Lockdown will be a letdown if we do not overhaul the test and trace system – it is time for a local approach

Reckoning for the failures can await another day. The imperative is to improve the system, so the current personal sacrifices from both restrictions and the virus itself are not wasted

Dr John Oldham
Tuesday 03 November 2020 13:13

Second lockdown extension inevitable unless failing test-and-trace system fixed, says Starmer

The Test and Trace system has repeatedly failed to deliver and a further lockdown will be a letdown unless that changes.  

Figures for the week ending 14 October show only 15 per cent of people getting results within 24 hours, down by half from the previous week; only 59.6 per cent close contacts of Covid-positive people identified; and of them, only 57.6 per cent reached. This contrasts with 94.8 per cent contacts reached of cases handled by local authority public health teams.  

The failure matters. It is one reason why coronavirus hasn’t been contained from the low numbers in the summer because cases weren’t identified quickly and traced effectively enough by the central system. This ended in tiers. In turn, this failure adds to the dissolving trust in the government and its measures, which contrasts with successful countries where trust is high, such as New Zealand, South Korea and Singapore.  

There are new calls to replace the leadership of Test and Trace just a few months after it was revamped. It is unclear whether this alone would make much difference because of the inherent flaws in the design of the system.  

An effective system design seeks to reduce steps and hand-offs, bring to bear relevant technical expertise, and have seamless data transfer. The Deloitte-created system involves multiple companies: Capita, Serco, Sitel G4S, Levy, Amazon, Randox, Sodexo and Boots, none of whom had ever done anything like this before, had no relevant public health expertise, nor worked together on a project of this size.

The different IT systems operated by these individual companies provided an extra layer of complexity and friction in set up, access by workers, and data transfer. This didn’t even work well within the central system between the test and trace arms – witness the numerous reports by contact tracers sitting doing nothing in the face of a pandemic, and the multiple occasions that workers couldn’t access the IT helplines.  

Connections with key people outside the central system were even worse, notably with local public health teams who only accessed meaningful and operable data that allowed them to identify clusters of cases from July. Descriptions of mess, shambles and disgrace have all been applied by senior, knowledgeable and normally moderate people. This is not to say that systems comprising multiple organisations cannot work. They can and do; most of us taking a flight, when we could, pass through the hands of around seven companies without noticing.  

The lack of appropriate technical expertise in the design and operation has been instrumental in the impaired performance of Test, Track and Trace. The contrast between the central system and the capability and effectiveness of the local public health teams and leadership has been stark. Centuries of experience in contact tracing informs us the local community has to be the hub and should be the immediate focus of reform of Track and Trace, and only transformation will now suffice.  

The central contact tracing call centres should be scrapped and the resources for those contracts distributed to local public health teams. The national testing system should work to the requirements of local teams with regional public health review committees monitoring the efficacy of testing and contact tracing in their areas. Some 750,000 people volunteered at the beginning of the pandemic to help in their areas and have remained largely unused. This is a moment to call on their talent to assist local contact tracing. 

As for the central testing system and labs, we should bring into play Sir Paul Nurse’s “small ship labs” at the expense of further Lighthouse labs. This will shorten supply and distribution chains and provide local overflow capacity. A reengineering of the central test process should take place to ensure timeliness and better data connectivity with local teams. Local public health should be the prime customers.

Reckoning for the failures can await another day. The imperative is to improve the test, track and trace operation, so the current personal sacrifices from both restrictions and the virus itself are not wasted.

EAs professor Paul Batalden once stated: “Every system delivers exactly the results it is designed to give.” If you want to change the results, you need to change the system.

Sir John Oldham is adjunct professor of global health at Imperial College with expertise in large system transformation

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