Outsourcing Test and Trace: child’s play or obsessive ideology?
This is my third article on the national Test and Trace operation. I have tested the patience of the editor, and now readers because I believe close scrutiny of the national, centralised Test and Trace system provides insights into the real nature of the neoliberal, ideological approach to public policy that has become orthodox authority in Britain, even in areas of life that already provide established, proven and professional public services, especially complex areas in science and medicine – such as Public Health; and the excessive insistence on using free market models of service provision even where it is inappropriate, such as its gratuitous insertion into a national pandemic crisis. It follows that in the case of the newly developed Test and Trace operation in 2020, this is not a public crisis suited to ‘free market’ solutions, but rather presents us with an ill-considered, dogmatic but straightforward operation of crude Government patronage, in this case to promote private sector, ‘free market’ absolutism, but using a technique that would be instantly recognisable for what it is, even to that master of selective political patronage Robert Walpole, who operated as ‘PM’ three hundred years ago. Some things never change. This approach to government has the advantage of neither merit nor necessity in the twenty-first century.
The latest developments in our public knowledge of the national Test and Trace system that the Government initiated early in the pandemic with Baroness Dido Harding at the head (Harding was appointed to the brand new operation in May, 2020), include an important meeting of the House of Commons Select Committees of Health and Science together (10th November), with key witnesses called to review the Test and Trace system. This event is the principal subject of this article. My recommendation is that readers view the full event for themselves; but it runs for a little over three hours, and I understand both reticence or unwillingness to spend the time; but it is possible to dip into it. I have attempted here to summarise the issues that were, to me of particular note. I am a critic of the national Test and Trace system, and for those who disagree with my perspective, I invite them simply to view the Select Committee and draw their own conclusions about the evidence – I ask no more; it was noticeable to me that most of the MPs asking questions appeared unconvinced by Harding’s evidence, and they were drawn from across the floor of the House of Commons.
For the avoidance of doubt, I believe that testing and contact tracing should be managed and executed under the scrutiny of politicians, but run by highly experienced public health, medical and scientific professionals, principally as a largely devolved, locally managed and run operation as was the proven, long established case throughout Britain until 2010, when the instinctively centralising Conservative Government dismantled the existing public health system under the guise of austerity, but with the purpose of replacing it with a neoliberal, free-market system ill equipped to tackle a national crisis and world pandemic, should it arise. Operation Cygnus in 2016 proved the failure (see my previous article). I believe the new Test and Trace system has failed, and will continue to absorb resources, delay effective responses and provide an unsatisfactory service at greatly inflated cost, until it can be claimed to be working, in order to save the face of a government that was spectacularly wrong. I find it difficult to believe that anyone beginning with a tabula rasa, would decide deliberately on rational, informed grounds to construct a test and trace system for Britain, in a short space of time in the centralised form chosen for the Dido Harding operation; save to ensure the prime opportunity for the private sector not only to participate, but to take a leading part; and to learn at its leisure and in its own time acquire the experience to operate effectively, however long it takes, whatever it costs; all in the middle of a pandemic.
Dido Harding, the head of Test and Trace appeared before the House of Commons Health and Science Select Committee (two committees combined) on 10th November. For those inclined to sit through the whole three hour sitting, or view it selectivity, the link to the Select Committee event is provided here.
It is worth saying that the first set of expert witnesses examined, before Dido Harding’s evidence was taken, provide illuminating and well informed evidence; usefully framed by the first witness, Sir Chris Ham (Coventry and Warwickshire Health Partnership, CEO of the King’s Fund, 2010-2018), which comes early and establishes a useful benchmark for understanding of the issues. For those who would seek to criticise the overall performance of Public Health England (PHE) throughout the pandemic, it is worth remembering that the principal causal, or perhaps culpable party here is the Conservative Government that set it up, and the public health professionals in PHE are simply making the best of a bad job that in very many cases they neither initiated nor sought (see my previous article in Bella Caledonia ‘Without a Trace’).
