NHS staff’s ‘personal responsibility’ to avoid misuse of covid-19 app

In an interview with HSJ, Isle of Wight Council’s chief executive John Metcalfe said one of the app’s “challenges” is to ensure health and care staff disable the app before going into working environments where the technology will register a high-risk contact with covid-19 patients.

Such contacts between staff and covid-19 patients should not be deemed a noteworthy contact if the staff are wearing PPE in line with national guidance. But, if a staff member does not disable the app, they face being alerted to the contact without knowing it occurred in hospital under the protection of PPE because the app does not tell you where the contact occurred due to privacy rules.

Mr Metcalfe, who described the app - developed by NHSX - as a “powerful tool” in local outbreak mitigation plans, said health and care chiefs must “keep communicating” to remind staff of their responsibilities when using the app.

“We have to encourage stakeholders to give staff the right guidance about when to use the app in working environments and when not to,” he said.

“[Employers] have to think about the advice and guidance they give to their staff using the app in a work situation where they might have PPE or need to protect themselves.

Mr Metcalfe said the council’s advice to staff in a working environment where they might come into contact with covid-19 patients while being protected by PPE was they should disable Bluetooth (on which the app runs) or leave their phones elsewhere.

He added the island’s care homes and hospital had successfully introduced a “bluetooth off, PPE on approach”, but warned it will be key for employers to “keep communicating and give [staff] the right messages to help them engage and understand”.

There have been around 53,000 downloads of the app from islanders since the app was released in early May, according to Mr Metcalfe. It is thought around 90,000 of the island’s 140,000 population have the opportunity to download the app. There have been 196 confirmed cases of covid-19 on the island.

Mr Metcalfe said the number of downloads was “better than we had expected”. He said were a “chunk of people” who couldn’t access the app due to their older or less popular phones not being compatible with the software, and “we knew some people wouldn’t want to take it up because they would rather wait and see”.

Asked about feedback from users that had provided learning for NHSX, Mr Metcalfe said most of the negative feedback centred on the app’s messages and advice after a person uploaded their symptoms.

“That caused a little bit of confusion at the start and we had to work through that,” Mr Metcalfe said.

“There was a confusion about whether they needed to self-isolate when their phone pinged to say they had been close to someone reporting symptoms.”

There were also “one or two” incidents of the interference from other wearable devices such as fitbits, which also operate on low energy Bluetooth.

The council received a “data dump” three times daily with information about users reporting symptoms through the app. They would then deliver tests to people’s homes and return the following day to pick up samples which were taken to the laboratory.

Asked if the low cases of covid-19 had hampered the chance to properly test the app, Mr Metcalfe said: ”I think it’s been good because people can focus on app development in a measured way rather than trying to do the development of the app and respond to what it’s telling them at the same time.

“We’ve been able to look at in a measured way that you couldn’t have done if you were rushing around as new covid-19 cases come in. I think that’s been a real benefit of doing it on the island.”

He said there had been no impact on the NHS trust or council’s absence rates after the app was rolled out, while there was also no discernible behavioural change from the public and only a few concerns about privacy.

“I don’t think people saw it as an excuse to come out of lockdown,” he said.

“The most unusual thing about the app is it’s not very exciting.

“If it’s doing its job and is just ticking away in the background, and you haven’t been near anyone, it doesn’t do anything.

“It only becomes exciting when you get pinged and that’s a different kind of excitement that you don’t want. You have to help people understand that if it’s boring that’s good.”

Asked what advice Mr Metcalfe would give other councils ahead of the app’s launch nationally, he said: “I think people want to genuinely help fight the virus, and the app gives them the chance to do their bit. That’s a key message you can put out. You have to keep repeating the message about using the app, and reinforcing social distancing, and to take personal responsibility for what you do.”