The must-read stories and debate in health policy and leadership.

The NHS Test and Trace service, and its boss Dido Harding, have come in for quite a lot of stick over the past few months.

The agency has been criticised for consistently failing to meet a key target for tracing close contacts to covid cases. It has been decried as not really an NHS service at all but a funnel taking government cash into the private sector. MPs have called for Baroness Harding to resign.

For her part, Baroness Harding has been consistent in her defence of the agency, its staff and her leadership of it. She points out that this vast organisation has been created in the space of six months, has grown the UK’s covid testing capacity 250 times over since March, and is tracing hundreds of thousands of people a day when before it could manage just a handful.

NHSTT is now operating on such a scale that it has a bigger budget than the fire or police services. As Baroness Harding is keen to point out, it’s operating on a larger scale than Asda.

This week Baroness Harding was interviewed by our editor at the HSJ Providers Summit. There she again defended the organisation’s record.

She refused to apologise for its performance and responded to the suggestion that its failings had dragged the good name of the NHS through the mud by instead thanking NHS colleagues. She thanked them for “the extraordinary support and help” in the fight against covid, and in running NHSTT.

Big decisions under cover of covid 

This week has seen a flood of coronavirus-related news so the podcast this week discusses two other important happenings, that might have been given more attention in normal times: the spending review and the latest development in the undoing of the Lansley reforms.

The chancellor’s spending review, although described as a welcome boost for the health service, was criticised for its failure to deliver any sort of meaningful commitment for social care, despite warm words earlier this year.

Deputy editor Dave West argues that despite the “obsession” in much of the press about NHS capacity, it is actually “much more plausible and sensible to expand capacity in social care and intermediate care… to improve the flow of patients, rather than constantly cutting it”.

We also delve into what the settlement for the health service could mean in terms of the day-to-day running of hospitals and the thorny issue of staff pay.

Correspondent – and in-house finance expert – Tom Norton is clear: “It’s abundantly clear that a proper multi-year settlement is what is needed here – not just because everyone is tired of the medium-term announcements around capital – but because you can’t plan effectively.”

We also discuss the latest development in the undoing of the 2012 Lansley Reforms and the timeframe for new NHS legislation.

Not so fast…

Local leaders have been put on notice to vaccinate their workforces from as early as next week, but some face an altogether different challenge which may prove difficult to solve.

Trust bosses have told HSJ that some of their staff feel “anxious and worried” about the safety of the Pfizer-BioNTech vaccine, which is pending approval from the independent regulator.

Jacqueline Totterdell, chief executive of St George’s University Hospitals Foundation Trust, wants a “clear narrative” from “the centre” so she can reassure workers.

This issue could be hard to fix, and if not resolved quickly, may have some serious ramifications.