Andrew Haldenby: The private sector has delivered in this crisis – creating the UK’s outstanding network of test centres

1 Dec

Andrew Haldenby is a director of Haldenby Woodford, a public services consultancy.

A Western European country has done something remarkable in the fight against Coronavirus. It has built a national network of test centres with the first one set up and running within days of the pandemic starting. It has recruited from scratch a workforce equivalent to the five biggest police forces in the country. It has used private sector expertise to deliver genuine quality: 24-hour mobilisation to high risk areas, all-but-perfect safety from infection on 650 national sites, full weekday and weekend service.

The nation is the United Kingdom. We have been so self-critical over NHS Test and Trace that we have failed to recognise an incredible public service achievement.

Running test centres safely and reliably is a real challenge. Any transmission of the virus from staff to visitor, or vice versa, would result in a centre being closed and the opportunity to test people being lost. The Government and companies have together worked up rigorous safety standards. The companies seen as highest quality, such as Sodexo, go further by providing bespoke training to all members of staff.

The scale of the operation, with a total workforce of over 40,000, has required creative management. The best companies have set up dedicated seven-day-a-week recruitment operations to ensure centres are always fully staffed. Many staff have been recruited from the hard-hit hospitality sector, supporting the economy during the pandemic.

Centres are best located in areas of greatest infection, responding to local data that is constantly updated. Often, the Government will call companies in the evening to require a centre to be set up on the following morning, and companies can do it. The firms have also trialled the instant result, antigen tests which will be a game-changer in the fight against the virus.

This success is a blow for critics of private sector delivery of public services. That includes Keir Starmer. (While he has been keen to distinguish himself from his predecessor, in terms of actual policy the Labour leader is just as opposed to private sector delivery as was Jeremy Corbyn.) Centres have performed well partly because of firms’ long experience in running services for hospitals and in running major events around the world.

Some may say that this achievement is a worthy one, but it is the overall performance of Test and Trace that matters, and that performance is poor. That seems to have become the received wisdom but I would challenge it.

In his key lecture on government reform, Michael Gove rightly said: “We need, as a Government, to create the space for the experimental and to acknowledge we won’t always achieve perfection on Day One.” This is the right test for any new public service, especially one set up from scratch in unprecedented circumstances. In fact Test and Trace has got some things right since day one – for example test centres. In others it has learnt and improved. Unlike many firms, it has not had the luxury of refining its services before launching them. It has had to develop them in real time.

It has learnt lessons on contact tracing. To be successful, contact tracing requires the knowledge and co-operation of local communities. Test and Trace was set up as a national organisation but accepted that it should work in tandem with local agencies as long ago as May. The Director of Public Health at Blackburn with Darwen Council recently described to the Health Select Committee described how his team is picking up local people with positive test results whom the national team have not been able to reach. The Blackburn team is reaching 89 per cent of the local group. As Matt Hancock rightly said to the Committee last week, the combination of the national and local effort is working.

(It is worth noting that every major European country has found contact tracing hard. Even Germany, with a much-praised local tracing system, has gone into partial lockdown because its tracers had been overwhelmed. It is difficult to compare the UK to Asian countries, such as South Korea, which have run contact tracing successfully. Those countries were simply years ahead given their experience with the SARS virus in 2003 and the MERS virus in 2015.)

Test and Trace is also addressing a subject that has been little discussed: the fact that at least 50 per cent of people refuse to isolate when they are asked to do so. It has studied the reasons behind these decisions (often a fear of losing income). It has put forward solutions, such as the £500 payment to those isolating, introduced in September.

The big hope here is the instant-result antigen tests. These offer the prospect that people asked to isolate can themselves receive a test with an immediate result. If negative, that will give them immediate release from isolation. As the Prime Minister said last week, this changes the incentives for people. Instead of seeing the Test and Trace system as a potential route to lockdown, it becomes a way back to normal life. Test and Trace distributed 600,000 tests to local authorities eight days ago. It is piloting antigen tests which can be self-administered, further increasing their impact.

