It was meant to be the system that would allow the country to emerge confidently from lockdown. But the development of the NHS tracing system has been characterised by missteps, conflict and frustration behind the scenes.
At the heart of the difficulties have been tensions between central government and local public health officials, or as one insider complained: “There has been control freakery from start to finish by the NHS and the Department of Health.”
Public health officials say systems and protocols to manage so-called “complex cases” involving central and local cooperation, such as the outbreak in Weston-super-Mare, have not yet been fully worked out days before schools start reopening on 1 June.
“I think councils will be told who will need extra help because they are vulnerable in a shielded category, and that’s about it,” the official added, saying there had been difficult meetings between officials from both sides.
Contact tracing is one of the most basic planks of public health responses to a pandemic like the coronavirus. It means literally tracking down anyone that somebody with an infection may have had contact with in the days before they became ill. It was – and always will be – central to the fight against Ebola, for instance. In west Africa in 2014-15, there were large teams of people who would trace relatives and knock on the doors of neighbours and friends to find anyone who might have become infected by touching the sick person.
Most people who get Covid-19 will be infected by their friends, neighbours, family or work colleagues, so they will be first on the list. It is not likely anyone will get infected by someone they do not know, passing on the street.
It is still assumed there has to be reasonable exposure – originally experts said people would need to be together for 15 minutes, less than 2 metres apart. So a contact tracer will want to know who the person testing positive met and talked to over the two or three days before they developed symptoms and went into isolation.
South Korea has large teams of contact tracers and notably chased down all the contacts of a religious group, many of whose members fell ill. That outbreak was efficiently stamped out by contact tracing and quarantine.
Singapore and Hong Kong have also espoused testing and contact tracing and so has Germany. All those countries have had relatively low death rates so far. The World Health Organization says it should be the “backbone of the response” in every country.
Sarah Boseley Health editor
Tensions came to the fore after it became clear that a mobile phone app trumpeted by the health secretary, Matt Hancock, as being ready to launch nationally “mid May” was beset with technical difficulties. There is now no set date for its launch.
That switched attention to what was intended to be a supplementary system of national call centres, where 25,000 people, including more than 6,000 clinicians, had been hastily recruited to interview people testing positive for coronavirus and ask who they had been in contact with.
Public health experts believed they had the expertise that people who had been trained with the help of a script did not have. But they claim that for weeks during March and April they were sidelined and only became actively involved in May after “a massive campaign behind the scenes” to get them on board.
Working within local councils, contact tracers have been employed for decades, tackling infections such as tuberculosis and sexually transmitted diseases. It is an interview-based process that requires experience and tact to obtain sometimes sensitive information from sick individuals, and employs dozens of people in large councils scattered across environmental and sexual health teams, although the services have been hit hard by spending cuts.
Meanwhile, some of those hired for the national contact tracing centres have had relatively cursory training. One told the Guardian that the guidance on doing the job simply consisted of watching videos and reading scripts. “I have not been given any details of who to call if I have problems. Only an email address has been provided which largely goes unanswered.”
Others warned that they had little experience of using computer systems intended to help them talk through cases. Another worker talked of being “thrown in the deep end”. He added: “The online system is really complicated and I want just a couple of days once it goes live to navigate it.”
Last week, Rupert Soames, chief executive of Serco and brother of the former Conservative MP Sir Nicholas Soames, posted a video message saying the recruitment process was “an unprecedented achievement”. But he also conceded there had been problems with the training process. “Inevitably, I am afraid, we will have made some mistakes along the way and if it has all felt a bit clunky and rushed, I apologise.”
Insiders have been reluctant to go public because they want the tracing system to succeed but some have told the Guardian they would have liked more time and that a three-month joint effort, including local public health experts from the start, could have created a comprehensive system for England.
On Tuesday a letter from Public Health England to councils’ directors of public health asked for information on the “current resources” devoted to managing the more serious outbreaks, an audit that could have happened weeks ago.
Once it became clear the system would be entirely reliant on patient interviews at launch because the app was not ready, ministers were keen to link up with local authorities.
Last Friday it was announced there would be a new £300m fund for local authorities in England to support test-and-trace services, with a promise that data on the spread of the coronavirus would be shared with local authorities.
Dido Harding, chair of the NHS Test and Trace service, said that the role of public health officials was hugely important in tackling a game of virus “whackamole”. The Conservative peer added: “Where we see an outbreak, or the signs of an outbreak, the best way that we contain it will be through local, public health professionals, and local authority leaders, going in and understanding what’s really happening.”
Sally Brinton, the Liberal Democrats’ health spokeswoman in the Lords, said it was “a relief” to hear that Public Health England was now working with local directors of public health. “However, it is also worrying that this has only happened in the last few days,” she added.
With just hours until the launch of the NHS Test and Trace service, on Thursday, everyone involved is keen to make the coronavirus tracing system for England work, although the exercise has laid bare long-established tensions between central and local government.
“This has been an exercise in people above my position telling me they know better and in almost every circumstance they turned out not to,” said one senior public health official. “That’s what this whole pandemic has been like – and I won’t forget that.”