“Muddled, overstated, eye-wateringly expensive”: PAC damning on Test & Trace that has “failed on main objectives”

In a damning report published today the Public Accounts Committee says “NHST&T has not achieved its main objective to help break chains of COVID-19 transmission and enable people to return towards a more normal way of life” despite being handed an “eye watering” budget of £37 billion over two years – and not managing to spend £8.7 billion of the first year’s allocation.  Instead, since the end of October 2020 “the country has had two more national lockdowns and case numbers have risen dramatically”. 

NHS Test and Trace has been one of the most expensive health programmes delivered in the pandemic – equal to nearly 20% of the entire 2020-21 NHS England budget – but the Committee says it “focused on delivering programmes but outcomes have been muddled and a number of its professed aims have been overstated or not achieved.”

Only 96 million of 691 million lateral flow device (LFD) tests distributed by NHST&T have been registered - 14% of the total. The Committee says “it is not clear what benefit the remaining 595 million tests have secured”.

While the Committee acknowledges some improvements since reporting earlier this year that NHST&T had “failed to deliver on its central promise of averting another lockdown”, it notes that “when under pressure, as it was over Christmas 2020 and more recently in April, performance deteriorates, with only 17% of people receiving tests within 24 hours in December 2020.”

Most of the testing and contact tracing capacity that NHST&T paid for has not been used, and despite previous commitments to reduce dependency on consultants, it employed more in April 2021 than in December 2020.

Urgent improvements are needed regarding public outreach with over 60% of people who experience COVID-19 symptoms reporting that have not been tested, and certain groups such as older people, men, and certain ethnic minorities less likely to engage with the service.

Dame Meg Hillier MP, Chair of the Public Accounts Committee, said: Dame Meg Hillier MP, Chair of the Public Accounts Committee, said: “The national Test & Trace programme was allocated eye watering sums of taxpayers’ money in the midst of a global health and economic crisis. It set out bold ambitions but has failed to achieve them despite the vast sums thrown at it. Only 14% of 691 million lateral flow tests sent out had results reported, and who knows how many took the necessary action based on the results they got, or how many were never used. The continued reliance on the over-priced consultants who ‘delivered’ this state of affairs will by itself cost the taxpayer hundreds of millions of pounds.

“For this huge amount of money we need to see a legacy system ready to deliver when needed but it’s just not clear what there will be to show in the long term. This legacy has to be a focus for government if we are to see any value for the money spent.”

PAC report conclusions and recommendations 

1. NHST&T has not achieved its main objective to help break chains of COVID-19 transmission and enable people to return towards a more normal way of life. NHST&T’s main objective is to help break chains of COVID-19 transmission and enable people to return towards a more normal way of life. Yet since the end of October 2020 the country has had two national lockdowns and case numbers have risen dramatically. It is not clear how much of this should be laid at the door of NHST&T because it did not set out what it specifically needed to do to achieve this objective, and what contribution would be made by other policy tools such as social distancing and closing parts of the economy. It may never have been an achievable goal for a testing and tracing service, but it was a goal set by NHST&T in its own business case. The Delta variant became the dominant strain in the UK within four weeks of being identified as a variant of concern and, even with the benefit of hindsight, the Chief Executive of the UKHSA cannot identify anything NHST&T could have done to prevent this. We have previously found that gaps in data meant NHST&T was unable to demonstrate how effective it was at reducing the transmission of COVID-19. Continuing gaps in NHST&T’s data collection means it still does not have a full picture of its performance. It only routinely monitors in-person PCR tests but lacks targets for PCR tests taken at home or in care homes, which make up the majority of these tests. NHST&T has not been able to monitor the proportion of all COVID-19 cases that it identifies through testing, a key measure of its success, since November 2020 because the ONS stopped publishing the data it used to calculate it.  

Recommendation: UKHSA should set out in detail its objectives and the impacts it aims to secure, and publish, by the end of December 2021, a performance management framework which:  

• supports delivery of a comprehensive plan of activities to deliver its overall objectives;  

• includes specific published targets and metrics for each major area of activity; and  
• captures speed, reach and compliance measures across the whole test and trace process from experiencing symptoms to complying with requirements to self-isolate. 

1. Uptake of NHST&T’s services by the public is variable, and some vulnerable groups are currently much less likely to engage with it.  Only a minority of people experiencing COVID-19 symptoms get a test. Between 18% and 33% of people who experience COVID-19 symptoms report getting a test. Some groups, such as older people, men, and certain ethnic minorities, are much less likely to request tests. While it recognises that some groups of people are underrepresented in the testing programme, NHST&T’s test and trace data is not sufficiently robust to establish a baseline against which progress can be measured. The UKHSA is planning to establish a baseline data set against which the new organisation will prioritise its work and assess its impact in all areas of health protection. The NHS Covid-19 app has had some success in identifying and contacting those who need to self-isolate and sharing information. But there is a risk that people delete or switch it off to avoid self-isolating, reducing how effective it can be. The NAO reported that in late April around 16 million people had the app fully or partially enabled on their phone, but the Department is not able to provide us with more recent figures. Around 16% of people who have tested positive for COVID-19, and around 20% of their contacts, do not fully meet self-isolation requirements. The Department is working to improve the percentage of people who comply with self-isolation, including how it communicates that it is still important to get a test if someone has COVID-19 symptoms and removing the physical barriers to getting tested or to self-isolation. The Department has appointed a cross-government senior officer responsible for compliance with self-isolation. 

