Staggering TAT figures and government’s aspiration driven by superfactors, by Andy Cowper.

Perhaps it was inevitable that in the week which saw a statue erected celebrating our Colt Seevers of health secretaries, M*tt H*nc*ck, the performance of his department’s Test And Trace programme would surprise us all.

So it has proved.

And it’s surprised us on the upside, of course? This “world-beating” system that the Prime Minister promised us back in May must surely at the end of September be ready to slip into its smoothly-oiled gears and deliver a service that can suppress the spread of covid-19 as fast as possible?

Erm, no.

M*tt’s TAT

The latest performance data shows us that M*tt’s TAT’s performance is actually getting worse.

Its own report states that “the total number of test results processed decreased by 19 per cent compared to the previous week”.

The number of people reached by contact tracing has fallen again, to 77.7 per cent (down from 83.9 per cent previous week). TAT reached 74.7 per cent of those identified as close contacts of those who tested positive in the week ending 16 September (last week, this figure was 75.9 per cent). Baroness Harding last week confirmed to the Commons Science Committee that the TAT target for this metric was 80 per cent: this has never been reached, not even fictionally, as happened with the 100,000 tests a day nonsense.

Just 10 per cent of covid-19 test results hit the 24-hour turnaround target, set by the PM back at the start of June. This figure is, staggeringly, getting worse (last week’s figure was 14.3 per cent).

The proportion of people who got an in-person test at a local testing centre, a mobile unit or a regional test site and received the result within 24 hours has fallen once again, to just 28.2 per cent from 33.3 per cent the week before.

As ever, it is well worth reading the expert analysis of Dr Duncan Robertson and Adam Briggs on the latest TAT data. And this data visualisation from the Nuffield Trust is a good resource.

Tom Newton Dunn, chief political commentator of Times Radio, observed that “the testing chaos of the last two weeks is having a further serious knock-on effect inside government, I’m told. Officials no longer feel they can fully trust the testing data coming in, as they feel it no longer fully tracks where the virus now is. Instead, they’re looking harder at what they call ‘soft data’ - hospitalisations, and calls to 111. Both are going up fast. The number in hospital is double that from a week ago, 1,141 yesterday from 633 on September 12. 10-20 per cent in hospital die.“

Meanwhile, I was struck by this from Labour MP Rosie Cooper, on a constituent’s experience of being told to self-isolate for 14 days from the TAT phone call, and not from the potential infection incident.

“Government policy indicates that you need to isolate for 14 days from the point of contact, so I’ve asked the Prime Minister, Secretary of State for Health and Social Care and the Test and Trace Chief to explain why callers from Test and Trace are telling people they have to isolate for 14 days from the telephone call notifying them, not 14 days from the point of contact with the positive person … the system says if that is what Test And Trace say, it can’t be overruled! … It is ridiculous that Test And Trace are requiring people to stay away from work unnecessarily. This will rob public services of people vital to keep the country going … doctors, nurses, teachers, to name but a few!”

The in vitro diagnostics industry’s trade association this week warned that supply chain shortages may threaten the government’s promise of 500,000 covid-19 tests a day by the end of October.

And when the Daily Mail is doing this story about the government’s use of the private sector, that government is in trouble.

Oh, and off the back of Mr H*nc*ck’s spectacular comments about free covid-19 testing driving up demand last week, the noble Baroness Harding of Winscombe this week suggested that the cost of the PM’s fictional, instant Operation Moonshot tests could be shifted neatly onto the public and businesses. The FT reports that she told the Confederation of British Industry “I can imagine that that’s actually a business and consumer product rather than a symptomatic healthcare product”.

We are in a mess. This government’s mixture of incompetence, over-claiming, speed, braking and changing direction abruptly is leaving skidmarks all up and down Whitehall.

The PM’s weak efforts in Prime Minister’s Questions to turn challenges on TAT’s non-performance into a disgraceful attack on the efforts of the noble Baroness Harding, left us none the wiser as to whether (as Labour leader Sir Keir’s inquired) we should believe the Boris Johnson who said back on June that Test And Trace could be a “real game changer”, or the one who the previous day had said “Testing and tracing has very little or nothing to do with the spread or the transmission of the disease.”

Dear me. The key figures seem to be shrinking by the week in this pandemic: perhaps that is another “long covid” symptom. Mr H*nc*ck this week told the Commons that “the strategy is to suppress the virus while protecting the economy and education”. This is, of course, a group of objectives: it is very much not a strategy.

