24.11.2020

Contact tracers still waiting on work as Test and Trace criticism mounts

Sir David King, the former government chief scientific adviser who now leads the Independent Sage group of scientists, has warned that the current measures will not be enough to pick up 80 per cent of the contacts of people with the virus, which they say is needed to prevent the infection rate rising. “The system as it stands is not fit for purpose,” he said earlier this month.

“I just don’t think it was very well thought through. I don’t think the government took it seriously enough, early enough” says Emma*, a contact tracer based in Newcastle. She’s one of 27,000 tasked with “unlocking the lockdown”, as health secretary Matt Hancock put it last month. But after more than four weeks of work, during which she’s made just six calls, Emma isn’t so sure the government’s “world-beating” system is proving the solution.

She isn’t alone. The Test and Trace programme, which identifies those who have tested positive for coronavirus and seeks to track down people they may have come into contact with, has been widely criticised for its shortcomings.

Figures released by the Department of Health and Social Care (DHSC) show that in the two weeks up to 10 June, some 20,968 people were referred to tracers after testing positive, of whom 15,324 were reached and provided details of the people they had been in close contact with in recent days. This means that 5,644 known cases and potential transmission routes were overlooked, along with the thousands of others who the Office for National Statistics (ONS) estimate were infected over the same time period.

Downing Street has meanwhile said it is unable to say if Boris Johnson’s pledge to get all coronavirus tests completed within 24 hours by the end of June has been met, adding that it was in discussion with the DHSC to “make that data available”.

Those implementing the system describe a picture of confusion and conflict. In Emma’s case, she is expected to contact those individuals deemed at low risk. Under the system formulated by the government, health professionals first obtain a list of recent contacts from people who have tested positive for coronavirus. Then, that list of contacts will be passed on to “tier three” workers who, like Emma, have been recruited from the customer services sector.

Next, this group of tracers calls these contacts to let them know there is a chance they have been exposed to Covid-19 and therefore need to self-isolate for 14 days. “It’s all quite easy to do,” Keith Neal, a professor of infectious diseases at the University of Nottingham, tells The Independent.

Emma similarly accepts that the job is a straightforward one – but in reality, it’s been far more simple than she ever envisioned. “I’ve only been allocated six calls since,” she says. “I’ve spoken to one person just once. The rest have been engaged or gone to voicemail.”

She says that for the 60 people in her team – all of whom are “tier three” tracers – there will be an average of 10 calls to make a day. “There’s not many of us who have spoken and done a full call,” she adds. “There’s some that haven’t had anything allocated to them.

“Most people are probably just sitting watching Netflix and clicking away and obviously having a bit of a chat in the work chat.”

Others have shared similar experiences with The Independent, describing the work, or lack of, as “mind-numbing” and a “waste of time”. Steve*, a contact tracer based in the Midlands, said he hadn’t made a single call before he quit after a month. Another said he was being paid “£375 a week to basically sit in front of my laptop all day and click refresh”.

“There’s only so much Fifa you can play during a day,” he added.

The system was launched on 28 May, following a hectic scramble to get it up and running, with thousands of rolling three-month contracts handed out to poorly trained and low-paid contact tracers. This came after the government scrapped the initial contact tracing system that was briefly rolled out in the early stages of the pandemic. “If we’d have stuck with it, we’d have far more work to do now,” says David.

Whereas other nations in Europe have turned to their robust public sectors to implement an equivalent approach, the government has outsourced parts of the test-and-trace service to a number of private companies, including Serco, whose contract is said to be worth £48m, Sitel, a multinational firm based in Miami, and Deloitte, which was entrusted with delivering England’s testing centres.

Emma received just one day’s training for the job from Sitel – having been informed at 1.20am by email that the session was due to start at 9am that day. “No webcam, just a screen share. 9-5, one full day. They talked us through the systems they were using, the theory, what it was going to be.” This was also the moment she was first told the job actually involved track and tracing, after initially applying for an unspecified vacancy on the gov.uk website back in April.

Although she says she was happy with the amount of training provided, others felt they could have benefited from more. “There were a lot of people who weren’t comfortable with that and didn’t feel they were prepared enough,” Emma says. “When people are getting allocated calls there’s a work chat and they’ll come on the chat and get worried and work themselves up. A lot of people aren’t from the right background.”

David*, a London-based tracer who was given his job without sitting an interview, said a number of his colleagues “shouldn’t be anywhere near this role”. He added: “You need customer-facing skills. You need to be able to read and write. There’s a lot of people who don’t fit into that category.”

Management has been absent at times, Emma adds. Those tracers who were first employed when the programme was being put together in early May have, at times, been entrusted with teaching and guiding new recruits, as opposed to senior team leaders who “hadn’t completed any of the training we’d done”, she says.

As for the process of informing people they’ve been exposed to someone with Covid-19, the tier-three tracers are unable to say who it is that they’ve come into contact with. The reason? They simply do not hold this information.

