Monday 5 October 2020
How test, track and trace became a national disaster
[Clip: Matt Hancock welcoming users to his smartphone app in February 2018]
There’s Matt Hancock, cheerily welcoming to you his new smartphone app, way back in February 2018.
How long ago that seems. He’d just been appointed Culture Secretary. Theresa May was still in Number Ten, still battling to sort out Brexit and – we foolishly thought – as bad a Conservative Prime Minister as it was possible to be.
Looking back now from the bleak depths of the Covid era, it was a time of great innocence. We genuinely thought things couldn’t get worse.
But they have. So much worse.
I’m Matt d’Ancona and in this special episode of Slow News I’ll be looking at the national scandal of test and trace. Basia will be back in front of the microphone next week.
It’s a journey that’ll take us all the way from the corridors of Downing Street to a desolate car park in Catford.
I’ll be sifting through the story of how the coronavirus test and trace system has been such a colossal, shaming failure. and how that story is a fable of much that is wrong with our politics, our statecraft and even the way we see ourselves as Britons.
But why start with a Cabinet minister’s vanity app, two years on from its launch? Because it didn’t work very well, and we all need a bit of comic relief right now. But also because our story has another app (several other apps, actually) at its very heart.
And because the central character – though far from the only suspect in this detective story – is none other than Hancock himself, elevated in July 2018 to the role of Health Secretary.
It’s a story of policy failure, of course. Why did the Government fail so miserably to get a test and trace system in place, in time?
Political hubris mingles with Whitehall farce. The centralisation of the British state. The worship of post-Thatcher Tories for the private sector. The myth of British exceptionalism. It’s a potent, bitter recipe, and the whole country is paying for it today.
I’ve spoken to more than a dozen ministers, government advisers, senior scientists, MPs, business leaders, and local politicians to find out why it got as bad it did – and still is.
Little did Matt Hancock, or we, know, back in 2018 – but lurking in that cheery welcome to an ambitious politician’s app was the Ghost of Covid Future.
[Audio clip: 23 January, Matt Hancock, House of Commons]
There he is again, on January 23 this year, a few days before the first cases of coronavirus in the UK were reported in York.
Notice his use of the word ‘world-leading’, which, as it turned out, was pioneering. No matter how bad things were to get with the testing system, ministers would always claim that it was ‘world-beating’, ‘world-leading’ or even, when they were really being cheeky, ‘the best in the world’.
[Audio clip: 26 February – Matt Hancock, House of Commons]
That was February this year. The moment when, as it turns out, Covid really took root in the UK as families returned from half-term holidays.
But the virus that had caused such carnage in the Chinese city of Wuhan and was now making its vicious way around the world was far from a priority for this Government.
As one senior Conservative source put it to me: ‘Remember, we had just won a bloody big election victory over Corbyn. We had just left the European Union. Everyone thought the challenge of 2020 would be the detail of Brexit. It was just another bug, and – to be honest – we weren’t paying it too much attention’.
The Prime Minister had recently returned from a break in Mustique with his pregnant fiancee Carrie Symonds. He was fretting over his divorce from his second wife, Marina Wheeler, and an unwritten biography of Shakespeare that he owed his publishers.
In fact, the Prime Minister didn’t chair a COBRA emergency meeting on the outbreak until March 2.
[Audio clip: first death]
That moment – the first UK fatality – focused minds in the government and public alike, tragic evidence that the invisible enemy of the pathogen was a mortal threat.
It also led to a momentous decision.
[Audio clip: 11 March – Matt Hancock]
It’s hard to overstate the importance of what the Health Secretary was saying – though few outside the world of the NHS and the nation’s labs appreciated its significance at the time.
What Matt Hancock was doing was dumping any ambition for contact tracing – that is to say, a system where you test as many potentially-positive people as possible, and, crucially, try to get in touch with everyone they might have infected so that they, in turn, can self-isolate too.
