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Covid-19: NHS Test and Trace failed despite “eye watering” budget, MPs conclude

BMJ 2021; 375 doi: (Published 27 October 2021) Cite this as: BMJ 2021;375:n2606

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  1. Elisabeth Mahase
  1. The BMJ

England’s covid-19 testing and tracing system failed to achieve its main objective—to break chains of transmission and enable people to return to a more normal life—despite an “eye watering” budget of £37bn (€44bn; $51bn), MPs have said.1

The damning report from the House of Commons Public Accounts Committee said that the contact tracing service was one of the most expensive health programmes delivered during the pandemic, equal to nearly 20% of the entire 2020-21 NHS England budget. However, after it was set up the UK still had two national lockdowns and significant case numbers.

“Its outcomes have been muddled and a number of its professed aims have been overstated or not achieved,” the MPs said.

Although named NHS Test and Trace the system was largely run by two private companies, Serco and Sitel, that handled the national call centre and online system. Led by the Conservative peer and former head of NHS Improvement Dido Harding, the system has been widely criticised for its use of expensive consultancy companies, its poor performance in reaching people who tested positive for SARS-CoV-2 and their contacts, and its centralised rather than localised approach. An earlier report from the Public Accounts Committee found that NHS Test and Trace could not show it had made a difference to the pandemic.2

The MPs found that despite a promise by NHS Test and Trace to reduce its reliance on consultants the number it employed was higher in April 2021 (2239) than in December 2020 (2164). The Department of Health and Social Care pays consultants an average of £1100 a day, though some are paid even more. The report said that NHS Test and Trace did not know what its overall spending on consultants was and that although it estimated that it will have spent £195m on consultancy in 2021-22 it also said it would be spending £300m on its top 10 consultancy suppliers alone.

Unused laboratories

Another major issue was capacity and usage of laboratories and contact tracing centres. In 2020-21 NHS Test and Trace paid £3.1bn to secure the laboratory capacity to process PCR tests and £911m for contact tracing, mainly on call centres.

However, it only used a minority of the laboratory and contact tracing call centre capacity it paid for, even at times when demand for testing was high and few people were getting test results back within 24 hours. Over Christmas 2020, when there seemed to be spare laboratory capacity and covid-19 case numbers were rising, performance declined, and in December only 17% of people received their test results within 24 hours. Meanwhile, just 49% of the staff capacity in call centres was used at the beginning of January 2021, and this fell to 11% by the end of February 2021. Overall, between November 2020 and April 2021 only 45% of laboratory capacity was used, on average.

Meg Hillier, chair of the Public Accounts Committee, said, “The national Test and Trace programme was allocated eye watering sums of taxpayers’ money in the midst of a global health and economic crisis. It set out bold ambitions but has failed to achieve them despite the vast sums thrown at it.

“The continued reliance on the overpriced consultants who ‘delivered’ this state of affairs will by itself cost the taxpayer hundreds of millions of pounds. For this huge amount of money we need to see a legacy system ready to deliver when needed, but it’s just not clear what there will be to show in the long term. This legacy has to be a focus for the government if we are to see any value for the money spent.”

Next steps

The committee has asked the Department of Health and Social Care and the UK Health Service Agency to carry out several actions and to report back on progress over the next few months. These actions include setting out which groups have been most under-represented in the testing programme and how engagement with the public and these specific groups will be improved, and what the programme will deliver, and how, with the funding expected in this week’s spending review, with an evidence base for this.

The UK Health Service Agency must also write to the committee by the end of November detailing how it will reduce dependency on consultants and to report on its progress in March and June 2022. The role of local government in the future operating model must also urgently be made clear, so local authorities get the resources they need to deliver their side of the process.

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