Review of our plan and improvements on testing key (critical) workers.
Purpose and focus of the review
On 15 April, the Health Minister commissioned a review of the testing regime to identify where improvements could and should be made. This phase of activity of the testing plan has been focussed on our critical workers and so, this review is necessarily focussed on the testing of critical workers and the key elements of our plan:
- testing capacity
- access to testing
- the testing referral and results process
Working with Public Health Wales, using the evidence provided to us by the WLGA and drawing on feedback and other sources of information, it aims to:
- provide a summary of where we are
- identify key issues, and
- identify areas that could be improved.
The current position
COVID-19 is an unprecedented public health challenge, which so far we have dealt with well as a nation. We have suppressed the exponential rate of infection, the NHS has not fallen over and in so doing we have helped to save lives.
COVID-19 testing led by Public Health Wales has helped the NHS identify and care for patients who are unwell from COVID-19. As at 12 May 2020 our laboratories have carried out more than 51,000 tests so far. Between 18 March and 10 May, over 17,000 NHS workers (directly employed staff) have been tested helping those who are negative back to work. In Wales, we were the first of the 4 nations to begin testing our frontline healthcare and social care workers, but we must do more.
What were the key elements of our Testing Plan and where are we?
The broad categories of Critical Workers and the 3 key elements of the Testing Plan are set out below:
- Health and social care workers
- Public safety(emergency workers) and national security workers
- Local and national government workers
- Education and childcare workers
- Food and other necessary goods
- Utilities, communication and financial services workers
- Key public service workers
1. Testing capacity
Our plan set a target of reaching 5,000 tests a day in April. We expected to be able to do so by the 2nd or 3rd week of April. The other UK nations have set their own targets.
This number was our best understanding at that time based on the agreements in place to secure tests from a number of sources. Over the last 4 weeks we have experienced a range of delays in securing some of the equipment and reagents for processing and running swab tests. Wales is not alone in being affected by this. There are supply chain issues as countries across the world are scaling up testing.
We will provide weekly updates that will set out expected and actual increases in capacity and provide an update on any issues experienced as a result of changes in the global market.
In addition, some tests are reliant on UK contract arrangements. We are, however, clear that Wales is receiving a fair share of the UK arrangements.
Testing has been key in the early stages of the outbreak to help us track, trace and isolate infected individuals. In the delay phase, where we are using measures to control community transmission through social distancing. Our testing priorities going forward are:
- Testing in healthcare and social care settings to reduce harm
- Testing in the community so that we can understand the scale of the spread of the virus in Wales, to inform our next steps
- Testing of critical workers to enable people who test negative and cannot stay at home and are not infectious with another illness to return to work earlier.
Actions and progress
- Public Health Wales has analysed the supply chain and identified areas for action to mitigate supply issues. Public Health Wales, is working with:
- Working with suppliers to secure greater confidence about delivery dates
- Co-ordinating with UK partner to ship equipment and reagents from the same overseas supplier to the UK, and
- Liaising with the military to support transport planning.
These actions are expected to result in greater progress in the delivery of equipment and reagents in coming weeks.
- Welsh Government has committed further monies – currently making £50 million available, to bring in further equipment, reagents and other activity to increase our testing capacity.
- The Minister for Health and Social Services will provide a weekly public update on testing capacity.
2. Access to testing
Establishing test centres and access to testing will become increasingly important as we gradually move away from the delay phase. We are building capacity to do this in Wales through our 20 Community Testing Units across Wales, 6 mass drive-through centres in Newport, Cardiff, Swansea, Abercynon, Carmarthen and Llandudno, and 8 mobile testing units across Wales.
We committed to standardising and simplifying access to testing, and the move to join up with the UK-wide web-based booking platforms and processing systems will enable us to do this. Through our new Test, Trace, Protect strategy, we will rapidly scale up our existing testing policy for critical workers, broaden testing to include members of the public, implement an effective symptom reporting system, conduct proximity tracking, contact tracing, and health surveillance.
We plan to test many more people and will be significantly scaling up our testing programme in line with our modelling of the testing needed over the coming weeks and months.
We will increase testing in hospitals and care homes, for patients, residents and staff. We are continually reviewing our policy on care home testing in response to the latest scientific evidence. Read the latest updates on our policy around care home testing.
Not everyone will be able to drive to a mass testing unit. Work is ongoing to provide more local services for those eligible who cannot travel.
Welsh Government committed to overseeing a national approach with Military Planners, Public Health Wales, NHS Wales, LRFs, SCGs and LAs to ensure that the next phase of COVID-19 testing in the recovery phase is coordinated at a national, regional and local level; and delivered at pace. We have already seen progress in this area with the introduction of 8 mobile testing units across Wales and new home testing kits available to critical workers and the general public.
3. The testing referral and result process
Feedback to date tells us that these processes need to improve, in particular:
- there is too much form filling to process social care workers which is acting as a barrier to accessing the tests as quickly as we would like
- the ceiling of 15 referrals per local authority may have depressed demand
- there are instances where the result can take longer than the 24 hours, and
- lack of clarity on the referral process itself and information on testing numbers.
- Officials are working to provide a web-based booking platform to remove the bureaucracy. This is at an advanced stage and updates will be provided on progress next week.
- Removing of the ceiling on referrals per local authority.
- The Critical Worker Policy has been published which outlines how and when critical workers beyond those in health and social care can be referred for testing.
- Welsh Government officials were tasked to work with local authorities and Local Resilience Forum to ensure that process are reviewed and revised in light of experience and to make sure that there is effective prioritising of testing requests so that essential services can remain viable – i.e. care homes/fire. This exercise has been completed with local referral processes in place to ensure critical workers are prioritised for testing at the mass drive-through testing centres and mobile testing units.
- Welsh Government officials were also tasked to work with the military to undertake a rapid review of how to operationalise the programme arrangements for testing to support and improve the end-to-end process. It was determined that this would help speed up and eliminate any fragmentation in the system. This exercise has also been completed.