The final argument against testing is that it will no longer be needed given the vaccines that are on the way. Certainly the vaccines will affect the need for tests, and future contracts for test centres should be flexible in length and volume, taking advantage of the adaptability of private firms. It would however be a mistake to scrap the infrastructure that has been built.

The length of the immunity from Covid-19 due to a vaccine is not yet known. Even after the vaccines are introduced, society will want to test to ensure the safety of gatherings of people, for example in universities and offices. Most importantly, the UK should not leave itself as exposed as it was at the beginning of 2020, when our testing capacity was found to be wanting. Given the steady rise in global movement of people, we are more at risk from pandemics than in the past. Part of the legacy of this pandemic should be a much greater level of readiness for the next one.

With two new Lighthouse Labs opening in early the New Year, testing capacity will pass one million per day. By any standard that is a remarkable achievement compared to the daily capacity of 10,000 per day in March 2020. Self-administered antigen tests will make blanket lockdowns redundant. All of this is founded on a test centre network which is a model of public-private partnership, and which, in current politics, only a Conservative government could have delivered. It may be time to revise the received wisdom on Test and Trace.

If test and trace is to succeed, a centralised approach won’t work

9 Oct

Despite being initially hailed as the main way to manage Covid-19, test and trace has proven something of a nightmare for the Government. From technological flaws in its contact tracing app, to u-turns on whether to use Apple and Google’s technology, the papers have been filled with negative stories about progress in this area.

Perhaps it could be said that this week has provided the biggest headache so far for ministers, beginning with the news that 16,000 people who tested positive for Covid-19 between September 25 and October 2 disappeared from official records in England.

This was reportedly due to Public Health England (PHE) using an outdated version of Microsoft Excel to process data. The spreadsheet could only handle a limited amount of information, hence why so many contacts were missed.

The result is that there are potentially tens of thousands of infectious people who have not been contacted; indeed, NHS Test and Trace apparently had to track down an estimated 40,000 Covid-19 cases.

Matters were made worse by the fact that Ring Central, NHS Test and Trace’s call system, allegedly failed to work too – locking workers out of their profiles for prolonged periods.

As if that wasn’t troublesome enough, yesterday it was shown that NHS Test and Trace contact rate figures have reached their lowest rate yet, with 68.6 per cent of close contacts of individuals who’d tested positive for Covid-19 in England reached in the week ending September 30 (the system needs to reach 80 per cent of contacts in order to be considered viable). 

Furthermore, it was shown that fewer than one in four people testing positive for Covid-19 receive their results in 24 hours – a far cry from Boris Johnson’s initial pledge that, by the end of June, results of all in-person tests would be back within that timeframe.

With all of these events, the Government can look forward to even harsher criticisms from Keir Starmer and the opposition on testing, which has repeatedly been called a “shambles”.

No doubt many members of the public, too, are wondering how many more of these problems are to come in test and trace; whether the strategy will ever work, and what it means for their livelihoods in the meantime. So what exactly has gone wrong?

Several hypotheses have been put forward to explain the repeated weaknesses in the contact tracing system.

The first, straightforward one is that the Government simply did not plan enough for a pandemic. Whereas countries like South Korea were able to deploy pre-existing infrastructure for contact tracing, the Government started from scratch – creating NHS Test and Trace, which has had to “learn” on the job.

Even more significantly, NHS Test and Trace highlights an instinct of the Government that has run throughout this crisis; its tendency to create large-scale, centralised solutions to managing Covid-19, rather than utilising existing systems (one of the main examples being its initial desire to build a centralised contact tracing app – instead of going with Apple and Google’s technology).

Many will remember Dido Harding announcing of NHS Test and Trace at its inception: “This is a brand new service which has been launched at incredible speed and scale.” But it is this speed and scale that might explain why there have been so many issues – as rushing something out of this complexity in a pandemic represents huge logistical challenges.

