When Boris Johnson announced, late on the afternoon of May 27, that the NHS England Test and Trace program would go live the next morning, some of the newly hired contact tracers heard the news the same way much of the country did: from the prime minister’s televised appearance before the House of Commons Liaison Committee.
The emails from Sitel, one of the companies running the operation, followed that evening, some around 6pm and in at least one case after 10pm that night. Earlier in the afternoon, though, one of the two main tools, the call centre script software Synergy, was still not syncing with the web-based CTAS (Contact Tracing and Advisory Service) rendering it useless. Some contact tracers had also yet to successfully complete a mock phones call as part of their training and communication around the start date was poor. “Obviously we knew yesterday that it wasn’t working,” one contact tracer, who wished to remain anonymous, told us on day one of the service. “When I was doing test calls, it still wasn’t syncing up. But I think that because they made the announcement, we had to go live today.”
Dido Harding, the former CEO of TalkTalk who was appointed to head up Test and Trace as executive chair, noted in the daily coronavirus conference that we should expect “some kinks” on the first day of NHS England’s contact tracing. Similar initiatives will be rolled out in Wales from June 1 and are already live in Scotland and Northern Ireland. Harding told MPs that contact tracing won’t be fully operational until the end of June; one of the contact tracers we spoke to estimates it will take at least two weeks to get the existing systems and staff working effectively.
By this point, some contact tracers will have technically completed more than one or two week’s worth of paid work, split into four, eight and twelve hour shifts available from 8am to 8pm, seven days a week. The NHS Covid-19 tracking app is delayed until June but the government has been keen to stress that it has recruited 25,000 contact tracers. Most of these are 'Tier 3' call handlers with no medical experience but around 3,000 'Tier 2' staff have clinical backgrounds; Tier 1 is made up of Public Health England employees who deal with cases in settings such as care homes and prisons.
Tier 2 contact caseworkers, recruited via the NHS Professionals job bank, are tasked with calling people who have tested positive for Covid-19 and inputting the information on CTAS for anyone they have come into close contact with between two days before presenting coronavirus symptoms and seven days afterwards. Tier 3 staff then follow up with the individuals named in CTAS and give them advice on symptoms and testing and instructions to self-isolate at home.
Sitel’s contact tracing training consists of signing up for one mandatory eight-hour shift and working through a series of documents and a few videos of software demos, each between five and ten minutes long. A clinical contact tracer we spoke to, who has years of medical experience and is working remotely, spent “five to six hours” reviewing the training materials and did not have any form of one-to-one or group call with Sitel staff as part of the training, though it’s understood that some contact tracers have had guided sessions.
As well as information on the software and the script to follow during the phones calls – “don’t go off script” – the materials are mainly concerned with “statutory training on safeguarding children and adults and data protection”. In other words this is guidance that doctors and other clinical workers would need to know anyway. It reportedly provides only a rough outline of the job: “it’s not very specific training, it’s not specific enough to make you able to do what you’re supposed to do.” A DHSC spokesperson says all contact tracers have received “appropriate training and are following detailed procedures and scripts designed by the experts at Public Health England”. Contact tracers will also receive “ongoing support for their role”, the spokesperson says. They add that the system “will help reduce the spread of the virus and save lives”.
On May 23 and May 24, contact tracers were invited to sign up for a limited number of mock call sessions with volunteers acting as Covid-19 patients. Some of these were completely successfully, while others had technical difficulties and as a result were not able to participate and were given no further opportunities to do so. There was a feedback form to fill in afterwards with comments.
Days later, on the afternoon of May 27, as Johnson was gearing up to announce that Test and Trace would launch in less than 24 hours, there was a second, wider opportunity. This time it was possible to pair up with other contact tracers to role play the conversations that would make up the 30 minute phones interviews they would be conducting. These were carried out via the VoIP platform RingCentral used by Sitel, with contact tracers able to choose a fellow tracer at random from the online directory.
