NHS Improvement chair Baroness Dido Harding on Woman’s Hour: a rough transcript. Interview by Emma Barnett.
Emma Barnett: Is TAT system robust enough to deal with Covid19? It’s been in the papers yesterday about your possibly going for the top NHS England job once Sir Simon Stevens goes. Have you applied?
Dido Harding: Today’s my first day back as chair of NHS Improvement. I've just had two weeks' holiday. I’ve not applied. I’ve been thinking about what I want to do with my life. Today, I’m looking forward to picking up with NHS colleagues.
EB: Might you apply?
DH: I’m thinking about it. I’ve loved working in the NHS for the last three-and-a-half years, it’s been the privilege of my life working alongside our NHS people. Many people have been thinking about what they’ve learned these last 18 months: I’m no different.
EB: There have been noises of concern and opposition about your possibly applying. The Daily Mail talks about the ‘bungling former TAT boss wants to run NHS despite TAT being the most wasteful public spending. How do you react?
DH: There’s been so much media coverage of this all in the last year, I’ve not had time to read it. I’ve not been reading media coverage over half-term with my family. I’m pleased to be back in my NHS role: that’s it
EB: There has been big criticism of cost of Test And Trace (TAT): £22 bn year one; £15 bn since. Is it value for money (VFM)?
DH: Let’s break down that cost first. 80% of the cost is in testing, and 80% of those costs are variable, based on numbers of tests required. £37 bn was earmarked, but not yet spent. Done huge number of tests: over 100 million. There’s clear value in making sure anyone with symptoms can get PCR tests, and get twice-weekly lateral flow tests (LFTs). VFM? Look at disease challenges: we have to find it; know what’s happening locally, so we can surge TAT and vaccination where dangerous variants occur. I think it’s important to spend money on that
EB: But it’s such big money. To put it in context: a 5% pay rise for all NHS staff would cost £2.3 bn. You say you’re very proud of NHS, but in the context of money needed but not given by the government for education catch-up (£15 bn), or £4bn for the 0.7% of GDP foreign aid commitment. It’s eye watering: the former Treasury Permanent secretary Sir Nicholas Macpherson described TAT as the most wasteful spend of all time. He’s right, isn't he?
DH: You’ve just mentioned the NHS and education: two huge customers for TAT. Clearly, NHS patients must be tested before they go in; then education is giving everybody 2 x weekly LFTs. In the last year, all developed countries spending huge sums on test trace and isolate (TTI) programmes. We all want a more normal way of life: this is the way back to that.
EB: Is it fair to say of TAT that the test bit worked, the tracing bit not?
DH: I disagree
EB: Some examples: this year, TAT took a week to find someone with the Brazilian variant: SOS had to go on TV to appeal for them to come forward (which they did). For three weeks, eight local authorities (LAs) missed access to data on contacts, including Blackburn with Darwen, where the Delta (India) variant was common. That’s failure, isn't it?
DH: There’s a danger that you and I trade stats. Here are a few back. In one week in January, our service reached a million people in 24 hours, extraordinary for service only existing 8 months. The reality we built an effective service for 65 million people.
A year ago, none of us thought vaccines were on the horizon. A lot of us had great hope invested in the TTI programme. Expectations were set too high. This year, we’ve learned that TTI is part of the response, but not a silver bullet for return to normal. It's not possible to do it with TTI alone. Everyone wanted to believe TTI alone could mean that we didn't have to do the horrible, unnatural things we’ ve had to do to contain Covid19. I think we’ve all learned a lot about how to fight this difficult infections disease
EB: But TAT’s job was to stop successive lockdowns, which it did not?
DH: It’s had a huge role in saving lives, but no. It didn't singlehandedly stop lockdowns.
EB: Do you want to do what Dominic Cummings did, and say sorry?
DH: I’d be apologising for the science of exponential spread. You can't contain Covid19 with just TAT.
EB: But there have been real failures. In October 2020, another data failure (relating to use of Excel) meant that 48,000 not told in contact with people testing positive. Also, we heard in April that about 20,000 people who should be are not isolating. That’s not good enough for the money TAT has cost, is it?
