Slow turnaround for test and trace results is pushing NHS trust leaders to the limit

Testing for coronavirus and tracing the contacts of those who are Covid-19 positive is a central plank of the government’s strategy to control the spread of the virus. Test and trace will become even more important as we reach winter, when it will be vital for patients and NHS staff to quickly tell the difference between those who have winter flu and those who have Covid-19. The symptoms for both are very similar, even to a trained eye.

Making a national test and trace service work is a collective national responsibility for all of us, just like making lockdown work. It’s all too easy to pretend that this is just NHS Test and Trace’s job. It isn’t. Though they do have a key role to play.

People with symptoms need to get a test as fast as they can. Traced contacts need to self isolate as soon as they are asked to do so. And NHS trusts have a key role to play in building the extra testing capacity that will be required this winter. It’s NHS Test and Trace’s job to co-ordinate all this activity so everyone can play their required role as easily and effectively as possible.

The reality, though, is that NHS Test and Trace, which is only three months old, has to overcome a difficult legacy.

Our new report, "Standing up to the test", details the many frustrations that NHS trust leaders have with the government’s approach to testing thus far. It highlights the absence of a clear, coherent, and effective strategy in the first few months of the virus. While there’s more faith in the current direction, following the creation of NHS Test and Trace, many are worried that current plans for testing won’t meet the needs of local NHS providers and the communities they serve in the coming months.

Our report, based on the results from a survey of over 100 trust leaders, shows how hard trusts have been working to deliver their part of the national testing strategy. They’ve massively expanded the testing capacity they control, delivered many more tests for patients and staff and ensured that they have tested all the patients and staff they were required to. They’re now ready to go again, to play their part in this next phase, when the target is to double national testing capacity to 500,000 tests a day by October.

While four out of five trust leaders believe their trust is meeting testing requirements under current government guidance, the turnaround time for results of Covid-19 tests remains hugely important to minimise the risk of transmission.

Trusts with their own NHS laboratories on-site told us they usually receive results within 24 hours. However, for those without their own testing facilities (almost half of those who responded to our survey), turnaround times were much slower. These trusts tend to be outside the acute hospital sector but their requirements for Covid-19 testing are just as critical.

Almost all mental health, ambulance and community trusts must arrange testing of patients and staff through a lab at a neighbouring trust, or use a lighthouse lab (one of the new diagnostic facilities created by the Department of Health and Social Care in partnership with a number of medtech organisations) or another independent facility. When results are slow to come back, trusts tell us the resulting delays to patients being admitted impacts care. This can mean Covid-negative members of staff staying at home – highly frustrating at a time when the workforce is so stretched.

Ambitious targets for resuming non-Covid service levels will be stretching for many trusts, in large part because of constraints on testing capacity. We asked trusts to rank their highest priorities for testing if more resources were available. Improving standards with faster turnaround times and regular testing of all clinical staff were high on the wish list for most. Many trusts have told us that a greater roll-out of testing at the point of care – rather than having to use walk-in centres some distance away from where NHS care is delivered – is also important.

The other theme to emerge from our report is the importance of greater local control and co-ordination of test and trace activity. As we have seen from the very first Covid-19 cases, the virus hits different communities in different ways at different rates of transmission. It’s much better to think of Covid-19 transmission as a series of varying local outbreaks, not a single national outbreak.

The key challenge is to quickly identify and control these regional upsurges. Trusts want to play a greater role in the management of testing as they can lend support while working alongside local government partners.

Considering that it was born in difficult circumstances due to significant failures in the government’s overall approach to testing, NHS Test and Trace has made good progress in its short life. It still has many challenges to overcome ahead. But we all have a part to play in ensuring the success of its work.

Chris Hopson is chief executive of NHS Providers