Test and trace service not ready despite ‘launch’

Local Government Chronicle May 28th 2020

The new test and trace system is not fully operational, despite its launch by government this morning, sources involved in its delivery are reporting.

There are also frustrations within local government that crucial data needed for contact tracing, as well as key information on how local lockdowns should be implemented, has not yet been shared by Whitehall.

The new ‘NHS Test & Trace’ system, launched today by health and social care secretary Matt Hancock, should mean anyone who has been in contact with someone who tested positive for coronavirus will be contacted by a ‘tracer’ and asked to self-isolate for 14 days. Councils will focus on identifying and containing potential outbreaks in places such as workplaces, housing complexes, care homes and schools.

It is intended to replace the national lockdown and allow for smaller local lockdowns where necessary to respond to a flare ups using tailored local outbreak plans developed by public health directors.

However, LGC has learnt that significant concerns remain over how the new system will work.

Public health directors were told yesterday at 5pm to start the tracing system in order for it to be launched at 9am this morning.  But the £300m trace resources for local government announced on Friday have not yet been allocated, leaving cash-strapped councils unsure how much they will receive or where the money will go.

Meanwhile, the Local Government Association is urgently seeking to understand how ‘localised restrictions’ will work in practice, and is raising a range of queries with Whitehall about local powers to enforce lockdown arrangements.

The government claims that NHS Test and Trace, which will include 25,000 dedicated contact tracing staff working with Public Health England, will have the capacity to trace the contacts of 10,000 people who test positive for coronavirus a day, with the potential to be scaled upwards if needed.

Yesterday, Sir Chris Ham, former chief executive of the King’s Fund and chair of the Coventry & Warwickshire Sustainability and Transformation Partnership, retweeted a message from someone claiming to be a contact tracer saying they were “frankly astonished” to hear the launch was happening this morning as they “don’t even have a log-in for the CTAS [Contact Tracing and Advice Service software] system”.

Sir Chris said this was a “reminder of how much more needs to be done to bring a coherent test and trace system into existence”.

He said there were many “practical issues” still to be “resolved” including sufficient tests, reporting results rapidly, and sharing results with local authorities and GPs as well as “clarity of roles” between the different parties involved.

Dominic Harrison, director of public health for Blackburn with Darwen BC, said “the systems protocols between [government] levels” and the standard operating procedures have not yet been agreed.

Despite Mr Hancock’s announcement yesterday that eligibility for a test now extends to everyone who is symptomatic, including under-fives, Mr Harrison claims “there is not enough testing capacity to even complete the care homes testing for three weeks.” “This system is not up and running yet!” he said.

This morning, the BBC claimed there have been reports from contact-tracers that the website is crashing.

The deputy chief executive of NHS Providers, Saffron Cordery said: “Rather than pretending we are about to see a world class test and trace service, the government should acknowledge that this will take time. It should not repeat the mistake of overpromising and under-delivering.”

Both the LGA and ADPH are calling on the government to share more data with the sector in order to make the contact tracing more efficient, including test results and “assumptions used to generate the testing and tracing models in the first place”.

Chair of the LGA’s community wellbeing board, Ian Hudspeth (Con), said: “It is important that councils have the capacity and necessary data to play their full part in this national programme, so they can understand where the outbreaks are happening and be able to act quickly to contain them.”

Cllr Hudspeth also claimed the programme’s success depends on the continued co-operation of the general public, who would be “reassured and encouraged if the roll-out of the service is underpinned by the leadership of their local council”.

 

How can any scientists stand by this government now?

Guardian Wed May 27 2020

The Cummings saga has made it plain that scientific advisers are shielding the government’s collapsing reputation on coronavirus

• Richard Horton is a doctor and edits the Lancet

Dominic Cummings predicted the events that have threatened both him and the government he serves. Writing on his blog in 2014, in an essay he called The Hollow Men, Cummings said: “The people at the apex of political power (elected and unelected) are far from the best people in the world in terms of goals, intelligence, ethics, or competence … No 10 will continue to hurtle from crisis to crisis with no priorities and no understanding of how to get things done … the media will continue obsessing on the new rather than the important, and the public will continue to fume with rage.”

Indeed, the public’s rage against Cummings, Boris Johnson and the prime minister’s lapdog cabinet seems to be growing day by day. The government’s goals, intelligence, ethics and competence are all under scrutiny and have been found wanting. Yet a cordon sanitaire has been placed around Cummings. He must be protected at all costs.

As Laura Spinney argues in Pale Rider, her history of the 1918 influenza pandemic and how it changed the world, getting the public to comply with disease-containment strategies means that each of us has to “place the interests of the collective over those of the individual”. In democracies, this is a hard ask. A central authority must temporarily suspend the cherished rights of individuals. And this demand carries dangers “if the authority abuses the measures placed at its disposal”.

Cummings certainly abused his authority as the prime minister’s chief political adviser. Matt Hancock, the health secretary, had given an instruction to “stay at home”. It wasn’t a guideline. It wasn’t advice. It wasn’t a suggestion. Hancock made clear that it was an instruction. Cummings violated that instruction. That violation has demonstrably undermined a carefully crafted public health message.

As long as Cummings remains in his position, the public can have no confidence that this government is putting their collective interests above those of a few privileged individuals at the heart of power. Johnson looks startlingly unable to understand the sacrifices made by families up and down the country he leads. Those families at the very least deserved an apology from Cummings. To dismiss their anguish reveals a man astonishingly detached from reality.

