Exclusive: Commercial covid labs seek NHS support

An email sent by NHS Test and Trace official on 24 August to NHS and Public Health England labs, seen by HSJ, relayed an “urgent call for support from the pillar 2 [commercial labs] team” because of a “surge in demand”.

It comes with pillar 2 — which is meant to serve routine and targeted population testing, as well as outbreaks and social care providers — running short of capacity as more tests are carried out, and with the scrapping earlier in the summer of one type of commercial test.

The email said it was a “short-term call for support”, asking for “additional capacity for next 2-3 weeks” from labs that could provide “an additional 500 or more tests per day”.

The email said: “We have been piloting this [use of commercial capacity] for a couple of weeks at one of our NHS Labs, learning about potential issues and finding resolutions.

“At this stage my request is that any Lab with spare capacity to support this workstream, make contact… We need quite a quick turnaround on this and would welcome your urgency in responding by midday tomorrow (Tuesday 25th August 2020 – 12pm),” it added.

The NHS and PHE labs are “pillar 1” of the government’s testing strategy. They sit alongside the principally commercial run network of Lighthouse Labs in England, Scotland and Wales, known as “pillar 2”, which also includes university labs and other partners.

While pillar 2 has run short of capacity, NHS testing capacity is now running well ahead of the demand on it, because the number of hospital suspected covid cases — which are the main call on it — have dramatically reduced, while lab facilities have slowly been expanded.

HSJ has been told that local NHS representatives have regularly offered to help other areas, such as social care testing, to try to improve access and turnaround speed, but often been turned down. 

One local NHS lab source said many trusts would offer to help, but were frustrated, stating: “Do you really want to put the effort in if you have been being told for months you are not needed, and now you are but only for two-three weeks?”

The person added: “There is clearly an issue when [pillar two] has been telling us we are not needed for surveillance testing, and then come looking for help.”

They said the capacity problem in pillar 2 may be a result of relying too much on newly developed rapid-throughput systems such as DNA Nudge or MinION technology, which the NHS is seeking to roll out. “That was the story [at the] beginning of August, but while that technology will help later in the year, I’m not sure if any are actually in place apart from those associated with initial evaluation,” the source said.

The Department of Health and Social Care, which runs NHS Test and Trace, yesterday also announced their latest moves to expand core testing capacity, acknowledging: “The growth in demand means that existing capacity for pillar 2 swab tests is being fully utilised and in line with existing plans, the capacity is being quickly expanded.”

This includes a new Lighthouse Lab at Loughborough in the East Midlands opening this month, and ”brand new large-scale processing units… being rolled out for use across both NHS and Lighthouse Labs”. So far these include a machine supplied by the firm LGC to the Milton Keynes Lighthouse Lab. ”Each LGC machine is able to process up to 150,000 tests per day, at reduced cost and speed,” the DHSC said.

A DHSC spokeswoman said: “We are expanding testing capacity to 500,000 tests a day by the end of October – as well as bringing in new technology to process tests even faster.”

Capacity crunch

The first chart below shows trends in capacity and usage for three of the UK testing pillars.There was early rapid growth in pillar 2 — commercial — testing, but demand rose steeply through the summer, while capacity flatlined and fell when Randox home test kits were withdrawn.

NHS (pillar 1) capacity has been expanded more slowly and steadily, while demand has not substantially grown.

Pillar 3 (antibody testing) has seen very steep expansion in capacity, as testing equipment was purchased amid national enthusiasm, but steeply dwindling demand after an initial surge among NHS staff. 

Pillar four, which is for surveillance surveys, is not included.

The second chart shows the “headroom” in each pillar — the difference between capacity and usage on a seven-day total basis. It shows headroom tightening in pillar 2 from late June.

Source for capacity data: Time series of capacity statistics: 18 August 2020 (https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public). Source for tests data: Test results, by date reported (https://coronavirus.data.gov.uk/testing)

Updated 12.30pm 4 September to include DHSC statement and information on planned expansions.