Select committee inquiry
COVID-19: Test, track and trace (part 1)
Closed
What the inquiry looked at
“Test and trace programmes are a core public health response in epidemics that can be used with other measures such as social distancing, barriers (such as masks) and handwashing to reduce infections. The basic principles of test and trace are identifying individuals, or groups of individuals, with an infectious disease, and tracing their contacts to limit further transmission. Through early identification, potentially infectious contacts can be encouraged or obliged to reduce interactions with other people, thereby reducing the spread of disease. The National Audit Office’s (NAO) first, interim report on test and trace finds that the government has rapidly scaled up COVID-19 testing and tracing from a low base, but is achieving too few test results delivered within 24 hours and too few contacts of infected people being reached and told to self-isolate. The Department of Health & Social Care (DHSC) rapidly increased testing capacity in England from April and launched the NHS Test and Trace Service (NHST&T) at the end of May to lead the overall test and trace programme. NHST&T’s budget for 2020-21 has grown over time and now stands at £22 billion. Of the £15 billion of funding confirmed before the November Spending Review, around £12.8 billion (85%) is assigned to testing and £1.3 billion to tracing. Much of the additional £7 billion budget allocated in the Spending Review will be needed for mass testing, which was formerly referred to as “Operation Moonshot”. Contracts worth £7 billion have been signed with 217 public and private organisations to provide supplies, services and infrastructure, including test laboratories and call handlers for tracing. NHST&T has plans to sign a further 154 contracts, worth £16.2 billion, by March 2021. In total, 70% of early contracts by value were directly awarded without competition under emergency measures that were in use across government. International comparisons show that outsourcing is a part of many testing systems but is unusual for tracing. A range of stakeholders have queried why the government did not involve local authorities more in its initial approach to tracing, given their previous experience in this area. The government did not document with a business case the basis for the delivery model it initially chose until September. A target to provide results within 24 hours of in-person testing in the community has not been met. Turnaround within 24 hours peaked in June at 93% but subsequently deteriorated to reach a low of 14% in mid-October before rising to 38% in early November. NHST&T did not plan for the sharp rise in testing demand in September when schools and universities reopened. Laboratories processing community swab tests were unable to keep pace with the volume of tests and experienced large backlogs, which meant NHST&T had to limit the number of tests available and commission extra help from other laboratories. Rationing of tests meant some people were told to visit test sites hundreds of miles away. It is important to get hold of people with COVID-19 or who might have been exposed to it quickly so they can self-isolate, but the service saw increases in the time taken to reach people between May and mid-October, before improvements in the last two weeks of October. At times, parts of the national tracing service have barely been used: in May, DHSC signed contracts for the provision of 3,000 health professionals and 18,000 call handlers. The call handler contracts were worth up to £720 million. By 17 June, the utilisation rate (the proportion of time that someone actively worked during their paid hours) was low for both health professional (4%) and call handler staff (1%), indicating that they had little work to do. This means substantial public resources have been spent on staff who provided minimal services in return. National and local government have tried to increase public engagement with tracing, but surveys suggest that the proportion of contacts fully complying with requests to self-isolate might range from 10% to 59%. NHST&T acknowledges that non-compliance poses a key risk to its success and has taken steps to increase levels of self-isolation, for example by making follow-up calls to people while they are self-isolating. For as long as compliance is low, the cost-effectiveness of NHST&T’s activities will inevitably be in doubt. The Committee will question senior officials and executives at DHSC and NHS Test & Trace. If you have evidence on the effectiveness and value for money of the UK’s test and trace programme to date, please submit it here by 6pm on Monday 11 January 2021.”
The committee's words, from the inquiry page on parliament.uk ↗.
What it found
In the committee's words, from the summary of Forty-Seventh Report - COVID-19: Test, track and trace (part 1) ↗
A well-functioning test and trace programme is key to our success in the fight against the COVID-19 virus. Since May 2020, the NHS Test and Trace Service (NHST&T) has led the national programme for testing and tracing in England, aiming to help break chains of transmission and enable people to return to a normal way of life.
The scale of NHST&T’s activities is striking, particularly given its short life. Between May 2020 and January 2021, daily UK testing capacity for COVID-19 increased from around 100,000 to over 800,000 tests. NHST&T had also contacted over 2.5 million people testing positive for COVID-19 in England and advised more than 4.5 million of their associated contacts to self-isolate.
