The government is “determined” to test more care workers, but what does that mean, and is it enough?

Topics covered: COVID-19, CQC, Maddi Gaunt, NHS

In yesterday’s daily briefing, the Heath Secretary Matt Hancock said he was “determined” to ensure everyone who needed a test had access to one.

It is all very well showing determination to have “access” to testing for care staff in theory, but will it work in practice? And will it be too little too late?

Some care sector workers have already been able to request testing when they are displaying symptoms. However, obtaining appointments has proven difficult and the the testing facilities offered to them have in many cases required them to travel, often long distances, to use “drive-through” testing facilities.

These new “drive-through” facilities started operating in March 2020 and have sprung up in various locations around the UK. Some are based at or by hospitals but many are located in out-of town areas. In London, for example, facilities have been set up on the outskirts of the City which are not easily accessible to many. You need to be in a car to be able to “drive-through” for the test.

Care workers are amongst the lowest paid in the health and social care sector. Many do not have the luxury of owning their own transport. Even for those that do and who are lucky enough to be able to secure an appointment, the significant time pressures they are under in their work and home lives – which will be exacerbated under the current restrictions and government guidelines – are likely to make access to the current testing facilities infeasible to many because they will have to travel a significant distance to access one. Further, we have seen various reports of chaos at testing sites, with long queues and in some cases people being turned away even when they had appointments. For those that are tested, there is often a significant time lag until the results are confirmed.

To put it bluntly, the program of testing for social care staff to date has been woefully inadequate. To their credit, the healthcare regulator, the CQC, has been seeking to support the adult social care sector and push for more feasible testing. The CQC’s Chief Inspector of adult social care confirmed, for example, in a statement yesterday:

Testing for adult social care staff has been an issue that providers have consistently raised with us. Over the Easter bank holiday, we worked with DHSC to begin using CQC’s national infrastructure to contact care providers in order to book appointments at a national testing centre for any staff who are self-isolating with symptoms of coronavirus – and soon staff will also be able to use this service to order a kit to test at home. We are working closely with local decision makers, including the Association of Directors of Adult Social Services (ADASS), and alongside national bodies, such as PHE to ensure we prioritise access to testing based on local need.

We support the CQC in their efforts on this front, albeit this seems to have come rather late in the day.

The question remains: how does the government expect to decide which care workers which “need” to be tested? Those displaying symptoms have to date been prioritised over those who don’t but we are being repeatedly told that many of us may carry the virus and display no symptoms at all and that it the virus is highly contagious. Surely then the only effective way to control the virus in the care sector is to determine that every care worker “needs” to be tested, and to ensure that they can be tested regularly.

Does that mean all care workers will be classed as “in need” and will be able to access testing as often as they need to? We highly doubt that Mr Hancock’s vision stretches that far. There are over 15,000 care homes in the UK, with a further ½ million or so people receiving community care at home. That means a lot of care workers (and support staff coming into contact with those care workers) to test.

Even if this is what he hopes to achieve, it should not be forgotten that testing sites are already being used, and will continue to be used for NHS staff and other key workers, many of whom still have not been able to get tested either. This is not – and should not be –  an NHS vs social care priority battle; but even with testing being ramped up, this does not mean that there will suddenly be sufficient facilities to test all care workers who are (or whose families are) showing symptoms, never mind those that remain asymptomatic.

There is also a question of how quickly this can all happen. It is all very well showing determination to test everyone who “needs” it, but that testing needs to take place before it is too late.

It only takes one person to enter a care home with the virus, or one COVID-19 positive community care worker visiting numerous patients in a day, to put a significant number of very vulnerable people at risk of death. We know, both from reports over the Easter weekend in the UK, and from recent reports in Italy, France and Spain, that care homes and those receiving community care are particularly susceptible to the virus and whilst we probably do not have the full picture yet, that there is already an alarming number of deaths taking place outside of NHS hospitals.

The government has committed to a target of carrying out 100,000 tests per day by the end of April and whilst that is not impossible, all indications are that it is highly unlikely to be achieved. Even if testing does reach the government’s target, the peak of the virus may be long gone by the time there is adequate access to testing. For the many vulnerable people at risk in the care sector, sadly, the government’s pledge appears to be too little too late.

We can only hope that the self-testing kits become available for the care sector as a matter of urgency, and that the government can get its act together to ensure that there are enough facilities to process those tests and get results out quickly.

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