Twenty-Third Report - Test and Trace update

Select Committee

Public Accounts Committee HC 182 27 October 2021

Report Status Government responded

Conclusions & Recommendations 25 items (8 recs)

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Government Response (AI assessment · 25 of 25 classified)

Accepted 13

Acknowledged 1

Not Addressed 7

Rejected 4

Government response

Treasury minutes: Government response to the Committee of Public Accounts on the Twenty Third report from Session 2021-22 · published 21 Jan 2022

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Recommendations & Conclusions

13 results

5 Recommendation Accepted

NHST&T’s continued over-reliance on consultants is likely to cost taxpayers hundreds of millions of pounds.

Recommendation

NHST&T’s continued over-reliance on consultants is likely to cost taxpayers hundreds of millions of pounds. Our previous report found that NHST&T was overly reliant on expensive contractors and temporary staff and recommended that it needed to reduce this. Despite NHST&T … Read more

Government Response Summary

The government agrees and states the UKHSA wrote to the Committee in December 2021 regarding reducing consultant dependency, continues to recruit civil servants, and will provide further progress updates in March and June 2022 as requested.

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9 Recommendation Accepted

In our March 2021 report, we concluded that NHST&T published a lot of performance data...

Recommendation

In our March 2021 report, we concluded that NHST&T published a lot of performance data but that this did not demonstrate how effective test and trace was at reducing transmission of COVID-19. We recommended that NHST&T should improve the data … Read more

Government Response Summary

The government stated that NHS Test and Trace developed a performance framework in summer 2020 and the UKHSA regularly publishes and adapts performance information and supporting methodology. It did not explicitly commit to new actions to improve data to specifically demonstrate effectiveness in reducing transmission or conduct periodic evaluations.

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10 Conclusion Accepted

The Scientific Advisory Group for Emergencies (SAGE) recommends that, for a test and trace system...

Conclusion

The Scientific Advisory Group for Emergencies (SAGE) recommends that, for a test and trace system to be effective, no more than 48 hours should elapse between identifying an original case and their contacts self-isolating. NHST&T routinely monitors the speed with … Read more

Government Response Summary

The government states that NHS Test and Trace developed and continues to adapt its performance framework, and the UKHSA regularly publishes performance information and methodology.

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12 Conclusion Accepted

We asked our witnesses what progress had been made across government to improve self-isolation rates...

Conclusion

We asked our witnesses what progress had been made across government to improve self-isolation rates since we last examined the programme. The Department asserted that it has done significant work, including appointing a cross-government senior officer with responsibility for compliance … Read more

Government Response Summary

The government states that UKHSA is already delivering targeted communications and campaigns, and making testing accessible through community testing programmes, to drive engagement and reach underrepresented groups, further detailing existing efforts.

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13 Conclusion Accepted

We asked our witnesses about the role of the NHS COVID-19 app in ensuring that...

Conclusion

We asked our witnesses about the role of the NHS COVID-19 app in ensuring that people self-isolate if they need to, particularly given suggestions that some people might delete the app or stop it being enabled in order to avoid … Read more

Government Response Summary

The government states the UKHSA has already delivered targeted communications and campaigns to drive up engagement and made testing more accessible, including through community testing programmes.

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17 Conclusion Accepted

NHST&T does not yet know how it will secure the promised benefits from the laboratory...

Conclusion

NHST&T does not yet know how it will secure the promised benefits from the laboratory infrastructure it has established. NHST&T’s November 2020 business case for a £10 billion expansion of its testing capability stated that a £150 million investment 30 … Read more

Government Response Summary

The government accepts the recommendation, stating UKHSA continues to strengthen its benefits evaluation and will produce a three-year strategic plan, updated annually, detailing how resources will be used to achieve objectives, with a target implementation date of Spring 2022.

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19 Recommendation Accepted

Our first report on NHST&T concluded that it was overly reliant on expensive contractors and...

Recommendation

Our first report on NHST&T concluded that it was overly reliant on expensive contractors and temporary staff. We found that by October 2020, it had signed 407 contracts worth £7 billion with 217 public and private organisations. By the end … Read more

Government Response Summary

The government accepts the recommendation, stating UKHSA has reduced consultant dependency and continues to recruit civil servants, while developing a sustainable resource plan with updates due in March and June 2022, aiming for implementation by June 2022.

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20 Conclusion Accepted

We therefore asked our witnesses why NHST&T’s use of consultants continued to be so high.

Conclusion

We therefore asked our witnesses why NHST&T’s use of consultants continued to be so high. The previous Head of NHST&T explained that up to the end of May 2021, 196 (37%) of the 523 recruitment campaigns run by NHST&T failed … Read more

Government Response Summary

The government agrees, stating the UKHSA has reduced dependency on consultants and continues to recruit civil servants, with plans to develop a sustainable resource strategy and provide further updates in March and June 2022.

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21 Conclusion Accepted

We again challenged the Department and NHST&T on the value for money of their spend...

Conclusion

We again challenged the Department and NHST&T on the value for money of their spend on consultants. The Department told us the average day rate for consultants was £1,100 but that some would have “undoubtedly” earned more than that. They … Read more

Government Response Summary

The government accepts the recommendation, stating UKHSA has already reduced consultant dependency and continues to recruit civil servants to replace them, while developing a sustainable resource plan, with updates due in March and June 2022.