NHST&T, however, still has work to do to ensure it meets its critical targets and objectives in a timely and cost-efficient manner. We appreciate that NHST&T had to be set up and staffed at incredible speed, but in particular it now needs to wean itself off its persistent reliance on consultants and temporary staff. Up to November 2020, NHST&T had spent £5.7 billion, although it has been allocated far more (£37 billion over two years).
The Department of Health & Social Care justified the scale of investment, in part, on the basis that an effective test and trace system would help avoid a second national lockdown; but since its creation we have had two more lockdowns. There is still no clear evidence to judge NHST&T’s overall effectiveness. It is unclear whether its specific contribution to reducing infection levels, as opposed to the other measures introduced to tackle the pandemic has justified its costs.
A major focus for NHST&T in early 2021 was the mass roll-out of rapid testing in different community settings, but there have been particular setbacks for the roll-out to schools. Both the Department and NHST&T must learn lessons from this about their role in engaging stakeholders and setting out how rapid tests can be used. The Department must also remain one step ahead in setting the future strategy for the national test and trace service, including how to secure long-term benefits from the vast expenditure it will have incurred.
This is our first examination of NHST&T and its performance. We intend to follow up on progress on the test and trace programme later in the year.
What the government said
The government responded on 31 August 2021. The deadline was 10 May 2021.
Summary written by Accountability Index from the government's response.
The government agrees with each of the Committee's six recommendations on NHS Test and Trace, marking two as implemented and giving target dates of June 2021 and November 2021 for others.
- On published data, it agrees, and the department "will explore the quality of the data" on contact times "with a view to regular publication if acceptable" by June 2021, and is "developing plans to publish estimates periodically" of impact on infection levels.
- On surplus capacity, it agrees and lists the recommendation as implemented, stating the aim "is to run at 80% capacity" while being able to respond to surges.
- On rapid testing, it agrees (target date June 2021) and says it is "in the process of reviewing" its asymptomatic testing plan and intends to publish it, with updates on progress in each setting.
- On the future strategy, it agrees (target date November 2021). It says longer term plans "are being considered and will be finalised with the new Chair and Chief Executive before publication" of the UK Health Security Agency.
Read the government's response ↗ Read the report ↗ Report an error
How the inquiry ran
Each dot is a dated item listed on this page, from the inquiry's opening on 17 December 2020 to 10 September 2021. The dashed mark is the deadline Parliament records for the government's response.
- Oral evidence 18 Jan 2021
- Report 10 Mar 2021
- Government response 31 Aug 2021
- Correspondence 2 letters
What it recommended 9 recommendations · 14 conclusions
2NHST&T still struggles to consistently match supply and demand for its test and trace services,...
Recommended (the committee's words)
NHST&T still struggles to consistently match supply and demand for its test and trace services, resulting in either sub-standard performance or surplus capacity. We accept the need to build surplus capacity into test and trace services to handle unexpected, sometimes exponential, surges in infections. However, the percentage of total laboratory testing capacity used in November and December has remained under 65%, at the lower end of what NHST&T states is best practice (between 60% and 85%). Even with spare capacity, NHST&T has never met the target to turn around all tests (in face-to-face settings) in 24 hours. In September 2020, NHST&T significantly underestimated the increase in demand for testing when schools and universities returned, resulting in poor performance. When the demand for tests surged again over Christmas, NHST&T feels it managed access to tests better, but there were still dips in turnaround times despite apparent spare laboratory capacity. For tracing, the Department accepts that, with hindsight, it did not need to scale 6 COVID-19: Test, track and trace (part 1) up central tracing services for May as much as it did. While it has sought to reduce capacity and increase flexibility since then, low utilisation rates—well below the target of 50%—persisted into October. Recommendation: For all aspects of its testing and tracing operations, NHST&T should identify opportunities to make better use of the capacity it has paid to create. Where it retains surplus capacity, this should be for a clear and explicit purpose. It needs to strike a better balance between meeting surges in demand, maintaining timely services, having eligibility criteria that allow it to identify as many people with the virus as possible, and not paying unnecessarily for surplus capacity.
3Although it had to act quickly to scale up the service, NHST&T is still overly...
