Local contact tracing: Leicester

• Leicester was the first council to set up a local contact tracing team
  
   
• The service was launched in July and is staffed by customer services and library staff with separate officers brought in to do door-to-door tracing
  
   
• Flexibility is key with extra staff able to be pulled in when the need arises

The local context

Leicester never really left lockdown. In late June it had the highest rate of positive cases in the country so just before the re-opening of restaurants, bars and hairdressers on 4 July it was announced the city was to go in reverse.

Not only would those venues not open, but non-essential shops were to close too. Cases did start to come down, but some level of extra restrictions have always remained in place. It is now classed as a tier two area.

What was done

As part of the arrangements put in place for the second lockdown at the end of June, an incident management team ( IMT) was set up including senior officials from the local council and NHS as well as national representatives from Public Health England and government.

The team oversaw the introduction of a series of immediate measures, including door-to-door testing of residents. During those discussions it was also decided to set up a local contact tracing service.

A team of contact tracers was recruited from the customer support team and library staff and training provided.

Edward Quick, who manages the contact tracing team, said: “The staff were all used to talking to the public and having difficult conversations so they were the perfect fit for these new roles. At the start many of them were not able to do their day jobs because of the restrictions in place.

“But that has changed as the months have passed. We have kept it quite flexible – so we have a team of 11 now that can be pulled in when the need demands.”

The service operates seven days a week and is capable of handling 70 new cases a day. At first the team were handed cases that the national team had not been able to reach in the first 72 hours. That was soon reduced to 48 before coming down to 24 on 17th August ).

There is also a team of contact tracers on the ground who carry out home visits. They are handed cases that cannot be contact by telephone within the first 24 hours – sooner if there is clearly incomplete or incorrect phone contact details.

There are six members of this team, drawn form property services, smoking cessation and health promotion teams. Again, they are carrying on with their day jobs and are brought in if and when needed.

The impact

The service has achieved impressive results, reaching 91 per cent of cases the national team have been unable to.

“We have found people are really responsive. We sometimes have to make repeat calls. People may not always reply if they are ill so we will keep trying them. We also look at what other contact details we have for people by looking at our council tax records.

“We sometimes find we have a better way of contacting them. It also helps that within our team we have a number of people who speak different languages – and of course we have the council’s language translation service too.”

Public Health Lead Commissioner Liz Rodrigo said: “The performance has been excellent. I think the local element is really important. The calls come from a local number, which I think makes people more likely to take the call. But just having that local knowledge can make a big difference. You can have a bit of banter, remark on the weather locally or something like that. It immediately builds up a rapport with the individual.”

Lessons learned

Ms Rodrigo said setting up the service has been challenging. “We were doing all this from scratch. There was no off-the-shelf training available like there is now, data-sharing agreements had to be drawn up and we started off without even having access to CTAS. It took a lot of work and effort. I would hope other areas starting now would find that element easier.”

But she says even now there are problems, particularly with CTAS. “We are just tasked with speaking to the index case – the person who has tested positive. We do not chase up the close contacts. So it means we only submit contacts information back into CTAS - we cannot set up case files as we have limited access.

“That then leads to the national team contacting each close contact separately, even if they are from the same household. It means families are receiving multiple calls.

“We also have to keep our own records on spreadsheets – there is a bit of duplication of data entry. We have set aside staff who are in charge of that side of things. The problem is CTAS was not set up to work effectively at the local authority level. Therefore, the solutions we have had to find that allow us to work in this way have been bolted on.”

Next steps

The council is in the process of expanding the team of contact tracers so there is the capacity to deal with up 150 cases a day. Ms Rodrigo said: “We know pressures are growing on the national service and infections are increasing so we want to be ready for that. It will remain flexible - so people will continue with their days jobs and only be called in if needed.”

Talks are also under way with NHS Test and Trace to see if it would be worthwhile to get contact details earlier at the eight-hour point. Around a third of cases are reached in the first eight hours.

Ms Rodrigo said: “After that we know the national team struggles, so it would enable us to get to the case quicker. With the delays in

the system getting test results we can sometimes find we are chasing up people four or five days after the test is taken. That is too late.

“We are also open to exploring what we can do in terms of chasing up the close contacts. But there are difficulties with that – the close contacts could be in other areas outside of the city council boundaries. It is something that needs careful consideration.”

Contact details

Liz Rodrigo

Public Health Lead Commissioner, Leicester City Council

[email protected]