Leadership of our testing system needs an overhaul

No one doubts the scale of the task facing the government and the huge efforts being put in by both front line staff in many sectors, and I am sure the less visible civil service, and indeed politicians. We all want the government to succeed.

We have not yet reached the peak of covid-19 but nonetheless our attention must also be given to an exit strategy.

In any large scale process it is necessary to have critical friends who can take a helicopter view independent from the hurley burley. I have always found such opinions invaluable. It is in that spirit that I offer the following observations regarding an exit strategy, for some of the signs are worrying.

Exit strategy

I am struck how successful South Korea and Singapore have been with classic case identification through mass testing, rapid contact tracing using technology, and rigorous quarantine for relevant individuals.

This enabled continued economic activity, and a mortality rate in their affected citizens of 0.6 per cent compared with 6.4 per cent here. Both are experiencing a second mini-wave with returnees from overseas and have had to adapt swiftly, but nonetheless the response is impressive.

There seems a reluctance to cede quality control to multiple competent labs, the aptly metaphored small ships, but this approach has been at the core of Germany’s efforts

Any successful exit strategy in the UK has to require mass testing, not least for designated key workers. This will need to be both antigen and antibody tests

Any successful exit strategy in the UK has to require mass testing, not least for designated key workers. This will require all types of tests, including antibody tests. We are informed that the current antibody tests are “not of acceptable quality”. These tests are used perfectly satisfactorily elsewhere.

There seems a reluctance to cede quality control to multiple competent labs, the aptly metaphored small ships, but this approach has been at the core of Germany’s efforts. A respected ex-NHS clinician Karol Sikora, now chief medical officer of a private health organisation, is utilising these tests on all his front line staff just so they can help with covid-19 patients for the NHS.

That is not happening to NHS staff and raises the question why not?. We read of multiple anecdotes of life science companies offering help to receive no reply at all. I heard of one executive giving up after six weeks of attempts. What criteria and decision making process is therefore preventing us from creating a national effort for such a critical part of the overall response to coronavirus?

Balancing the effects

Any exit strategy will also have to balance the effects of covid-19, limiting mortality and morbidity in non-covid patients, and limiting future morbidity and mortality that come from a moribund economy. A one club tactic will not be successful ultimately.

A single solution across every area of the country is also likely to be less successful than one nuanced for the different points on the curve of each region according to Professor Allyson Pollock. Is the thinking therefore sufficiently balanced at present?

The strategy for ramping up testing seems dependent upon creating mega hubs, presumably to keep central control. This is the strategy that prevented us increasing testing fast enough in the early stages, and will do so again.

It is inevitable that a process involving such centralised processes will have delays, be unable to be agile and ultimately mean people who should be tested, are not to their potential detriment.

In turn this impedes identification, contact tracing and relevant quarantine. Conversely, it also drives non-relevant quarantine which impacts on exit and a resumption of economic activity.

Sound leadership

For the answers to the questions I raise we have to look at leadership decisions and style. I conclude that the necessary ramping up of testing and the exit strategy requires leadership with different skills from those acquired as an academic epidemiologist, which currently dominate decision making.

It needs a dedicated multi-skilled task force led by a person who understands supply chain formation, project management, swift and pragmatic decision making.

Such a leader would naturally corale the knowledge in the wider country that could be used. People are around in senior roles who have these skills, such as Andy Street (former managing director of John Lewis and now Mayor of the West Midlands) or Michael Barber (founder of Tony Blair’s delivery unit). We need them yesterday — for tomorrow.

We need the right skills in the right places for the next phase in this battle.

Currently, we do not.