October 27, 2021

expert reaction to Public Accounts Committee report on Test & Trace

The House of Commons Committee of Public Accounts has published a report on Test & Trace.

Prof Jim Naismith, Director of the Rosalind Franklin Institute, and Professor of Structural Biology, University of Oxford, said:

“I am not an expert on economics nor do I advise government.  My comments are from a scientific viewpoint.

“Track and trace failed to halt the waves of infection; this was clear in real time last year.

“The fundamental reason for the failure was clear by comparing ONS survey data on infections and the track/trace statistics.

“Too small a proportion of contacts were identified and instructed to isolate in a timely manner.

“The Royal Society had quite early on shown that success depended on isolating a very high proportion of the contacts of infectious people within a very short time window.

“The Royal Society had warned an effective system would be a formidable challenge.

“However, the system was easy to describe and to make big promises for, thus attractive to public and politicians the world over at a time of crisis.

“However its implementation proved to be a failure in autumn 2020 in the UK and in many other countries, the UK was far from alone..

“Other flaws were:

(1) Isolation was not monitored or supported, so it was unclear of those who were contacted isolated.

(2) Such a system if it works at all, will work best when cases where low, once cases rose it becomes increasingly ineffective.

(3) There was no attempt to ascertain the expected number of non-household contacts would be for an average person and thus no way to judge or improve effectiveness.”

Dr Simon Clarke, Associate Professor in Cellular Microbiology, University of Reading, said:

“The Public Accounts Committee report has highlighted a great many shortcomings in the NHS Test & Trace service, which it says has failed in its objective of breaking the chains of Covid-19 transmission.  Baroness Harding previously boasted that the operation was size of Tesco, without conceding that the supermarket chain actually works.  Greater attention seems to have been paid to headline grabbing initiatives to build-up the system than to ensuring it actually did its job.

“The report highlights the over-reliance on expensive consultants and an initial reluctance to work with local authorities.  While it acknowledges that this situation has improved, it seemed that at the start of the pandemic, there was an ideological block on working with Councils, which already have experience in tracking things like food poisoning and sexually transmitted infections in their local communities.  It also highlights the failure of most lateral flow tests to be reported, which suggests that people are using tests for personal reassurance purposes rather than for important central tracking of infections.  Tests not used properly will just end up in landfill without fulfilling their intended role.

“Failure to cut infections could mean that we suffered more sickness and death, and longer time spent living under restrictions than would otherwise have been the case.  While scientists now know much more about how the coronavirus spreads, our understanding hasn’t changed so much that a properly functioning test and trace system would not have broken chains of infection.”

Prof Michael Hopkins, Professor of Innovation Management, SPRU – Science Policy Research Unit, University of Sussex Business School, University of Sussex, said:

“The Public accounts committee ‘Test and Trace Update’ report comes at a crucial time, with Covid cases and scepticism of NHS Test and Trace both rising.

“The fact is that NHS Test and Trace has structural failings because of the way it was set up.  Specifically, it is not a cohesive system as it does not control all of the resources needed to incentivise and encourage the public to engage with testing and isolation, as required.  Instead it was set up in a disjointed way to provide testing and contract tracing, but not the care for those who need it to ensure chains of infection are broken.

“The big danger here is that politicians and the public conclude that test and trace is expensive and simply does not work.  But in South Korea, a world leading test and trace system has actually averted the need for national lockdowns (see our recent article for The Conversation on how this was achieved: https://theconversation.com/the-secret-to-south-koreas-covid-success-combining-high-technology-with-the-human-touch-170045).

“The South Korean example shows that high technology can help control the spread of the virus, but this is helped too when the service has a human touch, supported by local public health workers.  By contrast NHS Test and Trace has been hard wired not to provide care, with its centralised call centre approach, and operators that have no understanding of people’s context when they speak to them, and no ongoing contact with them either.  The value of trust and rapport for boosting engagement and compliance has been discounted in the UK’s system, with tragic consequences.

“Another key failing is that NHS test and trace was not set up with anything like an adequate evaluation system.  This is really basic stuff in management, because organisational learning is supported by feedback.  For example in South Korea, daily reports on the numbers of those complying (or not) with isolation provide real-time data on system performance.  This is the key measure for system success, but it is not adequately monitored in this country, while instead we focus on things like test result reporting times – assuming that everyone will do the right thing when they get the test results.

“Also the Public Accounts Committee, dominated by the government’s MPs, curiously did not criticise the government’s laisse faire approach to Covid testing.  The UK is an international outlier because it relies on self-testing and home testing to a degree not seen in other countries (we are looking at Australia, Canada, Germany, Ireland, S Korea, S Africa, Spain).  Because we use so many unsupervised tests in the UK, the results of which are mostly unreported, we don’t know who is testing positive and who is not.

“The government’s laisse faire approach to Covid, including testing, is a missed opportunity because the severity of Covid downplayed here.  We need to create a culture of social responsibility to encourage people to engage with test and trace.  Failure to engage with testing is now the major problem that we face in the UK, because the test and trace system may only see the tip of the iceberg – especially if people think vaccination is the be all and end all of their personal responsibilities.”

‘House of Commons, Committee of Public Accounts, Test and Trace update: Twenty-Third Report of Session 2021–22’ was published at 00:01 UK time on Wednesday 27 October 2021.

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Prof Michael Hopkins: “I lead a team of 16 medics, scientists and social scientists as the principal investigator on the UK Research and Innovation funded study ‘Optimising Covid Testing Systems’, see https://www.octs.info/.  We study the organisation of Covid testing systems in eight countries across the world.  I am also a Professor of Innovation Management, specialising in diagnostic testing for healthcare.”

None others received.