The information contained in this briefing draws on a wide range of feedback from councils.
- The information contained in this briefing draws on a wide range of feedback from councils.
- Councils know their communities better and how best to engage with them, particularly in diverse communities. We estimate that local contact tracing systems have a 97.1 per cent success rate at finding close contacts and advising them to self-isolate, compared to 68.6 per cent of close contacts reached by national Test and Trace.
- Quicker access to local support, for example through community hubs.
- Talking to a local is more likely to generate compliance, as well as understand wider context of the family and the household to explain why self-isolation is crucial.
- Local tracing will generate much richer data and information. Local tracers know and understand the local area and community. Hence they can have a much more engaged conversation and are more likely to pick up of fragments of information that relate locally.
- Tracing teams being local would be much better at discussing and exchanging information with each other to pick up patterns in the data, infections and behaviour. Also they are more able to work with local partners to share information such as with the police, health colleagues and the fire services.
- Faster data turnaround.
- More able to target testing better and faster.
- Would avoid multiple phone calls that are simply putting people off, there is a lack of join up. Some families receiving 30+ calls as a result of one positive case and then multiple follow up calls telling others to isolate.
Foundations for increased localisation
For increased localisation to work we would need:
Fast accurate local data from current test and trace system: current handoffs are often 72+ hours after test, limiting their benefit. Data shows that NHS Test and Trace is still struggling to reach the number of cases and contacts needed to help slow the spread of COVID-19. While the number of cases reached is no small achievement there is still a large number who were not contacted and advised to isolate. Fewer still were contacted within 24 hours. A lag in contact tracing on top of the time required for a test to be complete has serious implications for the impact on R rate in the local area. The system is still far from achieving the 80 per cent of contacts needed for the effective system recommended by the Government’s Scientific Advisory Group for Emergencies (SAGE).
Optimise the effect of contact tracing as a cornerstone to suppressing the spread of COVID-19, recognising the need for sustainable resource to do it at scale. Now is the time to review a system which was set up at great pace. The system works in responding to tackling outbreaks in institutional settings but it is a harder task (locally) to respond to increasing cases in areas of high deprivation, overcrowded and multi-generational housing, concentrations of vulnerable communities and a younger age groups. This is where the virus seeds quickly and is often invisible to agencies. This requires:
- Localisation (by region or local authority) of tier 2 contact tracers over next few weeks. Regional coordination with local government, locally delivered but nationally enabled
- Councils funded to build up their tracing teams to take on more cases. Support on training resource and on data systems in addition to funding.
- Accurate and complete data from CTAS to support the local teams to identify people quickly.
A graduated programme to allow localisation of testing which would need to be fully funded.
- Initially hand over a higher proportion of cases earlier (eg after three calls or 24 hours) to avoid creating call fatigue in families who then feel jaded and do not respond.
- Enable local direction of testing, in particular allocation of places at local testing centres, and coordination and flexibility in deployment of local testing stations and walk in stations.
- Grow proportion to full hand over of tracing, but retain central “surge capacity”.
- Put in place systems for local commissioning or delivery of testing capability (not lab analysis) where they are carrying out the test, but sending samples to a local testing lab. This should largely be done after local tracing is established and to be based on Local Authority commissioning. This may change as testing technology changes:
- Initially targeted testing (rather than testing centres.)
- Local testing centres.
- Regional testing centres would still require some regional or national systems.
- Mass testing on basis of new technology such as lateral flow tests (some councils could take this on early to pilot.)
- Local deployment of new testing technologies as they come on stream.
- Reverse Tracing – this will overlap with the above. Identifying contacts and immediately testing and again at seven days. Current anecdotal evidence suggests low compliance with isolation. Putting in testing and reducing isolation to seven days if a negative test is likely to increase compliance. It would also lead to much faster response on the positive cases, allowing clampdown faster.
Testing could also be extended to others who are supposed to be isolating for example travellers from abroad to encourage compliance.
The aim could be full localisation in the long term, which could be aligned with the new arrangements for PHE responsibilities. But there is a need to work with local areas so that the expectations placed on them are reasonable given current pressures, capacity and resourcing.
It may make most sense to increase localisation first (on a voluntary basis) in those areas with low infection rates rather than the areas in tier 3 – because some of the most obvious benefits are in preventing the spread of the virus rather than in infection control, and because the capacity requirements for tracing escalate hugely with infection rates.
Deployment of MOD project managers to local directors of public health. The ‘COVID Support Force’ is run from the Headquarters Standing Joint Command in Aldershot, which coordinates resilience missions for the state. Military planners from there have been placed in government departments dealing with the crisis. Reservists, especially those with specific skill sets, are used in the operations with measures in place to call them out when necessary. We need consider how we ensure that local directors of public health can use this support and direct their expertise on the local frontline.
The public should be given ongoing access to digital first system for reporting contacts and encourage reporting of contacts.
The isolation element is not working as well as it could be so local and central government must work together to think about incentives, accompanying communications and review the support offer. Local flexibility would be beneficial to best tailor these support packages.
Desired approach to achieve this
There needs to be full and proper engagement with the sector to establish that local systems will be fully funded for the long term and how the funding will work. Involve local leadership and local people to build trust in a way that is more effective than more distant interventions. Include citizens in design process at every level.
Need a ‘one system’ approach to planning and delivery that is based on local to regional to national.
To review all processes during the national Test Trace Isolate structure and ensure unnecessary steps are removed.
Ensure programme management processes are undertaken within a 'whole system' framework.
Local government to be involved in discussions with Government on the future strategy for Test, Trace and Isolate as part of a broader commitment to co-design and coproduction. Work to create an inclusive and transparent whole system co-design approach that brings people together (i.e. create a convening function).
There needs to be a hybrid approach to localisation that enables councils to localise at different speeds, to reflect both their capacity and situation on the ground in terms of COVID-19 cases and workload.
Support to deliver impactful and targeted communication to localities to influence citizen behaviours and enable prevention. Support from behavioural insights teams.
Arrangements will need to be put in place to allow appropriate oversight by the director of public health and to ensure sufficient capacity in terms of public health and wider teams.
Local governance should be based on existing local structures (for example those established for local outbreak management) and ensure local political accountability. Arrangements should recognise and build on the role of regional, combined authority and local arrangements by local agreement.
Develop approaches that focus on the interconnections between the necessary elements of the programme at every level.
Any expectations of monitoring and assurance to central government need to be clear from the outset so that it can be built into local planning and management arrangements. Shape the workforce strategy in a way to ensure a sustainable and resilient system can be built across local government.
Improving the performance measurement of the system including key indicators on whole system success at local authority level as well as regional and national levels.
Alexander Saul, Adviser – Test, Trace and Contain
Phone: 020 7664 3232