The easing of the lockdown and a safe return to school for hundreds of children and their teachers is dependent on an effective test, track and trace programme. Over the past few weeks deadlines for the system have slipped from mid-May to 1 June, then suddenly Matt Hancock announces its launch at 9am today (28 May) and exhorted every person to do their “civil duty” and stay at home when instructed.

Questions have been raised about the suddenness of the launch and the reasons for pulling it forward, but Matt Hancock in an interview with Kay Burley on Sky News, denied that the government has rushed in the system to take the spotlight off Dominic Cummings and his failure to follow lockdown rules.

The track and trace system involves 25,000 contact tracers phoning people who test positive for the virus and being asked for the names and phone numbers of family, friends and colleagues whom they have been within 2 metres of for more than 15 minutes within the previous two days. The tracer will then phone these people and tell them to self-isolate for 14 days and remove children from school.

Whether an effective track and trace system is actually ready for launch is in question, however.  For a start the system will be without the app, which is currently still on trial in the Isle of Wight. Boris Johnson at Prime Minister’s questions 20 May said “a test, track and trace operation that will be world-beating….will be in place by 1 June. But just a few hours later, Downing Street confirmed that the NHS smartphone app, an integral part of the track and tracing operation, would not be ready for 1 June.

Adding to the doubt, Justice Secretary Robert Buckland admitted the test and trace system would not be “as widespread as we’d like” by June.

Privateers recruited

Without the app, the system launched by Matt Hancock relies on more traditional contact tracing; thousands of people physically picking up a phone and tracking down the contacts of those who have reported Covid-19 symptoms and/or have tested positive. This is a labour intensive business requiring thousands of people, however reports over the past couple of weeks throw into doubt whether the contact tracing programme is ready to be launched.

Earlier this year under emergency procurement rules, Serco was awarded contracts to recruit the vast majority of 25,000 contact tracers, with Capita also responsible for a few thousand. After some confusion about how many contact tracers had been recruited, it seems that at least 21,000 have now been recruited.

Contact tracing is a skill and training is required. The recruits are expected to show empathy and demonstrate “communication skills”, but will only receive one day’s worth of remote training, involving classroom-style teaching. However, even this small amount of training is reportedly proving difficult to achieve. The Guardian reports that people are spending days trying to just log in for virtual training sessions. One person told the Guardian that when they were on a training session, run by contact centre company Sitel, they asked for guidance on how to speak with somebody whose loved one had died of coronavirus, they were reportedly told to look at YouTube videos on the topic.

New contact tracers will work on a call centre model and have been told to rely on a two-page script and a list of frequently asked questions, reports the Guardian. The contact tracers are expected to refer specialist queries to a separate team of 3,000 medics or senior nurses.

Both Serco and Capita have a difficult history of working in the UK public sector – Serco was fined by over £19 million last year by the Serious Fraud Office for its part in defrauding the government over electronic tagging and Capita’s running of the NHS Primary Care Support Services contract has been the source of numerous complaints and the company has now had part of the contract, for cervical cancer screening, removed. Serco has already had to apologise for accidentally sharing the email addresses of 300 contact tracer recruits – an error that could be referred to the Information Commissioner for investigation.

This form of contact tracing will be bolstered by the app, when this is ready. The app being developed by NHSX, the Department of Health and Social Care’s technology department, is currently being piloted on the Isle of Wight. It uses Bluetooth technology to detect and alert people who might have come into contact with those infected with the virus and requires at least 60% of the population to report their health status to be effective.

App hazard

The app has received considerable criticism. At the start of May, just prior to its launch, HSJ reported that the app had failed all of the tests required for inclusion in the NHS app library, including cyber security, performance and clinical safety. Despite this it was rolled-out 7 May on the Isle of Wight.

The app uses Bluetooth technology to register a “contact” when people come within 2 m of each other for at least 15 minutes. If someone develops symptoms of coronavirus they inform the app and an alert will be sent to other people they have been in close contact with.

Soon after its launch, glitches were being reported, including that it doesn’t work on older phones and NHSX said that it was working to iron out problems,.

Concerns are also being raised around the app’s privacy and information governance. The government has insisted on deploying a centralised tracing database, which records a user’s contacts and the first half of their postcode if they declare they are ill.

This is at odds with the approach taken by Apple and Google, who say contact data should be retained only by a person on their phone. A major issue is that unlike contact-tracing apps under development elsewhere in Europe, the UK version does not incorporate new Google and Apple technology to improve the Bluetooth function.

Scammers have already targeted the app. The Chartered Trading Standards Institute (CTSI) reports that it had received evidence of a phishing scam themed around the app. A further embarrassment came when the tech publication Wired reported that a considerable number of documents on the app’s development had been left open to the public via a google drive link.

Criticism
The government’s approach to track and trace has been criticised by some senior directors of public health, according to a report in the Local Government Chronicle. They report being kept in the dark and fear it will be a “shambles”  on the same scale as personal protective equipment (PPE) and Covid-19 testing. They also note that they have not been involved in co-designing the track and trace programme despite what the Whitehall press briefings might say.

On Twitter, Kate Ardern, Wigan MBC’s director of public health, tweeted: “You cannot expect people with no appropriate background knowledge, skills or experience to do this vital job with little training or expert supervision… contact tracing is a skilled job!”

Contact tracing is not a new thing; it is regularly carried out by highly trained personnel in public health departments, which puts these departments in an ideal position to help Serco and the other private companies, you’d have thought. However, one public health director told LGC that not a single document about the work of Serco had been shared with them during national calls and they were under the impression that government officials “do not yet know themselves” how Serco’s work would be joined up with that of local government. More positively though, the government has shown more willingness to get local government involved with the appointment of Tom Riordan, Chief Executive of Leeds City Council as national lead on tracing.

Opposition proposals
The Labour Party has put forward its own ten proposals for an effective “test, track and protect system” in a letter from Jonathan Ashworth to Health Secretary Matt Hancock. The proposals for track and trace include allowing local government directors of public health to lead on contact tracing, the recruitment of more contact tracers; clear public communication; and work with tech companies to show greater flexibility developing an app.

The government row with unions and teachers over whether it was safe to restart classes continues. The BMA, the largest doctors’ union, backed the teaching unions. in a letter to the National Education Union on 15 May that the number of coronavirus infections remained too high to allow them to run safely. It said teaching unions had been “absolutely right” to urge caution and prioritise testing before reopening schools on 1 June.

Finally at the press briefing 20 May, Robert Buckland, the justice secretary, conceded that not all schools would be able to open on 1 June. At least 11 councils are refusing to reopen their schools.

Ultimately the success of the test and trace system rests with how high compliance is and this is bound up with how much people trust the system and the government.  Commentators think that such compliance is now unachievable following the revelations that Boris Johnson’s adviser Dominic Cummings has broken lockdown rules.

Shadow Health Secretary Jonathan Ashworth told Good Morning Britain “lots of people who are asked to stay home for two weeks with no symptoms will think why is it one rule for us and one rule for Dominic Cummings?” He believes that the government’s defence of Cummings could affect the test and trace programme.

 

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