Uncertainty over Covid funding leaves local test and trace teams ‘in the dark’

Publicly run test and trace services across England remain “in the dark” over future funding commitments from the government, raising fears that local teams will be scaled down and left unable to effectively respond to Covid-19 outbreaks in the community.

In areas with high rates of continuing transmission, councils could be forced to divert resources away from other health services – such as mental health support and drug rehabilitation – to sustain efforts in controlling and minimising the localised spread of Covid-19.

Money provided by the government to manage the Covid response at a local level runs until the end of March 2022. Although the UK’s epidemic is expected to have subsided by then, directors of public health are concerned that outbreaks in communities with low vaccination rates will continue to “create challenges”.

“There’s absolutely no doubt that local authorities will be required to provide a continued response next year to the ongoing risk of Covid transmission,” said Professor Dominic Harrison, director of public health for Blackburn with Darwen council.

However, authorities have been met with silence from central government as to whether funding will continue for the 2022-23 financial year – despite the large commitments that have been made to the NHS and social care services for tackling the fallout from Covid.

“We have no idea of forthcoming funding,” said Evelyn Akoto, the council lead for health and wellbeing in Southwark, where just 63.8 per cent of people have received a first vaccine dose. “Our fear is that … we’ll still be left with community transmission going on and not able to deal with it.” Prof Harrison said his team has similarly been left “in the dark over this”.

As a result, councils have been unable to plan their Covid response beyond March 2022, leaving local test and trace teams in limbo.

“There are lots of risks with this but in particular the ability to recruit, train and importantly retain the right people to do this well,” said Alice Wiseman, director of public health for Gateshead. “This is a challenge when we can only offer a guarantee of employment until the end of March.”

Throughout the pandemic, locally run test and trace teams have enjoyed far greater success than their counterparts in the private national system, which has a budget of £37bn and been described as an “eye-watering” waste by MPs.

Since the UK’s testing system was launched in May 2020, 98 per cent of all contacts managed by local teams have been successfully reached, according to government data. This figure has varied hugely within the private branch of the system, ranging between 60 to 90 per cent.

The team at Blackburn with Darwen council was one of the first to replace the outsourced national call centres in ringing up local positive cases and then tracing their contacts.

“The national centres were getting very poor engagement from the population, particularly in northern low-income areas,” said Prof Harrison. “They simply weren’t willing to answer an anonymous phone call. When we went local, we got a very high response rate because people recognise it’s a local number and were willing to speak to a council employee.”

But Prof Harrison said he fears his council’s test and trace teams will start to lose staff ahead of March 2022 if the government refuses to continue pumping Covid funding into local health authorities.

“Many employees who are employed on effectively temporary contracts whilst we have this extra Covid support money will be looking before well before March to get another job if we’re unable to finance a continued role,” he said.

Ms Akoto said she fears that if Southwark’s local health teams, including contact tracers and Covid vaccinators, “stop going into communities, stop advising, stop working with the NHS” due to limited finances in the future, “things could unravel very quickly”.

The alternative, if funding is lost, would be to scale back other public health services to ensure the Covid response can be maintained, Prof Harrison said. “So things like smoking cessation services, the prevention of mental ill health programmes – these may have to be cut. We’ll have to make a decision on this if the worst comes to the worst.”

Ms Wiseman said efforts to redeploy staff from other areas of the council, while manageable earlier in the pandemic when certain services were closed, are “less manageable now as residents expect all the businesses to be open”. The “uncertainty” around funding is presenting “lots of operational issues,” she added.

Prof Harrison said he expects localised outbreaks in workplaces, schools and households across England will continue for “at least five years” and “create challenges” for health protection teams tasked with limiting the spread of Covid-19.

Directors of public health are also concerned by the lack of commitment that has been made to funding councils’ core public health grant – a pot of ring-fenced money that is used for sustaining local sexual, mental and child health services, none of which have received the same financial “largesse and generosity” shown to the NHS and social care sector in recent weeks, said Prof Harrison.

In response to last month’s Spending Review, the Association of Directors of Public Health said it was “unfathomable that the government has not prioritised public health funding in the wake of the worst public health crisis of our time”.

A Department of Health and Social Care spokesperson said: “We have made over £12bn available to local councils since the start of the pandemic to address the costs and impacts of Covid-19 and testing remains a vital part of our defences against this virus. In line with the approach taken throughout the pandemic, we will keep our response under review.”