A year is a long time. A year ago, we were marching towards the 2019 elections and no one had heard of Covid-19. No one envisaged spending 2020 caught up in a cycle of lockdown and release, with thousands of deaths, dire economic predictions, jobs lost or furloughed, and with young people missing months of education. The newly elected Prime Minister declared in January that 2020 was to be a fantastic year, in which inequality would be levelled up and we would invest in our NHS.
What terrible luck, you might say, for a PM to have to deal with such an unforeseeable event at the beginning of his tenure.
What terrible luck indeed, for us all. If events weren’t entirely foreseeable, are the criticisms made of our government’s handling of the crisis simply unhelpful carpings of a Captain Hindsight? Could anyone else have done any better? And in the end, whatever we do now, is the vaccine the solution to all of our Covid nightmares?
So what do the experts say?
For the last four months, the All-Party Parliamentary Group on Coronavirus (APPG) chaired by Layla Moran MP, has been holding hearings on the management of the pandemic. Over the course of 11 hearings, it has heard from frontline workers and from experts and received over 2000 pieces of evidence. Throughout these hearings, which are all available for public view, the characterisation of our government given by the frontline workers and experts is of one that does not consult and does not listen.
Let us look first at the issue that has been in the news since the outbreak: testing. You don’t have to be Captain Hindsight to appreciate that the first line of defence to the virus is to test as much as possible, and to test at our borders. The advice from the WHO in March was to “Test Test Test”. However, the UK abandoned testing early on in March, including testing at ports and airports, due to a lack of capacity. In so doing, we lost all ability from the very start to identify where outbreaks were occurring.
It didn’t have to be this way. We have diagnostic testing capability. It needed scaling up. Allan Wilson, President of the Institute of Biomedical Science, with decades of experience in diagnostic testing, twice offered to help scale up UK capacity. He wrote to Matt Hancock in March and to Dido Harding in April. He didn’t receive a reply to either letter.
The Royal College of Pathology and the Institute of Biomedical Science, the bodies with the most expertise on diagnostic testing in the UK, have both been entirely frozen out of the government’s testing programme. As Pathologist Dr Rachel Liebmann told the APPG, there is no one on any of the government’s Test and Trace committees with any experience of diagnostic testing. Similarly, no one with any experience of organising diagnostic testing has been allowed to contribute to any management decision. Further, the two Pillars of testing – Pillar 1 (NHS) and Pillar 2 (commercial) are in competition for all the resources. Cooperation and coordination would ensure testing capacity over the whole country, but this does not happen: the UK’s considerable expertise in this area has been entirely overlooked in favour of the commercial labs. The private contracts have not alleviated pressure on the public sector; they have been set up instead to undermine public sector effort.
Did we get Test & Trace right?
Testing makes up one part of the normal programme of Find, Test, Trace, Isolate and Support (FTTIS) system, standard for identifying outbreaks of communicable diseases in the community. The other parts of the system – Find, Trace, Isolate and Support – are equally important in controlling outbreaks.
Instead of using the well-established local NHS driven FTTIS systems, through GPs and primary healthcare, the government by-passed existing provision and pursued its own outsourced project of Test and Trace, Contain and Enable. The country has so far spent over £10bn on this. In the first truly major health decision that affected the country since the new parliament, and despite Johnson’s promise at the start of his tenure to invest, the NHS was bypassed, and its work outsourced to commercial companies.
The verdict of every front-line worker and expert who submitted evidence to the APPG was that the system is failing. Testing centres are difficult to get to and unreliable in their availability of tests. Turnaround times for tests were too often too long to be useful. Results have not always been easy to access. Tracing was consistently failing to meet the 80% target, by some margin (on average around 60%).
Furthermore, even if the centralised outsourced elements of test and trace were working, there is also the element of persuading contacts to isolate. It is estimated that compliance levels for isolation in the UK are less than 20%.
Answer: No! We undermined public health capability in favour of private enterprise
As recognised by everyone involved in public health who attended the APPG’s hearings, from the leaders of local public health to experts working at Public Health England and Dr David Nabarro of the WHO, existing established local networks would have been a much better starting point for managing the pandemic. The centralised outsourcing of tracing was bound to be problematic, as it is not embedded in the community. Its only option is to trace people by telephone from a distant call centre. This makes it much harder to ensure contacts have been reached, or that they have fully understood, or further, that they will comply with their obligations to self-isolate.
In one of the most recent hearings, Alice Wiseman, Director of Public Health for Gateshead said ‘People are much more likely to comply when they hear a voice who understands the nuances of a local area, who understands the places that somebody may have gone to or may need to go, and who is also able to say this is the support we can offer you at the same time’. She went on to explain to the APPG the difficulties inherent in persuading a single parent to self-isolate when that person is on minimum wage and is carrying out three jobs to keep her family’s head above water. The likelihood of compliance is considerably higher if done face to face and with support, than if done through a call centre. If inequality and levelling up was a major concern of the new parliament, its failure to offer sufficient support at a local level to those most unable to isolate flies in the face of that ambition.
The government has been fully aware of all this advice for some time. In response to pressure to change, it has now made concessions to some local authorities to empower them to trace contacts. Even so, as Alice Wiseman told the APPG, it hasn’t followed this up with the finances, the information or the powers to enable local teams to be as effective as they could be.
And the final question: if all else fails, should we simply rely on the vaccine? Apart from the unanswered questions about whether it will reduce transmission, or alleviate symptoms, and how long immunity will last, we cannot forget that the virus is still not under control in the United Kingdom, let alone suppressed. And the logistics of rolling out a vaccination programme to the whole country are challenging; it will take some time. Unless we control and suppress the virus in our communities properly, now, we risk a very long period of next year, locked down, before we can hope for sufficient roll out of the vaccination programme.
The consistent complaint from experts and those working at the frontline is that their offers of help have been rejected and that no-one in government is listening. It is these same frontline workers who put themselves at risk as they manage the pandemic on society’s behalf. It is these same frontline workers who treat the people whose lives have been catastrophically impacted by a dangerous pandemic that has run wild in our country, while the authorities have not done enough to bring it under control.
Outsourcing test and trace has failed. It’s beyond time to change tack.
At some point, trust in government disintegrates, as people see that the outsourced contract is deemed worthy of continued protection despite its obvious and consistent failings.
As Dr Kevin Fong, consultant anaesthetist put to the APPG: in the first wave of the pandemic, we talked about stuff – ventilators, PPE, beds – but really, we should be talking about staff. We should always have been talking about staff. For it is the staff who is the irreplaceable resource, the resource we may find we have lost: demoralized and exhausted, fed up with a government who refuses to listen, while continuing to reimburse commercial failure.
The government has failed to listen to its experts and continues to do so. In this way it has mismanaged the pandemic. It is time this government stopped trying to claim that it is world beating. It is time that it embarked on a different ambition: that of being competent.
This year has been an exceptionally long one. A clear message stands out: the government needs to take the advice of its experts and implement a locally led Find Test Trace Isolate and Support system, backed up with the funds, the information and the powers to make it work properly.
If the government wants to open society up sustainably, if it is serious about its ambitions of supporting the NHS and reducing the inequality that scars our country, Johnson and his government have to start listening now. He may wish to call his chief opponent Captain Hindsight, but he should look to the advice he has been given over the last 9 months and wonder why we don’t call him Captain Contempt.
Ed: March for Change provides as the Secretariat for the APPG on Coronavirus. Based on work with scientists and politicians across the political spectrum, it is campaigning for a Covid-Secure UK. You can view its campaign and sign the petition at https://covid-secure-uk.marchforchange.uk.