Recommendations & Conclusions
13 items
5
Recommendation
Twenty-Third Report - Test and Trace up…
Accepted
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 …
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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.
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Government response AI summary
The government agrees and states the UKHSA wrote to the Committee in December 2021 regarding reducing consultant dependency, continues to recruit civil servants, and will provide further progress updates in March and June 2022 as requested.
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HM Treasury
9
Recommendation
Twenty-Third Report - Test and Trace up…
Accepted
In our March 2021 report, we concluded that NHST&T published a lot of performance data but that this did not demonstrate how effective test and trace was at reducing transmission of COVID-19. We recommended that NHST&T should improve the data it published so that people were able to get a …
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In our March 2021 report, we concluded that NHST&T published a lot of performance data but that this did not demonstrate how effective test and trace was at reducing transmission of COVID-19. We recommended that NHST&T should improve the data it published so that people were able to get a better sense of its effectiveness, as well as 9 Qq 34–35, 113; C&AG’s report para 2 10 Department of Health and Social Care, Coronavirus (COVID-19) cases in the UK data tables 11 Qq 34, 120 12 Qq 34–35, 120 13 Q 51, Department of Health and Social Care, Confirmed cases of COVID-19 variants identified in UK 14 Qq 51, 52 Test and Trace update 11 periodic evaluations of its impact on infection levels.15 The NAO found that NHST&T had worked to model the impact of its activities, which was an inherently challenging task, but that there were some uncertainties in these estimates.16
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Government response AI summary
The government stated that NHS Test and Trace developed a performance framework in summer 2020 and the UKHSA regularly publishes and adapts performance information and supporting methodology. It did not explicitly commit to new actions to improve data to specifically demonstrate effectiveness in reducing transmission …
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HM Treasury
10
Conclusion
Twenty-Third Report - Test and Trace up…
Accepted
The Scientific Advisory Group for Emergencies (SAGE) recommends that, for a test and trace system to be effective, no more than 48 hours should elapse between identifying an original case and their contacts self-isolating. NHST&T routinely monitors the speed with which it provides results for PCR tests carried out in …
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The Scientific Advisory Group for Emergencies (SAGE) recommends that, for a test and trace system to be effective, no more than 48 hours should elapse between identifying an original case and their contacts self-isolating. NHST&T routinely monitors the speed with which it provides results for PCR tests carried out in person and met its target to reach 80% of these within 72 hours from January 2021 onwards. The NAO found that NHST&T did not routinely monitor performance for other types of PCR tests, such as those taken in peoples’ homes or in care homes which make up the majority of PCR tests.17 However, the former Head of NHST&T was able to provide this data at our evidence session and it showed significantly worse performance for all PCR tests than for in-person PCR tests. They told us that, by mid-January 2021, 73% of results for in-person tests were returned within 48 hours and 91% were completed within 72 hours. For all PCR tests 54% of results were provided within 48 hours and 75% of results were provided in 72 hours. They accepted that NHST&T had more work to do on home testing, and highlighted how it was working with Royal Mail to make it easier for people who could not get to a physical test site to get their home test quickly.18 One of NHST&T’s main targets was to identify 60% of COVID-19 cases through its testing. However, it had not, since November 2020, been able to monitor this because of changes to the methodology used by the Office for National Statistics to calculate new infections, a key input to this metric.19 Engagement with test and trace
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Government response AI summary
The government states that NHS Test and Trace developed and continues to adapt its performance framework, and the UKHSA regularly publishes performance information and methodology.
