Policy paper

Breaking chains of COVID-19 transmission to help people return to more normal lives: developing the NHS Test and Trace service

Published 30 July 2020

This policy paper was withdrawn on 10 December 2020

This has been superseded by the NHS Test and Trace business plan published on 10 December 2020.

Applies to England

This applies in England

Foreword from Dido Harding, Executive Chair, NHS Test and Trace

It’s hard to believe that NHS Test and Trace is just 8 weeks old. Since we launched, over 2 million more people have been tested for coronavirus, and over 34,000 people have tested positive. We have been able to contact over 200,000 people who might have unknowingly spread the virus otherwise. Over 30,000 people have given us their feedback – and 87% were satisfied or very satisfied with the service. And if you now go to get a test in person you can be confident that you will get your test result the very next day. We have made extra funding available, published a framework to show how we will work on a more local level, and given local authorities new powers to make it easier for them to do what’s right for their area, with national backing and support. And we have created the Joint Biosecurity Centre to be the data brain of the organisation.

NHS Test and Trace has been stood up at great pace and scale, but we do not operate alone. We work with and through partners across the country. Every week our brilliant public health teams in Public Health England and local authorities are successfully managing over a hundred local outbreaks.

We are now publishing our business plan for the months ahead, to stop the spread of the virus over the summer and into winter. This sets out what we plan to do and how we will do it. This is an ambitious and challenging plan which includes doubling testing capacity, making testing easily accessible to everyone, launching an app, expanding local public health teams and launching backwards contact tracing. But when it comes to the virus, the sum really is greater than the parts. NHS Test and Trace is a service that only works when we work together. It requires all of us to play our part – from wearing face masks, washing our hands and following social distancing rules, to getting tested if we feel sick and self-isolating if we are asked.

I am hugely grateful to everyone who has been involved in getting NHS Test and Trace off to such a successful start, including every member of the public who continues to play their part. Together we can get back to the things we love.

– Dido

Introduction

NHS Test and Trace forms a central part of the country’s COVID-19 recovery strategy, which seeks to return life to as close to normal as possible, for as many people as possible, in a way that is safe and protects our NHS and social care.

The primary goal of NHS Test and Trace is to help break chains of COVID-19 transmission and enable people to return towards a more normal way of life. This involves working across local government and local communities, Public Health England (PHE), other national bodies and a wide range of partner organisations to deliver the following objectives, which form the basis for the 4 key workstreams set out in this business plan:

1. using testing to find people who have COVID-19 and ensure both they and their recent contacts self-isolate to avoid passing the virus on to other people
2. managing outbreaks in local communities and reducing the risk of local outbreaks
3. helping individuals, businesses and public services to better understand and manage risks of COVID-19 transmission
4. building a trusted service with and for the citizens who use it

We launched NHS Test and Trace on 27 May, building on the expansion of testing capacity to ensure everyone with symptoms can get a test. Since then:

• we have provided up to 200,000 swab tests a day for COVID-19, delivered over a million antibody tests, and are now able to deliver next day results for over 95% of in-person tests
• through over 27,000 dedicated contact tracing staff working under the leadership of PHE, local public health experts and online contact tracing services, we have worked with over 33,000 newly diagnosed people to identify their recent contacts and successfully reached over 184,000 contacts and advised them to self-isolate
• we have published our Contain Framework which sets out how national government and local authorities will work together to manage local outbreaks. All 152 upper tier local authorities have published local outbreak management plans and local and national bodies have worked together to manage specific local outbreaks, most notably in Leicester
• we have established the Joint Biosecurity Centre (JBC) as an integral part of NHS Test and Trace, combining epidemiological expertise and analytical capability to provide data, insights and analysis to help identify and manage outbreaks and prevent the onward transmission of the virus

Our model is designed to be:

• driven by scientific and operational expertise. We are fighting an ever-evolving public health threat. To have maximum impact we need to base everything we do on expert scientific, medical and technical advice. Our plans are informed by the best science as we know it today – and we will collaborate with national and international experts to ensure we adapt our approach as the science evolves
• local by default. The virus strikes at the heart of our local communities. To most effectively counter it, we need local planning, response and insight. We will work with local authorities and other community partners to minimise the risk of local outbreaks occurring and, when they do occur, to respond swiftly and effectively to stop the spread of COVID-19
• inclusive and tailored to the needs of diverse users. The virus affects people differently and our service needs to counteract this so all can benefit. All our work is designed to foster an inclusive culture, listen to the communities that we serve and develop trusted services that work for everyone who needs to use them
• partnership-based. Countering this virus requires a collective effort, with everyone playing their part – from people washing their hands to companies putting in place COVID-secure working practices. We will work collaboratively with the public, local government, PHE, the NHS and social care, other public services, businesses and employers, the life sciences industry and a range of other partners, so that NHS Test and Trace is a shared, common endeavour
• continuously improving. We are still a new organisation and our knowledge of the virus is improving week on week. We need to continuously improve, learning from things that worked and did not work, and innovate to enhance the experience of service users and increase the impact of the service. We will use the analytical data and local insight we derive from testing, contact tracing and other sources, the latest scientific evidence from around the world, and the insights of people using the service

This document sets out the key next steps in the development of the NHS Test and Trace service and our priorities for the next 3 to 6 months.