This system had worked very well in other countries – especially South Korean and Taiwan. Germany, Hong Kong, New Zealand and Canada had also got ahead of the game in test and trace.
But in this country, a number of people told me, there was a reluctance to look further afield, to learn lessons from other parts of the world. The emphasis in Brexit Britain was to be: we can do this our way, the British way.
In practice, this was big talk to disguise small action. Even as he claimed to be ramping up testing capability, the Health Secretary was narrowing the objectives of the system: ditch the limited attempts to test and trace, and focus on testing NHS patients and workers.
Here’s Chris Whitty, the chief medical officer for England, at a Downing Street press conference on 12 March, confirming the change.
[Audio clip: 12 March – Chris Whitty, No.10 coronavirus briefing]
What was going on?
On 16 March, Tedros Ghebreyesus, director general of the World Health Organisation, gave the pandemic what was to become its mantra.
[Audio clip: 16 March – Tedros Ghebreyesus: Test, test, test…]
But this was exactly what we weren’t going to do. The scientists on the Government’s Scientific Advisory Group for Emergencies or SAGE had judged – correctly – that testing capacity was limited, and then decided – quite wrongly – to recommend parking the idea of contact tracing as the nation headed for lockdown and the NHS braced itself for more than 1,000 deaths a day.
As one senior source who has been involved with the process from the start told me: ‘Chris Whitty gave precisely the wrong advice to ministers. He should have been saying: ‘For God’s sake, get the capacity in place now, be creative, chuck money at it’. But he didn’t.’
More than one senior scientist expressed anger and disbelief at this fatalism. ‘Why the hell did Whitty just accept all this?’ one said. ‘This was his time to take a lead and he just didn’t.’
No less important, the Prime Minister didn’t push back – or at least not very much. Some people who were present at the key meetings during this period say that Boris Johnson was pretty content to go along with the advice on test and trace given to him by Chris Whitty and Sir Patrick Vallance, the government’s chief scientific adviser.
According to one Cabinet source: ‘Boris just didn’t get that this was his Falklands moment, so to speak’.
And this was a crucial moment – perhaps the crucial moment – in the fiasco that was to come.
Much later, in July, Whitty was to be asked about it at the Commons health select committee by its chair Jeremy Hunt, who is also the former Health Secretary. Just listen to this – it runs for over a minute, but its worth it:
[Audio clip: Chair: The SAGE minutes on 18 February say: “when you gave that advice to Ministers, why hadn’t we modelled what test, trace and isolate, à la South Korea, would do? The modelling on South Korean test, trace and isolate did not actually happen until April, so why were we able to give that advice to Ministers without having modelled what a test, trace and isolate strategy would do?
Professor Whitty: Let me be very clear about this. I am absolutely confident that we had no capacity to do it on the scale that would have been needed for the kind of epidemic we had. It is nothing to do with theory here. This is a—
Chair: But we got it up in four weeks in April. We got the test capacity up to 100,000 a day in just four weeks. If you had advised doing that in January, we could have got to that stage by the end of February.
Professor Whitty: SAGE was consistent, and I was consistent, in saying that we needed considerably more testing capacity. Many of the problems we had came from our lack of testing capacity, but testing alone is not sufficient to have a full test, contact-trace and isolate system. That requires an infrastructure we did not have, which was built up by places like Korea and—]
[Audio clip: Chair: But why didn’t you advise that we put that infrastructure in place? I want to go back, because the SAGE minutes on 12 February, and even before then, say: “We recommend that contact tracing should be discontinued when person to person spread is epidemiologically demonstrated to be dominated by second and subsequent generational cases, or when the number of contacts being contacted gets more than 8,000 a day.”
I am trying to understand why you did not say, “We need to expand our testing and contact tracing capacity,” rather than what you actually did, which was to accept the capacity as a given. We know now that we were able to expand the testing capacity and the contact-tracing capacity, so why didn’t you advise that in January or February?]