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HM Treasury
12
Conclusion
Twenty-Third Report - Test and Trace up…
Accepted
We asked our witnesses what progress had been made across government to improve self-isolation rates since we last examined the programme. The Department asserted that it has done significant work, including appointing a cross-government senior officer with responsibility for compliance with self-isolation. It explained that it was focussing on three …
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We asked our witnesses what progress had been made across government to improve self-isolation rates since we last examined the programme. The Department asserted that it has done significant work, including appointing a cross-government senior officer with responsibility for compliance with self-isolation. It explained that it was focussing on three areas: communications so people understand the importance of getting a test when they have symptoms; removing physical barriers to testing; and providing financial and practical support for people that are self-isolating, such as through hardship payments and medicine deliveries. It told us that it now had over 1,000 testing sites and 35,000 post- boxes to receive tests, as well as home testing and pharmacies that could give out tests. It 15 Committee of Public Accounts, COVID-19: Test, track and trace (part 1), Forty-Seventh report of Session 2019–21, HC 932, 10 March 2021, para 1 16 C&AG’s Report, para 17, 3.24–3.28 17 C&AG’s Report, para 15 18 Qq 42–43 19 C&AG’s Report, para 3.18, 3.19 20 C&AG’s Report, paras 16, 3.21–3.23 12 Test and Trace update similarly explained that it had made £176 million available to support those who need to self-isolate, including £73 million to pay for the Test and Trace support payment, which provided £500 to anyone who needed to self-isolate and was on qualifying benefits, and £75 million for discretionary hardship payments.21
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Government response AI summary
The government states that UKHSA is already delivering targeted communications and campaigns, and making testing accessible through community testing programmes, to drive engagement and reach underrepresented groups, further detailing existing efforts.
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HM Treasury
13
Conclusion
Twenty-Third Report - Test and Trace up…
Accepted
We asked our witnesses about the role of the NHS COVID-19 app in ensuring that people self-isolate if they need to, particularly given suggestions that some people might delete the app or stop it being enabled in order to avoid having to self-isolate. The Chief Executive of the UKHSA told …
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We asked our witnesses about the role of the NHS COVID-19 app in ensuring that people self-isolate if they need to, particularly given suggestions that some people might delete the app or stop it being enabled in order to avoid having to self-isolate. The Chief Executive of the UKHSA told us that they were aware that some people were choosing not to use the app, but stressed that it continued to be important in alerting people they needed to self-isolate, and in passing information to large numbers of people quickly.22 The NAO reported that in late April 2021 around 16 million people had the app fully or partially enabled.23 In its letter to us after our evidence session, the Department and the Chief Executive of the UKHSA told us that the app had been downloaded over 27.1 million time since it was launched, but that they were unable to estimate the number of people who had the app enabled at any one time and therefore unable to provide us with more recent figures.24
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Government response AI summary
The government states the UKHSA has already delivered targeted communications and campaigns to drive up engagement and made testing more accessible, including through community testing programmes.
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HM Treasury
17
Conclusion
Twenty-Third Report - Test and Trace up…
Accepted
NHST&T does not yet know how it will secure the promised benefits from the laboratory infrastructure it has established. NHST&T’s November 2020 business case for a £10 billion expansion of its testing capability stated that a £150 million investment 30 C&AG’s report, Figure 6 31 Committee of Public Accounts, COVID-19: …
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NHST&T does not yet know how it will secure the promised benefits from the laboratory infrastructure it has established. NHST&T’s November 2020 business case for a £10 billion expansion of its testing capability stated that a £150 million investment 30 C&AG’s report, Figure 6 31 Committee of Public Accounts, COVID-19: Test, track and trace (part 1), Forty-Seventh report of Session 2019–21, HC 932, 10 March 2021, para 2 32 Qq 64, 87; C&AG’s Report, paras 7, 12, 14, 2.15, 2.17 and Figure 12 33 Qq 87, 97–100 34 C&AG’s Report, para 2.11 35 Qq 97–100 Test and Trace update 15 in laboratory infrastructure would leave a lasting ‘legacy’ for NHS England, in terms of preparedness for future disease emergencies and early diagnostic capabilities for cancer and cardiovascular and metabolic diseases. However, the NAO found that NHS England and NHS Improvement had not been informed of this commitment at the time it was made and only recently began having discussions with NHST&T about potential legacy opportunities. We asked our witnesses how this had happened. The previous Head of NHST&T told us that they were surprised by the statement in the NAO report as they had ongoing discussions with NHS England and NHS Improvement about the importance of ensuring that better diagnostic capability was in place rather than having to be built from scratch. We noted that both the Department and NHS England signed off the account in the C&AG’s report as factually accurate.36 The November business case also committed to drawing up a detailed benefits realisation strategy by December 2020 setting out how benefits would be achieved from the £10 billion funding that NHST&T was requesting. However, the Department accepted that this was not yet in place. Without this, it is not clear what benefits are expected from this funding, who is responsible for delivering them or whether there are risks that need to be managed.37
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Government response AI summary
The government accepts the recommendation, stating UKHSA continues to strengthen its benefits evaluation and will produce a three-year strategic plan, updated annually, detailing how resources will be used to achieve objectives, with a target implementation date of Spring 2022.
