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NHS Test and Trace

Volume 813: debated on Monday 28 June 2021

Private Notice Question

Asked by

To ask Her Majesty’s Government what assessment they have made of the effectiveness of the NHS Test and Trace system.

My Lords, NHS Test and Trace currently provides 6.5 million virus tests each week, with more than 80% of in-person test results received within 24 hours. It successfully traces 92% of positive cases and 90% of their identified contacts, with more than 80% of contacts reached within 48 hours of someone reporting symptoms. Test and trace is continuously improving the speed and reach of its services and further enhancing the role of local authorities in community testing and contact tracing.

My Lords, the Innova lateral flow test purchased by the Government without open competition at a cost of more than £3 billion was last week described by the US Food & Drug Administration as not proven; it said it should be thrown in the bin. Why do the Government still maintain that the Innova lateral flow test is effective, safe and offers value for money to the British taxpayer?

My Lords, the Innova test has gone through the rigorous Porton Down assessment process that the UK uses for coronavirus testing approved by the MHRA, the independent regulator for medicines and medical devices in the UK. I reassure the noble Lord that there is rigorous assurance work in the lab and in the field to ensure that Innova tests consistently perform to the required standard.

My Lords, will the Minister go back to her department and the Department for Education to see whether we can get some consistency in the advice given by directors of public health in relation to sending children home when someone in the year group or the bubble—whatever advice might be given at any time—tests positive? There are some quarter of a million young people out of education today because of the varying advice. It would be good if we could sort this out.

My Lords, I assure the noble Lord that I will take up that point with the Department of Health and Social Care and the Department for Education. We are piloting a programme of daily lateral flow tests as opposed to self-isolation; perhaps that might help avoid such situations in future.

My Lords, does my noble friend the Minister agree that, given the challenges we have of speed, confidence, reach and public compliance, we need a comprehensive and independent assessment of why the rate of tests registered has been low and to make improvements to the system, so that the UK Health Security Agency can be strongly resourced to face down future threats and viruses?

I believe my noble friend may be referring to the low rate of registration for lateral flow tests issued for asymptomatic testing. That is something we are looking at very carefully. Around 40% of people say they have taken tests but not registered the results. NHS Test and Trace is taking steps to improve the registration of test results by streamlining the reporting process and improving communications about the importance of reporting results.

My Lords, test and trace can work only if those who are told that they should isolate do indeed isolate. I believe that companies are now being paid to send people to knock on doors to check whether people are at home as they should be. One report stated that the hit rate was 40% success. Can the Minister tell us the current rate of success on that sort of check?

My Lords, I do not have data for those who might be physically checked in their home, but the ONS conducts surveys of those who have been asked to isolate, which show a higher compliance rate of about 80%. The Government’s focus in ensuring isolation is to provide the right incentives and support for people to isolate, including, for example, the £500 self-isolation payment for those on low incomes. We take enforcement measures, but we seek to persuade and then enforce.

My Lords, I refer the Minister back to her answer to my noble friend Lord Scriven. The American FDA pointed out that the previous analysis pointed to Innova providing false statistics. What new evidence do the Government have that the FDA is wrong?

My Lords, my understanding is that the Innova test has passed the UK’s assessment process and that ongoing assurance work is conducted in labs and in the field to ensure that the tests consistently perform to the required standard. My understanding is also that the latest evidence suggests that Innova lateral flow devices have a specificity of around 99.97%.

My Lords, this morning it was announced that Serco had been awarded a new contract with the Department of Health and Social Care worth up to £322 million to continue providing Covid test-and-trace services. Will the Minister justify this just days after the NAO review found that 600 million tests were unaccounted for, and that the £22 billion scheme was still missing targets and was wracked with problems? Can the Minister explain why more taxpayers’ money is being handed out to what has been found to be an ineffective and inefficient company instead of supporting local public health teams to do this work?

My Lords, more than 80% of the budget for test and trace goes towards the testing part of that programme. That has proved highly effective. The programme is working to increase its partnership with local authorities and local directors of public health. We are also reducing our reliance on private sector contractors by around 17%, but we recognise the work that those partners have done with us in building up the system over the past year and continue to work with them where it is in the best interests of the country.

