Thanks to outsourcing, England’s test and trace system is in chaos | Allyson Pollock

Thanks to outsourcing, England’s test and trace system is in chaos

NHS services have been sidelined in favour of private giants with a poor track record – and billions are unaccounted for

Serco staff at an NHS test and trace centre in Stone, England, July 2020




Serco staff at an NHS test and trace centre in Stone, England, July 2020.
Photograph: Christopher Furlong/Getty Images

We all know that an effective and integrated find, test, track and trace system is hugely important in tackling the coronavirus outbreak. It’s crucial if we’re going to come out of lockdown safely, prevent a second wave of suffering and see our loved ones again.

Yet Britain’s test and trace programme – lauded by the government as “world-beating” – is about as far from integrated or effective as you can get.

That’s because a key part of it operates not as part of the NHS, but in parallel to it – as a network of commercial, privatised testing labs, drive-through centres and call centres. The chaos this has brought has resulted in huge gaps in information available to local services, causing delays in accessing results and hampering efforts to control the outbreak.

Instead of putting local public health experts and NHS services in charge of contact tracing, the health secretary, Matt Hancock, handed over responsibility to private companies such as the outsourcing giant Serco, which has previously been fined for deaths of workers and members of the public that could have been prevented. The list of problems in the test and trace system is already immense – three data breaches, poor training and faulty online administration systems among them.

Despite this convoluted mess of a setup, local health protection teams are delivering. In public hands, teams are tracing far more contacts than the privatised national call centres and online system. They are achieving this even in the face of local public health departments being hampered by lack of access to real-time data on cases in their communities. The health secretary needs to amend the current notification system urgently to ensure test results for all cases are sent to local public health departments and primary care within 24 hours. Lack of timely, detailed data on people testing positive for Covid-19, including postcodes, is currently hindering the work of local authorities and public health departments.

The government’s own emergency science group, Sage, says the target to ensure the virus doesn’t spread further is finding and reaching 80% of all close contacts of symptomatic cases. Yet in Blackburn, where health chiefs are battling a major outbreak, leaked analysis shows that the national tracing service is reaching only 52% of all close contacts.

This privatised system clearly isn’t working – and even the government appears to recognise there are problems. It has appointed the management consultancy firm McKinsey to review the contact tracing service, following many media reports of the system not working well.

Yet despite all this, it still hasn’t published the details of its contracts with the likes of Serco. According to the Treasury, £10bn of public money has been allocated to England’s test and trace programme. Only £300m of additional funding has been offered to local authorities to support the system.

Billions of funding are unaccounted for. Some will be spent on contracts with Serco, Sitel and Capita, among others. Right now, we can’t see how much they’re being paid, for how long and for what. How are these contracts being monitored and by whom? What about subcontractors, and their contractual agreements?

The fact that this information is not readily available is an insult to those working night and day to stop the spread of this virus, and to our communities who worry night and day about loved ones.

I’ve joined more than 100 public figures – including academics, journalists and health professionals – in writing to Matt Hancock, demanding he publishes the contracts given to private companies as part of the test and trace system. We believe it is essential for the public and the wider health community – including the NHS and local government public health teams – to have a better understanding of these contracts.

That’s the immediate priority – as an absolute minimum. But more broadly, the public knows this is not a good way to run contact tracing, and it is for all of these reasons that over two-thirds of those surveyed believe local public health teams and local health services should be in charge of the contact tracing system.

The Independent Sage group has already offered a solution that Hancock could take up easily. 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. This is the system Wales and Scotland have opted for, as has Germany. That would be a test, track and trace programme the public could have faith in.

Allyson Pollock is professor of public health research and policy at Queen Mary University of London and author of NHS plc: the Privatisation of Our Health Care