson told the Com­mons in May.

But this week the Gov­ern­ment’s sci­en­tific ad­vi­sory com­mit­tee, Sage, is­sued its ver­dict: NHS Test and Trace is sim­ply not work­ing. “The rel­a­tively low lev­els of en­gage­ment with the sys­tem … cou­pled with test­ing de­lays and likely poor rates of ad­her­ence with self-iso­la­tion sug­gests that this sys­tem is hav­ing a mar­ginal im­pact on trans­mis­sion at the mo­ment,” the sci­en­tists wrote.

Mr Johnson yes­ter­day an­nounced a se­ries of pilot schemes that will see schools, hos­pi­tals and care homes try new forms of test­ing for quicker re­sults.

They in­clude saliva tests that give re­sults in 15 min­utes and new meth­ods that do not have to be sent to a lab. They are an at­tempt by the Gov­ern­ment to in­tro­duce mass test­ing.

Yet for now, sci­en­tists say, all three pil­lars of the flag­ship pro­gramme – Test, Trace and Iso­late – are fail­ing.

TEST

As the virus faded over the sum­mer, Mr Johnson made a prom­ise to prepare for win­ter by in­creas­ing Bri­tain’s test­ing ca­pac­ity to half a mil­lion tests ev­ery day.

“We will in­crease test­ing ca­pac­ity to at least 500,000 anti­gen tests a day and 3.5 mil­lion anti­gen tests a week by the end of Oc­to­ber,” he told MPS in July, and re­peated the pledge last month.

Ac­cord­ing to the lat­est data, how­ever, his target ap­pears a long way off.

Daily ca­pac­ity is cur­rently 345,135 tests with 295,690 pro­cessed. To hit half a mil­lion tests by Oct 30, ca­pac­ity would have to shoot up by around 45 per cent in the next fort­night. Yet, data from NHS Eng­land showed that the num­ber of tests com­pleted last week only risen by 5 per cent in a week.

“I don’t think the Gov­ern­ment will hit that 500,000 target in two weeks, un­less they mas­sage the fig­ures some­how,” said Al­lan Wil­son, pres­i­dent of the In­sti­tute of Bio­med­i­cal Science, which rep­re­sents NHS lab­o­ra­to­ries pro­cess­ing tests across the UK.

“They might try to say they’ve got the ca­pac­ity but that’s mean­ing­less un­less you can ac­tu­ally process the tests on that day. We had a sim­i­lar sit­u­a­tion when Matt Hancock promised 100,000 tests a day ear­lier this year.

“You might have the ma­chines but you still need the staff to op­er­ate them. It’s like say­ing you’ve got a car, but no driver. The car’s not go­ing to move.”

Mr Wil­son added that NHS labs “just don’t have the ca­pac­ity at the mo­ment” to meet the Gov­ern­ment’s plans to test front-line health work­ers and GPS ev­ery week in ar­eas with high in­fec­tion rates, even if they show no symp­toms.

“We live in trep­i­da­tion of politi­cians say­ing all of a sud­den that we’re go­ing to start test­ing X num­ber of asymp­to­matic staff ev­ery week, and with­out ask­ing whether it’s pos­si­ble or not,” he said.

“Com­mu­ni­ca­tion from the Gov­ern­ment is bet­ter than it used to be, but at the mo­ment we just don’t have the ca­pac­ity to test asymp­to­matic NHS staff ev­ery week across the coun­try.”

A gov­ern­ment source in­sisted the labs were “well on track” to hit the 500,000 target be­fore the end of Oc­to­ber as gi­ant test­ing ma­chines be­came op­er­a­tional in the com­ing weeks.

Test­ing has cer­tainly in­creased rapidly since the early days of the pan­demic, when the re­sponse to Covid-19 was crip­pled by a lack of ca­pac­ity.

The Gov­ern­ment turned to phar­ma­ceu­ti­cal gi­ants such as As­trazeneca to set up the Light­house labs, gi­ant fa­cil­i­ties de­signed to han­dle test­ing in the com­mu­nity. Five Light­house labs are op­er­a­tional, with three more set to open in the com­ing months.

During the first wave, min­is­ters split test­ing: NHS and Pub­lic Health Eng­land labs pro­cess­ing so-called Pil­lar 1 tests, swabs taken from hospi­tal pa­tients and health­care work­ers; while the Light­house labs were handed Pil­lar 2, swabs taken from the wider com­mu­nity at test­ing cen­tres and at home. Last month, how­ever, com­mu­nity test­ing was brought to the brink of col­lapse when chil­dren went back to school. Long queues formed at test­ing cen­tres while some symp­to­matic peo­ple were sent to cen­tres hun­dreds of miles away.

