Andy Cowper on governments’ ‘comms big, real problems away ambition’, the PM’s three-tier local alert system and concerning TAT performance.

In any really bad situation (let’s say, for example, enduring, glaring and huge failures during a pandemic of a government-sponsored, inexpertly-led and private sector-delivered programme aspirationally called Test And Trace), the key question seeks clarity. Specifically, that key question goes something like this: which is our biggest problem here: incapacity, incompetence, or malice?

Until we are clear what the nature of the really big problem is, it obviously can’t be fixed.

The Cummings-Johnson government is led by campaigners (Mr Dominic Cummings) and former journalists (Mr Boris Johnson and Mr Michael Gove): these are people whose career-fundamental belief is that you can “comms” big, real problems away.

HSJ readers know that you cannot “comms” big, real problems away. They have watched past attempts to do that fail, often with disastrous consequences for patient safety and care quality.

The gulf between Mr Cummings’ lengthily-blogged ambition for a “data-and-delivery-driven” government and the ongoing lousy performance of Test And Trace prove that he is neither a serious person, nor one with the slightest clue of how to fix big, real problems. The chasm between his writing about an intersection of decision-making, technology, high performance teams and government”, and what the government he jointly leads has delivered, could scarcely be more ironic, nor wider.

Tiers of a clown

This week saw prime minister Johnson announce a new three-tier local alert system, with different rules in the medium (Tier One), high (Tier Two) and very high (Tier Three) alert localities.

“But hang on!” I hear you ask, “what happened to the government’s covid-19 Five Alert Levels? You know, the Nandos scale one?’

Ah, our communications genius of a prime minister has decided that was too confusing, and this new “simpler and standardised” approach will be better.

But if it’s “simpler and standardised”, why can gyms open in Lancashire but not Liverpool, and vice versa for soft play areas and car boot sales? This looks a lot like two different categories in Tier Three.

Simpler and standardised? Or the right hand not knowing what the further-right hand is doing? Moreover, the basis for areas’ categorisation into these three/four tiers seems somewhat ambiguous, as House of Commons Library statistician Carl Baker pointed out.

The PM’s speech launching the new three/four tier system concluded with the line “I am as convinced as I have ever been that the British people have the resolve to beat this virus”.

Ah, it’s “resolve” that beats the virus? Not a functioning test and trace system, and proper incentives to self-isolate? No, no. Bring the “resolve”.

Cracks in the scientists

It’s been an interesting week for watching the chief scientists.

In the briefing following the PM’s speech CMO Chris Whittyinitially said that while he was confident the measures would help to slow the spread of the virus further, but then warned that the “absolute base” of measures included in Tier 3 would “absolutely not be sufficient” for driving down infection rates and that there were “quite a lot more additional things” which would be needed to be done on locality by locality basis. Deputy CMO Professor Jonathan Van Tam clearly took a similar view during the negotiations with leaders of the Greater Manchester region this week.

Just after the “tiers” announcements, the latest working papers from the government’s Scientific Advisory Group for Emergencies (SAGE) were released. Their document, “Summary of the effectiveness and harms of different non-pharmaceutical interventions” (dated 21 September 2020), is a powerful read.

It states that “a package of interventions will need to be adopted to prevent this exponential rise in cases. Single interventions are unlikely to be able to reduce incidence. If schools are to remain open, then a wide range of other measures will be required. The short- list of non-pharmaceutical interventions that should be considered for immediate introduction include:

  • A circuit-breaker (short period of lockdown) to return incidence to low levels.
  • Advice to work from home for all those that can.
  • Banning all contact within the home with members of other households (except members of a support bubble)
  • Closure of all bars, restaurants, cafes, indoor gyms, and personal services (e.g. hairdressers)
  • All university and college teaching to be online unless absolutely essential.

“The more rapidly these interventions are put in place the greater the reduction in covid-related deaths and the quicker they can be eased. However, some restrictions will be necessary for a considerable time”.

TAT: “marginal impact” and likely decline

This SAGE report also states that “an effective test, trace and isolate (TTI) system is important to reduce the incidence of infections in the community. Estimates of the effectiveness of this system on R are difficult to ascertain. The relatively low levels of engagement with the system (comparing ONS incidence estimates with NHS Test and Trace numbers) coupled with testing delays and likely poor rates of adherence with self-isolation suggests that this system is having a marginal impact on transmission at the moment. Unless the system grows at the same rate as the epidemic, and support is given to people to enable them to adhere to self-isolation, it is likely that the impact of Test, Trace and Isolate will further decline in the future”.

