Exclusive: Dozens of trusts on course to run out of gowns as PPE crisis escalates

Several well-placed sources in procurement reported widespread concerns, more severe than so far in the covid-19 outbreak. One had information that at least 60 trusts would run out this weekend without supplies, and that it was likely the large majority of NHS providers were affected.

One well-placed source told HSJ the situation today was “not normal even during this pandemic”. Another described the “critical” shortage as “a dire situation for everyone”.

The news follows weeks of shortages of crucial protective equipment, and the situation with gowns has deteriorated in recent weeks after updated guidance recommended wider use.

One senior procurement source said: ”London will run out of gowns by Monday if no stock is received over the weekend, from the national stockpile.” It is understood trusts across the capital would require several tens of thousands of gowns delivered to ensure they can last until Monday. 

The Department of Health and Social Care was this afternoon forced to respond to worsening shortages, issuing guidance on what to do when there are no disposable gowns. This includes using washable gowns instead of the safer disposable gowns, and reusing these — although some trusts will not have laundry capacity to allow this. The alternatives offer less protection, and differ from the existing Public Health England guidance currently in place, which has been subject to much debate and concern among clinical groups.

Some trusts have experimented with washing disposable gowns, to mixed results. A senior source in the north west London NHS, one of the worst hit areas, said they had tried washing single-use gowns previously because of shortages: “We tried this last weekend. The gowns disintegrated or lost their protective properties…. There may be some that are washable.” However, many trusts do not operate an in-house laundry service, limiting the scope for washable gowns.

Professor Jennie Wilson, vice president of the Infection Prevention Society, said hospitals were turning to surgical gowns usually worn by operating staff in theatres, which are washable.

However, she added this would result in some “logistical” problems as the gowns are typically transported directly from sterilisation facilities to theatres and would inevitably get “lost” when used elsewhere in hospitals.

Asked if trusts were coping with the PPE stock levels, Professor Wilson said the picture was “very varied”.

HSJ understands the government expects to receive a shipment of 800,000 gowns this weekend, but this equates to only a few thousand per trust. A large acute provider can use between 4,000 and 7,000 gowns a day.

HSJ has seen figures laying bare the extent of shortages at trusts across one region.

Matt Hancock was quizzed on whether gowns would be available to get through the weekend by MPs at a Commons health and social care committee hearing on Friday morning. He said: “It is a big challenge delivering against that new guidance [recommending wider usage].”

Pressed on whether there would be supply to get through this weekend, he said: “That is exactly what we are aiming to do. There is a question of exactly what type of gown… Of course [any change to] that has to be signed off by the Health and Safety Executive.”

Public Health England now recommends gowns should be worn during certain procedures on suspected or confirmed covid-19 patients. Trusts were told last weekend they could use coveralls if gowns were not available.

But gowns, unlike aprons and gloves, were not included in the government’s pandemic influenza stockpiles.

Trusts previously told HSJ they had spent hundreds of thousands of pounds supplementing inadequate and unpredictable personal protective equipment deliveries. A new covid-19 specific supply channel has been set up to improve deliveries, but shortages of some key items persist.

Update at 5.10pm 17 April: The Department of Health and Social Care has issued guidance to trusts late this afternoon, shortly after HSJ published this piece, on what to do when there are extreme shortages, stating they should switch from disposable to less safe reusable gowns and coveralls.

It advised trusts to reserve disposable gowns for those performing high-risk aerosol-generating procedures, where there are small numbers. It acknowledged some hospitals would not have the laundering capacity for use of the reusable washable gowns, coveralls, or lab coats, which it recommended.

The DHSC said in a statement: “We are working round the clock given the global shortage of gowns and other PPE to secure the NHS and the social care sector the equipment they need.

“New clinical advice has been issued today to make sure that if there are shortages in one area, frontline staff know what PPE to wear instead to minimise risk. This has been reviewed by the Health and Safety Executive, and is in line with WHO and CDC guidance on PPE use in exceptional circumstances.

“There is a 24 hour NHS-run helpline where NHS and social care workers can call to report shortages in supply and it is crucial the relevant guidance for protective equipment is followed closely.”

Updated at 6.40 p.m. 17 April with comment from Professor Jennie Wilson