The Sage group has said there must be a 24-hour turnaround from sampling to test result to ensure the system is efficient (Getty)

“If I ring someone and say they’ve been in contact with someone for longer than 15 minutes, they’re supposed to already know as I don’t have any access to who it is, I can’t tell them as we don’t know,” says Emma. “And just because we’re calling them up and say they have to isolate for 14 days, I don’t really see what difference it makes. If you’re going to ignore the advice, you’re going to ignore what we have to say.”

In this sense, the public has a duty in fulfilling its role and making sure the system actually works, argues Prof Neal. “It’s over to the public now to actually be part of this system. It’s a public health problem which relies on public involvement.” This means getting tested when necessary, answering calls, providing a full list of contacts and going into quarantine when asked, he adds.

Baroness Dido Harding, the Conservative peer appointed to head the programme, said she was encouraged that the “vast majority” of contacts who spoke to tracers in the first week of the programme were willing to go into self-isolation. Yet, 4,809 people whose details had been passed on to the Tier 3 tracers (15 per cent) either proved impossible to track down or refused to heed advice to stay at home, the data showed.

“The system is there and ready to go – but it’s not getting enough information through. It needs cooperation from the members of the public,” says David. “If you’re not answering your phone or not giving over the info, or ignore the calls, then they’re not helping it. We’ve all got to take accountability for ourselves and do what we’ve been asked to do.”

According to Emma, tracers will make four attempts to get through to these individuals over a 48-hour period. After this, they are “deleted” from the system and not contacted again. The recent claim by Baroness Dido that NHS tracers try to contact people 10 times during a 24-hour period is a “lie, complete b******s”, says David. “We don’t do that,” he adds. “It’s against the law that level of contact, it’s harassment.” The DHSC told The Independent it stood by Baroness Dido’s assertion.

Prof Neal accepts there is going to be “thumb-twiddling” among some contact tracers as “we have surplus capacity”, which, he argues, is needed.“We’re better doing it this way,” he adds. “It’s the only way to get on top of it very fast.”

But such an approach naturally comes at a cost. NHS Test and Trace reports that out of the total 87,639 contacts who have been reached during the first two weeks of the programme, 9,997 of these were contacted by tracers outsourced to Serco. The remaining 77,000-plus contacts have been reached by Public Health England and council-led local health protection teams, who, only now, are being called upon to help get the system going.

This raises the raises question of whether 27,000 staff are needed at the national level and why the government has opted for outsourcing, instead of building on public sector expertise from the very beginning, argues Sir Chris Ham, the independent chair of Coventry and Warwickshire Health and Care Partnership.

“The government has tried to respond in a very centralised fashion throughout the pandemic, rather than recognising what the NHS can do at a local level,” he tells The Independent, adding that public health directors were “astonished” back in March when the government first asked Deloitte and Serco to implement the early tracing system, rather than turning to local authorities.

He points to the example of Germany, with its devolved system of governance across the country’s 16 states, where local leadership has been trusted with leading the local response, helping to deliver a system that puts England’s to shame. “What the pandemic is showing up is the very deep seated weaknesses in the system of government, which relies far too much on Whitehall and Westminster and doesn’t recognise and value what can be done locally, and much effectively.”

The most recent Sage report on Test and Trace, released on 17 June, echoed this sentiment. It concluded that “key components of this system are themselves based on outsourced services, are fragmented, suffer from poor data linkage, and do not provide an integrated system based on the existing public health and NHS infrastructure”.

It added that in order for the system to be efficient, there must be “a requirement for a 24-hour turnaround from sampling to test result precipitating contact tracing”.

Labour MP and shadow minister for the Cabinet Office Rachel Reeves has criticised the government for its “obsession with outsourcing”, telling The Independent “it is in fact the achievements of public services which have delivered almost 9 in 10 successful contacts of those at risk of Covid-19”.

The government has outsourced parts of the test-and-trace service to a number of private companies (POOL/AFP via Getty Images)

“We would urge the government to learn swift lessons and utilise the existing expertise we have within our public services because as the evidence shows it leads to better outcomes as well as value for money.”

In response, the government said the claims made against the contact tracing system do not reflect the scale of work being carried out, and that it was working to improve the programme.

A spokesperson for the DHSC said: “NHS Test and Trace has already helped to stop more than 100,000 people from unknowingly spreading the virus.

“We have over 27,000 fully trained contact tracers in place who receive the initial contact and escalate cases to local public health protection teams where necessary, as part of our integrated system.

“With rates of infection relatively low it is entirely right that some call handlers have spare capacity. As restrictions lift and people return to a more normal way of life, the role of contact tracers and social distancing measures will be even more vital.”

When contacted for comment, Sitel told The Independent it supported the response provided by the DHSC.

A Serco spokesperson said: “In just four weeks we mobilised many thousands of people which is a huge achievement and we are focussed on ensuring that our people are able to support the government’s programme going forwards.”

http://www.independent.co.uk/

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