Despite what Corbynites like to claim, Britain’s National Health Service has always relied heavily on the private sector for lots of things. The food it serves to patients is not grown on state-owned farms, nor are the pills it prescribes manufactured in state-owned factories. Yet when it comes to diagnostic tests there seems to be a reluctance to buy them in, even from other public bodies let alone from private firms. This ideological prejudice is proving costly.
A new report by Matthew Lesh for the Adam Smith Institute, published today may explain the British failure compared with other countries when it comes to tackling the current pandemic by testing. On 14 March, Britain was the fifth best country for quantity of Covid-19 viral tests performed per capita. By 30 March it had fallen to 26th in the league.
The contrast with the United States is especially striking. America was found badly wanting at the start of the epidemic when the federal Centers for Disease Control insisted on controlling the process of testing people for the virus. It 'sought to monopolise testing, discouraged the private sector developing its own tests and misled state and local authorities about efficacy of its tests', writes Lesh. After heavy criticism, it reversed course, decentralised the system and rapidly expanded testing.
Germany and South Korea began farming out the work of testing samples to contractors from the very start. Britain did not. It initially sent all samples to one laboratory, at Colindale, in north west London. Public Health England also 'chose to develop and encourage the use of its own diagnostic tools, rather than seeking the development of a range of private sector tools and providing fast-track approval', Lesh finds. On 12 February, it began to use 12 other laboratories, but still only with its own tests.
When the number of people showing symptoms shot up in the second week of March, rather than outsource the testing, the NHS simply gave up testing all but patients in hospital. As if to reinforce the centralisation strategy, the government then announced the construction of a huge new testing facility in Milton Keynes, which may work well eventually but to date has been accumulating testing devices donated by universities some of which are sitting idle. The centralisation urge runs deep in this organisation.
By all accounts government ministers were calling for more involvement of the private sector from the start but their orders were being frustrated somewhere inside the bureaucracy of the NHS and Public Health England. The excuse was that the reliability of the tests had to be maintained at a high level, or else false positives and false negatives would cause confusion and danger. So even when other laboratories were eventually allowed to do tests, any 'presumptive positives' had to be sent to Colindale for confirmation right up till 28 March. The United States had suspended a similar policy on 14 March.
Lesh reports that 'On 27 January, South Korean regulators summoned the top 20 medical companies to a special meeting to give them one key task: develop an effective test to detect the novel coronavirus. At the time, South Korea had just four known cases.' In Germany, as Dr Christian Drosten of Berlin’s Charité University Hospital explains, 'Germany does not have a public health laboratory that would restrict other labs from doing the tests. So we had an open market from the beginning.'
Here, private-sector providers were banging on the door of the NHS throughout, offering to do testing. These were not cranks and charlatans, but reputable firms like Northern-Ireland based Randox, one of the biggest manufacturers of diagnostic tests in the world (and the list of companies trying to help includes, I hereby disclose, QuantumDX, a Newcastle based startup in which I became an early stage investor several years ago). I have spoken to neither of these two firms lest they think I am the source for this article and become subject to retribution, but I have heard rumours from others that conversations became heated.
This reluctance of the NHS to buy new tests is not new. One diagnostic industry insider complained to me some years ago that 'I can sell in 140 countries, but the country I find hardest to crack is my own'.
Probably not all the blame lies at the door of the public sector. The shortage of reagents to use in the testing kits is now clearly a problem, and some of this may be down to the way the reagents have been bought up by the big private firms that make the testing cassettes used in the key PCR machines that diagnose the presence of viral RNA. So there may yet prove to be a blockage caused by Big Pharma, which for whatever reason has left Britain exposed. Unlike America, we lack home-grown manufacturers of the key materials – a hole in our life-science industrial strategy, it seems.
Yet centralisation is plainly a big part of the problem. Lesh finds that 'The UK’s Covid-19 testing has been dangerously slow, excessively bureaucratic and hostile to outsiders and innovation. There appears to be an innate distrust of outsiders. PHE has actively discouraged use of private sector testing. Even within the system, the process for testing and validation is very centralised.'