Audit Wales recently published an overview of progress on the Welsh Government’s Test, Trace, Protect (TTP) programme. The report covers delivery of the programme up to the end of 2020, a point when COVID-19 cases were surging again, with more recent data up to the end of February 2021. The second part of the report focuses on the challenges ahead as the programme and the pandemic continue.

Healthcare is a devolved public service, so the Welsh Government runs a separate programme to NHS Test and Trace (NHST&T) in England, although there are some UK-wide arrangements such as the Lighthouse Laboratories that process tests. 

The principle behind both the English and Welsh programmes is broadly the same. The programme is a technique the majority of countries are using to try to control the spread of the pandemic in line with World Health Organisation advice. It consists broadly of three elements:

• testing those likely to have COVID-19;
• identifying the recent close contacts of those who test positive; and,
• instructing the close contacts to self-isolate to prevent them from spreading the disease further.

The National Audit Office (NAO) produced an interim report on the UK Government’s approach to test and trace in England in December 2020. It plans to publish a full value for money report in the spring of this year. The findings should not be directly compared with the Audit Wales report because the NAO report had a different scope and only covers the period up to the end of October 2020.

The NAO’s interim report found that NHST&T had achieved a rapid increase of testing capacity but had not achieved many of its objectives due to factors including the slow turnaround of test results and the failure to reach the target number of close contacts. The NAO also questioned the delivery model and called on the programme to learn lessons to ensure it plays a greater role in the suppression of the virus going forward.

The Welsh Government announced its Test, Trace, Protect strategy in May 2020 and has scaled up the programme since then. Audit Wales estimates it will cost at least £120m in 2020-21 in addition to redeployed staff time and costs borne by the UK government.

The report acknowledges there was limited testing and tracing infrastructure before the pandemic beyond small arrangements to respond to previous local public health outbreaks. The bodies involved have scaled up the TTP programme at speed but there have been times when it has struggled to cope with surging demand. 

When cases started to rise in late September, turnaround times for tests started to slip. For example, Lighthouse Laboratories provided results on only 30% of tests within the target of the next calendar day. This risks delaying the individual self-isolating and crucial contact tracing or, if the test is negative, the individual returning to work. 

Contact tracing has struggled during periods of rapid surges in the prevalence of COVID-19 in Wales. As of 19 December 2020, contact tracers reached only 24% of positive cases within 24 hours and only 23% of eligible contacts within 48 hours. This risks potentially infectious people being unaware they need to self isolate. The report identifies several factors that have hindered contact tracing including lack of capacity and the inefficiency of inexperienced staff brought in to cope with surging demand.

Despite these issues, Audit Wales concludes that overall contact tracing has performed well. It praises how the different public sector organisations have worked together and the “mutual aid” between the different regions, with the support of an all-Wales surge team, that has helped the system cope with local outbreaks. 

The report outlines how the parties involved quickly learnt lessons and resolved issues such as the quality of information or problems with the Customer Relationship Management (CRM) system. These have resulted in significant improvements in recent performance. As of 20 February, contact tracers reached 93% of positive cases within 24 hours and 75% of close contacts within a further 48 hours.

However, the report warns that challenges remain. There is a need for better data on the performance of the programme as a whole from the point at which an individual requests a test to when their contacts are traced and on compliance with self-isolation. This will be crucial information for ensuring the continued success of the programme as Wales gradually emerges from lockdown and continues its vaccination programme.

Audit Wales closes the report with a call for public sector organisations to use the positive lessons of the TTP programme to shape future public sector programmes. The urgency of the situation and the need for a coordinated response meant that organisations had to work well together and evolve at pace. It singles out the fast development of an all-Wales CRM system in only six weeks as a striking contrast to the slow and sometimes disjointed roll out of previous IT infrastructure. 

Oliver Simms, Manager, Public Sector Audit & Assurance for ICAEW, commented: “The COVID-19 pandemic has meant that governments have had to deploy unprecedented measures to attempt to control the spread of the virus. It has been essential that organisations work together and quickly learn lessons, as the Welsh Test, Trace, Protect programme has done.

“When the NAO publishes their report later this year, it will be interesting to see whether NHS Test and Trace in England has also been as successful at quickly evolving and addressing issues. Moreover, public sector organisations across the UK must heed the call to build on the positive lessons from the TTP programme, like effective partnership working and reacting at pace, to tackle the numerous challenges during the recovery.”