My Lords, the latest variant is pretty mild—deaths have gone right down—but we are spending billions of pounds on this, while huge waiting lists are building up in the NHS. Is it not about time that this programme was wound down and the money spent on the millions of delayed operations and procedures?

My Lords, we are looking at the evidence in relation to the variant and the effectiveness of the vaccine against it all the time. I assure my noble friend that additional resources have already gone into the NHS to catch up on those waiting lists that have grown because of the pandemic. If we were to get this wrong and there were increased hospital admissions due to Covid, we would not be able to make the progress that he and we all want to see on tackling those waiting lists.

My Lords, the recent National Audit Office evaluation of the track and trace performance revealed that the programme is still not as effective as promised and relies heavily on the use of expensive management consultants. Does the Minister agree that more independent medtech and diagnostic providers should be incorporated into the test and trace programme to meet demand, and can she elaborate on the cost-benefit analysis?

My Lords, the test and trace programme seeks to partner with all organisations that can help its effectiveness: the private sector, public health authorities in local areas and the NHS. SAGE recommends that an effective contact-tracing service should trace 80% of contacts within 48 to 72 hours of someone reporting symptoms and ordering the test. Test and trace has achieved the 72-hour standard since January 2021 and the more stretching 48-hour standard since March this year.

My Lords, I follow the line of questioning of the noble Lord, Lord Moynihan, and the noble Baroness, Lady Wheatcroft. According to the NAO, test and trace

“is responsible for … public compliance”—

but it has no targets for increasing the number of symptomatic people coming forward for testing, the uptake of lateral flow tests or compliance with self-isolation. All three are vital to the success of the scheme. Why are there no targets?

My Lords, test and trace is working to improve performance across all those areas, in particular through the community testing programme. Local directors of public health are playing a leading role in targeting testing to those parts of their local communities where it will have the greatest impact. In addition, all 314 local authorities in England have local tracing partnerships working with test and trace to improve performance in those areas.

My Lords, to return to my noble friend Lady Thornton’s question, economy, efficiency and effectiveness are the National Audit Office’s and the Public Accounts Committee’s measures of confidence in public expenditure. On economy, do the Government regard the £22 billion budget of track and trace as good value for money? On efficiency, is a response rate of 14% on 700 million kits an efficient use of resource? And on effectiveness, do not European calls for the quarantining of UK tourists suggest a total lack of confidence in our tracing systems here in the United Kingdom?

My Lords, the noble Lord is correct that the Government allocated £22 billion to test and trace in the last financial year. As I said, more than 80% of that has been allocated to testing. He is absolutely right that we have sought opportunities to drive down costs where possible and free up resources. We have taken a number of steps to reduce costs, including through commercial negotiations with suppliers, which have released £2.2 billion of savings, and technological advancements. A further £6 billion of savings were achieved by lower demand, changing priorities and deferred activities during the national lockdown from December to March.

My Lords, this pandemic is far from over. We also know that testing has to go hand in hand with tracing to be effective. The Minister mentioned local authorities playing a vital part. Is she satisfied that what we have at the moment is a sustainable system of sufficient support for our directors of public health, to marshal us for future demands in a way that is both effective and responsive to the communities they serve?

My Lords, we have recently increased the resources available to local authorities—for example, in the amount of money they have for discretionary payments to support those who are self-isolating. The noble Baroness is absolutely right about the importance of partnership in this work, and in particular the role of local authorities and directors of public health, to ensure that the uptake of testing is as high as we need it to be. We find that, once people are tested, they do tend to self-isolate.

My Lords, will the Minister say how many firms of management consultants have been employed on the test and trace system since it began? Were they all appointed by competitive tender, and what evidence is there that this is money well spent?

My Lords, I believe that all the processes in setting up test and trace will have followed the relevant guidance on both the use of private-sector consultants and how the processes for tendering should take place, and I am sure that we will continue to ensure that that is the case.

My Lords, research has shown that many people will not co-operate with test and trace because those on low income or in insecure employment fear the loss of vital income when isolating. What assessment have the Government made of the impact of this in delta hotspots?

My Lords, we are continually working with local authorities to understand, for example, the uptake of the support payments available to those on low incomes who need to self-isolate. One of the challenges we have found is low awareness of the support available. We are working with local authorities, particularly in hotspots, to see what we can do to improve the communication of that available support—not just financial support but social support for those who may then need to isolate.