All over-70s and clinically extremely vulnerable people in the UK – as well as frontline health and care workers – have now been offered their first Covid-19 vaccination, as promised by the government at the beginning of January. Given their record of meeting targets throughout the pandemic, it’s a miraculous achievement.
In contrast with the debacles of outsourced Test and Trace, this was a programme that had the NHS and clinicians in the front seat, driving it forward. It is down to the hard work, intuition and determination of doctors and their colleagues that those most at risk from the virus are now on their way to being protected. This protection is so vital not only for preventing serious illness and more needless deaths of some of the most vulnerable people in society, but the vaccination programme will also play a decisive role in slowly, eventually, bringing an end to the pandemic.
When the programme was first announced at the end of November, GPs and their teams rallied around to rapidly prepare for the biggest vaccination programme in history, drawing on their expertise and proven track record in delivering mass immunisation campaigns from within the community. Meanwhile, staff stepped up to take part in the campaign in their workplaces – with some doctors and nurses coming out of retirement to help too – and our colleagues at Public Health England, NHS England and NHS Improvement, NHS Professionals and in other local organisations who coordinated logistics and distribution.
The vast majority of vaccines have been delivered at GP-led sites, while others have taken place in NHS hospitals and the rest through community pharmacies and mass vaccination sites.
There have been teething problems, but these pale into insignificance when compared to problems we’ve seen elsewhere in the government’s pandemic response.
Of course, there have been frustrations and teething problems largely centred around the supply of vaccines and bureaucracy, but these pale into insignificance when compared to problems we’ve seen elsewhere in the government’s pandemic response.
Take the confusingly branded ‘NHS’ Test and Trace system ran by the likes of Serco, Amazon, Deloitte and G4S. Outsourced to companies with minimal transparency, and with an eye-watering budget of £22billion for the last year, the rollout was beset with problems and poor results from the start.
Testing targets were routinely missed and the programme has been far from the world-beating system promised by the government. Over the last year people have been forced to drive hours from home for a test and faced unacceptably long delays in receiving results.
Meanwhile, local public health teams, led by clinicians with knowledge and expertise in dealing with the wider health of their communities, were shut out of the process, not receiving the much-needed data required to help stop localised outbreaks in their tracks. The lack of engagement with local public health leaders was blamed for the slow response to rising cases in Leicester, for example, a city which has to all intents and purposes never left lockdown.
We know that local public health clinicians working within their communities have the necessary local intelligence and skills to tackle flare-ups – as shown by figures comparing their success rates with outsourced call centres. In October for example, when the national Test and Trace scheme was only able to reach just over half of close contacts of positive cases, local health protection teams reached almost 95% of the cases referred to them (SAGE recommends that 80% of contacts need to be reached within 24 hours for a contact tracing system to be effective).
The pandemic has shown how vital it is that we break our over-reliance on outsourcing.
But with an estimated £1billion real-terms cut in the public health grant in England since 2015, health protection teams are vastly under-resourced, public health doctors are exhausted from being stretched so thinly and outsourcing has been used to plug this gap. Meanwhile, the annual budget of the soon-to-be disbanded Public Health England sits at £300m – 73 times smaller than that of the NHS Test and Trace programme.
This week we’ve seen the biggest health reforms in almost a decade proposed by the government, promising to improve collaboration and integration. One proposal is to remove the wasteful ‘competition’ rules that require the NHS to put all contracts out to tender, something the BMA has campaigned for since their introduction in 2012. However, this must go further in ensuring that the NHS is always the preferred provider for healthcare services.
It cannot be used to dodge scrutiny and hand more lucrative contracts to unsuitable outsourced providers to the cost of the public’s health and taxpayer purse – as we have seen with Test and Trace.
In the vaccine rollout we have seen the progress that can be made when doctors and their colleagues are given the flexibility to lead. Ultimately the NHS must be accountable to the government, but politics must not sideline frontline clinicians, who know their patients, know their communities and are in the best possible place to drive forward positive change.
Above all, the pandemic has shown how vital it is that we break our over-reliance on outsourcing and invest in high quality publicly funded, publicly provided and publicly accountable services, now and for the future.
Dr David Wrigley is an NHS GP and deputy council chair of the British Medical Association. Follow him on Twitter at @davidgwrigley