Editorial Wednesday 10 March 2021: Does Test And Trace work?

On 4 April 2020 the Department for Health But Social Care launched its plan to provide a major testing service.

The Prime Minister promised in May 2020 that it would be a "world-beating" service by June 2020.

The People's Partridge, Health But Social Care Secretary Matt 'Alan' Hancock claimed in September 2020 that "compared with international systems, ... we are absolutely in the top tranche".

The Test And Trace programme has had money thrown at it. Its budget rose from an initial £12 billion to £22 billion, and then in the Budget to £37 billion (to cover a second year of operation).

Former Treasury permanent secretary Nicholas Macpherson observed that TAT "wins the prize for the most wasteful and inept public spending programme of all time. The extraordinary thing is that nobody in the government seems surprised or shocked".

So, given this enormous budget, does TAT work?

The new report from the Commons Public Accounts Committee acknowledges its rapid growth, noting that "Between May 2020 and January 2021, daily UK testing capacity for COVID-19 increased from around 100,000 to over 800,000 tests. NHST&T had also contacted over 2.5 million people testing positive for COVID-19 in England and advised more than 4.5 million of their associated contacts to self-isolate".

So, political over-promising aside, what's the problem?

Part of the problem is that one of the repeated justifications for such high-cost TAT, including by the DHBSC, is that as the PAC report observes, "an effective test and trace system would help avoid a second national lockdown; but since its creation we have had two more lockdowns.

"There is still no clear evidence to judge TAT’s overall effectiveness. It is unclear whether its specific contribution to reducing infection levels, as opposed to the other measures introduced to tackle the pandemic has justified its costs".

The PAC report observes that TAT "quotes findings from an “independent verified analysis”, which suggested that its activities in October 2020 may have contributed to a reduction in the “R number” (the number of other people a person with COVID-19 infects) by 0.3 to 0.6, provided that people with the virus start self-isolating once they develop symptoms, i.e. before even engaging with the test and trace system. Most of the reduction arises from the assumption that people self-isolate as required, in particular between developing symptoms and receiving their test results. In reality full compliance with self-isolation rules can be low. NHST&T also has plans to increase the proportion of cases identified through the mass testing of people without symptoms.

"However, the interim report on the Liverpool mass testing pilot did not find clear evidence that the pilot reduced positive COVID-19 cases or hospital admissions ... (TAT) publishes weekly performance data, but these do not provide an overview of the speed of the process from beginning to end (“cough to contact”) and thus do not allow readers to understand the overall effectiveness of the programme".

The political hope must be that the highly effective vaccines (good job, Vaccines Taskforce) and the successful NHS-run vaccination programme (which is about to enjoy a 'tight-lipped on supply problems' bonus in the near-doubling of vaccine availability) is going to obscure the fact that TAT signally failed on multiple occasions.

Its test turnaround performance was woeful for long periods, as was its contact tracing.

It failed to predict high demand for tests in September 2020 (return from holidays, back to school/college/university).

The Scientific Advisory Group on Emergencies (SAGE) assessed that TAT has only "a marginal impact on transmission:".

Who is responsible?
It was the decision of Matt Hancock and Boris Johnson to proceed with Test And Trace on a largely outsourced basis.

One of the challenges if you outsource a thing is that you may have very limited control over it (and also big issues of 'work as imagined' vs. 'work as done'). In and of itself, outsourcing does not have to be a bad thing: it does, however, have to be competently done in contracting, delivery and management.

TAT has been a demonstrable failure in all three of those regards.

Certainly, as I revealed in this September 2020 HSJ column, if you have no performance clauses in the contract, which DHBSC didn't, then you have almost zero leverage over your suppliers.

TAT's performance has tended to indicate that this has not gone well.

Outsourced TAT is the Spotify of public health epidemiology: as soon as you unsubscribe, you no longer own the thing for which you paid all that money.

And £37 billion is A Lot Of Money: if TAT were a nation, its budget would be enough to make it the 83rd biggest economy in the world.