A new report by NHS Providers shows the size of the task ahead to build a national test and trace service that will be fit for purpose for this coming winter.

Standing up to the test says testing and tracing is an essential part of the national strategy to combat COVID-19. But, despite the good progress shown by NHS Test and Trace since its creation in May, there is a difficult legacy the new service has to overcome.

The report shows that only one in five NHS trust leaders feels the government has had the right approach to testing so far. The reasons given for the lack of confidence in the government’s approach include:

• the need for wider testing and community contact tracing earlier in the pandemic
• a lack of clarity over where responsibilities lie
• persistently slow turnaround times for testing, especially when using third party, non NHS, laboratories
• the failure to set up an effective, at scale, national test and trace service between March and May

The report highlights how current testing constraints could also act as a brake on efforts to restore and extend routine NHS services in the coming months.

However it also shows how trusts are working hard to ensure that the testing laboratories and processes that they control are delivering what the government’s current national COVID-19 testing strategy requires of them.

The report’s findings are informed by a survey of trust leaders carried out over a three-week period from the end of June. More than half of trusts responded, covering all regions of England and including leaders from hospital, mental health, community and ambulance services.

Key findings include:

• 32% said the government’s plans for testing would meet the needs of their trusts and the communities they served over the next three months.
• 18% felt the government had the right approach to testing
• 83% were confident they could meet testing requirements under current guidance
• 56% said they had the capacity to test patients as required when paused services resume
• 70% want a greater role in co-ordinating testing in their local areas.

 
The report includes extensive quotes from trust leaders on their perceptions of the national testing strategy. One said the overall approach had been ‘shambolic’. Another said ‘we just don’t know what the plans are or what is being asked of us’. Concern was also expressed that the government had ‘overestimated the benefits of centralised and national systems’.

However Standing up to the test does highlight improvements in developing testing capacity and the work of trusts in meeting current testing guidance. While the vast majority told us they are meeting current requirements, there are continuing concerns about the variability in turnaround times. These are often based on whether trusts have access to on-site laboratories, with those having to access third party laboratories outside the NHS facing much longer turnaround times, on average. This has created particular difficulties for mental health, learning disability, community and ambulance services, which typically do not have these facilities.

The report also raises important concerns as the NHS looks to restart and extend routine services. Trust leaders have persistently questioned how this can be achieved when they are not able regularly to test all patients and staff.

The survey also highlights trust leaders’ desire for more local involvement and buy-in to the national testing strategy. A strong majority (70%) want a greater role in the management of testing locally, along with more significant involvement for key local partners.

Commenting on the report, the chief executive of NHS Providers, Chris Hopson, said:

“An effective national test and trace service is a key part of the fight against COVID. And making that service work is a collective national responsibility for all of us, just like making lockdown work.

“It’s all too easy to pretend that this is just NHS Test and Trace’s responsibility. It isn’t, though they have a key role to play. People with symptoms need to get a test as fast as they can. Traced contacts need to self isolate as soon as they are asked to. And NHS trusts have a key role to play in building the extra testing capacity that will be required this winter. NHS Test and Trace’s job is to co-ordinate all of this activity, making it as easy as possible for each of us to do what we need to do. But we need to recognise that they have had to start from a very difficult position, due to the failure of government to have the system in place at an earlier stage, when it was sorely needed.

“Trust leaders have achieved a great deal in supporting and delivering their part of the government’s national testing strategy. They’ve massively expanded the testing capacity they control, delivered many more tests for patients and staff and ensured that they have tested all the patients and staff they were required to. They’re now ready to go again, for this next phase.

“But they’ve struggled with the limitations of the government’s approach to testing – the early lack of a clear strategy, the obsession with hitting an artificial 100,000 test capacity target at the end of April and the time taken to realise the importance of local control and co-ordination.

The creation of NHS Test and Trace has generated more confidence but these findings highlight real concerns about the challenges trusts continue to face.

“The creation of NHS Test and Trace has generated more confidence but these findings highlight real concerns about the challenges trusts continue to face.

“We need to see further improvements in the turnaround speeds of test results for symptomatic patients and staff when trusts have to use third party, non NHS, laboratories.

“The government’s overarching strategy needs to be based on more local involvement, with an appropriate role for trusts alongside local government partners.

“There is no time to lose as trusts stand by for a second surge of COVID-19, prepare for added winter pressures, and work towards restoring normal levels of routine services.

“This has been the toughest year in the history of the NHS, but the worst may be yet to come if we can’t all pull together to build the national test and tracing regime we need for winter.”