Hertfordshire is home to nearly 1.2 million people. It has had relatively low rates of infection, but like many areas saw cases start to climb quite significantly in the autumn. This case study is part of a series on local contact tracing.
- Local contact tracing was launched in two stages in Hertfordshire with two districts going live first
- This was followed by the remaining eight districts a few weeks later
- The approach to contact tracing has now been standardised with a core team based at the council supported by district council staff
Local context
Hertfordshire is home to nearly 1.2 million people. It has had relatively low rates of infection, but like many areas saw cases start to climb quite significantly in the autumn. The highest infection rates have been seen in Watford, Broxbourne and Hertsmere. The county is currently classed as tier one on the Covid alert system. But by late October seven of the 10 districts were recording rates above 100 per 100,000 each week and local leaders were warning a move into tier two could happen soon.
What was done
Hertfordshire started planning its local contact tracing service during the summer. The public health team consulted with Sandwell MBC, which was one of the first areas to launch such a service in July. Watford and Three Rivers borough councils teamed up to launch the first service. This went live in mid September with the two councils having a core team of contact racers support by door-to-door tracing provided by environmental health officers. The other eight districts followed suit in early October, but with a central core team of tracers provided by the county and the individual districts doing their own door-to-door tracing. Calls that are made display a local number. The call centre service operates seven days a week.
Public Health Project Manager Annette Sheer, who has overseen the launch of contact tracing in the county, said: “It is difficult for two tier local authority areas. The guidance is more geared towards unitaries. I don’t think the complexity of sharing information and working across the sort of footprint that two tier areas do is properly understood.” The rollout of the service has not been without challenges – and changes have been made to the service already. Ms Sheer said: “The fact Watford and Three Rivers went early was, in a way, a good thing. It allowed us to test what was happening and then compared it to the second phase of our roll out when the other districts were supported by a central team. “Watford and Three Rivers were up against it with demand and they have now merged with the rest of the service so that the cases are initially dealt with by the county’s centre team before being passed on to the districts after 24 hours.”
The impact
There is currently a core team of eight contact tracers and a success rate of 63 per cent has been recorded in the early weeks.
Ms Sheer said: “We are pleased with that given all the challenges we have faced. These are cases that the national service have not been able to reach so each one of those are people who are now hopefully self-isolating and whom we have details of their close contacts. “It is helping to break those chains of transmission. What is more, we offer them help. We have Herts Help, a partnership with the voluntary sector, which is able to support people to isolate by arranging food deliveries and medicines pick up.”
Lessons learned
Hertfordshire did find its service was overwhelmed in the early days. Figures from NHS Test and Trace suggested there would be around 35 cases a week.
But at the start of the county-wide service there were nearly 200 – the launch coincided with the moment when a large backlog in positive cases was identified by the national system because of an IT failure. Since then it has settled down and is now averaging 67 a day, but that is still many more than was planned for. Ms Sheer said: “We were not prepared for those numbers. It was overwhelming. NHS Test and Trace had worked off out of date figures, which meant we had planned for a much lower level of demand. “We are having to hand cases back to them that we don’t reach. It is not ideal, but is something we are having to work through.”
Ms Sheer said there are also high levels of duplicated names being transferred. “Some days 40 per cent of cases have been duplicates. People with the same name being entered twice. Maybe with slightly different contact details or spellings. “I know this is being worked on, but I would warn others that you cannot expect a clean set of records.”
Next steps
Hertfordshire is doubling the size of its central contact tracing team and should soon have capacity to deal with around 50 cases a day.
It is also in the process of rolling out a new IT platform using Microsoft dynamics. It is due to go live on 1 December. The service is currently using Egress software, which provides a secure system to transfer information, but requires more manual inputting than Microsoft Dynamics will.
Ms Sheer added: “We still have to submit the information we collect on to CTAS, which is time consuming for the team. In an ideal world we would be able to integrate some of this to make it more efficient.
“I wish we had got going earlier on the IT side of things. Having Microsoft Dynamics running from the moment we went live would have made a big difference and I would recommend other councils, especially in two tier areas, think about this from the very start.”
Contact details
Annette Sheer
Public Health Project Manager, Hertfordshire County Council
[email protected]