Forty-Seventh Report - COVID-19: Test, track and trace (part 1)

The introduction of rapid-results testing was supposed to be a ‘gamechanger’ but confusion persists over why and how it should be used in different community settings. Around one-third of people who have coronavirus are asymptomatic. There is now a widespread … Read more The introduction of rapid-results testing was supposed to be a ‘gamechanger’ but confusion persists over why and how it should be used in different community settings. Around one-third of people who have coronavirus are asymptomatic. There is now a widespread roll-out of rapid tests (primarily lateral flow device (LFD) tests, which give results in 30 minutes) for local authority use and in other community settings, such as schools and workplaces. To support this roll-out, the government allocated a further £7 billion to NHST&T in December 2020 on top of £3 billion already budgeted. The Department had already purchased 384 million LFD test kits. However, a number of reports have raised concerns about the effectiveness and risks of mass testing using LFD tests, given their lower accuracy compared to laboratory- processed tests, particularly the higher risk of ‘false negatives’ (people who actually have the virus getting a negative result). NHS T&T told the committee that a negative test result means that an individual is around 77% likely to be negative for Covid-19. Initial NHST&T and PHE guidance for schools suggested that they could use LFD tests for daily tests as an alternative to self-isolation, but this advice has now been withdrawn. On 21 January, PHE announced that it would pause or scale back the roll-out of mass testing in schools, with further evaluation needed because COVID-19: Test, track and trace (part 1) 7 of the emergence of the new, more transmissible variant of the virus. Following the Prime Minister’s announcement on 22 February, schools will test students and staff regularly using LFD tests, but guidance on rapid testing in schools is yet to be updated. Recommendation: The Department and NHST&T should set out clearly how and why mass rapid testing should be used in each of the settings where roll-out is planned, alongside clear targets and updates on progress in the various sectors. Any plans should take account of the approved purpose and accura Show less

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NHST&T claims to be a learning organisation, but since last May many important stakeholders have at times felt ignored by it. NHST&T emphasises to us that it is “constantly learning what works and what does not” and that it is … Read more NHST&T claims to be a learning organisation, but since last May many important stakeholders have at times felt ignored by it. NHST&T emphasises to us that it is “constantly learning what works and what does not” and that it is critical to develop “an integrated team of all the different organisations, institutions and individuals in the country”. However, a range of stakeholders have queried why local authorities and NHS primary care bodies were not more directly involved in testing and tracing activities at the outset, given their existing networks, experience and expertise. Local authorities have subsequently become much more involved, for example undertaking contact tracing for people who are hard to reach. We are also concerned by a lack of engagement with school heads and education stakeholders in the roll-out of rapid testing, and the lack of general public health expertise at senior levels of NHST&T. NHST&T will need to focus more on engagement and collaboration with other sectors if the rapid testing expands to cover an increasing range of settings. Recommendation: NHST&T should review how it engages with and draws expertise from the wider public health establishment and other sectors that are especially dependent on its work. This should include, but is not limited to, local government, the schools sector and the hospitality industry. Show less

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NHST&T still struggles to consistently match supply and demand for its test and trace services, resulting in either sub-standard performance or surplus capacity. We accept the need to build surplus capacity into test and trace services to handle unexpected, sometimes exponential, surges in infections. However, the percentage of total laboratory …

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Although it had to act quickly to scale up the service, NHST&T is still overly reliant on expensive contractors and temporary staff. To scale up the test and trace service rapidly, the Department and NHST&T worked with a wide range of public and private sector partners, including consultants. By the …

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As we hope for longer-term and sustained reductions in infection levels, the Department needs to think about the future shape of national test and trace services, and how it will secure lasting benefits from its spending. NHST&T will be part of the newly formed National Institute for Health Protection (NIHP). …

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On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department), including the NHS Test and Trace Service (NHST&T).1

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NHST&T’s effectiveness also relies on people complying with its processes, from coming forward to take a test when they have symptoms, to self-isolating in line with requirements. NHST&T noted that the single most important part of the process was people coming forward for testing.18 The National Audit Office also highlighted …

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In September 2020, SAGE concluded that “test and trace was having only a marginal impact on transmission”. NHST&T said that the situation had improved, and highlighted that it was now meeting all its operational performance targets for contact tracing.21 22 It also quoted findings from an “independent verified analysis” which …

