Doubling the target to 200,000 tests per day is not enough to beat coronavirus

The former target of 100,000 tests per day by the end of April certainly had a galvanising effect on building testing capacity. But now is the time to move to a more sophisticated view

On 30 April, depending on how you count it, there were over 122,000 Covid-19 tests delivered in the UK, meeting the government’s target of delivering 100,000 tests a day by this point.

The target certainly had a galvanising effect on building testing capacity. But now is the time to move to a more sophisticated view.

Sole focus on daily testing numbers obscures the fact that some NHS trusts still can’t get regular and consistent access to tests for all their patients and staff showing Covid-19 symptoms within the turnaround times they need. As the government’s own testing plan acknowledged, these groups should be our top testing priority. But in too many places, due to testing facilities being too far away and capacity constraints in individual laboratories, thousands of people who need testing each day simply aren’t being tested and results are taking too long to return.

We have also seen problems matching swabs, chemicals and testing kits with the test processing equipment. If they are not the same brand they won’t work together, resulting in further disruption.

And 100,000 tests on 30 April is just an arbitrary target for a politically-driven deadline. In the days since, the number of tests delivered, using the government’s own preferred means of measurement, has dropped significantly. This week, for example, NHS and public health laboratories are trying to solve a giant Rubik’s Cube puzzle as they move tests between labs, because one of the major testing equipment manufacturers is reducing its supplies to the UK to step up international supply elsewhere.

These are the real issues that matter most to NHS trust leaders. They know that if these issues can’t be solved, patient and staff lives are at risk. Hopefully, now we have passed the 30 April deadline, there can be greater focus on this key issue of ensuring that every single person who needs a test can get one.

But we need to look to the future too. The UK has reached an important point. We have successfully passed the first peak of coronavirus demand and are now about to enter the next, arguably more challenging, phase of easing and exiting lockdown. We need to restart the economy but ensure we protect the NHS and vulnerable people, and so avoid a second peak. As the government itself acknowledges, effective testing, tracking and tracing is vital in this phase.

We must be able to rapidly identify any outbreak and immediately isolate anyone who has contracted the virus and those they have been in contact with. There will need to be comprehensive geographical coverage and sufficient volume of testing, tracking and tracing resource to move at high speed.

Whilst early top line plans have begun to emerge – an initial pilot on the Isle of Wight, for example – there is no real detail, as yet, on how this will actually work and how the NHS will be involved. For example, what role will 111, GPs and pharmacies – the first NHS point of contact for most patients – play? This information is needed now if the NHS is to prepare properly.

The other emerging evidence is that Covid-19 can be particularly concentrated in health and care settings. As the number of care home deaths shows, there is a potentially deadly combination here – staff and patients who may be unaware they have the virus, as we can all be infectious for a few days without showing symptoms, and significant concentrations of those most vulnerable to Covid-19.

We must move, as quickly as possible, to regularly and frequently testing everyone in these settings – staff and patients and residents alike – irrespective of whether they are showing symptoms. This is important, for example, to ensure that we bring the number of care homes deaths under control and can safely restart ordinary hospital activity.

Regularly testing all health and care staff requires a more localised testing infrastructure than the large drive-through testing centres, supplemented by mobile units, that were built in the run up to 30 April. It also requires careful planning – testing at least a million health and care staff every week is a huge operational and logistical undertaking that we need to start preparing for now.

Underpinning this next phase of testing activity are some important questions. Up to now, our testing regime has been tightly controlled from the national level in pursuit of the target of 100,000 tests by 30 April. But providing regular, easy access to tests for all health and care staff and patients will require locally-led decisions. This approach has worked very successfully in other countries.

And we also need to know how much testing capacity we will need in this next phase, and how this will be built. For example, testing a million NHS and care staff once a week, by itself, requires at least 142,500 tests a day.

We also need to be clear that every organisation involved in testing has an important role to play and an important responsibility. The NHS, along with all other parts of the testing infrastructure, must be continually identifying the barriers and solutions to all the testing challenges that arise and, of course, the potential solutions. It’s their job to share their insights loud and clear. It’s the government’s job to take them on board and adapt their approach accordingly. So, we need to move from tactical, top down, command and control, to a strategic, collective, effort.

These, and other, questions need proper debate and discussion with health and care professionals and the wider public, to arrive at a robust and effective testing strategy. The government’s 4 April testing plan started to build such a strategy but it now desperately needs updating. Tactical responses are understandable in the first phase of a crisis response but we now need a clear path forwards for how our testing regime will develop.

Chris Hopson is CEO of NHS Providers, the membership organisation for England’s 217 acute hospital, ambulance, community and mental health NHS trusts