As for Mr Cummings’ aspiration to lead a government driven by “Superforecasters”, set out in this piece, one can only wonder if the Dominic Cummings Experience is some anhydrously dry ironic performance art project. If anyone wants a trip down Nostalgia Lane to see what a grown-up approach to handling the pandemic would look like, I commend to you former Cabinet secretary Lord Gus O’Donnell’s speech to the Institute for Fiscal Studies this week.

Panic on the streets of Whitehall

The government is in trouble. Its own backbenchers are unusually hacked off so early into a Parliament in which they have a huge majority, as articles show.

While they are only snapshots, the opinion polls are starting to suggest that the public is registering the government’s competence deficit in dealing with the pandemic, with implications for broader public policy. New polling for the FT found that 42 per cent of respondents said the UK’s handling of the pandemic had made them feel less confident about the country’s ability to prosper if it is unable to agree a future relationship when Boris Johnson’s transition period agreed last year with the EU ends on 31 December. Only a quarter said they had confidence in the country’s resilience, the survey found.

New Opinium polling for The Observer suggests that Labour has actually overtaken the Conservatives. These polls don’t mean anything serious: not yet. But nor do they mean nothing. They add on further pressure to an underwhelming government.

In place of fear: more fear

It is worth reading Chancellor Rishi Sunak’s conclusion to his Commons speech presenting the latest extension to the government support schemes “we have so often spoken about the virus in terms of lives lost, but the price our country is paying is wider than that.

The government have done much to mitigate the effects of those awful trade-offs between health, education, and employment, and as we think about the next few weeks and months, we must bear all those costs in mind. As such, it would be dishonest to say that there is now a risk-free solution, or that we can mandate behaviour to such an extent that we lose any sense of personal responsibility. What was true at the beginning of this crisis remains true now: it is on all of us, and we must learn to live with it, and live without fear.”

These words about fear, and implicitly, about blame, are important - and I would like to see him try to deliver them to an audience of people who were working on hot covid wards in the first wave of the pandemic. Mr Sunak heads the “minimalist restrictions” faction in Cabinet, which faces off against The People’s Partridge Mr H*nc*ck and the PM, whose own brush with mortality from covid-19 seems to have modulated his traditionally libertarian views.

This duality matters: Mr Sunak is currently popular with Conservative MP colleagues and the public, although as yet, he has merely spent money. He will surely have to raise it in taxes, in the medium-term future and once an economic recovery is well under way.

A farewell to ASR

It also matters because the prospect of a 2020 autumn spending review and Budget is now gone. My colleague Tom Norton’s summary is a good read on this.

The consequence is that huge NHS issues around workforce (which as reports this week from the King’s Fund and Commons Public Accounts Committee reminded us, is still in a crisis), and about capital will remain un-resolved.

And a report in the FT hints at the government starting to mess around on NHS finances, asking for regular funding requests and covid-19 funding requests to be separated. “Whatever it needs”, eh, Rishi? I think you all know what to do here, in a money no object, except when it is” scenario.

Speaking of which, I’m grateful to the sharp-eyed Paul Waugh of Huffington Post, who noted that another £2bn has been slung TAT’s way with no explanation: “Sunak says £12bn has been spent on test and trace. His last summer statement allocated £10bn. So where has the new £2bn come from? Especially as the service has got worse on several metrics, not better”. Quite.

My HSJ colleague Tom Norton spotted that health minister Helen Whateley told Walthamstow MP Stella Creasy in a written answer that it cannot say how much the Department of Health and Social Care paid Deloitte for testing contracts. This raises the pertinence of the National Audit Office’s current inquiry, and of prominent barrister Jolyon Maugham’s Good Law Project work on the same topic.

It’d be nice to conclude with a bit of good news: ITV News reported that Manchester’s Wythenshawe hospital staff have designed a Powered Air-Purifying Respirator (PAPR): a reusable collar that sits around the neck and contains a fan to draw in air through a virus filter and deliver a cooling airflow around the face. This simple, low-cost device can easily be recycled and has been designed to be compatible with infection control practices.

But I’m not going to end on something so upbeat, because I know what’s kicking in for you all. So I will link to Dave Jones, intensive care consultant, Prince Charles Hospital, Merthyr Tydfil in Wales catching up with Channel Four News to give his view of the lie of the healthcare land as we head in to the Second Cummings Wave.

Good luck, and stay safe.