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 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.
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.
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.
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’