Recommended (the committee's words)
Although it had to act quickly to scale up the service, NHST&T is still overly reliant on expensive contractors and temporary staff. To scale up the test and trace service rapidly, the Department and NHST&T worked with a wide range of public and private sector partners, including consultants. By the end of December 2020, the Department had signed over 600 contracts for NHST&T-related services. At the beginning of November 2020, a ministerial announcement said there were 2,300 consultants and contractors working on NHST&T. When we took evidence in mid-January the Department estimated that from Deloitte alone there were still around 900 contractors on the books. In early February NHST&T said it was still employing around 2,500 consultants, at an estimated average daily rate of around £1,100, with the highest daily rate paid of £6,624. It is concerning that the DHSC is still paying such amounts—which it considers to be “very competitive rates”—to so many consultants. Recommendation: NHST&T should put in place a clear workforce plan and recruitment strategy which aim to reduce significantly, month by month, its reliance on costly consultants and temporary staff. NHST&T would benefit from learning lessons on how other NHS bodies manage the need for additional personnel, for example, through staff banks and should explore incorporating these into its approach.
4The introduction of rapid-results testing was supposed to be a ‘gamechanger’ but confusion persists over...
Recommended (the committee's words)
The introduction of rapid-results testing was supposed to be a ‘gamechanger’ but confusion persists over why and how it should be used in different community settings. Around one-third of people who have coronavirus are asymptomatic. There is now a widespread roll-out of rapid tests (primarily lateral flow device (LFD) tests, which give results in 30 minutes) for local authority use and in other community settings, such as schools and workplaces. To support this roll-out, the government allocated a further £7 billion to NHST&T in December 2020 on top of £3 billion already budgeted. The Department had already purchased 384 million LFD test kits. However, a number of reports have raised concerns about the effectiveness and risks of mass testing using LFD tests, given their lower accuracy compared to laboratory- processed tests, particularly the higher risk of ‘false negatives’ (people who actually have the virus getting a negative result). NHS T&T told the committee that a negative test result means that an individual is around 77% likely to be negative for Covid-19. Initial NHST&T and PHE guidance for schools suggested that they could use LFD tests for daily tests as an alternative to self-isolation, but this advice has now been withdrawn. On 21 January, PHE announced that it would pause or scale back the roll-out of mass testing in schools, with further evaluation needed because COVID-19: Test, track and trace (part 1) 7 of the emergence of the new, more transmissible variant of the virus. Following the Prime Minister’s announcement on 22 February, schools will test students and staff regularly using LFD tests, but guidance on rapid testing in schools is yet to be updated. Recommendation: The Department and NHST&T should set out clearly how and why mass rapid testing should be used in each of the settings where roll-out is planned, alongside clear targets and updates on progress in the various sectors. Any plans should take account of the approved purpose and accura
5NHST&T claims to be a learning organisation, but since last May many important stakeholders have...
Recommended (the committee's words)
NHST&T claims to be a learning organisation, but since last May many important stakeholders have at times felt ignored by it. NHST&T emphasises to us that it is “constantly learning what works and what does not” and that it is critical to develop “an integrated team of all the different organisations, institutions and individuals in the country”. However, a range of stakeholders have queried why local authorities and NHS primary care bodies were not more directly involved in testing and tracing activities at the outset, given their existing networks, experience and expertise. Local authorities have subsequently become much more involved, for example undertaking contact tracing for people who are hard to reach. We are also concerned by a lack of engagement with school heads and education stakeholders in the roll-out of rapid testing, and the lack of general public health expertise at senior levels of NHST&T. NHST&T will need to focus more on engagement and collaboration with other sectors if the rapid testing expands to cover an increasing range of settings. Recommendation: NHST&T should review how it engages with and draws expertise from the wider public health establishment and other sectors that are especially dependent on its work. This should include, but is not limited to, local government, the schools sector and the hospitality industry.
6As we hope for longer-term and sustained reductions in infection levels, the Department needs to...
Recommended (the committee's words)
As we hope for longer-term and sustained reductions in infection levels, the Department needs to think about the future shape of national test and trace services, and how it will secure lasting benefits from its spending. NHST&T will be part of the newly formed National Institute for Health Protection (NIHP). However, the Department has not set out the details or timetable for the establishment of NIHP, scheduled for April 2021. In allocating additional funds to NHST&T, the 2020 Spending Review outlined that this funding will be subject to review as the vaccine programme is rolled out. The Government is now accelerating the roll-out of vaccines across the country, but we have not seen a future strategy for test and trace in response. NHST&T anticipates a continuing need for large-scale testing and tracing alongside the vaccine programme and the Department says it still needs to think through how best to wind down capacity at the appropriate time. The Department and NHST&T talk about leaving a legacy for the NHS through the vast investment in testing capacity, but they have not articulated even at a high level what this will be. We challenged NHST&T whether large testing centres were 8 COVID-19: Test, track and trace (part 1) the best way forward for the NHS, compared to having more testing capacity in local hospitals. NHST&T explained “there is not a single model” and that it is yet to “work through how it should evolve in a post-COVID world”. Recommendation: Within the next six to nine months, the Department should outline publicly its future strategy for testing and tracing services in England, including: • its timetable for transitioning to the new National Institute for Health Protection, • its exit strategy when infection levels reduce, including downscaling, mothballing and reallocating national and local capacity; • how it will cost-effectively maintain a degree of readiness for future surges of COVID-19 and other influenza-like infections; and • how it will
1On the basis of a report by the Comptroller and Auditor General, we took evidence...
