Testing, the government keeps telling us, is the way out of the coronavirus lockdown. Soon, the Prime Minister assured us in his address to the nation last Sunday, we will be testing ‘literally hundreds of thousands of people every day’. Given that Matt Hancock seems finally to have achieved his ambition of testing 100,000 people day – as he promised to achieve by the end of April – who could doubt that the PM will realise his promise?
True, there was some controversy over the way that the health secretary reached his 100,000 tests on the very last day of April, by counting tests which had been put in the post. The numbers of tests performed then fell back in subsequent days. But this Wednesday there seemed no doubt: the government was able to announce that 126,064 tests had been conducted in England.
Except look a little more carefully at the figures and there is something a little odd. While 126,064 tests were performed on Wednesday only 71,644 people were actually tested. In order words, 54,420 of these tests were performed on people who had already been tested that day. Either three quarters of people are being tested twice, or a smaller number of people are being tested multiple times.
How come? One possibility put to me by a GP was that the Department of Health and Social Care could be counting the nasal swab test and throat swab test – usually conducted together, at the same time – as two separate tests. DHSC denied this, saying they only counted it as one test. Its explanation was simply ‘For clinical reasons, some people are tested more than once. Therefore the number of tests completed may be higher than the number of people tested.’
It is very odd that this should apply in so many cases. But regardless of this, if the government is going to set itself a target for testing surely it should be for the number of people being tested, not the raw number of tests being performed. I have to say it never occurred to me, until it was pointed out, that the target of 100,000 tests a day didn’t mean 100,000 people being tested.
The Conservatives rightly lambasted Blair for his target-obsessed NHS and the perverse outcomes which came out if it. In 2014, for example, the then health secretary Jeremy Hunt attacked the 18-week waiting target introduced in 2007, saying:
‘The four hour waiting time for A&E was dealt with, for example, by If faced with a choice between treating a patient who had missed the 18 week target or someone who had not yet reached it, the incentive was to treat the person who had not yet missed the target rather than someone who had because that would help the performance statistics, whereas dealing with the long waiter would not. So a target intended to do the right thing ended up incentivising precisely the wrong thing.’
But now the government is travelling down the same road: setting impressive-sounding targets but then reaching them by questionable means.
Who cares precisely how many tests are being undertaken anyway? What matters, surely, is that people are being tested at the right time and for the right reasons – say because they are a patient presenting with symptoms, they are a member of staff about to begin a shift or they are a hospital patient about to be discharged to a care home (the latter being a prime case when people really needed to be tested but sadly sometimes weren’t). There is no point in launching into a national swabathon just for the sake of it. Sadly, Blair’s target culture is not only still alive but it is looking rather healthy.
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