Chris Whitty was defensive and acted like an expert who had given duff advice and finally been busted. He had, after all, made the key recommendation in the whole saga – and then watched as Hancock and other ministers were pummelled in the press and Parliament for its consequences.
Jeremy Hunt was surprised that the exchange at his committee was not picked up by the media. But this was in July, of course, when lockdown was being relaxed and we were being promised that things were going to return gradually to something approaching normal.
Let’s go back, though, to March 19, four days before the Prime Minister declared national lockdown. Here he is at a Downing Street press conference.
[Audio clip: Boris Johnson, Downing Street Conference]
Listen to all those numbers, reeled out as if they have their own magical healing power. This is the populist playbook in its purest, most bombastic form: overwhelming the public with claims of brilliance, promises of astounding feats, an inventory of the amazing.
On April 2, Matt Hancock – now recovered from a short bout of coronavirus infection himself – also made a big pledge.
[Audio clip: 2 April – Matt Hancock, Press Conference]
In case you were wondering, the ‘pillars’ he refers to are the five different kinds of testing – NHS jargon that covers everything from tests on NHS workers and patients to mass testing of the general population – the latter, of course, being out of the question at that point.
But the key was the 100,000 figure – that was the headline the government wanted and the headline that it got. Unfortunately, as often happens with politically-driven targets, this single-mindedness crowded out broader strategic thinking and became the focus of too much energy.
[Audio clip: 30 April – Announcement that 100,000 has been achieved]
The trouble was that the target had only been reached by counting tests posted out, rather than those actually implemented. Which, when it was widely reported, did nothing to improve public trust in the government’s corona-strategy – trust that had been high in early lockdown but was fast eroding.
The fixation on the 100,000 had other damaging consequences. For weeks, scientists, NHS diagnostics experts and public-spirited businessmen had been pleading with the government to do something it seems to find difficult – which is to concentrate on more than one thing at a time.
Yes, the immediate priority had to be to save lives and keep the NHS from being overwhelmed. But – for there to be a meaningful exit strategy after the peak and to get the country out of lockdown – there had to be a decent contact tracing model in place, without delay.
Professor Sir Paul Nurse of the Francis Crick Institute called it the ‘Little Boats’ initiative – a reference to the Dunkirk rescue of British troops from French beaches in 1940, that was possibly designed to appeal to Johnson’s Churchillian obsession.
As one senior epidemiologist who was involved said to me: ‘The position was – we have a whole network of accredited labs, we all know each other, we can collaborate, integrate data. Give us the resources to build on what we already have and we can have a pretty good testing system in place for you within weeks.’
Matt Hancock rejected that, politely but firmly. ‘It’s a lovely idea,’ he said, ‘but if we just do that we’ll only have a fifth of what we need.’
Not for the first or last time, the key players were speaking at cross-purposes. Nurse and co had never suggested that the ‘little boats’ could solve the problem completely, any more than the rescuers at Dunkirk had expected to win the war. But to quote the same epidemiologist ‘it might prevent us from losing it.’
Meanwhile – and it is a big meanwhile – the Prime Minister himself had nearly died from Covid-19, a dreadful episode that had stretched the government’s competence and cohesion to its very limits.
On April 12, the very day that Boris Johnson was discharged from St Thomas’ Hospital in Westminster, Matt Hancock announced the full return of contact tracing and the app technology to support it.
[Audio clip: 12 April – Matt Hancock, Press conference]
This, remember, was a full month after Chris Whitty had cancelled the first phase of contact tracing. And – as bullish as Matt Hancock sounded – he was not announcing the start of a system, only its planning phase.
To be clear: there are essentially two sorts of tests. Antigen or PCR tests which tell a person whether they have the virus at that moment, and antibody tests which let you know if you have already had it.
They each deploy different science and need different kit. By April, it was a seller’s market and ministers were desperately playing catch-up, negotiating to get the special swabs and chemicals they needed in competition with every other nation fighting the virus.
