Test, track and trace is the key to getting out of lockdown. Time is truly of the essence, as an ominous UCL study by researchers warns us: if we don’t improve it, we could face a second coronavirus wave worse than the first.
The principles of infection control are internationally recognised. Local public health professionals need to track disease outbreaks to their sources and isolate them. It’s a core public health approach which dates to the 1850s, when Victorian doctor John Snow traced cholera infection in London to a single Soho water pump, showing the disease was spread in water rather than by the smell of London’s filth. Snow showed the possibility of tracing the contacts of all people exposed to a disease, and how doing so was key to stopping further infections.
A basic track, trace and isolate approach is regularly used by authorities dealing with outbreaks of diseases, including legionnaires, food poisoning or STDs. Covid-19 is a much bigger outbreak, so the system needs to be ratcheted up. But the common feature of public disease control is that it is led by local public health professionals. Local, because they will know the area where they chase the disease; professional, because this is not a job for amateurs.
Except in the United Kingdom, that is. We have hired favoured privatisation corporations with little medical experience to run their version of infection control, and it is failing badly. Back in March, against World Health Organisation advice, the government stopped contact tracing. In May, Boris Johnson used the Mail on Sunday to announce a U-turn, with an “army of contact tracers” recruited to restart essential public health measures.
However, it soon became clear this ‘army’ was largely made up of unqualified call centre workers supplied by privatisers Serco. Unique among the nations, our government was using unqualified workers, rather than public health professionals, to try and chase the virus.
Serco’s reward for its unmitigated failings will be the sum of £108 million for the first 14 weeks of their contact tracing work up to August 23rd. If the contract is extended for another year, they will receive £410 million. Their partners, the US corporation Sitel, will get £310 million for a year’s work. At the end of it, we will have paid three quarters of a billion to corporations for their broken systems.
The government announced as little detail of the contract as they could, giving the impression this was a professional operation, But I saw the job adverts for the call centre contact tracers, who were offered wages as low as £8.72 per hour. While Serco bosses are paid billions, the “army of contract tracers” march on low pay.
The skills required? “Call Centre: 1 year (Preferred)” and “Customer Service: 1 year (Preferred).” Neither contact tracers nor supervisors were expected to have any medical experience but needed a “passion for customer services” – in one case, applicants were even expected to “bring your own individual quirkiness,” and all adverts made it clear that the work is nothing but “heavily scripted.”
Alongside the 18,000 low-paid and unskilled call centre “contact tracers” supplied by Serco, Public Health England did put some 4,000 health-qualified staff on phone lines, like senior nurses or retired doctors. However, these qualified staff do not supervise, train, or have much contact with, the unqualified majority.
In taking this low-pay, high-cost route, the government were breaking with international norms. From Germany to South Korea, contact tracing is led by local public health officials. Where they are helped, they are supplemented by ‘town hall’ type professionals, such as librarians and town planners, or medical students working under their lead.
And one wonders how Serco, a company that was fined £22.9 million for cheating on another high profile contract only a year ago, could have been even the safest pair of hands among the privatisers. Upon closer look at the ads, it was revealed that they were corporate middlemen, subcontracting much of this work to smaller call centre firms. After being pushed on these figures, Health Minister Nadine Dorries revealed that Serco contracted 86% of their 10,000 “Contact Tracers” to “a panel of 29 subcontractors”.
And predictably, the results have been poor. Sitel, the American firm, showed how much these firms understand infection control: their own call centre became the site of an outbreak, and testimony given to MSPs from Sitel workers over lack of social distancing, PPE and adequate cleaning at the call centre has led to calls for a police investigation into the corporation.
Realising their approach was in trouble, the government reluctantly brought in local health authorities. They have created this structure:
Where the private sector deals with ‘non-complex cases’, the seriously ill are passed to the public sector, while ‘local health protection teams’ are made up of Public Health England and Local Authority staff. While Serco and Sitel receive £720 million for this, local authorities have only been given £300 million for their part of the deal.
Despite having more money and less ‘complex’ cases to handle, the private scheme contributes less to chasing the virus. Recent figures (up to July 22nd) show that since contact tracing started in May, 184,000 contacts have been reached and told to self-isolate. In this time, public sector teams dealing with serious cases contacted three quarters of them (76%), while Serco and Sitel have only contacted 24% of them. The private sector contact tracers also let more people slip through their fingers: while the public sector teams reached 98% of people identified as contacts, Serco and Sitel only contacted 83% of people they were chasing.
