How councils were sidelined in favour of outsourcing firms as virus slipped out of control
The saga of the attempts to set up an English test-and-trace system is perhaps the central story of the government’s Covid-19 failure.
At the heart of the tale is a prime minister who promised NHS test and trace would be a “world beating” operation. Next to him sits Matt Hancock, the health secretary whose record is now indelibly associated with the smartphone app that was meant to be integral to controlling the virus, but has yet to materialise. Other key actors include Serco, the multinational outsourcing company that has previously been contracted to run everything from prisons to air traffic control – and, at a cost of £108m, was recently put in charge of recruiting and training thousands of call centre workers to establish contact with infected people and ensure that anyone they had been close to went into self-isolation.
Over the five months since lockdown began, one other set of voices has been central to the drama: local authorities, whose 140-odd directors of public health are expert in disease control and contact tracing, and whose councillors, officials and staff are forensically familiar with the areas they serve, even after a decade of crushing austerity. During the outbreak’s initial phase – roughly, from February to the end of May – many of these people complained of being cut out of decision-making about the pandemic, and deprived of resources and the all-important data that would allow them to get on top of local outbreaks.
According to Sir Chris Ham, a lifelong NHS insider and the former chief executive of the health charity the Kings Fund, the basic insight either ignored or misunderstood by the government was plain. “Contact tracing has to be led locally by people who work in the communities that are affected and understand them,” he says.
“They’re part-detectives, part-anthropologists: they work with leaders in faith groups, in community organisations, and public services, to understand why there are more cases in a particular area, and how to work with everyone to contain and reduce the challenges. You can’t do that sitting in a remote call centre.”
But now, with the reopening of schools in England less than a month away, everything is to change. From 24 August, nationally-recruited call-centre staff will be “ringfenced” into individual teams that will be linked to specific councils, and the national test-and-trace effort will take a new “integrated” and “localised” approach. This shift follows the arrival of local measures aimed at controlling Covid-19 flare-ups in Leicester and Greater Manchester – and the trailblazing creation of dedicated local test-and-trace operations in Blackburn, Lancashire, Calderdale in West Yorkshire, and Liverpool.
Last week, figures were published showing that whereas call-centre or online workers managed to trace 56% of people’s contacts, the figure was 98% among local health protection teams. The imbalance between the two approaches was perhaps most clearly demonstrated by stories of call-centre workers making handfuls of calls per month, while council staff were worked off their feet.
For those of us who have been following this story, disentangling the confounding mess that was hastily built to administer testing and tracing has been an onerous task. If the tale has a single point of origin, it was the abandonment of initial efforts on 12 March, and the outbreak therefore being allowed to slip free of any meaningful monitoring or official control. When the government then resolved to begin mass testing, its network of regional testing centres was outsourced to yet another private company, Deloitte.
Serco was joined at the heart of the national contact-tracing system by the US “customer services” giant Sitel. Local directors of public health, meanwhile, complained that they were unsure of their relationship with these players, and had woefully insufficient access to detailed data which – in theory at least – was being harvested by the government’s testing machine: information showing people’s age, address, and ethnic origin, all vital to local control of the pandemic.
Andy Burnham, the mayor of Greater Manchester, said that people on the ground had ended up being “like local detectives being asked to solve crimes without being given the names of any of the victims or suspects.” Even when Leicester became the first area of the UK to impose a local lockdown, the city council initially bemoaned its lack of access to crucial infection data.
Belatedly, however, the basic orientation of the test-and-trace system had begun to change. In mid-May, NHS test and trace had announced the recruitment as a “national lead on tracing” of Tom Riordan, a highly-respected figure in local government, seconded from his job as the chief executive of Leeds City council. Insiders say that as he worked with Dido Harding, the Tory peer and former CEO of the mobile phone company TalkTalk who is now the executive chair of the test-and-trace operation, its workings at least began to tilt in a more localised direction. Insiders now talk about a “reverse takeover”, whereby the very councils that were initially cut out of the national test-and-trace system have been belatedly pushed to its forefront.
Nonetheless, change has taken months to materialise. On 1 July, it was announced that councils were to be offered the postcode-level infection data that they had been frantically requesting for months. Two weeks later, the government said that councils would be granted powers to close sites and premises hit by coronavirus outbreaks – and on 6 August, their access to information about local Covid-19 levels was enhanced to “near real-time data”.
If these things suggest palpable improvement, big questions remain. Concerns continue to be expressed about the numbers of test-and-trace workers councils are able to call on. Even if the national test-and-trace operation is now set to shed 6,000 workers, what will the continuing role of outsourcing companies be, and how much will it cost?
There is also a low rumble of concern about base politics. With signs of a second wave and the looming arrival of autumn, councils’ expertise will be essential for any meaningful control of the virus. But if England’s woeful experience of Covid-19 takes another turn for the worse, putting them at the core of how the disease is dealt with may also allow Boris Johnson and his colleagues to slip free of blame – something that must have at least flitted across the collective mind of this most calculating of governments.