Public Accounts Committee demands “proper long-term strategy and legacy” for public health system
MPs have condemned the “muddled”, “overstated” and “eye-wateringly expensive” NHS Test and Trace system set up during the Covid-19 pandemic.
In a strongly worded report, the Public Accounts Committee said the system had “not achieved its main objective to help break chains of Covid-19 transmission and enable people to return towards a more normal way of life”.
Despite being handed an “eye-watering” £37 billion budget over two years—equal to nearly 20 per cent of the entire 2020-21 NHS England budget—the committee said the service’s outcomes had been “muddled”, while a number of its professed aims were “overstated or not achieved”.
“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,” said the committee’s chair, Meg Hillier. “This legacy has to be a focus for government if we are to see any value for the money spent.”
Although the committee acknowledged that some improvements had been made to the system since it was set up in May 2020, it noted that, “when under pressure, as it was over Christmas 2020 and more recently in April, performance deteriorates, with only 17 per cent of people receiving tests within 24 hours in December 2020”.
Meanwhile, the committee found that only 96 million of the 691 million lateral flow tests distributed by the service to date have been registered. “This represents only 14 per cent of the total so it is not clear what benefit the remaining 595 million tests have secured,” the report said.
In addition, the committee said that most of the testing and contact-tracing capacity paid for by the service had not been used, and blasted the service’s spending on “overpriced” consultants, pointing out that it employed more in April 2021 than in December 2020.
“If NHS Test and Trace is to control spending on consultants, it must produce a plan with targets,” it said.
The MPs called for “urgent improvements” to be made regarding public outreach, pointing out that 60 per cent of people who experience Covid-19 symptoms are still not getting tested.
Long-term legacy
The MPs also demanded a “proper long-term strategy and legacy”, as the Test and Trace service moves into the newly formed UK Health Security Agency (UKHSA).
In particular, they urged the agency to set out in detail its objectives and the impacts it aims to secure, and to publish a performance-management framework by the end of December. This framework should include “specific published targets and metrics for each major area of activity”, it suggested.
In addition, the UKHSA should “clearly set out how it plans to deliver the benefits expected from the funding it receives” from the spending review and budget, set to be delivered just hours after the publication of the report, they said. “This should be informed by an evidence-based understanding of the actual benefits delivered by its major areas of spending to date, as measured against the intended outcomes.”
The report’s findings were echoed by several researchers.
Lingering concerns
“Track and trace failed to halt the waves of infection; this was clear in real time last year,” said Jim Naismith, professor of structural biology at the University of Oxford.
“Too small a proportion of contacts were identified and instructed to isolate in a timely manner.”
Simon Clark, an associate professor in cellular microbiology at the University of Reading, said the system’s failure to cut infections “could mean that we suffered more sickness and death, and longer time spent living under restrictions than would otherwise have been the case”.
And Michael Hopkins, a professor of innovation management at the University of Sussex’s Science Policy Research Unit, said the report had come at a “crucial time, with Covid cases and scepticism of NHS Test and Trace both rising”.
He added that the “big danger” was that politicians and the public conclude that the system is “expensive and simply does not work”.
“But in South Korea, a world leading test and trace system has actually averted the need for national lockdowns,” he pointed out.
“We need to create a culture of social responsibility to encourage people to engage with test and trace,” Hopkins said. “Failure to engage with testing is now the major problem that we face in the UK, because the test and trace system may only see the tip of the iceberg—especially if people think vaccination is the be all and end all of their personal responsibilities.”
Essential role
In response, Jenny Harries, chief executive of the UK Health Security Agency, said NHS Test and Trace had played an “essential role” in combating the pandemic.
“The fact is NHSTT is saving lives every single day and helping us fight Covid-19 by breaking chains of transmission and spotting outbreaks wherever they exist,” she said.
“In a matter of months NHSTT built from scratch the largest UK testing network in history, from processing a few thousand tests a day to well over a million, meaning anybody who needs a test can now get one.
“The majority of NHSTT spend delivers the testing infrastructure at the heart of the pandemic response—both for patients and the public—and accounts for 80 per cent of all costs.
“More than 323 million tests have now been carried out across the UK. More than a million positive results have been reported through rapid LFD testing to date, and around a quarter of the positive cases that we are identifying come from LFDs. NHSTT has now contacted more than 19.9 million people, helping to slow the spread of the virus.”