On testing, Sir John Bell, Regius Professor of Medicine, Oxford University and a powerful influencer, provides invaluable evidence at around 1 hour, 18 minutes on. Bell is particularly valuable on the links between test and trace and the psychology of public responses to the demands of isolation; he emphasises the need to encourage those testing positive, or their contacts to accept restrictions through what he terms individual ‘enablement’ rather than in an atmosphere of negativity, of accusation, failure and severe disablement of activity. Recent developments in science and methods to tackle the virus are now increasing the opportunity to develop policies of ‘enablement’.
On Harding’s contribution, I would point to her answer to Jeremy Hunt MP’s (Chair of the Health Committee and Conservative ex-Health Minister) very first question, which neatly encapsulates the problem; asked about the quantum of her monthly total Budget and its allocation between national and local test and tracing services, Harding could not answer; the figures were not to hand. Harding much later in the meeting closed her whole, lengthy evidence by again failing to provide basic statistics requested by Greg Clarke MP (Conservative), Chairman of the Science Committee, on the success of test, trace and isolate to meet the 48 and 72 hour targets; who was quietly acerbic in his response to Harding’s inadequate answer, reflecting that providing this kind of information was presumably “the whole point of your organisation”. Harding demurred, emphasising this was subject to ongoing work (six months in and waiting), and few if any countries were doing as much to provide national information on this scale as her operation. We may wonder then, whether given the time-scale, the delay in achieving these elusive facts, and the relentless advance of the virus, whether in fact the game was ever worth the candle; or whether it is a good idea to attempt to reinvent the wheel, and then change it while you are actually driving the vehicle at high speed. Why are we doing it this way, if it cannot be done expditiously? The virus is not waiting until Baroness Harding is ready to tackle it.
The Test and Trace budget, as Hunt had gently pointed out to her earlier failure to provide information, is her responsibility; but we were then treated to the classic rigmarole of the floundering executive; a discursive, bureaucratic description of the budget structure, rather than an explanation of its logic, purpose or priorities. Examined by Dawn Butler MP (Labour) on the extensive use of highly rewarded external consultants, Harding defended the practice as necessary to build the new structure; notably begging the question, since the particular expertise of the management consultants does not appear to have been in public health, but the private sector: or that some of the management structure, and consultancy may have been required to develop processes to serve the needs of the private sector outsourcers. None of this is clear, but whether the consultancy or structure serve primarily the needs of public health remains a matter of contention. The same MP, who had written to Harding after her last Select Committee appearance in September, and never received a reply from Harding, took the opportunity to ask the same questions again, and raised the matter of a £2Bn overspend in Test and Trace (when the Chancellor suddenly announced the budget for Test and Trace was £12Bn, not £10Bn), which Harding explained was spent in order to build up the testing operation; revealing the heavy priority given to ramping up testing volumes, and the readiness of the government to throw money there. It remained a mystery why civil servants, public health specialists in the public sector, and local networks could not have developed a sound public health system, especially if lavished with a £12Bn budget, without extensive support from management consultants and Dido Harding’s operation. The question that could be asked is whether the centralised national panoply of the Test and Trace management and operational structure would be required at all in this form if its principal purpose was not to make room for, meet the needs of, and provide a profitable opportunity for the private sector in public health? Indeed, I predict that management consultants, principally on the strength of involvement in Test and Trace, will now begin to advertise their credentials to the world as experts in Public Health, solely on the back of the insertion of private sector consultancy into the Harding operation; this, after all is how “market” economics actually works in our faux-market economy.
