nhs test and trace nhs test and trace nhs test and trace is a government-funded service in england, established in 2020 to track and help prevent the spread of covid-19. despite its name, the programme was never in fact run by the nhs: the programme is part of the uk health security agency; the service and the agency are headed by jenny harries. not to be confused with the nhs contact-tracing app. nhs test and tracea box containing a covid-19 lateral flow testagency overviewformed28 may 2020jurisdictionenglandminister responsiblesyed kamall, baron kamall, parliamentary under secretary of state (minister for innovation)agency executivejenny harries, chief executive of uk health security agencyparent departmentdepartment of health and social care the service is the responsibility of the secretary of state for health and social care and the minister of state for social care. it has devolved to the parliamentary under-secretary of state for innovation at that ministry, currently lord kamall. the initial budget for the service was £15 billion, rising to £22bn in november 2020, and a further £15bn was allocated for 2021–22 to bring the total for the two years to £37bn. routine contact tracing was halted on 24 february 2022. the service provides temporary sites where samples are taken from individuals, processes the samples at a newly created network of laboratories, and communicates the results; infected people are instructed to isolate themselves from others and asked to provide details of their recent close contacts, who are also told to isolate. almost all of the work is outsourced to consultants and contractors, although some of the laboratories involve other government bodies and universities. nhs test and trace is separate from the pre-existing infection control function of public health england, which works with nhs laboratories. creation during the early stages of the covid-19 pandemic, contact tracing was carried out by public health england, working with local authorities; phe was an agency of the department of health and social care and not part of the nhs. tracing efforts largely ceased on 12 march 2020 in view of the wide spread of infection in the population. around the same time, testing nhs patients and staff was made a priority, and took all available test capacity. the new agency was announced by matt hancock, the then secretary of state for health and social care, in april 2020 and began operations towards the end of may. it was led by dido harding, baroness harding, a conservative peer and businesswoman, until the establishment of the uk health security agency in april 2021. overview nhs test and trace's remit is to find people who have come into close contact with those infected by the virus, thus enabling the lifting of blanket lockdown restrictions and a potential shift towards more localised measures should they be required. the organisation employs a team of (initially) 25,000 contact tracers who contact people who have newly tested positive for covid-19 and ask them about their recent movements, before identifying others they may have come into contact with. those people are then required to go into self-isolation for ten days (fourteen days until december 2020; some workers exempted from july 2021; double-vaccinated exempted from august 2021; isolation reduced to seven days in some cases in december 2021 and then five days in january 2022). the contact tracers are employed by serco, who engage subcontractors – 29 of them in september 2020. serco were paid £108 million for the first phase of the work, up to late august 2020. the call centre is operated by american specialists sitel, who were paid £84m for the first phase. in november 2020, dido harding described it as "the largest outbound calling centre in the uk". software from salesforce is supplied by ibm under a strategic sales solution contract worth around £25m for 2020–21. all components – administering tests, processing samples in laboratories, and contact tracing – are contracted to private companies. multinational consultants deloitte handle testing logistics, including collection of statistics, and in turn appointed outsourcing companies serco, mitie, g4s and sodexo, together with the boots pharmacy chain, to run drive-through or walk-in test centres. in october 2020, over 1,100 deloitte consultants were reported to be engaged. in march 2021, the public accounts committee criticised "persistent reliance on consultants", stating that 2,500 were being used at an average cost of £1,100 per day each. mobile testing units (mtus) were designed, prototyped, bought and operated by the army in april. by 20 july there were 218 in operation in england, wales and scotland, and the units were then handed over to undisclosed civilian contractors. mobile units in northern ireland were operated by civilians from the outset. the system works in parallel with public health england's local health protection teams, who in turn work with local authority staff. cases involving institutions such as hospitals, care homes and prisons are handed off to the local teams, who give advice to the institution rather than the affected individuals. less complex cases are handled by nhs test and trace: the infected person is contacted by text, email or phone, and asked to give details of their recent close contacts. they may either enter these contact details into the test and trace website, or give them over the phone to a contact tracer. if they do not respond, in some areas nhs test and trace passes their details to a team employed by the local authority, who make further attempts by phone or text and in some cases by home visit. as of december 2020, there were in excess of 700 testing sites in operation with the stated average distance of travel to reach one at 2.4 miles. all sites operate 7 days a week, including over christmas and new year albeit with reduced hours. geographic scope the scope of the nhs test and trace contact-tracing service is england only, the other united kingdom administrations making their own arrangements. however, the laboratory network operates uk-wide. budget the initial budget for 2020–21 was £15bn, of which around 85% (£12.8bn) was for testing. in november 2020, a further £7bn was allocated as part of the uk government's covid-19 winter plan. £15bn was allocated for the 2021–22 financial