Test and trace – ‘world-beating’ system or a Tory privatisation shambles?
Testing and tracing can have a huge impact on reducing the infection rate of Covid-19. Researchers from Imperial College’s Covid-19 Response Team showed in their study the potential impact of testing and tracing strategies on transmission of the virus. They claim that if 80% of cases and contacts are identified, immediately tested once showing symptoms, and contacts quarantined within 24 hours, then the R number could be reduced by up to 26%. The World Health Organisation Director General also said that the most effective way to fight infections is through breaking chains of transmissions, which can be done through testing, isolating and tracing those who have been in contact with the confirmed cases up to two days before they show symptoms.
However, the test and trace system in Britain is far from being adequate and is not meeting the timeliness necessary for effective contact tracing. Half of the confirmed cases receive their test result at least three days after they have been tested. In fact, only 6% of positive cases get a result the next day, down from 63% at the beginning of September.
There are cases of people showing symptoms of the virus being asked to travel hundreds of miles just for a test. Despite the peak in schools, children are not being prioritised for being tested. People who show symptoms but don’t live in ‘hotspots’ will also struggle to get a test. People who do not show one of the three main symptoms are struggling to be tested despite cases of people not showing symptoms still transmitting the virus. Labs processing the tests are not coping with the high demand and swabs are even being sent to other countries in Europe and even to the US, despite their validity then being limited. This can mean tests needing to be redone.
‘NHS’ Test and Trace app
Last week, the NHS Test and Trace app was launched after months of delay. It is an app which is supposed to alert users and ask them to self-isolate if they have been in contact with someone that was later diagnosed as a positive case of Covid-19. Despite having the NHS in its name, the tests processed in the app are operated by private firms such as Deloitte, Boots, Serco, Amazon, G4S, Sodexo, Randox, AstraZeneca and GlaxoSmithKline. In overall, 35 organisations are listed as “data processors”; the vast majority are private firms.
In fact, the app does not include test results that were processed by the NHS. A few days after the app was launched, a patient wanted to update the app with their Covid test result was told by the app’s own account on Twitter: “If your test took place in a Public Health England lab or NHS hospital, or as part of national surveillance testing conducted by the Office for National Statistics, test results cannot currently be linked with the app whether they’re positive or negative.” On Friday 25 September, over 61,000 tests were conducted by the NHS and PHE, which shows it is not a minor ‘flaw’.
The app is just one example of the outsourcing of the whole Test and Trace system.
Test and Trace was launched in Britain on 28 May with £10 billion allocated to the scheme. Initially the tests were processed by NHS and PHE labs only. Meanwhile, the Tories contracted Deloitte, an accounting firm, to build a new testing system. Despite not having anything to do with healthcare, this was the second contract Deloitte was given. Deloitte was also responsible for the supply and provision of PPE during the first wave of the pandemic. To say this hasn’t been very successful would be an understatement.
Almost every part of the Test and Trace system is privatised. Deloitte runs the booking site of Covid tests. Companies such as Serco, G4S and Sodexo were also subcontracted to run the test centres. The labs used to process the kits are also privately-run. Some of the swabs used for testing are sent to privately-run Lighthouse labs, that are using different equipment than the NHS. So there is no ability to coordinate in case of either lab being overcapacity. The tests are also processed by university and pharmaceutical labs such as GlaxoSmithKline and AstraZeneca.
The testing kits are provided by Randox, which has voided more than 35,000 used test kits since the start of August. In addition, 750,000 unused Randox testing kits were recalled over safety concerns. Yet Randox received £133 million for Covid testing. Is it a coincidence that Randox pays Tory MP and former Cabinet minister Owen Paterson £8,333 a month as an adviser? Probably not.
Even the logistics of delivering the test kits is private and run mostly by Amazon and DHL. Amazon showed its reckless approach to safety during the pandemic when warehouse workers in France had to go on strike to demand the bosses provide hand sanitiser and to protest overcrowding. Amazon, which is known for its aggressive anti-union policies, threatened the workers with suspending all of its activity in the country as a result of their action.
Adding to this shambolic conduct, the contract of the Tories with Deloitte does not require Deloitte to “report positive cases” to either Public Health England or local councils. The local lockdown in Leicester came as a surprise to the residents. It was only a few days beforehand that the outbreak in the city was known about at all because the council was only receiving test results from the NHS. Read more here about what Socialist Alternative members in Leicester say.
In the first wave of the pandemic, the Tory government was rightly criticised for failing to meet the testing targets. Now, over ten months since the first outbreak of Covid-19, there are no excuses. Failing to meet demand for testing as soon as there is a spike in cases raises the question of why production was not completely repurposed for meeting the need for all medical equipment in regards to testing, such as reagents, swabs, testing kits and training of more staff.
