Gaps in policy, not just operational failings, are the problem with Covid test and trace

By allocating the vast sum of £37 billion to the UK test and trace (T&T) system the government has in effect given its executive chair, Dido Harding, and her team a blank cheque. So Meg Hillier, the chair of the Public Accounts Committee, was right to highlight the “unimaginable” cost of the system. Hillier heavily criticised T&T and pointed out, self-evidently, that its existence did not prevent the imposition of lockdowns across the country at the end of last year.

The reality, though, is more complex than a story of wasted money and operational failure. Allocating the money does not mean that it will get used. As of last November “only” £5.7 billion had actually been spent. Still an enormous sum, but way below the headline figure and an indication that the programme will undershoot its huge budget.

The government can mount a reasonable defence on T&T effectiveness, certainly on the testing side. And the expectations about what any tracing system can achieve have been inflated beyond reason – partly, of course, by government ministers themselves. But while T&T has increasingly played an important part in the UK’s efforts to contain and control the spread of the virus, it can still be improved.

After a bumpy start there are signs test and trace is having some success

There have certainly been mistakes. The Public Accounts Committee’s report correctly criticises the system’s expensive over-reliance on consultants. There is not enough transparency about how money is spent or how decisions are made, and the report highlights T&T’s failure to work closely enough with schools around their reopening.

The judgement in the early phase of the pandemic to rapidly pursue an outsourced national system that did not incorporate local structures was wrong and caused delay. And ministers put too much faith in a mobile phone app to revolutionise rather than complement more reliable “boots on the ground” tracing methods. The government seems to have learnt from these missteps and should continue to work to improve T&T’s operational effectiveness.

But the Public Accounts Committee is wrong that there is “no clear evidence” of T&T’s effectiveness. There are indications that it is having a positive effect. Harding points to government research that shows a notable reduction in the reproduction rate of the virus (although her figures included people who self-isolated with symptoms but had not been contacted by tracers ^[1]). An encouraging independent study, if very unfortunately derived from one of T&T’s worst blunders, looked at the consequences of an Excel spreadsheet error where nearly 16,000 test results were not transferred into the contact tracing system. It concluded that the areas affected "subsequently experienced a drastic rise in new Covid-19 infections and deaths”. ^[2] Testing and tracing seemed to be keeping the virus in check.

From the figures that are available, we know that around 85% of T&T’s budget goes on testing. Questions remain about the current effectiveness of contact tracing, but the benefits of the expanded testing programme are clear. Tests that now give more rapid results than earlier in the pandemic allow people – in some situations – to return to work and school if they test negative, and mean that public officials can follow the spread of the disease and design appropriate policy and operational responses. The genomic sequencing derived from tests has meant that new variants have been identified and assessed.

High case numbers will overwhelm any tracing system

The prime minister promised that a “world beating” test and trace system “will enable us … very greatly to defeat this disease”. These claims heaped unrealistic expectations on T&T, which never had a chance of meeting them. When Covid-19 case numbers and the reproduction rate of the virus are high, any test and trace system will become overwhelmed and governments need to turn to other responses. The nature of the disease itself, with transmission happening asymptomatically or before symptoms develop, also makes it much harder to comprehensively identify dangerous contacts.

Germany, which had been considered to have a very successful response structure, had to go into a lockdown last autumn when its system could not cope. The only countries to have avoided lockdown ^[3], by using versions of test and trace are those that had good underlying systems before the pandemic, used intrusive surveillance and heavy sanctions, managed to ‘backward trace’ cases by identifying the original source of infection, and kept case numbers low. Even then other policy responses have been important, most obviously border restrictions to keep the disease out. Test and trace should have been seen – and sold – as just one part of the response.

Addressing wider policy gaps like sick pay is now more important

The gaps in test and trace are now less about its operations, staffing and structure, and more about the government’s wider policy response.

The proportion of people who self-isolate after a positive test or being informed of a contact will remain low until the government provides more effective financial support for those who cannot earn wages from their homes. Vulnerable people need to be given safe places to go if they cannot isolate, and those who do not have enough space domestically need an alternative.

Ministers should also be careful in how they decide to use lateral flow tests. With their lower accuracy rate they should be used to make essential activities safer rather than justify unnecessary contacts – as a safety net rather than a passport. And however effective the testing and tracing system is, social distancing rules, and requirements to ventilate enclosed spaces, are likely to be with us for some time to come.

There is plenty to criticise in the government’s coronavirus response, and much for the leaders of the new National Institute for Health Protection to learn from the past year. But test and trace has not, as one shadow minster put it, seen £37 billion of public money “flushed down the toilet”. The real cost of T&T is for the moment impossible to pin down, although it is, and will remain, phenomenally expensive. But in Covid times providing mass testing is a core part of the government’s function, and a well-resourced tracing system is needed to help keep a lid on the virus where possible and to postpone or head off dangerous spikes of infection.

The former Treasury permanent secretary Nick Macpherson said on twitter that T&T “wins the prize for the most wasteful and inept public spending programme of all time”. He is right to keep a sharp eye on public spending, but while we remain in the midst of the pandemic ministers are justified in keeping the spending taps just a little looser. The government’s main error is not to have over-spent on test and trace, but to ignore the policy gaps, particularly on sick pay and encouraging self-isolation, that have undermined the effectiveness of the whole system.