This sad episode also shows a regime that has lost its moral compass. And by regime, I don’t only mean politicians and their special advisers. I mean the regime of doctors and scientists shoring up this dysfunctional government.

Every day, government scientific advisers stand next to increasingly discredited politicians, acting as protective professional shields to prop up the collapsing reputations of ministers. Why did Yvonne Doyle from Public Health England agree to stand next to Johnson when he was defending Cummings on Sunday? Why did John Newton, who leads the UK government’s Covid-19 testing programme, stand next to Matt Hancock as the secretary of state for health and social care again sought to defend the indefensible?

Every day a cast of experts – led by the chief scientific adviser, Sir Patrick Vallance, and the chief medical officer, Chris Whitty – lends credibility to this government by annealing their reputations with those of ministers. This fusion of character works when we believe the collective interest is being put first. But when the government places the instincts of an individual above the tragedies of a people, it is surely time to step away. Tying the reputation of advisers to a government that is now an international laughing stock seems a mistake. It cannot be a coincidence that Vallance and Whitty have not been seen for a few days. But even so, government scientific and medical advisers should now disengage from these daily briefings immediately and completely.

The failures within the scientific and medical establishment do not end with government experts. The UK is fortunate to have an array of scientific and medical institutions that promote and protect the quality of science and medicine in this country – royal colleges, the Academy of Medical Sciences and the Royal Society. Their presidents have been elected to defend and advance the reputation of medicine and medical science. And yet they have failed to criticise government policy. Why? Surely their silence amounts to complicity.

The relationship between scientists and ministers has become dangerously collusive. Scientists and politicians appear to have agreed to act together in order to protect a failing government. When advisers are asked questions, they speak with one voice in support of government policy. They never deviate from the political scripts.

Why was PPE not reaching  frontline health workers? Instead of saying honestly that proper planning had not taken place, the adviser said the government was doing its best. Why was testing capacity so poor? Instead of saying honestly that the government had ignored the World Health Organization’s recommendation to “test, test, test”, the adviser said that testing wasn’t appropriate for the UK. Why did the government stop reporting mortality figures for the UK and other countries? Instead of saying honestly that the government found those figures embarrassing, the adviser said that such comparisons were spurious. Advisers have become the public relations wing of a government that has betrayed its people.

What is at stake here is not the fate of one political adviser or even of a government in crisis. It is the independence and credibility of science and medicine. Whitty and Vallance must now practise their own version of physical distancing – a distancing from a government that cares not one bit for the sacrifices made by its people.

In Pale Rider,  Spinney warns us: “At some point … the group identity splinters, and people revert to identifying as individuals. It may be at this point – once the worst is over, and life is returning to normal – that truly ‘bad’ behaviour is most likely to emerge.” It is indeed at this point that the “hollow men” have appeared. It’s time to cut them loose.

• Richard Horton is a doctor and edits the Lancet

A public inquiry into the UK’s coronavirus response would find a litany of failures

Guardian April 1st 2020 This article is more than 1 month old but remains very relevant.

Anthony Costello

Any self-respecting pandemic crisis team should have realised the importance of mass testing from the outset

• Anthony Costello is a former director of maternal and child health at the World Health Organization

Will the inevitable public inquiry into the UK’s Covid-19 response pin the blame on a few scapegoats? I hope not. Britain’s failure to move quickly and effectively is the symptom of a more comprehensive system failure. More than three months after the virus first appeared in Wuhan, England and Wales still lack the necessary testing capacity and surveillance infrastructure to shut down the epidemic. Crucial frontline workers are still doing their jobs without adequate personal protective equipment. Public Health England (PHE) seem unable to increase the daily number of tests in line with European neighbours. As other countries acted swiftly to contain the epidemic, the UK appears indecisive and delayed, shifting late in the day from a controversial herd immunity strategy to a lockdown. History won’t look kindly on Britain’s response.

We must ask at least five far-reaching questions about how our health system deals with a pandemic. First: who’s in charge? Many actors have been involved in devising a response to coronavirus – Downing Street and its advisers; Cobra; the Department of Health and Social Care; NHS England; PHE and its Scottish, Northern Irish and Welsh counterparts; the National Institute for Health Research; the chief medical officer, Chris Whitty; the chief scientific adviser, Sir Patrick Vallance; and the Scientific Advisory Group for Emergencies (UK Sage). Coordination appears chaotic. I’ve reliably been told that leaders across these various bodies often don’t know what each other is doing.

 

The second question concerns history. The UK’s haphazard coronavirus response wasn’t just a result of chaotic planning. The groundwork was laid years ago. During the last decade, funding for public health has been fragmented and downgraded. In 2013, the Lansley reforms created PHE, a new executive agency within the Department of Health and Social Care that was separate from the NHS. Its mission was to protect and improve the nation’s health in order to address inequalities. Its funding came from local authority budgets; as local authorities suffered the sharp end of austerity, funding for PHE stagnated. Spending on the public health grant in 2019-20 was £850m lower in real terms than initial allocations in 2015-16.

