Recommendations & Conclusions
7 items
2
Recommendation
Twenty-Third Report - Test and Trace up…
Not Addressed
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 …
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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 6 Test and Trace update 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, w
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Government response AI summary
The government's response focused entirely on the department's value for money assessment processes and a commitment to include more detailed evidence in future letters to the Committee. It did not address the specific recommendation to report on underrepresented groups in testing or plans to drive …
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HM Treasury
3
Recommendation
Twenty-Third Report - Test and Trace up…
Not Addressed
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 …
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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.
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Government response AI summary
The government's response is entirely unrelated to the committee's recommendation regarding the UKHSA's benefits realisation plan and understanding the actual benefits delivered by its spending.
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HM Treasury
4
Recommendation
Twenty-Third Report - Test and Trace up…
Not Addressed
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 …
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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 Test and Trace update 7 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.
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Government response AI summary
The government's response discusses the Defence Equipment & Support (DE&S) and its cost savings and project delivery, which is entirely irrelevant to the recommendation regarding UKHSA's laboratory and contact centre utilisation targets.
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HM Treasury
6
Recommendation
Twenty-Third Report - Test and Trace up…
Not Addressed
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 …
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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. 8 Test and Trace update 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. Test and Trace update 9 1 Breaking the chains of COVID-19 transmission
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Government response AI summary
The government's response discusses defence funding and equipment plans, and provides general background on NHS Test and Trace, entirely failing to address the recommendation for UKHSA and the Department to provide clarity on the future operating model to local government.
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HM Treasury
1
Conclusion
Twenty-Third Report - Test and Trace up…
Not Addressed
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department), the former Head of the NHS Test and Trace Service (NHST&T), and the Chief Executive of the newly formed UK Health Security Agency (UKHSA) about …
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On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department), the former Head of the NHS Test and Trace Service (NHST&T), and the Chief Executive of the newly formed UK Health Security Agency (UKHSA) about the Test and Trace Service in England.1
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Government response AI summary
The government acknowledges the committee took evidence based on the NAO report and published its own report, stating that this is the government's response to it, without addressing any specific recommendation.
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HM Treasury
8
Conclusion
Twenty-Third Report - Test and Trace up…
Not Addressed
In April 2021, the Department identified the Delta form of COVID-19 as a variant of concern and within four weeks it had become dominant in the UK, accounting for 99% of positive cases.13 The Chief Executive of the UKHSA told us that even with the benefit of hindsight they could …
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In April 2021, the Department identified the Delta form of COVID-19 as a variant of concern and within four weeks it had become dominant in the UK, accounting for 99% of positive cases.13 The Chief Executive of the UKHSA told us that even with the benefit of hindsight they could not identify anything NHST&T could have done to stop the spread of the new variant. They noted that while there had been isolated local successes in containing pockets of variants, such as in Sefton and Bolton, the transmissibility of the Delta variant made controlling it particularly difficult. They told us that there had been over 4,000 mutations of the virus and the combination of the sheer number of virus mutations and the time taken to understand whether a variant was of significance or concern, created difficulties in managing them effectively. This meant that, despite NHST&T’s significant and internationally well-regarded efforts to sequence the genomes of variants, the Delta form of COVID-19 was able to spread rapidly once it arrived in the UK.14
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Government response AI summary
The government's response was a non-sequitur, providing only a list of unrelated reports concerning Greensill Capital, and did not address the committee's conclusion regarding the rapid spread of the Delta variant despite genomic sequencing efforts.
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HM Treasury
18
Conclusion
Twenty-Third Report - Test and Trace up…
Not Addressed
Since October 2020, NHST&T has introduced lateral flow device (LFD) tests to detect infections in people without symptoms. NHST&T distributed around 691 million LFD tests between October 2020 and May 2021 as part of its plans to roll out regular asymptomatic testing. These were initially targeted at specific high-risk groups, …
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Since October 2020, NHST&T has introduced lateral flow device (LFD) tests to detect infections in people without symptoms. NHST&T distributed around 691 million LFD tests between October 2020 and May 2021 as part of its plans to roll out regular asymptomatic testing. These were initially targeted at specific high-risk groups, such as care home residents, before being made available to other groups and then the wider population. By 26 May 2021, of the 691 million tests distributed by NHST&T, 96 million had been registered as used, representing only 14% of the total.38 We questioned our witnesses about this low number. The Chief Executive of UKHSA explained that if tests believed to be in storage or transit were discounted the percentage of tests which had been registered rises to 20%. However, they also noted that, beyond that, it was difficult to identify what had been done with the rest. The NAO report found that there was no system in place to monitor LFD results and ensure they are reported.39 We were told that around 40% of people were using tests and not reporting the results. LFD tests have been distributed since October 2020, but the NAO report in June 2021 found that NHST&T had only recently started work to understand why LFD registrations were so low.40 We were also told that as a third of cases of COVID-19 were asymptomatic, lateral flow tests were an important way of identifying positive cases, particularly when used by people who do not have symptoms who would otherwise be unlikely to get a test.41 The 96 million test results registered by the end of May identified 223,000 positive cases.42 Reliance on consultants
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Government response AI summary
The government response provides a general introduction to NHS Test and Trace and context for the report, but does not address the conclusion regarding the low registration rates of LFD tests or the lack of a system to monitor results.
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HM Treasury