Northern cities seek overhaul of national tracing ‘shambles’

Local health teams are outperforming the NHS Covid contact system, but as cases rise they want a rethink

Under the grandeur of Preston market’s Victorian canopy, the nervousness wrought by a resurgence of Covid-19 is not far away. Amid the fruit, veg and dairy stalls, all the shoppers and stallholders are wearing masks, keeping their distance. “Everybody seems to be sticking to the rules as much as they can,” said Gary Quinn, the landlord of the Orchard pub. “People haven’t been very clear on what is allowed, but I haven’t seen people acting maliciously. People are trying their best.”

Despite the efforts, the city is again seeing a resurgence of the virus, with 324 cases per 100,000 in the past seven days. Like dozens of other local authorities around the country, Preston city council is not solely relying on the national test and trace system to help track the virus. It has taken matters into its own hands, setting up walk-in test sites and its own tracing system. Its team has received 300 local contacts a week, with council staff making home visits to more than 100 people who needed to self-isolate and could not be contacted by any other means.

In Preston, as elsewhere, council leaders talk publicly about the need to “complement” the NHS test and trace system, helping to contact hard-to-reach cases that cannot be reached by workers in national call centres.

In private, the Observer encountered extraordinary anger and frustration among local health and council figures across England at the way the national system was created and continues to operate. “It’s been a complete shambles,” said one despairing public health director. “One colleague described it as an intergalactic catastrophe. It is probably the very worst system I’ve ever seen in my life.”

There has long been frustration that local expertise was not put at the heart of the national response. However, new data is amplifying those concerns. Last week, it emerged that the national test and trace system reached just 68.6% of close contacts of Covid-positive people in England in the week ending September 30, the lowest since the scheme began. However, local health protection teams were able to contact 97.1% of contacts.

The misplacement of 16,000 positive Covid cases, because rows were missed off an Excel spreadsheet, was the last straw for many public health directors. “After about 72 hours, tracing is pointless,” said one local government official. “The people are in the system. They’ve circulated. They’ve been to supermarkets, they’ve done the shopping.” Several said it was evidence of a fragmented system, lacking expertise.

Local health officials pointed to several recurring flaws in the national system, including families being called dozens of times by the national service. The Observer has been told of one family contacted as many as 100 times.

Meanwhile, an issue has also emerged with students. In several cases, public health directors in the south of England are being informed of cases involving students in halls hundreds of miles away, because the system assumed they still lived with their parents.

Dido Harding, the Tory peer in charge of the national programme, has also been accused of breaking a promise that the system would be “local by default” as it evolved. “That would be co-design, it would be resources,” said one local leader. “It would be additional powers and flexibilities. We’re not seeing any of that.” Another public health director said: “It just hasn’t happened. It’s a complete and utter myth.”

Some 82 councils have now drawn up their own tracing scheme, with 46 already live and many more starting in the next fortnight. Some districts in Lancashire and Oxfordshire are due to start this week, with Herefordshire, Sheffield and Enfield not far behind. Greater Manchester is using firefighters and police to help in its local tracing system. Yet many councils said they had been largely left “picking up the tab”.

Jim McManus, vice-president of the Association of Directors of Public Health, is diplomatic – but reflects some of the private concerns. “We have found a high level of success in reaching contacts, as people will pick up the phone to a local number – and local expertise means we are able to understand where people have been and what that entails,” he said. The national and the local need to complement each other. We need to go back and ask ourselves what the system needs to do and then go from there. It isn’t necessarily the case that a centralised approach is the right one in all circumstances, but local efforts also need the resources to help them.”

There are now demands for ministers to bite the bullet and overhaul the system, putting local teams in charge. Donna Hall, chair of the New Local Government Network, said: “We’ve lost control. It’s particularly impacted on the north. I think it’s actually a dangerous system and needs a complete overhaul. It needs someone with the courage to say this isn’t working. And if we’re going to be managing the virus for another 12 months, it’s worth thinking again, isn’t it?”

Preston city centre.
Preston city centre. Photograph: Richard Saker/the Observer

Dominic Harrison, director of public health at Blackburn with Darwen council, which was one of the first to set up a case tracing system in the summer, said the system could be reset – but it would take a couple of months. “Practically speaking, it would mean that the national system would have to pull out the resource relevant to each local authority and give it the local authority,” he said. “They would then have to recruit staff to do that. And those numbers could be very large.”

Another local health official was more blunt. “Go back to the drawing board. Design it with local expertise. Have some nationally led elements. Bring in Ministry of Defence logisticians for mobile testing. Plan to launch the brand-new system by Christmas, and then sack every other bloody company involved.”

A Department of Health and Social Care spokesperson said: “NHS test and trace is breaking chains of transmission thanks to local and national teams working hand in glove – almost 700,000 people who may otherwise have unknowingly spread coronavirus have been contacted and told to isolate. We’re working with directors of public health and have more than doubled the size of local health-protection teams to increase local contact tracing and stop outbreaks.

“We are reaching the vast majority of people testing positive and their contacts and are providing tests at an unprecedented scale, with capacity being expanded further to 500,000 tests a day by the end of October.”


Michael Savage and Rachel Smith

The GuardianTramp

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