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22 Conclusion Accepted

At the time of the NAO’s report, NHST&T provisionally estimated that it had spent £372...

Conclusion

At the time of the NAO’s report, NHST&T provisionally estimated that it had spent £372 million on agency and contractor staff and £195 million on consultancy fees, compared with £52 million on permanent and seconded staff in 2020–21. It had … Read more At the time of the NAO’s report, NHST&T provisionally estimated that it had spent £372 million on agency and contractor staff and £195 million on consultancy fees, compared with £52 million on permanent and seconded staff in 2020–21. It had not yet completed its year-end checks, and anticipated that the amount recorded as consultancy spend would increase. However, the NAO’s own enquiry on contract spend indicated that NHST&T was expected to spend £300 million on the top 10 consultancies with the highest contract values.49 We were concerned that NHST&T’s consultancy expenditure may have gotten out of hand. The previous Head of NHST&T explained that the nature of the pandemic had meant that NHST&T had needed to bring in contingent, short-term labour from all parts of society, including the Army, civil servants, volunteer contracts, unpaid staff, as well as consultants. They explained that NHST&T needed to rely on consultants in part because some of the skills it needed did not exist in the civil service, and partly because the nature of the pandemic response meant the roles available were temporary rather than 43 Committee of Public Accounts, COVID-19: Test, track and trace (part 1), Forty-Seventh report of Session 2019–21, HC 932, 10 March 2021, para 3 44 Q 129, C&AG’s Report, para 13 45 Q 135 46 Qq 136, 141 47 Qq 132–133 48 Letter from Sir Chris Wormald, Department for Health and Social Care, and Dr Jenny Harries, UK Health Security Agency, to Rt Hon Meg Hillier MP, Chair of Public Accounts Committee, 4 August 2021 49 Qq 129, 138; C&AG’s Report para 2.20 Test and Trace update 17 permanent. The Chief Executive of the UK Health Security Agency confirmed that it had a “very detailed ramp-down plan” to reduce the number of consultants by the end of March 2022.50 In their subsequent letter to us, the Department and the future Chief Executive of UKHSA told us that NHST&T had reduced the number of consultants from a peak of 2,504 to 1,864 over the previous four months. The Show less

Government Response Summary

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23 Recommendation Accepted

Local authorities and public health experts play a vital role in protecting the health of...

Recommendation

Local authorities and public health experts play a vital role in protecting the health of the population. Our previous report on test, track and trace, concluded that many important stakeholders had at times felt ignored by NHST&T. We found that … Read more

Government Response Summary

The government accepts the recommendation, stating UKHSA continues to engage with local government and partners, citing a £2.1 billion fund, and commits to strengthening these partnerships to co-design a future operating model once funding is agreed, with a target implementation date of Spring 2022.

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24 Conclusion Accepted

Our report in March 2021 on local government finance highlighted how the pandemic had caused...

Conclusion

Our report in March 2021 on local government finance highlighted how the pandemic had caused sudden and severe drops in local authorities’ income, whilst at the same time creating additional financial pressures from the need to deliver new services and … Read more Our report in March 2021 on local government finance highlighted how the pandemic had caused sudden and severe drops in local authorities’ income, whilst at the same time creating additional financial pressures from the need to deliver new services and the increased costs of delivering existing services.54 In 2020–21, NHST&T paid a total of £2.2 billion to local authorities out of its overall budget of £22 billion and actual spend of £13.5 billion. This included: £1.7 billion for ‘contain’ activities to identify local COVID-19 outbreaks and support local responses to the pandemic; £176 million for test and trace support payments; and £13 million for practical support for self-isolation.55 Local authorities’ involvement in testing and tracing increased significantly during the course of the pandemic. The Chief Executive of the UKHSA explained that some local authorities had taken responsibility for contact tracing through the Local Zero programme. However, as cases have increased NHST&T had taken some of this back because local authorities did not have the capacity to do it.56 The NAO report noted that some tracing often fell to staff of local bodies, and the additional time and effort required put a strain on resources, which may not be sustainable in the long term. It also found that funding for local responses to the pandemic was one of only three areas where NHST&T had budgeted less than it eventually needed to spend.57 We questioned whether, given the involvement and responsibilities of organisations at a local level, too much money was being held centrally. The Chief Executive of the UKHSA told us that it was committed to learning the lessons 52 Q 145; Committee of Public Accounts, COVID-19: Test, track and trace (part 1), Forth report of Session 2021–22, HC 239, 4 June 2021, para 18 53 Qq 143–145, 147–151 54 Committee of Public Accounts, COVID-19: Local government finance, Forty-Seventh report of Session 2019–21, HC 932, 10 March 2021, para 3–8 55 Q 143; C&AG’ Show less

Government Response Summary

The government agrees and states the UKHSA is working with local authorities and partners to design its future operating model, aiming to strengthen partnerships and facilitate co-design of policies and responses once funding is agreed.

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25 Conclusion Accepted

From 1 October, NHST&T will become part of the newly created UKHSA.

Conclusion

From 1 October, NHST&T will become part of the newly created UKHSA. We asked witnesses how they were involving local authorities and other stakeholders in designing the model for this new organisation.59 The Department acknowledged that it had not always … Read more

Government Response Summary

The government agrees and states the UKHSA is continuing to work with local government and partners, committing to strengthen these partnerships to co-design the future operating model for health security once funding from the Spending Review 2021 is agreed.

HM Treasury

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