COVID-19 testing and tracing in the UK has had a difficult birth. The whole NHS Test and Trace service has been built from scratch at a very rapid pace. So, we should have some sympathy and understanding for those who have had to create a brand new public service, covering 66 million people across nearly 100,000 square miles, in less than four months. It was always going to be difficult. We should also acknowledge that, from a standing start, we are now testing more people per head than France, Spain and Germany.
However, we share the view of many other commentators that the UK was slow to initiate its testing strategy and build the requisite capacity. That government seemed, initially, to prioritise chasing a single overall capacity target, at the expense of paying enough attention to creating the right strategy and infrastructure including appropriate local control. That the focus on an arbitrary capacity target for a particular day crowded out other, equally important, issues such as ensuring appropriate access to, and turnaround times, for tests. Ensuring every trust had sufficient local access to tests, and being clear about the priority order for testing. NHS Test and Trace has faced, and still faces, a difficult and operationally complex set of tasks. There has been real progress since late May, but there is still a long way to go.
Winter looms as a critical challenge, especially as the risk of increased transmission is now high following the initial easing of national lockdown restrictions. It seems likely that transmission rates will continue to rise in colder weather and as we have to spend more time indoors. Testing will therefore become even more important, as a key means of distinguishing between COVID-19 and flu or colds whose symptoms can be very close, even to the trained eye. The NHS and social care system always come under huge pressure in winter, and we also know that health and care settings can be a key point of transmission for the virus. It is particularly important, therefore, to ensure good infection prevention and control, and rapid, effective testing is central to that task.
So, what must be done to ensure the test and trace programme is fit for purpose ahead of the challenges that winter will bring? Below, we outline our view of the task ahead in the form of 12 winter tests that NHS Test and Trace needs to pass. We’ve been ambitious for testing and tracing because we need to be, and we think clear measures of success are important, so we've included success measures for each test.