How Outsourcing Failures Led to England’s Lockdown Mess

From care homes to the test and trace system, England's coronavirus fiasco has been caused by outsourced companies running what should be public services for private profit.

Listeners to BBC Radio 4’s More or Less last week will have been struck by the fact that its presenter, Tim Harford, failed to wrap up his review of the data on the testing system with his usual summary: the gap between official claims and the reality seemed to leave him speechless.

The Department of Health had declared that testing capacity was up from 100,000 a day in May to 375,000 by early September. But 120,000 of this turned out to be for antibody tests. The relevant capacity figure, for the purpose of preventing a new surge of infections, was 250,000. But only some 200,000 tests a day were actually being processed: according to the government’s data there was spare capacity of almost 60,000.

Yet on September 7th the director of England’s coronavirus testing programme tweeted an apology for the fact that not enough tests were available, saying the problem was lack of capacity in the labs. The Department of Health could not explain the contradiction, Harford said.

The government also tried to minimise the extent to which the shortage of tests was forcing people to travel absurd distances to get one. It cited the median distance travelled (6.4 miles) rather than the mean distance, which would show the extent to which some people were driving huge distances. Hancock was looking for the same effect when he declared that 90% of people who travelled to get a test travelled 22 miles or less – i.e., simply omitting those who had to travel farther. 

So what’s new in this?, most people will ask. But few of us would fly with an airline that routinely misrepresented the qualifications of its pilots or the record of its safety inspections, and yet our lives are currently in the hands of a government which does this all the time.

The results of what the government has actually done, as opposed to what it says, can be seen in the international statistics collected by the Johns Hopkins Corona Virus Resource Center, using the UK government’s own data:

We know, of course, that in August the total UK death toll from Covid-19 was reduced by 5,000, by adopting for England the same criteria for counting deaths that was already in use in Scotland and Wales – in effect excluding Covid-19 patients who die more than 28 days after being diagnosed with it.

A more realistic measure of the death toll is excess deaths – the number of deaths that exceed those that would have been predicted on the basis of previous years’ totals. In early September this stood at 53,000, 95% of which are down to Covid-19. By that measure, the true UK death toll from Covid is closer to 50,000 than 40,000.

What is especially striking, besides the contrast with France and Germany, is the high case fatality rate compared with all the other large European countries – except Italy, which was struck first and had less time to prepare. This clearly has to do with the fact that almost half of all deaths from Covid-19 in the UK occurred in care homes, the great majority of them run for profit by companies.

Few of these businesses, if any, ever considered that protecting their residents from epidemics needed to be factored into their business plans. Now the government is putting half a billion pounds of public funds into subsidising these companies, in the form of free PPE and salary support for staff who need to self-isolate, hopefully before the next surge of infection reaches them.

And for the rest of us facing the new surge, the crucial elements in epidemic control – testing, contact tracing, and the effective isolation of contacts – have likewise been entrusted to private companies with no qualifications for this work, overseen by an unsuccessful business executive with no experience in public health.

The ‘Lighthouse’ labs that Dido Harding’s companies have set up are officially described as government labs, but they are run by commercial companies and are not subject to the Freedom of Information Act. So we have only leaked documents and reports by disillusioned staff to account for the lack of capacity which has now led to only a third of test results for the general public being returned within 24 hours of taking the test.

It is worth remembering what this failure means in practice: 2/3 of the results were received too late to be really valuable for stopping the spread of the virus by tracing and isolating the infected people and their contacts.

In the first week of September a total of 15,000 positive cases were nonetheless referred to the tracing companies. But here further slippage occurred: the tracers reached only 83% of the 15,000 cases, i.e, 12,000, and of these only some 10,000, or 2/3 of those infected, could provide any details of their contacts.

This yielded a total of 62,000 contacts to be reached. Of the 44,000 of these who were located outside institutions such as care homes or prisons only 64% were reached, and of these only 58%, or about 16,000, were reached within 24 hours. In other words, the test and trace system was reaching just over a third of these contacts early enough for their isolation to be beneficial.

But on top of this the government has no idea how many of those instructed to self-isolate are actually doing so – at the end of May only half of those who tested positive and were told to self-isolate were complying, and it seems rather unlikely that compliance by contacts is any better.

Even an effective test and trace system will not do the key job of controlling the spread of infections if people feel compelled to go on working to make ends meet, and if there is no system to monitor and support compliance. But the government is resolutely failing to come up with adequate financial support for people who can’t afford not to keep working, or any plans for field staff to monitor those who need to self-isolate.

The government’s ideological hostility to state initiatives leaves us prey to a fresh cycle of mismanagement, deaths, and economic suffering. Instead of scrapping its failed outsourcing programme it has signed a further secret contract worth £45 million with Serco for testing stations.

There is an additional reason to feel angered by the government’s failings: up to 20% of the results of the current swab test are thought to be false negatives. This makes combatting the virus additionally challenging and means that efficient use of the results from those who do test positive is even more crucial.

We have very limited clinical weapons to fight the virus with, and depend on the basic processes of disease management being conducted with the maximum efficiency and precision. There should be no room, in a war for survival, for ‘backlogs’, empty promises, or misrepresentations of the state of the struggle.

The plain truth is that a government that loves to talk about security has failed to keep us safe, and is now failing again. It has outsourced our security to private companies and lies about the consequences of their incompetence. It uses military language but does not really see the pandemic as anything like a war.

Its mind is on politics and the next election, not on the thousands of families, few of them living in conditions familiar to ministers, who are paying the cost. The scale of this massive failure to protect the population, and the reasons for it, must be clearly registered. Accepting official deceit with a cynical shrug is not something we can afford.

About the Author

Colin Leys is the co-chair of the Centre for Health and the Public Interest (CHPI), an independent think-tank on health and social care policy. He is also an emeritus professor of political studies at Queen's University, Canada.