England’s test and trace service is being sub-contracted to a myriad of private companies employing inexperienced contact tracers under pressure to meet targets, a Guardian investigation has found. Under a complex system, firms are being paid to carry out work under the government’s £22bn test and trace programme. Serco, the outsourcing firm, is being paid up to £400m for its work on test and trace, but it has subcontracted a bulk of contact tracing to 21 other companies. Contact tracers working for these companies told the Guardian they had received little training, with one saying they were doing sensitive work while sitting beside colleagues making sales calls for gambling websites. One contact-tracer, earning £8.72 an hour, said he was having to interview extremely vulnerable people in a “target driven” office that encouraged staff to make 20 calls a day, despite NHS guidance saying each call should take 45 to 60 minutes. Another call centre worker, who had no experience in healthcare or emotional support, said she suffered a nervous breakdown during an online tutorial about phoning the loved ones of coronavirus victims in order to trace their final movements. The call-handlers, who agreed to speak on condition of anonymity, said they felt ill-equipped and unqualified to carry out the complex work, which until October had been handled only by NHS clinicians, known as tier 2 clinical contact caseworkers. NHS job adverts for this role list a health or science degree and previous experience in the NHS or social care as essential requirements. A report by the National Audit Office last week said test and trace, which costs a fifth of the NHS budget, had repeatedly failed to hit targets and spent substantial public money on contact-tracing staff who were working only 1% of the time by June. At the start of the pandemic, call handlers working for sub-contracted companies were employed only to telephone those who had been in close contact with an infected person; however, since October some have been drafted in to call those who have tested positive for coronavirus – the work originally carried out by clinical caseworkers – due to the surge in demand. One of these contact-tracers, who was employed in July, said it was about two months before she made her first call as the infection rate fell over summer. She was paid throughout this time. The Guardian has seen a 37-page training manual drawn up by NHS test and trace, dated 13 November 2020, which details how low-paid call-centre staff should submit the details of these more complex calls, suggesting the practice of using less qualified staff for this work has become more widespread since it became known in October. One call-handler said the “target driven” culture of telesales firms meant that staff “skipped through” questionnaires when calling infected people. They said: “We have a lot of people aged 18 to 25 – it’s a very, very young team – who don’t understand the bigger picture, the nature of what they’re dealing with, but do feel the weight and the pressure for achieving results.” He said he was calling potentially infected elderly people while sat beside colleagues making telesales calls for gambling websites: “You’re doing this very sensitive role, dealing with extremely vulnerable people, on a shop floor filled with a multitude of other companies. They’re running this campaign exactly as they would a sales campaign. It’s not appropriate at any level.” Another contact-tracer said the more complex calls “amount to intense emotional labour” and that often involved gathering sensitive information from “some very confused, upset, hurt, angry people”, including calls to people with dementia and people who do not speak English. Gabriel Scally, a visiting professor of public health at the University of Bristol and a member of Independent Sage, said it was a “complete and utter disgrace” that inadequately trained staff were handling such sensitive calls. He called on the government to publish a list of all the companies involved in contact tracing work: “These are complex matters of people’s health history and very confidential information that questions are being asked about. That is why it is specified that it should be carried out by clinically trained people, to protect the public,” he said. “The government has turned to these commercial organisations that are totally unsuited, inexperienced and unfit to do this really specialised contact tracing work. They are the modern equivalent of low-skilled sweatshops.” Dr David Strain, a senior clinical lecturer at the University of Exeter Medical School and the co-chair of the medical academic staff committee of the British Medical Association (BMA), said there was “a probability” that less qualified staff following a script would miss the subtle signs of coronavirus that healthcare professionals would pick up. “That [missed sign] potentially could leave someone at home even just for 48 hours longer than they need to be,” he said. “The consequences of leaving Covid untreated compared to [treating a patient with] dexamethasone is a 20% increase in mortality.” Serco said all of its staff had received the appropriate training and were following scripts provided by Public Health England. A DHSC spokesman said: “All calls that require a clinical input are carried out by appropriately trained healthcare professionals. All call handlers have received appropriate training for their role and are fully supported in their vital work, following procedures and guidance designed by experts at Public Health England.”