On the detail of Test and Trace operations, it became noticeable that much of the critical content of the questions asked by MPs was simply passed on by Harding, who is not a public health expert or medical professional, to be answered by Test and Trace’s Chief Scientific Adviser, who attended. It was very striking that Harding was not only not the master of the Budget brief for which ultimately she is responsible, but most of the critical questions of the committee on the substantive operations of Test and Trace were simply passed on by Harding, confessing these were best answered by the scientific experts; here represented by the Chief Scientific Advisor, who explained the real meat of Test and Trace Operations. Later, Harding was robustly challenged on deferring to a scientific advisor on future infection rates, implicitly on the grounds that scientists advise policy, executives decide policy; which was defended by Harding resorting to circularity, acknowledging again she was not an expert.
Pressed on where effort should be directed between local and national tracing services, Harding gave the Delphic response that in the urgency of the pandemic both were needed, but conceded that more resources were now directed to the local contact tracing. The questioner was not convinced by the reply, expecting Harding to give a cogent explanation of how the balance was struck. Lurking beneath this exchange, I believe rests an important issue, highlighted by the deferral to expert knowledge by Harding. Putting it simply, is a management consultant, by background, training, knowledge and experience the best person to take critical decisions between investing the balance of resources towards centralised or local contact tracing in public health? This is not the same case as SAGE, where SAGE advises, the democratically elected politicians decide. The political decision has already been decided at the political level. It is now a matter for professional, informed executive action. Until Conservative politicians, informed by neoliberal ideological dogma, decided it knew best how to manage Public Health services in epidemics, these actions had been executed by locally based public health professionals; able to call on the acquired knowledge from a long history of fighting pandemics and epidemics world wide.
This raises the critical point why the effective CEO of a huge, national public health operation, in the middle of a pandemic is not in fact a public health professional, or scientist by background, training and experience? Is it on some spurious ground that only management consultants can manage? Or white-coated scientists should stick to the laboratory? Or public servants, ‘a priori’ are hopeless managers? Are we saying that in a proper executive selection process for the top role, there were no candidates from a medical, public health or scientific background who were potentially better equipped, ready-made than Dido Harding, a management consultant? Notably it may be observed at this point, that the quasi-CEO of Test and Trace, Baroness Harding is not a scientist or public health professional, but tellingly, science is in fact almost certainly under-represented at the highest levels of Test and Trace’s formal management organisation structure, to make room for far more numerous representatives at the top, of the private sector; from such supposed experts in public health as the retail sector, or even the car industry. We can see here where Harding appears to look for advice.
On testing in care homes Harding actually presented some facts in the form of ‘improving’ statistical rates, but since these statistics showed the needle rising from a dismal 28% to 35% in some areas, this brought the insistent response from the MP questioning her, that it was all too late and simply demonstrated “a waste of money”. He did not mean it was a waste of money doing testing, but rather had the execution of the activity, by Harding’s operation in his sights.
Harding was closely questioned about local contact tracing and the contrast between resources there, and the national, centralised operation. She quickly acknowledged the vital importance of local operations, but in the face of sustained criticism from MPs in the questioning on contact tracing, addressed the challenge simply by claiming to represent an operation that possessed ‘all the talents’; local and national. Effectively her centralised operation now solves the problem by taking the credit for the local contact tracing; even in the statistics. This was sophistry. Harding’s claim is like a Venn diagram, with a fourth circle that includes the other three. By this neat manoeuvre National Test and Trace takes credit for local contact tracing: simple. Harding’s answer was parasitical on every local operation, effectively criticism of national tracing effectiveness washed away by the simple acquisition of all local effort, whatever the circumstances, as part of Harding’s operation. Inconveniently for Harding’s casuistry BBC Newsnight (11th November, Katie Razzell report from 16 mins. 30 in) visited a local test and trace operation in Calderdale, West Yorkshire where a real foot-soldier, contact tracer was withering in his criticism of the central Test and Trace operation, and its negative impact on effective local tracing. Razzell’s report did not give Harding’s proposition much room for solace.
