On 16 March, in response to the coronavirus outbreak, the prime minister announced the UK government’s advice for all people to avoid “all unnecessary social contact”. As the potential scale of the pandemic started to become clear – with national lockdown officially announced one week later – it became apparent that the UK was not fully prepared for the programme of mass testing required to identify prevalence and effectively control the spread of the virus.
In the early weeks of the pandemic, testing capacity for NHS services was strictly limited. Having flagged at an early stage the need to test significant numbers of staff for COVID-19 to limit the proportion of the workforce needing to self-isolate, trusts were formally instructed by national bodies to use all capacity for patient testing. This requirement was phased out in late March/early April, at which point the first signs of a national strategy emerged via an intervention from the health and social care secretary. He announced a five-pillar plan, led by Professor John Newton, “bringing together government, industry, academia, the NHS and many others, to dramatically increase the number of tests being carried out each day.” An ambitious target of 100,000 tests per day was promised by the start of May and ultimately said to have been reached, although the accuracy of this figure was not universally recognised (Full Fact, May 2020).
At the time of writing – four months since the 100,000 tests announcement – the number of tests completed or sent to individuals each day has far surpassed this mark, with over 260,000 made available on 11 August.
These figures, however, do not tell the full story. The five-pillar plan (Department of Health and Social Care, April 2020) released on 4 April did provide a relative sense of improved order and direction to the national testing programme. Efforts to increase capacity over a short period of time were welcome, particularly as trusts had been reporting ongoing shortages of swabs, plastic testing kits and chemical reagents needed to complete the tests at this stage. These shortages were exacerbated by the fact that there were a number of different testing equipment manufacturers, with consumable swabs, reagents and plastic kits often tied to a particular testing platform (NHS Providers, April 2020). Equally, and certainly prior to early April, efforts to bring together a coherent national strategy for testing were also hampered by a confusing split in responsibility between government departments and their national arms-length bodies. Simply put, responsibility and accountability for testing was diffuse and unclear.
Despite the gradual increase in overall numbers of tests available since April, the more detailed arrangements needed to address a series of priorities which have been slow in coming together, such as:
- mass testing of symptomatic and asymptomatic staff
- testing key workers outside the NHS
- testing asymptomatic patients to enable on-site infection control and non-COVID care
- population-based measures (test and trace, antibody testing)
In particular, trusts have indicated that their aspirations to resume a pre-pandemic level of service delivery had been made difficult in the intervening weeks due to the lack of a clear, national plan for regular testing of patients and staff. Likewise, the slow emergence of the national test and trace programme hampered efforts to better understand and control community transmission from the centre. Despite calls for a national contact tracing system from senior parliamentarians including Jeremy Hunt and Jonathan Ashworth in March (Hansard, March 2020), the government’s test and trace service was not officially launched until 27 May under Baroness Dido Harding until (Department of Health and Social Care). Trusts have also noted that their ability to provide more tests at a faster rate has been largely dependent on their access to a testing laboratory within their own trust – a fact which leaves the ‘have nots’ in this area facing inevitable delays, with a knock on effect on the range of services that can be provided to their communities.
This briefing explores these issues in detail by analysing trusts’ responses to our testing survey. It presents views on:
- the government’s overall testing strategy during the pandemic as well as its current approach,
- the extent to which providers are able to deliver testing under current national guidance
- opportunities to deliver, and barriers preventing the level of testing to resume non-COVID services
- assessments of population-based testing priorities, including the test and trace programme.
This briefing also presents trusts’ perspectives on their role in the evolving national testing strategy, with a suggestion that the public would benefit from a greater level of coordination and local involvement from trusts.
About the survey
NHS Providers conducted a survey of chief executives and chief operating officers in all trusts between 25 June and 15 July 2020, to gather feedback on trusts' experience of the current COVID-19 testing regime, as well their views on the role testing will play in resuming services in the coming months.
The survey included questions on the following:
- current testing arrangements for COVID-19
- trust testing capacity to resume services
- wider population testing and tracing
- the role of trusts and other organisations in testing in the future
- reflections on the government’s approach to testing.
The survey received 122 responses from 112 trusts, or 52% of the provider sector, with all regions and trust types represented in the data.