Concluded (the committee's words)
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department), including the NHS Test and Trace Service (NHST&T).1
7NHST&T’s effectiveness also relies on people complying with its processes, from coming forward to take...
Concluded (the committee's words)
NHST&T’s effectiveness also relies on people complying with its processes, from coming forward to take a test when they have symptoms, to self-isolating in line with requirements. NHST&T noted that the single most important part of the process was people coming forward for testing.18 The National Audit Office also highlighted the low compliance with self-isolation rules, with estimates of the proportion of people fully complying with requirements ranging from 10% to 59%. We are concerned that lack of 10 Qq 13, 43 11 C&AG’s Report, para 1.13 12 Scientific Advisory Group for Emergencies, Thirty-second SAGE meeting on Covid-19, 1 May 2020 13 Department of Health and Social Care, Weekly statistics for NHS Test and Trace; Department of Health and Social care, The COVID-19 dashboard; Office for Statistics Regulation, Ed Humpherson to Stephen Balchin; NHS Test and Trace statistics (England) 14 Qq 27–30; Weekly statistics for NHS Test and Trace; Department of Health and Social care 15 Office for Statistics Regulation, Ed Humpherson to Stephen Balchin; NHS Test and Trace statistics (England). 16 Department of Health & Social Care submission point 2; C&AG’s report, para 3.17 From November 2020, NHST&T no longer contacts household contacts individually; instead the person testing positive is asked to inform their household contacts that they need to self-isolate. This change was intended to “optimise… productivity… by minimising the number of calls made”. In terms of performance metrics, it increases the total proportion of contacts counted as reached, and the proportion reached within 24 hours. See also: https://www.gov.uk/ government/publications/nhs-test-and-trace-statistics-england-methodology. 17 Department of Health & Social Care submission point 2; C&AG’s report, para 3.17 18 Qq 15, 16, 96 COVID-19: Test, track and trace (part 1) 11 compliance is undermining the effectiveness of the test and trace programme.19 When challenged, NHST&T acknowledged more could be done but
8In September 2020, SAGE concluded that “test and trace was having only a marginal impact...
Concluded (the committee's words)
In September 2020, SAGE concluded that “test and trace was having only a marginal impact on transmission”. NHST&T said that the situation had improved, and highlighted that it was now meeting all its operational performance targets for contact tracing.21 22 It also quoted findings from an “independent verified analysis” which suggested that, NHST&T activities in October 2020, may have contributed to a reduction in the ‘R number’ (the number of other people a person with COVID-19 infects) by 0.3 to 0.6 (18–33% of the estimated ‘R number’ in October).23 However, as set out in the analysis published by NHST&T the biggest part of this estimated impact arises from the assumption that people self-isolate for the period between developing COVID symptoms and receiving their test results, i.e. before even engaging with the test and trace system. NHST&T’s model also suggested that only around 10% of the total reduction in the “R number” could be attributed to NHST&T’s contact tracing activities.24 We are also aware that the interim report on the Liverpool mass testing pilot did not find clear evidence that the pilot reduced positive COVID-19 cases or hospital admissions.25 Managing supply and demand
9We found that NHST&T was still struggling to consistently match supply and demand for its...
Concluded (the committee's words)
We found that NHST&T was still struggling to consistently match supply and demand for its test and trace services. In September 2020, NHST&T significantly underestimated the increase in demand for testing, when schools and universities returned.26 Laboratories processing community swab tests were unable to keep up with demand, leading to large backlogs, limits on the number of tests available, longer turnaround times and some people having to travel hundreds of miles to get a test.27 At other times, the issue has been the large amounts of reported capacity, both for testing and tracing, not being used.28
10The Department and NHST&T emphasised to us the importance of maintaining excess capacity in the...
