Andrew Haldenby is a director of Haldenby Woodford, a public services consultancy.
A Western European country has done something remarkable in the fight against Coronavirus. It has built a national network of test centres with the first one set up and running within days of the pandemic starting. It has recruited from scratch a workforce equivalent to the five biggest police forces in the country. It has used private sector expertise to deliver genuine quality: 24-hour mobilisation to high risk areas, all-but-perfect safety from infection on 650 national sites, full weekday and weekend service.
The nation is the United Kingdom. We have been so self-critical over NHS Test and Trace that we have failed to recognise an incredible public service achievement.
Running test centres safely and reliably is a real challenge. Any transmission of the virus from staff to visitor, or vice versa, would result in a centre being closed and the opportunity to test people being lost. The Government and companies have together worked up rigorous safety standards. The companies seen as highest quality, such as Sodexo, go further by providing bespoke training to all members of staff.
The scale of the operation, with a total workforce of over 40,000, has required creative management. The best companies have set up dedicated seven-day-a-week recruitment operations to ensure centres are always fully staffed. Many staff have been recruited from the hard-hit hospitality sector, supporting the economy during the pandemic.
Centres are best located in areas of greatest infection, responding to local data that is constantly updated. Often, the Government will call companies in the evening to require a centre to be set up on the following morning, and companies can do it. The firms have also trialled the instant result, antigen tests which will be a game-changer in the fight against the virus.
This success is a blow for critics of private sector delivery of public services. That includes Keir Starmer. (While he has been keen to distinguish himself from his predecessor, in terms of actual policy the Labour leader is just as opposed to private sector delivery as was Jeremy Corbyn.) Centres have performed well partly because of firms’ long experience in running services for hospitals and in running major events around the world.
Some may say that this achievement is a worthy one, but it is the overall performance of Test and Trace that matters, and that performance is poor. That seems to have become the received wisdom but I would challenge it.
In his key lecture on government reform, Michael Gove rightly said: “We need, as a Government, to create the space for the experimental and to acknowledge we won’t always achieve perfection on Day One.” This is the right test for any new public service, especially one set up from scratch in unprecedented circumstances. In fact Test and Trace has got some things right since day one – for example test centres. In others it has learnt and improved. Unlike many firms, it has not had the luxury of refining its services before launching them. It has had to develop them in real time.
It has learnt lessons on contact tracing. To be successful, contact tracing requires the knowledge and co-operation of local communities. Test and Trace was set up as a national organisation but accepted that it should work in tandem with local agencies as long ago as May. The Director of Public Health at Blackburn with Darwen Council recently described to the Health Select Committee described how his team is picking up local people with positive test results whom the national team have not been able to reach. The Blackburn team is reaching 89 per cent of the local group. As Matt Hancock rightly said to the Committee last week, the combination of the national and local effort is working.
(It is worth noting that every major European country has found contact tracing hard. Even Germany, with a much-praised local tracing system, has gone into partial lockdown because its tracers had been overwhelmed. It is difficult to compare the UK to Asian countries, such as South Korea, which have run contact tracing successfully. Those countries were simply years ahead given their experience with the SARS virus in 2003 and the MERS virus in 2015.)
Test and Trace is also addressing a subject that has been little discussed: the fact that at least 50 per cent of people refuse to isolate when they are asked to do so. It has studied the reasons behind these decisions (often a fear of losing income). It has put forward solutions, such as the £500 payment to those isolating, introduced in September.
The big hope here is the instant-result antigen tests. These offer the prospect that people asked to isolate can themselves receive a test with an immediate result. If negative, that will give them immediate release from isolation. As the Prime Minister said last week, this changes the incentives for people. Instead of seeing the Test and Trace system as a potential route to lockdown, it becomes a way back to normal life. Test and Trace distributed 600,000 tests to local authorities eight days ago. It is piloting antigen tests which can be self-administered, further increasing their impact.
The final argument against testing is that it will no longer be needed given the vaccines that are on the way. Certainly the vaccines will affect the need for tests, and future contracts for test centres should be flexible in length and volume, taking advantage of the adaptability of private firms. It would however be a mistake to scrap the infrastructure that has been built.
The length of the immunity from Covid-19 due to a vaccine is not yet known. Even after the vaccines are introduced, society will want to test to ensure the safety of gatherings of people, for example in universities and offices. Most importantly, the UK should not leave itself as exposed as it was at the beginning of 2020, when our testing capacity was found to be wanting. Given the steady rise in global movement of people, we are more at risk from pandemics than in the past. Part of the legacy of this pandemic should be a much greater level of readiness for the next one.
With two new Lighthouse Labs opening in early the New Year, testing capacity will pass one million per day. By any standard that is a remarkable achievement compared to the daily capacity of 10,000 per day in March 2020. Self-administered antigen tests will make blanket lockdowns redundant. All of this is founded on a test centre network which is a model of public-private partnership, and which, in current politics, only a Conservative government could have delivered. It may be time to revise the received wisdom on Test and Trace.