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We Still Need an NHS Test and Trace System

While the vaccine is rolled out, continued contact tracing will protect against new and potentially resistant variants – but giving it to Serco and Sitel is a waste of time. We need a public system.

‘No clear impact’. These are the three words that have been the main takeaway from the House of Commons Public Accounts Committee report into the much maligned test and trace system in England. Despite having been set up as a key tool in our arsenal in the battle against Covid-19, despite Boris Johnson promising it would be ‘world-beating’, despite an eye-watering £37 billion having been allocated to it, the conclusion MPs scrutinising it drew was that it has had ‘no clear impact’ on the spread of disease.

This feels like groundhog day. Back in October, the government’s scientific advisers admitted that the impact the test and trace system has had on transmission was ‘marginal’. An integral part of the system—contact tracing—was found in February to only be reducing the R-rate by between two and five percent. And so on and so on. Report after report, study after study has consistently and repeatedly found that the system isn’t working.

So how did we get here? How did we end up nearly 12 months on with a crucial part of the pandemic response still failing to deliver in even the most basic of ways? The problem is in the design.

From the system’s inception, the government decided to discard the knowledge and experience in our public health teams and in our NHS, instead opting to build a system reliant on private companies and consultants.

This happened in the testing element – where NHS laboratories with decades of experience were eschewed in favour of private companies like biotech firm Randox, and even more bizarrely, management consultancy companies like Deloitte. They set up a parallel network of laboratories which the NHS labs said have failed to process tests quickly enough and failed to effectively communicate.

It also happened in the second stage—contact tracing—where local public health teams were set aside in place of the notoriously disaster-prone Serco and call centre company Sitel. Those companies have consistently failed to reach the SAGE target of ensuring at least 80 percent of all contacts of identified Covid cases are reached and asked to isolate. From the most recent data, just 71.7 percent of contacts who were from a different household to the case from which they were identified were successfully reached and told to self-isolate.

Managing public health is challenging work at the best of times – even more so in an unprecedented global pandemic. The demands placed on those leading the response are huge. Setting up an effective mechanism for testing and getting results back to people quickly isn’t straightforward: it’s not something that a company with no prior experience can jump into and take on.

Contact tracing requires intricate community knowledge. It requires building trust and rapport with people being spoken to and providing human interaction and support for those who are asked to self-isolate, whether it be collecting food for the two-week period of isolation or things as simple as making sure a dog gets walked. The last thing it needs is remote call centres and corner-cutting companies.

There is not a single public health explanation as to why the government adopted this approach. The only logical conclusion that can be drawn is that the government decided to hand huge chunks of the pandemic response to wholly ill-equipped private companies because of its obsession with the toxic ideology of privatisation and outsourcing. Nothing else could explain why they would cling doggedly to a system that has failed again and again despite the spiralling costs and the mounting death toll.

Thankfully, the government does appear to have conceded some ground on this. The vaccination programme has largely been conducted by the NHS and primary care services.  We’re ahead of many comparable countries on our vaccination precisely because of the efficacy of running such a public health initiative through a publicly-run health service. No wonder that 80 percent of people think the vaccination programme has been a success, compared to just 29 percent of people who think the same of contact tracing.

But despite the successes of the vaccine rollout, this is far from a silver bullet. The overwhelming majority of people who have started receiving the vaccine have only had their first dose. Huge portions of the population are yet to be vaccinated, and many won’t be for months. We still need a properly functioning test and trace system to stop the spread of the virus and the risk of the development of more deadly and potentially vaccine-resistant variants.

So the Public Accounts Committee’s report isn’t ‘old news’, as the test and trace scheme’s head Dido Harding claimed. It’s vital for the here and now.

And it’s not too late to fix. The government should be learning the key lessons of the past year. When you pump £37 billion into a system which has routinely fallen short, throwing more money at the problem won’t fix it. Rather, the whole system needs an overhaul. That requires the private companies to be kicked out of test and trace, and for the programme to be handed to our NHS and local public health teams to deliver.