Chris Ham: Test and trace strategy must value local leadership to be a success

The government has unveiled a covid-19 test and trace strategy for England, but it wasted valuable time in recognising what needed to be done after the lockdown was imposed and has been playing catch up ever since

A crisis on the scale of covid-19 demands a national response. The government’s actions have been evident in decisions to reshape the NHS to deal with the surge in infected patients, establish Nightingale Hospitals, procure personal protective equipment (PPE), and increase testing. They are also seen in the request to the public to wash their hands, socially distance, and stay at home during the lockdown.

A national response may be necessary, but is insufficient because covid-19 is not a national pandemic that plays out uniformly across England. As we now know, it is a series of regional and local outbreaks that occur at different times with different degrees of severity. Health and care staff have been learning about its impact in real time and are often further ahead of the government in knowing what is and is not working. 

Responding effectively to covid-19 therefore requires a blend of national and local leadership. Tragically, the government has been slow to recognise this, no more so than in plans to resume community testing and contact tracing as the lockdown is relaxed. These plans are essential to identify further outbreaks when they occur and to contain their impact.

Ministers have led work on testing and tracing through the Department of Health and Social Care and its executive agency, Public Health England. In so doing, ministers chose to use private sector expertise, including Deloitte in the testing programme and Serco on contact tracing, rather than local authorities. Ministers also chose to develop testing and tracing in parallel programmes when a fully integrated approach of the kind that has worked well in other countries is needed.

The government acknowledged the errors of its ways two weeks ago when it appointed Dido Harding to lead these programmes. She quickly appointed Tom Riordan, chief executive of Leeds City Council, and Sarah-Jane Marsh, chief executive of Birmingham Women and Children’s Hospitals Foundation Trust to work alongside her to integrate testing and tracing. Together, they are seeking to ensure that local expertise is utilised with additional funding of £300 million for councils already announced for contact tracing.

The challenge now is to ensure that every area of England has effective arrangements in place ahead of further relaxations of the lockdown in June. These arrangements must involve people being able to access tests in convenient locations, including their own homes, and for tests to be analysed rapidly. Agreement is needed on sharing test results with GPs and contact tracing staff to enable effective follow up.

Contact tracing must draw on the experience of public health, environmental health, and other staff in local government and the leadership of public health directors. These staff must in turn work closely with Public Health England and the national contact tracing service which involves around 7,000 health professionals and around 18,000 staff hired by companies who have been contracted to deliver this service. The NHS app may also play a part if it can be shown to work in practice.

Supporting people who are tested positive and their contacts to isolate is essential in combating covid-19 in the next phase. Local authorities are best placed to do this building on the support they have provided to vulnerable people who are shielding. Much hinges on the public’s willingness to self-isolate. This task has been made harder by Dominic Cummings’ decision to drive with his family to Durham in the early stages of the pandemic, a decision that risks undermining trust in government and those who advise them.

The prime minister has set out an ambition to establish a “world beating” system of testing and tracing. While everyone involved in the design and implementation of the programme shares this ambition, it is unrealistic to expect it to happen immediately. The government wasted valuable time in recognising what needed to be done after the lockdown was imposed and has been playing catch up ever since.

A more realistic goal would be for every local area to put in place arrangements for testing, tracing, and isolating in the knowledge that a fully-fledged system will follow on from that. Some areas like Greater Manchester which were ahead of the game will lead the way. It will be important to capture and share their learning with other areas. Finding ways of communicating what’s happening on the ground quickly and effectively with ministers and national leaders is also essential.

The wider lesson from the troubled evolution of testing and tracing is that the government must value local leadership in the next stages of the response to covid-19. They must also bring together expertise and insights from different perspectives and avoid siloed thinking. The military learnt this lesson in combating new terrorist threats and coined the phrase “team of teams” to describe the shared leadership needed to avoid fragmented and over centralised crisis responses. 

It’s high time our government followed this example instead of persisting with the futile task of trying to run everything itself. The government must also publish its plans for testing and tracing to enable effective scrutiny of what is being developed. Setting targets like increasing the number of tests to 100,000 a day may galvanise action, but is no substitute for a well-designed and coherent strategy capable of providing the protection the public expect and need.

Chris Ham is non-executive chair of the Coventry and Warwickshire STP and non-executive director of Royal Free Hospitals. He was chief executive of the King’s Fund from 2010 until 2018.

Competing interests: None declared