It could be said that the Government has missed a trick by not tapping into local teams and networks to carry out processes such as contact tracing. This is why Germany, Italy and much of Asia have got ahead, using large-scale local investment and resources to do contact tracing.

And indeed, when England started to switch to using local contact tracers, it made a massive difference to success rates. In the week to September 30, for example, these teams were able to reach 97.1 per cent of contacts, much higher than NHS Test and Trace’s rate of 68.6 per cent (done via online messaging or phone calls).

The added advantage of local teams is that they can help ensure compliance in those contacted, some of whom may want to avoid call centres – wary that a number beginning 0300 could mean a tracing team is getting in touch.

It’s not only that devolving responsibilities can enhance the tracing process, but decentralisation can boost testing too – which smaller labs in universities and the private sector initially offered to help the Government with. Instead, it has mostly relied upon PHE labs and NHS trusts to carry out this work.

While the Government should be praised for how quickly it managed to scale up testing, there have been problems with laboratories being too slow to process results (allegedly as a result of over-reliance on post-graduate science students to analyse lab results, who were only there over summer), and incompatibilities between systems – both of which might have been addressed with a more decentralised approach, and flexibility about which labs were used.

Robert Buckland, Secretary of State for Justice, since said that the Government would open 100 more test centres, including a “mega lab” on the way to enhance capacity.

But maybe this brings us back to the initial point – that the Government’s quest for new systems, as opposed to tapping into local and/ or existing solutions, might ultimately hold it back in accelerating testing. Instead of devolving powers, the Government’s instinct has always been to take more responsibility.

Will there be a change to the direction the Government is going in? The shift to using more contact tracing teams is certainly promising – and should be built upon, but given the amount of money, energy and investment that has gone into Test and Trace – along with the Government’s recent plan to merge PHE and NHS Test and Trace into the new “National Institute for Health Protection” – centralisation seems one area it is reticent to u-turn on.

Starmer’s speech: Passionate, confident – yet, will it prove his patriotism?

22 Sep

After Labour’s disastrous performance at the last General Election, Keir Starmer was keen to put the Corbyn years behind him at the party’s conference today. He gave one of the most passionate speeches of his career, telling voters that “[t]his party is under new leadership.”

It had been carefully constructed, and tried to address many of the reasons why Labour lost, as well as giving Starmer some much-needed personality. At one point he commented that “while Boris Johnson was writing flippant columns about bendy bananas, I was defending victims and prosecuting terrorists”. He later attacked the Tories on Covid-19 and social care, the latter of which the Labour leader said was a “disgrace to a rich nation”.

Starmer reinforced his commitment to “root out the antisemitism that has infected” Labour and repeatedly spoke about “security”, in yet another attempt to reverse Corbynism. No doubt many voters will still remember the former leader failing to condemn Russia after it launched a chemical attack on Britain, among other events, and Starmer knows he has a lot to do – to prove that Labour can protect the country.

This is why patriotism was such a dominant feature of Starmer’s speech. He talked about “the country I love”; his desire for Britain to be “the best country to grow up in and the best country to grow old in”, and how he’s “hugely ambitious for this country”.

But will this do the trick? Much of the reaction – on Twitter, at least – was incredibly optimistic about Starmer, partly spurred by recent polling on Labour – which shows the party closing in on Conservatives.

Even so, it’ll take a lot more than overuse of the word “country” to convince the electorate, particularly in the Red Wall, that Labour is now patriotic. The biggest reason for this is Brexit, in which voters expected all politicians to stick up for Britain – and instead found Starmer and others pushing for a second referendum.

Today he promised that Labour “is not going to be a party that keeps banging on about Europe” – and it’s no wonder he wants to move on, given his previous actions. During the speech he discussed “decency” and “fairness”, but 17.4 million people will be wondering where these traits were when he, and other MPs, tried to overturn their vote.