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HM Treasury
19
Recommendation
Twenty-Third Report - Test and Trace up…
Accepted
Our first report on NHST&T concluded that it was overly reliant on expensive contractors and temporary staff. We found that by October 2020, it had signed 407 contracts worth £7 billion with 217 public and private organisations. By the end of December 2020, this had risen to over 600 contracts. …
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Our first report on NHST&T concluded that it was overly reliant on expensive contractors and temporary staff. We found that by October 2020, it had signed 407 contracts worth £7 billion with 217 public and private organisations. By the end of December 2020, this had risen to over 600 contracts. We recommended that NHST&T should put 36 Qq 170–174, 178 ; C&AG’s Report, para 21 37 Qq 172–173, C&AG’s Report, para 21, 4.18 38 Q 154; C&AG;s Report para 8, 1.13–1.14 39 Q 119; C&AG’s report para 2.19 40 Qq 119, 154, C&AG’s Report, para 8, 1.13, 1.14 41 Q 40 42 Q 154 16 Test and Trace update in place a clear workforce plan and recruitment strategy which aimed to significantly reduce its reliance on consultants and temporary staff. As part of our previous inquiry, the Department assured us that it had plans in place to reduce NHST&T’s use of external consultants, but that this was dependent on the availability of civil service recruits to fill posts and on future demand for test and trace services.43 Despite this, NHST&T employed more consultants in April 2021 (2,239) than in December 2020 (2,164). As of April 2021, consultants accounted for nearly half of all NHST&T’s central staff.44
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Government response AI summary
The government accepts the recommendation, stating UKHSA has reduced consultant dependency and continues to recruit civil servants, while developing a sustainable resource plan with updates due in March and June 2022, aiming for implementation by June 2022.
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HM Treasury
20
Conclusion
Twenty-Third Report - Test and Trace up…
Accepted
We therefore asked our witnesses why NHST&T’s use of consultants continued to be so high. The previous Head of NHST&T explained that up to the end of May 2021, 196 (37%) of the 523 recruitment campaigns run by NHST&T failed to appoint anyone. They told us that this was because …
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We therefore asked our witnesses why NHST&T’s use of consultants continued to be so high. The previous Head of NHST&T explained that up to the end of May 2021, 196 (37%) of the 523 recruitment campaigns run by NHST&T failed to appoint anyone. They told us that this was because the skills NHST&T was trying to recruit for, in data, digital, and operational and project delivery roles, were in short supply in the civil service. They explained that as part of reducing the number of consultants, it would be important to ensure that there were permanent civil servants in the total, which had been difficult to do.45 They also acknowledged that plans to reduce consultants need to be managed in a staged manner, to ensure skills are transferred into permanent roles. The Department assured us that detailed plans were in place to reduce consultants and that it expects their numbers to be lower by March 2022.46
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Government response AI summary
The government agrees, stating the UKHSA has reduced dependency on consultants and continues to recruit civil servants, with plans to develop a sustainable resource strategy and provide further updates in March and June 2022.
