A local response to test and trace system gaps

Proper contact tracing that includes support to isolate is the drum that EH professionals have been banging since the start of the pandemic. And at the east London borough of Newham, EH and public health have joined forces, working together to tackle COVID-19 starting with contact tracing and then evolving into a much larger service offering.

Newham has a huge number of risk factors for COVID-19: high population density, multi-generational households, a very mobile community, a large BAME community, poor air quality, low paid work and underlying health issues.

And while the national NHS Test and Trace team has been downsized, as the UK progresses along the road map to open up, Newham is actively recruiting to fill its COVID response team that has been supporting residents to self-isolate, and more.

Data was only made available in early autumn 2020 to allow the council to see the gaps where the national NHS Test and Trace system could not reach people in its borough. It then carried out research to find out what was going wrong and set up a local test and trace scheme to fill these gaps, which then evolved into the COVID response team formally launched in October.

In September last year, in England just two in ten people were found to be quarantining properly, according to the Scientific Advisory Group for Emergencies (SAGE), so this has been a big problem. More recent figures from the Office for National Statistics in March reverses this somewhat, finding just 15% in England are not following the rules.

Jason Strelitz, Newham’s director of public health, said: “We'd identified some time ago that actually there were considerable barriers where we work in Newham for people to isolate: there are a range of socio-economic barriers.

“And test and trace is only helpful if people isolate on the back of it. Even beyond that, we knew that there were barriers to people actually even testing because of the consequences if they tested positive.

“So we have really evolved our local contact tracing service into an isolation support service that tries to support people as best we can around the financial, psychological and practical barriers to isolation.”

He added: “Local authorities have increasingly been augmenting the NHS Test and Trace system to try and offer more support because of the absence of all of that support for isolation”.

Strelitz said the team calls residents that have tested positive for COVID-19 “immediately” and unlike the national team, which has been described as quite impersonal and even “robotic”, the Newham team carries out a welfare check.

This involves finding out how people are coping, making sure they understand evolving symptoms and how to access healthcare, and seeing if they need support through any aspects of isolation.

Depending on needs, the Newham team can then link a resident up with food support, for example, or with a befriending service, or advice about how to get financial support. The council can even offer free accommodation to assist with quarantining.

Some 33 people are being recruited to replenish the team as local authority officers return to their pre-COVID roles helping with opening up businesses, and the backlog of work that has been on hold. As with many PH initiatives, it can be difficult to evidence efficacy, as Strelitz says: “The outcome measure is that people isolate. And actually, that's a difficult thing to evaluate because people aren't forthcoming if they're not.”

Newham is currently working with Public Health England on how to evaluate the work. However, he added that his team has qualitative feedback giving them a lot of “interesting and important” insight so that “we absolutely believe it makes a massive difference”.

Strelitz stresses that the work Newham has been doing on COVID has been “ a real collaboration” between the council’s PH and EH departments.

EH officer Kerry Wood, who has been seconded to work on the COVID response team, spoke about her experience contacting residents. She said: “When we first started the conversation people would think we were just like the national team, but because we have these supportive conversations and are not just information gathering, they start to understand that we are here to help and they open up far more.”

Wood added that these types of conversations allowed officers to understand a person’s circumstances and pre-emptively offer services that the resident might not know was available. In addition, it can be complicated to connect to the right department within a council but because the team is local, and networked within the authority, they can get help much more quickly.

The team has been able to sort out a broken toilet for a family isolating, for example, arrange financial help with funeral arrangements, and in one instance was able to deliver insulin over the bank holiday weekend to a patient in need. To this day, one COVID-19 patient in her nineties who has no family around, although long recovered, still receives a weekly call from the team, ‘just because’ it’s what she needs and a connection has been made.

These sorts of interventions make “a real difference” to people’s lives and this is the feedback Wood said her team receives regularly.

What started off as an augmentation of the national NHS Test and Trace developed into isolation support and is now evolving further, into what Wood now describes as more of a “one-stop-shop” evolving with the different needs the pandemic throws up.

Last month, for example, the team contacted 2,000 people to encourage them to get vaccinated and on the back of that 600 appointments were made for people that had difficulties booking it for themselves, through for example not having online access or due to language barriers.

Wood said it had been a really positive experience working so closely with PH. She added: “Environmental health is really all about public health, as is local government. So we've seen the connexions for a very long time. But obviously in a pandemic, it brings it more to the fore it.”