So how much money has the government spent on the contact-tracing programme? Silly question. Everyone knows the number is £12bn. Or maybe £22bn.
I am generally sceptical of the National Audit Office; it’s managed to mission-creep into being a general purpose policy evaluation group, but its terms of reference haven’t kept up, so it has to couch all its opinions in terms of a hard core Treasury-view opposition to ever spending public money on anything. That said, it does try to introduce actual information into the debate, so any port in a storm.
Their latest report is here. Key finding 22 complains that the government should have laid off tracers faster in the summer, although it did in fact cut 2,000 of them from the 17th of August:
There has been no shortage of central tracers and, at times, parts of the national tracing service have been barely used. In May, the Department signed contracts for the provision of 3,000 specialist health professionals and 18,000 call handlers for an initial three-month period. It had very limited and uncertain information to determine what initial level of contact tracing capacity would be required. During the initial three months, the call handler contracts had no provision to vary the staffing levels that the Department had set, but the Department quickly became aware of the possibility of excess capacity. By 17 June, there were low utilisation rates for both specialist health professionals (4%) and call handlers (1%). Flexibility clauses, allowing the Department to change staffing levels, were introduced to the call handler contracts from 17 August, after which it immediately reduced its paid-for capacity from 18,000 to 12,000 staff. However, utilisation rates for call handlers remained well below the target of 50% throughout September and for much of October. Spend on the call handler contracts up to the end of January was projected to be 22% lower than had been budgeted (paragraphs 1.7, 3.28 and 3.33).
Key finding 17, though, complains that the government was unprepared for the new outbreak in the autumn:
NHST&T did not plan for a sharp rise in testing demand in early autumn when schools and universities reopened. The September spike in demand was much larger than NHST&T expected so it did not take adequate steps to prepare for it. Laboratories processing community swab tests were unable to keep pace with the volume of tests and experienced large backlogs, which meant that NHST&T had to limit the number of tests available, lengthen turnaround times, and commission extra assistance from NHS and ‘surge’ laboratories. Rationing of community tests in some geographical locations meant that average travel times to test sites lengthened in August and September with some potential users told to visit test sites hundreds of miles away. NHST&T could face similar spikes in future, perhaps owing to a surge in cases in the general population, or the end of the university and school terms in winter and if this happens it will need to consider again how best to balance processing volumes against speed of turnaround (paragraphs 2.17 to 2.20).
This is mostly about testing rather than tracing, but I still find it a bit rich. Looking back, what on earth was anyone doing laying off contact tracers in mid-August? And in what world would getting rid of tracing capacity be consistent with planning for a sharp rise in testing demand? This is what I mean about the NAO being unable to say anything that isn’t “public spending bad”.
It turns out that the budget for tracing, as such, is some £1.3bn out of the total, and up to the end of October, some £478m of this had actually been spent, about £80m/month. This…is not very much? Why not a billion? Why not five billion? It’s only the biggest and most urgent problem we face! Why are we even bothering with this conversation?
It obviously follows that the scope to avoid public spending wasn’t huge, either. The cut after the 17th was a third of the tracing capacity – I can’t believe I am writing this, but let’s be merry – so that gives us an idea. Applying it from the beginning would have saved £50m before the inevitable screaming U-turn in the autumn as the case numbers spiked. Also, you have to appreciate the implicit belief that the best way to form an effective team for a vitally important job involving emotional sensitivity is, ah, brutal casualisation. Amazingly, having just advocated sacking a third of the staff and rehiring them in the space of three months, NAO also complains that there is turnover!
NHST&T’s high vacancy and turnover rate. This seems to be confirmed by some of the documentation we reviewed. In October, NHST&T had a headcount of 3,800, with a vacancy rate of 14%, or 550 vacancies. It has identified insufficient capacity as a key risk to its ability to respond to local outbreaks.
But I was really astonished to learn that the central government has spent £785m on aid to local authorities. To put it another way, government aid to local authorities for COVID-19 response is 1.6x what the central government spent on centralized tracing. This is not what you read in the newspaper, to put it mildly. Nor would you find out from the media that the biggest single contractor is the Office for National Statistics (for the national infection rate survey) and most of the others are big-name medical devices or drugs companies. There’s also a lot of useful how-it-works detail. NAO does, in fact, introduce information into public life. On the other hand, it operates from a gruesomely Thatcherite perspective that gives it weird biases.
Here’s Figure 20 from the report:
If we take the ONS modelling at face value – and the virus map for London currently looks like a German situation map for the siege of Berlin, so they can’t be all that wrong – this suggests that by far the biggest problem is just general chaos, acracy, and a lack of social trust and all the idle tracer discourse, which takes up a startling proportion of the NAO report just as it does the papers, has been either complete hot air or else actively harmful. Interestingly, NAO notes that the testing system was significantly under capacity in July but doesn’t anywhere suggest that the government should have scaled it down to save money. There are things you expect of mere call handlers, it seems, that you wouldn’t say to white coats or Abbott Labs representatives.