Again, what is so striking is how bad the government was at accepting help when it was offered. I spoke to Simon Harrison, a Bath-based businessman whose nephew runs a bio-tech start-up company called Curative in California.
Harrison had what seemed like an appetising offer. Curative had already developed an oral fluid test which had been approved by the authorities in the United States. It’s got what is called an ‘orthogonal supply chain’ – which is simply to say its tests didn’t depend upon outside kit. The company used short swabs and its own chemicals. It had done deals with FedEX and DHL so tests could be returned to the UK quickly.
It was already able to offer 10,000 tests a week, scaling up quickly to 30,000 a week. Not 100,000 a day, it is true, but not to be sniffed at when you are trying desperately to build capacity. And by the way: Curative is now carrying out 200,000 tests a week in Florida alone.
So Simon Harrison was dismayed when he received a firm ‘no, thank you’ from Public Health England. He has kept banging on the door of the test and trace system with only a limited response. To describe him as frustrated is a serious understatement.
This matters because it is an anecdotal example of a greater pathology which had two main symptoms.
The first was to prefer big and shiny to what was practical and immediately available.
So instead of biting Mr Harrison’s arm off, ministers and Public Health England signed a huge contract with Deloitte to build a series of mega-diagnostic facilities or Lighthouse Labs.
Why? Some people have pointed to the Government’s existing close connections with the accountancy giant, and hinted darkly at the revolving door that makes today’s minister tomorrow’s high-paid corporate executive.
I think the explanation is simpler, and has its roots in Eighties Thatcherism: an almost religious belief that big private sector solutionsare better than fragmented public services.
The reflex that led Hancock and co to Deloitte was deep in their DNA. To this day, they defend the decision on the grounds that big global companies are good at solving problems of scale.
But the verdict in early October is at best mixed. One leading academic and research scientist sent in to advise Deloitte on their plans told me that they were “so fucking useless” that he didn’t bother to go back to further sessions.
A similar reflex, it appears, drove ministers to appoint Dido Harding as head of NHS Test and Trace in May. True, she was very much part of the Tory dinner party gang: a Conservative peer, married to a Conservative MP, John Penrose, and already head of NHS Improvement since 2017. If the phrase ‘one of us’ still carries any weight, it certainly applies to Baroness Harding.
As one senior adviser puts it: ‘There’s a lot of chumocracy in this, of course, but I think the greater reason Matt and the others wanted Dido is that she has a long history in business – you know, McKinsey, Tesco and TalkTalk. That stuff is almost narcotic to a certain sort of Tory.’
As CEO of TalkTalk, it should be remembered, Dido Harding was in charge of the telecoms company in 2015 when the personal and banking details of up to four million customers leaked in a cyber attack.
No matter, it seems: she was now at the helm of test and trace.
[Audio clip: App launched on Isle of Wight]
The second symptom of the pathology at work at this point in our story was a bizarre determination, as far as possible, to fight the global threat of the virus with British tools.
It was as though the spirit of Brexit could somehow be imported to the world of epidemiology – a serious delusion, if ever there was one.
So the initial version of the test and trace app was not the joint venture between Google and Apple that was, to use a phrase beloved of the Prime Minister, ‘oven-ready’, but to go with a home-grown NHS alternative.
In this case, British exceptionalism trumped the love of the private sector. Better to go with home-grown technology than the work of two US-based tech giants.
Better – but worse. The app was quickly revealed to have all manner of compatibility problems with different kinds of smartphone, as well as raising questions about data privacy. The over-arching test and trace software that governed the whole system was also in deep trouble. Here’s a whistleblowing contact tracer lifting the lid on the fiasco on last week’s BBC Panorama.
[Audio clip: 12 June – Panorama]
In Scotland and Northern Ireland, things were not so bad – health ministers there having decided to use proven Irish technology rather than develop their own glitch-ridden algorithms.
By 18 June, Hancock was forced to throw in the towel and announce that he would be switching, after all, to the Google-Apple option.
