'Way behind the curve': test, trace and a local credibility gap

Councils are supposed to play a big role in the coronavirus strategy, but do they have the means to do so?

Just under a fortnight ago, council leaders across England received an email containing three attachments. It had been sent on behalf of Nadine Dorries, the health minister and former I’m A Celebrity … Get Me Out Of Here! contestant.

Official material related to Covid-19 has frequently been full of numerical scales, shaded shapes and perplexing diagrams, and so it proved this time. As well as the promise of “an integrated and world-class Covid-19 test-and-trace service”, one of the documents featured four circles in different shades of green, and the words “test”, “enable”, “contain” and “trace”. Close by were two lines of text that sounded important, but baffled some of the people who read them.

“Continuing data capture and information loop at each stage that flows through Joint Biosecurity Centre to recommend actions … Underpinned by a huge public engagement exercise to build trust and participation.”

Over the previous few weeks, the government had begun to announce details of a new system that would define how it dealt with Covid-19 in the immediate future. Dido Harding, the former chief executive of the phone company TalkTalk, had been appointed to lead the test-and-trace effort. The outsourcing giant Serco and call-centre multinational Sitel were recruiting and training tens of thousands of people who would contact people by phone, while the smartphone app intended to be at the new system’s core was being trialled in the Isle of Wight.

Dido Harding.
Dido Harding. Photograph: Pippa Fowles/10 Downing Street/AFP/Getty Images

Given that new local outbreaks of the coronavirus would inevitably demand the attention of people on the ground, there had been rising frustration about the apparent lack of a role for councils in the government’s approach. Now, though, there was to be a “central” role for local authorities in “supporting the new test-and-trace service across England”, and an extra £300m from Whitehall to fund their new responsibilities.

The following week, Matt Hancock said future flare-ups would be met with “local lockdowns”, an announcement that came on the same day that the health secretary also heralded the early launch of the national test-and-trace system.

But many of the local politicians and officials who will apparently play a key role in making everything work say hugely important questions remain unanswered. Nick Forbes, the Labour leader of Newcastle city council, says: “We don’t know what this system looks like, we don’t know how much it’s going to cost, we don’t know what money we’re getting. The government is way behind the curve here. We’ve only started to scratch the surface of what it all means.”

‘I will accept the responsibility if they give me the powers’

The new testing and tracing regime is branded with the logo of the NHS. It involves the government agency Public Health England, and official material on testing and tracing and local outbreaks identifies seven organisations and agencies that will also be involved, ranging from health protection boards and local strategic coordinating groups to outbreak engagement boards and local resilience forums. From the perspective of many people working at the grassroots, this is part of the problem. “Everything feels so fragmented,” one local government insider told me this week. “It feels like we’re trying to stick it all back together again.”

The basics of what testing, tracing and isolating entails are clear enough. If someone develops possible symptoms of the virus, they must self-isolate for at least seven days and register for a test. If that test comes back positive, leaving aside the possible operations of an app that will be introduced nationally “in the coming weeks”, they will then have to share detailed information with the authorities.

This will include details of the people they live with, anyone they have been within 2 metres of for 15 minutes or longer, and places they have recently visited. In turn, people who have been close to anyone infected “will be told to begin self-isolation for 14 days from your last contact with the person who has tested positive”.

Linked to these complicated arrangements are proposals for what the government calls “local outbreak control plans”, so far focused on care homes, schools and places such as sheltered housing developments, and what official documents term “dormitories for migrant workers”. This is one of the areas where local authorities will seemingly be crucial, along with “supporting vulnerable people to get help to self-isolate”.

The Department of Health and Social Care is initially working “intensively” with 11 “beacon” areas of England – including Leeds, Newcastle and Leicestershire – and has told local politicians and officials across England that they “need to develop local outbreak plans in June”.

Things seem to be moving. But inescapable truths hang over everything, not least that the lockdown has been loosened before many of the important elements of the testing, tracing and isolating system are in place.

People in local government say they were encouraged by the appointment of Tom Riordan, the chief executive of Leeds city council, to a senior role in the testing and tracing system in mid-May. Nonetheless, big questions remain. Forbes says that as well as his uncertainties about local lockdowns (“We don’t even have the power to close down a school at the moment, let alone lock down an area of a city”), he has other worries.

“This is a government which has tried to create a hostile environment. There’s huge fear in many BAME communities that their data will be passed on. And if communities don’t have the confidence to engage with the testing and tracing work, then it’s going to fail.”

Nick Forbes, the leader of Newcastle council.
Nick Forbes, the leader of Newcastle council. Photograph: Christopher Thomond/The Guardian

On the other side of the River Tyne, Alice Wiseman is working flat-out in the borough of Gateshead, a coronavirus hotspot. She is a director of public health, and therefore charged by the government with defining how local authorities will “identify and contain outbreaks and protect the public’s health”. She too is still waiting for clarity on an array of issues.

