1/20 Good time to update on testing. @DHSCgovuk statement yesterday. Strong letter from @CommonsSTC to Prime Minister sharing many of the concerns we have been raising: https://committees.parliament.uk/committee/135/science-and-technology-committee-commons/news/146472/committee-writes-to-the-prime-minister-lessons-learned-so-far-from-the-covid19-pandemic/. And pick up of the media comment we made yesterday. Twitter thread follows.

2/20 Usual basis – we are not Government or NHS England. We don't have any operational responsibilities in NHS. We are not involved in the design or delivery of the testing regime. We are the public voice of 217 NHS trusts. Full details of our role here: https://nhsproviders.org/news-blogs/press-office

3/20 Testing regime improving. Capacity increasing – now starting to consistently hit 100k tests/day. Appointment of @didoharding to lead, supported by @BWCHBoss & @tomriordan, welcome. Frontline engagement growing. But still very long way to go to reach fit for purpose regime.

4/20 Most important priority for testing regime, as stated in Commons Statement yesterday, is NHS and care patients, residents and staff. We asked trust Chief Executives yesterday for their up to date feedback on testing and their responses can be summarised in the following.

5/20 Every trust leader acknowledged testing was improving. They are proud of the role they have played to build capacity in NHS laboratories. They are also proud that their contribution to the 100,000 capacity target was met before April 30 and has been met every day since.

6/20 Trusts who've been able to build their own capacity are generally in a good position – “we pushed our local testing capacity up and built a decent drive through and digital booking system to support. All locally developed but means we have next day results across our patch”.

7/20 But lots of trusts can't build their own capacity and are therefore still very reliant on external testing capacity they don’t control. This capacity is part of the wider Government testing regime. Obtaining timely results from this capacity is extremely unreliable.

8/20 Trusts are concerned that this unreliability is currently risking their ability to provide the right, safe, patient care. And it will definitely prevent them from safely restarting the full range of services they have been asked to restart as quickly as possible.

9/20 One commented: “at present we have to send around 2/3rds of our tests out of area and, until recently, this has involved a 48hr turnaround. Not good enough. Others are in a much better place…It feels a long way off having sufficient capacity to allow real step in activity”.

10/20 A second trust CEO said: “more local testing for patients is really what is needed…we can do this in under four hours but not yet in the volumes that are required. Turnaround times for external tests are too slow still…and are still not reliably within 48 hours”.

11/20 Other comments included: “External testing turnaround times still very slow and not as advertised! They state 48 hours but our experience is closer to five days with 13 days being record”. And “Testing still pretty shambolic. Supply chain of swabs & reagents is poor”.

12/20 We have described this as a patchwork quilt. Completing a patchwork quilt requires identification and filling of individual gaps. Measuring success through national level testing capacity and national testing turnaround time therefore completely misses this point.

13/20 Trust leaders recognise they must play their part in filling the gaps but they need help and support from Government and its national testing regime partners. Trust leaders are also convinced that gaps can only be effectively filled if more control is decentralised.

14/20 Care homes need even greater support. They are numerous, geographically dispersed and have no testing capacity of their own. Vital that their needs are properly identified and quickly met. It's welcome that the Government has decentralised some control here.

15/20 There are three other gaps. Gap 1. If trusts are to safely restart the full range of NHS services, they need to know when and how all hospital/trust bound patients, e.g. those requiring elective surgery, and all staff treating those patients, can be regularly tested.

16/20 In words of one CEO: “We currently have good access to staff and patient testing but are not yet at all ready for rapid testing of staff and patients to support the new infection protection and control guidelines". These guidelines need to be met to fully restart services.

17/20 Gap 2. NHS organisations still unclear on their role in general population test, track and trace that accompanies lockdown easing which has already started. Good to see creation of national track and trace fieldforce and app. But how do they interact with mainstream NHS?

18/20 Gap 3. Trusts still waiting for proper, updated, testing strategy so they can see where they are going, how fast capacity will be built and who will be prioritised. They still feel they are on the end of tactical announcements and not full partners in a clear strategy…

19/20 …Strategy needs to test right people, with right speed of access to results with this driving what capacity is needed where. Strategy drives capacity not the other way round. Delivering 100k tests by April 30 is not a strategy - nor is delivering 200k tests by end May.

20/20 Trusts still frustrated by announcements expanding who can be tested whilst promises about priority for NHS patients and staff remain unfulfilled. The gap between the tone of public statements and the reality on the ground is still painfully wide and needs closing quickly.