The NHS test and trace system will not survive without local leadership

Ministers may not be keen on scrapping it entirely, says Andrew Grice, but at the very least they should seek help from councils. There’s just enough time to make it work before schools reopen

Councils have been itching for months to play a bigger role in contact tracing (AFP/Getty)

Boris Johnson is in denial about the government’s test and trace system, sticking to his guns by insisting it is the “world-beating” one he promised by June. His justification is that the UK is testing more per head of population than anywhere in Europe. He didn’t say that only about half the UK’s capacity of 338,000 tests a day is actually being used.

The prime minister can be forgiven for not wanting to admit to another mistake. The list is already longer than any politician would want – the delayed lockdown and quarantine measures; the problems with personal protective equipment; the tragedy in care homes; the disappearing NHS app soon to be relaunched (again).

But Johnson should bite the bullet by conceding that NHS test and trace isn’t working before it is too late. It certainly isn’t working well enough, even for the government’s advisers, the Scientific Advisory Group for Emergencies (Sage). Latest overall figures show that 79 per cent of people who tested positive were traced (down from 82 per cent the previous week) and that 72 per of their close contacts were reached and asked to self-isolate (down from 76 per cent). Only 56 per cent of close contacts handled online or by call centres were reached and told to self-isolate. More complex cases are referred to Public Health England (PHE) local teams.

The government concedes the percentage of contacts reached has declined since test and trace began two months ago, saying this is primarily due to local outbreaks. “These are managed by local health protection teams and have a higher success rate than those dealt with by contact tracers,” its report admitted. The figures are striking. In Greater Manchester’s 10 boroughs, local teams contacted 99 per cent of their targets, while the centralised operation had a 53 per cent success rate locally.

Councils have been itching for months to play a bigger role. Their public health directors have expertise in contact tracing, and they have “boots on the ground” who can go door knocking. Local officials report that their teams have a better hit rate because people are more likely to answer or return a call from a local phone number than an unrecognisable 0300 one which might be a scam or hoax. They say the national system is missing many people in Bame communities because of language barriers.

Council officials believe many people are reluctant to disclose their close contacts because they do not want them to have to self-isolate for 14 days and, in many cases, lose their earnings or rely on £95.85 a week statutory sick pay. The government should make the system more effective by bringing in a two-week furlough payment of their wages in full. It would be a good investment.

Ministers have belatedly agreed to share more information about cases with local authorities. But councils have little confidence in the centralised operation; several in hard-hit areas of the north and Midlands are understandably taking matters into their own hands and preparing to launch their own contact tracing system.

The government has a big decision to make. Its contract with Serco, which provides 10,500 of the underemployed NHS army of 25,000 contact tracers, comes up for renewal on 23 August. The company has just announced a 53 per cent rise in pre-tax profits to £77.5m for the first half of its financial year but insists its contact tracing contract has had little effect on its figures.

Although some emergency spending was inevitable during such an unprecedented crisis, ministers would surely struggle to justify renewing Serco’s contract when a value-for-money reckoning takes place. Independent Sage, the alternative group of scientists who are not among the government’s advisers, says the centralised test and trace system is “not fit for purpose” and that Serco’s contract should be ended. It wants a localised scheme involving PHE teams, GPs and council officials, similar to the one in Germany, Scotland and Wales.

Ministers should go local. Even if they can’t bring themselves to make another embarrassing U-turn by scrapping test and trace, they should at the very least switch more of its £10bn budget to local efforts. So far, councils have received only £300m.

There is still time – just – to make the system work before schools are due to return fully in England next month. A more effective test and trace operation would also ease the pressure to impose 14-day quarantine on people arriving from more countries; an ever-growing list will harm efforts to revive the economy.

But will a centralising Downing Street regime that wants to concentrate power at the centre, whether inside or outside government, be prepared to go local? It gives the impression that it doesn’t want to share power with anyone. It needlessly regards local government as one of its many enemies.

It would be outrageous if Johnson allowed such attitudes to get in the way of creating an effective test and trace operation that could help prevent a second wave of the virus.