Revealed: The inside story of the ‘Dunkirk labs’ and the test and trace fiasco

Health Editor Ross Lydall reports on the anger over unused capacity and secrecy over screening
Boris Johnson during his visit to the UK Biocentre in Milton Keynes
10 Downing Street/AFP via Getty
Ross Lydall @RossLydall23 September 2020

They were hailed as the “little ships” ready to ride to the rescue, in a Dunkirk-style mobilisation of the national response to coronavirus. But the failure to involve the UK’s small laboratories in the test and trace programme has been highlighted by an Evening Standard investigation as one of many problems with a system described by critics as secretive and shambolic.

Thousands of people have been unable to get coronavirus tests as a direct result of the lack of laboratory capacity to process them. Put simply, testing centres have been told to stop swabbing people because the laboratories cannot process the swabs quickly enough.

The problem dates to the decision of the Government in April to establish a new network of privately run mega-labs. The alternative would have been to expand capacity in the existing NHS and Public Health England labs, and call upon support from the small labs.

The first of the “Lighthouse Labs” opened in Milton Keynes on April 9, in partnership with the private sector and utilising emergency Covid rules that avoided the need for open competition. They are managed by the Department of Health but are not part of the NHS.

There are now seven Lighthouse Labs across the UK, with two more, in Newcastle and Bracknell, announced last week. Together, they will do the bulk of the testing as the country moves towards a target of 500,000 antigen tests a day by the end of next month.

Their job is to process “pillar 2” tests — the swabs from drive-through and walk-in facilities in the community that have been so heavily criticised. About 160,000 people a day are being swabbed in the community — but the demand for tests is three to four times higher.

Separate to this are the “pillar 1” swabs from patients and staff in hospitals and care homes. These swabs — about 55,000 a day — are processed by NHS labs. The Lighthouse Labs are doing the bulk of the work, but they are far less efficient.

Last week, NHS labs returned 92 per cent of samples within the target 24 hours. The Lighthouse Labs managed 33 per cent. The delay matters because the longer it takes to diagnose someone with Covid, the longer it then takes to trace their close contacts — meaning that both the infected person and others they may have infected remain at large in the community and potentially spreading the virus.

Testing mystery as cases fall in London despite coronavirus spreading

The Lighthouse Labs have been under such pressure that the UK has asked centres in Germany and Italy to process “tens of thousands” of swabs. NHS labs are also being asked to process thousands of community swabs. Figures yesterday showed the problem was getting worse. Joint pillar 1 and 2 daily capacity for the UK stood at 263,689. But only 188,865 tests were processed — the lowest figure for a fortnight.

Both Health Secretary Matt Hancock and Baroness Harding, the head of Test and Trace, have spoken recently of including the small labs in the drive to double capacity to 500,000 tests a day.

It was Sir Paul Nurse, who heads the Francis Crick Institute, who first called in April for the small labs in universities and private research facilities to be mobilised. He said that ministers should remember the lesson from Dunkirk and call upon “little watercrafts” rather than launching “destroyer” mega-labs.

The Crick immediately got to work and continues to process about 2,000 tests a day for NHS staff, patients and care home residents in north London.

Sir Paul told the Standard today: “An efficient testing programme is vital to controlling the pandemic. It is our strongest defence against a second wave of this virus.” But the supposed mobilisation of the small labs remains a closely guarded secret. Parliamentary written questions remain unanswered. Requests from the Standard for information have failed to elicit a response.

Sir Paul said: “Both a local and national approach to testing is needed, and the news that more labs will be up and running soon is welcome. But how the testing strategy will draw on smaller, local labs which are serving the communities around them is still unclear.

“The Crick approach could be run throughout London to improve the quality of testing by linking university research labs to healthcare facilities.”

Allan Wilson, of the Institute of Biomedical Science, said the focus should be on utilising and then expanding capacity in NHS labs. He said: “We have been calling for a closer working relationship between pillar 1 and pillar 2 — the NHS and Lighthouse Labs. It is a real frustration that we don’t know what happens in these Lighthouse Labs, and we are paying for them. There was a drop in capacity recently and we still don’t fully understand why.”

The IBMS is unsure of the practicalities of mobilising small labs. There remains a “grey area about what can these small labs do?” Mr Wilson said. “There is a potential role if you could somehow think of a group of tests that could relieve the pressure on both Lighthouse and NHS labs. But it takes quite a bit of effort. The more labs, the more difficult it is to ensure the quality of what you are doing.”

Professor Allyson Pollock, a member of Independent Sage, the rival group of experts to the Government’s scientific advisory panel, said it had been disastrous to exclude GPs from the system. This prevented them from “sifting” people with coughs and colds from those with Covid symptoms, so that the right people were tested.

Professor Deenan Pillay, of University College London and Independent Sage, said: “It’s not too late now to develop a national consortium based around NHS laboratories, Public Health England laboratories, as well as the private labs.”

There is hope too for Test and Trace. Professor Christina Pagel, from University College London, said: “The good news is that you don’t have to improve it a lot. It doesn’t have to be world-beating. It just has to be better.”