Until a vaccine or effective treatments become available, we face the prospect of living with coronavirus and the risks it presents. Public health experts are clear that testing and contact tracing offer the best hope of managing these risks. But as the lockdown is relaxed, England seems ill-prepared to undertake the testing and tracing that will be necessary to avoid a second peak in cases and deaths.
The prime minister and the health and social care secretary announced on 27 May that the NHS test and trace service would commence the following day. Both testing and tracing have been brought together under the leadership of Dido Harding, who was appointed by the prime minister on 14 May to bring clarity and coherence to two previously separate programmes. Her team is seeking to ensure much greater local influence over testing and tracing.
Harding made it clear in a briefing to MPs that an effective system of testing and tracing would not be in place until the end of June. This is partly because of the scale and complexity of the work involved and also because local authorities were not involved until very late in the day. Councils require time to develop robust local outbreak plans and put staff in place, giving the lie to ministers’ claim that testing and tracing is already up and running.
Much more needs to be done to strengthen the testing regime before it is fit for purpose. Priorities should include reducing the time needed to analyse tests and report the results, and ensuring that tests can be booked easily and undertaken in convenient locations. Test results also need to be shared with the staff responsible for contact tracing, and GPs need to be informed when their patients test positive.
These issues should have been resolved before the lockdown was relaxed. Instead, the government wasted valuable time in understanding what needed to be done after the lockdown was imposed, and has been playing catch-up ever since. Rather than bringing local authorities on board and consulting expertise already available in the NHS during the initial stages of the outbreak, the government chose to rely on the private sector, outsourcing testing facilities to Deloitte and contracting Serco to deliver a tracing system.
Compounding these errors, ministers have been overly focused on meeting specific targets, such as increasing the number of tests to 100,000 a day, appointing 18,000 (now 25,000) contact tracers, and developing an NHS app which may or may not work. The actions now being taken by Harding and her team are a step in the right direction, but their success depends on the ability of central government to execute complex projects – a skill it has often lacked.
Unfathomably, the government decided to ease restrictions while the Covid-19 alert level was still at four, which denotes a high level of transmission. A reasonable inference to make is that politics has taken precedence over “the science”. Indeed, members of Sage have expressed concern that the lockdown is being relaxed too soon. The more cautious approach taken by devolved administrations in Northern Ireland, Scotland and Wales is a reminder of English exceptionalism, even in the face of death rates higher than anywhere else in Europe.
Relaxing the lockdown in advance of having an effective and fully integrated system of testing and tracing in place creates unacceptable risks to the public’s health. If infections and hospital admissions from coronavirus begin to increase, the NHS will face renewed pressure. Many NHS staff have been affected profoundly by their experiences in recent weeks, and some have expressed concerns at having to go through the same again.
The uneven spread of coronavirus will make these risks greater in some parts of England than others. Political leaders in the north-east have voiced concern about rising pressures in their areas, at the same time as these pressures are easing in London and the south-east. England should learn from countries such as Spain, where different regions need to meet specific epidemiological criteria before lockdown can be eased.
It seems likely that we will see flare-ups of coronavirus cases before winter. So it’s all the more important that local authorities use the limited time they have been given to work with Public Health England and local resilience forums to prepare for these outbreaks. Public health directors and their staff are best placed to lead this work using local intelligence and expertise to contain the impact of Covid-19.
The government’s mishandling of testing and tracing could have been avoided by much earlier engagement with local authorities and leaders from across the NHS. The deputy chief medical officer has described this as a “very dangerous moment” – but the dangers we face have been made greater by ministers’ decisions.
• Chris Ham is the chair of the Coventry and Warwickshire Health and Care Partnership and former chief executive of the King’s Fund