The fourth session of the joint inquiry Coronavirus: Lessons Learnt considered the establishment of NHS Test and Trace, the growth of laboratory capacity and turnaround times for returning test results.
Leading immunologist Professor Sir John Bell and President of the Royal College of Pathologists Professor Jo Martin also gave evidence, as well as distinguished experts Professor Dame Anne Johnson and Professor Sir Chris Ham. Dean Russell focused on the effectiveness of contact tracing, based on experts’ understanding of the virus, as well as the benefits of centralised or local approaches and adherence to self-isolation.
Expansion of the types of tests available, including new rapid testing and prospects for mass testing within ‘Operation Moonshot’ was also discussed.
Baroness Harding previously appeared before the Health and Social Care Committee in its inquiry into the management of the coronavirus outbreak in June shortly after the launch of the Test and Trace programme, and gave evidence to the Science and Technology Committee in September as part of its inquiry into UK science, research and technology capability and influence in global disease outbreaks.
Professor Dame Anne Johnson, Professor of Infectious Disease Epidemiology, University College London
Professor Sir Chris Ham, Chair, Coventry and Warwickshire Health and Care Partnership, former Chief Executive, The King's Fund
Professor Dominic Harrison, Director of Public Health and Wellbeing, Blackburn with Darwen Borough Council
Professor Sir John Bell, Regius Professor, University of Oxford
Professor Jo Martin, President, Royal College of Pathologists
Professor Gerard Krause, Head of Department for Epidemiology, Helmholtz Centre for Infection Research and Director, Institute for Infectious Disease Epidemiology, TWINCORE, Hanover
Baroness Dido Harding, Executive Chair of NHS Test and Trace programme, Department of Health and Social Care
Dr Susan Hopkins, Chief Medical Adviser, NHS Test and Trace
Dean Russell: Baroness Harding, I extend my thanks to the team that has been building up the test and trace system over the past few months. It has been absolutely unprecedented. My question relates to engagement with directors of public health. I am very fortunate in Hertfordshire. I have a fantastic director of public health, Jim McManus, to whom I speak on a very regular basis. I have one question related to that. What is the strategy, and how regularly do you engage with directors of public health to get their feedback and to listen to their learnings on the ground?
Baroness Harding: Very regularly. As I said, on Sunday I was in Liverpool with Matt Ashton, their director of public health. Perhaps Susan should come in to talk more about the work that she and Carolyn Wilkins, who works for me and leads our contain team, are doing to make sure that we embed the wisdom, experience and advice of our directors of public health in everything we are doing. Susan led a large session at the end of last week. It might be useful for the Committee to hear about that.
Dr Hopkins: We ran a workshop, looking particularly at what we wanted from the future, jointly with local government directors of public health, Public Heath England teams and Test and Trace. We are going to use the learning from that workshop to work together with the new director of trace, Steve McManus, who is a nurse by background and is the chief exec of Royal Berkshire, to try to ensure that we implement the best way forward. I have a weekly call with the presidents of the academy and colleges, including the Faculty of Public Health, and engage with them regularly. I also regularly join a telephone call with the Association of Directors of Public Health. All of them know that they can reach out to me regularly, and they do, by both email and telephone contact. We continue to have very good directors or ex-directors of public health embedded across the test and trace team.
Dean Russell: Are you actively engaging them with regard to getting feedback on things like low cost and opportunities for improvement? I am hearing that some directors of public health may be on those calls, but the recommendations and suggestions they make are not always getting through to the frontline. Is that something you recognise?
Dr Hopkins: My door and my phone line are open—everyone in the country seems to have my mobile phone number—so they can call me at any time. I make sure that I amplify their voice at the board of Test and Trace. Equally, I ensure that we review all of their proposals that come through, to try to find a way forward. Clearly, I do not personally hold the purse strings of local authorities, but I am very keen on ensuring that their voice is heard.
Dean Russell: You absolutely commit to working with them moving forward on any papers that they might submit, for example.
Dr Hopkins: Absolutely.
Dean Russell: Brilliant. Baroness Harding, on the wider strategy with regard to using test and trace to help to slow the virus, could you give an outline of what the strategy is going into the next few months, particularly around how test and trace will help to slow the virus?
Baroness Harding: Absolutely. Thank you for that. There are two main things that test and trace will do as we go forward. The most important is finding people who have the disease or are highly likely to get it, and encouraging and supporting them to isolate. We are continuing to scale and to speed up that testing and tracing, to have more tests, so that we can find a larger proportion of the people who have the disease each day and reach them faster. The second piece is to be able to spot outbreaks early and support local teams to suppress outbreaks before they gain momentum. That is through a combination of more engagement, as Susan has just mentioned, working closely with local health protection teams in Public Health England and local authorities, and data analytics, using the data that we now have from test and trace and from other sources, such as waste water analysis, to spot outbreaks early and then support directors of public health to reach out to their communities to stop them growing. Think of us as doing those two main things. Our short-term plan has four themes: more scale, more speed, more engagement and leveraging more insight. That is the next phase of test and trace, off the organisation that we have built in the last five months, which, as I said, is already the size of Asda, and growing.
Dean Russell: With the announcement yesterday on the potential success of vaccines, do you foresee a point when the app will include an opportunity for you to say that you have been vaccinated and, therefore, can be opted out from the test and trace system? I am very conscious that as vaccinations go up, ideally, the testing will not have quite as much pressure on it.
Baroness Harding: It is very early days. As the Prime Minister and Professor Van-Tam said yesterday, we must all be careful not to get too excited and cross too many bridges on the vaccine. My job is to make sure that we scale and speed up test and trace so that it is another arrow in the quiver, as the Prime Minister said yesterday. It is an and, not an or. You are right to point to one of the potential scenarios for the future as being able to use some combination of our understanding of immunity, both natural and acquired, and testing data to enable people to do more things, but it is very early days.
Dean Russell: Dr Krause, thank you for your time. I was fascinated to hear your evidence just now. Often, from a UK-centric point of view, when we talk about what the successes are in other countries, everything sounds like it is running perfectly. It was fascinating to hear your views on the challenges. I am interested in those challenges a bit more. In Germany, you seemed to be way ahead of the curve in the early stages. I am interested to know why you think you were so far ahead at the start, and where Germany is now compared with the UK in terms of testing numbers and from a general public perception of how the Government are doing. Every country has its challenges. I would be interested to see whether ours are similar to yours.
Professor Doctor Gérard Krause: I have difficulties in making those kinds of comparisons because I do not know enough about the situation in other countries. One of the reasons why it may have been perceived that we were ahead of the curve for some time is that the surveillance system in Germany is generally quite good in international comparisons. It needs a lot of improvement and we are not happy with it as it is, but compared with many other countries—I don’t want to name a single one—it is effective and timely. To a large extent, it is digitalised and that has helped. It was, in fact, the German surveillance system that picked up the outbreaks in Austria that caused a huge wave in Germany. The Austrian outbreak was detected by Germany before the Austrians themselves, and that has to do with the surveillance system. That has helped, but, other than that, I am not sure what made the difference. It was probably because the Government took it very seriously from the beginning. That certainly helped.