Covid-19 local test booking, administration and reporting solution

Briefly describe the initiative/ project/service; please include your aims and objectives

During the early outbreak of the coronavirus in 2020, Wigan Council was required to provide COVID-19 PCR testing for its300,000+ residents as part of a pilot scheme along with nine other Local Authorities. Under instruction of the Department of Health and Public Health England, the scheme was to commence as soon as possible, at numerous Council-run centres across the borough. Within 24 hours, each swab needed to be tested and processed by a private lab, before each resident was then informed of their results. However, the quick development of the crisis meant we had only five days to create a public test booking and back-office administration system as the pilot schemes were not to be included on the national booking system. With allocated centres set to begin testing in less than a week, and further sites set to open, we faced a significant challenge in allowing our residents to access and receive COVID-19 testing.

We recognised from the beginning that we needed to keep our data secure but local as this would allow us to immediately identify potential workplace outbreaks based on the number of positive results at the same location and, therefore, allow us to commence local surge testing to stop the spread (it would have been a further 24-48 hours post result before the data was accessible had we not kept it local). Local data was automated and visualised using PowerBI, which provided decision makers with secure access to live data, that was easy to interrogate. This enabled a swift response both to community transmission and workplace outbreaks, as data was mapped geographically and segmented according to age group, place of residence and workplace, etc. Whilst the local testing represented only a proportion of the full extent of cases in Wigan, it provided an insight into the areas of the borough that were escalating. From an operational perspective, it provided the business intelligence necessary to enable the testing site itself to operate effectively, enabling management of flow through the testing centre and demand, etc.

We also needed a way to automate the process of matching the results with the bookings and ensure they were securely returned to the resident. This required liaison with the private sector laboratories to agree a set file format which they would produce the results and securely return electronically each day; flexibility on both sides was required to meet our needs but without putting too much demand on the laboratory staff and a highly pressured time. Due to the timescales, the original booking process consisted of a basic booking form on the council’s website. Test requests were populated into a spreadsheet, and residents were manually emailed their booking confirmations. Each morning, an offline version of this document was sent to test centre staff, who then used the spreadsheet on an encrypted laptop for check-ins at testing sites. The daily data from the spreadsheet was automatically imported into a database and we would then automatically send off a list of barcodes used for that days testing to the respective laboratory ready for population and return with the test results. Once returned, the results were automatically imported into a database, matched with the corresponding resident and the result would be sent out electronically.

What wasn’t working?
• Time constraints: The original process was labour intensive, requiring human intervention at many of the stages. At the height of the programme, over 500 emails were awaiting booking allocations in the email inbox at one time.
• Low adaptability: Offline spreadsheets meant data and bookings were extremely difficult to amend, and slot cancellations were rarely filled.
• Room for error: With such vast amounts of data requiring quick action, there was ample room for human error to impact the testing process.

The original booking system was always going to be an interim, “quick fix” product. As the pandemic evolved and the need for testing increased, it was clear an end-to-end digital solution was required to support both residents and council workers. In line with project, Public Health England and Department of Health requirements, easy-to-use, secure, and fully integrated booking eForms were created in collaboration with NDL. Residents accessed the eForms with their own devices, selecting an appointment slot and test centre to suit them, before receiving an instant email confirmation notification once booked. If they arrived on site without prior booking, they could scan a QR code and immediately book. The test staff then used an eForm front end to update the data directly in the database, removing the need for spreadsheets. We later introduced barcode scanners to remove the requirement to manually type in a barcode, further removing pitfalls of human interaction. All forms had to pass penetration testing by an external, private security organisation prior to going live.

What are the key achievements?

The solution delivered several valuable benefits to the council and our residents, allowing better allocation of resources throughout challenging times. The streamlined approach and easy access to data for local reporting allowed mobile testing to be deployed at surge sites, helping to control and track the spread of the virus. But most importantly, the digital solution provided a better experience to members of the public whilst ensuring the sensitive demographic and medical data was securely held in line with GDPR.

At its peak, we delivered over 1,000 tests across our centres each week – with 287 tests taken on our single busiest day. New testing centres were easily added to the booking system, and old centres were easily removed. The collaborative, agile development in partnership with NDL allowed us to quickly iterate through the changes imposed by government and improve the solution at each point. NDL were always available and regularly in contact to ensure the development of the booking system was on track and functioned as required. The use of MS Teams was a key communication tool with everyone working from home at the height of the pandemic.

Benefits from further developing the solution, removing the basic booking webform and manual booking/email included;
• Improved employee morale
• Improved service and experience for residents
• Significant reduction in admin time and overheads
• Faster COVID-19 test bookings and recordings
• Local data aiding surge and hotspot testing

The active use of and response to localised data has been attributed to Wigan remaining in a lower level of restriction tier than neighbouring GM authorities during the summer of 2020 (local lockdown restrictions were removed from Wigan and Stockport on 20/08/20 and only reinstated on 25/09/20 in line with wider national directives). Thus, having a positive impact on the wellbeing of residents and socio-economic challenges associated with lockdowns. The project exceeded expectations, gaining recognition at a national government level along with other award ceremonies. Since sharing our story, other local authorities are making contact to find out what we did and how we did it.

How innovative is your initiative?

Given we were one of the pilots, the speed of the delivery with a limited understanding of what the ask was, along with the changing requirements as the pandemic developed, meant that we had to be extremely creative and innovative in our attempts to understand what data and processes may be required to support at both a national and local level. A lot of the time we were “building the plane whilst trying to fly it”. Understanding our local landscape and then using the testing data to identify potential hot spots would not have been possible without our end-to-end initiative. The fact we held the sensitive test data locally, whilst still securely transferring it to the national teams, allowed us to deliver a more efficient and effective targeted testing service to keep our population safe and reduce the spread of the virus whilst ensuring that personal information was protected. Our use of intelligence during the pandemic has spearheaded our drive to become a ‘data-led’ organisation; providing a
watershed moment that we are now capitalising on. Out of the 10 testing pilots in England, Wigan Council was the only local authority able to find a viable end to end digital solution. All our process mapping and documentation was shared with the Department of Health and Public Health England as part of the pilot. The subsequent national lateral flow testing programme followed a similar process to our solution.

What are the key learning points?

Identify the important elements of a project, the “must haves”, and work on those rather than trying to have a perfect solution from the start, then iterate: we knew that the webform/spreadsheet solution was not an ideal solution, but it was quick to implement, and it worked in the short term whilst still ensuring data security and gave us time to work on automating the matching and disseminating of the results. Once we had cracked the matching, we went back and improved the booking element. Know your organisation, its teams and skillsets, and use them: we had members of staff from various teams working on the solution at the same time. Because we knew who had what skill, we were able to work together on our own little piece of the solution. By breaking it down into manageable pieces we were able to release a solution much quicker than a traditional waterfall approach.

Working collectively also enabled us to add value to our individual skills and areas of expertise and ensure that our outputs met each other’s requirements from the start of the project. Don’t take “no” for an answer, question ‘why?’ and, more importantly, ‘why not?’: if we had not pushed the laboratories for their cooperation with the electronic sending of the test data to us, we would not have had a workable solution. If we had not pushed the Department of Health and Public Health England to work with us in finding a solution which allowed us to retain local data, while still meeting their obligations, we would not have had a workable solution. Even in times of crisis, there’s usually a way around things if you have a creative mindset, a collaborative approach and flexibility on each side. As previously stated, in terms of scalability, since sharing our story other local authorities are making contact to find out what we did and how we did it.