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NHS Test and Trace celebrated its first birthday last week.

Through its first year, we’ve tracked its up and downs and reported on its successes and failures. In this blog, we reflect on what we learned and what’s to come of this £37bn government programme.

The evolution of NHS Test and Trace

NHS Test and Trace (NHSTT) was launched on 28 May 2020 as part of the government’s COVID-19 recovery strategy. Over the past year, more than 31 million people in England have been tested at least once. There has been a remarkable ten-fold increase in the number of people tested each week, from 450,000 in May 2020 to more than 4.5 million in May 2021. This amounts to around 8% of the population now being tested weekly.

The testing model has also shifted, from initially focusing on polymerase chain reaction (PCR) tests for those with a cough or fever, towards a combined testing model with the increased use of rapid tests over the past 6 months to identify people who may be infectious but don’t have symptoms.

Alongside changes to testing, the approach to contact tracing has also evolved over the past year, including the rollout of local contact tracing systems across local authorities throughout England. NHSTT has handled nearly 3.9 million cases, reaching 3.3 million of these. At the same time, more than 8.3 million contacts have been identified and 6.9 million of these reached and advised to isolate. Case numbers peaked in the week of 31 December at a record 388,150 cases and 737,044 contacts identified.

Challenges faced by NHS Test and Trace

Performance of NHSTT has varied, with issues around contact tracing, testing provision and isolation adherence all highlighted in a report from the Public Accounts Committee. People’s ability to get tested and self-isolate has been a major challenge over the past 12 months. In September 2020, demand for tests outstripped laboratory capacity. People were unable to book tests or were offered tests more than 100 miles away.

Although tests are now widely available, studies suggest that as few as 22% of people with symptoms got tested in January 2021. People may also be less likely to take a test if they don’t feel able to self-isolate, with surveys suggesting that anywhere between 40% and 90% of those asked to self-isolate report doing so for the full 10 days.

Barriers to testing and self-isolation include being unable to take time away from work due to financial insecurity. The UK has the lowest sick pay in the OECD and the government’s current self-isolation support payments are insufficient, offering only £500 and rejecting two-thirds of applicants.

COVID-19 has had a profound impact on inequalities, with NHSTT potentially having exacerbated these further. In December, we reported that 62% of contacts in the least deprived areas were successfully contacted, compared with 56% in the most deprived areas. The percentage of contacts reached has improved, but the inequality persists. From the launch of NHSTT up until 26 May 2021, 84% of contacts were reached in the least deprived areas, compared with just 77% in the most deprived areas.

Where next for NHS Test and Trace?

While case rates are relatively low nationally, uncertainty remains over the impact of new variants of concern on the next stage of the government’s roadmap, and the possible timing and impact of a third wave of infections. As NHSTT moves into the UK Health Security Agency, testing and contact tracing must become resilient not only to the possibility of new variants of concern, but also to a winter flu season that in any normal year would see high levels of illness and hospitalisations, never mind the possibility of another COVID-19 peak.

It is no coincidence that the areas of England with high case rates now are the same places that experienced higher case rates, hospitalisations and deaths in the first two waves, and were subject to the most prolonged and restrictive local lockdowns. These are places that are more deprived, where people are less likely to be able to work from home, and where people are more likely to live in more crowded, multiple occupancy households. Until these structural drivers are addressed, inequalities in case rates will persist, variants will still emerge, there will be no levelling up, and the places that have lost the most throughout the pandemic will have to wait longest to recover.

Any future approach to testing and contact tracing must be developed with local authorities and local health protection teams, ensuring they are able to meet local needs and address inequalities. This means co-designing policies for testing, contact tracing and self-isolation with the communities and places most affected, with a genuine ‘local by default’ approach where local leaders have the resources and flexibility they need to deliver local solutions. And it means no-one being worse off for having to isolate.

Caroline Fraser (@cfraserepi) is an analyst in the policy team at the Health Foundation.

Adam Briggs (@ADMBriggs) is a senior policy fellow in the policy team at the Health Foundation.

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