We need a tracing strategy, not toxic outsourcing – Ashworth’s Covid-19 update

Over 23,000 more people have died in care homes in the first four months of this year compared to last. The ONS says almost 12,500 of these are due to Covid-19; more than 10,600 are as yet unexplained. Meanwhile ministers boast that they put a ‘protective ring’ around care homes from February. But the tragic truth is, like with personal protective equipment (PPE), lockdown and testing, ministers were slow to respond and negligent in policy decision. Now we’ve seen an unfolding crisis in care homes.

There was no lockdown of care homes when needed. And while hospitals would not have purposefully discharged sick patients, there was no testing of people transferred from hospital to care homes until mid-April. Given what is known about asymptomatic transmission, many in the care sector believe this failure to test contributed to the seeding the virus.

Rather than prioritising infection control, PPE was requisitioned from care home staff and given to the NHS because of wider shortages. Guidance suggesting infection was unlikely was still in place even when there was community transmission. Shockingly, there is still no full testing of all residents and staff in homes nearly 12 weeks later. Failure after failure.

Labour has called for more support for social care from the start. We warned early on in this crisis that testing was a crucial tool in our fight to contain its spread in care homes, and we called for all staff and residents to be tested. Testing for all staff and residents is now urgent.

Our hard-working care staff are playing a vital role in keeping people safe during this pandemic. They go above and beyond every day to ensure older and vulnerable people receive the support they need. But they need more support themselves. Vacancies in the care sector and high numbers of staff self-isolating has meant care staff have had to make difficult choices that they shouldn’t be forced to make – such as whether to self-isolate when they start displaying symptoms or continue going to work to provide safe levels of care.

I have always argued that the lockdown in itself is not a strategy and that the government needs to build an effective plan to control the spread of the virus in the community. Testing should be expanded further beyond symptomatic carriers – with health and care workers the priority. A recent study from Imperial, for example, suggested that weekly testing of healthcare workers is “estimated to reduce their contribution to transmission by 25-33%, on top of reductions achieved by self-isolation following symptoms”.

Similarly, a paper in the New England Journal of Medicine warns that symptoms-based screening alone in nursing homes failed to detect large numbers of infectious cases. It recommends that “testing to include asymptomatic persons residing or working in skilled nursing facilities needs to be implemented now”.

But testing isn’t enough. Extensive testing, tracing and quarantining has reduced the spread of the virus in South Korea. Yet in the UK ministers abandoned this approach on March 12th. It means we’ve wasted precious time when we should have been building up tracing capacity, develop protocols and recruiting staff. This week, I wrote to Matt Hancock asking a series of questions about why this was allowed to happen.

Local government Directors of Public Health and public health staff – alongside other key local government staff such as Environmental Health Officers who know their local patch – have years of experience in contact tracing and case finding. They must now be fully mobilised to spearhead tracing.

Instead of giving local public health services the funding and resources needed to tackle the virus locally, ministers are relying on outsourcing company Serco. Serco has shown that it can’t be trusted to deliver on government contracts – it was fined £19m for failing to properly disclose the profits made from running the Ministry of Justice’s electronic tagging service.

Serco has already been forced to apologise over a data breach from its recruitment of contact tracers – before the service has properly got off the ground. Covid-19 shouldn’t be an excuse for yet more wasteful, toxic outsourcing. Our public health experts should be leading our response.

Tracing should be locally-led and properly integrated with primary care. GPs should be involved so they can monitor the health of their patients. And if people are asked to isolate, we need to provide support for those who otherwise would not be able to. We know that those in more deprived, overcrowded areas are at risk. Hotel space should be used free of charge to help people isolate if they don’t have the space to do so at home. It also means people need decent sick pay.

Without a strategy to test, trace and isolate people, society will not be able to reopen safely. Without support for care homes, our elderly and vulnerable relatives will continue to be the victims of this cruel virus. Both are crucial in the fight against this virus, and every day without proper action puts too many people at risk.