Furthermore, Starmer’s speech lacked substance. Though he has promised new leadership for the party, it’s not obvious what this looks like in policy terms, although he promised Labour’s manifesto “will sound like the future arriving” (whatever that means). Without more concrete proposals, and given the continued factionalism of Labour, many will simply think it sounds like more of the same.

Surprise lockdown measures are unsustainable. At some point, Test and Trace must deliver.

9 Sep

Yesterday the Government announced that social gatherings – both indoors and outdoors – of more than six people will be illegal in England from Monday (with fines of £100 upwards for anyone breaking the rules). 

In a press conference today, Boris Johnson expanded on the rationale for the move; there has been a steep rise in cases, with 8,396 reported since Sunday and 2,460 reported on Tuesday alone. Cases are increasing particularly among those aged 17 to 29. 

For many, the new measure seems like a step backwards. With the Eat Out to Help Out scheme, and the push to get employees back to work, it appeared that reopening the economy was the main direction the UK was heading in.

Dare I say there’d been some optimism the nation was winning the fight against Covid-19, especially as hospitalisations and deaths have dramatically gone down. 

Some will see the Government’s latest move as disproportionate, given that no vaccine is coming any time soon, and that the NHS’s capacity has never been overstretched.

There will also be questions about whether the rises in cases are as problematic as often made out, as they do not always correlate with more serious outcomes (deaths and hospitalisations).

One thing is for certain, however, which is that the Government cannot continue to yo-yo between opening and closing the economy. Worryingly, it has been suggested that a 10pm curfew for bars could be introduced across Britain to reduce cases. But we’re at the point where measures (such as the six-person limit) are creating widespread economic uncertainty.

As I wrote for ConservativeHome yesterday, the Government urgently needs to get a move on with its test and trace programme; its ultimate exit strategy. At PMQs today, Keir Starmer called the system “frankly ridiculous”, and while his words might have been hyperbolic, there will be continuous questions about why Northern Ireland, Germany and others have been able to release a contact tracing app as England’s is still going through trials.

Of course, creating this technology is an enormous logistical task, and it’s clear that Dido Harding, who’s heading up the operation, would rather get it right (regardless of whether it takes longer than others to implement). The Government has also invested £500 million into improving testing around the UK, and has made important moves, such as enrolling local council teams to record contacts. Johnson has even introduced £1,000 fines for pubs from Monday if they do not adequately monitor contacts; though harsh, it takes the Government’s test and trace efforts further.

But with the public appetite for more measures waning, and winter approaching, it’s imperative for the Government to speed its process up – lest it gives weight to Starmer’s words.

Stephen Booth: With four months left to get a Brexit deal, state aid is the major stumbling block for the UK and EU.

3 Sep

Stephen Booth is Head of the Britain in the World Project at Policy Exchange.

At this delicate stage, predictions of whether the Brexit negotiations will conclude with a trade agreement or not are bound to be no more than guesswork. With only four months until the end of the Brexit transition period, the chances of a UK-EU trade deal being ready for January 1, 2021 are in fifty-fifty territory.

The EU’s “parallelism” policy – blocking progress in one area as long as there isn’t progress elsewhere – means that Michel Barnier is refusing to discuss British proposals on fishing until the UK moves on other issues, including the most difficult of them all: the EU’s desire to establish a “level playing field” for state aid. It could be argued that Brussels’ insistence on solving the difficult issues first prevents rather than permits progress.

Ultimately, fishing is not likely to be the deal-breaker. The eight EU member states with significant fishing fleets will completely lose access to UK waters if there is no deal at all, so cutting a deal is clearly better than the default, even if it falls well short of the desire for “relative stability” for existing EU quotas.

At the start of the summer there were reasons for optimism about a deal. The EU had signalled a willingness to water down its most ambitious demands on fishing and state aid and the UK had acknowledged the EU’s concerns about the overall structure of the agreement.