The NHS Test and Trace service covers England. We work in collaboration with the devolved administrations to ensure a consistent and joined-up approach to testing, tracing and outbreak management across the UK. The JBC is also working with the devolved administrations to explore how it can work most effectively across the UK.

Finding people who have COVID-19 and ensuring both they and their recent contacts self-isolate to avoid passing the virus on to other people

Key objectives:

• increase awareness of NHS Test and Trace from around 60% today to over 80% by October, supported by a new marketing campaign
• double our capacity to test for COVID-19 from almost 200,000 daily tests today to 500,000 by the end of October
• expand asymptomatic testing and target it at groups and areas of greatest risk to help us find more positive cases, with an average of at least 150,000 asymptomatic tests per day by September
• ensure testing is accessible to all who need it by increasing to over 500 testing sites across the country by October and continuing to expand the range of additional local settings where people can access tests
• further improve testing turnaround times, with the aim of providing results within the next day after booking a test wherever possible and in at least 80% of cases for urgent in-person tests by the end of July
• increase the number of contacts we reach and advise to self-isolate
• reduce the average time from a person ordering a test to the point – if they test positive – of advising their contacts to self-isolate

The Test and Trace journey generally begins with someone developing symptoms, self-isolating, and ordering a test to find out if they have the virus. The proportion of people with symptoms who self-isolate with other members of their household and order a test – and the speed with which they do so – are critical factors in stopping the spread of the virus. The faster we carry out tests and report results, the faster we can then act to trace people’s contacts and close down chains of transmission. Targeted use of asymptomatic testing, for instance in high-risk settings or as part of local outbreak management, also enables us to go further in identifying new cases.

During the first phase of the pandemic, our testing priorities were to find a reliable test and scale up the capacity to deliver it. We focused on the safety of patients and those at greatest risk, on getting critical workers back to work, and on improving our understanding of the virus and its spread. Our goal was to ensure that anyone who needed a test would be able to access one.

In a few short months, that is exactly what we have achieved. At the beginning of the pandemic, we had the capacity to conduct around 2,000 tests a day. Today, we have the capacity to conduct over 200,000 tests a day and have delivered more than 15.4 million tests. We are testing on a scale that has never been seen before in the UK. Reporting methodologies vary, but data suggests that the UK is testing at a higher rate per 1,000 of the population than other countries of comparable size, including Germany and Spain.

We are now building on these foundations to ensure that our testing is reaching all those who need it, that testing is effective in finding and containing the virus, and that we are well prepared for winter. We are incorporating testing into an end-to-end Test and Trace journey that enables people who have tested positive to share information about their recent contacts quickly and confidently, and enables those contacts to self-isolate promptly to stop the further spread of the virus.

We will increase our capacity to test for COVID-19 to 500,000 daily tests by the end of October in time for the winter

We have already built enough capacity to ensure that anyone with symptoms can rapidly access a test, and that we can test those without symptoms where clinical advice recommends that we do so because of an increased level of risk. We will continue to grow our capacity so that we are resilient, including being prepared for winter when we expect increased demand for testing as people experience flu-like symptoms that may be hard to distinguish from COVID-19.

As well as growing and improving our current testing network, we will drive forward the most promising new testing techniques and technologies and accelerate the path to their safe and effective deployment. These innovations will enable testing to be undertaken at greater scale, in a wider range of places, by a wider range of partners.

By the start of the winter, we aim to double UK daily swab test capacity to 500,000 by increasing capacity within existing labs, opening and partnering with new labs, and introducing cutting-edge testing techniques and technologies.

We will promote greater awareness of the importance of self-isolating and taking a test for anyone who has symptoms of coronavirus

We are introducing a new marketing campaign and targeted communications strategy to raise awareness of the importance of testing – and make it easier for people to realise they have symptoms of COVID-19. This will help increase the number of people with symptoms who self-isolate and quickly order a test to find out if they have the virus as soon as they display symptoms.

We will improve our ability to target tests to find more positive cases

For testing to be effective in helping to contain the virus, we need our tests to find as many positive cases of the virus as possible. Our top priority is to make it as easy as possible for anyone with symptoms to come forward and take a test. But many people with the virus either have no symptoms at all or symptoms that cannot easily be identified as COVID-19. This means that a proportion of the people we want to find won’t ever know they need to take a test.

We will therefore also use our testing to find more positive cases among those without symptoms, so we can ensure they self-isolate and stop onwards transmission and so we can learn more about the virus and how it is spreading. The best way to do this is by testing around any clusters or outbreaks, so that we can find further cases and stop further transmission.