Today, the repercussions of fragmentation and underfunding are clear. Scaling up Covid-19 testing requires a community surveillance system that integrates PHE local outbreak management teams with NHS primary care facilities and laboratories. In its 3 March Covid-19 action plan, PHE assured us that “once a case has been detected, our public health agencies use tried-and-tested procedures for rapid tracing, monitoring and isolation of close contacts, with the aim of preventing further spread”. By all accounts, this didn’t happen at scale. On 12 March PHE stopped all community testing as part of the government’s delay strategy, instead focusing its efforts on patients and health workers.

The third question is political. This epidemic has tested the reigning political emphasis on market mechanisms and public-private partnerships, and found it wanting. During a national epidemic, our system of outsourced providers and internal markets simply doesn’t work. As one senior British doctor close to the Covid-19 crisis organisation told me, the chaos of the UK’s response has “reflected the wholesale destruction of a coordinated and focused state sector. Outsourcing, delegated powers, internal markets … have made a single response impossible. It is affecting every aspect of policy.”

A fourth question concerns the pool of experts advising the government. Vallance has stated that UK Sage comprises the best of British science – with expertise in virology, mathematical modelling and behavioural science. But for an overall crisis response, UK Sage was too narrow in scope. It needed public health science, logistics, IT, social and citizen science, communications and community mobilisation expertise at the table. Government funding for health has always had a strong bias towards clinical medicine. According to one 2018 report from Nesta, 94% of all health research funds are spent on clinical medicine, drugs and biosciences; only 6% is divided between psychology and behavioural sciences, and public and community health. During an epidemic, public health expertise is vital.

But perhaps the gravest problem with the UK’s response is that it didn’t act sooner. The 12 March decision to stop community testing meant the government effectively gave up on containing the spread of the epidemic. In South Korea, regional data and maps about coronavirus deaths are available online, and virus test data shows that just two out of 18 regions account for 84% of cases. The UK doesn’t have a reliable regional data bank because it collected too little community information. Where South Korea and China used digital apps to assist contact tracing, clinical deterioration and quarantine compliance, NHS Digital has simply recorded data since 18 March on 111 calls and online assessments. This data is not linked to community case surveillance or quarantine.

 

Maybe it is already too late in the day for the government to remedy these mistakes. Pandemics move fast; if you don’t get ahead of a virus, it quickly spreads. The government stuck stubbornly to its delay policy to “flatten the curve” through social distancing alone, despite the evidence of epidemic suppression through testing in South Korea, Singapore, Hong Kong, China, Taiwan and Germany, which have all recorded lower death rates.

On 23 March Paul Romer, a Nobel prize-winning economist, wrote a blogpost about his models of social distancing and community mass testing. “If we contrast a nonspecific policy of social distance with a targeted policy guided by frequent testing … how much more disruptive is the nonspecific policy? Answer? Way more disruptive.” Though an economy can survive with 10% of its population in isolation, it can’t survive when that figure is 50% or above. Without community surveillance and testing in place to detect new outbreaks and isolate individuals once the current lockdown is lifted, we face hugely damaging national lockdowns, over and over again. Any self-respecting Cobra, UK Sage or pandemic crisis team should have realised the importance of mass testing from the outset, and never allowed this to happen.

• Anthony Costello is professor of global health and sustainable development at UCL and a former director of maternal and child health at the WHO

UK excess deaths reach almost 60,000

Financial Times May 26th 2020

PM wants to focus on additional mortality rates rather than daily total
The UK has suffered almost 60,000 more deaths than usual since the coronavirus pandemic struck the country in mid-March, according to official figures released on Tuesday. The Office for National Statistics said that in the week ending May 15, 14,573 deaths were registered in England and Wales — 4,385 more than average for that week and a deterioration on the 3,081 excess deaths recorded in the previous week.

With separate official figures for Scotland and Northern Ireland included, the total number of excess deaths, directly or indirectly caused by Covid-19 across the UK rose to 59,359 over the past nine weeks. Nick Stripe, head of life events at the ONS, said there had been “just under 60,000 excess deaths across the UK”.

The prime minister and his scientific advisers have said that they want to focus on excess mortality rates rather than the daily total announced by the Department of Health and Social Care, which stood at 36,914 in figures released on Monday. Boris Johnson said last month that the only accurate way to compare coronavirus death rates with other countries was by using excess deaths figures, although he hoped to delay any comparisons until the end of the epidemic.

The deputy chief medical officer, Jenny Harries, said excess deaths was “probably the most useful statistic”.

The FT’s coronavirus model suggests that the number of excess deaths likely to have been recorded since the pandemic started is more than 63,000.

The ONS uses excess deaths as its primary indicator. It cautioned on Tuesday that the total of 4,385 excess death registrations in the week ending May 15 was distorted because it included deaths that were not registered the previous week when offices were shut for the VE Day public holiday. Deaths occur on average four days before they are registered.

Without the VE Day distortion, the figures would show excess deaths reducing from a weekly peak of 11,854 in the week ending April 17 and illustrate that the deadly impact of coronavirus is now on the wane. Deaths in care homes for those not tested for Covid-19 continued to represent the largest difference between the ONS figures and those announced daily by ministers. In the past five years, there was an average of 21,699 deaths in care homes over the nine weeks from March 20.

By contrast, in 2020 there were 46,336 deaths in care homes over the same period — an excess of 24,637 in the sector, which has been hit hard by the spread of infection. The latest data also show there were still excess deaths of people at home. Removing the distortion of VE Day, 6,976 people died at home, compared with an average of 4,595 during the same period over the past five years.