Com­pleted swabs were sent to lab­o­ra­to­ries in Italy and Ger­many for pro­cess­ing, cru­cial ca­pac­ity had to be di­verted away from Lon­don, while in ar­eas with the high­est rate of infections peo­ple could not ac­cess tests at all.

Ac­cord­ing to Mr Wil­son, the chaos could have been avoided if the NHS and Light­house labs had been set up as “one or­gan­i­sa­tion” work­ing to­gether.

“If NHS labs had been told about the short­age when the schools came back, we could have moved peo­ple, sam­ples, con­sum­ables and been ready, rather than wait­ing for the whole thing to hit. But we don’t com­mu­ni­cate with the Light­house labs. They were set up in se­crecy and it has re­mained that way ever since,” he said.

To ease pres­sure on the Light­house labs, care-home tests in some ar­eas have been repa­tri­ated to NHS labs. In­sid­ers said the Light­house labs “fell over” at the end of the sum­mer when aca­demics and stu­dents who had been brought in during the first wave re­turned to their in­sti­tutes for the new term. The labs are now fac­ing a re­cruit­ment cri­sis, with an acute short­age of ex­pe­ri­enced sci­en­tists ca­pa­ble of qual­ity-as­sur­ing the tests and su­per­vis­ing new re­cruits, many of whom have lit­tle bio­med­i­cal ex­pe­ri­ence and often work 12-hour shifts.

“I found they’ve got no ex­pe­ri­ence with this sort of fa­cil­ity or han­dling bio­haz­ards, and then they’re just launched into this fa­cil­ity,” one whistle­blower told the BBC af­ter re­port­ing “chaotic and dan­ger­ous” work­ing prac­tices to the Health and Safety Ex­ec­u­tive.

“Given the rep­u­ta­tional is­sue at the mo­ment, there’s a real prob­lem find­ing the right se­nior peo­ple to han­dle this. They are in short sup­ply be­cause ev­ery­one is fish­ing in the same pond,” an­other in­sider said.

“Job se­cu­rity is also a real prob­lem, be­cause there’s no ob­vi­ous exit strat­egy for the Light­house labs. Coro­n­avirus won’t be around for­ever, so what hap­pens to your job af­ter­wards?”

As well as over­all ca­pac­ity, speed of test­ing is crit­i­cal to test-and-trace func­tion­ing ef­fec­tively.

Around 42 per cent of infections hap­pen be­fore pa­tients show symp­toms, so to break the chain of trans­mis­sion the sys­tem has to move fast enough to warn peo­ple to iso­late be­fore they have any idea they are in­fected.

On June 3, Mr Johnson pledged to get all non-postal tests “turned around in 24 hours by the end of June”.

Yet data from NHS Eng­land for the first week of Oc­to­ber showed that only 32.8 per cent of drive-through tests were com­pleted within 24 hours and 24.4 per cent of walk-in tests. Mean­while, 41.9 per cent of tests from mo­bile units were pro­cessed in the 24-hour target.

The fig­ures also showed that only 16 per cent of home-de­liv­ery test­ing kits were see­ing re­sults de­liv­ered within 48 hours, a drop of al­most half on the 30.2 per cent the week be­fore.

Frus­trated by the slow turn­around times, some coun­cils have lost faith. Bark­ing and Da­gen­ham coun­cil this week an­nounced it will open its own Covid-19 “ex­press” test­ing lab.

TRACE

The per­for­mance of NHS Test and Trace in track­ing down the con­tacts of pos­i­tive cases has been any­thing but “world beat­ing”.

Data re­leased on Thurs­day showed the sys­tem had recorded its worst ever week for con­tact trac­ing, track­ing down only 62.6 per cent of close con­tacts of peo­ple who tested pos­i­tive for the virus in Eng­land – well short of the 80 per cent target set by Down­ing Street.

The rea­sons for the re­peated fail­ure to hit tar­gets are many, com­pli­cated and often un­cer­tain. Lead­ing pub­lic health ex­perts, how­ever, blame the Gov­ern­ment’s de­ci­sion to hand much of the work to out­sourc­ing gi­ants, rather than us­ing the ex­per­tise of lo­cal au­thor­ity teams who had al­ready been do­ing the job of con­tact trac­ing for years.

In May, Serco and an­other out­sourc­ing gi­ant, Sei­tel, were awarded con­tracts worth up to £750 mil­lion to run call cen­tres to trace the con­tacts of peo­ple ex­posed to Covid-19.

Un­usu­ally, how­ever, the Serco con­tracts con­tained no “suc­cess clause” that would al­low the Gov­ern­ment to claw back money if ser­vices were run poorly or failed to reach tar­gets.