We will use JBC’s insight and analysis and the latest scientific advice and evidence to ensure our tests are targeted where they are needed most. We will target our testing to help us monitor risk levels in different groups, settings and regions, so that if any outbreaks occur or levels of infection rise, we can respond rapidly.

While our priorities will evolve in line with the evidence, our current asymptomatic testing priorities are to:

• test widely around any outbreak to help find more cases
• test all staff in adult care homes weekly, alongside targeted testing of the wider social care community
• test staff in hospitals where there is any indication of increased prevalence or risk
• undertake targeted testing of groups and occupations who may be at higher risk, such as in prisons, among the homeless and in high-exposure occupations
• undertake extensive testing for research studies, to help monitor changes in prevalence of COVID-19

We will ensure testing is fast and accessible to all who need it

For testing to have maximum impact, we need everyone to take a test as soon as they start to experience symptoms and to receive their results quickly. This is so that we can reach their contacts promptly and advise them to self-isolate, preventing the virus from spreading further. Our aim is to ensure that people receive results the next day from symptom onset wherever possible.

To achieve this, we will make it far easier to get a test close to where you live. We have already established a national network of 70 drive-through test sites in every region. We are now rolling out mobile testing units which local public health experts can rapidly deploy to places where testing is most needed. By the end of July, we will have over 200 of these units in operation and able to be deployed across the country.

To improve access for local communities, we will significantly improve access to walk-in testing and enable local authority directors of public health to set up local testing centres in settings that best meet local need. We will be guided by directors of public health, but we expect to be able to provide around 200 local testing sites in primarily urban locations. We will also make it easy for GPs to order or provide tests and have testing stock available in community settings where possible. Taken together, our ambition is that a majority of urban populations will be able to access a test within 30 minutes’ walk by the end of October.

We will overcome barriers individuals or groups may face in accessing testing with confidence – whether as a result of disability, language barriers, lack of digital access or cultural factors – by working in collaboration with specialist partners and the users themselves. And we will continue to ensure that home testing is available for anyone who needs it.

We will improve our end-to-end processes to speed up the time it takes to get results. We will drive efficiencies across all our channels and at every stage of the testing process. We will improve the speed and efficiency of laboratory processes. We will make improvements across our testing operations to optimise digital booking, courier collections and sample tracking, and we will accelerate results from home tests.

We will enhance the overall Test and Trace user journey to increase the number of contacts who successfully self-isolate and reduce the time from symptom reporting to self-isolation

NHS Test and Trace has already worked with over 33,000 people with coronavirus to identify over 220,000 people who have had close recent contact with them and who are therefore at heightened risk of having the virus. Of those contacts, over 184,000 – around 83% – have been successfully traced and advised to self-isolate to protect the people around them.

Our priorities over the next 3 months are to:

• increase the overall number of people who enter the Test and Trace journey by reporting their symptoms and ordering a test, as set out above – this will have the single greatest impact in increasing the number of contacts who are traced and who self-isolate
• strengthen collaboration with local government to further enhance contact tracing in relation to more complex cases
• increase the proportion of identified contacts who we reach and who successfully self-isolate
• shorten the average length of the user journey so that the great majority of contacts self-isolate before they are likely to be infectious to other people

We will work with the public to improve awareness of the service and its importance in stopping the spread of COVID-19, help them use the service quickly and confidently, and ensure they feel supported throughout. We will provide a more seamless user journey through enhancements to user experience and the user interface – for example, reducing the number of ‘clicks’ through the digital journey and the need to provide the same information at different stages.

We will work with local government to enhance the role of local authority public health teams and PHE’s health protection teams in relation to contact tracing in more complex settings or involving vulnerable people. This will include further expanding expert contact tracing capacity in public health teams across PHE and local authorities and establishing arrangements for surge capacity and mutual aid to meet peaks in demand.

Over the next 3 months we will continue to speed up, and reduce drop-offs in, the user journey using the latest innovations and technology to:

• reduce the time it takes for people who have symptoms to identify them and book a test, for example by providing clearer information earlier in the booking process on test availability
• increase the number of contacts we successfully identify and the speed with which we can trace them, including by:
  • using QR code technology to help people keep an accurate log of the places they have visited (see section 3)
  • encouraging people to start to compile information about their recent contacts at the point they order a test
  • introducing an inbound calling route to make it easier for people who have tested positive to share information with us
• increase the number of contacts we successfully reach, for instance by working with local government to pilot a range of approaches for outreach to people who do not respond when contacted by NHS Test and Trace
• support people who need to self-isolate – whether they are people who have COVID-19, other members of their households, or non-household contacts – for instance by offering follow-up calls and more proactively signposting the support available from the NHS volunteers service, as well as continuing to explore further targeted support with wider government, building on the financial support which has already been provided so far

We will continue to adapt and tailor NHS Test and Trace – and the information and guidance we provide for the public – so that it is easy for everyone to access and use. This includes delivering further improvements for:

• non-digital users (for instance, making it easier to relay test results to people who can only access them by phone)
• those who speak languages other than English (for instance, through additional language support options)
• those who lack capacity to make decisions for themselves
• people with disabilities

We will continue to work with other countries to ensure effective contact tracing where someone who has contracted COVID-19 or one of their contacts has travelled abroad, working through the National Focal Point that each country has established under the International Health Regulations.

