Instead of over promising and under delivering, ministers must be open to learning from elsewhere
An update on NHS Test and Trace published on 18 June appeared to show progress towards the goal of providing what Boris Johnson, the UK’s prime minister, has described as a “world beating” service. In the two weeks up to 10 June, 10,192 of the 14,045 people (72.6%) who tested positive were reached and asked to provide details of recent close contacts. Of the 96,746 close contacts reported, 87,639 (90.6%) were reached and asked to self-isolate. Baroness Harding, executive chair of NHS Test and Trace, claimed that tens of thousands of people were remaining safely at home as a result, and that the service was saving lives.
The reality is more complex and more worrying for two reasons. First, ONS surveillance figures report that there are around 4,000 new cases per day in the UK, suggesting that the Test and Trace service is reaching only a fraction of these cases. Much more needs to be done to increase the scope of testing, including by identifying asymptomatic people and people with symptoms who are not currently coming forward to be tested.
Second, NHS Test and Trace reported that 9,997 of the close contacts who were reached and asked to self-isolate were “non-complex” cases. These cases are contacted by the national online and call centre service which has been outsourced by the government to Serco in a contract reported to be worth up to £108 million. The remaining close contacts (77,642) relate to complex cases which are the responsibility of Public Health England and local health protection teams under the leadership of directors of public health.
Questions must now be asked about value for money in the use of public resources when the 25,000 staff working in the national contact tracing service have so far reached fewer than 10,000 contacts and when reports suggest that these staff are underutilised. The government’s decision to use Serco is part of a piece with reliance on private companies in the testing programme and the supply and delivery of PPE. It also reflects a preference on the part of ministers for centralised control and a distrust, or perhaps ignorance, of local resources and expertise in contact tracing.
Local authorities have belatedly been given a leadership role in contact tracing and are working to develop local outbreak plans and put in place staffing by the end of June. Those now leading test and trace express an ambition to engineer a “reverse takeover” of the service in which councils and their partners in the NHS and other public services are given more control over regional and national resources. This would bring England more in line with countries like Germany where contact tracing is undertaken by skilled staff who work in the communities affected rather than a remote call centre.
The government’s troubles were accentuated when Matt Hancock, the Health and Care Secretary, announced that he had decided to stop development of the much-trumpeted NHS covid-19 contacting tracing app. Instead ministers have decided to work with Apple and Google in a model in which no data are held in a single official database following the example of countries like Germany and Italy. This decision raises further questions about the government’s preference for centralised control and tailor-made solutions.
Another uncertainty concerns the Joint Biosecurity Centre which has been described by Baroness Harding as “an integral part of NHS Test and Trace.” Its role is to bring together data from testing and contact tracing and other sources to provide insight into patterns of transmission and early warning to support local authorities to control local outbreaks. It also has a role alongside the Chief Medical Officer in setting the alert level for Covid-19, which has just been reduced from level 4 to 3 in the UK. The new head of the Centre, in evidence to Parliament on 15 June, said that the Centre will not reach full operating capacity until the end of the summer.
The difficulties in developing contact tracing, an app and establishing the Joint Biosecurity Centre demonstrate that a world beating test and trace service is far from the current reality. This matters because test and trace is our collective insurance policy in the event of further outbreaks and a possible second wave. The likelihood of a resurgence of covid-19 is apparent from what is now happening in Beijing, Germany and other countries which appeared to have contained the virus and the reality that we will be living with covid-19 until a vaccine becomes available.
The worry for England is that the lockdown has been eased before an effective test and trace service is in place. The pressures to restart the economy and reopen schools are understandable and will bring benefits, but the risks to the public’s health from covid-19 remain. Instead of over promising and under delivering, Ministers must be open to learning from elsewhere and have the insight to understand the limits of English exceptionalism. They should also be prepared to acknowledge mistakes and their willingness to learn from them.
Chris Ham is non-executive chair of the Coventry and Warwickshire STP and non-executive director of Royal Free Hospitals. He was chief executive of the King’s Fund from 2010 until 2018.
Competing interests: None declared