After a week back in school, my teenager had a temperature. My partner is vulnerable so we separated our household as best we could, and I started trying to book a Covid-19 test. Four days and many online hours later, the best I managed was a time slot at Bristol Airport – a four hour round trip – using my sister’s postcode. But I never managed to download the QR code I needed from the Government system, and without a QR code, no test.
I lost a week of work, my teenager lost more learning time, the family was stressed. But we’re OK. What’s not OK is knowing that the same scenario is playing out in households all across the country. Without a working test and track system, a cold is enough to shut down a classroom or a workplace. More worrying, without it local public health teams can’t get a grip on cases in their area. Vulnerable people can’t find out whether or not members of their household pose a lethal risk.
We Own It has compared the chaotic approach in England to other countries, from Taiwan to Germany. Governments with far fewer resources are doing better at getting the virus under control, as our place among the countries at the bottom of the global league table shows. So what is going wrong?
From public health to private profit
To understand why sick children are being turned away from private test centres in airport carparks – all under the banner of the ‘NHS’ – we have to go back to the 2012 Health and Social Care Act. This was written by advocates of a US model of healthcare, and required the NHS to put its services out to private competition. Many crucial aspects of care are now under private contract, from diagnostics and pathology (including testing labs) to community health care. Because they are contracted by an NHS commissioning group and allowed to use the NHS logo, most people are completely unaware that these services are run by private providers.
But an open market in NHS contracts was not enough for the big health corporations. For one thing, their cost-cutting approach might lead to contracts being lost. In Devon, a consortium of NHS providers successfully won back the contract for children’s mental health services from Virgin, while in Cornwall, Serco was forced to pull out of running out-of-hours doctor services after being found falsifying data. For another thing, once they’d covered the costs of bidding and the nuisance of actually delivering care, the profits could be uncertain.
So the Conservative government has been under pressure from its corporate funders, and a range of healthcare lobbyists, to offer bigger and bigger contracts. Contracts that only the biggest corporations can afford to underwrite or bid for, where profits can be extracted across larger parts of the system, and with greater certainty. This is the purpose of Integrated Care Providers – a way of dealing with some of the inefficiencies of the internal market, by giving away huge chunks rather than small titbits to be privately run. You can read more about how this was playing out pre-Covid in a 2019 report from Health Campaigns Together and Keep Our NHS Public.
Sell the best, starve the rest
Meanwhile, as profitable parts of the system have been privatised – and the costs of managing this ‘internal market’ have soared – other parts of the NHS have been starved of funds. In a recent report for Save Our Hospital Services, an NHS campaign group in Devon, I recorded the loss of 71 per cent of our community hospital beds, and dozens of acute beds and wards. Our main hospitals routinely miss their targets for treatment and waiting times, despite the heroic efforts of hospital and ambulance workers, and there are annual crises in recruitment, staffing, and bed capacity. Public health has been cut by 25 per cent since 2016. County councils were instructed to get rid of supplies of PPE as they were no longer responsible for responding to an epidemic. Earlier this year, our director of public health admitted that the service had no budget for preventative health.
NHS testing labs have been among the victims of the cuts. In 2017 an NHS pathologist went public with fears that the labs were on their last legs, forced to merge for greater financial ‘efficiency’, and to compete with one another. Fewer, larger labs mean longer distances and longer waits for tests. Still, NHS labs went on processing diagnostic tests in an efficient way, and the precious links between labs, hospitals, primary care (GPs) and public health teams stayed – precariously – intact.
The pandemic opportunity
Into this situation came the worst pandemic for 100 years. And right from the start, the government decided it was the perfect time to expand the rôle of the private sector.
Instead of resourcing local public health teams – who track and trace people all the time for things like TB, STDs and gastro-enteritis – they set up a parallel system. They paid more than £100m to Serco, a company whose previous record included a disastrous attempt to run NHS labs in London and a £23m fine for ‘quite deliberate fraud’. Serco subcontracted to a call-centre company, Sitel – because all ‘phone calls are the same, right? – but in August it emerged that Sitel was failing to reach half the contacts allocated to them, even during the summer’s long dip in infections. The government promised to divert resources to local public health teams, who were reaching eight times the number of contacts with no new funding. This promise was immediately broken.
Serco’s partner in crime for that earlier fraud case, Deloitte, has been rewarded with the contract for private testing. Once again, instead of boosting the capacity of NHS labs, the government allowed new ‘Lighthouse Labs’ to be established, with volunteers and students working in empty offices to develop testing protocols. It was months before these ‘Lighthouse’ labs were returning test results reliably, but by ensuring scarce testing supplies went to them, NHS labs were left twiddling their thumbs. Deloitte also subcontracted home and care home testing to Randox, another Conservative Party donor and employer of under-worked Conservative MPs. But in July all its test kits were withdrawn amid safety concerns.
Deloitte’s agenda for public services is clear. In a recent Insight piece for investors the company salivated over prospects that the crisis would force governments to ‘transform’ the public sector and accept more private sector involvement, so that: ‘very few services require in-person delivery’ (technology does it better), ‘regulation is agile and adaptive’ (ie, does not get in the way of profit), and ‘procurement processes are flexible, fast and efficient’ (rather than accountable and transparent).
If you feel that a long-term NHS campaigner may not have an objective view on these developments, I’m happy to step aside. A scathing report by the British Medical Association has concluded that an ideological fixation on private solutions is to blame for the country’s poor performance on test, track and trace.
The public sector to the rescue
Established NHS labs have now been summoned to help out the new ‘Lighthouse’ Labs to turn their testing times around. Local public health teams have stepped in to do the work of tracking and tracing where Sitel’s call centre army failed. That they failed is not surprising. Setting up new systems takes time, and even with the endless goodwill of PhD students, minimum-wage workers and clapping members of the public, a pandemic is a bad time to try it. The question is not why is it difficult, the question is why embark on it, when robust systems were there all the time, with public trust and years of expertise to draw on.
No doubt when present failures have been forgotten, or put down to the chaos of the moment, we will find ourselves with key parts of the NHS in private hands. That is certainly what the President of the Institute of Biomedical Sciences fears. But we can come out of this better prepared for the struggles ahead. Love for the NHS was in decline, after years of under-funding, corporate-speak and obscure re-organisations. Now it has never been so strong. People have remembered that the measure of a good society is how it treats people when they are frail and ill, and that the measure of good government is how it keeps its citizens safe from harm. The NHS is the best of us, and people will not give it up without a fight.