Recommended (the committee's words)
The Department and NHST&T emphasised to us the importance of maintaining excess capacity in the test and trace system, due to the difficulty of predicting the pace and direction of COVID-19.29 While we accept the need to build in surplus capacity to handle surges in infections, we remain concerned that significant mismatches in supply 19 Qq 96–102; C&AG’s report, para 25 20 Qq 25–26, 96–100 21 Q 14 22 See footnote 17 for details of changes in how NHST&T reaches household contacts and the associated performance metrics. 23 Qq 13,25 24 Department of Health & Social Care, The Rúm Model Technical Annex – assessing the impact of test, trace and isolate parameters on COVID-19 transmission in an October-like environment, 11 February 2021. 25 https://www.liverpool.ac.uk/research/news/articles/covid-19-liverpool-community-testing-pilot-interim-findings- published/; https://www.bmj.com/content/371/bmj.m4690 26 Qq 83–85 27 C&AG’s Report, para 17 28 C&AG’s Report, paras 15, 22 29 Qq 46, 89–90, 95 12 COVID-19: Test, track and trace (part 1) and demand do lead to some capacity being persistently under-used. To take the example of laboratory capacity for swab testing, NHST&T intentionally runs this at less than 100%, noting that best practice is to run at between 60% and 85%.30 However, throughout November and December 2020, the weekly percentage of total laboratory testing capacity used (for swab tests administered in community and hospital settings) remained below 65%.31 And even with this apparent spare capacity, NHST&T has never met its target to turn around tests taken face-to-face within 24 hours.32 NHST&T told us its target was to turn these tests around as quickly as possible, with a particular interest in whether people get results the day after they take a test.33 As demand for tests surged over Christmas 2020, NHST&T felt it managed access better than it had in September, but the increase in volumes still led to increased turnaround times, despite apparent spare laborat
11For tracing, the Department accepted that, with hindsight, it did not need to scale up...
Concluded (the committee's words)
For tracing, the Department accepted that, with hindsight, it did not need to scale up central tracing services for May 2020 as quickly as it did. It highlighted the very uncertain environment in April and May and the limited basis it had for estimating the numbers of people it would need to contact and trace.37 For example, the Department initially assumed that on average each person would have 10–30 contacts to trace, but by June the actual average was 2.4.38 The Department did not have any flexibility to change the level of tracing staff for the first three months, but did include break and review points in the contracts. Following this, from August, it built more flexibility into the contracts and reduced the levels of central call handlers it had contracted for. However, even through to October 2020, utilisation rates of central call handlers remained well below the target utilisation rate of 50%, and as low as 1% in August.39 Use of contractors and consultants
12NHST&T relies on contractors for many of its supplies, services and infrastructure.
Concluded (the committee's words)
NHST&T relies on contractors for many of its supplies, services and infrastructure. The Department stated that, to scale up NHST&T so rapidly, it had used a “blended mix” of civil servants, military support, contractors and consultancy support.40 By the end of October 2020, NHST&T had signed 407 contracts worth £7 billion with 217 public and private organisations, of which 121 (or 70% of the contract value) were assigned as direct awards without competition under emergency measures.41 The Department told us that, 30 Qq 45–46 31 Q 46; https://www.gov.uk/government/publications/nhs-test-and-trace-england-statistics-31-december-2020-to- 6-january-2021. The weekly utilisation rate is calculated from the published statistics on available capacity and number of tests processed. 32 C&AG’s Report para 16; https://www.gov.uk/government/publications/nhs-test-and-trace-england-statistics-31- december-2020-to-6-january-2021 33 Qq 128–134 34 Qq 134–143; https://www.gov.uk/government/publications/nhs-test-and-trace-england-statistics-31-december- 2020-to-6-january-2021 35 Qq 38–39 36 Department of Health & Social Care submission point 4 37 Qq 88–89 38 Q 88; C&AG’s Report, para 3.30 39 Q 89; C&AG’s Report para 22, 3.30–32, Figure 22 40 Q 32; C&AG’s Report para 9 41 C&AG’s Report para 9, 1.34 COVID-19: Test, track and trace (part 1) 13 in November and December, it had awarded a further 207 contracts worth £1.3 billion, of which around 30 were direct awards under emergency regulations. It anticipated further reductions in the use of these regulations in favour of competitions and tendering exercises in future.42
13The response to a parliamentary question confirmed that, at the beginning of November 2020, there...
Concluded (the committee's words)
The response to a parliamentary question confirmed that, at the beginning of November 2020, there were 2,300 consultants and contractors working for 73 different suppliers in NHST&T, with a total consultancy cost of approximately £375 million up to that point.43 However, when giving evidence to the Science and Technology Committee on 3 February, NHST&T said that it was still employing around 2,500 consultants.44 When we took evidence in mid-January, the Department estimated around 900 contractors from Deloitte alone were still on NHST&T’s books.45 The Department reported to us that the average cost per consultant was about £1,100 a day, up to a maximum of £6,624 for some consultancy staff.46 It also said it had plans to reduce NHST&T’s reliance on external consultants, although this was dependent on the availability of civil service recruits to fill posts and future demand for test and trace services.47
14We challenged the Department and NHST&T on the value for money and their scrutiny of...
