{"id":47839,"date":"2020-06-19T14:25:29","date_gmt":"2020-06-19T13:25:29","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47839"},"modified":"2020-06-23T18:26:25","modified_gmt":"2020-06-23T17:26:25","slug":"test-and-trace-it-didnt-have-to-be-this-way","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/06\/19\/test-and-trace-it-didnt-have-to-be-this-way\/","title":{"rendered":"Test and trace: it didn\u2019t have to be this way"},"content":{"rendered":"

A doctor describes her experience of working in the test and trace service<\/span><\/i><\/p>\n

On the afternoon of 27 May 2020, the UK prime minister Boris Johnson <\/span>told<\/span><\/a> the House of Commons Liaison Committee that it was time \u201cto move on\u201d from the row about whether Dominic Cummings had broken lockdown rules. Hours later, Matt Hancock, the health secretary, announced the launch of England\u2019s Test and Trace service.\u00a0<\/span><\/p>\n

The launch was news to me, as a doctor and contact tracer, and, it would transpire, to many others.<\/span><\/p>\n

I had already been redeployed during a year out from my frontline clinical role of 15 years, to work as a <\/span>clinical contact caseworker <\/span><\/a>as part of the Test and Trace service. As one of three thousand c<\/span>linical contact caseworkers<\/span><\/a>, I was meant to speak by telephone to people who had tested positive for covid-19. I had to conduct a public health risk assessment and identify any potential contacts. At least 18,000 non-clinical call handlers were tasked with following up those contacts. Johnson <\/span>described<\/span><\/a> it as a \u201cworld-beating\u201d system that would manage 10,000 new cases a day.<\/span><\/p>\n

An email landed in my inbox at 9.48pm on the night of Hancock\u2019s announcement: \u201cNHS Test and Trace is going live tomorrow!\u201d Then, a series of further email and text messages: \u201cyou are performing a crucial role in the fight against Coronavirus\u201d and \u201cgo live is at 8am!\u201d<\/span><\/p>\n

It was a swift turnaround from an NHS Professionals message two days before: \u201cPlease remain patient during the sessions as this is very much a test environment.\u201d Many of us had not yet completed training and <\/span>technical issues<\/span><\/a> put paid to promised mock calls.<\/span><\/p>\n

Not that the training would have mattered anyway. The Contact Tracing and Advisory Service (CTAS) website was inaccessible to me on launch day and tracers were notified of <\/span>a \u201ccritical incident.\u201d<\/span><\/a> The Department of Health denied the system had crashed, but acknowledged that there had been some technical difficulties, claiming issues were \u201crapidly being resolved\u201d.<\/span><\/p>\n

During my shifts later that week, there were no cases to trace, an experience echoed by others who <\/span>spoke<\/span><\/a> to other mainstream media and newspapers, labelling the system \u201cchaotic\u201d and \u201ca complete shambles.\u201d \u201cI\u2019m yet to know anybody who has made a call to a member of the public,\u201d <\/span>said<\/span><\/a> one.<\/span><\/p>\n

So, what went wrong? One thing seems clear: too many organisations spoil the broth. NHS Professionals employed us as clinical tracers, but we were recruited by Capita and placed with Public Health England (PHE). Sitel provided access to the tracing applications and systems, and these all required different usernames and passwords. Synergy CRM assigned cases and held scripts, CTAS captured contract tracing information, RingCentral was used for voice calls, and MaxConnect was used for storing knowledge about contacts. All of these systems were accessed through Amazon Workspace. Training was initially through Public Health England’s Learnspace, and then moved to Health Education England’s e-Learning for Health.<\/span><\/p>\n

When systems are disconnected, cracks rapidly appear. Simply resetting a broken password before a shift required calling Sitel (wait time 45 minutes) to log the issue; an Amazon \u201creset password\u201d email followed 24 hours later. At times, established systems shone through. Sign-up to NHS Professionals was smooth: its platform simplified booking shifts and accessing payslips. But calls about basic training required holding for 45 minutes\u2014subsequently this helpline number was withdrawn entirely. Email queries went unanswered. The organisation seemed to have been caught off guard by Hancock\u2019s announcement.\u00a0\u00a0<\/span><\/p>\n

Last weekend, there appeared to me, at least, a tacit admission the system is not yet fit for purpose for clinical caseworkers.\u00a0 I received notification that all my future shifts were cancelled. Available caseworker shifts over the next two months seem to have disappeared. Previously there were up to 50 per day. Could this truly relate to a surge in caseworkers suddenly booking thousands of shifts overnight? NHS Professionals told me via livechat that demand has been met and that I should keep checking the website for updates. Internal reports suggest full functionality might only emerge in <\/span>September or October<\/span><\/a>.\u00a0<\/span><\/p>\n

Official figures<\/span><\/a> just released suggest Test and Trace was unable to trace one third of those who tested positive (and thus their contacts, too) between 28 May and 3 June. However, Independent Sage labelled Matt Hancock\u2019s claim that 85% of contacts had been traced as \u201c<\/span>deeply misleading\u201d<\/span><\/a> since Test and Trace entirely missed 75% of all new symptomatic cases during this time.\u00a0<\/span><\/p>\n

Three thoughts come to mind as I reflect on recent weeks:<\/span><\/p>\n

Firstly, there is a pressing need to prioritise a well-funded tracing system before another pandemic, with improved testing capacity, supported by local authorities who have felt largely <\/span>neglected<\/span><\/a> this time around. In early March, PHE had just 290 contact tracers with, according to SAGE, capacity \u201c<\/span>to cope with five new cases a week<\/span><\/a>.\u201d To give a sense of the challenge ahead, <\/span>over 300,000 people<\/span><\/a> have tested positive for SARS-CoV-2 in the UK. Widespread community tracing stopped on 12 March.\u00a0<\/span><\/p>\n

Secondly, any forthcoming inquiry should probe the muddled formation of Test and Trace and interrogate the vested interests involved. Patients suffer when dissimilar companies with disparate interests are hastily assembled. Ministers used special powers to <\/span>bypass<\/span><\/a> established tendering processes, handing contracts to private companies without open competition. In a <\/span>leaked email<\/span><\/a>, Serco\u2019s chief executive Rupert Soames doubted the scheme would evolve smoothly but wanted to \u201ccement the position of the private sector in the public sector supply chain.\u201d As a tracer, am I\u2014an NHS worker\u2014complicit in privatisation by stealth?\u00a0<\/span><\/p>\n

Finally, this is a call for candidness and sincerity about the failings of the UK government\u2019s public health response. The UK Statistics Authority <\/span>told<\/span><\/a> Matt Hancock that data on testing is \u201cfar from complete and comprehensible,\u201d tests have been <\/span>double counted<\/span><\/a>, and high profile figures have broken the rules, or at least played fast and loose <\/span>with<\/span><\/a> them.<\/span><\/p>\n

As the tracing system expands, I am hopeful some logistical issues can be rectified, but issues of lost trust and compromised transparency might be much more difficult to repair.\u00a0<\/span><\/p>\n

The author has asked to remain anonymous<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

A doctor describes her experience of working in the test and trace service On the afternoon of 27 May 2020, the UK prime minister Boris Johnson told the House of […]<\/p>\n

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