Recommendation: The Department and UKHSA should write to the Committee, by the end of November, setting out which groups are most underrepresented in its testing programme and what plans it has to drive up public engagement with NHST&T, with a particular focus on these groups. 

1. NHST&T has focussed on getting programmes up and running and paid less attention to ensuring these programmes delivered the benefits they promised.  NHST&T has distributed 691 million lateral flow device (LFD) tests but only 96 million of these have been registered. This represents only 14% of the total so it is not clear what benefit the remaining 595 million tests have secured. LFDs have been distributed since October 2020, but NHST&T has only recently started work in June 2021 to understand why test registrations was so low. In the business case for the funding it received in November 2020, one of the benefits NHST&T committed to deliver was that a £150 million investment in the laboratory network would provide NHS England with a legacy in terms of diagnostics capacity for future emergencies and for certain diseases such as cancer. But it has only recently began having detailed discussions with NHS England about these potential legacy opportunities and NHS England was unaware of this commitment at the time it was made. In the same business case NHST&T committed to drawing up a detailed benefits realisation strategy by December 2020, but this has still not been done.  

Recommendation: UKHSA should clearly set out how it plans to deliver the benefits expected from the funding it receives from the forthcoming spending review. This should be informed by an evidence-based understanding of the actual benefits delivered by its major areas of spending to date, as measured against the intended outcomes. 

1. NHST&T’s approach to laboratory and contact centre usage is still not flexible enough to meet changing demand and risks wasting public money. In 2020-21, NHST&T paid £3.1bn to secure the laboratory capacity to process PCR tests and £911 million for contact tracing, primarily on contact centres. However, NHST&T used only a minority of the laboratory and contact centre capacity it paid for. Between November 2020 and April 2021, the average utilisation of its laboratories was 45%. In December 2020, the Department said 85% of laboratory capacity could safely be used. In June it said this figure was 80% and in July UKHSA said that it may actually be closer to 70%. NHST&T does not have a target utilisation rate for its laboratories, but at 45%, the utilisation rate is well below the threshold of laboratory capacity that is available. NHST&T has a 50% target utilisation rate for its contact centre staff, but the highest reached was 49% at the beginning of January 2021 and this had fallen to 11% by the end of February 2021. Over Christmas 2020, when there appeared to be spare laboratory capacity and COVID-19 cases were rising, performance declined and it took longer to provide test results, with only 17% of people receiving test results within 24 hours in December 2020. NHST&T plans to move to a more flexible approach for both laboratories and contact centres, so there should be less need in future to hold unused capacity.  

Recommendation: UKHSA should establish and monitor clear utilisation targets for both the laboratory and contact centre capacity it pays for. In January 2022, it should write to the committee to provide an update for laboratory and contact centre utilisation for the first 9 months of 2021- 22. 

1. NHST&T’s continued over-reliance on consultants is likely to cost taxpayers hundreds of millions of pounds. Our previous report found that NHST&T was overly reliant on expensive contractors and temporary staff and recommended that it needed to reduce this. Despite NHST&T committing to reduce the number of consultants it employed, the number of consultants employed was higher in April 2021 (2,239) than in December 2020 (2,164). The Department pays consultants an average of £1,100 per day but some are paid more. NHST&T does not have a firm grip on its overall spending on consultants. It estimates that it will spend a total of £195 million on consultancy in 2021-22, but at the same time, indicated it would be spending £300 million on its top ten consultancy suppliers alone. The skills that NHST&T is currently using consultants to fill are in short supply across the civil service. Over a third of the 523 recruitment campaigns run by NHST&T up to the end of May 2021 failed to appoint anyone. The Department asserts that it has detailed plans in place to reduce the number of consultants it employs and that it expects this to be lower by the end of March 2022. 

Recommendation: UKHSA should write to the Committee by the end of November 2021 detailing how it will reduce its dependency on consultants and write to us again in March 2022 and June 2022 setting out its progress against this. 

1. UKHSA has still not set out how it would like to work with local authorities, leaving them little time to plan for the new approach. The UKHSA was announced in March 2021 and is expected to be in place by the end of October 2021. However, NHST&T has still not finalised the operating model for the new organisation, meaning local authorities will have less than three months to plan for new arrangements. Local authorities play a vital and crucial role in public health, including in the response to COVID-19. We have previously criticised NHST&T for not properly engaging with important stakeholders, including local bodies. NHST&T has made progress in its relationship with local authorities and the UKHSA has committed to co-designing its new operating model with local stakeholders. At present, tracing often falls to the staff of local bodies and the additional time and effort this requires puts a strain on already stretched resources and may not be sustainable longer term. Our report earlier this year, on COVID-19 local government finance, highlighted how the pandemic had caused sudden and severe drops in local authorities’ income, whilst at the same time creating additional financial pressures from the need to deliver new services and increased costs and demand for existing services. 

Recommendation: The Department and UKHSA must urgently provide clarity to local government and other stakeholders about the future operating model. As part of this, it should ensure local authorities and other stakeholders have the resources to deliver their parts of the process. It should write to the Committee to provide an update on progress by the end of November 2021.