Under close questioning of Harding by the Select Committee Chairman, Greg Clarke MP, he pointed out the clear greater success of local contact tracing over the national tracing operation. It is important here to notice that Harding was obliged by the bald facts to concede that over five months that was true; but insisted a national effort was required to produce the scale of testing and tracing being produced: quantity over quality is the new orthodoxy, it seems. Indeed, Harding took great pride in the scale of her operation, and meeting the target of 0.5m tests, but without reflecting on the effectiveness of the testing programme that was created. Never mind the quality, count the big numbers. She was parroting the PM at his most egregious.
The real question here is whether Harding and her operation is the most effective way to take charge of the critical financial resources to deliver Test and Trace, and how to deliver it. So far the Test and Trace operation has not provided either value for money, or an effective delivered service. The key remark Harding made to precisely that challenge, gently insinuated by the Select Committee Chairman, was to say “we are learning all the time”. This is a new virus, and we can all recognise that everyone is learning from it, including the scientists; but the Public Health scientists and professionals who are already there around the country, did not require the long, painful, never-ending, time-consuming, delaying, inherently redundant, never enough personal education of Dido Harding and her ‘management’ team, before we can even make a fist of delivering a properly functioning test and trace service. All the existing professionals needed was the money, and the confidence and the support of government. They received none of them when they needed it. Harding, appointed for no easily discernible or explicable reason already has a firm grip on all three. The trump card here is simple; Harding holds almost all the financial resources available to Public Health (even if she is hazy about the quantum), especially to do new things, or invoke advanced technology, or select priorities, and she undoubtedly is the only executive in the public health arena who possesses the ear of government.
At last Keir Starmer for the Opposition, at PMQ’s (11th November) seems to have discovered the iniquity of the government’s contracts methods applied to outsourcing, including – merely as illustration of the louche nature of the system – a £130m contract for face-masks given to a company that failed to supply a single usable mask. Later in PMQs in answering a challenging question on the total failure of the Test and Trace operation presented by James Murray MP, the PM resorted to a weasel-worded Ratneresque excuse that triumphantly insisted we forget altogether about the quality of the results; just focus on the large numbers. I can only suppose the large numbers the PM actually had in mind were the wasted money, human effort, and time expended on bringing to fruition this particular example of the crackpot fantasies of neoliberalism’s universalisable market solutions that may be brought to solve every single problem in the world.
You may believe the analysis in this article exaggerates the problem. It doesn’t. The Guardian (11th November), in an article titled, ‘Boris Johnson on last chance, say Tory MPs after Lee Cain row’ reports on what Conservative MPs really think of the PM and have until now suppressed; the lack of professionalism and incompetence in Downing Street. Among the despairing comments of elected colleagues on the PM in the article, there is this extraordinary anonymous comment: “One MP, who asked not to be named, said: ‘They’re children. Ideologues and self-obsessed fools’.” Meanwhile the Praetorian Guard of Vote Leave are fighting a rearguard action as they are driven out of Downing Street, while Bernard Jenkins MP (Conservative, Brexiter, ERG-leaning) is now reduced to confessing (BBC Radio 5 news interview, 13th November) that all along, Conservative MPs did not even know who actually took the Government decisions – which means a well connected Conservative MP did not even know whether elected ministers took the big decisions. SAGE advises, Ministers decide? Who knows.
Childish unprofessionalism? Self-obsessed? The action of ideologues? Do elected ministers even make the decisions? Who runs the Government? This is precisely the dysfunctional politics and parliamentary ineptitude that produces such a poorly judged, inexperienced decision to construct a centralised, national Test and Trace system, from scratch, sidelining professional public health specialists from leadership, in the middle of a desperate pandemic, and headed by management consultants with no background in public health, medicine or science.
This is what neoliberal theory, transformed over forty years into blind dogmatic faith brings us to confront; mindless ideologists, the neoliberal priesthood now running amok in government: but at a deeper level we must face something that should trouble us all: the transparently antiquated, dysfunctional, dangerously obsolete, over-reliant on self-serving political patronage, inflexible, reactionary, British, Unionist system of government that has brought us all to this bleak pass.