Hackney LBC’s contact tracing service went live on September 22, with the job of filling gaps in the centrally managed system of Test and Trace. What impact has it had on the challenge of reaching those who have tested positive for COVID-19 and need to be contacted?
Cllr Chris Kennedy is cabinet member for health, adult social care and leisure for Hackney. He told The MJ the ‘first positive thing is the stats’. The local approach has ‘shifted the dial’ - pushing the proportion of people testing positive from 70% up to 80%. This has got the rate ‘into the zone we are aiming for’.
By November 9 the local tracing programme was given 850 cases that NHS Test and Trace were unable to reach, and Hackney got in touch with 351 of those – ‘a 43% contact rate for what we’ve been handed’. This is what moved the overall contact rate up to 80%.
It takes about half an hour to do the full interview with every single case referred to them, ‘because you’re checking that people are alright, checking that they know where their local support is, and then and only then, right at the end of the call are we saying “it would be really helpful for us to know who you’ve been in contact with before you started showing symptoms”, so then we’re filling in that contact bit of the form online and sending that back to the national system.
The second ‘really positive thing’ about the approach, he said, ‘is that we also ask – and I don’t know how many other local authorities do it – for details of the successful contacts of those who’ve had a positive test that the national system have already got through to as well’.
He adds: ‘ We’re then giving them courtesy calls as a local authority just to say “we know from the national system that you’ve tested positive, we’re just phoning from the local authority to check that you know all the help that’s available here if you need any help self-isolating. We can we help you claim the £500 if you are unable to work while you’re self-isolating”. This is just to encourage them to self-isolate properly. Actually most people have said I’m ok thanks. But the thing that most people have said is, wow, thanks for calling.’
Better data collection at the point at which people book their tests would push the successful contact rate up even further, he added. ‘If people are doing walk-up tests we are getting scruffily hand written phone numbers, sometimes even numbers with a digit missing.’
He also believes it would be helpful to add an extra question at the point when people book a test, asking if there is any time when the system shouldn’t call them. While he said it would ‘be an extra layer of bureaucracy, but certainly for people of very strongly held religious faith or with caring commitments, if they are always looking after the care needs of someone else at a certain time of day they are not going to pick up the phone when it rings either’.
Local contact tracers are using their local knowledge in tracing people the national system has been unable to reach. Hackney has a very large Jewish Orthodox population in the north of the borough, and the team of contact tracers ‘are very good at guessing just from a surname which particular section of the population people might belong to and they are trying not to make any calls from Friday evening through to the end of Saturday out to the Jewish population.’
He continued: ‘We know for a fact that the national system isn’t that aware. Those people sitting in their own rooms at home who have just been sent a whole load of data, they don’t know where those people live, they don’t understand the community they’re from. They can’t look at the surname and say ‘well I’d probably best not call on a Saturday’.
Enabling local contact tracers to speak to the contacts in the same household of someone who has tested positive immediately they get through on the phone to them would help improve results across the national and local programmes, he added. Currently they can’t instantly reach the contacts of a positive case this way. ‘We just take their details and their phone number and are not asked to speak to any of the contacts.’
He believes this makes much more sense than the case going back into the national system - sending it back to a tracer for the job of tracing the contacts of positive cases to start. ‘That seems counterproductive. There’d probably be some data checks you’d have to go through. You might have to ask them to have a conversation away from the phone first just for it to be completely GDPR compliant. ‘
The local team is expanding. ‘We’re training up more people. We’ve got a team with six call handlers and four managers and we’re adding another six call handlers. They’re people from our coronavirus helpline that we ran from the start of the pandemic. So they’re already used to what happens in the system. Then as they come out of our call centre we backfill and train new people into the call centre.’
Despite the successes of the approach, he is frustrated, because he believes the borough would have been ‘in a much better place’ if the council had been involved much earlier in contact tracing. ‘Right at the beginning we knew that local authorities had the ability to do good contact tracing because we’d done it here where we’ve had communicable sexual diseases, we’ve done it when we’ve had measles outbreaks, and we knew we had that essential expertise. We would have been able to train people up into that given enough of a run in.’
He added: ‘My biggest frustration is that huge chunk of central government resource went out to a few big multinational companies and the resource disappeared into the private sector ether. We, with enough run-in, could have employed and trained local people to do the local contact tracing so that the people who were doing the calls knew the area.’
He argues that while the council is now providing an ‘extra value added 10% for the national system, we could have got to 80% if you’d given us that resource’. According to figures obtained by the Labour party and reported in the Daily Mail this summer, at one point the NHS Test and Trace contract with Serco was costing £900 plus per person contacted. Cllr Kennedy concluded: ‘We could have got a better contact rate for less money and we know that. But that was a decision that got taken in April and May. The Government should have gone local then.’
