When it emerged today that Dido Harding had indeed applied for the top job to run NHS England, the verdict from Labour’s Justin Madders was drier than the Sahara.
“I would hope that all candidates’ applications are judged on the basis of their recent performance in public sector roles, which in her case speaks for itself,” the shadow health minister said. “Failing which, Dominic Cummings WhatsApp ought to provide a candid assessment.”
Trying to replace NHS chief exec Sir Simon Stevens is certainly a bold move by the former head of Test and Trace. The litany of failures is well documented, but it’s worth a swift recap of some. The Commons Public Accounts committee said there was “no clear evidence” her organisation had cut Covid rates despite its huge cost (£22bn last year, £37bn over two years).
Former Treasury permanent secretary Nick Macpherson said Test and Trace “wins the prize for the most wasteful and inept public spending programme of all time”. The National Audit Office discovered the DHSC’s business case for the spending last year was “the avoidance of a second national lockdown”. (Narrator: a second, and third, national lockdown took place).
Harding is characteristically unabashed, however. She recently told Radio 4’s Woman’s Hour that her “one regret” was that the expectations for the service were “set too high”. She suggested that the big mistake at its conception was the hope that “testing and tracing and isolating, on its own, would stop the course of the disease”.
Part of the problem, almost certain to be highlighted in the forthcoming “lessons learned” report by the joint health and tech committees inquiry, was the lack of local expertise in contact tracing. While testing capacity was hugely expanded, much of that progress was undermined if each person’s contacts were not being tracked down quickly or effectively enough.
Yet the real clue to the problem lay in the organisation’s very name. It was always ‘Test and Trace’, never ‘Test, Trace and Isolate’. And all the tests in the world, and all the contact tracing in the world, count for nothing if at the end of the process there are large chunks of people failing to stay at home in self-quarantine.
As Jeremy Hunt has pointed out, there was such an obsession about the numbers of tests done per day that the government failed to focus on the metric that mattered: how many potentially infectious people were isolating. At times, the proportion of those who were not doing so was upto 40%.
To be fair to Harding, she eventually grasped this and admitted in February that perhaps as many as 20,000 people a day were ignoring calls to isolate. There are lots of reasons, from boredom to lack of shopping and childcare, for people breaking 10-day isolation. But lack of cash is certainly a key one, as many in public health will attest.
The Tory peer did manage to get some more state support, notably in offering £500 isolation payments for people on low incomes, often administered locally. But as with most means testing, the take up is far less than it would be if there was a universal, across the board, salary replacement system.
And the blame for that may ultimately lie with chancellor Rishi Sunak. When a flat-rate payment was floated earlier this year, the Treasury ruled it out on the grounds that the cost would be too high because of the sheer numbers who were getting Covid. That ignored both just how dynamic the situation was (the cost reduces as cases reduce) and also the huge savings to the public purse achieved by avoiding lengthy lockdowns.
This whole issue reignited today when Politico revealed emails from senior civil servants complaining that the furlough scheme was being used to help those temporarily off work because of Covid isolation. The most telling line, written in January at the height of the third wave, was this: “Incentive payments are too low to incentivise employees to take tests due to risk of loss of income.”
Even aside from using furlough more flexibly to cope with illness, the chancellor has refused repeated requests to increase statutory sick pay (the UK has one of the lowest rates in Europe).
That seems to be partly because of a fear (possibly misplaced given the government’s majority) that such a hike could not be reversed in future. Yet the sums needed for isolation payments are minor compared to the £37bn earmarked for Test and Trace.
Of course, surge testing still matters (and Test and Trace should get credit for its ability to help councils rapidly boost testing). So too does surge vaccination, although as Blackburn’s public health director today pointed out, jabbing the over-12s is desperately needed particularly in areas with high Asian populations, many of them young.
But it’s the lack of a surge in sick pay that is perhaps the most baffling part of the government’s response. With vaccine protection taking two weeks, getting the infected to swiftly stay at home arguably matters more even than getting them jabbed.
And with Chris Whitty warning today of an “exit wave” that will follow the July 19 unlocking, and “winter surge” later this year, the need for higher levels of self-isolation is as pressing as ever.
The economic risks of further possible lockdowns ought to be enough to prompt a rethink on isolation payments from Sunak, before he’s inevitably urged to do so by the parliamentary inquiry.
If not, he may just gift Keir Starmer the present he desperately needs to tie both No.10 and No.11 in a joint enterprise on Covid failures.