However, the mood appears to have turned and the last negotiating round yielded very little, according to the readouts from both sides. This week Jean-Yves Le Drian, the French Foreign Minister, cited the “intransigent and frankly unrealistic attitude” of the UK for the lack of progress. Barnier yesterday gave a speech outlining the continued areas of disagreement. Equally, recent media reports suggest the UK is preparing the ground to walk away from the talks if the stalemate continues much longer.

State aid is the major stumbling block. The impasse would appear to be a bigger problem in theory than in practice. UK orthodoxy has seen past governments refrain from major interventions in the economy. According to the European Commission’s “State aid Scoreboard”, the UK spent state aid equivalent to 0.34 per cent of GDP in 2018, compared to an EU average of 0.76 per cent. Meanwhile, France spent 0.79 per cent, slightly above the EU average, and Germany spent a much larger per cent.

The perception in Brussels is that this UK Government is different. David McAllister, the German MEP who chairs the European Parliament’s Brexit committee and who is close to Angela Merkel, has said the “UK’s interest in subsidising sectors”, such as steel and cars, would have “direct consequences for EU industries and jobs if these goods have ‘duty-free, quota-free’ access to the single market”.

This precise fear of the UK turning to a historically continental strategy of promoting “national champions” may be wide of the mark. Nevertheless, it is clear that some members of this Government view industrial policy and strategic investment as important levers at its disposal.

In this area, the devil will be in the detail. In the post-Covid world, it is difficult to predict what will be required of the state and nimbleness may be critical. Therefore, it is understandable that the UK would not want to find itself bound permanently by treaty into the EU state-aid regime, much of which is “temporarily” suspended in any case due to the pressures of the crisis on national and regional governments.

Little headway appears likely until the UK sets out its blueprint for domestic state subsidy control, which is expected to be later this month. At a minimum, the UK will need to comply with WTO rules, but these fall far short of the requirements of the current EU regime.

WTO rules only apply to goods, while the EU rules apply to both goods and services. The EU rules are prescriptive in what and what is not permitted, whereas, in practice, WTO rules set a high threshold because complainant countries must demonstrate that disputed aid is harmful in its effect.

The EU appears to have walked back from its initial position – clearly unacceptable to the Government – that the UK should continue to be bound by EU state aid rules into the future, with the European Court of Justice (ECJ) having the final say in respect of enforcement. In contrast, the EU’s agreement with Canada simply uses the WTO model as a basis and expands it to services, but there are limited options for enforcement.

A possible compromise would be for the UK to implement domestic legislation, adopting some aspects of the status quo, enforced by an independent UK authority and subject to review by Parliament and the UK courts (not the ECJ). Subject to dispute settlement, set out in the UK-EU trade agreement, the EU (and the UK) would retain the right to adopt countermeasures, such as tariffs, against any state aid deemed to be trade-distorting.

Whether this would be acceptable to the EU remains to be seen. The essential objective from the UK’s perspective is to depart from the EU’s desire to micromanage the UK’s subsidy policy by treaty. However, the UK would need to accept the principle that the EU could deal with the consequences of UK subsidies with countermeasures such as retaliatory tariffs.

A bust up in September or October does not necessarily preclude a deal at the last minute. Weighed against these important, yet technocratic considerations, is the prospect of no agreement at all.

A trade agreement, with no tariffs on UK-EU trade and regulatory cooperation, would better enable the UK to implement the Northern Ireland Protocol in the light-touch way the Government has outlined.

Any disruption attributed to a no deal exit, however transient, would give Keir Starmer ammunition in his continued attack on Government competence. Against this, the Government is in a much stronger position than it was in the autumn of 2019 when renegotiating the Withdrawal Agreement.

Failure would have economic and geopolitical consequences for the EU too. The UK may only be Germany’s seventh largest trade partner, but it ranks second in contributing to Germany’s trade surplus.