David Davis, the for­mer Brexit sec­re­tary, said the lack of ac­count­abil­ity in the con­tact-trac­ing con­tracts showed a “too cosy re­la­tion­ship be­tween the big de­part­ments of state and the com­pa­nies whose pri­mary busi­ness is pro­vid­ing a ser­vice to the de­part­ments”.

“Or­gan­i­sa­tions work to the in­cen­tives you give them, and if they haven’t got a penalty clause, it’s not go­ing to hurt them if they slip be­hind on the timetable,” he said.

How­ever, Serco – which yes­ter­day an­nounced soar­ing prof­its as a re­sult of work given to it during the pan­demic – blamed NHS trac­ing staff for the lat­est fig­ures, ar­gu­ing the com­pany was not re­spon­si­ble for sourc­ing con­tact de­tails.

A spokesman said: “The trac­ing is done by NHS pro­fes­sion­als. The 62 per cent is the fig­ure for the whole sys­tem, and we are only re­quired to con­tact the peo­ple for whom we have con­tact de­tails. Our ex­pe­ri­ence is that we are able to do that in 85 per cent of the cases.” Nev­er­the­less, min­is­ters have been re­peat­edly ac­cused of ig­nor­ing an army of con­tact trac­ers in “plain sight”.

En­vi­ron­men­tal health work­ers in lo­cal gov­ern­ment have wide ex­pe­ri­ence in track­ing out­breaks of norovirus, sal­mo­nella or le­gion­naires’ dis­ease, while sex­ual-health teams usu­ally linked to the NHS are also trained in the tech­nique. Some coun­cils in the north of Eng­land have set up their own con­tact-trac­ing pro­grammes.

Ac­cord­ing to lat­est fig­ures, 97 per cent of cases han­dled by lo­cal health pro­tec­tion teams were reached and asked to self-iso­late, com­pared with only 57.6 per cent of con­tacts for cases han­dled ei­ther on­line or by call cen­tres.

Prof Jackie Cassell, head of pub­lic health at Brighton and Sus­sex Med­i­cal School and a Covid-19 ad­viser to the Depart­ment of Health, said the Gov­ern­ment should have fol­lowed Ger­many’s lead, where lo­cal pub­lic-health teams were handed the job of trac­ing con­tacts at an early stage in the pan­demic.

“This gov­ern­ment is very keen on the Do­minic Cum­mings-style of stand­alone big tech solutions – but they don’t al­ways work, and es­pe­cially not with con­tact trac­ing,” she said.

“There was a rad­i­cal lack of un­der­stand­ing and a de­sire to get a sin­gle offthe-shelf so­lu­tion. Why would you build a sys­tem that ba­si­cally par­ti­tions the in­for­ma­tion and doesn’t al­low you to make ef­fec­tive quick joined-up lo­cal re­sponses? I would say it’s rad­i­cally an­tifree mar­ket and a re­ally, re­ally odd thing for a Con­ser­va­tive gov­ern­ment to do.”

She said the na­tional con­tact trac­ing sys­tem suf­fered from a lack of in­fec­tion con­trol ex­perts and lo­cal knowl­edge.

“If you want to pick up on clus­ters, you want a sin­gle sys­tem with se­nior pub­lic-health pro­fes­sion­als who know the area who can join up the dots,” she said. “The more you know about your lo­cal­ity, the bet­ter the de­ci­sions you can make. Also, con­tact trac­ing is highly sen­si­tive, as you’re often fol­low­ing up on peo­ple who weren’t where they said they were. You might have a do­mes­ticvi­o­lence sit­u­a­tion, for ex­am­ple, or peo­ple car­ing for el­derly rel­a­tives.”

A gov­ern­ment source said NHS Test and Trace was now work­ing “hand in hand” with lo­cal au­thor­i­ties, adding that more than 100 Lo­cal Trac­ing Part­ner­ships had been set up. The num­ber of pri­vate sec­tor con­tact trac­ers has been re­duced from 18,000 to 10,000 with greater sup­port from lo­cal au­thor­i­ties, the source added.

One in­sider at Pub­lic Health Eng­land said se­nior lead­ers “thor­oughly dis­agreed” with na­tional con­tact trac­ing. “This was set up and PHE had to play ball with it. I don’t think you’d find any­one who ac­tu­ally thought that set­ting up a na­tional sys­tem was in any way sen­si­ble,” the source said.

ISO­LATE

Even when peo­ple are tested and warned in time to pre­vent infections, stud­ies show that the vast ma­jor­ity are sim­ply ig­nor­ing the in­struc­tion to self-iso­late.

Sage es­ti­mates that around 80 per cent of peo­ple con­tacted by the test-and-trace sys­tem need to ob­serve strict self-iso­la­tion for the strat­egy to work.

How­ever, a study by the group found that rates of full iso­la­tion were be­low 20 per cent, with young peo­ple and those on low in­comes who can­not work from home most likely to break the rules.

