The Ward Round: Ready, steady, test your staff

Staff testing has been a hot potato since the beginning of the pandemic. And with the proportion of new covid hospital patients catching the virus inside hospital increasing to 15-20 per cent in recent weeks, it is an issue that has become harder and harder for government and NHS leaders to brush aside.

Jeremy Hunt - the very influential former health and social care secretary - has been pressing for routine asymptomatic staff testing for some time; and last month the Commons health and social care committee which he chairs said a full rollout was needed to prevent the health service being “forced to retreat into being a largely covid-only service during a second spike”. The Labour party's health shadow Jonathan Ashworth has long been citing it as an “urgent priority” too.

Despite all this, many in the service were blindsided by the letter from NHS medical director Stephen Powis to Mr Hunt, which surfaced late yesterday, setting out that the NHS would rollout twice-weekly asymptomatic testing for all patient-facing staff by the end of next week, beginning with 250,000 staff at 34 trusts this week. Quite the ambitious timetable.

It was only last week that government said asymptomatic staff testing would start in December and instead use Loop-Mediated Isothermal Amplification (or LAMP) saliva tests. This latest announcement seems to be something of a rushed out stop-gap before there is sufficient LAMP test capacity installed across England (targeted for next month).

It is perhaps unsurprising that such a significant and quick-turnaround testing announcement has been met with a mixed reaction and left various points still needing clarification.

While also welcoming the news, NHS Providers deputy chief executive Saffron Cordery said getting the staff tests done on this scale would be a “significant challenge”.

“There could be real difficulties for trusts under major operational pressure that have to manage the risk of losing a number of key frontline staff all at once if a significant number of tests come back positive at the same time,” Ms Cordery warned.

She also said the NHS would have liked more “advance warning” of this move so it could “plan effectively”.

On a similar operational note, concerns have been raised by HSJ readers around the distribution of the lateral flow test kit to trusts. If the tests are not received on time, trust leaders could quickly lose faith in this new staff testing drive.

And of course it is crucially important staff are not forgotten. Kate Jarman, director of corporate affairs at Milton Keynes University Hospital FT, and an impressive advocate on important staffing issues, stressed how important it is that staff understand exactly what is being asked of them.

“We need to make sure we have the practical support available for staff testing at home, the emotional support for those who test positive for covid having been asymptomatic and the policy framework to make sure staff across the NHS are treated equally,” Ms Jarman told HSJ.

“Staff support has never been so complex and so crucial,” she stressed. “There will doubtless be challenges around logistics, but keeping our staff engaged and supported remains the most vital.”

The point about making sure staff across the NHS are treated equally is important – and there were questions following the letter around who is included in patient facing roles.

In response to this question, NHS England pointed towards existing NHS Employers’ guidance for asymptomatic staff testing, which defines patient-facing staff as those involving direct patient contact, including clinicians, porters, cleaners.

Another point where there is room for confusion is exactly what sectors are covered. The official line from NHSE is that "all patient-facing NHS staff" will be covered. Surely this must include those in NHS mental health, community or ambulance trusts, in addition to acutes, but given the operational challenges, it's unclear if tests will really land in all these at the same time.

On top of this, there are grey areas like primary care, contractors, and independent providers of NHS services. NHSE has so far declined to clarify for us on these points.

Layla McCay, director at the NHS Confederation, said the organisation looks forward to the test being extended beyond hospital settings “without delay” to staff who “have direct contact with patients and play a vital role”.

“As we approach winter it will be all hands on deck,” she stressed.

And finally, the test itself selected for this stop-gap measure is well accepted to be less sensitive and specific than PCR swab testing. Some are already questioning whether this could have an adverse impact on staff numbers, if the test is not sensitive enough and delivers false positives, resulting in staff being asked to self-isolate. (The programme will require that positives are confirmed with PCR, but timing pressures then arise).

A full rollout - at last - of asymptomatic staff testing is of course good news, but the right staff support and engagement could make or break such an ambitious and significant programme such as this.