“Test and Trace had given us a good start but we really believe in the value of contact tracing and wanted to maximise the number of local people it reached. We felt we could make a difference." This case study is part of a series on local contact tracing.
- Sandwell was one of the first areas not facing government intervention to set up its own contact tracing service
- The system went live in July and has since been expanded to include a core team of 25 contact tracers with extra in reserve if the need arises
- Alongside contact tracing, people are offered support to help them isolate
The local context
Sandwell is a metropolitan borough in the West Midlands. It is home to more than 300,000 people.
Infection rates have been consistently above the national average without often being among the very highest.
The borough was made an area for intervention in September along with Birmingham, which meant household mixing was no longer allowed. In October it was classified as tier two in the new alert level system.
What was done
Director of Public Health Dr Lisa McNally said she decided to act in early summer as the national Test and Trace service was reaching 60 to 70 per cent of its residents who tested positive.
“Test and Trace had given us a good start but we really believe in the value of contact tracing and wanted to maximise the number of local people it reached. We felt we could make a difference.
“We understand the culture of the local area and just hearing a Black Country voice immediately helps. People need help understanding the rules – you can’t assume everyone is following the news or up-to-date with the guidance.
“So as well as doing the contact tracing we wanted to reassure people that we were here and that this is what you need to do.”
Like many councils, Sandwell developed a support offer in partnership with the local voluntary sector that can provide food and medicines delivery as well as helping people who are isolating access financial support.
It means everyone who is traced is offered access to these services – in fact Sandwell contacts all those who have been reached by NHS Test and Trace to see if they need welfare support although welfare-only calls are done by a separate team.
The contact tracing team has 25 core members, with another 50 plus available to be called on if need be.
Public Health Consultant Tanith Palmer said: “We have recruited people from all over the council. Our staff have really wanted to play a role and step up. We have people from public health, customer services, education and social care.
“We always make sure we have someone who speaks another language. We have a lot of Punjabi and Gujarati speakers in particular. Those sort of skills are invaluable.
“It’s also important that we don’t assume a person has access to the internet or is comfortable giving information online. There are no weblinks or forms to access. It’s all person to person.”
The contact tracing team has helped drive up overall performance significantly. An evaluation of cases in September, showed of the 1,286 Sandwell residents who tested positive, 67 per cent were reached by NHS Test and Trace.
Of the 422 hard-to-reach cases passed to Sandwell, nearly 200 were engaged, including 21 people who were classified as refusing to engage by the national team. This took the overall reach to well over 80%.
Dr McNally said: “We are really pleased with the impact the service has been having. Contact tracing is not rocket science. Some people are put off because they think it requires a lot of clinical knowledge. But I would say only about 10 per cent of it is clinical, the other 90 per cent is about personality, energy and communication to get the trust of the individual and find out what they need.”
Dr McNally also said the service had the added benefit of helping to identify potential outbreaks early. “We collect a lot of extra data, such as where people work and where they have been. It helps us identify potential outbreaks early.
“For example, we had two men who worked in the same garage test positive within a few days of each other. They didn’t mention each other as close contacts but our team clocked they were from the same workplace and we sent our environmental health team there to talk to the business about what was happening and what measures needed to be taken.”
As Sandwell started early, it has been able to build up slowly. At the start it was only getting around 20 cases a day, but now sees between 80 and 120.
Ms Palmer said that enabled the service to evolve as it went, recruiting and training more staff to work on the service. “You need a flexible workforce, that is why we have trained extra and developed the bank of staff we can call on. Many work part-time so can be quite flexible in terms of doing extra hours.
“We have needed that flexibility as the pandemic has gone on. We have had to increase the numbers we have on each shift. We now have four regularly, while before it was two.”
Over the months, Sandwell has also found the scripts the contact tracers work from can be simplified. “We used the national script to start with,” said Ms Palmer.
“It is quite long and what we have found - and this has come from feedback from our team - is that you do not need to be so prescriptive. You can make it simpler and still capture the information that is needed and make it a more natural conversation.”
Sandwell is in the process of changing the way it runs its door-to-door contact tracing. To date it has relied on domiciliary care workers to speak to people at their homes and encourage them to take the call from the contact tracing team. The contact tracers then follow this up with a call to provide the official advice and gather the information on close contacts.
But this responsibility is now being handed to the community services team, which is responsible for the repair and maintenance of the social housing stock. In future, they will be offering support and getting the details of close contacts, just as is done within the phone calls.
Dr McNally believes this should take Sandwell’s reach to well over 90 per cent. But she said the growing levels of infection are also presenting challenges, which may force a change in the way welfare calls are carried out.
“Unfortunately, we may reach the point where we have to prioritise who receives welfare calls to ensure we can keep up with contact tracing.
“We would look to target it to older people and those from deprived areas who are more likely to need support. It’s not something we need to do yet, but we are aware as we move into winter it is something that may be needed.”
And given those pressures, Dr McNally believes other areas just starting to set up their contact tracing services will need to prioritise their efforts. “I think it would be quite daunting setting up local contact tracing now with the high levels of infection. My advice would be to still build it up slowly. Perhaps start with your really hard-to-reach cases and go from there.”
Dr Lisa McNally
Director of Public Health,Sandwell MBC