[Audio clip: 18 June – Matt Hancock, Press conference]
Back to square one, in other words.
Just as the first version of the app had failed, so the test and trace system was starting to fall foul of yet another problem which was the absurd levels of centralisation in the system.
When she was appointed, Dido Harding was phoned by a longstanding political friend who advised her to take a look at how to decentralise the system radically and involve local health authorities, town halls and neighbourhood emergency services much more closely.
‘That’s a very good thought,’ she replied. But – she went on to explain – she was already working to central targets set by ministers and towards what became the system of Deloitte mega-labs.
The logic of a much more localised response was clear. In the Milton Keynes lab alone, for instance, 30,000 test samples a day had to be opened obviously with extreme care given their potentially-infectious samples. Would it not make sense to share out as much of this work as possible to local facilities, aided by people who knew the communities in question?
Almost certainly. But the Great Fiasco Train had already left the station. Data was hard, sometimes impossible for local services to prise out of centralised systems.
Absurdly, Deloitte’s right to commercial confidentiality was cited as a reason not to share – until it was pointed out that Covid was a notifiable disease and there was a legal duty upon all parties to make information available.
But, while such questions like that were being resolved, crucial time was lost. The metro mayors tore their hair out: in Birmingham, the Conservative Andy Street had to be careful what he said in public but Labour’s Sadiq Khan in London and Andy Burnham in Greater Manchester spoke openly of their frustrations.
[Audio clip: Metro Mayors complain]
In the middle of May, a testing system arrived at Manchester airport – with absolutely no prior warning to the local authorities. This was only one pointed example of a general lack of communication.
Andy Burnham spoke as often as he could to Matt Hancock and the Prime Minister. He urged them either to include all metro mayors in COBRA meetings or to set up some sort of forum where problems and information could be shared, to prevent local leaders from having to use the media to air their grievances and proposals.
The government listened – and then did exactly the opposite. Here’s Matt Hancock on 18 June:
[Audio clip: Matt Hancock on Leicester]
That caught the Mayor of Leicester, Peter Soulsby, completely off guard and made the business of reimposing lockdown in Leicester – hard enough already – more difficult than it needed to be.
[Audio clip: Peter Soulsby complaining]
The government was adamant that renewed restrictions like this would be localised and specific, rather than national: but it was unwilling to follow its own logic and think locally. It hugged data close to its chest. It was slow to share crucial and potentially life-saving information in good time.
In the last few weeks, Andy Burnham has reached agreement to involve the Greater Manchester Police and Fire Services in contact tracing – to get public servants with real local knowledge engaged, real boots on the ground.
This is good news for Mancunians and shows what can be done. The question that hangs in the air is: why did it take so long?
A large part of the problem was, and remains, the Government’s infuriating insistence that everything is already magnificent, and globally-recognised as such. Here’s Boris Johnson at Prime Minister’s Questions on July 15.
[Audio clip: 15 July – Boris Johnson at PMQs]
By now, that was an insult to the intelligence. For nine weeks running in July and August the health department’s own figures showed that test and trace failed to reach its own target of contacting 80 per cent of close contacts of people who had tested positive for Covid-19. Councils across the land struggled to cross-index the information that was now, slowly and grudgingly, being released to them.
Such were the wages of the lost weeks earlier in the year and failure to act with speed in February and March.
By September, the system was close to breaking down completely, as the infection figures started to rise again. Schools had reopened, students were heading off apprehensively to university. More and more workplaces were back in business, albeit with social distancing where possible.
Not surprisingly, people began to ask for tests whether or not they had symptoms worried that they might be infected anyway and – quite reasonably – keen to know if they should be at work, or see vulnerable relatives, or self-isolate – or what?
At this point, the government’s strategy became contradictory in a way that was as hilarious as it was objectionable.
