NEW YORK ─ The National Audit Office, a UK public spending watchdog, on Friday released a follow-up report that heavily criticized the region's test-and-trace program for COVID-19, saying that only a small proportion of distributed lateral flow tests have been registered as used.
In the report about the UK government’s approach to test and trace services in England from November 2020 to April 2021, the NAO said that only 96 million, or 14 percent, of the 691 million lateral flow tests distributed as part of the program in England had been registered as used.
The UK NHS Test and Trace Service, or NHST&T, responsible for testing capacity, tracing activities, and the distribution of rapid tests, has started a research program to understand why the registration of test results is so low and is working to increase public awareness of the need to register results and improve its ability to track tests, the NAO said.
"NHST&T is responsible for driving up public compliance, but research suggests that only a minority of people who have COVID-19 symptoms come forward for testing," the NAO said in its report. "It has no target for increasing this, the uptake of LFD testing, or compliance with self-isolation."
According to the NAO, NHST&T said it has spent £13.5 billion of its £22.2 billion budget in 2020 and 2021, representing an underspend of £8.7 billion. It spent less than expected because a predicted high level of demand for testing in January and February 2021 did not materialize due to the national lockdown. Overall, NHST&T spent £10.4 billion on testing; £1.8 billion on identifying and containing local outbreaks; and £900 million on tracing, the NAO said.
From October 2020, NHST&T rolled out mass testing for people without symptoms, using lateral flow tests to detect SARS-CoV-2.
As part of the test and trace program, NHST&T has reduced the time taken between a person booking a test and their contacts being asked to self-isolate for in-person PCR tests. "However, in‑person PCR tests make up a declining minority of tests, and it is less clear whether the wider system is operating as quickly as it needs to," the NAO said in its report, adding that NHST&T's "internal targets do not cover the period between a person experiencing symptoms and coming forward for a test."
The NAO also said that some testing and tracing services are still being procured under emergency regulations without competition. Although NHST&T has steadily reduced the number of contracts awarded using emergency regulation, the amount awarded has more than doubled to £2.6 billion from January 2021 through March 2021 compared to £1.1 billion from April 2020 through June 2020.
"The largest contract NHST&T awarded using emergency powers in January to March 2021 was for LFDs for self-tests (£1.9 billion)," the NAO said. "NHST&T told us that only one supplier had secured regulatory approval to supply these tests, so it was not possible to run a competition. The absence of competition and normal regulatory processes brings risks to value for money."
NHST&T relied on management consultancy to staff up its organization quickly and continues to rely heavily on consultants, NAO said.
In November 2020, NHST&T sketched out plans to reduce the number of consultants it employed. However, it employed more consultants in April 2021 than in December 2020, and by mid-April, consultants still accounted for 45 percent of its central staff. NHST&T told the NAO that among other reasons, reducing its use of consultants has been made more difficult because of skills shortages in certain areas in the civil service.
The report follows an earlier one published by the NAO in December 2020, saying that "overall NHST&T had achieved a rapid scale-up in activity in respect of both testing and tracing, and had built much new infrastructure and capacity from scratch … [but] it is not yet achieving all its objectives."
Since then, NHST&T "has introduced a lot of changes, including mass testing, closer working with local authorities, and initiatives to identify and contain variant forms of COVID-19," Gareth Davies, the head of the NAO, said in a statement. "However, some pressing challenges need to be tackled if it is to achieve its objectives and deliver value for taxpayers, including understanding how many lateral flow devices are actually being used and increasing public compliance with testing and self-isolation."
The lateral flow testing component of the government's test and trace program has been criticized in other circles. Earlier this month, Bedford, UK-based test developer Mologic said it is suing the UK government over the validation of its rapid antigen test for SARS-CoV-2.
Among other concerns, Mologic is dissatisfied that the UK government's testing facility has approved the use of a lateral flow antigen test developed by Innova Medical Group, which has reportedly supplied the UK government with more than 1 billion rapid tests under contracts worth more than £3 billion. The US Food and Drug Administration recently requested that the firm stop sales of its Innova SARS-CoV-2 Antigen Rapid Qualitative Test and warned the public against using the test, citing concerns about its performance.
However, the UK government's Medicines and Healthcare Products Regulatory Agency, or MHRA, announced in June that it has extended to Aug. 28 an Exceptional Use Authorization for National Health Service test-and-trace lateral flow devices covering Innova Medical's test.