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“I am prepared for the worst, but hope for the best.” As the country struggles with this second wave of coronavirus, many will hope that Benjamin Disraeli’s words are being taken to heart by his self-proclaimed “One Nation” heir, Boris Johnson.
Way back in July, the PM did indeed echo his predecessor as he set out his new “Recovery Strategy”. “I know we can beat this virus,” he declared. “Hoping for the best, but planning for the worst.”
With his next breath, Johnson said: “I’ll now hand over to Dido…” Yes, as he tried to reassure the nation that things in the summer were under control after an awful spring, it was NHS Test and Trace chief Dido Harding who was standing next to him at that No.10 briefing.
Today, almost exactly three months later, the PM’s tone had changed. Harding – these days dubbed “Dido Hiding” by some in Whitehall for her lack of public appearances – was notably absent at the Downing Street press conference. And even Johnson was forced to admit for the first time his frustration at her service’s latest performance failures.
The system is continuing to fail on two key measures. First, it has never met Johnson’s target of 100% 24-hour turnaround of in-person tests. The latest figures show that just 15% of tests hit that metric in the week to October 14. Second, its contact tracing rate (taking into account all contacts identified) scored a new record low of 59.6%, way below the 80% that Sage said was needed to make the entire thing viable.
Even on the contact tracing measure that is preferred by the department of health (“where communication details are available”), the figure was a new low of 75.1%. So no amount of spin could suggest the magic 80% figure was being achieved, as has all too often occurred in recent months when the stats were bad.
Johnson, who normally bursts with pride at what he once called his “world beating” test-and-trace system, said: “I share people’s frustrations. We do need to see faster turnaround times. We need to improve it.” Chief scientist Patrick Vallance said the turnaround delays and contact tracing rate “could be diminishing the effectiveness” of the whole system. Vallance also suggested the virus was so widespread, test-and-trace’s impact would be limited anyway.
Johnson was even reduced to saying test-and-trace was “helping a bit already to break the transmission” of the virus. Yes, it’s costing the taxpayer £12bn and its impact is to help “a bit”. Whatever happened to “gamechanger”? To be fair, “a bit” almost exactly the verdict Sage came up with in September. That bombshell data dump revealed the scientists felt that test-and-trace “is having a marginal impact”.
So why is “NHS Test and Trace” (we use the quote marks these days because it is in fact “DHSC Test and Trace” and always has been) going backwards in recent weeks? Well, the good news is that its capacity has actually been growing, and is now around 345,000 tests a day. It’s perfectly possible that with a jump in lab space, staff and robotics at current labs, it can hit the 500,000 capacity by the end of the month. New rapid testing pilots also offer great hope.
But the clue is in the name, test and trace. The system has sensibly recalibrated in recent weeks to cut its outsourced national call centre staff and instead boost numbers of public sector local contact tracers and (crucially) the clinicians who advise people over the phone. Yet so far, there has not been any prime ministerial “big target” for increasing tracing capacity, as there has been for testing.
One irony is that it is the shift to hiring more local contact tracers that has made the performance worse, at least temporarily, according to insiders. Specialist training and access to the database takes time and there has been a hiatus of late, I’m told. If that’s true, the contact rate ought to improve after a blip.
Local contact tracers are much better at finding and isolating contacts (a 98.4% success rate this week) than call centre staff (57.6%). But that is in part because those local teams have dealt with very localised outbreaks (called “complex” cases in the jargon), in hospitals or care homes where it’s easier to identify contacts. “Non-complex” cases’ contacts in the community or social settings are harder to reach. And the proportion of non-complex cases is now much, much higher than it was in the summer.
The real power of local tracers is in getting to “hard to reach” communities, often the most deprived or which need tailored English language support. Around 80% of the 100 or so areas where councils have been put in the lead have shown improvements in getting to such people. Yet it has taken months to localise the service significantly.
There were two stark numbers the underlined the problem on Thursday: 101,690 close contacts of people with Covid were not reached in the week to October 14; and 17,141 people who tested positive for Covid were not reached in the first place. Those are big, big numbers of people walking around the country potentially infecting others, and they are growing each week.
Some people may be refusing to give their contact details, or ducking out of the system because they fear both the loss of income (statutory sick pay is still way too low) and the social isolation that comes from 14 days quarantine. Some may not want to admit they broke the social distancing rules either in their homes or elsewhere. You can have all the testing and even all the tracing but if people don’t self-isolate (and who is going to check on every home?) the system will fail.
As hospitalisations and deaths rise, the hope must be that more people will be scared into doing the right thing to protect their friends and family. Insiders in test-and-trace do their best to give background insight, but the lack of a public, regular briefing on test-and-trace means there’s a vacuum when there should be reassurance. A full month after the NHS app was launched, DHSC has not published a single statistic on how many people it has helped self-isolate.
Oxford University’s James Naismith said today that he had doubts whether the system could now ever be effective. The NHS Confederation said “without significant improvements, the situation will simply deteriorate”, while NHS Providers said the system was “falling short”. And don’t forget many in the NHS resent their brand being used for what is a ministerial brainchild.
It’s possible that case numbers, then hospitalisations and deaths, will plateau in coming weeks. Everyone will hope the PM’s tier system works out. Test-and-trace could yet improve. But the real problem perhaps was the lack of a contingency plan for when things went wrong with tracing rates and test lab times. Then again, to misquote Disraeli, it’s hard to prepare for the worst when you think you’re the best.