Many thanks to a member of KONPNE for this overview on developments regarding Testing Labs – crystal clear that every aspect of the Governments response to Covid-19 is typified by privatisation.
In recent weeks the media has been consumed with talk about testing and there has been much discussion concerning the privatisation of goods and services relating to the COVID-19 pandemic. This article discusses the first of these.
Since the start of the pandemic, it has been acknowledged by many public health experts that an efficient test, track and trace system was vital for the UK to reduce the impact of the Covid-19 pandemic. The government strategy of a centralised system has come under a great deal of scrutiny and criticism. In September, Maggie Rae (President of the Faculty of Public Health) stated in the BMJ (21/09/20) that localised systems of contact tracing, with a more agile and intelligent testing strategy such as is seen in Germany, could work to better effect, with potentially less testing.
At the start of the pandemic, in response to the need for extra testing capacity, the government chose to set up the centralised system of Lighthouse laboratories in collaboration with private companies and universities, and not with pre-existing NHS laboratories. This did not meet with universal approval; many public health experts called on the government to utilise and develop the local laboratory infrastructure.
Testing was designated into four groups known as ‘Pillars’, two of which are relevant to this discussion. Testing carried out in healthcare settings for NHS workers and patients going into hospital is referred to as Pillar One. These tests have been caried out in NHS and Public Health England (PHE) laboratories.
For the general public, with suspected community acquired infection, testing is designated Pillar 2. These tests are performed in the country-wide Lighthouse laboratories that receive swabs from the commercial drive-in/walk-in test sites set up by Deloitte; the £12 billion Test and Trace contract. The availability of Pillar 2 testing has been an issue and in September the Sunday Times (13/09/20) reported that swabs were being sent to Italy and Germany for analysis.
The President of the Institute of Biomedical Sciences, Allan Wilson, stated“The Lighthouse lab model isn’t sustainable in the long term, and we need an exit strategy,”(BMJ 21/09/20).
Clinical virologists writing in the BMJ 15/10/20 stated
“The opportunity to bring together UK laboratory expertise…was lost as a result of a spurious assumption of lack of capacity, leading to the outsourcing of pillar 2 testing to Lighthouse laboratories. This approach, divorced from the NHS and Public Health England diagnostic expertise, has [had problems] accessing testing, sample receipt and processing, test quality, and data linkage to public health and other NHS structures. All of these would have been minimised if the testing programme had been developed and expanded…[using]…existing NHS centres of expertise…”
Development and expansion of pre-existing facilities was required because successive governments had presided over a series of changes and cuts to the UK Public Health Laboratory Service (PHLS) which had worked alongside the NHS hospital laboratories.
The PHLS had been set up in 1946 with the passing of the National Health Service Act that year. It became a nationally organised network of laboratories which were able to exchange information about new scientific and epidemiological methods. The laboratories could collaborate and support one another when outbreaks of infection occurred and facilitate a response to national challenges. In 1994 the PHLS comprised approximately 50 laboratories, organised into nine groups across England and Wales. In addition, there were two national centres: the Central Public Health laboratory and the Communicable Disease Surveillance Centre. Thus, the PHLS was able to deliver an integrated microbiology and epidemiology service to the population of England and Wales.
In 2003 the PHLS merged with additional facilities to form the Health Protection Agency which protected the population from infectious diseases and environmental hazards. As stated on GOV.UK:
“The Health Protection Agency’s role was to provide an integrated approach to protecting UK public health through the provision of support and advice to the NHS, local authorities, emergency services, other Arms Length Bodies, the Department of Health and the others. The HPA became part of Public Health England in 2013”.
Writing in the Guardian, 01/04/20, Professor Paul Hunter (Professor of Medicine at the University of East Anglia) stated:
“Many of the laboratories in the old network were shut down, taken over by local hospitals or merged into a smaller number of regional laboratories”.
Following another reorganisation, Public Health England became the body whose remit included to protect the population from infection. But now, following further cuts, there are just four ‘public health’ laboratories and yet more reorganisation has been announced as stated on GOV.UK:
“Public Health England has a superb professional and scientific base, on combating infectious disease, other health hazards and other risks to health….But [it] has not had the at-scale response capacity we have needed to handle a full-blown pandemic…”
…so government cuts have come home to roost, but there is a new plan…
“To give the UK the best chance of beating COVID-19, and continue to monitor, identify and be ready to respond to other health threats, now and in the future, we are creating a brand-new organisation to rigorously extend our existing science-led approach to public health protection – the National Institute for Health Protection.”
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