For weeks, Gateshead has run its own testing programme from labs in a local hospital. At the same time, a nationally run testing facility administered by the outsourcing firm Deloitte has been in operation – first from the car park of Gateshead’s shuttered branch of Ikea, and then across the river in Newcastle. It has since been joined by a walk-in national testing centre three miles from the city centre.

Wiseman says it has taken her eight weeks to access data from the nationally run testing system, and that even then the information is not detailed enough to be of much use. As of this week she can access information about Covid-19 infections across the whole of the north-east of England broken down by gender, age and some information about such “settings” as schools, hospitals and prisons. But she says she still has far too little information about cases in Gateshead from the national testing system, other than crude figures showing the number of people who have tested positive.

She also says the testing results concerned are not available in anything like real time, which risks the virus spreading. Indeed, though the Department of Health insists that “approximately 90% of people now receive a result within 48 hours of their test”, she says she is still having conversations about results taking more than 72 hours to arrive with individuals, before they are then collated into official data. “We haven’t had a picture of the issues in our local area since the start, and we don’t have one now.”

In Leicestershire, the Conservative leader of the county council is also awaiting answers. Nick Rushton says that when he has talked with ministers, a term he has heard is “local political accountability”.

“If we’ve got local accountability, I want local responsibility,” he says. “So, for example, if I had an outbreak in a factory where there’s a lot of people, I don’t want to say: ‘Yes, we’ve got an outbreak and we need to shut the factory and isolate all those people,’ and then have to phone up the secretary of state and ask them if I can do it. If they want me to do it, I will accept that responsibility if they give me those powers locally.”

In response to this point, the Department of Health said it “will shortly be issuing guidance on how local and national government can work to ensure local outbreaks can be contained”.

Rushton says Dorries “seems very keen to help us, on a Zoom call. But we need to see the colour of her money. Because we don’t know how much we’re going to get to do this.”

Though the government has provided an extra £3.2bn in emergency Covid-19 funding for councils, and the Department of Health insists they have the resources they need to “tackle the immediate pressures they have told us they are facing”, Rushton’s authority has so far spent twice as much on the effects of Covid-19 as it has been given by ministers.

“It’s extremely concerning. Hopefully they’ll realise just how dire the situation will be next year. What you’ll have to do is cut services, it’s as simple as that. If you don’t have the money … you just have to stop doing things.”

Rushton says Leicestershire has enough reserves to cope with any financial crisis, but scores of councils do not. And if the government insists that they take on all these new responsibilities but does not adequately fund them, the combination could tip many places into bankruptcy.

In Leeds, the city council leader, Judith Blake, says the financial gap left by the virus on her finances will be around £160m. “It’s very, very serious indeed,” she says. She also expresses scepticism about whether she and her colleagues will be able to respond to crisis as they would like. “We don’t expect that the government is going to be giving us the powers we need any time soon. I just don’t think it’s in their DNA. It’s a cultural issue.”

‘The government doesn’t seem to want to let go’

A source within the new national testing and tracing system says the involvement of councils came “too late, without a doubt”, but that over the last few weeks the government’s turn towards local authorities has made a “palpable difference”.

They speak with guarded optimism, but also say there is an ongoing tension between what ministers say in public and how people working locally have to put plans into practice.

 “Every night you hear from a secretary of state or the chancellor or the prime minister, and they want an announcement to make. So they almost manufacture things. If they consulted with people, they would still end up doing things, but at least there’d be buy-in, and warnings to people on the ground,” the source says.

On Wednesday the Daily Telegraph reported that “a shake-up in Downing Street will see the government’s entire approach to the pandemic run by two centrally run committees”. This was not the kind of news that people trying to get cities, counties and boroughs through this crisis wanted to hear.

“It’s frustrating that we’ve only recently been seen as a resource to help the country get through this crisis,” says Forbes. “And even now, the chains of centralisation are still being rattled. The government doesn’t seem to want to fully let go.”

Asked about these issues, the Department Of Health provided a statement. “We have now launched NHS Test and Trace which will help stop the spread of the virus and save lives … Eleven cross-party beacon councils have formed an advisory group to establish methods of best practice and to assist with the development and introduction of local outbreak plans which will be in place by the end of June,” it said.

“In the meantime, local infection outbreak plans will be utilised where necessary. We’ve made £300m available to local authorities, and are giving them support with Public Health England to fight infections in care homes and help tackle wider outbreaks in businesses and the community.”

Forbes says: “The virus is still real. We’re not on top of it. We don’t yet have the systems in place to know where it is. Nor do we have the mechanisms to deal with an outbreak, yet. But we’ll move heaven and earth to try and do as much as we can.”


John Harris

The GuardianTramp

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