NHSX reveals full details of UK Covid-19 contact-tracing strategy

NHSX, the UK National Health Service’s digital innovation unit, has revealed fuller details of the contact-tracing app which it believes could be important in helping the country return to normality and beating the coronavirus.

The revelation comes as the UK government struggles to ramp up its Covid-19 test and tracking capability and follows an announcement in Parliament on 22 April by health minister Matt Hancock that the government would introduce large-scale contact-tracing via a smartphone app once the number of new cases of the coronavirus falls.

“The more people who sign up for this new app when it goes live, the better informed our response will be and the better we can therefore protect the NHS,” said Hancock, noting the development of a new NHS app to facilitate this. The next day, reports emerged of NHSX enlisting the services of the Royal Air Force to test the contact-tracing app at one of its bases at Leeming, North Yorkshire.

Now NHSX has revealed details of the app and the how it is developing, before a launch that it says will take place in the coming weeks.

NHSX chief executive Matthew Gould and public health doctor and programme lead Geraint Lewis both noted that, fundamentally, the app would automate the “laborious” process of contact tracing and has the goal of reducing transmission of the virus by alerting people who may have been exposed, so they can take action to protect themselves. The technology is based on research evidence developed by epidemiologists, mathematical modellers and ethicists at Oxford University’s Nuffield Departments of Medicine and Population Health.

Once installed, the app will start logging the distance between a user’s smartphone and other phones nearby that also have the app installed using Bluetooth Low Energy. The anonymous log of how close users are to others will be stored securely on the user’s phone.

If a user become unwell with symptoms of Covid-19, they can allow the app to inform the NHS which, subject to sophisticated risk analysis, will trigger an anonymous alert to those other app users with whom the user came into significant contact over the previous few days.

The app will suggest what action to take if anyone affected has been close to someone who has become symptomatic – including advising to self-isolate if necessary. The exact advice on what to do will depend on the evolving context and approach.

NHSX said the app’s functions will be based on “the science” and will be approved by the UK’s chief medical officer. It said scientists and doctors will continuously support NHSX to fine-tune the app to ensure it is as helpful as possible, both to individuals and to the NHS in managing the pandemic.

NHSX said future releases of the app will allow people to choose to provide the NHS with extra information about themselves to help identify disease hotspots and trends. To encourage such information to be provided, NHSX said users who agree to provide this extra information will play a key role in providing additional information about the spread of Covid-19 that will contribute to protecting the health of others and getting the country back to normal in a controlled way, as restrictions ease.

One of the major issues about the app has been privacy of information – in fact, the NHS has been involved in a dispute with Apple and Google about this issue with regard to the IT companies’ own contact-tracing technology – and NHSX has accepted that the app could only make a positive contribution if installed by a large proportion of the population who trusted the app and followed the advice provided.

NHSX gave an assurance that data on the app will only ever be used for NHS care, management, evaluation and research. It stressed that users would always be able to delete the app and all associated data whenever they wanted.

“We will always comply with the law around the use of your data, including the Data Protection Act, and will explain how we intend to use it,” NHSX said in a statement. “We will be totally open and transparent about your choices in the app and what they mean. If we make any changes to how the app works over time, we will explain in plain English why those changes were made and what they mean for you.

“Your privacy is crucial to the NHS, and sos while these are unusual times, we are acutely aware of our obligations to you. Just as the NHS strives at all times to keep your health records confidential, so it will keep the app data secure. Patient confidentiality is built into the NHS. It is one of our key values.”

This view was echoed by the UK Information Commission’s Office (ICO). “People must have trust and confidence in the way personal data is used to respond to the Covid-19 crisis,” said information commissioner Elizabeth Denham. “The ICO also recognises the vital role that data can play in tracking the pandemic and the need to act urgently. We have been working with NHSX to help them ensure a high level of transparency and governance. We will continue to offer that support during the life of the app as it is developed, rolled out and when it is no longer needed.”

NHSX said it was committed to listening to users’ ideas and concerns to ensure the app will develop and improve over time. It said it will explain to app users when and why it makes any changes. It emphasised that user-testing sat at the heart of the app’s design, its implementation and its continuous improvement.