Concluded (the committee's words)
We challenged the Department and NHST&T on the value for money and their scrutiny of these consultancy contracts and associated spend. On day rates, the Department felt it had mitigations in place, including specifying within contracts that services are to be obtained from staff at an appropriate grade, rather than directors and partners by default. It also noted that some consultancies had dropped their normal public sector rates for COVID-19 work.48 The Department felt it had mitigated the risk of profiteering through its approvals and contract management processes, and the way it structured its contracts, e.g. by not committing to fixed levels of volume. It also told us it had “beefed up” NHST&T’s commercial function.49 The Department said that it was as confident as it could be, based on monitoring information, that there was no profiteering, and that it did not have, and had not had, any “red flags” on contractors or contracts linked to NHST&T.50 42 Qq 58–59 43 https://questions-statements.parliament.uk/written-questions/detail/2020–10–14/103454 44 Select Committee on Science and Technology, Oral evidence: UK science, research and technology capability and influence in global disease outbreaks, HC 136, Wednesday 3 February 2021, Qq 1928, 1931 45 Q 47–48 46 Qq 33–35; Department of Health & Social Care, point 3 47 Qq 32, 47; Department of Health & Social Care, point 3 48 Qq 33, 36 49 Q 49; C&AG’s Report para 1.35 50 Qq 50–52 14 COVID-19: Test, track and trace (part 1) 2 Learning lessons for the future Rollout of rapid testing
15In December 2020, the Department announced that it would roll out mass Lateral Flow Device...
Concluded (the committee's words)
In December 2020, the Department announced that it would roll out mass Lateral Flow Device (LFD) testing for schools and colleges in the New Year, building on its earlier use at universities.51 LFD tests give results within 20–30 minutes, compared with the standard PCR swab tests, which must be sent to a laboratory for processing. NHST&T confirmed it was also rolling out LFD tests for key workers, such as in care homes or food processing plants, and for community testing, for people without COVID-19 symptoms.52 To support the roll-out of mass testing, as well as the continued increase in testing capacity, the government allocated a further £7 billion to NHST&T in November in addition to the £3 billion already made available for mass testing for 2020–21.53 The Department informed us that it had already purchased and taken delivery of 384 million LFD test kits, with a further 239 million to be delivered in February. It was in the process of tendering for up to a further 200 million LFD tests by early March.54
16A number of significant commentators, including the British Medical Association and British Medical Journal, have...
Concluded (the committee's words)
A number of significant commentators, including the British Medical Association and British Medical Journal, have raised concerns about the effectiveness and risks of mass testing with LFD tests.55 A particular issue raised is the relative accuracy of LFD tests compared to PCR tests and the higher risk of false negatives.56 Published evidence indicates that LFD tests had a sensitivity of only 77% (broadly, if 100 people with the infection take the test, only 77 of them will return a positive result). NHST&T considers LFD tests a “very useful addition to our overall testing toolkit”.57 But the interim evaluation of the Liverpool mass testing pilot found that, when self-administered, LFD tests overall only detected 40% of positive cases detected by PCR tests. In the evaluation, LFD tests did detect a higher proportion of positive PCR tests—around two thirds—when individuals had a higher “viral load” and were more “substantially infectious”.58 While the authors of the Liverpool evaluation pointed out the benefits of LFD tests in identifying many infectious asymptomatic cases who would otherwise go undetected, they also stressed the need to communicate clearly that when people test negative, it does not provide assurance that they are not infectious.59
17We are aware that the Medicines and Healthcare products Regulatory Agency (MHRA), the government’s regulatory...
