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Poor controls hamper test and trace effort

MPs on the Public Accounts Committee highlighted ineffective performance data and over-reliance on private consultants in a report that questioned the effectiveness and value of the government’s test and trace programme.

12th Mar 2021
Editor in Chief (interim) AccountingWEB
Columnist
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Covid-19 testing - were results effectively used?
iStock_Covid test_Courtney Hale

MPs on the Public Accounts Committee highlighted ineffective performance data and over-reliance on private consultants in a report that questioned the effectiveness and value of the government’s test and trace programme.

As part of an ongoing investigation into the operation, performance and resourcing of the NHS Test & Trace Service (NHST&T), the Public Accounts Committee issued an interim report this week. So far, the committee reported, the test and trace programme has run up £5.7bn in costs, with up to £37bn projected over two years.

In spite of the “unimaginable” sums showered on NHST&T, the PAC concluded: “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.”

The report acknowledged that NHST&T was set up and staffed at incredible speed, but echoed criticisms from a range of stakeholders that the government opted to build a new infrastructure from scratch rather than working more closely with local authorities.

As millions of pounds money flowed out to hundreds of private consultants, “The government did not document with a business case the basis for the delivery model it initially chose until September,” the PAC stated.

Questionable results

In a pandemic, it’s vital to track down people who might have been exposed to the infection quickly so they can self-isolate. Unfortunately, but through to the end of 2020, the service failed to hit its internal target to provide results within 24 hours of an in-person test.

Figures from a National Audit Office (NAO) Covid-19 report, cited extensively by the Commons study, showed that sub-24-hour turnaround times peaked at 93% in June but subsequently dropped to 14% in mid-October before recovering to 38% in early November.

Performance data

While not directly responsible for the famous test results spreadsheet mishap, NHST&T has been hampered by collecting lots of data that does not necessarily prove its effectiveness, the PAC concluded.

NHST&T publishes a daily data dashboard and weekly statistics on a range of performance indicators such as the number of tests carried out and people contacted, and test turnaround times.

“These indicators cover individual stages of the test and trace process but do not provide information across the test and trace process from beginning to end (‘cough to contact’),” the report noted. In the absence of data that demonstrated how long it took someone for someone with symptoms, or exposed to an infected contact, to self-isolate, the Office for Statistics Regulation said that it was not possible to judge “the impact the programme has on reducing the spread of Covid-19”.

According to the NAO, at the end of October the median time taken between an original case presenting symptoms and their contacts being traced and advised to self-isolate was 119 hours. This average time had been reduced to 78 hours by the beginning of February, but still falls short of the organisation’s internal target of 48–72 hours, the PAC revealed.

Poor data makes for poor decisions. Digging into the NAO’s December report reveals evidence about how NHST&T was caught out by a sharp rise in demand for testing when schools and universities reopened in September 2020.

Testing labs were unable to keep pace with the volume of tests, which led to backlogs and rationing that further lengthened turnaround times – with some potentially ill people directed to test sites hundreds of miles away.

Outsourcing and value for money

If only there were some accountants available who could bring some process and controls to such a chaotic operation, a professional reader might wonder. Think again. One of the most prominent organisations among the 217 that signed contracts with the Department of Health and Social Care was Big Four accountant Deloitte.

A ministerial response to a parliamentary question confirmed that at the beginning of November 2020 2,300 consultants and contractors were working for 73 different NHST&T suppliers. They accounted for approximately £375m of the £7bn committed to test and trace up to that point. Around 70% of the contract values were awarded without competition under emergency measures, the NAO reported.

Deloitte attracted the MPs’ attention with its eye-watering top daily rate of £6,624. In evidence to the PAC in mid-January, the DHSC estimated that around 900 Deloitte contractors were still working for NHST&T at an average cost of £1,100 a day.

The health department told the committee it planned to reduce NHST&T’s reliance on external consultants, but 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 and had reduced the risk of profiteering by beefing up its contract management processes.

The MPs nevertheless concluded: “It is concerning that the DHSC is still paying such amounts - which it considers to be ‘very competitive rates’ - to so many consultants.”

The combination of poor financial oversight and questionable performance makes for depressing reading and contradicts bullish ministerial claims about the UK’s “world beating” test and trace capability. It also calls into question the role that Big Four accountants like Deloitte have played in promoting private sector-led solutions to large-scale public challenges.

With another report due from the PAC and continuing calls for a full public enquiry into government handling of the pandemic, it’s unlikely that this is the last time we’ll hear these arguments.

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