Managing localised outbreaks in local communities and reducing the risk of local outbreaks

Key objectives:

• extend and enhance contact tracing from August to help identify clusters and outbreaks and stop them growing into wider community transmission
• establish an effective and resilient integrated operating model to identify and respond to outbreaks, supported by the new CONTAIN framework
• support county and unitary councils to refine and improve their Local Outbreak Control plans and ensure they have the capacity and capability to deliver
• increase our ability to deploy additional testing capacity to respond to outbreaks and clusters within 24 hours of request, and within 12 wherever possible
• establish robust processes to ensure effective stakeholder engagement
• provide tools to support effective community communications and engagement

In the early phase of the pandemic, the government applied national lockdown measures to bring the incidence of new cases – and the rate of reproduction – under control. The significant reduction in the daily incidence of new cases enabled the government to ease or lift those national lockdown measures on a phased basis, while continuing to achieve the overall goals of saving lives and protecting the NHS and social care system.

Those national lockdown measures are increasingly being replaced by more targeted and localised actions to prevent the spread of the virus, enabling more people to return to more normal lives. Those more targeted actions take place at 4 main levels:

• identifying individual new cases of coronavirus and ensuring that they and any close recent contacts self-isolate to stop the further spread of the virus (as set out in section 1 of this document)
• identifying clusters, i.e. where two or more new cases are associated with a specific setting such as a factory, but without evidence of a common exposure and taking targeted action in that setting to prevent onwards transmission and reduce the risk of recurrence
• identifying outbreaks, i.e. where two or more new cases are associated with a specific setting and there is evidence of a common exposure, and taking targeted action to prevent onwards transmission and reduce the risk of recurrence
• identifying community spread, i.e. where there has been a more widespread increase in new cases across a local community, and more intensive local or national actions are needed

We will continue to develop our insight and analytics function, integrating a wide range of data and research techniques, to support early identification of outbreaks and drive effective local and national decision making across the NHS Test and Trace service

As an integral part of NHS Test and Trace, the Joint Biosecurity Centre (JBC) acts as its central analysis and insight function, working closely with PHE. The JBC brings together capability and expertise in data science and public health to inform national and local decision-making and help direct action on testing, contact tracing and local outbreak management as part of our national response to COVID-19. The JBC and PHE are key strategic partners, working together to strengthen knowledge and understanding of the evolving COVID-19 epidemic and provide intelligence to national government, local government, local Health Protection Teams and others.

The JBC brings together data, insight and predictive analytics from across the whole NHS Test and Trace service and from a range of other sources. Working in partnership with PHE and across the Office of National Statistics, the NHS, local government, industry and academia, we provide targeted and actionable data, information and insight to decision makers at all levels to:

• provide insights into the factors that affect the spread of COVID-19 and their potential consequences, including focused insight into the sectors and settings that are the most significant drivers of the transmission of the virus
• help local decision makers understand how their infection rates are changing relative to the national picture, what factors lie behind localised increases in infection rates, the potential consequences for the local health and care system, and where action should be prioritised to stop the spread of the virus
• help drive decisions on where and how to deploy testing capacity, improve the speed and coverage of contact tracing, identify and manage clusters, and improve understanding and awareness of risk for individuals, businesses and public services

We and PHE share data with local authorities so they can take informed decisions about the action which may be necessary. All Directors of Public Health in upper tier local authorities now have secure access to daily postcode-level data on tests, positive cases and contacts. We will continue to improve this area to ensure local authorities – and other relevant local leaders – have access to the data they need along with improved tools and insight to tackle the virus in their local area.

We also assess the overall level of risk posed by the virus, identify where that risk is most concentrated, understand the primary drivers of risk and draw on this insight to inform the COVID-19 Alert Level.

We will also provide an assessment of the risk of transmission of COVID-19 from abroad and ensure that lessons from other countries’ experiences are brought to bear on national and local decision making in this country. We will develop our ability to source, assess and operationalise the best research, analysis and models from academia and industry.

We will increasingly automate our processes to support rapid, timely decision-making. We will standardise the insight we provide into a defined product suite and put in place a commissioning process for national and local decision-makers to request JBC analysis and advice.

We will follow a transparent approach to the assessments and analysis we undertake. We will ensure peer scrutiny and challenge of our analytical methods and seek to crowd-source new approaches to incorporate in our work. We will work to a strict privacy and data ethics framework.