Concluded (the committee's words)
We are aware that the Medicines and Healthcare products Regulatory Agency (MHRA), the government’s regulatory body which approves medical devices, approved 51 https://www.gov.uk/government/news/staggered-rollout-of-coronavirus-testing-for-secondary-schools- and-colleges; https://www.gov.uk/government/publications/coronavirus-covid-19-asymptomatic-testing-in- schools-and-colleges/coronavirus-covid-19-asymptomatic-testing-in-schools-and-colleges; https://www.gov.uk/ government/news/all-students-offered-testing-on-return-to-university 52 Qq 13, 16–17, 118 53 C&AG’s Report paras 1.28–1.29 54 Q 117 55 For example:https://www.bma.org.uk/news-and-opinion/the-implications-of-rapid-testing-for-nhs-workers; https://www.bmj.com/content/371/bmj.m4436 56 See, for example, https://www.bmj.com/content/371/bmj.m4916 57 Q 116; https://www.gov.uk/government/publications/evidence-on-the-accuracy-of-lateral-flow-device-testing/ evidence-summary-for-lateral-flow-devices-lfd-in-relation-to-care-homes 58 https://www.liverpool.ac.uk/research/news/articles/covid-19-liverpool-community-testing-pilot-interim-findings- published/ 59 Microsoft Word - Deeks Response 210114.docx (liverpool.ac.uk) COVID-19: Test, track and trace (part 1) 15 the LFD test in December 2020.60 However, we are concerned at media reports that it had advised the Department against using LFD tests in schools for daily testing of contacts of people with COVID-19 (as an alternative to self-isolation), because of the false assurance it may give to those testing negative.61 NHST&T contended that it had worked closely with MHRA on “all the rolling out of different testing protocols”, including piloting and rolling out LFD tests in schools. It confirmed that it was continuing with the process of rolling out LFD tests for people returning to school and for weekly testing of school staff, and that by the time of our session “up to 250,000 lateral flow tests were registered by schools”.62 Despite this, on 21 January, three days af
18NHST&T told us the biggest lesson it had learnt from the last year was that...
Concluded (the committee's words)
NHST&T told us the biggest lesson it had learnt from the last year was that “you can only deliver this sort of service as an integrated team of all the different organisations, institutions and individuals in the country”. It said it had learned a lot about “how to build this coalition between local government and national Government, the NHS, the broader public sector and the private sector—and, ultimately, with the general public as a whole”.65 However, a range of stakeholders have queried why local authorities and NHS primary care bodies were not more directly involved in the government’s approach to test and trace from the outset, given their existing networks, experience and expertise.66 For example, the Local Government Association felt that a lack of consultation with local areas had led to test centres being set up in places that many people had difficulty getting to. Since July, local authorities have assumed a bigger tracing role, setting up their own locally run contact tracing schemes to cover the minority of cases that the national service cannot reach, working in conjunction with NHST&T.67
19The Department acknowledged that it took the decision to build up tracing capacity centrally at...
Concluded (the committee's words)
The Department acknowledged that it took the decision to build up tracing capacity centrally at the beginning because of the need to do this quickly, but it maintained that there had been “a series of conversations” with local authorities and directors of public health. NHST&T stressed that it had always engaged with and had senior representations from local authorities at a national level.68 As of October 2020, the National Audit Office noted that NHST&T’s Executive Committee included one member from a local authority 60 MHRA, https://www.gov.uk/government/news/mhra-issues-exceptional-use-authorisation-for-nhs-test-and- trace-covid-19-self-test-device 61 Q 10; Guardian, https://www.theguardian.com/world/2021/jan/14/regulator-refuses-to-approve-mass-covid- testing-schools-in-england?CMP=Share_iOSApp_Other 62 Q 10 63 https://www.gov.uk/government/publications/daily-contact-testing-in-schools-statement-from-phe-and-nhs-tt- about-next-steps/position-statement-regarding-daily-contact-testing-in-schools-from-phe-and-nhs-test-and- trace 64 https://www.gov.uk/guidance/asymptomatic-testing-in-schools-and-colleges 65 Q 5 66 Qq 86–87; Local Government Association submission para 3; British Medical Association submission paras 1.1–1.8; We Own It submission paras 3–5; C&AG’s report, para 7 67 C&AG’s Report, para 19, 1.24 68 Qq 86–88 16 COVID-19: Test, track and trace (part 1) (out of 15 members).69 NHST&T told us that it had increasingly involved local authorities in its test and trace programme, for example through rolling out community testing.70 It has also established contact tracing partnerships with nearly 300 local authorities, and has plans to increase local support for ‘extended’ contact tracing (when tracers seek to identify where an individual was infected, not just their close contacts).71 However, both the National Audit Office report and evidence submitted by the Local Government Association highlighted a lack of clarity about whether and how much funding was avai
20While we welcome NHST&T’s increasing collaboration with local authorities, we see a need for it...