On the one hand, ministers began to scold the public for seeking too many tests. Here’s Matt Hancock on September 9:
[Audio clip: 9 September – Matt Hancock, BBC News]
In March, when lockdown was announced, the public had given the government the benefit of the doubt. But now tempers were starting to fray, and trust collapsing. Here’s one father venting his anger to Good Morning Britain’s Susannah Reid:
[Audio clip: Father expressing anger to Susannah Reid on GMB]
On September 15, Matt Hancock’s Labour shadow, Jon Ashworth, summarised the problem with embarrassing vigour:
[Audio clip: 15 September – Jon Ashworth]
But trust Jacob Rees-Mogg, the leader of the Commons, to take us all to task for not celebrating the supposed success of – you guessed it – this world-beating system.
[Audio clip: 15 September, Jacob Rees-Mogg]
Couldn’t the Government have seen the problem coming? School and university terms are in the calendar after all. Ministers had been telling us to get out, eat out and spend money. Shouldn’t test and trace have acted accordingly?
On September 17, Greg Clark, chair of the Commons science committee, suggested to Dido Harding that she and ministers might have done more to plan ahead.
[Audio clip: 17 September – Dido Harding at Science Committee]
Not my fault, in other words – with the slight suggestion that Clark was being impertinent in asking the question at all. Why couldn’t we all just recognise how utterly brilliant the government was?
So on the one hand ministers were berating the voters for their ingratitude and failure to ration their demands for tests.
But then, on the other – in darkly hilarious contrast – Boris Johnson was promising an end to all our troubles with a so-called Moonshot project delivering millions of tests a day within a few months.
[Audio clip: September 9 – Boris Johnson]
All manner of hyperbole was spun to the media – notably that £100 bn was going to be spent on the Moonshot. It felt like a full descent into Trumpesque populist politics: the Johnson government’s testing Moonshot was the equivalent of the President’s Wall. Something to brag about rather than to actually do. Something to fill in the awkward gaps in public conversation.
We should be fair to the scientists working on the new so-called ‘lateral flow tests’ involved in this initiative – a swab and chemicals, without the need for a machine. They were unhappy with it being called ‘Moonshot’, but were overruled by excitable ministers
Instead, researchers are cautiously optimistic that the system, which tests infectiousness rather than infection, will be clinically ready by the end of the year.
There are also hopes in the scientific community that the Oxford AstraZeneca vaccine trials will deliver a scalable product by the first quarter of 2021. And the drug dexamethasone should reduce mortality rates during the expected spike of hospital admissions in the next few weeks.
The immediate question, then, is how to get the new mass testing kit manufactured in sufficient quantity, which the UK alone certainly can’t do. And how to pay for it – you hear anything from £3 to £60 a test.
Things are slowly getting better, or so we are assured. But we should not exaggerate progress to satisfy political narratives. We are still some way off the pandemic equivalent of landing safely on the moon.
By last week, more than 13 million Britons had signed up to the new app. But contact tracing was still not working properly – with many reports of the same people being contacted more than 30 times…or not at all.
One of the key players in the story who spoke to the Prime Minister in the past few days described him like this: ‘I think he is lonely and a bit downhearted. He knows that the system doesn’t really work but can’t quite say so. It’s less than ten months since he won a historic election victory and now he is already being treated as a failure and a has-been’.
It’s the kind of justice of the gods that a classicist like Johnson should understand.
Who was guilty? Everyone. Boris, Johnson, Matt Hancock, Chris Whitty, Dido Harding, Deloitte, and the Whitehall officials who clung on to power and data as if it truly belonged to them.
In this story, all the suspects are guilty. It is not Corona-Cluedo – Colonel Hancock, in the office, with the rubbish app – but Murder on the Orient Express.
And now we are heading into winter, with 7,000 new cases a day, the annual outbreak of flu compounding the threat to the vulnerable, woefully unready for what is coming.
And the outrageous fact is that – this time – we could have been so much better-prepared. Posterity will not be kind to all the culprits.
After all this delving, I decided to get a breath of fresh air and go for a walk…