Central government is looking to make mass testing available and is belatedly considering how to work with local government to deliver a successful and effective service.
Since the beginning of the pandemic, the Local Government Association (LGA) has stressed the value of local council’s expertise and capability in local contact tracing, and has also sought more control over local testing arrangements. Despite this, the national arrangements have not been based in local systems, and of course there are still great concerns over the speed of testing, availability of test sites and reliability of data sharing for contact tracing. Local tracing has already been rolled out first in areas of very high incidence but there hasn’t been sufficient funding to enable all local areas to do this, and we do not yet know what is meant by “local by default” in terms of NHS T&T.
I believe that a greater local oversight delivery would provide a number of benefits:
- Councils know their communities better and how best to engage with them, particularly in diverse communities. Councils have been able to reach up to 9 out 10 cases that couldn’t be reached by national team.
- Quicker access to local support, eg through community hubs
- Talking to a local is more likely to generate compliance as well as understand wider context of the family / household to explain why self-isolation is crucial
- Local tracing will generate much richer data and information. Local tracers know and understand the local area and community and hence can have a much more engaged conversation and are more likely to pick up of fragments of information that relate locally
- Tracing teams being local would be much better at discussing and exchanging information with each other to pick up patterns in the data/infections/behaviour. Also, they are more able to work with local partners to share information such as Police/Health/Fire
- There is faster Data turnaround
- Target testing would be better and faster
- Multiple phone calls that are simply putting people off would be avoided, there is a lack of join up. Some families receiving 30+ calls as a result of one positive case and then multiple follow up calls telling others to isolate.
There needs to be full and proper engagement with local government to establish that local systems will be fully funded for the long term and how the funding will work. Given the high cost of the central system, localisation should result in both a saving and improved performance, but it cannot be done on the cheap if it is to be successful. We note the Greater Manchester proposal which costs £20m.
There needs to be a hybrid approach to localisation that enables councils to localise at different speeds, to reflect both their capacity and situation on the ground in terms of Covid cases and workload. Given the huge task involved it would make sense for different councils to undertake different aspects as pathfinders – for instance some might spearhead local tracing while others can pilot mass testing based on new technologies such as lateral flow. This should take account of the local infection patterns which will require different priorities depending on local circumstances.
Arrangements will need to be put in place to allow appropriate oversight by the Director of Public Health and to ensure sufficient capacity in terms of public health and wider teams.
Local governance should be based on existing local structures (eg those established for local outbreak management) and ensure local political accountability. Arrangements should recognise and build on the role of regional, combined authority and local arrangements by local agreement.
Any expectations of monitoring and assurance to central government need to be clear from the outset so that it can be built into local planning and management arrangements.
How can this be done?
For increased localisation to work we would need:
- Fast accurate data from current T&T system: current handoffs are often 72+ hours after test, limiting their benefit. Speeding up the handover of cases would enable current complex cases to be done faster/better and getting people to isolate earlier reducing transmission
- Councils to be funded to build up their tracing teams to take on more cases. There will be need for support on training resource (ie people) and on data systems in addition to funding. Can some of the central tracers transfer to their local area?
- A stepped programme for localisation of testing: this will need to be fully funded.
a. Initially hand over a higher proportion of cases earlier eg after 3 calls or 24 hours. Key is to avoid creating jaded targets that do not respond
b. Enable local direction of testing, in particular allocation of places at local testing centres
c. Grow proportion to full hand over of tracing, retain central “surge capacity”
d. Put in place systems for local commissioning or delivery of testing capability (not lab analysis), should largely be done after local tracing established and to be based on LA commissioning / carrying out the test, but sending samples to local testing lab. This may change as testing technology changes
- Initially targeted testing (rather than testing centres)
- Local testing centres
- Regional testing centres would still require some regional or national systems
- Mass testing on basis of new technology such as lateral flow tests (some councils could take this on early to pilot)
- Reverse Tracing – will overlap with the above. Identifying contacts and immediately testing and again at 7 days. Current anecdotal evidence suggests low compliance with isolation. Putting in testing and reducing isolation to 7 days if a negative test is likely to increase compliance. This will also lead to much faster response on the positive cases, allowing clampdown faster
- Testing could also be extended to others who are supposed to be isolating eg travellers from abroad to encourage compliance
The aim could be full localisation in the long term, which could be aligned with the new arrangements for Public Health England responsibilities. But need to work with local areas so that the expectations placed on them are reasonable given current pressures, capacity and resourcing.
It may make most sense to increase localisation first (on a voluntary basis) in those areas with low infection rates rather than the areas in tier 3 – because some of the most obvious benefits are in preventing the spread of the virus rather than in infection control, and because the capacity requirements for tracing escalate hugely with infection rates.
None of this really changes because of the lockdown and in fact the imperative to introduce an effective T & T regimes is strengthen by it. What is the point of a lockdown after which will return to a tiered basis unless we can stop yet another surge thereafter.
Getting an effective track and trace system in place is vital if we are to control outbreaks and get society moving again. Central Government has failed to do this. Now the responsibility should pass to local councils.