Johnson and Matt Hancock have also developed a private sector imitation of public health control in the ‘test’ as well as track and trace regime. One of the government’s first public steps against the virus was creating drive-through testing sites, in imitation of South Korea. However, the Korean drive through sites were run by city councils, while Hancock hired Deloitte to set up ours.
Deloitte have no expertise in disease control, so in turn they were helped by a bunch of other firms who didn’t have any experience in infection control either. As a result, they brought in numerous contractors, including Sodexo, Mitie and G4S. Boots did supply staff used to clinical procedures, including furloughed opticians and pharmacists, to carry out swab testing. But when contractors ran out of qualified Boots staff, they started directly hiring their own unqualified staff.
The drive-through testing sites were criticised for high rates of failure, for result returns taking too long, and for being based in out-of-town locations, so people without cars or very unwell people couldn’t get to them. This excluded key groups who really needed testing, including many low-paid care workers. The sites are often based in sporting venues like football stadia and racecourses – because Sodexo and other firms used their “sport event” management teams to set them up.
Local authority leaders were frustrated – they had many city centre ‘community’ sites, like leisure centres or libraries, that could have been converted to testing, but were overlooked. However, after the failure of their private regime, the government began drawing in local expertise. As Leicester wrestled with a new outbreak, the council set up seven “walk through” testing sites in accessible locations, including parks, leisure centres and community centres. They also added door-to-door testing services run with volunteers from the university. By contrast the privatised scheme offered just one drive-through service, run by G4S at a park-and-ride outside the city.
The government also turned to the private sector to expand testing itself. Frustrated by low UK testing capacity, Matt Hancock started “commercial partnerships” in April, signing a £133 million contract with Irish diagnostic firm Randox for Covid-19 tests. He also commissioned three massive “Lighthouse labs,” run by a consortia made up of firms including the pharmaceutical giants AstraZeneca and GSK, to do tests, in another set of multi-million pound contracts.
At the same time, the NHS and Public Health England expanded their lab testing. As a result, of the 7.2 million tests that have been taken for Covid-19, 3.9 million (54%) of these were carried out in NHS hospitals. The remaining 3.3 million (46%) were carried out by private labs commissioned by the government, known as “Pillar 2”, showing that despite the government’s preferences, public sector labs have performed better.
Private sector labs have also failed to turn around tests as quickly. Most importantly, they have often been unable to provide local Directors of Public Health with precise details of those testing positive – such as postcodes or occupations – so preventing local health officials from being able to stop outbreaks.
It is clear the privatised system isn’t working. So why have the government created this private empire? Serco’s chief executive, Rupert Soames, has explained why. In an email to staff leaked to the Guardian, Soames said that critics of “private companies delivering a public service” would have “plenty of opportunity” to point to their failures. But if all succeeds, Serco’s plan would “go a long way” in “cementing the position of the private-sector companies in the public-sector supply chain”.
Philip Aldrick, the economics editor of the Times, put it another way. He said projects such as these were a “no regrets policy.” Even though they might “soak up” billions of pounds, “they are where the government wants Britain’s future to lie.” Anxious about Britain’s post-Brexit place in the world, the government wants to use the crisis to increase “sovereign resilience” by spending public money. But it doesn’t want to increase the “resilience” of the public sector, it wants to increase the “resilience” of companies like Serco.
In the process, the government help their mates out. Soames is a grandson of Winston Churchill and brother-in-law of Tory MP Phillip Dunn. Health Minister Edward Argar was previously a chief lobbyist for Serco. Mitie, which helps run the drive-through test centres, has the Tory Baroness Couttie – a former David Cameron advisor and Westminster Council leader – on their board. Randox, which has a huge testing contract, employs Tory MP Owen Paterson as a £100,000 a year consultant.
Labour has pressed the government on the failing, privatised system. But Keir Starmer has done so in a managerial way, “constructively” asking the government for “a redoubling of efforts” on track and trace, or insisting the government “up its game” on virus control, without mentioning the outsourcing.
But the government is playing a different game entirely. If they redouble their efforts, they will redouble their privatisation. Labour should be exposing the government’s unique, failing experiment in privatised disease control. They should be calling for the contracts to be called, and for the money to be put into the hands of proper health authorities.
If we don’t want to stutter through new Covid-19 outbreaks and new lockdowns, we need to replace the poorly-performing, privatised imitation that Boris Johnson has bought us, and replace it with a real public disease control system.