The recent House of Commons Public Accounts Committee Report illuminates the absurd cost and failures of the NHS Test and Trace service. [1,2] It seems that the UK government is set to continue the scandal of commissioning Serco and other private companies to run the test and trace service. £37bn of taxpayers money is being given to this service—the figures are almost too large to comprehend. [3] To help, consider that the total annual NHS salary cost is around £47 billion, which amounted to 44.9% of the NHS budget in 2018/19. [4] A 5% pay increase for the whole of England’s NHS staff, as opposed to the 1% on offer to nurses, would cost only £1.7bn. [5] So, what is going on? Is it just incompetence? It is hard to believe that there is not an element of corruption with such large amounts of money disappearing to “consultants” or private companies. We must see open and transparent accounting immediately.

In March 2020, a nationwide lockdown was needed to do the heavy lifting of reducing transmission, hospitalisations, and deaths due to covid-19. But contact tracing, which is a key pandemic management tool, should not have been stopped. Movement of people from high infection areas within the UK and from other high incidence countries has not been adequately managed. 

Failures of the design of NHS Test and Trace are inexcusable. Run from national call centres it has only operated on two links of the crucial chain—Find, Test, Trace, Isolate, Support. It only tested symptomatic people who came forward and then only approached contacts suggested by index cases. It failed to find many infected cases, failed to reach the asymptomatic, failed to act in time. It still fails to support, fails to test contacts, and fails in backward tracing. Our government has imposed ideological solutions when what was needed was drawing on practical experience. Test and Trace was designed by an authoritarian government that sidelined scientific and medical expertise. It deserves radical criticism, a serious public inquiry and may even require criminal prosecution. Hundreds of thousands of people have died from covid-19 in the UK. We also need an investigation of the silencing and fear among NHS and public health staff.

It could have been a different story. A small group of retired public health and primary care staff formed Sheffield Community Contact Tracers (SCCT) a year ago. We linked with a local community volunteer hub and the local Primary Care Network. We demonstrated in a small study that volunteers could be quickly and safely trained to undertake contact tracing of covid-19 cases identified by local GPs. [6] We ensured that cases and quarantined contacts were supported throughout their isolation. 

A flexible supply of contact tracers is essential to run an efficient service. Furloughed public and private sector workers and volunteers could have been organized by local authorities into an effective and trusted service. This type of system could have been scaled up as it has been in many countries. The UK’s highly successful vaccination programme has demonstrated the power of the NHS, primary care, local authorities, and volunteers working together to rapidly scale up and deliver a new service based on existing infrastructure. Contact tracing should have been organised in the same way. A similar volunteer initiative in Sheffield is correcting the failure of the national Test and Trace to reach two thirds of inpatient cases of covid-19. [7] We must also make sure that the government resolves the conditions that have caused the disproportionate impact of covid-19 on disadvantaged and ethnic minority communities. Trust is imperative to engage these communities with testing, tracing, and vaccination. 

Using effective contact tracing has been an important feature of successful management of covid-19 outbreaks elsewhere. Thirty countries have achieved “zero covid” and another 15 are close. [8] But in the name of British exceptionalism Boris Johnson and Matt Hancock have engineered one of the world’s worst covid-19 death rates and most damaged economies. It’s hard to reconcile the amount of human suffering and the massive economic and social dislocation with their claims to be proud of their record. We must learn from those countries that contact trace well and make radical changes to our service now, and build effective public health for the future. [9,10]

The UK government is slavishly following the neoliberal capitalist mantra that the market-place and private sector are the answer to any problems the UK faces. Our embarrassingly ineffective national Test and Trace service is surely a classic example of market failure. In the USA Trump was voted out partly for following equally ineffective covid-19 strategies. The UK government is set to carry on for four more years. So the official opposition and the public need to push the government to another of its belated u-turns. Professional organisations, trades unions, local authorities, NGOs and other organisations must speak truth to power. The government must reverse the privatisation of Test and Trace and hand it over to NHS and local authority control. 

Jack Czauderna, SCCT and former general practitioner Sheffield

Bing Jones, SCCT and former associate specialist in Haematology

Shona Kelly, professor of Interdisciplinary Health Research Sheffield Hallum Univ

Nick Payne, honorary professor, Public Health ScHARR Univ of Sheffield

Paul Redgrave, SCCT and former director of public health

Jenny Shepherd, freelance writer and NHS campaigner

Declarations of interest: None declared

References:

1] House of Commons Public Accounts Committee. Covid-19: Test, track, and trace (part 1). 10 March 2021. https://committees.parliament.uk/committee/127/public-accounts-committee/publications/reports
2] https://www.theguardian.com/world/2021/mar/10/no-evidence-22bn-test-and-trace-scheme-cut-covid-rates-in-england-say-mps
3] Covid-19: NHS Test and Trace made no difference to the pandemic, says report | The BMJ
4] Key facts and figures about the NHS | The King’s Fund
5] Government would recover 81% of cost of pay rise for NHS England staff – report | NHS | The Guardian
6] Sheffield community contact tracers: training community volunteers to undertake contact tracing for covid-19 – The BMJ
7] Contact tracing of in-patients with covid-19: the use of volunteers to enhance NHS Test and Trace – The BMJ
8] Deepti Gurdasani, BMJ webinar on ‘zero covid’ 11.03.21
9] Why many countries failed at COVID contact-tracing — but some got it right (nature.com)
10] Which countries do COVID-19 contact tracing?, Mar 10, 2021 (ourworldindata.org)