With just days to go before the 1 April deadline marking the end of free covid testing for many, a last-minute update from the Department of Health & Social Care (DHSC) has failed to fully clarify how this move will affect the majority of staff working within the NHS.

The DHSC update, released barely two days before the deadline is due to expire, contains just two specific, limited concessions for NHS staff:

free symptomatic testing will continue to be provided for people working in some high-risk settings, such as for NHS workers

– free asymptomatic lateral-flow testing will still be available to those working in some high-risk settings – such as patient-facing staff in the NHS and NHS-commissioned independent healthcare providers – but only where infection can spread rapidly while prevalence is high

No attempt is made in the press release accompanying the update to define what constitutes a high-risk setting, or to list what roles within those settings may or may not still be eligible for free testing. It’s worth noting too that staff employed by NHS-commissioned independent healthcare providers – ie private companies – may receive free covid tests at the taxpayer’s expense. 

And tellingly, missing from the small list of groups who can still access free testing after 1 April are those staff members not working in high-risk clinical settings, which suggests that these employees could now have to pay for their own tests.

The press release goes on to claim that the cost of these changes – which ultimately represent a sizeable cost-cutting programme – “will be met within existing funding arrangements”, but that they will also be partly financed by reintroducing charges for NHS staff using hospital car parks, again from 1 April.

These changes had been flagged up by the government since the beginning of the year, albeit in a contradictory fashion. A spokesperson for prime minister Boris Johnson suggested on 22 February that NHS staff would probably remain eligible for free symptomatic testing only, and that a decision on asymptomatic testing would be made by the DHSC and NHS England (NHSE) “in due course”. 

But health secretary Sajid Javid told BBC Breakfast, on the same day, that NHS staff would continue to get free tests regardless.

The first hint of changes on the way came back in January, when Oxford University Hospitals NHS Foundation Trust told its employees that NHS England would no longer directly provide them with free lateral-flow testing kits, and so they would need to order free kits via the central government system. 

And in a parallel development – one which may have a direct impact on the debate about free testing in the health service – the government earlier this month moved to ditch the introduction of mandatory covid jabs for frontline NHS staff. That change, coincidentally, is also due to take effect on 1 April.

With NHSE appearing unlikely, for the moment, to continue picking up the tab for free covid testing across the entire health service, the NHS Confederation (NHSC) has warned that testing of staff at their own expense would cost each worker £50 a month

While certainly generating substantial savings for the health service – the NHS is, with 1.3m staff, the largest employer in Europe, so £50 per head equals £65m a month in reduced outgoings – such a charging regime would inevitably hit the lowest-paid staff hardest.

Nursing in Practice recently quoted NHSC chief executive Matthew Taylor saying, “In the face of a cost-of-living crisis, many staff will simply not be able to afford to regularly buy their tests.” 

That leaves NHS staff in an invidious position due to their continuing obligation to test during the pandemic. As Nursing Notes pointed out last week, “The most recent guidance from NHS England still requires staff to test and report their test results twice a week, but fails to outline how this will be funded [after 1 April].”

And two further cost-cutting moves by the Treasury, announced over the past ten days, can only make the challenge for health service employees more difficult. 

A press release dated 21 March heralded a new government drive, in the form of an ‘efficiency and value for money committee’ chaired by chancellor Rishi Sunak, which will see the NHS’ annual ‘efficiency commitment’ double to 2.2 per cent, in the process “freeing up” £4.75bn in “savings”.

A few days later came the news that the government had asked NHS England to ‘reduce core funding’ – ie make cuts – to the value of £500m as part of its ‘living with covid’ campaign. The move led NHSC chief exec Matthew Taylor to suggest the reduction would inevitably mean cuts to frontline services.

Further clarification on who pays for testing staff across the NHS – ie staff working in all settings, not just high-risk ones – may well emerge in additional guidance which, according to the DHSC press release, is due to appear on 1 April. However, as the House of Commons rises on 31 March for the Easter recess and doesn’t return until 19 April, that guidance is set to avoid parliamentary scrutiny for almost three weeks.

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