Only 301 of those who died at home had Covid-19 mentioned on their death certificates, suggesting some doctors had not been able to establish the cause of death was coronavirus, while others were unwilling or unable to go to hospital for treatment. Mr Stripe said the daily figures announced by ministers in the period after May 15 were still likely to be an underestimate of the true death toll. “We continue to see Covid-related death registrations running approximately one-third higher than the daily numbers reported at the time,” he said.

Directors of public health fear ‘shambles’ over contact tracing

Local Government Chronicle May 20th 2020.

Some senior directors of public health have told LGC they are still being kept in the dark on how government plans for track and tracing will be rolled out nationally, and have raised fears it will result in a “shambles” on the same scale as personal protective equipment (PPE) and Covid-19 testing.

They also expressed concern that DPHs have been described as “co designing” the track and testing programme in Whitehall press briefings when in fact their role is more minimal. “We are inputting our perspective and sharing our knowledge, but that is not the same as co-designing,” one source said.

The concern exists despite directors welcoming government recognition of their lead role on coronavirus testing in social care settings.

Lisa McNally, director of public health for Sandwell MBC, said: “Directors of public health and directors of social services have not been consulted enough on policy developments throughout the course of the pandemic. For example, on hospital discharge policies into care homes. But I think there has been an effort more recently to involve directors of public health more in conversations with government.”

The government announced this week that it has employed 21,000 contact tracers, many of whom have been recruited as call handlers by Serco, and there has been criticism of the training that Public Health England is providing to undertake contract tracing work.

Former King’s Fund chief executive Sir Chris Ham tweeted that the government’s use of the private sector is “not working”, slamming the NHS tracing app “a sideshow” and calling on public health directors to take on a greater role.

Kate Ardern, Wigan MBC’s director of public health,  tweeted: “You cannot expect people with no appropriate background knowledge, skills or experience to do this vital job with little training or expert supervision… contact tracing is a skilled job!”

One public health director said not a single document about the work of Serco had been shared with them during national calls and they were under the impression that government officials “do not yet know themselves” how Serco’s work would be joined up with that of local government.

Last week it was announced that Tom Riordan, chief executive of Leeds City Council, is co leading the new integrated national and local test and trace programme. One public health director said his priority needed to be “getting the system architecture clear”.

“My frustration is the lack of information coming out of the centre means I don’t even know what I will be asked to do at a local level. I do not feel included,” they said.

“Because of the lack of clarity, I have a pile of questions not answered. I am not clear how they will ramp up the testing without more delays.

“It is all deeply frustrating.”

The director also said they were “feeling quite anxious” about the fact the government has said it will roll out the contract tracing programme by the end of this month – a promise reiterated today by Boris Johnson at prime minister’s questions. “I am still no clearer on what it is exactly we are expecting to do.”

“They understand the timeline they are working to, but they seem to be incapable of standing it up in time. They are not thinking about what this will look like as a system.

“What they will generate is a shambles on the same scale that PPE and testing has been.”

The Department of Health & Social Care has been approached for comment.

 

£300 million additional funding for local authorities to support new test and trace service

Government Press release May 22nd 2020

Local authorities will be central to supporting the new test and trace service in England, with the government providing a new funding package of £300 million.

Published 22 May 2020
Last updated 24 May 2020 — see all updates

From:

Department of Health and Social Care

• Local authorities to work with government to support test and trace services in their local communities
• £300 million will be provided to all local authorities in England to develop and action their plans to reduce the spread of the virus in their area
• Work will build on the continued efforts of communities across the country to respond to the pandemic locally

Local authorities will be central to supporting the new test and trace service across England, with the government providing a new funding package of £300 million.

Each local authority will be given funding to develop tailored outbreak control plans, working with local NHS and other stakeholders.

Work on the plans will start immediately. Their plans will focus on identifying and containing potential outbreaks in places such as workplaces, housing complexes, care homes and schools.

As part of this work, local authorities will also need to ensure testing capacity is deployed effectively to high-risk locations. Local authorities will work closely with the test and trace service, local NHS and other partners to achieve this.

Data on the virus’s spread will be shared with local authorities through the Joint Biosecurity Centre to inform local outbreak planning, so teams understand how the virus is moving, working with national government where necessary to access the testing and tracing capabilities of the new service.

Local communities, organisations and individuals will also be encouraged to follow government guidance and assist those self-isolating in their area who need help. This will include encouraging neighbours to offer support and identifying and working with relevant community groups.

Minister for Patient Safety, Suicide Prevention and Mental Health, Nadine Dorries, said:

Local authorities will be vital in the effort to contain COVID-19 at a community level. The pandemic requires a national effort but that will only be effective as a result of local authorities, working hand in hand with Public Health England and contact tracers to focus on the containment of local outbreaks, in order to control the transmission and the spread of the virus.

For contact tracing to be effective when it is rolled out, we will need people to continue to follow guidelines and stay at home if they have symptoms.

Work will be led by local authority leaders and local directors of public health in charge of planning, and will build on their work to date to respond to coronavirus locally. They will operate in close partnership with local hospitals, GP practices, businesses, religious groups, schools and charities.

These new plans will build on the comprehensive work already being done by local authorities and directors of public health to respond to coronavirus locally.

