this week WOBBLE ROOMS page 297 • POPULATION TESTING page 298 • INFANT FORMULA page 300 FINNBARR WEBSTER/GETTYIMAGES “£18bn spent on opaque covid contracts” The government failed to provide Personal protective equipment accounted The government awarded transparency when hastily awarding for 80% of the contracts awarded (more contracts worth a total of billions of pounds’ worth of contracts during than 6900) and 68% of the total value £12.3bn to PPE suppliers, the pandemic, the UK’s public spending (£12.3bn) . The DHSC awarded £1.5bn many without a competitive tender process watchdog has concluded. worth of contracts to 71 suppliers, before The National Audit Offi ce said that there its process to assess applications was was also inadequate documentation on how standardised, the NAO found. the government had reached key decisions, The government also established a including why suppliers were chosen or “high priority lane” to assess potential PPE how potential confl icts of interest had been sources referred by offi cials and politicians handled. that were deemed more credible. About one The investigation found that the in 10 suppliers processed through this lane government awarded more than 8600 (47 of 493) obtained contracts, compared contracts worth £18bn by 31 July, with with less than one in 100 in the ordinary LATEST ONLINE most (worth £16.2bn) awarded by the lane (104 of 14 892). The NAO also found Innova lateral flow Department of Health and Social Care that sources of referrals to the high priority test is not fi t for (DHSC) and its national bodies. Contracts lane were not always documented. “test and release” totalling £10.5bn were awarded without a The NAO reported that many awarded strategy, say competitive tender process, the NAO found. contracts have not been published in a experts Gareth Davies, head of the NAO, said, timely manner. By 10 November details Nearly half “While we recognise these were exceptional were still missing for 55% of the 1644 of advertised circumstances, it remains essential that contracts worth more than £25 000 consultant decisions are properly documented and awarded up to the end of July. Only 25% physician posts made transparent if government is to were published within the 90 day target. left unfi lled, maintain public trust that taxpayers’ money Meg Hillier, the Labour chair of the Public census fi nds is being spent appropriately and fairly. Accounts Committee, said, “The mistakes Third covid-19 “The evidence set out in our report shows revealed by this report are likely to be only candidate vaccine that these standards of transparency and the tip of the iceberg.” will be tested in documentation were not consistently met in Gareth Iacobucci, The BMJ the UK the fi rst phase of the pandemic.” Cite this as: BMJ 2020;371:m4474 the bmj | 21 November 2020 295 SEVEN DAYS IN Government faces legal action over £75m contract for covid-19 antibody tests Legal action has been launched over the government’s award of a £75m contract for one million antibody tests to a business consortium, alleging the deal unlawfully bypassed safeguards protecting taxpayers’ money. Judicial review proceedings issued on 11 November by the Good Law Project, a not-for-profi t organisation, say the government was actively involved in setting up the UK Rapid Test Consortium and gave it £10m to manufacture testing kits. The contract to purchase the AbC-19 Rapid Tests was signed without a public tender and without evaluating the tests. This, the project argues, raises serious concerns about the maladministration of public funds. A study published this week in The BMJ (p 312) questions the test’s accuracy and suggests that, if used in real life settings, it would give a large number of false positive results. These conclusions contrast with an earlier (not yet peer reviewed) study suggesting the test gave no false positives. Jolyon Maugham (left ), director of the Good Law Project, said, “This was a £75m contract, let without competition, on the basis of profoundly flawed research.” The Department of Health and Social Care for England had not responded to requests for comment by the time The BMJ went to press. Stephen Armstrong, London Cite this as: BMJ 2020;371:m4427 Covid-19 to long covid, with support using the lateral flow test device, increasingly apparent from Care home visitors get materials for patients and health and full roll-out is expected by the 1980s, but some pregnant tests in pilot scheme professionals. the end of this week, including women were still receiving it three A pilot scheme has been primary care. However, Andy decades later. launched to provide regular Demand transparency on Robinson commented on Twitter, testing for one family member or vaccine deals, says MSF “Twice a week?? I’m a community Diabetes friend of care home residents in Médecins Sans