MPs call for test and trace improvements

by Seamus Ward

10 March 2021

It is unclear whether NHS Test and Trace has been effective in reducing Covid-19 infections and can justify its ‘unimaginable’ cost, MPs have said.

report from the Commons Public Accounts Committee said Test and Trace had been established with a £22bn budget in 2020/21, with a further £15bn allocated for 2021/22. It acknowledged the system's achievements. Test and Trace had been set up rapidly and was working on a significant scale. Capacity had increased from around 100,000 tests a day to more than 800,000 between May 2020 and January 2021. The programme had contacted more than 2.5 million people who had tested positive and advised more than 4.5 million of their contacts to isolate.Meg Hillier

However, the report said that the government had justified investment in the system partly because it believed it would help avoid a second national lockdown – since it was created there have been two further lockdowns.

It recommended a change in the weekly performance metrics published by Test and Trace to show its effectiveness in breaking chains of transmission. Test and Trace should publish the speed of reaching a person’s contacts after a positive test – the so-called cough to contact period – the number of days contacts are asked to self-isolate, and the indicators of compliance with this.

It added that despite the increase in capacity, utilisation was under 65% in November and December and Test and Trace had never met its target of turning around all face-to-face tests in 24 hours. The PAC said the NHS body should make better use of its capacity, only retaining surplus capacity for clear reasons and getting a better balance between meeting demand and paying unnecessarily for additional capacity.

The committee also criticised the mass roll-out of rapid testing. MPs said there was confusion over why and how rapid mass testing should be used in the community, such as in schools and workplaces

Rapid community testing aims, in part, to highlight asymptomatic cases and help break transmission chains. But there have been setbacks in school testing, with Test and Trace significantly underestimating the rise in demand when schools and universities returned in September 2020.

The government has purchased 384 million lateral flow test kits to support the roll-out of community testing, but there are concerns about the accuracy of these tests compared with those carried out in laboratories. Guidance on the mass roll-out was needed, alongside clear targets and progress updates, the report said.

Test and Trace must also ‘wean itself off its persistent reliance on consultants’. In November 2020, ministers said 2,300 consultants and contractors were working on the programme, and in early February Test and Trace told the committee it was employing 2,500 consultants at an estimated daily rate of £1,100. The highest rate paid was £6,624 a day.

The committee was concerned such high rates were still being paid, and called for a clear workforce plan and recruitment strategy to reduce, month-by-month, Test and Trace’s reliance on consultant and temporary staff. It should consider using staff banks, as other NHS organisations do, to cope with surges in demand for additional personnel.

PAC chair Meg Hiller (pictured) said: ‘The £23bn Test and Trace has cost us so far is about the annual budget of the Department for Transport. Test and Trace continues to pay for consultants at £1,000 a day. Yet despite the unimaginable resources thrown at this project Test and Trace cannot point to a measurable difference to the progress of the pandemic, and the promise on which this huge expense was justified – avoiding another lockdown – has been broken, twice.’

The Department of Health and Social Care and Test and Trace must begin to show the value of the taxpayers’ investment in the programme, she added.

‘Not only is it essential it delivers an effective system as pupils return to school and more people return to their workplace, but for the billions spent we need to see a top-class legacy system. British taxpayers cannot be treated by government like an ATM machine. We need to see a clear plan and costs better controlled.’

Nuffield Trust senior fellow Billy Palmer said the promised world-beating test and trace system had not materialised.

‘Despite the rapid roll-out of vaccines, new variants will mean a test and trace system will remain a tool to return to normality. But test, trace and isolate could never work unless people can and are supported to self-isolate when they need to,’ Dr Palmer added.

Dido Harding

‘Over 80% of people self-isolating with symptoms are estimated to have broken isolation. Selected support payments have not proved sufficient, so unless this question of broader support is addressed, test and trace will remain an expensive leaky system.’

However, Dido Harding (pictured), interim executive chair of the National Institute for Health Protection, who heads up Test and Trace, defended its record. The system had been built from scratch, performance was improving and it was now doing more tests than any comparable country, she insisted.

The committee made further recommendations on the future of testing and tracing services in England. It called on the Department to set out its plans for the future, including a timetable for transitioning to the new National Institute for Health Protection, which is due to take on most of Public Health England’s responsibilities. It should also outline how it intends to scale down, mothball and reallocate Covid-19 testing capacity, while cost-effectively maintaining readiness for new waves of Covid and other respiratory infections.