Local efforts will support the national rollout of the test and trace service, in which everyone will need to play their part to stop the spread of coronavirus.

National Test and Trace Adviser and Chief Executive of Leeds City Council, Tom Riordan, said:

It is essential that communities and local authorities are at the heart of our plans to roll out test and trace. Their work to respond to the virus has been exemplary, demonstrating how people across the country have come together to respond to the virus.

As we move forward with our plans to trace every case of the virus, and contact those at risk, we will need to continue to work together and tailor support at a local level. This joint endeavour between local government, the NHS and local partners will help those in self-isolation, and reduce the risk of widespread outbreaks in our schools, businesses, hospitals and communities.

A new National Local Government Advisory Board will be established to work with the test and trace service. This will include sharing best practice between communities across the country.

Work to share lessons learned will be led by a group of 11 local authorities from the breadth of the UK, representing rural and urban areas, who have volunteered to help localise planning.

Background information

• The Department of Health and Social Care will allocate funding to local authorities in England, working with the Ministry of Housing, Communities and Local Government on the allocation formula. The funding is ring-fenced for this specific purpose. £300 million will immediately be allocated to local authorities in England.
• This would mean an additional £57 million provided via the Barnett formula for the 3 devolved administrations (£29 million for the Scottish Government, £18 million for the Welsh Government and £10 million for the Northern Ireland Executive)
• The 11 local authorities that will initially share best practice with others are:
  • Tameside – as the lead authority for Greater Manchester Mayoral Combined Authority
  • Warwickshire – Coventry and Solihull connecting to West Midlands Mayoral Combined Authority
  • Leeds – as the lead authority for the Leeds City Region
  • London – Camden lead in collaboration with Hackney, Barnet and Newham
  • Devon – with Cornwall
  • Newcastle – with Northumberland and North Tyneside as lead authority for North of Tyne Mayoral Combined Authority
  • Middlesbrough – with Redcar and Cleveland as lead authority for Tees Valley Mayoral Combined Authority
  • Surrey
  • Norfolk – with Norwich and districts Breckland, Broadland, Great Yarmouth King’s Lynn and West Norfolk, North Norfolk and South Norfolk
  • Leicestershire – and Leicester with Rutland
  • Cheshire West and Chester – with councils within Cheshire local resilience forum
  • …………………

Now read Local Government Chronicle, May 20th 2020

Directors of public health fear ‘shambles’ over contact tracing 

Local Government Association says Coronavirus contact tracing at risk unless vital info shared with councils

Local Government Association 10th May 2020.

Crucial data must be shared with councils to make use of their local knowledge and expertise and ensure vital national efforts to track and trace coronavirus succeed, the LGA warns today.

Councils – with their knowledge of their local communities – are ideally placed with the skills, knowledge and experience on the ground to help the Government achieve its ambition to ramp up the level of testing and contact tracing necessary to defeat the disease.

The LGA said the sharing of information is essential if we are to succeed in driving down the numbers of new people being infected once the lockdown is gradually lifted and access people who will not be reached by the new NHS app.

The key sources of data needed by councils includes, but is not restricted to:

• Access to testing results across all sites
• Hospitalisation records for those with COVID-19
• Death certifications in which the disease is identified
• NHS 111 symptomatic data by postcode
• All GP or primary care and out of hours calls/data linked to COVID-19
• ONS all-cause mortality by local authority and postcode if possible
• Personal details of contacts, including information such as race, ethnicity and gender, along with their contact details

This data should also include unique property reference numbers (UPRNs), so that councils can identify hotspots, map where the virus is prevalent and plan for action. It will also enable councils to link the data up with their existing systems to fill important gaps in their information.

It is shortly to be expected that all new data sources from central government must include UPRNs, but in the meantime councils should be given access to this information to help deal with the current crisis.

Cllr Ian Hudspeth, Chairman of the LGA’s Community Wellbeing Board, said:

“Councils want to play their full part in the national effort to defeat this disease, but they cannot do so without having all the information they need.

“Environmental health, trading standards, public health including sexual health services and infection control nurses are just some of the services which have unparalleled skills, knowledge and experience on the ground, to support the Government’s test, track and trace system.

“COVID-19 is best understood as a pattern of local outbreaks, rather than a national pandemic with a similar impact in every community. To help councils understand where the outbreaks are happening and be able to act quickly to contain them, government needs to share vital and up-to-date data with them alongside other agencies.

“While the expected nationwide rollout of the NHS COVID-19 app will be useful, there are some areas in different communities where an app simply cannot reach. This is where councils can step in and make the most of their role as local public health leaders, but they need all the tools at their disposal to help do so.”

Notes

Information needed by councils for contact tracing also includes the below:

• Person-level records on testing both those carried out, on whom and where and positives, including on personal characteristics
• Person-level records on hospital inpatients, admissions and discharges –including where these have come from and where they are going to (to distinguish whether usual place of residence is a care home) and age, gender, underlying condition(s), outcome (i.e. discharged/died) and ethnicity
• Deaths – full and up to date all ages, all causes
• From care homes – accurate and complete information on cases (staff and residents) and deaths (all cause) together with ethnicity and vacancy information
• From home care providers – accurate and complete information on cases/vacancies (both in staff and clients) and details of who they are supporting and where
• Full and complete list of shielded people, together with the GP list of those who are eligible for flu jabs
• Full and complete list of assumptions used to generate the testing and tracing models in the first place.