Recommended (the committee's words)
While we welcome NHST&T’s increasing collaboration with local authorities, we see a need for it to expand its collaboration with a range of other sectors, reflecting the wider scope of the roll-out of rapid testing. In our local constituencies, we heard of lack of engagement with school heads in the roll-out of mass testing for schools, although NHST&T told us there were joint working teams with the Department for Education for activity within schools and universities.74 We also remain concerned at the lack of clinical public health expertise at senior levels within NHST&T.75 Without cross-working processes at different levels, linking well to regions and local areas, and rooted in sound clinical and practical public health considerations, it will be difficult to develop effective collaborations across different sectors on a consistent basis. NHST&T is not just a large- scale customer service organisation; it is a vital public health intervention. The National Institute for Health Protection and long-term strategy
21On 18 August, government announced that a new body, the National Institute for Health Protection...
Recommended (the committee's words)
On 18 August, government announced that a new body, the National Institute for Health Protection (NIHP), would subsume NHST&T, the health protection functions of PHE and the Joint Biosecurity Centre. The executive chair of NHST&T is also acting as interim executive chair for NIHP. The establishment of NIHP is due to take effect from 1 April 2021.76 However, to date, there have been no further details published on the transition arrangements to the new body.
22The 2020 Spending Review allocated £15 billion to NHST&T for 2021–22, to be kept under...
Concluded (the committee's words)
The 2020 Spending Review allocated £15 billion to NHST&T for 2021–22, to be kept under review as the vaccine programme rolled out.77 The government is now accelerating the roll-out of vaccines across the country, but we are yet to see a future strategy for test and trace in response. NHST&T anticipates a continuing need for large-scale testing and tracing alongside the vaccine programme, emphasising that vaccines and test and trace are not “either/or” strategies. The Department noted that there were still many unknowns about the vaccine, and that it still needed to think through how best to wind down test 69 C&AG’s Report, para 1.24 70 Qq 16, 24, 37, 120, 145–146, 71 Qs 24, 37, 93, 120 72 C&AG report, para 19; LGA submission 73 Qq 93–95 74 Qq 77–81 75 C&AG’s Report, para 1.24 76 C&AG’s report, para 1.21; https://www.gov.uk/government/news/government-creates-new-national-institute- for-health-protection 77 https://www.gov.uk/government/publications/spending-review-2020-documents/spending-review-2020 COVID-19: Test, track and trace (part 1) 17 and trace capacity at the appropriate time, and what kind, and level, of capacity would be required in the longer-term.78 If the country does reach a situation where outbreaks of COVID-19 are more localised and sporadic, exhaustive and prompt testing and tracing in those areas will be essential, as outlined in World Health Organisation guidance.79
23Both the Department and NHST&T signalled the opportunity to generate a long- term legacy from...
Recommended (the committee's words)
Both the Department and NHST&T signalled the opportunity to generate a long- term legacy from the vast public investment in, and expansion of, diagnostic capacity.80 However, they have not yet articulated how this is going to happen: NHST&T told us it was still working through how laboratory infrastructure should “evolve in a post-COVID world”. It explained, “there is not a single model” for the laboratories it has set up, which range from entirely private facilities to partnerships between the NHS and private or university laboratories.81 We challenged NHST&T specifically on whether large testing centres were the best way forward in terms of an NHS legacy compared with having more capacity within local hospitals. Its view was that a combination of public and private approaches was preferable, given the different types of testing each undertakes.82 78 Q 111 79 https://www.who.int/publications/i/item/contact-tracing-in-the-context-of-covid-19 80 Qq 44, 111 81 Q 113 82 Qq 41–44,126 18 COVID-19: Test, track and trace (part 1)
Evidence
Oral evidence sessions 1
- 18 Jan 2021COVID-19: Test, track and trace (part 1)4 witnesses, listed belowparliament.uk ↗
Who gave evidence 4 witnesses
- Baroness Dido HardingChair, NHS Test and Trace
- David WilliamsJournalist, Daily Mail
- Jonathon MarronDirector General, Public Health England
- Sir Chris WormaldPermanent Secretary, Department of Health and Social Care
Correspondence 2 letters
- 10 Sep 2021Correspondence from Sir Chris Wormald, Department of Health and Social Care and Dr Jenny Harries OBE, UK Health, Security Agency, re Public Accounts Committee, Forty-Seventh Report of Session 2019-21, COVID-19: Test, Track and Trace (Part 1), dated 22 July 2021
- 23 Feb 2021Correspondence from Baroness Harding, Executive Chair, NHS Test and Trace, DHSC & David Williams CB, Second Permanent Secretary, DHSC, re RUM model technical annex final and RUM model technical explainer, dated 11 February 2021