David Rowland produced a report in 2013 which suggested the UK was unprepared for a pandemic.
The director of the Centre for Health and the Public Interest had identified that the ‘hollowed out’ state would not be fit for purpose should a health crisis arrive – and hypothesised that the Government of the day would likely turn to the private sector to coordinate and deliver its pandemic response.
‘We were worried back then,’ Mr Rowland said, speaking at a BMA webinar looking at the relationship between the COVID-19 pandemic and outsourcing.
‘Since then we have seen a big reduction in the funding going to the NHS, in capital infrastructure, the resources available for public health and a big increase in the use of the private sector to deliver NHS services.
‘Put together all of those various trends since 2013 onward and it has led to a further hollowing out of the state and a further reliance on private providers operating under various different contracts to provide the pandemic response.’
And the evidence of this reliance is not hard to come by. Among the deals which have been struck so far: DHL, Unipart and Movianto were contracted to procure, manage logistics of and store PPE (personal protective equipment); Deloitte to manage the logistics of national drive-in testing centres and super-labs; Serco to run the contact tracing programme; Palantir and Faculty A.I. to build the COVID-19 datastore and Capita to manage returning health workers in England.
At every juncture, the Government has turned to the charms of the corporate world rather than investing in, and trusting, those working in public health, local authorities or primary care.
‘The scale of contracting out in the name of the pandemic suggests real danger that this becomes endemic in future NHS procurement,’ The Guardian journalist Polly Toynbee told the event.
The former director of maternal, child and adolescent health at the World Health Organization and member of the Government’s Independent SAGE, Anthony Costello, told the event that this pandemic response could have been very different had the political will been there.
Dr Costello said the Government could have mobilised GPs and local public health outbreak teams, giving them the vast amount of money set aside for pandemic response and allowing them to fight the crisis locally using experience, expertise and an appetite for innovation.
He said COVID-19 testing sites could have been linked to GP courier systems, samples sent to the 44 NHS molecular virology labs with results received in 24 hours, new staff employed in practices to contact trace, follow up and monitor symptoms and public health put in charge of contact tracing with significant funding and liaison with GPs.
Dr Costello gave rough estimates of £300,000 for an average GP practice of 8,400 people, pro rata, £10m to each of the 151 top-tier authorities in England to strengthen public health, and £30m to each of the 44 NHS molecular virology labs to cover the costs of expanded testing. The bill would total £5bn, which sounds like a lot of money but represents great savings on the £10bn to £12bn the Government has spent on outsourcing test and trace – and, crucially, the money would be following the expertise.
Dr Costello said: ‘It’s been a total dog’s breakfast. ‘We could have done this – but it would have required the mindset at the beginning and to give people the money in the first place.’
The BMA has consistently called for a publicly funded, publicly provided and publicly accountable NHS. It has surely now been proven that the best chance of a speedy and comprehensive response to a pandemic is a properly resourced health and care system – and it should not be forgotten that this pandemic is not over. We may only be at the start of the second of who knows how many peaks.
In future, the Government should place its faith and investment in those who know their areas, their populations and, frankly, their science, best.
As BMA deputy council chair David Wrigley said, if the Government can learn these lessons quickly then perhaps just perhaps ‘we might be able to turn the clock back and salvage something from the mess we are in’.
Watch the seminar