Shortcomings in the national test and trace regime have been well documented since its belated relaunch in late May. But is the government’s response – to restructure the two public bodies involved, and to bring in local health authorities to bolster the poor performance of the private contractors – really sound planning?
The first of those two bodies, the NHS Test and Trace (NTT) organisation, was set up barely three months ago with a £10bn budget but has already come in for considerable criticism. NTT is responsible for implementing the non-hospital testing and contact tracing but outsourced the delivery of these elements of the government’s pandemic response to private contractors – with the contract tracing element being run by outsourcing giants Serco and Sitel
Now that this key contract is up for renewal there is a chorus of calls for the government to ditch Serco and Sitel, due to their poor performance, as figures confirmed that they have not been able to contact 46% of Covid contacts in England’s worst-hit areas.
The seeming reluctance of ministers to drop the two firms has been accompanied by accusations of favouritism in the awarding of the original £108m contract.
The firms also oversee the development and introduction of the second-generation phone apps now on trial, primarily on the Isle of Wight.
Who does the testing? Deloitte manages the booking and results and a roll call of familiar outsourcing companies; Sodexo, Mitie, G4S and Serco operate the swabbing centres, which are then sent to a mixture of private and public labs.
The second body caught up in the government’s sudden reorganisation is Public Health England (PHE) – the executive agency handling broader aspects of the pandemic response, such as dealing with outbreaks and lockdowns. It was set up in 2013 and has a budget of just £300m.
Apparently to address increasingly negative perceptions of the government’s pandemic response, health secretary (and amateur jockey) Matt Hancock abruptly announced the abolition of PHE, and trumpeted the merger of its functions with those of NTT and the recently formed Joint Biosecurity Centre, a data analysis agency, with as yet no permanent base or organisational structure.
All these functions are to be overseen by a new body called the National Institute for Health Protection, headed – at least initially – by current NTT boss (and, again, an amateur jockey) Dido Harding, who is also a Tory peer and former TalkTalk CEO.
The abolition of PHE has been met with a chorus of disapproval, with many doctors and health experts accusing the government of trying to shift the blame for ministerial failures relating to testing during the pandemic on to the chronically underfunded agency. One senior NHS official has gone so far as saying, “Dido seems to be failing upwards, given that [NTT] has been a disaster.”
What impact this hasty reorganisation will have on the existing national test and trace programme remains to be seen, but it’s worth examining the record of NTT and its outsourced services so far:
– In April, as the NTT was being set up, the Guardian saw a letter from the Department of Health & Social Care (DHSC) to local authorities stating that only 3,000 of the 18,000-strong NTT team would have public health expertise, the rest would just be call handlers.
– The programme was late in launching, leaving a period of almost 11 weeks, between 12 March (when the earlier scheme was halted) and 28 May, during which no contact tracing was carried out. Anthony Costello, a professor of global health and sustainable development at UCL and a former WHO director, said, “If we hadn’t stopped it on 12 March, our epidemic would have been much less. [The government] effectively allowed it to spread.” A few weeks later, NTT’s then-CEO Tony Prestedge admitted that the scheme might not even be fully operational until September or October.
– If close contacts of infected people did not respond to texts, emails or calls from contact tracers, the NTT system could do no more, not having the capability to visit addresses. And even when those contacts agreed to self-isolate, there were no follow-up checks to ensure they’ve actually done so.
– Many people couldn’t afford to self-isolate when advised to by NTT contact tracers, because statutory sick pay isn’t available to everyone, and is often less than average earnings.
– When the programme launched in late May, reports emerged of inadequate training and faulty software, leading some NTT contact tracers to resort to Facebook and WhatsApp support groups for help.
– Reports of contact tracers being paid despite having nothing to do are legion. One employee, working for a Serco sub-contractor, claims to have made only four calls over ten weeks, two of which went straight to voicemail. Another was reported by the BBC as having so little to do that she was effectively being paid to watch Netflix.
– In its first week of operation, a third of those testing positive had failed to provide contact details of people they may have infected. In late July the Guardian obtained data showing that in areas with the highest infection rates in England, the proportion of close contacts of infected people being reached was far below 80 per cent, the level the government’s scientific advisers said is required for test and trace to be effective. In Leicester it was just 65 per cent, and in Luton it was only 47 per cent.
–The situation hadn’t changed a few weeks later when, in early August, researchers from UCL and the London School of Hygiene and Tropical Medicine claimed that only 50 per cent of contacts were being traced in England, far fewer than they deemed necessary to allow schools to open safely and to prevent a second wave.
– In mid-August the Guardian revealed that while NTT teams managed to trace barely more than 50 per cent of infected people’s contacts, the figure was 98 per cent among local health protection teams.
– Councils in England had to wait until mid-August before they received access to data showing live patient-identifiable data to help them spot and contain clusters of infections.
– Despite the NTT programme, the UK still has the highest covid-19 death toll in Europe. PHE says that that number stands at more than 41,000, although the Office for National Statistics claims the true figure is 57,000.
A hint of what was about to happen to PHE emerged several weeks before Hancock’s announcement when online news-site HSJ reported that management consultancy McKinsey – a former employer of NTT boss Harding – had been brought on board to review the NTT’s future governance, for a not-so-modest fee of £563,000 for six weeks’ work.
That move was presaged in April by the publication of an article by free-market thinktank 1828 – linked in the past to Harding’s husband (and Tory MP) John Penrose – calling for PHE to be abolished and for the private sector to be handed a key role in testing. In the same month, right-wing pressure group the TaxPayers’ Alliance (whose former campaign manager Chloe Westley is currently a special adviser to prime minister Boris Johnson) labelled PHE a “bloated agency” in an email to its supporters.
Almost coincidentally, just a few days before the abolition of PHE was announced, in mid-August, the DHSC put out a press release hinting that the government – in the form of NTT – was backing away from its earlier ‘public bad/private good’ stance and had decided to work with local councils, although cost-saving (ie cutting by a third NTT’s 18,000-strong team of contact tracers, employed by Serco and Sitel) could also have been a factor in the decision to change its approach.
Whether this new stance on the part of NTT came about as a result of the McKinsey review is unclear. But it was adopted after weeks of complaints from local authorities in the Midlands and northern England – councils like Bradford, Blackburn with Darwen, Calderdale, Leicester and Preston, often suffering high rates of COVID-19 infection, and which have all launched their own test and trace programmes because of NTT failures, particularly over incomplete access to data.
Blackburn with Darwen council instructed tracers to go door to door if after 48 hours they are unable to make contact by phone. Councils in Peterborough and Liverpool, have taken similar steps. Matt Ashton, director of public health in Liverpool, told The BMJ “I would argue that through our actions on a local level, we’ve prevented a large outbreak, a city lockdown, and kept our economy going,”
The DHSC press release acknowledged the new reality, describing it as a “new way of working” which “will give local areas dedicated ring-fenced teams from the national service”, although Harding was quoted as saying, without a hint of irony, “We have always been clear the NTT must be local by default.”
The £108m NTT contract with Serco, never put out to open tender, was due to expire on 23 August, but openDemocracy reported last week that the DHSC has already extended the company’s contract beyond that “initial review date”, an extension that could be worth over £300m.
The outcry at ministers favouring firms and rewarding failure is growing, The pressure group WeOwnIt is calling for the resignation of junior health minister Edward Argar, a former Serco lobbyist, claiming a clear conflict of interest.
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