Visit Wales to See what a Public Health Tracing System Looks Like
The Coronavirus crisis has established the realities of devolution more clearly in the public mind than any other issue, says Leighton Andrews
Is it really so hard to set up an effective Coronavirus testing and tracing system?
Perhaps it is if you have turned to the private sector in the hope of a transformative ‘moonshot’. The Prime Minister’s chief advisor, Dominic Cummings, believes that the private sector can do better than the public sector. Transformative performance, he has written in the past, depends on “replacing many Whitehall institutions with ones that can change as quickly as the world around them changes”.
It is the doctrine of ‘disruptive innovation’, based on a technological solutionism that first gave us a test and trace app that wasn’t even Isle of Wight-leading, let alone world-leading, and which we now learn has been stuffed full of glitches since its eventual launch in September – with hardly anyone sent alerts because of a failure to adjust the risk threshold, meaning that people who should have been isolating haven’t been doing so.
We might question further whether centralised state control backed by private sector delivery and imposed technological solutions is better than the low-tech tried-and-tested approach of the decentralised state when considering England’s Test and Trace service.
The problems have included: contact-tracers provided through a privatised approach left idle for weeks; levels of contact tracing finding only half of the close contacts of those diagnosed with COVID-19 at a cost of £900 per person traced, compared to much higher levels of tracing through the existing Public Health England system with local public health protection teams; and data not being shared with local authorities. Things got so bad that some English local authorities set up their own systems.
Next door in Wales, the entire Test, Trace and Protect system is being run through the public sector, with local authorities and the NHS collaborating. Very high levels of contacts are being tracked and traced, with the Welsh Government reporting on Friday that contact-tracers had traced 84% of cases and 88% of their contacts in the previous week.
The Welsh Government used the period of the Spring lockdown to establish the service, which formally launched in June. Local authorities redeployed staff from other roles to get the system up and running in collaboration with Public Health Wales and local health boards. The First Minister Mark Drakeford confirmed that the current firebreak lockdown in Wales would be used “purposefully” to recruit more contact-tracers and to catch up on outstanding contacts who need to be traced.
The biggest problem the Welsh system has suffered is delays in the processing of tests through the UK Government’s Lighthouse Labs.
No Welsh Government since the creation of the devolved Welsh Assembly in 1999 has had to cope with a challenge on the scale of COVID-19. No other issue has established the realities of devolution more clearly in the public mind. The most recent opinion polling shows clear public support for the stance taken by the Welsh Government.
Yet there has been a substantial decline in Boris Johnson’s popularity in Wales since April. The First Minister has a 35%+ rating for his Government’s handling of the pandemic, while the Prime Minister has a -22% rating for the way his Government has dealt with it.
Wales is due to come out of its firebreak lockdown on 9 November, while England will still be in the first week of its second lockdown. The Welsh Government used the opportunity afforded to it by the half-term break to kick off the firebreak, while Johnson’s dither and delay put off the new English lockdown at the cost of thousands of lives.
In Wales, there has been clarity on the rules and the objectives and considerable unity, aside from the Welsh Conservatives, who complained about Wales’s 17-day firebreak only to have the Prime Minister pull the rug from under their feet with his late announcement of a longer lockdown in England.
How much longer can the Prime Minister continue without a strategy? And what will it mean for the regions of the UK? Time is running out.
Leighton Andrews is Professor of Public Service Leadership and Innovation at Cardiff Business School and a former Welsh Government minister