Why is England so behind on testing?

This week I shall be publishing three posts about the wider aspects of how the Government has handled the crisis.

Today I want to take an initial look at testing, tomorrow there will be a guest post by my friend Paul Joyce. Paul has spent some time looking at the different flu pandemic contingency plans and will discuss his findings. Finally I want to examine some of the gaps that have emerged between forming Government policy and its implementation in the field.

I’ve previously suggested that once the virus threat subsides there is certain to be a public inquiry into how the Government and other organisations performed both before and during the emergency. Given that one of the main missions for any Government is to keep its people safe, this crisis offers an opportunity to assess how well they set about tackling this major task.  Did they do the right things? Did they do them in time? Did they ensure that their decisions were implemented?

The whole point of an Inquiry will be to discuss these issues in forensic detail. Some may think that this will take years and will effectively kick the issue into the long grass, but given the possibility/probability of another pandemic, it will be necessary to learn and implement lessons very quickly. So it will have to be completed in months not years.

The inquiry will have hindsight. Today we are reviewing decisions taken (and not taken) in January. Hindsight makes some of those decisions now appear shocking. Since the crisis will cost the country thousands of premature deaths and hundreds of billions of pounds, it looks odd now for us not to have spent a few hundred million on stockpiling tests and equipment. But in January no-one could be expected to make decisions based on knowledge gained in April.

From our April standpoint it now appears foolhardy for there to have been so little thought given beforehand on how we would increase our testing capacity. The fact that we do not have enough tests has determined our policy to deal with the virus. We have not been developing the best policy to deal with the virus, we have been developing all our policies in the absence of enough tests.

So when on April 2nd Matt Hancock said that it had been his priority to test patients in hospital who might have the virus before testing health and social care staff – it looked to be a good policy. But in terms of combatting the virus and given that we need all the health and social care staff we have it makes no sense at all. It only makes any sense if you start from the premise that we don’t have testing capacity.

But that premise was not inevitable. If, in January, when it was likely that there was a virus coming, just a moment’s thought had been given to the implications of a virus to the NHS and social care, it would have been recognised that testing staff was an essential part of ensuring that the NHS could function.

As we shall see in Paul Joyce’s post tomorrow, previous Governments did give more than a moment’s thought. They ran three day exercises and published sequential contingency flu pandemic plans. All were aimed at warning future Governments what they would need to do when a pandemic seemed possible.

And on one day in January someone would have taken that contingency plan down off the shelf and looked at it. Its content will have been communicated through the hierarchy of their organisation and from there to the Minister. All of this will be a matter of record.

We will know who failed to act, and when.

Today the question that needs to be answered is why – even allowing for the possibility that they may have acted late – did the strategy they followed to increase testing capacity up until April 2nd did not work?

On that date the Secretary of State had to change the strategy to resting on his five pillar plan. The pillars in the plan were all partnerships with a range of different bodies outside of Government: – Universities, research institutes and the private sector. They were each asked to mobilise their resources in the overall struggle to expand testing capacity.

Given the scale of the crisis, it looks like a very sensible idea to work in partnership with every organisation in society to expand that capacity. Certainly, it was sensible by April 2nd – but it was also sensible on February 2nd .

From the word go the Government would have had to have been searching, searching, searching for any spare laboratory, anywhere in the country, for this to work.

Before the late adoption of this second strategy of reaching out to partnerships, there must have been a first strategy which did not rely upon identifying all possible testing capacity. It appears that the NHS family thought it could do this itself.

In the two months before April 2nd there is strong evidence that two bio industry firms were trying to offer their testing facility to the Government to increase capacity – but being on the outside they couldn’t make this happen. The Government’s own animal health agency says it could have been running 40,000 human tests per week and has been eager to help. It first contacted PHE in January. They heard nothing.

The problem appears to be that the institutions to which the state had given the remit to carry out testing did not concede that others could also play a role. They appear to have felt they could do this for themselves. I am sure they ramped up their capacity – but theirs was only a fraction of the total available in the country.

Ideologically what seems strange to me is that this Government is full of people who believe in the great possibilities of the market sector. They believe that this part of our society makes the world go round. But even with this political view, they failed to create a strategy that sought and used that capacity – even when it was being offered.

It’s no good saying that, unlike Germany, we did not have a large company such as Roche to help us ramp up. It’s precisely because the UK does NOT have a Roche, that they should have mobilised our smaller firms into a network. By the end of this crisis there will be strong relationships with the hundreds of small organisations that can help us. It would have been good to have had them at the start. It took our leading scientist Sir Paul Nurse to use the analogy of small ships at Dunkirk getting people off the beaches to help out the larger ships that could not. These are the wider relationships that will get us through this crisis – by reaching out to every part of society to work together.

It’s a big enough crisis to have done that from the start.