Wales’ test, trace, protect programme will need to evolve if it is to remain fit for purpose and keep coronavirus “in check”, a major review has concluded.

The Wales Audit Office, an independent public body which looks at how public money is spent and used, has carried out a comprehensive assessment of the TTP service to date.

The programme was praised for rapidly building a system of testing and contact tracing “largely from scratch and on an unprecedented scale”, bringing together different parts of the Welsh public sector and other agencies.

Auditors noted that contact tracing teams were quickly established across Wales and generally performed well, helped by a “mutual aid agreement” between regions. However at times of high demand across Wales the system has “struggled to track positive cases and their contacts quickly”.

The report stated: “There is good information to show the range of services and support available to help the public self-isolate when needed but our work has found that it is difficult to know how well the ‘protect’ element of TTP is working in practice.

“The programme has demonstrated that it can adapt and evolve quickly, learning lessons from the management of early outbreaks and trying to effectively marry Wales specific and UK-wide arrangements.

“However this has been a challenge, with officials describing it as trying to ‘design, build, and fly an aircraft all at the same time’.”

40 testing sites in place, carrying out 96,000 tests per week (equivalent to the average number of outpatients seen by Cardiff and Vale University Health Board every two months) 2,400 staff appointed and trained to provide contact tracing (equivalent to just under half of the total workforce employed by the Welsh Government) Eight regional teams in place tracing, providing advice to, and following up on 14,000 positive (index) cases and 31,200 close contacts per week (equivalent to the average number of 999 calls made to the Welsh Ambulance Service each month)

The Welsh Government element of the TTP programme is expected to cost more than £120m during 2020-21 – three-quarters of which will be on testing.

But the actual costs to the taxpayer are considerably higher because Wales does not pay directly for its share of testing sites or laboratory facilities which are commissioned by the UK Government.

In the early stages of the pandemic the report noted that testing capacity in Wales was insufficient to cope with the increasing incidence of Covid-19.

Total processed tests for Welsh residents split by NHS Wales and Lighthouse Labs provision up to February 25, 2021

Total processed tests for Welsh residents split by NHS Wales and Lighthouse Labs provision up to February 25, 2021
(Image: PHW)

“Wales needed to make use of the UK Lighthouse Lab network and increase capacity within Welsh laboratories to cope with the demand for tests,” it stated.

“After some initial logistical challenges this hybrid testing system has largely been able to turn around tests quickly. However the testing system in Wales needs to continue to evolve to ensure it is fit for purpose, especially in respect of hospital patients.”

Welsh NHS lab turnaround times for hospital tests, and more latterly community and mass tests, have generally performed well, with more than 80% of hospital tests and more than 70% of community tests turned around within one calendar day.

But their turnaround times for asymptomatic key workers and care home residents within one calendar day has been as low as 25%. This has more recently increased to around 50%, although it is important to note that the expected turnaround times for this cohort is three calendar days.

In contrast Lighthouse Lab turnaround times for community testing performed well until September 2020 but timeliness sharply declined when demand increased, with an average of just 30% of tests turned around within one calendar day at the end of October. Performance has since improved and was running at 98%.

According to Public Health Wales, since the pandemic began 2,874,978 tests have been carried out on 1,733,848 individuals – more than half of Wales’ entire population.

The Wales Audit Office report has highlighted a number of key challenges and opportunities as the TTP programme continues throughout 2021. These are the main points:

Better information –the different parts of the Welsh public and third sector need to have better information to help improve efficiency and evaluate the overall impact of the TTP programme.
Fit-for-purpose testing – to continue to respond to the pandemic during 2021, tests will need to be easily accessible, supported by a clear rollout plan on how rapid test devices will be applied. Frequency of testing for patients and staff also needs strengthening to prevent any future outbreaks in hospitals. Skilled, resilient workforce – staff involved in TTP have been working under considerable pressure and, for many, have also been redeployed from other parts of the public sector. A skilled and resilient workforce is needed to enable TTP to continue throughout 2021 as the wider public services start to reopen. Influencing the public – TTP is only part of the response to limiting the spread of Covid-19 with a real reliance on the public to follow the rules and self-isolate. As the public grow weary of the pandemic and restrictions on everyday lives, influencing public behaviour remains a huge challenge. Applying the learning – the TTP programme has demonstrated the ability for public services to work together and at pace to get things done. As attention moves to different responses to the pandemic it is important that the positive learning from the programme is captured and applied to how partners work together in the future.

Auditor General Adrian Crompton said: “Wales has developed a test, trace, protect service largely from scratch and at unprecedented scale and pace.

“It’s been particularly encouraging to see how well public sector partners have worked together at a national, regional, and local level to combine specialist expertise with local knowledge and an ability to rapidly learn and adjust the programme as we’ve gone through the pandemic. It’s important that the positive learning is captured and applied more widely.

“There have been times when the test, trace, protect service has been stretched to the limit but it has responded well to these challenges. The programme needs to continue to evolve, alongside the rollout of vaccines, to ensure it remains focused on reaching positive cases, and their contacts, and supporting people to self-isolate to help keep the virus in check.”

In response a Welsh Government spokeswoman said: “We welcome the findings of the Wales Audit Office and are pleased the report recognises the significant achievement in rapidly creating a new and effective system that has helped to control the spread of Covid.

“The test, trace, protect system in Wales has proven successful thanks to the strong partnership between local authorities and local health boards and the incredible work of their staff whose knowledge of their communities has been instrumental in its success.

“Testing and tracing will remain a vital part of our approach as lockdown restrictions ease and we have recently confirmed an additional £60m to extend contact tracing until the end of September 2021.”

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