NHS trusts go full pelt for staff testing… but constraints remain

01 April 2020

NHS trusts across the country are rapidly ramping up their testing of staff now that they’ve finally been given permission to do so, but they continue to operate within significant constraints on swabs, reagents and the test kits that are required to test at scale.

Trusts report unprecedented levels of staff absence and also anecdotal evidence that some staff in 14-day isolation, because of a household member with COVID-19 symptoms, could return to work if they had been tested (see case study below).

For the last 10 days trust leaders have been calling on the government and national NHS leaders for permission to start testing staff. Having been given the go-ahead on Friday evening, trusts report that they have been doing everything they can to move forward with this. But they also say that capacity and access to the materials needed for testing remain an issue.

Feedback from our member trusts gathered today confirmed constraints as:

a shortage of swabs – one large district general hospital in the midlands is currently only able to test 3 members of staff a day due to a shortage of swabs
a shortage of reagent and testing kit – another west midlands trust says that it could perform up to 300 tests a day but reagent / testing kit availability has meant they can only test 20 a day
approval for new testing capacity – a third west midlands trust, in a coronavirus hotspot, has created its own new testing capacity but needs to wait for formal approval, which is being expedited, before it can start using that capacity
15% limit (now lifted) - one north western trust reported that because it uses a central laboratory and only 15% of that laboratory’s capacity has been allocated to staff testing it has only been able to test 3 staff a day. Now that the 15% capacity limit on staff testing has been lifted, the trust is waiting to hear how many staff it can now test.

However, other trusts have been able to rapidly move forward with staff testing and the member feedback gathered today confirmed that:

Northampton General Hospital NHS Trust (NGH) is part of a national pilot scheme and set up a staff testing station over the weekend. (See case study attached). Testing started on Monday for staff working in priority areas and more than 1,000 members of staff have been tested in three days. 184 test results have been received and so far 27 were positive, allowing 157 staff in critical roles to return to work and relieve pressure on their teams
one trust near London reported that it has tested 200 staff tested by opening up a drive through test facility at a nearby theme park
another trust in the South East reported that it set up a ‘drive through’ testing facility on Sunday and is now offering staff testing across five acute hospital sites and community services
trusts in Kent are looking to upscale their current 100 staff tests a day to a target of 1500 by bringing a new lab on line in Dartford, upscaling at East Kent and Maidstone and Tunbridge Wells and bringing in new technology. The work is being supported from University of Kent schools of pharmacy and bioscience in providing both staff and analysers.

Dr Sonia Swart, chief executive of Northampton General Hospital NHS Trust, said:

"We are proud to be able to pilot this staff testing in Northampton. We are very grateful for the dedication and adaptability of our staff to enable us to set this testing up in just four days. Offering this testing means that we can give our staff the reassurance they need to be able to come back to work and know they are healthy. There is still a lot of learning to do and we are looking forward to seeing how this has supported our staff". (See case study below).

Chris Hopson, chief executive of NHS Providers said:

"Trusts, national NHS leaders, and the government are doing everything they can to increase staff testing capacity and use every single testing slot available now that permission has been given to move to staff testing.

"There are many great examples, once again, of NHS staff mobilising to expand NHS capacity at the drop of a hat.

"Early results from a very small sample suggest that there is a significant potential prize here in terms of the number of staff who could return to work.

"But it is striking how many trusts are also reporting significant constraints due to swab and reagent shortages. Trust leaders will do the very best they can with the resources they have available. But these shortages, which trusts do not control, need to be overcome if we are to see the growth in testing capacity we are all looking for.

"Trusts will particularly welcome today’s announcement that they are free to determine the balance between staff and patient testing, and we expect that will lead to a significant increase in staff testing.

“We note the debate about the current shortages of reagents, and whether more should have been done earlier. The trust leaders we represent would like to participate in that debate, but don’t have the time to do so now, which is why they think this debate is for later, not now."

Case study

Northampton General Hospital NHS Trust’s new staff testing station

As part of a national pilot scheme, Northampton General Hospital NHS Trust (NGH) set up a staff testing station over the weekend.

On Monday, they started testing staff who worked in priority areas and were self-isolating to help them return to work as quickly as possible. As per the national guidance, NGH identified the priority groups as staff from critical care, intensive care units, emergency departments and cohorted wards.

NGH also offered the service to family members whose symptoms were causing the trust’s staff to self-isolate, and expanded the offer to staff from healthcare community partners including Kettering General Hospital (the neighbouring hospital), Northamptonshire Healthcare (the mental health and community trust for the county), East Midlands Ambulance Service, St Andrews (a large local voluntary sector mental health provider), the local clinical commissioning groups, and local primary care. Each partner organisation has been allocated testing slots and is prioritising from within their own staff.

Staff from across the trust pulled together to set up a drive-thru process for self-isolating staff from Northampton General Hospital and community partners. They also created an internal service for staff at work which enabled staff to be tested before leaving the site and starting self-isolation. The drive-thru process has been very popular with staff.

The trust has been phoning staff who are self-isolating and inviting them to come in for testing. Facebook has also been a helpful means of communication; the trust provides two daily staff briefings virtually and it providers a forum for staff to ask questions and receive updates on the facility and test numbers. For staff without cars, there is an option to do ‘walk-up’ testing to get their kits, although the trust is trying to minimise the amount of walk-ins to maintain social distancing.

What impact has this testing station in Northampton had?

The NGH staff testing station has tested over 1,000 members of staff in its first three days. The first batch of 184 test results have been received and so far 27 were positive. This means that 157 staff in critical roles have been able to return to work and relieve pressure on their teams. With support from partners, NGH aims to process around 1,000 tests a day.

While NGH was targeting a turnaround time of 24 hours for results, in practice, the logistics of completing the testing and resource used means that it takes more like 48 hours.

The key learning which has emerged at this early stage is the importance of having very clear lanes and entry and exit points to ensure appropriate social distancing.