Test and Trace must improve effective partnership

The National Audit office has released its second report on the government’s approach to test and trace services in England.

The report says that, although the NHS Test and Trace service has expanded its testing capacity, tracing activities and distribution of rapid tests, it still has much further to go to reduce the overall time taken for reaching all cases and their contacts.

The auditors argue that Test and Trace still does not have targets for how quickly the contacts of those testing positive should be reached for other types of PCR tests, such as home-based tests. Furthermore, its internal targets don’t cover the period between a person experiencing symptoms and coming forward for a test.

While Test and Trace’s performance has improved since the end of October 2020, it fell well below its targets when cases rose sharply in December. Test and Trace provided results for 90 per cent of PCR tests taken in person in the community within 24 hours in April 2021, up from 38 per cent in October 2020. However, this dropped to 17 per cent during December when testing and tracing activity was increased to manage the surge in infections.

The NAO report also claims that local authorities’ involvement in testing and tracing has increased significantly, but challenges to effective partnership working remain. Local stakeholders told the NAO that Test and Trace’s engagement and data sharing with local authorities has improved, but that they cannot yet access all the data they need. This makes it difficult for them to deal with localised outbreaks.

Local stakeholders told the NAO that Test and Trace’s engagement and data sharing with local authorities has improved, but that they cannot yet access all the data they need. This makes it difficult for them to deal with localised outbreaks.

The overall effectiveness of the test and trace process also relies on public compliance, which is still low or variable: only a minority of people who develop symptoms request a test, and not everyone self-isolates in line with requirements. However, Test and Trace has no targets for increasing the number of people coming forward for a test or self-isolating.

The service will transition to the new UK Health Security Agency before October 2021 and the NAO says that there is a risk that the restructuring will divert Test and Trace’s attention away from efforts to contain the spread of the virus. Local stakeholders also told the NAO there is uncertainty about the roles that national and local bodies will play following the transition to UKHSA. While Test and Trace has sought to improve its understanding of future testing and tracing needs, it has not yet determined what capacity will be required in the future.

Speed, reach, and levels of public compliance still constrain the effectiveness of the test and trace approach. The NAO recommends that the Department of Health & Social Care, through Test and Trace and relevant partners, should set out plans by October 2021 for improving the overall test and trace process, including addressing how to best support citizens to come forward for tests and comply with self-isolation requirements. They should also establish a clear strategy for how to integrate national and local efforts once England is no longer in lockdown.

Gareth Davies, the head of the NAO, said: “Since we last reported in December, NHS Test and Trace has introduced a lot of changes, including mass testing, closer working with local authorities and initiatives to identify and contain variant forms of Covid-19. However, some pressing challenges need to be tackled if it is to achieve its objectives and deliver value for taxpayers, including understanding how many lateral flow devices are actually being used and increasing public compliance with testing and self-isolation.”