By Dr Paul Redgrave, Sheffield Community Contact Tracers and retired director of public health.
The recent House of Commons Public Accounts Committee Report  condemns the absurd cost and failures  of the official Test and Trace service. It is crucial that the money be given to local authorities to run an effective and efficient Find, Test, Trace, Isolate and Support (FTTIS) service for their local communities. This service will be needed for the foreseeable future even if high levels of vaccination are achieved.
The phenomenal success to date of the Covid-19 vaccination delivery programme is built on existing systems for mass vaccination in primary care. It is coordinated by local authorities and there has been a massive effort by the voluntary sector as well as a lot of public cooperation. All these resources could have been used to create an effective FTTIS system a year ago. The fact that it has still not happened is a scandal, but it’s not too late to change the story. A lot of experience has been gained in places like Lambeth, Bradford, Calderdale, Sandwell and other areas piloting different models of contact-tracing which are quicker and more effective than the national Test and Trace service. In most places, with appropriate funding, an effective, locally managed service could be established within weeks. This could enable us to get close to or actually achieve zero Covid later in the summer. Many lives could be saved and much illness prevented and it would enable local economies to get going again.
It seems that the UK government is set to continue the scandal of commissioning Serco and other private companies to run the Test and Trace service. Thirty-seven billion pounds of taxpayers’ money has been allocated to this service  – the figures are almost too large to comprehend. To help, consider that the total annual NHS salary cost is around £47 billion, which amounted to 44.9% of the NHS budget in 2018/19.  We must see open and transparent accounting of the Test and Trace service immediately.
Failures in the design of ‘NHS’ Test and Trace are inexcusable. It has only operated on two of the five links of the crucial chain — Find, Test, Trace, Isolate and Support. It only tested symptomatic people who came forward and then only approached contacts suggested by index cases. It has failed to find many infected cases, failed to reach the asymptomatic, and failed to act in time. It still fails to adequately support people on low incomes, or to reach marginalised groups. It fails to provide facilities for people who cannot self-isolate at home and fails in backward contact-tracing.
Our government has imposed its ideological solutions – use the private sector whenever you can – when what was needed was to draw on existing practical experience. Public Health departments, environmental health officers, TB services, sexual health services and indeed primary care, are all very experienced at managing infectious diseases. ‘NHS’ Test and Trace was designed by an authoritarian government that side-lined scientific and medical expertise. It needs a radical critique and a serious public inquiry. Tens of thousands of people have died unnecessarily from Covid-19 in the UK. We also need to investigate the silencing of public health and clinical staff, imposed to prevent criticism of the government.
It could have all been so different. A whole year ago, a small group of retired public health and primary care staff formed Sheffield Community Contact Tracers (SCCT). We linked with a local community volunteer hub and the local Primary Care Network. We demonstrated in a small study  that volunteers could be quickly and safely trained to undertake contact-tracing of Covid cases identified by local GPs. We ensured that cases and quarantined contacts were supported throughout their isolation.
A flexible supply of contact-tracers is essential to run an efficient service. Furloughed public and private sector workers and volunteers could have been organised by local authorities into an effective and trusted service. This type of system could have been scaled up, as it has been in many countries. We must also make sure that the government resolves the conditions that have caused Covid to have a disproportionate impact on disadvantaged and ethnic minority communities. Trust is imperative to engage these communities with FTTIS and vaccination.
Using effective contact-tracing has been an important feature of successful management of Covid outbreaks elsewhere. Thirty countries have achieved ‘zero Covid’ and another fifteen are close.  But in the name of British exceptionalism, Boris Johnson and Matt Hancock have engineered one of the world’s worst Covid death rates and the most damaged economies. It is hard to reconcile the amount of human suffering and the massive economic and social dislocation with their claims to be proud of their record. We must have the humility to learn from those countries that contact-trace well and make radical changes to our service now,   and build effective public health for the future.
 House of Commons Public Accounts Committee. Covid-19: Test, track, and trace (part 1). 10 March 2021
 No evidence £22bn test-and-trace scheme cut Covid rates in England, say MPs | The Guardian
 Covid-19: NHS Test and Trace made no difference to the pandemic, says report | The BMJ
 Key facts and figures about the NHS | The King’s Fund
 Sheffield community contact tracers: training community volunteers to undertake contact tracing for covid-19 | The BMJ
 Deepti Gurdasani, BMJ webinar on ‘zero Covid’ 11.03.21
 Why many countries failed at COVID contact-tracing — but some got it right | nature.com
 Which countries do COVID-19 contact tracing?, Mar 10, 2021 | ourworldindata.org
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