NHS Test and Trace

NHS Test and Trace is an outsourced service provided to the National Health Service in England, established in May 2020 to track and help prevent the spread of COVID-19. It is headed by Baroness Dido Harding.[1]

NHS Test and Trace
Agency overview
Formed28 May 2020
JurisdictionEngland
Employees25,000
Agency executive
Parent departmentDepartment of Health and Social Care

Background

During the early stages of the pandemic, contact tracing was carried out by Public Health England, working with local authorities; PHE is an agency of the Department of Health and Social Care and is not part of the NHS. Tracing efforts largely ceased on 12 March 2020 in view of the wide spread of infection in the population,[2] and as the UK government changed its strategy for dealing with the virus. This decision led to criticism.[3]

Overview

NHS Test and Trace's remit is to find people who have come into close contact with those infected by the virus, thus enabling the lifting of blanket lockdown restrictions and a potential shift towards more localised measures should they be required.[4] The organisation employs a team of (initially) 25,000 contact tracers who contact people who have newly tested positive for COVID-19 and ask them about their recent movements, before identifying others they may have come into contact with. Those people are then asked to go into self-isolation for two weeks.[5] The contact tracers are employed by Serco, who were paid £108 million for the first phase of the work, up to late August.[6]

All components – administering tests, processing samples in laboratories, and contact tracing – are contracted to private companies, with logistic support from the army. Multinational consultants Deloitte handle testing logistics, including collection of statistics, and in turn appointed outsourcing companies Serco, Mitie, G4S and Sodexo, together with the Boots pharmacy chain, to run drive-through test centres. Deloitte also coordinates three new centres known as Lighthouse Labs where samples are processed, involving pharmaceutical companies GlaxoSmithKline and AstraZeneca, the army, Amazon and Boots.[7]

The system works in parallel with Public Health England's local health protection teams, who in turn work with local authority staff. Cases involving institutions such as hospitals, care homes and prisons are handed off to the local teams, who give advice to the institution rather than the affected individuals. Less complex cases are handled by NHS Test and Trace: the infected person is contacted by text, email or phone, and asked to give details of their recent close contacts. They may either enter these contact details into the Test and Trace website, or give them over the phone to a contact tracer.[8]

Phone app

The system was designed to work in conjunction with the NHS COVID-19 app, which was originally announced for mid-May but subsequently delayed due to technical issues during its testing phase.[9] Once the app is launched, it would enable those who have been in close contact with a person with COVID to be identified using their mobile phone. Prior to this, information would be gathered by questioning people about their recent movements.[10]

Following a further delay, Liberal Democrat MP Daisy Cooper tweeted on 28 May: "Dido Harding just told me that the #NHSX app described by PM a week ago as 'world-beating' is in fact just a 'cherry on top' of the tracing system: which itself won’t be fully operational until end June... 4 weeks after lockdown restrictions ease. This is a high risk strategy."[11] Replying to a question at the government's daily briefing on 11 June, Hancock was unable to give any date for rollout of the app, saying it would be brought in "when it's right to do so".[12] On 18 June, development of the app was abandoned in favour of a different design using the Apple/Google Exposure Notification system.[13]

More details of the second app were published on 30 July.[14] Public trials of the app began on 13 August,[15] with residents of the Isle of Wight, the London Borough of Newham, and NHS volunteer responders being the first to test it.[16]

History

The programme was outlined by Matt Hancock, the Secretary of State for Health and Social Care, at the UK government's daily briefing on 23 April, when he stated that 18,000 contract tracers would be hired; at that time the name given to the programme was 'test, track and trace'.[17] At the 4 May briefing, Hancock said he hoped to have the system in place by the middle of the month, and that 3,000 of the recruits would be medical staff.[18] It was reported that Serco and Sitel had been contracted to supply 15,000 call centre workers, who would have a short training period, and Hancock was criticised for not making use of around 5,000 environmental health workers in local authorities.[19]

On 7 May, Hancock appointed Baroness Dido Harding to lead the contact tracing programme for England, with a remit to oversee the implementation of the programme itself, and a contact tracing app.[20] On 18 May, Hancock said 21,000 tracers had been hired.[21] On 20 May, Prime Minister Boris Johnson told Prime Minister's Questions that a team of 25,000 contact tracers would be ready to begin work on 1 June.[22] The launch of the contact tracing service for England began on 22 May, when the government announced eleven pilot areas, including Norfolk, where the service would be initially rolled out. A £300 million investment package was also announced to help local authorities support the service.[23]

Deployment

The launch of the system in England – branded for the first time as NHS Test and Trace – was announced by Boris Johnson, the Prime Minister on 27 May 2020, and it went live the next day,[24] before it was fully ready.[25] Initially officials believed it would have the capacity to identify 10,000 people a day.[5] News that the service would be established without the phone app led to concerns manual tracing alone would not be effective enough to slow the spread of the virus.[1]

On the day of its launch, contact tracers began the process by contacting the 2,013 people who had tested positive for COVID-19 the previous day. Some tracers initially reported difficulties in accessing the system, but the UK government said it had not crashed and the problems were being resolved.[4]