The capacity for processing tests was shaped by cuts and closures of labs in the mid 2000s. As Paul Hunter, professor in medicine at the University of East Anglia, writes: “Many of the laboratories in the old network (The Public Health Laboratory service) were shut down, taken over by local hospitals or merged into a smaller number of regional laboratories.”
The capacity of testing is also clearly shaped by the Tory government favouring private firms in running healthcare services. Biomedical science Unite members, who are qualified to carry out testing, say they feel the NHS facilities and resources are not being used to their full capacity, instead private labs are prioritised. A Unite biomedical scientist member said: “We have been ignored in favour of private laboratory enterprise…we cannot get hold of reagents as they are being directed to private labs first. We could have achieved the required testing capacity from day one as we have the staff.” In addition, 85% of the surveyed members said they were concerned about the service quality from Lighthouse Labs and 90% were worried about transparency and arrangements for these laboratories.
The tracing begins after a person becomes a confirmed case of Covid-19. The patient has to provide information about their contacts in the 48 hours before becoming ill and provide details about places they visited. If they visited a high risk setting such as a hospital or a care home the case is defined as ‘complex’ and reported to local health and local government authorities to control the potential for an outbreak. All other cases are defined as non-complex. Initially contacts were contacted via an email, a text message or through a phone call, and now will be informed through the new app as well.
Tracing for non-complex cases is operated by Serco and Sitel. Right from the start it was apparent that the call handlers are not reaching a significant portion of cases and contacts. Around 20% of confirmed cases of Covid are not reached at all. And those who were reached, only around 60% of their contacts were contacted. There have also been reports by those who work as a part of the Test and Trace team saying they rarely make any phone calls. Alex Lee, a former BBC journalist and a healthcare professional, was working for the service and reported she had to call only one person in a period of three months.
In contrast, in response to a rise in cases on a local level some local authorities, such as Sandwell and Blackburn with Darwen, developed local contact tracing processes for non-complex cases and were able to contact nine out of 10 of the individuals that the call handlers were unable to contact.
Lisa McNally, director of public health at Sandwell Council told BBC West Midlands on 30 July: “We need to do it ourselves. We won’t be waiting to see which four people Test and Trace fails to reach – as by then it is too late,”. She also said that the council “had to really lobby” for quite a while to be “getting data on the personal information of positive cases”.
Recently it was announced that 6,000 jobs (out of 18,000) of the Test and Trace national team would be cut and some will be joining the local authorities’ teams.
Despite the deficiencies of the operation by Serco and Sitel. Their contracts are likely to be extended. The contract with Serco is worth £108 million and could reach to £432 million if extended into the new year. Local authorities were provided with only £300 million to deal with tracing.
Winter is coming
The upcoming winter will make it even more difficult to access tests and treatment. Already the situation, with many people unable to access testing and asked to travel hundreds of miles for a test, raises the critical necessity to increase the capacity of labs and test centres.
The underfunded NHS was brought to its knees after a decade of austerity and cuts as could be seen clearly before the pandemic. This was painfully demonstrated by the picture of a four-year-old boy lying on a coat in a hospital corridor in Leeds last winter.
As every winter brings the flu season, with similar initial symptoms as Covid-19, many households will need to self-isolate without access to full sick pay and with fines for breaking the regulations starting at £1,000. The draconian fines system, which can reach to £10,000, might deter people from going to be tested in the first place. This is not a policy to fight infections but a robbery of the poor. To prevent people from being forced to choose between going ill or going hungry, we need guaranteed full pay while self-isolating.
The Tories sell off the NHS
The dire functioning of the Test and Trace system reveals the failure and deficiencies of the privatisation of the healthcare system. From the provision of PPE to Test and Trace, the Tories have used the pandemic to increase privatisation of the NHS and give their big business friends fat contracts at the expense of the NHS. Serco, for example, has direct links with the Tory party; Edward Argar, the health minister was a senior executive; and the chief executive of Serco, Rupert Soames, is brother of a former Tory MP.
Rupert Soames also exposed the interests of big business in privatisation of the NHS. He wrote in an email that was leaked in June that he wanted the Test and Trace system to “cement the position of the private sector” in the NHS supply chain.
This must stop. We need to see a mass trade union-led movement of health workers and patients’ organisations to defend our NHS, including demanding that the entire Test and Trace system is brought into public ownership. Private labs, test centres, testing kits and other healthcare facilities need to be nationalised – with compensation only on the basis of proven need – and run by the NHS under the democratic control of health workers. This should be as part of a broader campaign against the privatisation in the healthcare service and for a fully integrated, fully nationalised and fully funded NHS.