We will scale up our capacity to identify clusters stop those clusters growing into wider community transmission

When someone tests positive for COVID-19, NHS Test and Trace works with them to identify people with whom they’ve had close contact in the period beginning 48 hours before symptom onset. This is vital in tracing people who may have recently contracted the virus: if they start to self-isolate within 4 to 5 days of exposure to the virus, this dramatically reduces the risk that they in turn will pass the virus to other people.

As lockdown measures start to be eased (for instance in the hospitality and leisure sectors), we will now extend this approach, so that we can also look back at where and when people are most likely to have caught the virus. This will enable us to identify potential infection clusters, i.e. where several new cases can be traced back to a specific setting or event. If we can identify other people who may have been exposed to the virus in that same setting at the same time, we can then take action to help prevent further transmission.

From August, we will extend and enhance our approach to contact tracing to enable us to go further in identifying where a number of new cases are linked to a specific setting. This is the approach we already follow in high-risk settings such as hospitals, care homes and prisons. To do this, we will:

• systematically collect wider information on where people who test positive for COVID-19 have been and any contact they have had with infectious individuals in the full seven days prior to the onset of symptoms
• identify common links between confirmed new cases of COVID-19 and identify possible chains of transmission linked to specific settings or events
• trace people who may have been exposed to COVID-19 infection as a result of these clusters and take appropriate action to prevent the onward spread of the virus

We are enhancing the data and analytics systems used by NHS Test and Trace to recognise matches between potential sources of transmission, filter those matches to identify those which may indicate a cluster, and escalate clusters for investigation by local public health experts. The JBC and PHE will work together to provide focused insight on the sectors and settings that are the most important drivers of the transmission of the virus.

Where multiple new cases can be traced back to a specific workplace or institutional setting, we will – as now – work with the relevant business or public service to identify who may have been exposed to the virus at the relevant time and place.

On 2 July, we published guidance for the hospitality sector (including pubs, bars, restaurants and cafes), tourism and leisure (including hotels, museums and cinemas), close contact services (including hairdressers and tailors), facilities provided by local authorities (including community centres and libraries) and places of worship, setting out how to maintain logs of visitors, customers and staff. This will enable NHS Test and Trace to trace people in these settings, where there is evidence of a cluster of cases.

Local public health experts – PHE’s local Health Protection Teams working with local authority directors of public health – will decide on a case-by-case basis on the most appropriate action to prevent the onward spread of the virus. In some cases, this will involve alerting people and asking them to take extra care with social distancing and hygiene measures and to be extra vigilant in spotting potential symptoms.

Depending on the length of time that has elapsed since the event, it may involve advising people to get a test, so that we can identify people who have caught the virus but do not have symptoms or have yet to develop symptoms. In cases of highest risk, it may involve asking people to self-isolate.

We will ensure an effective and resilient operating model to identify and respond to outbreaks, integrated with other parts of the Test and Trace service

A fast and effective operational response to local outbreaks is central to the impact of the overall Test and Trace service. All local authorities now have local outbreak plans specific to their area and community.

The COVID-19 contain framework published on 17 July sets out how local authorities and national government will work together to manage local outbreaks. It describes the powers available to local authorities to manage outbreaks, including new powers to close specific premises, close public outdoor spaces and cancel events, as part of a wider toolkit of local measures. These powers will enable local authorities to act more quickly in response to local outbreaks, where speed is paramount to prevent them from spreading more widely. Use of these powers will be subject to the necessary appeal routes and oversight structures to ensure they are used appropriately.

The COVID-19 contain framework also sets out the role of Test and Trace Support and Assurance teams in linking action at local and national levels, offering advice on escalation of critical issues and rapidly scaling up responses where necessary. It sets out how the NHS Test and Trace service will use a range of indicators to identify upper tier local authorities that are:

• areas of concern: those areas with the highest prevalence where the local authority is taking targeted action to reduce prevalence
• areas of enhanced support: for areas at medium or high risk of intervention, where there is a more detailed plan agreed with the national team and with additional resources to support the local team
• areas of intervention: where there is significant spread that requires a detailed action plan and augmented national support

To support local outbreak management, we will further increase our local health protection teams to work with local authorities, providing additional expertise in environmental health, epidemiology and health and safety. We already have plans to treble the size of these teams from 360 people to 1,100 by the end of July and will increase this further ahead of winter.

Over the coming months, we will complete work to:

• ensure clear ownership and accountability for each of the key decisions that need to be taken during the lifecycle of an outbreak (before, during, after)
• ensure the rapid flow of data to support integrated decision-making locally and nationally, supported by the JBC
• develop standardised processes and tools, including decision criteria and thresholds, to coordinate the response to outbreaks locally and nationally
• provide easy-to-use integrated dashboards that provide the necessary data and predictive analytics to provide early warnings, monitor outbreaks and support rapid, effective decision-making
• ensure that testing capacity can be rapidly and flexibly targeted at areas of concern as part of managing local outbreaks
• ensure a coordinated approach across relevant government departments to support local authorities, the local NHS and other public services (e.g. the police) during a local outbreak
• work with local authorities to ensure they have the right capacity for the winter period supported by enhanced health protection teams and by clinical contact tracers
• drive continuous improvements in performance, supported by the right behaviours and culture, including a rigorous focus on outcomes and follow-up action

We will support county and unitary councils to refine and improve their Local Outbreak Control plans and ensure they have the capacity and capability to implement those plans

All county and unitary councils have now published COVID-19 Local Outbreak Control plans, following a significant focused effort around the country in June, supported by the NHS Test and Trace service.