DH: We have testing infrastructure that’s the envy of the world, and our contact tracing reaches people faster (most systems don't even report contact tracing performance in the way we do). In the last year, launched and developed NHS Coivd19 app, which has been the 2nd fastest download after Zoom and ahead of TikTok. Research published in ‘Nature’ research showed that the app prevented 600,000 infections; so preventing 6,000 deaths. That’s saved lives and been an important part of our defences.
EB: I’ve had a message saying that other countries have used TTI succvessfully; NZ, Singapore, Taiwan kept Covid at bay with TTI. And a message from someone who worked at a TAT Guildford site, saying it was absurdly overstaffed. There’s a mismatch with your view, and those who’ve worked in TAT or got the app but turned it off, isn't there?
DH: We all hoped TAT would mean didn't have to have lockdown. Taiwan have just extended their lockdown, sadly no TAT in world has prevented exponential growth.
EB: Do you know how many people are not isolating who are meant to be isolating?
DH: Since March, TAT has been publishing ONS survey on people asked to isolate, asking how they how behave. 85% follow rules and isolate if asked. Another problem is coming forward in first place: I’ve been very clear we should provide enough support to enable self-isolation. Isolation is hard emotionally and practically.
EB: The Government let you do this role with one hand behind your back on that. 96% of people don't get the supposed £500 payment; or statutory sick pay (SSP)?
DH: This time last year, there was no support payment; I championed and argued for it. Also for physical practical support with LAs: it’s not just money. Should we be doing more? Probably yes.
EB: Is that a regret?
DH: With the benefit of hindsight, knowing what we know about the disease and how people behave, this time last year probably I would have shouted louder and campaigned harder. Not because people were rulebreaking, but to ensure support
EB: So your hand was behind your back? It’s still a problem now if you can’t get people to come forward to self-isolate or if they can't afford to, scared?
DH: I think the single biggest challenge for all TTI systems is to build trust
EB: Shouldn’t some of TAT’s money be diverted to support the poorer who need to isolate?
DH: That’s Exactly what TAT support does, and LA support has grown.
EB: But people need even more?
DH: We need to look forward. Those decisions are not my responsibility now. And in a world with such a high proportion of double-vaccinated adults, it’s more important that those at risk of spreading Covid19 can practically isolate.
EB: You’ve accept those breaches discussed, and confirmed them in select committee appearances. I want to ask you about the use of outsourced consultants, creating damage to trust for breaches and outsourcing.
DH: These weren’t data breaches, but errors in the system so data didn't flow,. Breach implies data being lost in dangerous way.
EB: I believe there were also data breaches, but anyway …
DH: I don't believe there were. This time last year, our service had by the end of May just hit 200,000 tests a day and contact tracing had been live for one week. Speed meant we needed to use all national resources available: the Army; local government; and private sector companies, contactors
EB: But didn't you over-rely on private sector consultants and outsourcers? Why did you not use LAs’ expertise from the start?
DH: When I started at TAT in May 2020, we had 300 people working on health protection nationally. There were no contact tracers in LAs. I appointed Tom Riordan on my first weekend to bring in the LAs, step by step. We provided £2bn for LA TAT support schemes. It’s absolutely important to have LAs and private sector. I'd be first to say mistakes were made,
EB: What was the biggest error made?
DH: Two big things that I learned: we didn’t have surge capability to cope with an infectious disease like Covid19. The Army is in total 80,000 staff; within 6 months, TAT had 55,000 staff. We didn't have the human capability and the digital capacity to surge. The other thing we underestimated in the early days was how Covid19 much would exacerbate extant health inequalities. Covid struck communities already struggling on many fronts. I think that was less clear this time last year. If starting from scratch.
EB: Why do you think there’s been animus towards you personally, that the PM or Health Secretary didn't attract?
DH: There have been some not nice things. As I say, I haven't followed media criticism. But at one point we had a TV crew outside house for several weekends. My younger daughter said to my 15 year-old, ‘what’s happening?’ My fifteen-year-old replied, ‘the world seems pretty awful at the moment, and some people need someone to blame, so they’re getting angry with Mummy’. I think that’s a pretty good summary.
EB: It’s not put you off applying to run NHS England?
DH: I didn't do this job for approval. I was asked by the PM to serve my country, and I did my best.
EB: Is there anything else you want to say?
DH: I’m not a politician: I’m not here to campaign for something. I’m just on here to describe the work I’ve done, and I’m very proud of all the people I’ve worked with this past year.