Baroness Dido Harding, the head of NHS Test and Trace, has defended the service’s reliance on private companies and consultants, saying it has been necessary to draw on "all the talents across all of society".
Appearing before the Health and Social Care Committee of MPs yesterday, Harding insisted it was accurate to refer to test and trace as an NHS service, despite large portions of its work being outsourced to private companies.
And she defended the use of external consultants to set up the organisation, saying civil servants alone could not have been asked to do the same job because test and trace was not a permanent organisation when it was set up in the spring.
“We stood this service up in May at extraordinary speed, we built something that’s the same size of Asda in the course of five months. When you start something very quickly you need to pull on all the talents across all of society,” she said.
“You can’t offer people permanent jobs when you don’t have a permanent organisation, so you have to employ people either as independent individual consultants or through consultancy organisations.”
Officials have been transferred and seconded between departments in the past to work on short-term projects, as happened in large numbers as the civil service prepared for Brexit.
As CSW reported this summer, McKinsey & Company banked £563,400 to help define the “vision, purpose and narrative” of test and trace. The Department for Health and Social Care later paid the firm £385,400 for six weeks' work to help determine daily coronavirus testing capacity.
Asked if officials could have done the work of consultants brought in to aid Test and Trace, Harding said “We need both.”
“To stand a service up at this speed we have needed to call on the talents across the whole of society, both the public sector and private sector. As the organisation becomes more established and more permanent we are able to offer people more long-term permanent jobs and we are seeing the proportion of civil servants grow,” she said.
‘That’s its name’
During the session Zarah Sultana, a committee member and Labour MP, asked Harding whether it was accurate to refer to her organisation as “NHS Test and Trace”, given the extent to which private companies were involved.
She noted that of the 35 organisations listed as data processors for test and trace, 22 were outsourcers including major government contractors Deloitte, Serco and G4S.
Just four are NHS bodies, she said. Four are Public Health England labs, one is the Ministry of Defence and four are Lighthouse Laboratories – public-private partnerships between organisations including the Department of Health and Social Care, the publicly-funded Medicines Discovery Catapult, universities and the pharma giants GlaxoSmithKline and AstraZeneca.
Responding to Sultana’s question, Harding said: “That is its name”.
“NHS Test and Trace is a free at the point of need service that we’ve built together, as you’ve rightly listed, with a whole group of different parts of society to deliver something at extraordinary scale,” she said.
“But it absolutely meets our basic fundamental NHS values as a clinical service available to everyone when they need it.”
And she said that NHS labs – which make up a small proportion of those processing coronavirus tests – were “plainly... an integral part of our overall ‘team of teams’”.
‘No one could have predicted’ demand
During the hearing, Harding also admitted NHS Test and Trace had not predicted a surge in demand in September, which led to a backlog and delays in test processing.
She said she recognised that the “balance between supply and the demand forecast wasn't right” around the time children returned to school. Reports at that time showed people unable to get coronavirus tests or being told to travel hundreds of miles to test sites in some cases.
“What happened, not so much in August as in... the first couple of weeks in September, as schools came back, we saw demand significantly outstrip that planned capacity delivery,” she said.
“With the benefit of hindsight, could we have built testing capacity faster? Well I'm not actually sure that anyone could,” she said, adding that Scotland had seen a similar surge in demand as schools returned. “None of us were able to predict that in advance,” she said.
Pressed on her comments, Harding clarified that she had meant test and trace “did not anticipate the exact amount” of tests that would be needed, “but we were expecting demand to grow and we were growing capacity faster than any other European country to meet it”.
She said the service had “met [its] commitments to get that supply and demand into balance” over the last six weeks and that access to testing is now “completely unconstrained” throughout the UK.
But she would not be drawn on when demand for tests might peak again, saying only: “My view is that we need to keep expanding testing capacity significantly and substantially.”
She directed the question to test and trace’s medical adviser, Dr Susan Hopkins, who also appeared at this hearing, saying: “In the end, this is about a view on where we think the disease will progress”.
‘Not a silver bullet’
Harding also said testing and tracing was not a “silver bullet to holding back the tide of Covid”.
However, she said the system was partly to thank for the lower rates of infection when England entered its second lockdown this month, compared to at the beginning of the first lockdown – along with behavioural changes including social distancing and increased hand washing.
“It’s very hard to disaggregate between the two, but there’s no doubt that the rate of growth of infection is much slower than in that first wave, and our ability to understand where the growth is spreading fast is so much better than it was, so we’re able… to act more locally and regionally,” she said.
Harding, whose select committee appearance came the same day as plans for a rapid coronavirus testing pilot across several areas of England were announced, said the NHS was in the process of “moving to the next stage of tailored testing”.
“Capacity really isn’t the constraint at all – there are millions of these to be deployed. The question is, how to work through these cases but make them fit with the way we live our lives,” she said.