While there are many great examples of robust and comprehensive plans, there are also some gaps or areas where further focus is needed to increase local readiness for outbreaks. The most important improvements needed are in the quality and timeliness of data available to councils to help manage local outbreaks – and in councils’ readiness to manage outbreaks in specific high-risk locations such as places of worship, dormitories for migrant workers and tourist attractions.

We will support councils to further develop their Local Outbreak Control plans and build readiness and capability to respond to outbreaks, with a focus on:

• developing and sharing learnings from recent outbreaks
• codifying and sharing locally developed best practice
• developing central guidance on specific areas of risk
• targeted support to build capacity in councils with the most acute needs

By the end of July, we will develop an assurance framework for local authorities to help gauge local readiness and capability to manage outbreaks and identify areas where more targeted support or oversight may be needed.

Our Good Practice Network of 11 local authorities will continue to help share learning and innovation through the Local Government Association’s Knowledge Hub across all seven areas of outbreak plans:

1. planning for local outbreaks in health, care, and education settings, including monitoring arrangements and scenario planning.
2. identifying and managing high-risk workplaces, communities of interest and locations, including defining preventative measures and outbreak management strategies.
3. ensuring readiness for local deployment of mobile testing units to high-risk locations.
4. ensuring local and regional capability for contact tracing in complex settings.
5. integrating national and local data and scenario planning, supported by the JBC.
6. supporting vulnerable people to self-isolate and ensuring services meet the needs of diverse communities.
7. ensuring effective governance, led by existing COVID-19 Health Protection Boards and supported by existing Gold command forums and new member-led boards to communicate with the general public

We will establish robust and effective processes for stakeholder engagement

Effective outbreak management requires rapid and tightly co-ordinated action across a very wide range of groups. It is critical that key stakeholders are clear about their respective roles and responsibilities and ready to play their part.

To achieve this, we will continue to engage key stakeholder groups in the ongoing design of our outbreak management capability and in its operation. Specifically:

• our Good Practice Network will be used as a forum to solve problems and share best practice
• our Advisory Board will be used for political engagement and sharing best practice
• we will maintain regular dialogue with all council leaders, chief executives and directors of public health
• we will maintain regular dialogue with other key groups, including local resilience forums, the Local Government Association (LGA), the Association of Directors of Adult Social Services (ADASS), integrated care systems, primary care representatives and the voluntary sector
• we will work closely with other government departments to ensure joined-up support for local authorities and local communities

Effective community communications and engagement are critical to building support for local action to prevent and manage outbreaks. We are continuously developing and updating a toolkit to support local authorities with communication and engagement, based on insights from local voices, complementing our national communications and marketing.

Helping individuals, businesses and public services to better understand and manage risks of COVID-19 transmission

Key objectives:

• shortly introduce – and promote widespread adoption of – an app that enables users to book a COVID-19 test and, if trials support it, allow for digital contact tracing
• have 100,000 people participating in research studies into antibodies and immunity by September and be at the forefront of research into immunity worldwide
• offer antibody testing to all NHS staff by the end of July and to all social care staff by the end of September

Our ability to start to lead more normal lives and to promote economic recovery relies in part on supporting and enabling everyone across society to better understand and manage the risks of COVID-19 transmission – both the risks to them personally and to their friends, families, work colleagues and local communities. The more effectively we as individuals can manage these risks, the more the government will be able to continue easing or lifting social and economic restrictions in ways that are safe and stop the virus from spreading. This relies on action across society and across local communities and government.

The NHS Test and Test service will play a key role by building tools to help people understand and manage risk and by using antibody testing to contribute to our scientific understanding of the virus. This will complement the more specific advice we give to businesses and other organisations to help them work effectively with their local public health teams to manage any local outbreaks

We will deliver an app which reduces the risk of contracting the virus and transmitting the virus to others

On 18 June, the government announced the next phase of development in building an app that supports the end-to-end NHS Test and Trace service. This next phase brings together the work done so far on the NHS COVID-19 app and the new Google/Apple framework to create an app which will enable anyone with a smartphone to engage with every aspect of the NHS Test and Trace service, from ordering a test through to accessing the right guidance and advice. This will help more people get back to the most normal life possible at the lowest risk.