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HM Treasury
21
Conclusion
Twenty-Third Report - Test and Trace up…
Accepted
We again challenged the Department and NHST&T on the value for money of their spend on consultants. The Department told us the average day rate for consultants was £1,100 but that some would have “undoubtedly” earned more than that. They were unable to tell us what NHST&T’s highest paid individual …
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We again challenged the Department and NHST&T on the value for money of their spend on consultants. The Department told us the average day rate for consultants was £1,100 but that some would have “undoubtedly” earned more than that. They were unable to tell us what NHST&T’s highest paid individual consultants received during our evidence session and committed to providing us with further detail.47 However, in their letter to us after our evidence session, the Department and the Chief Executive of the UKHSA subsequently informed us that they were not able to provide any further information as NHST&T did not hold data on the pay of individual consultants.48
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Government response AI summary
The government accepts the recommendation, stating UKHSA has already reduced consultant dependency and continues to recruit civil servants to replace them, while developing a sustainable resource plan, with updates due in March and June 2022.
Read full response →
HM Treasury
22
Conclusion
Twenty-Third Report - Test and Trace up…
Accepted
At the time of the NAO’s report, NHST&T provisionally estimated that it had spent £372 million on agency and contractor staff and £195 million on consultancy fees, compared with £52 million on permanent and seconded staff in 2020–21. It had not yet completed its year-end checks, and anticipated that the …
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At the time of the NAO’s report, NHST&T provisionally estimated that it had spent £372 million on agency and contractor staff and £195 million on consultancy fees, compared with £52 million on permanent and seconded staff in 2020–21. It had not yet completed its year-end checks, and anticipated that the amount recorded as consultancy spend would increase. However, the NAO’s own enquiry on contract spend indicated that NHST&T was expected to spend £300 million on the top 10 consultancies with the highest contract values.49 We were concerned that NHST&T’s consultancy expenditure may have gotten out of hand. The previous Head of NHST&T explained that the nature of the pandemic had meant that NHST&T had needed to bring in contingent, short-term labour from all parts of society, including the Army, civil servants, volunteer contracts, unpaid staff, as well as consultants. They explained that NHST&T needed to rely on consultants in part because some of the skills it needed did not exist in the civil service, and partly because the nature of the pandemic response meant the roles available were temporary rather than 43 Committee of Public Accounts, COVID-19: Test, track and trace (part 1), Forty-Seventh report of Session 2019–21, HC 932, 10 March 2021, para 3 44 Q 129, C&AG’s Report, para 13 45 Q 135 46 Qq 136, 141 47 Qq 132–133 48 Letter from Sir Chris Wormald, Department for Health and Social Care, and Dr Jenny Harries, UK Health Security Agency, to Rt Hon Meg Hillier MP, Chair of Public Accounts Committee, 4 August 2021 49 Qq 129, 138; C&AG’s Report para 2.20 Test and Trace update 17 permanent. The Chief Executive of the UK Health Security Agency confirmed that it had a “very detailed ramp-down plan” to reduce the number of consultants by the end of March 2022.50 In their subsequent letter to us, the Department and the future Chief Executive of UKHSA told us that NHST&T had reduced the number of consultants from a peak of 2,504 to 1,864 over the previous four months. The
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Government response AI summary
The government agrees, stating the UKHSA has reduced dependency on consultants and continues to recruit civil servants, with plans to develop a sustainable resource strategy and provide further updates in March and June 2022.