Peo­ple told to self-iso­late by hu­man con­tact trac­ers face fines of up to £10,000 for non-com­pli­ance. Yet, there are no such penal­ties for self-iso­late no­ti­fi­ca­tions from the NHS Test and Trace app, which are seen as ad­vi­sory.

Prof Christophe Fraser, who de­vised the NHS app in March and ad­vises the Gov­ern­ment on con­tact t rac­ing, re­vealed new plans to up­date the app to re­in­force the risks of fail­ing to iso­late.

The pro­fes­sor of pathogen dy­nam­ics at Ox­ford Univer­sity’s Big Data In­sti­tute said: “It’s all about giv­ing you the in­for­ma­tion you need, about the risk lev­els.”

The Gov­ern­ment has not re­leased much in­for­ma­tion on the app’s per­for­mance, such as the num­ber of alerts it has sent telling peo­ple to self-iso­late. Lat­est data re­veal it has been down­loaded more than 16 mil­lion times, al­though users have com­plained of re­ceiv­ing dis­ap­pear­ing “ghost no­ti­fi­ca­tions” sug­gest­ing they may have been ex­posed to the dis­ease.

Prof Fraser said the re­luc­tance to self­iso­late when in­structed by ei­ther the app or a phone call was the “big­gest prob­lem the sys­tem f aces at the mo­ment”.

“We’re at very low de­grees of com­pli­ance, iso­la­tion, and quar­an­tine. Too low,” he said. “If we ad­hered to all of the rules which are out there, the epi­demic would likely be com­pletely un­der con­trol and the num­bers would be go­ing down rather than up.

“One of the most pre­cious com­modi­ties in pub­lic health is the trust of the pub­lic. And we did see peo­ple rally around in lock­down in March and April and be­yond, a kind of na­tional unity. We’re now in dan­ger of los­ing that due to frus­tra­tion, cyn­i­cism or con­fu­sion.

“There’s also a cir­cu­lar prob­lem which is that peo­ple lose con­fi­dence in the test and trace sys­tem, and don’t fol­low the rules.”

Data sug­gest peo­ple are re­luc­tant to pass on the de­tails of pos­si­ble con­tacts out­side their own house­hold. “About two thirds of the con­tacts are re­ported in the house­hold, and we don’t know ex­actly why that is,” Prof Fraser said.

Last month the Gov­ern­ment in­tro­duced a new self-iso­la­tion coro­n­avirus grant f or peo­ple i n work on l ow in­comes, a £500 lump-sum pay­ment if they can­not work from home and are re­quired to self-iso­late.

But Prof Fraser sug­gested that for many peo­ple the fi­nan­cial cost of self­iso­lat­ing was still too high.

“The ma­jor­ity of peo­ple get­ting in­fected are quite young. There is a de­gree of be­ing fed up,” he said.

“How­ever, I think it’s im­por­tant to note that the in­fec­tion this time around is con­cen­trated in cer­tain ar­eas and among cer­tain groups, rather than across the coun­try. That sug­gests most peo­ple are still do­ing their bit.”

This week, Prof Fraser and his team pub­lished a study show­ing that a trial ver­sion of the NHS app on the Isle of Wight ap­peared to have led to a sub­stan­tial re­duc­tion in the R rate, even though the app was later aban­doned.

“There was very clear com­mu­nity en­gage­ment be­tween the lo­cal coun­cil, the lo­cal MP, the lo­cal ra­dio, the NHS. Peo­ple bought into it,” he said.

“You need a clear rep­e­ti­tion of mes­sages for peo­ple to take ac­tion. How­ever, the pub­lic de­bate is quite er­ratic at the mo­ment. To get peo­ple to re­spond, you need clar­ity of mes­sage, and clar­ity of strat­egy.”

A Depart­ment of Health spokesman said: “The target has al­ways been to ex­pand ca­pac­ity to 500,000 tests a day by the end of Oc­to­ber and we re­main on track to de­liver this.” But ac­cord­ing to The Times, some sci­en­tists have pre­dicted that Bri­tain will be car­ry­ing out a mil­lion tests a day by Christ­mas.

One se­nior sci­en­tist in­volved in the test­ing pro­gramme said: “It’s go­ing pretty well. They have re­ally scaled up their ca­pa­bil­i­ties. By Christ­mas, we’ll be at a mil­lion a day, I think. That seems per­fectly pos­si­ble.”

‘We live in trep­i­da­tion of politi­cians say­ing we’re go­ing to start test­ing X, with­out ask­ing if it’s pos­si­ble’

‘We did see a na­tional unity. We’re in dan­ger of los­ing that now due to frus­tra­tion, cyn­i­cism and con­fu­sion’

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