Failing the test: the calamity of COVID-19 testing in Scotland

Lilian Macer excoriates the Scottish Government’s approach as inadequate to deal with pandemic we are facing.

The World Health Organisation (WHO) in early March told us the best way to combat the COVID-19 outbreak was through testing. ‘TEST, TEST, TEST’ was the clear message from the WHO. It was clear that diagnostic testing for COVID-19 is critical to tracking the virus, understanding its epidemiology and to suppressing transmission. So, despite the advice form WHO, instead of maximising population testing in the Britain and Scotland, our governments decided to stop the widespread testing of symptomatic individuals to a focus on testing acute hospital inpatients.

We know that testing is an important tool in the overall approach to managing the pandemic and reducing as far as is possible all of the harms caused by COVID-19. Therefore, it is a concern that in the face of this public health emergency, the Westminster government testing strategy is heavily reliant on a private sector delivery model. Companies such SERCO who have secured a lucrative government contract for contact-tracing with an abysmal track record of failing time after time to deliver on government contracts. Despite being fined more than £1m for failures on another government contract just months ago, more public money is handed over to it. The privatisation of public services, again at the heart of this Westminster Government’s agenda, sees the outrageous handing over the £45.8m test-and-trace contract. This yet again puts a market driven ethos before the health, welfare and safety of the population.

Over the past 5 months, the Scottish Government has issued numerous guidance and policy initiatives on COVID-19 testing. However, there is no link with a strategy to deliver on the policy objectives so unnecessary additional problems have been created. There is a hugely confused landscape where policy needs to be linked to a clearly defined strategy that brings clarity for health boards in Scotland. As an example, there is increasing confusion and misunderstanding regarding the policy to screen all asymptomatic and pre-symptomatic staff in care homes on a weekly basis, and if there is supporting clinical evidence of the benefit from this policy intervention, why are only care home staff and not the entirety of health and social care workforce being included as well? The possible only explanation for targeting only care home staff is that it derives from a politically rather than a clinically driven decision. We need an honest discussion that brings clarity for everyone and not, as the Scottish Government have allowed, the priorities on testing to be driven by a reaction to political pressure. In times of uncertainty – and there is no doubt that we are living through such times – and in the face of complex problems, we need to see a clearly defined strategic direction that has public safety as its focus and not any political point scoring.

In late May, the Scottish Government launched its policy on ‘Test, Trace and Isolate (Test and Protect)’ which is now seen as an important part of the Scottish Government’s pathway to combatting COVID-19. However, the worry is if we do not address the misunderstanding and confusion that exist by producing a coherent strategy, then we will not succeed in the goal to protect our communities from this virus. The lack of strategic direction has meant that health boards have introduced their own policy around clinical priority and effectiveness in order to manage a level of control to meet the capacity.

We have seen already from other parts of Britain, and around the world, how quickly cases can become large outbreaks with transmission spiking across entire workplaces, or cities, leading to local lockdowns and reversal of progress made in suppressing the virus. As our schools across Scotland re-open their doors to pupils, the importance of having a robust system of contact tracing has been brought into sharp focus. Here, the ability of experienced public health practitioners will be vital in suppressing transmission of the virus. The strategic use of diagnostic testing in different transmission scenarios of COVID-19, from no cases to community transmission, including how testing needs to be driven through the entire public health agenda and both in policy and action.

In the past, the supply of re-agents has not been matched to demand, and this together with the workforce demands as paused health services are stood back up, requires that the testing capacity within Scotland is prioritised but on the basis of public health and clinical evidence and not political pressure. As health boards and local authorities move into addressing the winter pressures that will emerge on our public health system, it is important to understand that testing is part of our overall public health approach designed to minimise transmission of the virus. However, testing does not, in and of itself, reduce transmission of the virus. That is why it is always important to see it as one part of the picture and to have a continual focus on the use of face coverings, avoidance of crowded place, cleaning of surfaces and physical distancing so that they can play a critical role in reducing opportunities for the virus to spread.

Our health and social care workers are at the front line of the COVID-19 response. In order that they can deliver on the testing policy/guidance, we require clarity of vision through a joined-up approach within a coherent testing strategy from the Scottish Government. If our dedicated workforce is to continue the battle against this virus on top of the pressures winter will bring to our overstretch health and care services, the tools and resources need to be made available as a matter of urgency.

Lilian Macer is the Convenor of UNISON Scotland