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We found that NHST&T was still struggling to consistently match supply and demand for its test and trace services. In September 2020, NHST&T significantly underestimated the increase in demand for testing, when schools and universities returned.26 Laboratories processing community swab tests were unable to keep up with demand, leading to …

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The Department and NHST&T emphasised to us the importance of maintaining excess capacity in the test and trace system, due to the difficulty of predicting the pace and direction of COVID-19.29 While we accept the need to build in surplus capacity to handle surges in infections, we remain concerned that …

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For tracing, the Department accepted that, with hindsight, it did not need to scale up central tracing services for May 2020 as quickly as it did. It highlighted the very uncertain environment in April and May and the limited basis it had for estimating the numbers of people it would …

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NHST&T relies on contractors for many of its supplies, services and infrastructure. The Department stated that, to scale up NHST&T so rapidly, it had used a “blended mix” of civil servants, military support, contractors and consultancy support.40 By the end of October 2020, NHST&T had signed 407 contracts worth £7 …

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The response to a parliamentary question confirmed that, at the beginning of November 2020, there were 2,300 consultants and contractors working for 73 different suppliers in NHST&T, with a total consultancy cost of approximately £375 million up to that point.43 However, when giving evidence to the Science and Technology Committee …

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We challenged the Department and NHST&T on the value for money and their scrutiny of these consultancy contracts and associated spend. On day rates, the Department felt it had mitigations in place, including specifying within contracts that services are to be obtained from staff at an appropriate grade, rather than …

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In December 2020, the Department announced that it would roll out mass Lateral Flow Device (LFD) testing for schools and colleges in the New Year, building on its earlier use at universities.51 LFD tests give results within 20–30 minutes, compared with the standard PCR swab tests, which must be sent …

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A number of significant commentators, including the British Medical Association and British Medical Journal, have raised concerns about the effectiveness and risks of mass testing with LFD tests.55 A particular issue raised is the relative accuracy of LFD tests compared to PCR tests and the higher risk of false negatives.56 …

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We are aware that the Medicines and Healthcare products Regulatory Agency (MHRA), the government’s regulatory body which approves medical devices, approved 51 https://www.gov.uk/government/news/staggered-rollout-of-coronavirus-testing-for-secondary-schools- and-colleges; https://www.gov.uk/government/publications/coronavirus-covid-19-asymptomatic-testing-in- schools-and-colleges/coronavirus-covid-19-asymptomatic-testing-in-schools-and-colleges; https://www.gov.uk/ government/news/all-students-offered-testing-on-return-to-university 52 Qq 13, 16–17, 118 53 C&AG’s Report paras 1.28–1.29 54 Q 117 55 For example:https://www.bma.org.uk/news-and-opinion/the-implications-of-rapid-testing-for-nhs-workers; https://www.bmj.com/content/371/bmj.m4436 56 See, for example, https://www.bmj.com/content/371/bmj.m4916 …

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NHST&T told us the biggest lesson it had learnt from the last year was that “you can only deliver this sort of service as an integrated team of all the different organisations, institutions and individuals in the country”. It said it had learned a lot about “how to build this …

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The Department acknowledged that it took the decision to build up tracing capacity centrally at the beginning because of the need to do this quickly, but it maintained that there had been “a series of conversations” with local authorities and directors of public health. NHST&T stressed that it had always …

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While we welcome NHST&T’s increasing collaboration with local authorities, we see a need for it to expand its collaboration with a range of other sectors, reflecting the wider scope of the roll-out of rapid testing. In our local constituencies, we heard of lack of engagement with school heads in the …

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On 18 August, government announced that a new body, the National Institute for Health Protection (NIHP), would subsume NHST&T, the health protection functions of PHE and the Joint Biosecurity Centre. The executive chair of NHST&T is also acting as interim executive chair for NIHP. The establishment of NIHP is due …

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The 2020 Spending Review allocated £15 billion to NHST&T for 2021–22, to be kept under review as the vaccine programme rolled out.77 The government is now accelerating the roll-out of vaccines across the country, but we are yet to see a future strategy for test and trace in response. NHST&T …

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Both the Department and NHST&T signalled the opportunity to generate a long- term legacy from the vast public investment in, and expansion of, diagnostic capacity.80 However, they have not yet articulated how this is going to happen: NHST&T told us it was still working through how laboratory infrastructure should “evolve …

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