Over the past two months, the English health and care system has struggled to develop an effective testing regime as part of the response to coronavirus. As our new briefing sets out, there is now an urgent need for the Government to provide a clear, updated, testing strategy as we enter the next stage of the pandemic and begin planning to exit lockdown.
Trust leaders believe they have done all they could to support the national testing effort. The NHS has tested as many patients as capacity allowed. It has rapidly grown its testing capacity, and has tested as many staff as possible as soon as it was allowed to do so, significantly reducing staff absence rates. However, testing – along with personal protection equipment – is an area where NHS trust leaders would have liked the system to have started out in a much stronger position.
Trusts currently feel on the receiving end of a series of frequent tactical announcements extending the testing criteria to new groups of people, with no visibility on any long term strategy. They are being expected to accommodate these changes with no advance notice or planning, despite the fact that many of the changes have significant operational impact. Some trusts are frustrated that the needs of acute hospitals may have been excessively prioritised over the needs of ambulance, community and mental health trusts and primary and social care.
Trust leaders believe they have done all they could to support the national testing effort. The NHS has tested as many patients as capacity allowed. It has rapidly grown its testing capacity, and has tested as many staff as possible as soon as it was allowed to do so, significantly reducing staff absence rates.
The current public focus on reaching the arbitrary "100,000 tests by April 30" is a red herring. While the target may have had a galvanising effect, it risks distorting the testing approach in three key ways.
Firstly, it may be preventing the development of a proper, next stage, testing strategy and debate on what should be in that strategy. Secondly, it may be driving "testing for testing’s sake" as opposed to ensuring that each test is done for the right purpose. Finally, the target may also be encouraging an excessive focus on the number of tests completed, rather than focusing on whether those who should be tested can actually get tested when required, which is the most important priority.
Operating a successful testing regime is complex. It demands an effective and well communicated strategy, with clear criteria on who should be tested, for what purpose, when, and how often. We also need clarity on testing capacity, access and reliability so those who need a test can get easy access to one that’s processed quickly and accurately whenever required. And there must be a focus on coordination, ensuring a complex system with a vast number of different organisations and people involved, runs smoothly end-to-end.
The target may also be encouraging an excessive focus on the number of tests completed, rather than focusing on whether those who should be tested can actually get tested when required, which is the most important priority.
Trust leaders and the NHS are dependent on the Government's plans as ministers have overall responsibility for testing strategy, co-ordination, determining who should be tested, and for expanding testing capacity. Having started from a poor position, the English health and care system has struggled with all these different elements at different points over the last two months. It will be for any subsequent public inquiry to determine why these problems have occurred and whether the response was adequate.
The government’s 4 April plan needs to be urgently updated to reflect the stage we have now reached as a nation. The first peak of coronavirus demand has been successfully negotiated. We must now work out how to exit lockdown, carefully manage spread of the virus, avoid a second spike and allow the economy to restart. The newly updated plan should therefore answer the following six questions:
- When will every patient and health and care staff member with suspected COVID-19 symptoms who needs a test be able to consistently access that test within an appropriate turnaround time?
- How will the current problems with access to key worker testing be overcome?
- What are the detailed plans for the expansion of current swab testing, and how will the government prioritise the increased capacity?
- What is the plan to return to tracking and tracing any new outbreak of the virus as part of progressively exiting lockdown?
- Given the need to control the risk of cross infection in healthcare settings, what are the detailed plans to move to systematic regular testing of all NHS and care staff?
- What role does the government now expect antibody testing - to identify people who have had the virus - to play?
Focusing on the push for 100,000 tests a day is a distraction from the key issue of how the government’s testing strategy needs to develop. All six questions outlined above are just as important and relevant on May 1 irrespective of whether 50,000, 75,000 or 100,000 tests are performed on 30 April.
Creating an effective testing regime is a complex challenge, and a vast amount remains to be done. Trust leaders stand ready to play their part in this process, but they need to know a lot more, as quickly as possible, to play their part effectively.