The easing of the national lockdown has shifted the focus from central government to local authorities. Councils across England have made good progress in developing local outbreak plans and building capacity for contact tracing, working with Public Health England to decide how to manage outbreaks such as the one in Leicester.
But the main challenge facing councils is accessing the data about what is happening in their areas. Andy Burnham, the mayor of Greater Manchester, recently expressed his concerns about this, describing the lack of patient-specific data available to councils like “local detectives being asked to solve crimes without being given the names of any of the victims or suspects”. Burnham asked Matt Hancock to share all the information he has on Covid-19 in Greater Manchester to enable local public health teams to do their job, echoing similar concerns expressed by the mayor of Leicester.
Data is essential for councils to act quickly and to contain outbreaks. Public health directors leading this work need real-time information about the number of people who have tested positive for Covid-19 so they can direct their resources towards the places where the virus is spreading, and isolate people who may become infectious.
Currently, data is collected both by NHS laboratories and by the commercial labs that were established in March to process the results of home testing kits and drive-through centre tests. Positive results from commercial laboratories are reported to NHS Digital, the national technology partner to the health service, which then provides updates to Public Health England. Councils receive data about their areas from Public Health England, but information from commercial laboratories has only recently been made available to them. Most tests are now done in commercial laboratories – so the failure to include this data in reports to councils has created obvious difficulties.
One of the reasons for the delay in sharing information with local councils was concerns about data privacy. These concerns have now been addressed by requiring councils to sign data sharing contracts, enabling a more complete data set to be provided to public health directors. But delays in data sharing meant public health directors at the local level didn’t have data from commercial laboratories through most of June. At the same time that they were expected to take responsibility for local outbreaks, councils only had a partial picture of what was happening in their areas.
What’s abundantly clear is that centrally directed programmes that overlook local expertise are unlikely to succeed
The quality of data made available to councils has also been a problem. Information about people who have tested positive for coronavirus includes their postcodes, but not their names or other personal data such as where they work. This lack of detail matters: contact tracing involves time-consuming and time-sensitive work, which can’t be done effectively if public health directors don’t know which people in a particular area have tested positive. For example, if you don’t have data about an infected person’s occupation and workplace, it becomes far more difficult to contain workplace outbreaks. This is particularly important where people live in one area and work in another, or when a business operates from multiple sites.
These problems stem from the government’s decision to take control of the testing programme through the Department of Health and Social Care, and its preference for using commercial laboratories ahead of research centres such as the Crick Institute and the NHS.
The rapid expansion of the government’s testing programme was designed to meet Matt Hancock’s commitment to delivering 100,000 tests a day by the end of April. But questions about the standard of testing, the time it takes to turn around test results, and the number of tests that are delivered daily, appear not to have received the same level of attention. The recent announcement that the government will cease publishing data on the number of people tested daily, information that was already unavailable for several weeks, is further evidence of the flaws in its approach.
Compounding these errors, ministers and civil servants leading the national programme did not involve public health directors when establishing commercial labs or deciding how test results would be shared and used. If public health experts had been involved from the outset, it might have been possible to anticipate some of the problems that have since emerged.
Scientists have criticised the fragmentation between commercial laboratories and NHS systems as a fundamental flaw in the test-and-trace programme. Rather than building on the expertise of the NHS and existing research institutes, the government’s preference for deploying private sector solutions has undermined the efficiency of its pandemic response.
The DHSC is now creating a new framework to expand testing capacity, again choosing to use commercial laboratories at an estimated cost of £5bn. This same preference for the private sector is evident in the government’s programme of contact tracing, where ministers outsourced responsibility to Serco and its partners in a telephone-based national programme. Lobbying by councils eventually resulted in ministers giving local authorities a bigger role in contact tracing, but only after valuable time had been wasted.
Whether the government’s decision to sideline public sector expertise in favour of private sector solutions is driven by ideology, distrust of local government, or ignorance of what the NHS and councils can do is a moot point. What’s abundantly clear is that centrally directed programmes that overlook local expertise are unlikely to succeed.
The priority now should be to ensure that councils are receiving complete and detailed data on a daily basis. This will enable them to identify trends in infection rates, reduce the spread of infections in higher risk communities and settings, and contain outbreaks, such as the one in Leicester, swiftly when they do occur. Councils stand ready to play their part. They must be given the tools to do the job.
Chris Ham is chair of the Coventry and Warwickshire Health and Care Partnership and former chief executive of the King’s Fund. Kate Ardern is director of population health for Wigan council and lead director of public health in Greater Manchester combined authority