The app will allow citizens to:

• identify symptoms, seamlessly order a test and, if they need to self-isolate, feel supported during the period of self-isolation
• enable people to scan the unique QR codes of venues they have visited to aid contact tracing and help understand the spread of the virus
• quickly identify when they have been exposed to people who have COVID-19 or locations that may have been the source of multiple infections

We are committed to ensuring the highest standards of data privacy and data security. The app is built using the Google/Apple application programming interface (API) and a Quick Response (QR) code system, both of which are based on a decentralised model where the government does not have access to citizen data. Any services that require more information from a citizen will be provided only on the basis of explicit consent.

We will shortly release an initial version of the app to a selected group of users and gather rapid feedback on user experience. We will then further develop and roll out the app, based on user experience and testing to create more targeted advice and support for users. The real power of the app will come with mass adoption – and we will work with the public, business and public services to reach as high a proportion as possible of smartphone users. We will ensure a strong focus on building trust and coverage in communities that are at greater risk from COVID-19 and/or are currently less likely to engage with NHS Test and Trace.

We will drive world-leading research into antibodies and immunity to help improve our understanding of the virus and our ability to contain it

Antibody tests, which tell you if you have previously had the virus, play a valuable role in helping us understand more about the virus and how different people, groups and areas have been affected by it. Over 1 million NHS staff and patients have already taken a test, and we are extending testing to social care staff and care residents in England.

We are using antibody tests to conduct some of the biggest surveillance studies in the world to find out what proportion of the population have already had the virus. These tests are supporting an enormous research effort by a wide range of our partners to learn more about whether antibodies, or other factors, can protect somebody from future infection and prevent them transmitting the virus.

As our understanding of the role of antibodies improves, we will work to ensure we are ready to enable other groups who may benefit from it to access testing, and to ensure that testing will be able to give individuals valuable information about how to manage their risk and protect others.

Building a trusted test and trace service with and for the citizens who use it

NHS Test and Trace is a shared collaborative endeavour that encompasses the work of local authorities, PHE and a range of other partner organisations, alongside the work of those staff who work directly for the NHS Test and Trace service. We will work across all our partner organisations and all our staff – and in partnership with the citizens who use our services – to continue building a trusted NHS Test and Trace service, both nationally and in local communities.

This will include:

• working with staff across the Test and Trace service and with our key partners to develop clear shared purpose and values, based on the services we provide for the public and our central aim of breaking chains of transmission and helping people return to more normal lives
• setting clear expectations for the leadership skills and behaviours required across the service and seeking regular feedback on how we live up to those behaviours

We will improve awareness and understanding of Test and Trace

Since its launch on 28 May, NHS Test and Trace has tested over 2.6 million people, found over 42,000 new cases and led to over 220,000 people being contacted and asked to isolate who might otherwise have spread the virus. We have established an integrated national testing and tracing service, supported by marketing and communications across all significant media channels.

We have further to go, however, in ensuring widespread awareness of NHS Test and Trace and its importance in stopping the spread of the virus and helping people return to more normal lives. We will shortly be implementing a new marketing campaign and targeted communications strategy, building on work already undertaken and providing new and innovative ways of improving awareness, understanding and engagement. Our strategy will be tailored to different target audiences, such as people from black, Asian and minority ethnic (BAME) groups, younger people (18 to 24), working age adults, people aged 65 and over and single mothers with young children, and we are committed to co-designing with priority groups as much as possible.

Our aim is to reinforce the importance of Test and Trace as a central means by which everyone can beat the virus – and to harness the strong motivation felt by people across society to protect their friends, families and local communities. We will build greater awareness, understanding and trust among the public, employers and public services, with a focus on those groups at higher risk, by:

• identifying new and innovative ways of publicising NHS Test and Trace and promoting the importance of testing, contact tracing and self-isolation
• reaching into and engaging key groups, prioritising the most vulnerable and those currently less likely to engage with the service, and co-designing solutions directly with them
• securing the support of relevant partners and opinion leaders

We will work with national bodies and local government partners to reach into and engage different community groups, building on best practice such as by the ONS’s Community Engagement Unit whose work saw National Census compliance increase from 70% to 94% through systematic community engagement. We will draw on PHE’s review into disparities in the risks and outcomes of COVID-19 and the work of the Government’s Equality Hub. We will establish our own cross-programme equalities and inclusion panel, make sure that we are reaching people in BAME communities and ensure that our communications are translated or adapted to reflect the needs of different audiences.