The SAGE conclusions tally with findings of this detailed analytical paper in the journal Nature, which concludes that “lockdowns, especially nationwide ones, can be avoided or be less stringent if countries can put in place comprehensive (and, in the extreme, universal) and effective testing and contact tracing systems; provide information to individuals and local public health bodies in a timely manner; create a sense of trust and responsibility; and put in place economic and social support that helps to increase participation in testing, contact tracing and adherence to isolation advice”. Well, quite.

If this were a country run by an heroically mendacious and untrustworthy government, we might expect them to start anonymously briefing the media against the scientists, which by complete coincidence is what this current administration has chosen to do.

Circuit breaker

The Opposition leader Sir Keir Starmer responded to the government announcement and the SAGE paper’s conclusions by making a big judgment call for a 2-3 week “circuit breaker” national near-lockdown.

This strikes me as both appropriate and astute. The SAGE report recommendations ignored by the government gave Mr Starmer the ammunition he needed, and the consistent support for stricter measures if needed seen in public opinion polling will have helped him. Two of the government’s scientific advisers also told the FT that thousands of deaths – between 3,000 and as many as 107,000 – could be avoided by January if a circuit breaker lockdown is imposed over the school half-term at the end of this month.

If Mr Starmer is correct in his judgment that a 2-3 week lockdown is now inevitable, Test And Trace must be re-plumbed to move its resources under leadership of DPHs in the first few days after that decision is made.

Cracks in M*tt’s TAT’s stats (again)

In the least surprising event of this week, the Test And Trace system which is essential to getting the current Second Cummings Wave under some sort of control once again returned dismal performance figures. The latest data show that just 62 per cent of contacts of those infected are reached by this programme. Regular readers know that this needs to be over 80 per cent to make the programme effective.

M*tt’s TAT’s stats remain abysmal. With the upswing in infection numbers, this could not be more important. M*tt’s TAT is now in a vicious downwards spiral of failure: it fails to contact people who have been exposed to people proven infected with covid-19, and so infections increase. This then makes the contact tracing job that M*tt’s TAT could already not do even bigger and harder.

This is an iterative failure loop. It is neither clear that this government adequately recognises the depth of shit in which this leaves the country, not that it has a clue how to achieve change.

Dido’s lament

Conservative peer, NHS Improvement chair and TAT leader the noble Baroness Harding of Winscombe deigned to pop her head above the parapet to give the Sunday Times an interview, in which she laments that “everyone wants to believe that test and trace is a silver bullet. It has never been and it never will be”.

Life comes at you fast, eh? Dido’s lament is a long way from M*tt H*nc*ck’s statement on 23 April that “This test, track and trace will be vital to stop a second peak of the virus”. And an equally long way from the PM’s “world-beating” system promised five months ago in May.

Nor is it a reflection on why TAT’s performance in contact tracing is not just inadequate, but actually getting worse.

Baroness Harding adds, wash your hands, wear a facemask. Keep your distance. That’s more of a silver bullet than anything Test And Trace can do”. This seems very much like the noble Baroness washing her hands of responsibility for the massive ongoing failure of the programme that she is meant to lead.

Oh, and if this government wanted to further decrease public confidence in TAT, it could do something profoundly counter-productive like arrange for data on those infected and told to self-isolate to be shared with the police, for enforcement and fining purposes. As HSJ exclusively revealed they have done. Yes, that may well be the sound of people hastily deleting the covid-19 app from their phones.

Cracks in TAT’s management consultants and outsourcers

The lack of performance delivery/enforcement clauses for the outsourcers’ and management consultants’ abysmal performance of their roles in the test and trace programme has been getting some new attention this week. HSJ readers know that I wrote about these issues a month ago, linking to and quoting those contracts. This week care minister Helen Whately explained in a written Parliamentary Answer that “contractual penalties are often unenforceable under English law so they were not included in test and trace contracts with Serco or Sitel”.

This is incorrect, according to the prominent lawyer and commentator David Allen Green. His whole Twitter thread is (as usual) worth reading: “this means the Minister and the government has had poor commercial law advice: the rule against contractual penalties is more lore than law.

