It's right to recognise that on April 30th, depending on how you count it, there were over 122,000 covid-19 tests delivered in the UK meeting the government's target. The NHS trusts and public health scientists that run testing laboratories are proud of their contribution to this achievement - processing and obtaining results for 39,000 tests across the UK on April 29 and comfortably exceeding the target of 25,000 tests in England by 30 April that they were set.
The target certainly had a galvanising effect on building testing capacity, but now is the time to move to a more sophisticated view. The reality is that testing is a complex patchwork quilt which a single national measure of test capacity, on a single day, ignores.
The target certainly had a galvanising effect on building testing capacity. But now is the time to move to a more sophisticated view.
A focus solely on daily testing numbers obscures the fact that, at the moment, some of the 217 trusts NHS Providers represents still can't get regular, consistent, access to tests for all their patients and staff showing covid-19 symptoms within the turnaround times they need. As the government's own 4 April testing plan acknowledged, these groups should be our top testing priority, but in too many places due to testing facilities being too far away and capacity constraints in individual laboratories, thousands of people who need testing each day simply aren't being tested, and results are taking too long to return.
We also need to recognise that the swabs, chemicals, and testing kits required to complete tests are tied to each brand of test processing machinery, driving shortages in some areas and surpluses in others.
100,000 tests on 30 April is also just a capacity measure for a particular day. In the days since April 30 the number of tests delivered, using the government's own preferred means of measurement, has dropped significantly. This week, for example, NHS and public health laboratories are trying to solve a giant rubik's cube puzzle as they move tests between labs because one of the major testing equipment manufacturers is reducing its supplies to the UK to step up international supply elsewhere.
These are the real, live, testing issues that matter most to the NHS trust leaders we represent. They know that, if they can't be solved, patient and staff lives are at risk.
These are the real, live, testing issues that matter most to the NHS trust leaders we represent. They know that, if they can't be solved, patient and staff lives are at risk. Hopefully, now we have passed the 30 April deadline, there can be greater focus on this key issue of ensuring that every single person who needs a test can actually get one when they need it.
But we need to look to the future too. The UK has reached an important point. We have successfully passed the first peak of coronavirus demand and are now about to enter the next, arguably more challenging, phase of easing and exiting lockdown.
We need to restart the economy but ensure we protect the NHS and vulnerable people, avoiding a second peak. As the government itself acknowledges, effective testing, tracking and tracing is vital in this phase.
We must be able to rapidly identify any outbreak and immediately isolate anyone who has contracted the virus and those they have been in contact with. There will need to be comprehensive geographical coverage and sufficient volume of testing, tracking and tracing resource to move at high speed.
While early top line plans have begun to emerge – For example, an initial pilot on the Isle of Wight - there is no real detail as yet, on how this will actually work and how the NHS will be involved. For example, what role will 111, GPs and pharmacies - the first NHS point of contact for most patients – play? This information is needed now if the NHS is to prepare properly.
The other emerging evidence is that covid-19 can be particularly concentrated in health and care settings. As the number of care home deaths show, there is a potentially deadly combination here - staff and patients who may be unaware they have the virus, as we can all be infectious for a few days without showing symptoms, and significant concentrations of those most vulnerable to COVID-19.
We must move as quickly as possible, to regularly and frequently testing everyone in these settings – staff, patients / residents alike - irrespective of whether they are showing symptoms. This is important to ensuring that we bring the number of care homes deaths under control and can safely restart ordinary hospital activity.
Regularly testing all health and care staff requires a more localised testing infrastructure than the large drive through testing centres, supplemented by mobile units, that was built in the run up to April 30.
Regularly testing all health and care staff requires a more localised testing infrastructure than the large drive through testing centres, supplemented by mobile units, that was built in the run up to April 30. It also requires careful planning – testing at least a million health and care staff every week is a huge operational and logistical undertaking that we need to start preparing for now.
Underpinning this next phase of testing activity are some important questions. Up to now, our testing regime has been tightly controlled from the national level in pursuit of the 100,000 tests on 30 April target. However, given that the focus is now shifting to localised 'lockdown easing' testing and frequent, regular, testing of all health and care staff and patients, there are strong arguments to significantly decentralise control. This approach has worked very successfully in other countries.
We also need to answer the questions on how much testing capacity we will actually need in this next phase, and how this will be built. For example, testing a million NHS and care staff once a week, by itself, requires at least 142,500 tests a day.
Within all this we need to be clear that every organisation involved in testing has an important role to play and an important responsibility. The NHS, along with all other parts of the testing infrastructure, must be continually identifying the barriers and solutions to all the testing challenges that arise, and of course, the potential solutions. It's their job to share their insights loud and clear. It's the government's job to take them on board and adapt their approach accordingly. So, we need to move from tactical, top down, command and control, to a strategic, collective, effort.
These, and other, questions need proper debate and discussion with health and care professionals and the wider public, to arrive at a robust and effective testing strategy. The government's April 4 testing plan started to build such a strategy but it's now out of date and desperately needs updating. Tactical responses are understandable in the first phase of a crisis response but we now need a clear path for how our testing regime will develop going forward.
This was also published in the Independent.