Frontières nurse and I have not had a single “Every hospital should Hampshire, Cornwall, and Devon. called on governments to covid test since this all started.” have specialist team” Since 16 November visitors have demand transparency from drug Another tweet said, “Strange. All hospitals in England should been offered either polymerase companies on vaccine licensing Whilst working both frontline NHS have a specialist team dedicated chain reaction tests, to do at deals, costs, trials, and data as a and now supposedly employed to caring for inpatients with home, or the 30 minute rapid condition of funding. The charity as a doctor (despite being a med diabetes, said the latest report lateral flow tests, which can be said that the UK government has student) I have never had a single from the national Getting It administered in person at care contributed £84m to support the routine covid test.” Right First Time programme. It homes before a visit. The scheme development of AstraZeneca’s found that inpatient care, type 1 is expected to be rolled out more covid-19 vaccine, and early Sodium valproate widely in December. results are expected imminently. French drug regulator is But the terms of the deal between indicted for manslaughter Clinics are set up the company and the government French judges indicted the to tackle long covid have not been made public, nor country’s drug regulator, the A network of more than 40 long those of the four deals made with National Agency for Medicine covid specialist clinics in England other vaccine companies from and Health Product Safety, are due to open at the end of which the UK has pre-ordered for “injuries and involuntary November to help patients who 350 million doses. homicides through negligence,” diabetes care, and diabetic have long term physical and accusing it of failing to do enough foot care showed the most psychological symptoms. A total NHS staff cast to keep pregnant women from significant opportunities for of £10m will fund 10 sites in doubt on twice receiving the antiepileptic drug improvement. Trusts should also the Midlands region, seven weekly testing sodium valproate. Some 17 000 ensure that every healthcare in the North East, six in each NHS England and to 30 000 children are estimated professional who dispenses, of the East of England, South NHS Improvement to have experienced congenital prescribes, or administers West, and South East, five said that all 250 000 disease, developmental delay, insulin receives training to help in London, and three in patient-facing NHS autism, or behavioural disorders reduce insulin errors in hospital, the North West. A task staff working in 34 as a result of sodium valproate and every hospital should force will also help NHS trusts in England given to their mothers since it was have an electronic system to to manage the would be tested for first sold in France in 1967. The identify people with diabetes on NHS’s approach covid-19 twice a week drug’s teratogenic risks became admission, it advised. 296 21 November 2020 | the bmj SIXTY SECONDS MEDICINE ON . Smoking WOBBLE ROOMS Tobacco’s influence on UK policy grew in 2019 WHAT’S THIS, THE SORRY STATE OF The UK dropped from first to NHS BUILDINGS? fourth place in a global ranking No, this is a positive story. Wobble rooms table measuring how well are spaces where NHS staff can take a short break when things get too much. They’ve governments fared in 2019 at Tobacco lobbyists improved their influence on government in 2019 popped up across the country this year to preventing tobacco companies off er support during the pandemic. from interfering in policy and legislation. University of Bath in September 2019. Chaand SO STAFF CAN HAVE A WOBBLE? researchers, who led the work Nagpaul, chair of the BMA GPs Yes, exactly! As consultant psychiatrist Richard Duggins at Cumbria, with Action on Smoking and council, called on the government This year Health and others, highlighted to provide an urgent plan to help Northumberland, Tyne and Wear NHS the need for a legally binding and services cope this winter, backed 3793 Foundation Trust told The BMJ in April, publicly accessible lobby register. by appropriate funding. “Wobble rooms provide psychological fi rst In 2019 the UK scored 32 out doctors accepted aid as staff rise to challenges and adapt of 100, up from 26 in 2018 (the Family courts a GP training quickly. They care for those who care and help to make the unbearable bearable.” lower the number, the better the Allow medical experts to post, exceeding country is doing). give evidence remotely the mandatory HOW? Medical experts in family court target of 3250 and Well, at Duggins’s trust the rooms are Emergency surgery cases should be allowed to give stocked with drinks, food, and other nice Frail patients miss out on evidence from their hospitals, up things.