Republished, with permission, from The Mill. Originally published October 27 2021.
Recently, we’ve been having a look at how Greater Manchester’s sexually transmitted infection (STI) testing services have been working — or not working. Unlike with Covid testing, which has a centralised ordering system, STI services are run differently depending on where you are in the UK. Wales’ main service — the brilliantly named Frisky Wales — is open to everyone living in Wales, whereas in England, services differ by area.
For those who feel embarrassed or nervous discussing sexual health, or who just don’t have enough time to visit a clinic, home test kits can provide a convenient alternative to in-person appointments. They are sent directly to your address with a freepost return label – all you do is follow the instructions in the box, provide samples collected from various bodily areas, and pop your test kit in the post. Home tests are particularly important at the moment as local sexual health clinics are not offering a walk-in service, making it considerably more cumbersome to get an in-person appointment.
Members of the local LGBT+ community (a community known to be disproportionately affected by STIs, especially HIV) have told us they find it so difficult to get home tests in Manchester that they are getting friends to send them from London, which has a more reliable service. So we decided to have a look at what’s going on.
The numbers
The Northern, the massive sexual health service covering Manchester, Stockport, Tameside and Trafford, is run by Manchester University NHS Foundation Trust under contract from Manchester City Council, to whom the other councils contribute funding to pay for their share (it is local authorities who are responsible for sexual health in this country). That all sounds a bit technical, but it’s the service itself, and how it works for users, that we really care about.
Last month, we asked the trust for the numbers behind The Northern. Eventually, after multiple phone calls and follow-up emails — and two weeks after the trust was legally bound to send us the data under the Freedom of Information Act — they told us: The Northern only allocates 60 test kits per day for users to order through its website. That’s 60 kits per day for a service that covers an area with a population of over 1.3 million people.
We used web-page monitoring software to find out how long it took, on average, for test kits to become unavailable. The software refreshes the ordering page every five minutes and detects changes. As the STI test kit page changes between a form allowing users to input their details and an error message saying the kits have run out, we were able to put the times into a spreadsheet to work out the average amount of time it took between the kits being released (daily at 8.30am) and when the error message appeared saying they had run out.
On one Friday, it took 24 minutes before the order form was replaced by the message: “Unfortunately we have reached the limit we can possibly process today. We are working to increase capacity as much as possible. New kits are made available regularly.” Anyone who tried to order a kit after 8.54am that day was out of luck.
The trust told us that kits were available from The Northern for an average of 104 minutes on weekdays and 314 minutes on weekends and bank holidays. But during the 17 days where we were testing the service, it fell well short of those numbers. Test kits were available, on average, for just 44 minutes a day on weekdays and 231 minutes on weekends.
We found it difficult to get a comment from the trust about this discrepancy or answer our questions about why so few tests are available. Manchester City Council, who commission the service, told us:
The past 18 months have put an unprecedented strain on health services due to the severe disruption caused by the Covid-19 pandemic. At its peak, 50% of staff at the Northern were redeployed, with an additional 20% affected by the need to self isolate. Capacity is improving but it is important to recognise the scale of the challenge faced across the healthcare system.
Another twist
Last Friday, the service got even worse when a new error message showed up. Instead of running out of capacity after a short period of time, the website now didn’t have any capacity at all. Users were told: “Due to an issue with the delivery of our laboratory supplies we have had to take the decision to suspend home testing kits until further notice. We apologise for any inconvenience.”
That problem persisted through the weekend and all through Monday and Tuesday. It means that people across Manchester, Stockport, Tameside and Trafford who want to take a sexual health check at home currently have no way of getting one via the service.
The council spokesperson didn’t directly address this outage but said: “Being able to practice safe sex and access sexual health support services is incredibly important and it is important to stress that improvements are being made.”
For people who use this service in Greater Manchester, the comparison with other parts of the country is galling. The Welsh and London services have no daily order limit, meaning users can order a kit 24/7. In 2020, The Northern sent out an average of just under 56 test kits per day while London’s service sent out an average of just over 1,150 per day. This means London’s testing service provides over 20 times the test kits per day than The Northern, despite serving just over five and a half times the total population.
And whereas London’s service promises results within two or three days, ours takes seven times as long — kits are sent out second class rather than first class, and they aim to return results “in around 3 weeks.”
Using kits from London
We spoke to Matt, a Master’s student at the University of Manchester. A 22-year-old gay man, he told us that he’s given up on using Manchester’s services after weeks-long delays in getting test results. “It’s now gotten to the point where I just order a test from friends in London, and get the result within two or three days, rather than three weeks – which is insane,” he says. “I will have my results back from the London test before my Manchester test would have even arrived.”
He thinks the failures of the system are dangerous, particularly in a city that famously has a large gay community. “In terms of public health, I think it’s really dangerous. And in terms of personal health, I think it is putting people at risk.”
Dan, a 29-year-old bisexual man from London, helps to forward STI test kits from his address in London to those who want them in Manchester. People make their own account on London’s service, but type in his address rather than their own. “I think it’s something that everyone should just have access to,” he told me. “It baffles me that it’s so dire – especially in Manchester.”
Manchester City Council promises that the service will be improved in the months ahead. After explaining that the pandemic has hurt capacity in the service, a spokesperson told us:
The pandemic also delayed a planned service improvement to the Northern, which would have been in place during the first quarter of 2020. This included the implementation of a new clinical IT system and website. It is anticipated these changes will be in place by the end of the year.
In addition, provision of at-home testing kits will be moved to a new laboratory service, freeing up capacity within MFT [the trust] labs and releasing staff who will be able to take on clinical roles rather than testing. The aim is also to increase the number of tests made available each day and aspire to having an uncapped capacity.