in May, 2020, the UK Prime Minister promised to create a world-beating test and trace system. Many people have criticised the results of his initiative. This article explores whether such criticism is justified, and, if so, what lessons we should draw from this episode.
Our conclusion is that the UK’s test and trace system, the so-called ‘NHS test and trace’ has seen an extraordinary amount of money spent, largely outside the NHS, with very little to show for it:
- the total spend has been so large as to be difficult to understand;
- although the UK’s test and trace programme is constantly referred to as ‘NHS test and trace,’ this title is misleading;
- despite the enormous amounts of money spent, the results are poor.
The Total Spend is Mind-Boggling
The first difficulty in understanding the test and trace programme is that the amounts of money are so large that they are almost incomprehensible without some frame of reference.
Let’s start with the money, and then attempt to put it into some form of context.
The National Audit Office (NAO), which is the official watchdog in charge of making sure that public money is well-spent reviewed the test and trace programme in a report published in December 2020 and intends to review it again this year.
They found that the programme had spent or intended to spend by March 2021, over £23 billion, much of it without going out to competitive tender:
NHST&T has signed 407 contracts worth £7 billion with 217 public and private organisations. NHST&T relies on contractors for many of its supplies, services and infrastructure. It estimates it will sign a further 154 contracts worth £16.2 billion between November 2020 and March 2021 (with not all that spending occurring in this financial year). As with many other government procurements during the pandemic, 70% of early contracts by value were assigned as direct awards without competition under emergency measures.”
To add to this, the Budget proposes a further £15 billion: “The government has provided around £22 billion for NHS Test and Trace this year and announced a further £15 billion next year.”
That brings the total expenditure over two years to £37 billion.
Is that a lot? Of course, compared with the normal family budget it is an extraordinary amount of money, but how does it compare with other government spending?
The annual budget of the UK Armed Forces – Army, Navy and Air Force – is around £39 billion.
That £39 billion pays for 150,000 serving members of the military, 45,000 reservists and around 58,000 civilian employees – over 250,000 people in all – for one year.
In addition, it pays for 10 submarines and 79 commissioned vessels: Aircraft Carriers, Amphibious Warfare Ships, Destroyers, Frigates, Patrol Vessels and Mine-Countermeasure Vessels in the Navy; 529 Fixed-wing aircraft and 311 Rotary-wing aircraft as well as 287 Unmanned Aircraft Systems in the Air Force; and 990 Armoured Personnel Carriers, 1,906 Protected Mobility Vehicles and 1,175 Armoured Fighting Vehicles in the Army.
On a pro rata basis (because the £37 billion is spread over two financial years) we might expect that our test and trace system would have access to around 120,000 people and vast quantities of high-tech equipment. We do not see that.
Calling It ‘NHS Test and Trace’ is Misleading
The second thing which is confusing is that the government decided to call the programme ‘NHS test and trace;’ and indeed it is always referred to this way. The NAO report, for example, refers throughout to ‘NHST&T’ even though it is clear that they were well aware that the test and trace programme is not in reality an NHS programme:
“NHST&T has an unusual organisational relationship with the Department, with unclear accountability. NHST&T is subject to the Department’s financial, information and staffing controls, but its head, the executive chair, does not report to the Department’s ministers or permanent secretary, but rather to the Prime Minister and the Cabinet Secretary.”
Similarly, as City AM reports,
“NHS England’s boss, Sir Simon Stevens, when quizzed by the Health and Science Committee last month, said: ‘I can’t comment specifically on Test and Trace because that is run by the Department of Health and Social Care rather than the NHS or NHS England per se.’
Indeed, the answer is far more complicated than any one company or government department being in charge. According to the NHS Test and Trace website, a patchwork of 48 organisations are listed as ‘data processors’ for the contact tracing scheme. Just four of those are NHS bodies.”
So we have a programme which neither reports to the NHS nor consists of NHS bodies and yet has been deliberately and strongly branded as being ‘NHS test and trace.’
The Results Are Poor
None of this might matter, if the results had been good. As we and others explained in April 2020, a well-functioning, industrial-scale test and trace programme is critically important to the safe ending of lockdown. £37 billion is a colossal amount of money to spend, but if it had saved huge numbers of lives and prevented the enormous damage to the UK economy which has been caused by the spread of the virus and the need for repeated lockdown is, it might still be money well spent.
If the strange reporting lines, heavy reliance on private sector organisations outside the NHS and unorthodox procurement approach had enabled the UK test and trace programme to scale up more quickly and effectively, they could have been justified.
If the UK government had, for example, used this money and these unorthodox approaches to manage the interplay between the development of effective capacity for test, trace and supported isolation on the one hand and the phasing out of restrictions on the other, the UK would be in a far better position today. Countries such as New Zealand which locked down hard and early, and had effective test, trace and isolation have been able to return, in many respects, to normal life. And their death toll has been a tiny fraction of the UK’s – deaths in New Zealand for the whole of the pandemic total 5.3 people per million of population; for the UK, they are around 1,900 people per million.
But the UK results have not been good. The NAO report has some strongly-worded criticisms:
“16 NHST&T has not met a target to provide results within 24 hours for tests carried out in person in the community.
17 NHST&T did not plan for a sharp rise in testing demand in early autumn when schools and universities reopened.
22 There has been no shortage of central tracers and, at times, parts of the national tracing service have been barely used.
24 The Scientific Advisory Group for Emergencies (SAGE) has provided advice on what a testing and tracing system needs to achieve in order to be effective; to date NHST&T has not achieved these standards.”
The NAO report found that, of 850,000 positive cases (i.e. individuals who had tested positively for infection to cope with), 630,000 had been traced successfully. They also found that an estimated 66% of close contacts of these people had been successfully traced, and noted that, “The Scientific Advisory Group for Emergencies advised that an effective test and trace system should reach at least 80% of close contacts of index cases.”
So the overall picture looks like this: we should have a system which can trace virtually all of those with positive tests and at least 80% of their close contacts; in reality we have nothing like that.
We Must Make Sure This Does Not Happen Again
The cost of this failure is not simply that £37 billion public money may have been mis-spent – though this in itself is an extraordinary sum and the consequences should be serious – it is that a vital part of the UK’s battle against COVID has been ineffective. Many tens of thousands of lives have been needlessly lost and many hundreds of £billions of damage has been done to the UK’s economy.
To make sure it does not happen again, we need:
- to preserve the mechanisms that we can use to hold our government to account; and
- to ensure that the failures of the so-called NHS test and trace are not used as an excuse to privatise the NHS.
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