Have you ever faced a situation where there’s a problem and you’ve rushed to solve it? That urgency to act can turn into your curse. You could end up missing important pieces of the puzzle you’re trying to solve. What to do instead? Try understanding the problem first, before jumping to conclusions or actions. This blog gives an example of what this looks like in the real world. A case study from the United Kingdom regarding COVID-19 testing.
Last September the Institute for Government published a report analyzing the UK Government’s initial response to the COVID-19 crisis. I’ll use part of that information, to highlight some key messages of policy implementation.
Committing to 100,000 tests per day
At the start of April 2020, COVID-19 cases were raising in the UK and testing was falling short. The country was falling behind its peers and the ‘test and trace’ strategy had effectively failed due to low levels of testing. There was mounting pressure on the government to respond.
By the start of April, health secretary Matt Hancock committed to conducting 100,000 tests per day by the end of the month with a five-pillar strategy: NHS Swab testing, commercial swab testing, antibody testing, surveillance testing, and diagnostics national effort.
According to the Institute for Government, the strategy did address criticism of the slow ramp-up of testing and certainly galvanized the government machine. However, the struggles of implementation are real, even for developed countries like the UK.
One of my takeaways from the report is that the problem of limited testing capacity was addressed by setting a headline-grabbing target without fully understanding, let alone solving, the root causes of the problem. There are two issues I want to highlight from the report.
The testing iceberg: a media-based response to a real problem
According to the report, the government started with a headline, instead of an analysis of the problem it was trying to solve and its policy goals, and then setting specific objectives to serve those goals.
The ‘personal initiative’ of the health secretary lacked the advice of key scientific experts and senior civil servants in government. It wasn’t clear if the objective was appropriate or realistic. Furthermore, it was unclear how increasing testing fit into the overall strategy of stopping the spread of the virus and keeping people safe. Chris Witty, Chief Medical Officer of the UK Government, said it clearly: “if you do a large amount of undirected testing, it will not particularly help at all”.
The report by the Institute for Government does a great job explaining challenges in the system that were not taking into account when setting up the strategy to increase testing capacity. In summary, the focus was on increasing laboratory capacity without taking into consideration other aspects like access to tests and staff able to process samples.
A misleading objective
The objective was not the result of an analysis of the problem, rather a response to the media pressure to do more tests. The enormous emphasis on this numerical target for the 30 April deadline, became a distraction in government.
The government’s reputation was obviously at stake with the 100,000 tests per day target. By April 30, the government claimed success with more than 122,000 tests. However, that included over 39,000 testing kits that were mailed to people’s homes or sent out to centres such as hospitals – whether or not those kits were ever used or returned to laboratories.
Prof John Newton – a scientist advising the government on testing – said to the BBC: “So, the tests that are done within the control of the programme – which is the great majority – are counted when the tests are undertaken in our laboratories. But, for any test which goes outside the control of the programme, they’re counted when they leave the programme – so that’s the tests that are mailed out to people at home and the test that’s gone out on the satellite.”
The ‘target’ was met, the real policy objective was not.
It sounds unbelievable to read it. But, I wanted to include it because it’s illustrative of what happens in government sometimes—even in high-capacity governments. Essentially, they were measuring what they could, not what they should.
Final Takeaways
Having a clear objective and a deadline worked to mobilize the government. The number of tests performed did increase from 11,896 by the end of March to 84,215 tests by the end of April (over 7 times its initial capacity). Even though it didn’t reach its target. It’s interesting though, that by April 27, three days before the deadline, the capacity had only tripled (33,287). Whether that was “the national goal” to pursue, is a question for reflection.
Accountability from the public and the media do play a role in terms of what’s on the agenda. The media pressure about increasing testing capacity moved the government to respond in that direction. The problem was that it appears to have been disconnected from their overall health strategy to stop the spread of the virus and keep citizens safe. Testing was a mechanism towards an end, not an end in itself. This might sound trivial and obvious, but this is a real example of how quickly direction can change within government due to one public announcement.
Taking the time to think about the root causes of the problem before defining goals and strategies is essential. In this example, we see how energy, resources and attention were shifted towards this one specific goal, which arguably was not connected to a comprehensive strategy to address the overarching problem. Imagine how powerful the results could’ve been with similar effort and focus but a more comprehensive strategy.