year, bringing the total for the two years to £37bn. in february 2022 it was confirmed that the test and trace programme had cost £15.7bn in 2021/22. after the first phases, serco were awarded a 12-month contract worth up to £322m in june 2021. a month after the ending of routine contact tracing in february 2022, the company won a two-year contract for disease testing and contact tracing worth a maximum of £212m. test processing and 'lighthouse labs' "priority postbox", designated for returning home testing kits, great barr, birmingham, england test kits for use at home (and at some test centres) are provided and processed by randox under a £133m contract, with logistics by amazon and royal mail, and some identity checking by american consumer credit agency transunion. randox has a lab in northern ireland, although in may 2020 some samples were processed in the united states owing to lack of capacity. special arrangements were made with royal mail for the return of home testing kits via designated "priority postboxes", which were identified by the attachment of special stickers. before the covid-19 pandemic, tests for infections in england were carried out at laboratories within either public health england or the nhs (the latter often sited at hospitals, and reporting results to phe's surveillance system). in early april 2020, the government reserved the capacity of these labs for testing nhs patients and staff, calling this "pillar one" of their testing strategy. "pillar two" provided mass testing – at first to key workers, later to the general public – using a new network of large processing centres operated by commercial companies and universities, coordinated by deloitte. initially three of these sites were planned, at milton keynes, alderley park and glasgow. they were collectively named "lighthouse labs" since they employ the pcr test which uses fluorescent dye to detect the virus. at milton keynes, around 240 academics, researchers and students volunteered their services in march and april 2020, in some cases processing tests manually until automation was ready towards the end of april. geneticist paul nurse, director of the francis crick institute, repurposed academic laboratories to perform tests and later criticised the government's reliance on the private sector. as of november 2020, six sites were in operation: alderley park, cheshire – led by medicines discovery catapult cambridge – astrazeneca, glaxosmithkline and cambridge university glasgow – glasgow university, supported by the scottish government milton keynes – uk biocentre, part of the national institute for health research newport – perkinelmer, supported by the welsh government loughborough – perkinelmer in november two further 'mega labs' were announced as due to open in early 2021 at leamington spa and an unconfirmed site in scotland. the public accounts committee found that overall usage of laboratory testing capacity was below 65% in november and december 2020. the scottish lab was subject to delays and in january its construction was halted, as the uk government was reported to be assessing the long-term demand for the laboratory. meanwhile, smaller laboratories were opened in glasgow and aberdeen during december 2020, but another smaller one planned for edinburgh has not yet opened. three new laboratories managed by nhs trusts, at gateshead, bracknell (brants bridge) and plymouth, joined the system in march 2021. the leamington spa lab, described as the uk's first testing mega-lab, began operation in june 2021 and was later named as the rosalind franklin laboratory, in honour of the pioneering scientist in molecular biology. from 1 april 2022, access to free tests was withdrawn except for high-risk settings (such as hospitals) and some workers in high-risk roles. consequently, most of the lighthouse labs were closed. in january 2023 the rosalind franklin laboratory ceased to process pcr tests, leaving two sites operational alongside the nhs laboratories. phone app a venue poster showing a qr code to use with the nhs covid-19 app the system was designed to work in conjunction with the nhs covid-19 app, which was originally announced for mid-may but subsequently delayed due to technical issues during its testing phase. the app enables those who have been in close contact with a person with covid to be identified using their mobile phone. prior to this, information would be gathered by questioning people about their recent movements. following a further delay, liberal democrat mp daisy cooper tweeted on 28 may: "dido harding just told me that the #nhsx app described by pm a week ago as 'world-beating' is in fact just a 'cherry on top' of the tracing system: which itself won’t be fully operational until end june... 4 weeks after lockdown restrictions ease. this is a high risk strategy." replying to a question at the government's daily briefing on 11 june, hancock was unable to give any date for rollout of the app, saying it would be brought in "when it's right to do so". on 18 june, development of the app was abandoned in favour of a different design using the apple/google exposure notification system. public trials of the second version of the app began on 13 august 2020, and it was made available to the public on 24 september. users of the app can scan a qr code at participating venues. between 24 september 2020 and 18 july 2021 it was mandatory for hospitality, tourism and leisure venues, hairdressers and similar services, and local authority amenities to display a code. record-keeping by venues from early july 2020, establishments where people come into prolonged contact with those from other households were asked to collect and keep for 21 days records of the names and phone numbers of staff, customers, and visitors. no check for accuracy was required, and at first there was no requirement to refuse admission to anyone declining to provide these details. public health officers request these records if the premises are suspected to be the site of a covid-19 outbreak. applicable establishments included all hospitality outlets except takeaway food and drink, tourism and leisure, community facilities, places of worship, and close contact services such as hairdressers. from 18 september, hospitality venues were required to refuse entry to a customer or visitor when they (or the leader of their