The contact tracing programme in Wales is called “Test, Trace and Protect” (TTP) which emphasises the purpose of the exercise i.e to protect individuals, families and communities. This provides a better focus that “Test, Track and Trace” in England which seems to focus on the process rather than its purpose. The Welsh programme is firmly based on a partnership / public service model.

The population of Wales is about 3.1 million people ( approx. 55.5 million in England ). The internal market have been abolished in the Welsh NHS over a decade ago. Health care is delivered through seven unitary health boards ( and specialist health trusts for cancer and ambulance service). The health boards are responsible for the planning and delivery of primary and secondary services within their population footprint. There is no “payment by results”.

The health board geographical footprint is co-terminus with about 2-5 local councils. Partnership working between health boards and local authorities is delivered by Regional Partnership Boards – with improving, but variable, success.

Public Health Wales covers all of the country. There are public health practitioners attached to each health board though there is some criticism that the service is over-centralised. Local authorities are responsible for Environmental Health.

The care sector operates on a similar basis as England though means testing for services is more generous in Wales

With the outbreak of Covid-19, the Welsh Government supported a four nations UK response. Along with all the administrations across the UK it went into “lockdown” at the same time. But has time has gone on it has taken a more cautious and distinctive approach compared to the Westminster. This approach has fairly substantial support in Wales.

From the start the Welsh Government sought to mobilise a co-ordinated public sector response to the pandemic along with the voluntary sector. Support from the private sector was sought in the supply chain in areas such as PPE but otherwise scarcely involved in direct clinical or health roles.

Public Health Wales, along with some health board and university capacity, was responsible for the initial testing regime. At first the Welsh Government chose not to avail of the private sector led Lighthouse Testing programme that was being launched in England until it could guarantee the results of the testing was made available.

Like the rest of the UK, Wales had a hesitant start to the TTP process but things have now settled down. The service delivered on a three tier basis – national, regional and local.

The Welsh Government and Public Health Wales are main players at a national level. They set out the broad framework, set standards and provide professional advice. There is a single national IT platform which felicitates the TTP programme. This allows a national overview and more coherent understanding of what is happening.

Public Health Wales also provides the main testing facilities with some use being made of health board capacity and the Lighthouse laboratories. The present testing capacity is about 20,000 tests per day with about 5k being sourced via the Lighthouse capacity. However this capacity has never come close to being called upon with 3-5,000 tests typically done daily. About 50% of test results are available in 24 hours and 85% in 48 hours. The delays mainly arise in tests being undertaken in north Wales but this should be addressed as new capacity is being put in place to locally serve north Wales.

The regional tier is co-terminus with health board boundaries and involves the health board and its partner local authorities along with input from Public Health Wales. The region supports and co-ordinates the local delivery of the programme. It also provides step-up and advice and support for front line workers.

The health boards are now responsible for the setting up the testing services across their patch. These samples are taken and transferred on to Public Health Wales ( or the other involved laboratories) to undertake the tests. The test results are usually texted to patients. There in on-line access to the test service.

The local tier provides the front-line contact tracing service through local government Environmental Health officers and local government employees who have been transferred from other duties due to the pandemic. Some teams will also have some health authority staff. The tracing teams operate roughly at a Upper Super Output Area level (about 30-50,000 population). There are about 600 workers involved at the moment but is possible that 1,600 may be required depending on the level of demand.

In Wales, during the period from 1st June to 21 June, 1,905 positive cases were referred to local and regional contact tracing teams. This is now down to about 100 referrals per week.

At the moment over 85% of index cases have been contacted by these local contact teams with over 90% of contacts have been reached and advised. The local knowledge of the contact tracers is felt to be an important advantage in delivering the programme. As well, local government’s involvement allows for the provision a range of local support services where needed.

Prior to the launch of the main contact tracing programme the Welsh Government undertook a pilot exercise to across different parts of the Wales to identify potential problems. This has allowed the main programme be launched fairly smoothly.

To the middle of July the number of fatalities in Wales is in lower single figures with no deaths on some days – down from a daily peak of 43 in early April. There are less than 30 new cases daily a reduction from a peak of 391.

Plans are also being developed to boost the Welsh GP viral surveillance programme with the target of covering 20% of the population. This should provide improved sero-surveillance across Wales to provide an early alert system as we face the risk of a second wave of Covid-19.

Compared to some other parts of the UK, the Welsh Test, Trace and Protect scheme has attracted public confidence and support. The Welsh Government aspires to eradicating the virus as far as is possible but it recognises that its long, much used border with England means that not all the necessary levers are at its disposal. It also acknowledges that the lack of adequate welfare benefit support from Westminster for those who have to isolate due to Covid-19 infection or through being contacts is an avoidable vulnerability in the campaign to contain and eradicate the virus.

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2 Comments

  1. Judith Joy says:

    Please clarify the name of the Welsh system. Is it Test,TRACT,and Protect or the other name used Test,TRACE and Protect? It certainly seems to prove that local is best whatever you call it.

    1. Jim Gralton says:

      Apologies for the typo — it is “Test, Trace and Protect” as was indicated in the title.

      The local knowledge and organisation is intrinsic to the Welsh tracing system. As most of the “tracers” are local government employees they have a good initial knowledge of their patch and they understand local services and support networks. The frontline tracers are supported by more senior officers and health specialists who are also well versed about the local and national context in which the service operates in Wales.

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