On Wednesday 10th March the Parliamentary Accounts Committee published a damning report on “NHS” Test and Trace, finding no evidence that it had helped reduce rates of Coronavirus infection despite the “unimaginable” cost to the taxpayer of £37 billion.
In the same week an investigation by the Safe and Equal campaign found widespread use of super-spreader employment practices by Test and Trace’s contractors suggesting Test and Trace may actually be a net contributor to the spread of Coronavirus.
NHST&T employed three strategies designed to reduce infections: Test, Trace and Isolate. Testing alone does nothing to reduce infections. Despite developing over 500 test sites across the UK and performing 800,000 tests a day, the test is only important if it is coupled with contact tracing and isolation. A recent government-backed study has found contact tracing can reduce transmission by between 7-10% if infection rates are relatively low and it’s done well. But NHST&T’s contact tracing has been very poor. According to government figures 4.2 million people have now had a Coronavirus infection. NHST&T has identified 2.5 million positive cases and made contact with 4.5 million close contacts. So for every one individual that has tested positive, NHST&T has managed to contact less than two of their close contacts. Some of these are presumably people who live in the same household as the infected person and did not require a phone call. The substandard contact tracing performed last October reduced transmission by between 1.7% and 4.6%. Isolating has a much bigger effect on reducing transmission: between 18-33% reduction in the R rate. However this is the one part of the strategy outside of NHST&T control.
Compliance with isolation is extremely low in the UK. Several studies have found that only about one in five people are fully compliant with isolation rules meaning that 80% of potentially infectious people are still mixing with others outside their households. That suggests that most people who get tested and most people who are contacted by NHST&T are breaking the rules. We must also assume there are large numbers of people with symptoms who are avoiding getting tested all together and that there is a general reluctance to give names of close contacts to contact tracers.
Compliance with other infection control measures like spatial distancing and mask wearing is generally much higher with only a small minority (10%) flouting the rules https://blogs.bmj.com/bmj/2021/01/07/pandemic-fatigue-how-adherence-to-covid-19-regulations-has-been-misrepresented-and-why-it-matters/. As Tory peer and Head of Test and Trace Dido Harding told MPs on November 10th 2020 a major reason people struggle with isolation is that they cannot afford to take time off work. Around 12 million workers in the UK have no occupational sick pay and so have to rely on Statutory Sick Pay if they need to isolate which is just £95.85 a week, about a third of the take home pay of a minimum wage worker. There are a further two million workers on zero hours contracts who may not have a job to come back to if they take time off to isolate.
The government introduced a £500 isolation payment for low paid workers in September 2020 in response from lobbying from Harding. But this system is not working. A TUC study found that over 70% of applicants are rejected.
In late 2020 Safe and Equal activists received reports from Test centre staff that they were employed on zero hours contracts and similar and could not afford to take time off if they had to isolate. Working with Labour MPs, we wrote to Serco, Sodexo, G4S and Amazon who all have multi-million pound contracts operating parts of NHST&T. So far, only G4S has confirmed that they are employing workers on temporary contracts without full sick pay entitlement. We suspect the other contractors are using similar practices. G4S were at pains to say they were operating within government guidance, which is true. But this is a government that prioritises the profits of its favourite contractors over effective public health measures.
The way the government has organised Test and Trace through a cascade of subcontracting has meant that a system has emerged for everyone in the country with Coronavirus symptoms to file past an army of workers who cannot afford to follow isolation rules. Test centres are generally well ventilated or outside and workers take lots of infection control precautions, but nevertheless, these workers are at high risk of infection. If they themselves are attending work when they should be isolating then that creates a high risk of infection for fellow workers and anyone they are coming into contact with in local shops, public transport and Covid-negative patients at the test centre. These employment practices turn every test centre into a potential Corona hotspot.
In March 2020 the government recognised that its inadequate Statutory Sick Pay scheme and decades of outsourcing in the NHS, meant that many workers in hospitals could not afford to isolate. The super exploitative employment practices that are central to the business model of outsourcers are an infection control risk and NHS employers were instructed to ensure all workers operating on NHS premises, including outsourced workers and bank staff, could isolate on full pay. Despite carrying the NHS brand, this logic has not been extended to Test and Trace workers.
We do not know how many Test and Trace staff have been infected with Coronavirus and there is no way to find out as many will have avoided getting a test. However the government backed Vivaldi study into deaths in carehomes found that risk of infection increased up to 18% in homes where workers lacked sick pay. Given the negligible effect contact tracing has on infection rates and the super spreader employment practices of NHST&T contractors, it is possible that Test and Trace has actually made a bigger contribution towards spreading the virus than it has in reducing infection rates.
In any case, it is very difficult to imagine a more wasteful means of spending £37 billion of taxpayers money. That money would have been better spent ensuring every worker in the UK could isolate on full pay, as they can in many European countries. The government’s failure to act on this issue, despite clear evidence they have understood this problem for over a year, has meant they have overseen one of the highest death tolls in the world. The need for full sick pay for all is as urgent as ever.