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An ethical framework & practical recommendations for COVID-19 testing for NHS workers

THIS Institute has led an independent rapid-response project to develop an ethical framework for COVID-19 swab testing for NHS workers. Following work with an expert group and a stakeholder consultation, we identify ethical considerations and provide practical guidance and recommendations to identify good practice and support improvement.


Rapid scale-up of the testing regime for COVID-19 is a key element of the UK Government’s response to the global pandemic. This project took a consultative approach to developing recommendations for an ethical framework for testing of NHS workers. It aimed to provide a practical guide to decision-making, serve the interests of transparency and trust, assure people that their concerns have been heard, and offer the basis of an agreed, nationwide approach.

The project:

  • Identified influences on participation and barriers and concerns about the COVID-19 (swab) testing programme for NHS workers;
  • Explored views on relevant ethical considerations in relation to the testing programme;
  • Elicited suggestions on possible ways of addressing challenges.


THIS Institute collaborated with an independent 15-person diverse multi-disciplinary expert group to guide the development of an ethical framework and practical recommendations. An online consultation exercise with 93 stakeholders, many of them NHS staff and senior leaders, was held between 27 May and 8 June 2020 to characterise the range and diversity of views.

Results and recommendations

The project report emphasises that getting the COVID-19 swab testing programme for NHS workers right is crucial to support staff and patient safety and broader public health. It offers an ethical framework and practical recommendations to help guide good practice nationally and locally. The framework covers:

  • Clarity about goals of testing;
  • Access, effectiveness, and efficiency;
  • Acknowledgement and management of the strengths and limitations of the current test;
  • Understanding how the test is used in practice and the implications of these uses;
  • Clarity in relation to choices about testing both in principle and in practice;
  • Clarity about data protection and confidentiality;
  • Trustworthiness and legitimacy;
  • High quality information and communication about testing.

The report recognises that COVID-19 does not affect all population groups equally. People who are socio-economically disadvantaged or members of Black, Asian and Minority Ethnic (BAME) groups (while recognising the problematic nature of that term) may face distinctive issues in relation to testing. The possible unintended consequences and implications of testing, including frequent testing, for particular groups should be considered.

The report emphasises that building trust and confidence in the COVID-19 swab testing programme for NHS workers requires clear, transparent, and accessible communication from system leaders over all aspects of testing.

Offering a set of practical and actionable recommendations, the analysis illustrates the value of explicit, systematic and consultative consideration and ethical issues. The framework can allow progress that has already been made to be tracked, as well as providing direction and means of monitoring future improvement.  It is likely to have relevance to many other areas of practice and policy in response to the pandemic.

Expert group

  • Deborah Bowman, Professor of Bioethics and Clinical Ethics and Deputy Principal (Institutional Affairs), St George’s, University of London
  • John Coggon, Professor of Law, Centre for Health, Law, and Society, University of Bristol Law School; Honorary Member of the UK Faculty of Public Health
  • Jeremy Dawson, Professor of Health Management, Institute of Work Psychology and the School of Health and Related Research, University of Sheffield
  • Mary Dixon-Woods (Chair), Health Foundation Professor of Healthcare Improvement Studies, University of Cambridge
  • Zoë Fritz, Consultant Physician, Cambridge University Hospitals
  • Alberto Giubilini, Senior Research Fellow, Oxford Uehiro Centre for Practical Ethics and Wellcome Centre for Ethics and Humanities, University of Oxford
  • Yasmin Gunaratnam,Reader in Sociology at Goldsmiths (University of London)
  • Patricia Kingori, Wellcome Senior Investigator, Wellcome Centre for Ethics and Humanities and the Ethox Centre, University of Oxford
  • Roger Kline, Research Fellow, Middlesex University Business School
  • Jill Maben, Professor of Health Services Research, School of Health Sciences, University of Surrey
  • Calum McGregor, Consultant in Acute and General Medicine, University Hospital Wishaw, NHS Lanarkshire
  • Jonathan Montgomery, Professor of Health Care Law, University College London; Chair of Oxford University Hospitals NHSFT; Co-chair of the Moral and Ethical Advisory Group
  • Sean Ninan, Consultant Geriatrician, Leeds Teaching Hospitals NHS Trust
  • Claire Whitehouse, Senior Nurse for Nursing, Midwifery and Allied Health Professions (NMAHP) Research, The James Paget University Hospitals NHS Foundation Trust
  • Robert Winston, Professor of Science and Society and Emeritus Professor of Fertility Studies at Imperial College London

Funding and ethics

This study is funded by the Health Foundation’s grant to THIS Institute. It is also sponsored by the Department of Health and Social Care and supported by the Wellcome Trust and the Academy of Medical Sciences. The study was reviewed by the Cambridge Psychology Research Ethics Committee.

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