Test, trace and trust: digital technologies and the COVID-19 response across the UK’s devolved nations

Three speakers with legal and technical expertise in the governance and implementation of emerging technologies talk about how joined-up approaches to COVID-19 across England, Scotland, Northern Ireland and Wales could help to contain the virus and encourage public trust.

This is our third virtual event, following the publication of our rapid evidence review Exit through the App Store, where we explore approaches of different nation states to using technology to control the spread of COVID-19 and re-open the economy.

This post summarises the key points of discussion and debate from the webinar, which you can watch in full below:

There has been substantial variation globally in the measures adopted by governments to contain COVID-19 and the timing of adopting and enforcing them, as public health experts learn in real time which measures are effective and policymakers prioritise strategies.

This variation has invited debate over the implementation of different test and trace strategies among policymakers, and among the wider public, as public choice emerges as a factor in the success of measures.

This debate is concentrated in the governments of Scotland, Wales and Northern Ireland (the devolved nations of the United Kingdom), who have authority and responsibility for public health in their own jurisdictions and an opportunity to coordinate between themselves and Westminster to achieve an effective response.

In particular, as digital contact tracing is tested on the Isle of Wight, questions are forming about how digital technologies – and particularly the NHS COVID-19 app – can help public health efforts to stem the spread of the virus across the United Kingdom, how much collaboration is needed when developing technologies, how sensitive data can and should be collected at scale, and whether the public will trust these technologies enough to make them useful.

Questions include:

• Should citizens and businesses expect UK governments to work together to manage the data governance and privacy risks presented by COVID-19 technologies?
• What kind of collaboration is needed, and when, to produce insights that guide future planning to manage the spread of the virus?
• What concerns emerge if the interconnected public health service systems within the UK adopt different technologies and data-sharing practices, e.g. for digital contact tracing?
• What effect might that have on public trust in technologies, locally and nationally, and therefore on the success of the measures?

What is happening with digital technology in Northern Ireland? 

MAURICE:   

The Northern Ireland Department of Health currently has deployed a symptom tracking app and a live data dashboard, for cases and deaths. 

Northern Ireland might use the NHSX contact tracing app but there is a need for apps to work across borders, either through a shared app or interoperability. The Northern Ireland Health Minister has spoken in favour a whole-Ireland app. The Republic of Ireland is developing its own app in line with the Google and Apple framework and may sign up to a pan-European contact tracing system. It is unlikely the UK Government will align with Europe. So, it ultimately becomes a political question of who aligns with who. 

What is happening with digital technology in Scotland? 

ANGELA:   

The Scottish Government published its test trace isolate and support strategy on 4 May, which revealed it was developing its own web-based digital tool rather than necessarily adopting the NHSX app. Further, in Scotland there seems a bigger emphasis on manual contact tracing with the digital tool as a complement rather than the primary solution.   

The Scottish Government and its agencies seemed not to have been involved in the development of the NHSX app and are seeking greater involvement. They also implicitly raise some concerns about the app, about the data that is being used, about public confidence in it and are not wholesale adopting it. There’s welcome concern there from the Scottish Government but not a lot of clarity about what it is going to be doing with it its own digital tool.   

What is happening with digital technology in Wales? 

PETE:   

The initial focus in Wales was very much focused on responses to practicalities, like ventilators and PPE, and not so concerned about the digital response. But Wales has now started using some public-facing digital tools, for example a chatbot app to take strain off the 111 calls to help and go beyond standard diagnosis into a question-and-answer style system. 

There are still a lot of questions over the NHSX app. For example, it would need to meet the Welsh requirement for support for Welsh language, and the Welsh government seem to be engaging with NHSX on this point.  However, we would expect there to try to be as much as possible convergence in the app and the technologies used to track and trace. 

What sort of collaboration is needed and when to produce the insights we are going to need to guide future planning and manage the spread of the virus? 

PETE:   

Collaboration and co-operation are going to be key. The source code is now open for people to scrutinise, and there is more information becoming available about the data flows between the app and other systems, and what is opt-in and opt-out, etc. 

There is still frustration there is not more information available right now, especially on how this data will be used in future. Development is moving so rapidly to get out there because lockdown is already starting to loosen. But as with all technology, the danger is if you roll it out too quickly without thinking through the consequences of it, you get issues at the other end. 

We should be confident in the cybersecurity of the app, and the National Cyber Security Centre have given a really good lay view and overview of how the app works and why it is secure. 

What is the relationship between trust in devolved administrations and trust in these technologies? 

ANGELA:   

There is a feeling there is quite a lot of trust in the Scottish Government – more than in the UK-wide Government in Scotland. However, it is important that the administrations are as transparent as possible about what they are doing in order to generate more public trust.  

Currently, there’s not a huge amount of information publicly available about the Scottish contact tracing system, the data it will be using, what data sets are being combined, whether that is appropriate, or whether data is being taken from something that is not really health related and then being used with other data sets.   

PETE:   

On questions around the distrust or apparent distrust of the NHSX app, one of the key issues is the speed of development.  

There has been a lot of coverage of the app and what it might or might not be doing. There were assumptions it would track your location or know exactly who you have been in contact with, etc. It has become clear this is not going to happen, but the issue is that we are now in a position where a lot of other information which was released before this other information is now in the public domain. 

So, the NHS is now in a ‘respond and repair’ situation. Maybe more information could have been made earlier, but at the same time the speed of development means that information was not always necessarily available earlier. Strong clear messages now need to come out about what it is and what it is not, and what it is or isn’t doing and how it is being used, with very little opportunity for misinterpretation. 

MAURICE: 

The risk is that the UK Government undermine wider digitalisation efforts, e.g. apps for dementia, if the NHSX app goes wrong, so they must be transparent about the app’s development. 

What are the relative benefits to continuing a unified approach, versus more localised management, when it comes to using technology? 

PETE:   

It’s important to identify upfront the purpose of what the technology is being used for and how it is going to help us. We want people to be able to move around easily around the UK, so a borderless approach to a contact tracing app would make sense.  

Having multiple apps which cannot interoperate is not helpful in the same way that a unified one would be. Added to that, you could also do localised analysis of that kind of thing to support more nation-based approaches.  

MAURICE:   

One app to unite us might not work in between the Republic of Ireland and Northern Ireland, but perhaps if a European initiative comes forward and is adopted by Ireland, it might expand to Northern Ireland as well. Otherwise the system assumes that people will install all the apps as they cross borders. 

ANGELA:   

A pan-European app would make more sense than the UK having its own app and the Republic of Ireland having its own app. But the politics of devolution, the politics of separatism in Scotland, the politics of unification (or not) in Ireland also play a role. 

One UK–wide app would also be a better option than devolved divergence if the app was trusted and worked well, and was safe and respected human rights, but concerns with the NHSX app haven’t been addressed, and the flailing out at the moment with the NHS X app doesn’t exactly inspire confidence.