 

Open Letter to Coventry and Warwickshire Joint Health Overview and Scrutiny Committee to back local COVID 19 Test, Trace and Isolate policy

May 27^th 2020

Dear Councillors and Officers,

We address Coventry and Warwickshire Joint Health Overview and Scrutiny Committee members and officers in attendance at the most recent meeting (January 22^nd 2020). We would be grateful if you could forward this to anybody who is a member of the Committee who has been omitted from this email.

We hope you and all your colleagues at Warwickshire County Council, Coventry City Council and Coventry and Warwickshire Joint Health Overview and Scrutiny Committee are well.

Members and supporters of the Coventry and Warwickshire Keep Our NHS Public Campaign Groups believe it is imperative that the Coventry and Warwickshire Joint Health Overview and Scrutiny Committee meet as soon as possible, virtually and in public, in order to scrutinise the government’s, the Coventry and Warwickshire Health and Care Partnership’s and the CCGs’ response to the Covid19 pandemic.

Although the government may claim that it has achieved its overriding goal, this has been at the expense of many people’s lives and wellbeing. On May 5^th BBC News reported that the UK death toll was the highest in Europe (1)

As Dr Maria Van Kerkhove, Technical Lead, WHO, Infectious Disease Epidemiologist said:

“Asking the question “are we doing enough?” regularly and repeatedly is critical.”

We see the role of scrutiny as vital to transparency at this crucial time.

We need to ensure that the Nolan principles prevail under the wide-ranging and hastily legislated Coronavirus Act. We need the principles of objectivity, accountability, openness and leadership. 

Below are issues we would like you to scrutinise, since they remain unresolved and problematic. Bringing accurate information about them into the public domain is vital for the formulation of a more effective response to Covid-19 than what we have at present. 

We propose local primary care and public health systems must be central to the response to Covid-19

The first Independent SAGE online meeting of notable scientists from many relevant disciplines – including public health, computer modelling, behavioural science and intensive care medicine – revealed a strong consensus that local primary care and public health systems must be central to the response to Covid19.

Their report, COVID-19: What are the options for the UK? Recommendations for government based on an open and transparent examination of the scientific evidence (2) endorses the World Health Organisation guidance on transitioning from lockdowns.

The second of the six of the WHO requirements states that:

“Sufficient public health and health system capacities are in place to identify, isolate, test and treat all cases, and to trace and quarantine contacts.”(3) 

What is happening?

We are aware that there are significant weaknesses in the government’s centralised and privatised test/trace/track scheme, which sidelines local NHS labs and public health professionals.

Testing

• a) Testing is too centralised. Many people who need tests cannot reach the testing centres. Can the Joint HOSC find out how many people cannot get tested because of transport/logistical problems.

• b) What is the justification for outsourcing testing from the NHS to private companies? Testing contracts have been given to private firms. In Coventry and Warwickshire, the Ricoh Arena testing centre has been contracted to Deloitte, which has subcontracted to Sodexo. Why?

• c) Test results analysis has by-passed NHS pathology labs, and been contracted to private-public partnership ‘Superlabs’. A statement by The Institute of Biomedical Science raises concerns about the quality of the service provided by these three new Lighthouse Labs:

“It is clear that two testing streams now exist: one delivered by highly qualified and experienced Health and Care Professions Council (HCPC) registered biomedical scientists working in heavily regulated United Kingdom Accreditation Services (UKAS) accredited laboratories, the other delivered mainly by volunteer unregistered staff in unaccredited laboratories that have been established within a few weeks.”(4).

• d) Where do the results go? After the tests are processed it is vital that the results are shared with local authorities’ public health departments and GPs. Without this information it is impossible for GPs and Councils’ Public Health Departments to put in place proper health care for Covid-19 sufferers, and effective virus suppression measures, including local contact tracing and isolation support. But, as the Health Service Journal reported on May 12^th “Data on tens of thousands of tests not accessible to local NHS and councils; No data is being reported until further notice and Senior NHS source says national reporting has also stopped” (5)

Tracking and Isolating

The government is using private companies to start the tracking process. They are not delivering. 

Serco. The government will use a centralised call centre system of around 21,000 tracers. It has outsourced this to SERCO, despite the Serious Fraud Office having conducted a criminal investigation into this company’s false accounting by fraudulent tagging in July 2019. Serco has already shown incompetence in ‘accidentally sharing contact tracers’ emails’.

Sitel: Training, run by contact centre company Sitel, is deficient. Trainees reported spending days just trying to log into the online system, virtual training sessions left participants unclear about their roles, new contact tracers were told to rely on a two-page script and a list of frequently asked questions, and were told to consult YouTube for advice on how to deal with a bereaved person (Guardian May 20^th).

HR Go has been running recruitment. On May 18^th it told applicants applying for contact tracing jobs that hiring ‘had been paused’, while the government denied this.(6)

The current centralised, private system is proving to be incompetent and failing. Meanwhile, the lockdown is being gradually lifted. Unless and until a proper system of local testing, tracking and isolating is in place, more people will die – unnecessarily.

Local, Community Based Testing, Contact Tracing and Isolating. 

In some parts of the country, community run contact tracing has begun. Sheffield is one example (7). 