It is notable that Tom Tugendhat MP has on this site recently called for the UK to break with EU policy on Iran to adopt an approach closer to the United States. In the event of a breakdown in the trade relationship, Brussels should not be surprised to encounter a more muscularly independent UK in other fields.

We are now approaching the end game. The technical negotiations have probably achieved as much as they can at this stage. It will soon be up to the politicians on both sides of the table to make the big call about whether to make the deal or not.

Labour’s hypocrisy over A Level results

18 Aug

Almost every publication, including this site, has been critical of the Government’s U-turn on school exams in England.

Gavin Williamson’s decision to move from Ofqual’s model, which resulted in 40 per cent of predicted marks being downgraded, to teacher-assessed grades for A Levels and GCSEs (unless the grades produced by the algorithm are higher) caused chaos among students and teachers.

Now it’s universities who’ll have to deal with the consequences, given that many teenagers have different marks to before and want to change which one they go to.

As you might expect from the leader of the opposition, Keir Starmer has been scathing about the recent events. On his Twitter feed he is particularly fond of one word – “incompetent/ incompetence”, which he has accused the Government of being seven times since Sunday (heaven forbid there’s a thesaurus at Labour HQ).

After teacher-assessed grades (predicted grades) were accepted, he declared the changes a “victory for the thousands of young people who have powerfully made their voices heard this past week.”

Of course, it’s very easy for Labour to take the high road in these times, but its own position on exam results hasn’t been clear exactly.

In April, for instance, Angela Rayner, the party’s Deputy now, but Shadow Education Secretary then, criticised predicted grades, telling FE News:

“we have always said predicted grades are not always accurate, and can disproportionately affect the children who need the most support”.

In August 2019, she also said:

“Predicted grades are wrong in the vast majority of cases, and disadvantaged students in particular are losing out on opportunities on the basis of those inaccurate predictions.

Similarly, Kate Green, the now Shadow Education Secretary, was sceptical about predicted grades – and argued for grades to be standardised in July:

“Labour has argued for years that predicted grades already create significant challenges for disadvantaged students, and without fair standardisation and appeals many more students could be unfairly affected by calculated grades. The Government and Ofqual must urgently act to ensure that young people from ethnic minority and disadvantaged backgrounds do not lose out under this system”.

However, she has since called the results a “farce that is incredibly cruel to young people”, adding that teacher-assessed grades were the right way forward.

Indeed, she celebrated their implementation, Tweeting: “Well done to all students, parents and teachers who have campaigned for this u-turn. I am so pleased GCSE & A level results will be on basis of teacher assessment as you and @UK Labour called for.”

For all the horror about England, too, some have pointed out the party’s silence over results in Wales.

On Good Morning Britain, Rayner said the fact that 40 per cent of students had their marks downgraded was “completely unfair” and “completely flawed”. Starmer, too, launched a video which said “The Tories’ incompetent handling of this year’s exams” was “robbing a generation of their future”.

But given that 42 per cent of grades were downgraded in Wales, as a result of a similar algorithm, where was the video about Welsh Labour robbing futures?

For some Tory MPs, Labour’s complaints are too little, too late. 

Robert Halfon, Chair of the Commons Education Select Committee, told me: the “opposition parties mostly accepted the grading system that the Government and Ofqual had chosen, as did the trade unions. It’s easier to jump on a bandwagon after the event, but there were very few who were actually calling this out from the beginning.”

His colleague Jonathan Gullis echoed this sentiment, saying: “As a member of the Select Committee, we had spoken with Ofqual, and as I remember there were no serious concerns raised other than making sure that grades would be handed out as fairly as possible in exceptional circumstances.”

Speaking of Starmer, he added “[he] once again jumps on any bandwagon going. We heard nothing from him in the build up to results day about the system; in fact, the Shadow Education Minister, now Deputy Leader, was in favour of what Ofqual was doing. But once again Sir Keir Starmer is more interested in trying to please the people of Twitter and the mainstream media.”

Perhaps the Labour leader knows more about “incompetence” than he thinks…