To build wider support, we will:

• be listening and responsive: understanding the full range of insights, concerns and motivations that can be channelled into the common cause of people protecting people
• embrace diversity: listening to and drawing insights from across different groups of service users and different communities, with a focus on vulnerable groups and those at greatest risk of mortality from COVID-19
• build on our place in the NHS: demonstrating how NHS Test and Trace is an integral part of the National Health Service’s response to COVID-19 and deploying NHS professionals, such as our clinical contact tracers, to act as advocates for the service
• be transparent and accountable in everything we do

We will rapidly identify, incubate and accelerate innovation

We will invest in early-stage development of innovative new technologies – and research into immunity and patterns of COVID-19 transmission – so that we can roll out improvements in testing, contact tracing and outbreak management as fast as science and technology allow. We will do this by:

• promoting ‘left-field’ thinking within the Test and Trace service through scalable innovation methodologies
• establishing trusted partnerships with organisations at the cutting edge of innovation
• stablishing a close-knit community of innovators to facilitate an innovation culture

To ensure rapid adoption of new innovations, we will maintain a clear view of the innovations that can potentially be implemented over a six-month time horizon and have a consistent, repeatable process for identifying the highest impact innovations and incorporating them into NHS Test and Trace.

We have established an Innovation and Partnerships function, which will conduct targeted development ‘sprints’ to address specific high-priority needs. Each of these sprints will:

• use horizon scanning to understand the range of international solutions potentially available
• convene small groups of experts to generate ideas
• shortlist the most impactful ideas and further develop those ideas through targeted partnerships and/or public calls to action
• provide specialist support for partners who need help in incubating or accelerating innovations

As we strive to deploy the best innovations to help the NHS Test and Trace service achieve its objectives, we aim to do so in ways that bring lasting benefits to the health service, the life science industries and the public, which can extend far beyond COVID-19. The investments we make in tackling COVID-19 will help to ensure we emerge stronger, more resilient, and more adaptable, with our pathology infrastructure, diagnostics capability, and capacity for deploying innovations across our health systems greatly improved.

We will operate as an effective, agile and trusted data organisation

We will further invest in the data capability, processes and infrastructure needed to run the Test and Trace service over the winter period, to make rapid changes in response to changing circumstances and scientific knowledge, and to ensure we operate to the highest levels of data safety and trust.

We will implement common security standards with partners and strengthen risk tracking across all aspects of the Test and Trace service. All new technology workstreams will have dedicated security resources. Working with the National Crime Agency, National Cyber Security Centre and OFCOM, we will continue to minimise opportunities for fraud. We are currently carrying out a baseline assessment against cybersecurity criteria, which will form the basis for continuous improvements in security.

We will continue to work closely with the Information Commissioner’s Office, the National Data Guardian and other stakeholders and ensure we have expert ethical advice at the heart of the programme by working with a panel of experts in this area.

We will adopt a twin track approach, delivering ongoing improvements in the capability of the technology systems we have inherited while simultaneously building a new technology infrastructure for the future and transitioning existing services to the new model over time. By establishing a single cloud infrastructure with embedded security and access controls, we will improve our responsiveness to security threats and technology-related outages, allow integration testing across the full range of the Test and Trace service, and provide a stable operating environment that can be scaled up and down to meet changes in demand.

As we make the transition to an integrated technology infrastructure, we will implement common standards, so that our technology systems operate seamlessly alongside other parts of the health and care system. We will progressively introduce more automated solutions to reduce error and improve the speed of our services.

We will develop a diverse and engaged workforce that reflects the communities we serve

We will develop a diverse, engaged and high-performing workforce that reflects the communities we serve and puts the principles of equality and inclusion at the heart of everything we do. Our strategy for equality, diversity and inclusion will include:

• undertaking a baseline assessment of equality, diversity and inclusion across the Test and Trace service to identify key areas for improvement
• driving diversity in recruitment, building on established civil service programmes including META (an accelerated development programme aimed at staff from minority ethnic groups with the ambition and potential to become future leaders) and DELTA (an equivalent programme for people with a disability)
• establishing partnerships with other organisations (e.g. Disability Confident) to improve equality, diversity and inclusion
• building staff networks to drive an environment of inclusion and belonging, starting with an Internal Advocacy Group which has already been set up

We will foster a culture where individuals of all backgrounds feel confident and included, their talents are nurtured, and we empower them to contribute fully to our purpose.

Our 10 operational change priorities

To deliver this business plan, we have identified 10 operational change priorities.

Our purpose is to break chains of COVID-19 transmission to enable people to return towards and maintain a more normal way of life.

We will achieve this by:

• finding and isolating people who have COVID-19 and their close contacts
• local community action to prevent and manage outbreaks
• enabling individuals, businesses and public services to understand and manage risk
• building a trusted organisation with and for citizens

We will do this through our 10 operational change priorities:

1. an effective insight and analytics function to guide all our work
2. rapid and accessible testing at scale
3. fast, inclusive and user-friendly end-to-end Test and Trace journey
4. proactive identification of clusters and prevention of outbreaks
5. scaled-up local outbreak management and effective systems for escalation
6. an app and other tools to enable better management of risk
7. driving and deploying innovation and research
8. building awareness, understanding and trust
9. creating a resilient and stable service
10. developing a diverse and engaged workforce

Our model is:

• local by default
• inclusive and tailored to needs of diverse users
• working in partnership
• continuously improving
• driven by scientific and operational expertise