Local KONP groups, including retired doctors, one of whom was Director of Public Health in South Warwickshire, are pressing the Coventry and Warwickshire Health and Care Partnership to support local Public Health directors to organise local, community led testing, tracing and isolation.

Tracing must be run by people in the community who know the community. It must be run by Public Health departments, GPs, retired health professionals, volunteers, environmental health experts and others.

We urge Coventry and Warwickshire Joint Health Overview and Scrutiny Committee to support us in making the Government accountable for its decisions in this pandemic, including the failures outlined above.

The Government press release https://www.gov.uk/government/news/300-million-additional-funding-for-local-authorities-to-support-new-test-and-trace-service on May 22nd that there is ‘£300 million additional funding for local authorities to support new test and trace service’ and that ‘Local authorities will be central to supporting the new test and trace service in England, with the government providing a new funding package of £300 million’ leaves local authorities still subordinated to the centralised testing and tracing policy.

Senior directors of public health have told the Local Government Chronicle that ‘they are still being kept in the dark on how government plans for track and tracing will be rolled out nationally, and have raised fears it will result in a “shambles” on the same scale as personal protective equipment (PPE) and Covid-19 testing’ (https://www.lgcplus.com/politics/coronavirus/directors-of-public-health-fear-shambles-over-contact-tracing-20-05-2020/). The LGC cites Coventry and Warwickshire Health and Care Partnership Chair, Sir Chris Ham, is highly critical of the government approach, stating in a Tweet, that ‘the government’s use of the private sector is “not working”, slamming the NHS tracing app “a sideshow” and calling on public health directors to take on a greater role’.

Coventry and Warwickshire Joint Health Overview and Scrutiny Committee can play a key role in backing the Coventry and Warwickshire Health and Care Partnership to fully support local Public Health departments, local public and environmental health services, councils, and GPs in establishing a local Coventry and Warwickshire COVID-19 Test, Track and Isolate system. 

To start this, some immediate questions need asking and need answers.

Questions for the Joint HOSC to ask on Testing:

1. Are the Directors of Public Health (DPH) at Warwickshire County Council and Coventry City Council receiving daily reports of numbers tested by testing site – (Ricoh Arena and any others)
2. Are the DPHs informed of positive test results?
3. Are GPs informed of positive results?
4. How many results are going missing?
5. Will DPH & Public & Environmental Health teams have any involvement in contact tracing or will it all be done by call centres?

Other key issues

In addition to local testing, contact tracing and support, we ask Coventry and Warwickshire Joint Health Overview and Scrutiny Committee to scrutinise the following key issues to suppress the spread of Covid-19 from now on:

• Schools not opening until the National Education Union’s 5 tests have been met (8); a sustained downward trend in new cases, regularly weekly testing in schools and the ability to isolate cases, appropriate PPE, national guidelines for social distancing and a plan to protect the most vulnerable. The Independent SAGE Report on Schools re-opening is here: http://www.independentsage.org/wp-content/uploads/2020/05/Independent-Sage-Brief-Report-on-Schools.pdf

• Covid-19’s disproportionate impact on poor and Black And Minority Ethnic communities and individuals and what measures must be taken to stop this.

• The effect of the mass hospital discharge of patients at the end of March of Covid-19 patients and deaths in care homes in Coventry and Warwickshire.

• Whether the understandable push for GPs to make sure that patients with a frailty score of 6+ have made Advanced Care Plans has been associated with any CCGs’ directives or encouragement to deny such patients access to hospital care in the event that they fall ill with Covid19.

• The lack of PPE which has risked and in too many cases taken the lives of NHS, social care workers and other key workers.

• The rise in ‘excess deaths’ that are not from Covid-19 but are probably the result of inadequate public information about “green” zones in GP surgeries and hospitals, so that people can safely attend for non-Covid-19 health problems.

• How “normal” NHS services are going to resume, including resumption of elective surgery.

• The cost and effect of the block contracts for NHS use of private hospitals in Coventry and Warwickshire.

• The funding needs of Councils for Covid-19 costs including loss of income through business closures etc.

The advice by the government’s Scientific Advisory Group for Emergencies (SAGE) has been challenged by many science experts, who have formed Independent Sage (9). We recommend the latter’s list of issues relating to the Covid-19 pandemic response:

• Transitioning from lockdown and closures
• Test, Trace, Isolate, Support, Integrate
• Minimise outbreak risks in high vulnerability settings
• Establish preventive measures in workplaces
• Ensure communities have a voice, are informed, engaged and participatory in the transition
• Effective clinical care for patients and staff
• Health, social and economic protections for women, marginalised and BAME groups
• What is needed for the future?

References.