Read full response →
HM Treasury
23
Recommendation
Twenty-Third Report - Test and Trace up…
Accepted
Local authorities and public health experts play a vital role in protecting the health of the population. Our previous report on test, track and trace, concluded that many important stakeholders had at times felt ignored by NHST&T. We found that a range of stakeholders had queried why local authorities and …
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Local authorities and public health experts play a vital role in protecting the health of the population. Our previous report on test, track and trace, concluded that many important stakeholders had at times felt ignored by NHST&T. We found that a range of stakeholders had queried why local authorities and NHS primary care bodies were not more directly involved with testing and tracing activities at NHST&T’s outset given their existing networks, experience and expertise. We recommended that NHST&T review how it engaged with, and draws expertise from, the wider public health and other sectors, including local government.52 We challenged the UKHSA and the Department about how they will ensure UKHSA makes the best use of local expertise. The Department acknowledged the importance of getting this balance right, and told us it was trying to identify what was best delivered nationally to a common set of national standards and securing economies of scale, and which parts should best be delivered locally making use of local knowledge and expertise. It explained that, for example, laboratory capacity and data tracking systems such as barcodes might best be organised nationally, whereas setting up testing centres might best be done locally, drawing on local expertise about how to reach vulnerable communities.53
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Government response AI summary
The government accepts the recommendation, stating UKHSA continues to engage with local government and partners, citing a £2.1 billion fund, and commits to strengthening these partnerships to co-design a future operating model once funding is agreed, with a target implementation date of Spring 2022.
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HM Treasury
24
Conclusion
Twenty-Third Report - Test and Trace up…
Accepted
Our report in March 2021 on 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 the increased costs of delivering existing services.54 In 2020–21, NHST&T …
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Our report in March 2021 on 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 the increased costs of delivering existing services.54 In 2020–21, NHST&T paid a total of £2.2 billion to local authorities out of its overall budget of £22 billion and actual spend of £13.5 billion. This included: £1.7 billion for ‘contain’ activities to identify local COVID-19 outbreaks and support local responses to the pandemic; £176 million for test and trace support payments; and £13 million for practical support for self-isolation.55 Local authorities’ involvement in testing and tracing increased significantly during the course of the pandemic. The Chief Executive of the UKHSA explained that some local authorities had taken responsibility for contact tracing through the Local Zero programme. However, as cases have increased NHST&T had taken some of this back because local authorities did not have the capacity to do it.56 The NAO report noted that some tracing often fell to staff of local bodies, and the additional time and effort required put a strain on resources, which may not be sustainable in the long term. It also found that funding for local responses to the pandemic was one of only three areas where NHST&T had budgeted less than it eventually needed to spend.57 We questioned whether, given the involvement and responsibilities of organisations at a local level, too much money was being held centrally. The Chief Executive of the UKHSA told us that it was committed to learning the lessons 52 Q 145; Committee of Public Accounts, COVID-19: Test, track and trace (part 1), Forth report of Session 2021–22, HC 239, 4 June 2021, para 18 53 Qq 143–145, 147–151 54 Committee of Public Accounts, COVID-19: Local government finance, Forty-Seventh report of Session 2019–21, HC 932, 10 March 2021, para 3–8 55 Q 143; C&AG’
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Government response AI summary
The government agrees and states the UKHSA is working with local authorities and partners to design its future operating model, aiming to strengthen partnerships and facilitate co-design of policies and responses once funding is agreed.
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HM Treasury
25
Conclusion
Twenty-Third Report - Test and Trace up…
Accepted
From 1 October, NHST&T will become part of the newly created UKHSA. We asked witnesses how they were involving local authorities and other stakeholders in designing the model for this new organisation.59 The Department acknowledged that it had not always got the balance between local and national delivery right. It …
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From 1 October, NHST&T will become part of the newly created UKHSA. We asked witnesses how they were involving local authorities and other stakeholders in designing the model for this new organisation.59 The Department acknowledged that it had not always got the balance between local and national delivery right. It committed to co- creating the model for the new organisation with local authorities. The Chief Executive of the UKHSA acknowledged that the way it worked with local authorities, the NHS and other stakeholders will be critical and that it had sessions organised to work through this.60 58 Qq 143–144 59 Qq 91–96 60 Qq 151, 160 20 Test and Trace update
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Government response AI summary
The government agrees and states the UKHSA is continuing to work with local government and partners, committing to strengthen these partnerships to co-design the future operating model for health security once funding from the Spending Review 2021 is agreed.
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HM Treasury