NHS Test and Trace still ‘heavily reliant’ on consultants, NAO says

Watchdog says headcount of external workers increased between December and April despite pledge to reduce numbers “markedly”
Coronavirus testing message in Liverpool PA

By Jim Dunton

25 Jun 2021

Bosses at NHS Test and Trace have failed to slash the number of consultants at the flagship operation set up to stem the spread of Covid-19, despite assurances to MPs that figures would “reduce markedly”, the National Audit Office has found.

The public spending watchdog said that NHS Test and Trace continued to “rely heavily on consultancy support” in April this year, employing 2,239 – up from 2,164 in December. The NAO’s latest update said that as of mid-April consultants still accounted for 45% of its central staff, although the proportion is down from 76% earlier in the year.

It said the organisation, overseen by the Department for Health and Social Care, had blamed “skills shortages in certain areas of the civil service”, such as data scientists and technical architects, and “comparatively low salaries in the civil service” for the staffing situation. It also said uncertainties over test and trace’s transition to the UK Health Security Agency were a contributory factor.

In January this year, then Department of Health and Social Care second permanent secretary David Williams told members of parliament's Public Accounts Committee that there was a plan in place to “reduce markedly” the number of consultants from Deloitte who were working on test and trace.

Williams – who is now permanent secretary at the Ministry of Defence – said at the time there were “around 900” staff from the consultancy working on test and trace, who he expected were costing £1,000 a day each. He would not comment on reports that some of the Deloitte advisers were billing their services at up to £7,000 a day.

The following month, then head of test and trace Baroness Dido Harding confirmed in writing to the PAC that some consultants working on the operation had been paid up to £6,624 a day for their services. She also appeared to row back from Williams’ assurance that consultancy use would be cut in the long term.

The NAO said today that test and trace’s current plans for reducing consultancy spend included appointing a senior responsible owner for the reduction of the Deloitte contract from 1,035 consultants in February down to 449 in September.

Deloitte tops NHS Test and Trace consultancy tally

Deloitte is far and away the consultancy with the highest value of test and trace contracts, according to a top-10 included in the NAO report. It said the firm had contracts valued at £298m in place with test and trace, and that £174m had been spent by the end of March 2021. IBM UK was in second place, with contracts valued at £40m, with a figure of £21m for spend to the end of March.

Accenture, the Boston Consulting Group and PA Consulting Services occupied the next three places on the tally, each with committed contracts worth £30m and varying amounts of spend. Of the three, Boston Consulting Group had racked up the highest spend value: £28m by the end of March.

Elsewhere in its report, the NAO noted that NHS Test and Trace had an underspend of £8.7bn in its 2020-21 budget of £22.2bn. Test and trace said the underspend arose because the national lockdown earlier this year meant a predicted high level of demand for testing did not materialise.

No data from 600m test kits

The NAO also flagged that NHS Test and Trace had no information on almost 600m lateral-flow device tests that were distributed from October because “only a small proportion” of the 691m tests distributed in England by the end of last month had been registered as used.

It said the largest contract that NHS Test and Trace had awarded using emergency powers during the first three months of 2021 was for lateral-flow device self-tests and that it had been worth £1.9bn. The NAO said test and trace had told it Innova Medical Group was awarded the contract without a competition because it was the only supplier to have secured regulatory approval to supply the tests.

NAO head Gareth Davies acknowledged that NHS Test and Trace had evolved as an organisation in recent months, taking new approaches to reducing the impact of the pandemic. But he said the watchdog’s latest report showed that areas of concern remained.

“Since we last reported in December, NHS Test and Trace has introduced a lot of changes, including mass testing, closer working with local authorities and initiatives to identify and contain variant forms of Covid-19,” he said.

“However, some pressing challenges need to be tackled if it is to achieve its objectives and deliver value for taxpayers, including understanding how many lateral flow devices are actually being used and increasing public compliance with testing and self-isolation.”

'Deeply disappointing'

Public Accounts Committee chair Meg Hillier was more forthright. She said it was “deeply disappointing” that NHS Test and Trace was “still plagued by the same issues” it had been at the start of the year.  

“NHS Test and Trace needs to get to grips with some fundamental parts of the process, such as its timeliness in reaching contacts for all the tests it provides, people coming forward for tests when they have symptoms, and compliance with self-isolation,” she said.

“Meanwhile, budget remains unspent despite the continued use of costly consultants and high levels of unused capacity in the system.

“As we learn to live with Covid, NHS Test and Trace must urgently improve performance to deliver the effective test and trace system we so badly need.”

A Department of Health and Social Care spokesperson said NHS Test and Trace had “played an essential role” in combating the pandemic and that the NAO had recognised many of the rapid improvements that had been made since the organisation was created in May last year.

“The testing and tracing being delivered across the country is saving lives every single day and helping us send this virus into retreat by breaking chains of transmission and spotting outbreaks wherever they exist,” they said.

“While NHS Test and Trace continues to be one of the centrepieces of our roadmap to return life to normal, our new UK Health Security Agency is going to consolidate the enormous expertise that now exists across our health system so we can face down potential future threats and viruses.”

The NAO report warned that transitioning NHS Test and Trace to the new UKHSA, which is due to be complete by October,  risked diverting the operation’s attention away from its efforts to contain the spread of the virus.

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