Boris Johnson’s adherence to Thatcherite “public sector bad, private sector good” dogma lies behind much of what has gone wrong in his handling of the pandemic. – Owl
“A senior director of public health, speaking anonymously, said: “The government says data is now flowing, but that’s just spin. It’s not granular enough, it’s not quick enough and it’s not frequent enough. What we’ve been told is that the commercial company operating pillar two didn’t set the data up so it can shared easily, and that the quality was poor as well.”
Local health officials are being “kept in the dark” about Covid-19 infections in their area by Whitehall’s refusal to share all of its data, Andy Burnham, the mayor of Greater Manchester, has warned.
Public health officials and council leaders also told the Observer that they were receiving only partial postcode data, which prevents them from precisely monitoring local areas, and could allow the virus to spread.
Burnham has urged ministers to change their approach after a week that saw Boris Johnson impose a local lockdown on Leicester when health secretary Matt Hancock, revealed that the city had seen a surge of 944 Covid-19 cases over two weeks.
Amid a public row between ministers and Leicester’s mayor, Sir Peter Soulsby, health officials finally began sharing more data with the city authorities last Wednesday. Previously, all councils had to wait for official Public Health England data to be published, which meant a two-week lag.
Yet significant problems remain, Burnham told the Observer. “We need a new principle going forward: everything the government knows, we should know – and at the same time that they know it. Because we cannot contain this virus if people at a local level are being kept in the dark.”
Public Health England (PHE) wrote to councils’ directors of public health last Monday with details of how to access “pillar two” data – that taken from home testing kits and mobile testing sites set up by Deloitte. Until that point, local authorities had only “pillar one” data – how many people in hospitals had tested positive. In Manchester, there had been 78 pillar one cases, but that jumped to 465 when pillar two figures were revealed.
“We get pillar two data once a week, on a Monday morning,” Burnham said. “But a lot can happen in seven days. So if we’re going to manage and chase this virus down on the ground, we need the same daily data that the government gets.
“They also won’t provide patient-identifiable data. Our teams tell me that is crucial, but the government cites patient confidentiality. Our teams are experienced public health staff – they know how to deal with data confidentially. It’s as if the government doesn’t trust the professionals working at local level.”
Government health sources insist that “data protection” issues limit who can access postcode-level data, since if the information were to leak beyond councils and the NHS, it could be used to identify individuals.
This week, the government is expected to publish an “outbreak framework” as guidance on what might trigger further local lockdowns. Ministers are understood not to be following the approach used in Germany, where local lockdowns are considered whenever the number of cases reaches a threshold of 50 per 100,000 people.
A further problem for local health teams is that there is a huge quantity of testing data to decipher, including hospital admissions, contact-tracing data from the NHS system and their own local intelligence.
Louise Jackson, portfolio holder for public health and wellbeing at Bedford Council, said her teams were still not getting good-quality information.
“They tell me there are duplicates – for example, if there are four results in one postcode area, does that mean you’ve got four cases, or one person who has been tested four times? They just don’t know. The local data dashboards only give the number of tests, not how many were positive or where they are. It’s very, very messy.”
A senior director of public health, speaking anonymously, said: “The government says data is now flowing, but that’s just spin. It’s not granular enough, it’s not quick enough and it’s not frequent enough. What we’ve been told is that the commercial company operating pillar two didn’t set the data up so it can shared easily, and that the quality was poor as well.”
MPs have raised questions about the role of Deloitte, which was appointed to run testing centres in March. In a written answer last week, health minister Nadine Dorries admitted that the government contract “does not require the company to report positive cases” to PHE.Stella Creasy, the MP for Walthamstow who tabled the question, said: “This is a mess. Local authorities need clear data about positive tests: where they’ve happened, who’s involved and who is isolating. And that should be what the government has commissioned. It’s becoming very clear that’s not the case.”
Deenan Pillay, a professor of virology at University College London and a member of the Independent Sage group of scientists, said he was consulted by Deloitte about setting up the testing sites in March.
“I told them one of the key things would be data flow, since that is critical to optimal use of the data for individual clinical care and pandemic control,” he said.
“Health data is a very complex area, and the problems we are seeing are some of the consequences of this being set up as a structure separate from the NHS, rather than being linked to the NHS’s laboratory and data systems.”He said that testing did not just happen in a lab but was a whole process that began with collecting the right patient information. NHS tests use patients’ NHS numbers, allowing results to go to their GP, Pillay said.
“We are now seeing the consequences of this lack of data integration with primary and secondary care, PHE and local directors of public health, which needs a lot of behind-the-scenes retrofitting.”
Whitehall did not respond to questions from the Observer about the sharing of data.
Deloitte said that the consultancy had designed the online form used to book and register tests and had commissioned testing sites, but did not run either them or the testing labs. Test results are sent from labs to the National Pathology Exchange, which connects NHS labs with other parts of the NHS, including NHS Digital.