The number of true believers may be dwindling, but the private sector efficiency myth still reigns supreme in the corridors of power.
And yet, the current crisis has exposed just how nonsensical this myth really is. Take the disastrous outsourcing of the NHS supply chain and shambolic procurement of ventilators, PPE and Randox home test kits and other tests. More recently, it’s England’s test, track and trace system.
The established system for contact tracing is operated through Public Health England (PHE) and run by local public health protection teams in the public sector. Its services had been badly eroded as a result of decades of cuts and closures.
Instead of rebuilding capacity the government decided to create a centralised, privatised system managed by outsourcing giant Serco and call centre company Sitel – which had no experience in contact tracing.
The 27,000 workers employed by Serco and Sitel have reached and advised an average of about two cases and two contacts per call handler over a twelve week period. That’s the equivalent of around £900 per person traced. Call handlers report having nothing to do and some have had no calls to make at all – with some even claiming that they have been paid to sit around and watch Netflix.
To make matters worse, test and trace data show in the twelve week period leading up to August 5th, the privatised national call centres and online service reached and asked to self-isolate only just over half of close contacts of those diagnosed with Covid-19, leaving local health protection teams and local councils to mop up the rest from their scarce resources.
Things have got so bad that local councils across England, from Sandwell to Suffolk, have set up their own test and trace schemes out of sheer frustration at the failures in contact tracing.
Meanwhile, PHE and its local public health protection teams are already proving exceptionally effective – despite under-resourcing and the fragmentation inherent in the system. As of August 5th, PHE workload for contacts is one and a half times that of Serco and Sitel.
PHE teams are reaching and advising 95% of the contacts – whereas the privatised system run by Serco and Sitel is only reaching 57%.
The government appeared to recognise there were problems after appointing the management consultancy firm McKinsey to review the contact tracing service. More recently, it seemed the government had also understood the need for a much more localised approach to contact tracing, with their relaunch of the system on August 10th.
But it didn’t take long for this to unravel. Despite the apparent push to localise the system, the very same companies whose handling of the test, track and trace has put public health at risk – Serco and Sitel – are still going to be undertaking contact tracing.
Having already received £200 million, Serco and Sitel’s contracts are set to expire on August 23rd – and the government seems likely to extend them by an additional £528 million. PHE’s budget for control of all infectious diseases came to a total of £87 million in 2018/19 – Serco and Sitel could end up receiving eight times that at over £700 million.
Meanwhile, not a single contact tracer working with Serco or Sitel will be moved to work with local authorities. So much for a “new way of working” that would strengthen local systems. In this setup, private companies make the initial call to contacts and when they fail to reach contacts local council teams are expected to pick up the slack and escalate things. This disjointed fragmented approach is not fit for purpose.
Only 15% of the public want private companies in charge of the test, track and trace system, compared to 67% who want local public health teams in charge. This week people in dozens of cities across England – from Bristol to Brent, Liverpool to Leamington – are protesting the continued privatisation of the system.
Over 10,000 people have already written to their council leader asking them to write to Matt Hancock and demand he scrap Serco. Collectively, they’re saying they don’t want a single penny more given to Serco.
The Independent Sage group has already offered an alternative to Serco and Sitel, and it’s one that Matt Hancock could easily take up: put local authorities, local public health teams and local health services (including GPs and NHS laboratories) back in charge of testing and tracing in the community, and give them the resources to do this properly over the coming months and years.
Contact tracing is skilled work, which involves asking the right questions with sensitivity, building trust – and it is these teams that can deliver it. We’ve seen that it is these teams that have already proven far more effective at tracing contacts. And it is these teams that know their local areas, have the experience to deliver and are trusted by their communities.
Local contact tracing integrated with NHS labs and primary care is the building block of an effective test, track and trace programme. And it would be a programme the public could have faith in.