On 28 May, Harding told MPs that the system would not be "fully operational at a local level" until the end of June.[26][27] Contractor Serco stated in internal communications that they believed it would not be fully operational until September.[28]

By 1 June, Hancock described the system as "up and running" but was unable to say how many cases had been handled.[29] On 3 June Channel 4 News reported that 4,456 confirmed cases of COVID-19 were reported to Test and Trace between 28 and 31 May, with those people passing on 4,634 contacts, and of those it said 1,749 had been contacted by tracers. The government described the data as outdated. On the same day a contact tracer claimed in a BBC interview that although she had worked for 38 hours she had not been asked to speak to anyone since beginning work, and had spent her time watching Netflix. In response the government said her story did not reflect the work taking place.[30]

Evolution

A reorganisation of the contact tracing element was announced on 10 August, following criticism that the service was not making use of local knowledge. The number of tracers in national teams would soon be reduced from 18,000 to 12,000, and some tracers would be formed into regional teams;[31] the number of clinically trained advisors would not change.[32] Details of infected people would be passed to local teams in order to respond to the increasing number of local outbreaks, as recently trialled in Blackburn, Luton and Leicester.[31]

Criticism

Potential impersonation of contract tracers

Concerns were raised by members of the public and the media about how someone receiving a call from a contact tracer could be sure of it not being a scam. Speaking at the UK government's daily coronavirus briefing on 31 May, Dr Jenny Harries, the Deputy Chief Medical Officer for England, acknowledged those concerns but said it would quickly become apparent the call came from a professional, who "will make it very clear to you that they are calling for a particular reason. I think it will be very evident, when somebody rings you, these are professionally trained individuals and sitting over them are a group of senior clinical professionals."[33]

Data protection

Concerns over data security and data protection have been raised. At launch, the programme did not have a Data Protection Impact Assessment, which is required by law.[34] In July, it was reported that workers on contract were sharing patients’ confidential information on social media support groups, due to a lack of alternative means to solve problems within their teams.[35]

On 20 July, privacy campaigners the Open Rights Group claimed that NHS Test and Trace was unlawful and breached General Data Protection Regulations (GDPR) because sensitive information could be shared with third parties. In response the UK Government conceded an assessment of its impact on data privacy had not been carried out before the system was launched, but there was no evidence that data had been shared with third parties.[36]

Statistics

The Department of Health & Social Care publishes weekly statistics on contact tracing. Numbers shown below include the complex cases handled by local health protection teams as well as those handled online and by the call centre; the first week's report stated that a "high number" of contacts were managed by the local teams.[37]

By the end of July the percentage of contacts reached had decreased, which was said to be primarily due to a decrease in the number of complex cases handled by local teams, where the success rate is higher. Of the 3,688 cases handled in the week to 29 July, only 249 (7%) were classed as complex. After their close contacts were identified, in complex cases 93% were reached, while in non-complex cases 61% were reached.[38]

Dates Positive COVID-19 tests

referred to Test and Trace

 People reached Contacts identified Contacts reached
28 May to 3 June 2020

(revised 18 June)[39]

 8,096 5,826 (72%) 51,851 46,949 (91%)
4–10 June[39] 5,949 4,366 (73%) 44,895 40,690 (91%)
11–17 June[40] 6,923 4,869 (70%) 30,286 24,734 (82%)
18–24 June[41] 6,183 4,639 (75%) 23,028 16,804 (73%)
25 June to 1 July[42] 4,347 3,366 (77%) 14,892 10,547 (71%)
2–8 July[43] 3,579 2,815 (79%) 13,807 9,811 (71%)
9–15 July[44] 3,887 3,098 (80%) 16,742 13,034 (78%)
16–22 July[45] 4,242 3,455 (81%) 18,598 13,974 (75%)
23–29 July[38] 4,642 3,688 (79%) 19,150 13,866 (72%)
30 July to 5 August[46] 4,973 3,962 (80%) 20,638 (74%)
Cumulative[46]

(not exact sum due to retrospective revisions)

 52,735 41,254 (78%) 263,515 214,890 (82%)

Elsewhere in the UK

Northern Ireland became the first constituent country of the UK to reintroduce contact tracing when, on 23 April, its Chief Medical Officer, Michael McBride, announced that a scheme was "active".[47] Following a pilot, the system became fully operational in Northern Ireland on Monday 18 May.[48] On 23 July, Northern Ireland's Department of Health confirmed the release of the contact-tracing app, StopCOVID NI, for as early as 29 July. Northern Ireland was the first part of the UK to launch a contact-tracing app.[49] The app was launched on 30 July.[50] The app runs on both the IOS and Android operating systems, but the developer said that it would not work on iPhone 6 or older Apple devices.[51]

Plans for Test and Protect, a contact tracing service in Scotland, were published by the Scottish Government on 26 May,[52] and it was launched on 28 May, shortly after NHS Test and Trace went live.[4] The Welsh Government began a pilot scheme in some health board areas on 18 May. On 27 May, Wales announced that its contact tracing service would launch on 1 June.[53]

References
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