The Synergy script software was still not live at this point and there was no supervision or feedback mechanism: “I think those calls were for us to try it out but not necessarily improve the system. I’m not sure they know how many 'mock calls' I’ve done.” In the downtime between the mock calls and the suggested activity of 'refamiliarising' themselves with the limited training materials, the clinical caseworker got on with normal lockdown life: “I’ve mastered a three ball juggle, I’m getting pretty good.” Another contact tracer we spoke to reported taking up video-games.
As the contact tracers who started work at 8am on May 28 quickly realised, there was a problem with the launch day instructions that Sitel had sent out after the prime minister’s announcement on Wednesday evening. The log-in link wasn’t working and as some people began to phones the Sitel helpdesk number that was provided in the email, others looked for workarounds. “I have no idea what is going on with it,” one Tier-3 contact tracer told WIRED on Thursday morning. “I am yet to receive a login for the call-handling systems.” Another contact tracer that spoke to WIRED had been added to an unofficial WhatsApp group of clinical caseworkers. They were unaware of any formal support group available, though other contact tracers told The Guardian that online groups are running. That morning, “after it had supposedly already gone live”, the chatter was about how to actually access Synergy.
“We figured out how to access it but when we logged in, we didn’t know whether we were in the beta software or the live version,” the contact tracer said. “We were just guessing.” Then at around 10am Sitel sent out the email that quickly leaked to the press and made its way to Twitter, that the company was aware the contact tracers could not sign in, it had been logged as a critical incident and with the instruction not to email or call the Sitel helpline regarding sign-in difficulties.
It wasn’t until around 4pm, the same time as 377 more UK coronavirus deaths were confirmed, that the email appeared for some with updated log-in guidance along with an instruction not to talk to the media. With some contact tracers signing on for the afternoon-evening shift, they found that the guided script software Synergy was still not syncing with CTAS properly – the idea is to actually access CTAS through Synergy – but it was now possible to view the list of the names and details of people who had tested positive for Covid-19. Some aspects of the process weren’t clear even at this point: “For example, we didn’t know if we would be assigned cases or if we had to select them for ourselves. After that email in the afternoon, we realised we did need to select them ourselves.”
The contact tracers we spoke to are not aware of anyone who made successful calls using the Synergy script software, which guides the caller through the conversation via a series of on screen yes/no buttons, on day one. By the end of Thursday evening, a Tier-3 contact tracer told WIRED that they hadn’t managed to log in a single time. “It’s the same for a lot of people in my team as well,” they said. “We didn’t [work], basically.”
With thousands of contact tracers of the 25,000 total potentially working this week, this may not be representative. Contact tracers speaking to The Guardian, Sky News and LBC, over the course of the past few days, have given similar accounts of limited training and technical issues, suggesting these are not isolated incidents. Sitel did not respond to WIRED’s request for comment.
Once the clinical contact tracers could view cases in CTAS in the afternoon, they were also able to view the phones numbers of patients to call via RingCentral. As predicted by Baroness Harding, it was fairly quiet with “30 to 60 and no more than 100” cases available to a Tier 2 contact tracer at any one time and cases tending to get assigned quickly. With no further communication from Sitel, some of the most exasperated, concerned about “doing the wrong thing”, gave up for the day.
After hearing on WhatsApp from a colleague who ended up “botching their way through some calls” by ignoring Synergy altogether and instead improvising, flicking through PDFs of the script and FAQs, the contact tracer we spoke to decided to try it out. “I thought I’d give it a go,” they said. “It’s quite stressful even just trying to make a call when you are so unprepared. It went straight to voicemail but I couldn’t find the script for the message you’re supposed to leave in the documents. So I hung up.”
Updated 29.05.20, 19:10 BST: Additional comment from a DHSC spokesperson has been added.
Additional reporting by Gian Volpicelli
Sophie Charara edits WIRED Recommends. She tweets from @sophiecharara
This article was originally published by WIRED UK
