The Test, Trace, Protect (TTP) programme has successfully brought together different parts of the Welsh public sector, and other agencies, to rapidly build a system of testing and contact tracing largely from scratch and on an unprecedented scale. 

TTP has been at the frontline of the Welsh Government’s approach to limiting the spread of COVID-19. As in other parts of the UK, the TTP programme on its own has not been able to wholly prevent the spread of the virus and has needed to be supplemented by local and national lockdown restrictions. This report looks at how public services are responding to the challenges of delivering TTP services in Wales, in what has been, and continues to be, a rapidly evolving programme. 

In the early stages of the pandemic, testing capacity in Wales was insufficient to cope with the increasing incidence of COVID-19. Wales needed to make use of the UK Lighthouse Lab network and increase capacity within Welsh laboratories to cope with the demand for tests. After some initial logistical challenges, this hybrid testing system has largely been able to turn around tests quickly. However, the testing system in Wales needs to continue to evolve to ensure it is fit for purpose, especially in respect of hospital patients. 

Contact tracing teams were successfully established across Wales, drawing on rapidly expanding workforces that benefited from local intelligence and knowledge. Contact tracing has generally performed well, helped by a mutual aid agreement between regions. However, at times of high demand across the whole of Wales, the system has struggled to track positive cases and their contacts quickly. 
There is good information to show the range of services and support available to help the public self-isolate when needed, but our work has found that it is difficult to know how well the “protect” element of TTP is working in practice.   

The programme has demonstrated that it can adapt and evolve quickly, learning lessons from the management of early outbreaks and trying to effectively marry Wales specific and UK-wide arrangements. However, this has been a challenge, with officials describing it as trying to “design, build and fly an aircraft all at the same time”. 

Our report has highlighted a number of key challenges and opportunities as the TTP continues throughout 2021:

• Better information – the different parts of the Welsh public and third sector need to have better information to help improve efficiency and evaluate the overall impact of the TTP programme.
• Fit for purpose testing – to continue to respond to the pandemic during 2021, tests will need to be easily accessible, supported by a clear rollout plan on how rapid test devices will be applied. Frequency of testing for patients and staff also needs strengthening to prevent any future outbreaks in hospitals.
• Skilled, resilient workforce – staff involved in TTP have been working under considerable pressure, and for many, have also been redeployed from other parts of the public sector. A skilled and resilient workforce is needed to enable TTP to continue throughout 2021 as the wider public services start to reopen.
• Influencing the public – TTP is only part of the response to limiting the spread of COVID-19 with a real reliance on the public to follow the rules and self-isolate. As the public grow weary of the pandemic and restrictions on everyday lives, influencing public behaviour remains a huge challenge.
• Applying the learning – the TTP programme has demonstrated the ability for public services to work together and at pace to get things done. As attention moves to different responses to the pandemic, it is important that the positive learning from the programme is captured and applied to how partners work together in the future.

Notes to Editors:

• This report sets out the main findings from the Auditor General’s review of how public services are responding to the challenges of delivering TTP services in Wales.
• The evidence base for our commentary comes from document reviews, interviews with staff in health boards, local authorities, NHS Wales Informatics Service (NWIS), Public Health Wales (PHW) and the Welsh Government between September and December  2020, and analysis of key metrics that show how well the TTP programme has been performing. 
• As well as commenting on the delivery of TTP up to and including December 2020, the report sets out some key challenges and opportunities that will present themselves as part of the ongoing battle to control COVID-19.
• The Lighthouse Labs are managed by a partnership led by the UK Government. The partnership includes Medicines Discovery Catapult (a UK Government funded organisation), the UK Biocentre, the University of Glasgow, the University of Cambridge, and private companies: AstraZeneca, GSK, and PerkinElmer.
• The Auditor General is the independent statutory external auditor of the devolved Welsh public sector. He is responsible for the annual audit of the majority of the public money spent in Wales, including the £20 billion of funds that are voted on annually by the Welsh Parliament. Elements of this funding are passed by the Welsh Government to the NHS in Wales (over £8 billion) and to local government (over £4 billion).
• The audit independence of the Auditor General is of paramount importance. He is appointed by the Queen, and his audit work is not subject to direction or control by the Welsh Parliament or government. 
• The Wales Audit Office (WAO) is a corporate body consisting of a nine member statutory Board which employs staff and provides other resources to the Auditor General, who is also the Board’s Chief Executive and Accounting Officer. The Board monitors and advises the Auditor General, regarding the exercise of his functions.
• Audit Wales is the umbrella name for the Auditor General for Wales and the Wales Audit Office. Audit Wales is a registered trademark, but it is not a legal entity in itself.