Local authorities must be at the heart of contact tracing because covid-19 is best understood as a pattern of local outbreaks rather than a national pandemic. By Sir Chris Ham and Robin Tuddenham.
Community testing and contact tracing represent our greatest hope for managing the risks to health of covid-19, until a vaccine and effective treatments become available. Experts in infectious disease base their understanding of this on previous pandemics, and the experience of countries like South Korea and Germany.
Work is underway at pace to resume contact tracking and tracing in England. We understand that this programme will begin in earnest from May 18th, following a pilot on the Isle of Wight. This work is a core part of Matt Hancock’s five-point plan for combating covid-19, in support of some relaxation of lockdown anticipated soon.
Whilst the pace is understandable, the methods and approach taken are top down, lack an effective role for key regional co-ordination through the Integrated Care Systems/Sustainability and Transformation Partnerships and Local Resilience Forums, and risk marginalising the essential skills of local authorities, GPs and the voluntary and community sector in place.
Unanimous attempt in expanding testing
The Department of Health and Social Care is leading the expansion of testing, while Public Health England is overseeing the development of contact tracing. NHSX are leading the development of an app to be used in contract tracing, with expectations reliant on high rates of use from the public. Divided leadership at a national level is unlikely to deliver a programme that has to be wholly integrated to be effective.
We have already seen the many challenges in expanding testing. These include the lack of a coherent and well understood strategy to guide the programme, the involvement of a large number of agencies not always working effectively together, and the difficulty for NHS and social care staff in being tested at convenient locations.
NHSX are leading the development of an app to be used in contract tracing, with expectations reliant on high rates of use from the public
The focus on delivering 100,000 tests by the end of April means that other priorities, such as ensuring that tests are accurate and the results are reported quickly, have not received the same attention. The military teams drafted in to assist have struggled to respond to changes occurring from many directions.
There are also challenges in establishing an effective system of contact tracing. Public Health England has been asked to oversee the recruitment of 18,000 staff and volunteers through a complex regional and call centre model. The core experience of contact tracing sits in local authorities, who employ staff with many years of experience in this field, overseen by directors of Public Health.
Public Health England has been asked to oversee the recruitment of 18,000 staff and volunteers through a complex regional and call centre model
How key local authority staff in fields such as environmental health, trading standards and sexual health services will be involved in the national programme has not been specified. The role of GPs and primary care services has also not been articulated. It is not clear to us that 18,000 contact tracers will be sufficient to carry out this work at the required speed in view of the numbers of people being tested positive.
Local government in its present form began in Victorian England to rid the population of disease, to ensure clean sanitation and food that was safe to eat. This was enshrined in the 1848 Public Health Act, which created a Central Board of Health working with local doctors to improve the health of the population through the era of industrialisation. A wise partnership in place emerged that seems to have been forgotten as we live through the covid-19 pandemic.
Collaboration: the currency of health
Local authorities must be at the heart of contact tracing because covid-19 is best understood as a pattern of local outbreaks rather than a national pandemic with a similar impact in every community. Councils have an unrivalled understanding of their populations and this must be drawn on if contact tracing and isolating is to be effective. Many people isolating will need skilled support of local authority staff rooted in place.
The government’s decision to develop a national programme on testing and contact tracing continues the emphasis on central direction of the response to covid-19, which has not worked well with other key programmes like shielding the clinically vulnerable. Only now are MHCLG putting into place regional teams to support the shielding programme, and these will operate for many more months to come.
National leaders need to learn from this experience, by working with local leaders to ensure that the lockdown can be relaxed safely
Collaboration is the currency of health, care and resilient communities in places like West Yorkshire, Coventry and Warwickshire, and if given the opportunity our systems will play their part. A national framework will be necessary, but it should be delivered locally, supported by sufficient resources and flexibility.
The transformation of the NHS in the early stages of the pandemic demonstrates that fundamental changes can be executed quickly and effectively in response to a crisis. National leaders need to learn from this experience, by working with local leaders to ensure that the lockdown can be relaxed safely. The government’s duty of care to the public demands nothing less.