• https://www.bbc.co.uk/news/uk-52549860
• http://www.independentsage.org/wp-content/uploads/2020/05/The-Independent-SAGEReport.Pdf
• http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/4/whoeurope-publishes-considerations-for-gradual-easing-of-covid-19-measures
• https://lowdownnhs.info/comment/why-bypass-nhs-labs-for-mass-testing-concerns-over-new-super-labs/?
• https://www.hsj.co.uk/coronavirus/exclusive-test-data-from-commercial-labs-going-into-black-hole/7027619.article?adredir=1
• https://www.theguardian.com/business/2020/may/20/serco-accidentally-shares-contact-tracers-email-addresses-covid-19; https://www.theguardian.com/world/2020/may/20/no-one-had-any-idea-contact-tracers-lack-knowledge-about-covid-19-job; https://www.theguardian.com/politics/2020/may/17/uk-contact-tracing-applicants-wrongly-told-hiring-paused-in-latest-misstep
• https://www.communitycontacttracers.com/ ; See Guardian 21^st May 2020 https://www.theguardian.com/world/2020/may/21/uk-first-coronavirus-contact-tracing-group-warns-of-difficulties; and Newsnight 7 minutes in, May 21^{st, 7} https://www.bbc.co.uk/iplayer/episode/m000jbcj/newsnight-21052020.
• https://neu.org.uk/neu-five-tests-government-schools-can-re-open
• http://www.independentsage.org/read-the-key-recommendations/

Signed:

Dr. Gordon Avery formerly Director of Public Health, South Warwickshire

Martin Drew, Member, South Warwickshire Keep our NHS Public

Frances Hoch Retired SRN and Health Visitor, MA by Research Sociology of Health and Illness, University of Warwick, BScN (Hons) Specialist Community Public Health Nursing, University of Wolverhampton

Pat McGee Chair, Coventry Keep Our NHS Public

Dave Nellist, Secretary, Coventry Keep Our NHS Public

Professor Anna Pollert, Secretary, South Warwickshire Keep our NHS Public.

Professor Nick Spencer, Emeritus Professor of Child Health

 

 

Commit to testing target in exchange for key equipment, systems told

HSJ May 19th 2020

• Officials at NHSE/I told local leaders a testing target will be agreed for each pathology network
• Once a target has been agreed, NHSE/I will commit to delivering the necessary swabs and reagents

Local systems will have to sign up to meeting targets for coronavirus testing in exchange for a national commitment to deliver the necessary equipment, HSJ has learned.

According to multiple sources, officials at NHS England and NHS Improvement told local leaders on a conference call that a testing target will be agreed for each pathology network.

They said each network will be asked to submit a proposed target, and this may then be subject to some negotiation.

Once a target has been agreed, NHSE/I will commit to delivering the necessary swabs and reagents required to carry out the tests. Local networks will then be “performance managed” against the targets, the sources said.

The commitments would refer to polymerise chain reaction (PCR) tests carried out in local pathology labs. PCR tests are used to directly detect the presence of an antigen, rather than the presence of the body’s immune response, or antibodies. They detect whether someone is carrying the virus at the point of testing.

The conference call was led by David Wells, head of the pathology covid-19 testing cell. NHSE/I was approached for comment.

The government has pledged to increase testing capacity to 200,000 per day by the end of May.

The latest testing figures said just over 100,000 were carried out yesterday, of which around 25,000 were carried out in Public Health England and local NHS labs.

Around three-quarters were carried out by commercial labs including in Milton Keynes and Alderley Park in Cheshire.

There are 29 pathology networks covering England.

Coronavirus Staff urged to share covid-19 test results with their trust

HSJ By Matt Discombe 18 May 2020

Trusts don’t automatically receive test results under GDPR and
confidentiality rules
Concerns some test results not being shared with occupational health
teams

NHS staff are being encouraged to share their covid-19 test results with
their employers, which do not receive them automatically because of
privacy rules, sparking concern among some leaders.

Results from staff covid-19 tests are not automatically being shared with
employers, and confidentiality and GDPR rules place responsibility on
individual staff members to discuss their test results with their trusts,
it has been confirmed to HSJ.

It has raised concern that, with occupational health teams unable to
access results, employers may be unable to ensure staff are safe, or
monitor the situation in their teams and organisations.

One local NHS source said: “The results are not going to occupational
health services… even though we send a list of staff we have referred for
testing to the local drive-[though] every day.

“We asked at the start of this initiative how [occupational health] would
get the results and were told it was up to a member of staff to notify us
once they got [the] result by text.

“We could be in a situation where a member of staff who lives on site and
who we have referred for testing is found collapsed and unwell and we have
no idea of the test result.”

Another senior local medical leader told HSJ: “I think there’s an
expectation that employees will share their results with employers. But
that the way the Deloitte contract and others set up there was no easy way
to share results with more than the patient.”

President of the Society of Occupational Medicine Will Ponsonby described
the issue as a “difficult dilemma” but encouraged staff to share their
results.

He told HSJ: “It’s an issue because it means we can’t optimally monitor
the outbreak if we don’t know what people’s status is. Having said that,
they have a right to confidentiality.

“We should be encouraging individuals to share their test results with
employers and occupational health teams.

“It would have to be a decision made by the government to make these tests
results available [to employers]. They would have to balance that against
the fact that if they’re not kept confidential people may not want to go
to testing and we can’t force them. It’s a difficult dilemma.”

While there is no automatic reporting of results to employers, staff are
often required to notify their employer of the reasons for sick absence
under their terms and conditions.

A Department of Health and Social Care spokesman said: “Testing results,
like any other information relating to an individual’s medical background,
must be handled in accordance with the law. This is why it is not shared
automatically with the individual’s employers.

“We encourage employees to promptly inform their employers if they’ve
received a positive coronavirus result.”

It follows HSJ revealing that regional and local data on the results of
tens of thousands of tests carried out under the programme were
unavailable to local organisations.
Source

Information provided to HSJ