“What happens is the big powerful supplier objects to any contractual protections, saying ‘penalties are not enforceable’ and the government then nods along and deletes the clause. The current leading case on contractual ‘penalties’ (and they deserve a scare quote) is this 2015 Supreme Court Case. Five years later, government ministers seemingly unaware of the legal position.

“But the Urban Legend of ‘contractual penalties are unenforceable’” dies hard – and so ruthless and canny suppliers exploit this, and often get all and any contractual protections removed by gullible and inexperienced government departments. Ms Whately is correct in saying penalties may not be enforced – but where she and other ministers err is in their understanding of what can constitute an unenforceable contractual penalty All sorts of contractual protections are available to the government, if they want to use them”.

The scale of TAT’s spending on management consultants was laid bare by Ed Conway of Sky News, who found that executives from Boston Consulting Group are being paid day rates of around £7,000 – equivalent to an annual salary of around £1.5 million. This followed his story that Deloitte consultants working on TAT, as I noted last week.

Test And Waste

All that money. All those management consultants. And TAT is still tat. It is almost an impressive achievement, in a perverse way. Given its huge cost and ongoing ineptitude at contact tracing, maybe it should be rebranded Test And Waste”.

Still, it seems as if the management consultants and outsourcers are starting to notice that they’ve been noticed. See this from outsourcers Serco: “Serco has had no involvement in developing or managing the covid-19 app and does not have overall responsibility for the test and trace programme”. The fickle finger of blame is not-so-subtly directed towards the management consultancies: ah, those long legal meetings getting ready for the oncoming public inquiry must just fly by. The outsourcing/management consultancy blame-game has a long way to run yet.

Indeed, Serco’s unscheduled Q3 business update states that in the UK, we have been awarded extensions to our contracts to provide test sites and call handlers for NHS test and trace, which is an indication of our customer’s satisfaction with the quality of work we have delivered”.

Yes, that is the same Serco which is doing the contact tracing work, which TAT’s performance data repeatedly shows is getting worse.

Serco’s chief executive Rupert Soames, who famously hoped that the covid-19 TAT contract would “go a long way in cementing the position of the private sector companies in the public sector supply chain” and “if we do it well maybe people will say that they did it well so it [private sector involvement] is a good thing”, seems curiously unamenable to the public and political scrutiny of performance that goes with public money. It’s a tough old world.

The spending is so huge. Those interested in investigating it further should follow the Good Law Project and the Spend Network resources.

Grotesque grift and graft

The grotesque grift and graft don’t seem to stop: the FT revealed that the Department for Health But Social Care gave a £280,000 consulting contract to Elorehai Ltd, the family business of Debbie White, former chief executive of collapsed outsourcer Interserve, who had been given an unpaid public sector role running coronavirus testing centres.

This grift and graft are starting to turn the stomachs even of some in those industries profiting. I am grateful to sources in the Big Four management consultancy, outsourcing, tech and testing provider sectors for getting in touch with some fascinating anecdotes.

Contacts in the management consultancy sector have heard reports that the BCG total bill amounted to £22 million for 16 weeks work. The Sky News report cited above had information from documents suggesting “the government has paid BCG around £10m for a team of around 40 consultants to do four months’ work on the testing system between the end of April and late August”. I am also told that there were only 30 BCG consultants. If these reports are accurate, you have to wonder how the final BCG bill reached that number?

More than one ‘Big Four’ management consultancy source also suggested that the BCG consultants’ day rates of around £7,000 cited in Ed Conway’s report represent about three times what would be accepted as an industry day rate average.

The chaos around the missing 16,000 records discussed last week was partly driven by the national TAT data system relying on a 2006 version of Microsoft Excel, which used CSV functionality that was taking the zeros off the front of phone numbers and rearranging dates of birth.

The level of likely fraud in the PPE provision scramble may turn out even higher than we have so far seen. Only after transactions on the DHSC’s departmental credit card were blocked by banks because of the brand-new-ness of some supplier ‘companies’ did meaningful checks for fraudulence ensue. One transaction was reportedly traced to the account of a pub in the West Country, with enforcement officials having to be sent in to get the money refunded.

I’m also told that the slooooooow updating of the DHSC’s ‘Reasonable Worst Case Scenario’ to combine the effects of a No Deal Brexit and the Covid19 upsurge going pear-shaped is still not done. The current draft apparently considers the likelihood of troops on the streets to maintain civil order in January 2021.

Meanwhile, hospitals are filling up, and the heatmaps are getting hotter. Good luck, and be careful.

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