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Why Is ‘Test and Trace’ Still Failing?
Failed leadership, an abandoned public health system and a preoccupation with private sector involvement have all resulted in problems with COVID-19 testing, says Mike Buckley
Why is the Government’s test and trace system a failure? It has had nine months to get it working, with the full resources of the state at its disposal. It has spent billions trying to make the system work but still it fails, taking with it any chance of avoiding stringent lockdowns, lost lives and economic harm.
In the past week, ‘test and trace’ has seen its worst ever figures, reaching fewer than 60% of contacts when at least 80% is needed for it to work. Even when contacts are traced many ignore the mandated two week isolation.
The Government’s own MPs are now calling for change. Bernard Jenkin, chair of the powerful parliamentary Liaison Committee, has called for the system’s current lead Baroness Dido Harding to be sacked, warning of a “vacuum of leadership in test and trace which is destroying public confidence and compliance”.
Jenkin is right that Harding is part of the problem. She appears to be incapable of making the system work, and appears to have been appointed – along with many Cabinet ministers – more for her loyalty than her competence. But removing Harding alone is unlikely to make much difference.
A senior medic describes the current set up as a “completely dysfunctional private sector trying to work to headlines not deadlines in a field they’ve never actually worked in before”, arguing that Serco, Deloitte and the other private companies given the keys to run test and trace had no experience in running health tests or tracing contacts before this.
The Government has done with test and trace what it has done with many large public contracts over the past decade – passed them to the private sector. Whether because it genuinely believes that the private sector will do a better job, because it wants to give lucrative contracts to companies run by old school friends, or because it hopes for payback come the next election, the result is the same. Outsourcing has been king for 10 years and was the default when designing test and trace.
This is not the first time that outsourcing has been an expensive failure. But where other failures have been minor news items, this one has played out publicly and costs lives. Divorcing test and trace from the NHS, with which it has no relationship other than using its logo, has meant that untrained recruits have been tasked with administering medical tests which would normally be the job of nurses or health assistants.
Some doctors believe that failed tests or poor results are inevitable. One I spoke to admitted sending some of his own patients to a private clinic to be certain of getting an accurate test result. Most of us do not have that option.
Even if it recognised the failures of private provision, the Government has limited its room for manoeuvre. The public health system has been underfunded and downgraded for years. A report by the Institute for Public Policy Research found that 10 years of cuts had “ripped resilience out of health and social care”, with deprived areas receiving six times more cuts to public health budgets than wealthier areas from 2014 to 2019.
A prior review in 2016 found that there was “a high burden of preventable disease and unacceptable inequalities in England” and that “despite agreement on the need for prevention the Government has cut public health budgets by a cumulative 10% to 2020”. Like the scandal of personal protective equipment (PPE) stockpiles being junked years ago, the Government had simply not invested in public health. Pandemic prevention was never a priority, despite years of warnings.
Perhaps another Government would have used the pandemic to invest in the recovery of public health. Instead, this one has given more money and autonomy to the private sector.
The Spectre of ‘Herd Immunity’
Some see the Government’s behaviour as part of a centralising, privatising agenda.
Back in May, the Guardian reported that the Health and Social Care Secretary Matt Hancock was “using the pandemic to transfer NHS duties to private sector”, accelerating the dismantling of state healthcare. Hancock is centralising NHS data, potentially making it available to US pharmaceutical or insurance industries, and has provided no reasonable explanation for the test and trace contract given to US data mining group Palantir.
Providing credence to this theory is the Government’s decision to abolish Public Health England. Doing so allows it to reinvent the system through greater private sector involvement as it has done across the NHS since 2010.
In all likelihood, the test and trace system’s failure is a result of a hollowed-out public realm and the consequent need to rely on an ill equipped private sector. But there is an alternative explanation.
In March, pandemic advisor Graham Medley said that “we are going to have to generate what we call herd immunity” by allowing “a nice big epidemic”. The plan was rejected after Neil Ferguson, then a member of the Government’s Scientific Advisory Group for Emergencies (SAGE), published a report laying out the human cost of generating ‘herd immunity’ – hundreds of thousands of lives lost. But, if the dream did not die, then a failing test and trace system would help the cause, as would the refusal to enter a second lockdown despite rapidly rising infections.
Conspiracy or not, the tragedy is that every day that test and trace fails, more lives are lost. By taking time to lockdown when cases rise and by continuing to tolerate a malfunctioning test and trace system, the Government is condemning more lives, many of them from among the most vulnerable groups in society.
COVID-19 mortality in the UK has already taken a disproportionate toll on poor and minority groups, a reflection of systemic racism and poverty. That trend will only continue. At the same time, the Government is prolonging the economic pain, losing more jobs and spending more in employment support than would otherwise have been necessary.
The Government is not short of money, having spent billions on health measures and support for the economy. It is not restricted by Parliament as the use of public health legislation and the further powers conferred by the Coronavirus Act gives it complete freedom. This failure is the Government’s alone.