Trusts advise widespread use of PPE as staff ‘refuse to see patients’

It comes as national medical leaders seek to address concerns in a new letter (see below).

HSJ has seen guidance sent to staff at University Hospitals of Leicester earlier this week which tells staff: “Whenever you enter a clinical area you should wear a face mask.” It also indicates that in all areas, regardless of the patients being treated, all staff should wear eye protection, a plastic apron and one layer of gloves.

HSJ was told that nearby Northampton General Hospital had followed suit with the broad PPE recommendation.

One source who contacted HSJ about the situation at those hospitals said: “The two trusts have effectively been held to ransom by the medical staff… who have been refusing to see patients because they don’t feel safe / agree with [Public Health England] guidance.”

An acute trust chief executive in another part of England told HSJ some clinicians at their trust had also declined to treat patients in some clinical settings without protective equipment, and in the absence of clear new guidance.

Elsewhere, guidance sent to Guy’s and St Thomas’ Foundation Trust staff yesterday, seen by HSJ, told them to wear PPE for “All patient-facing encounters irrespective of covid-19 status, which involve being less than 2 [metres] distance from a patient”.

“This also includes any staff working in a clinical area within 2m of a patient, eg food services and cleaning teams,” the email said.

PPE shortages and concerns over standards have caused widespread frustration in the NHS reponse to covid-19. In an HSJ survey, chief executives named PPE as one of their top two concerns, with one saying they faced “a near revolt amongst my clinical staff about the national guidance on use of surgical masks for non-aerosol generating work”. Twenty chief executives said they were most in need of FFP3 masks, while 21 said they needed visors. One chief said a “lack of clarity in PPE guidance is exacerbating the PPE shortages”, indicating that more is being used than may be necessary.

Meanwhile, national medical leaders today issued a letter which sought to quell fears of the PPE guidance — particularly a belief that the reason for a downgrading of PPE requirements earlier this month was due to a lack of supply, rather than evidence. The letter from NHS England medical director Professor Stephen Powis, PHE medical director Professor Yvonne Doyle, and Academy of Medical Royal Colleges chair Professor Carrie MacEwen indicated this was not the case, and it was due to more being learned about the virus.

They cannot yet provide new guidance, because a rapid review which has been commissioned is still under way, but they say this should be available ”within days”.

Their letter does provide a condensed version of current guidance, stating: “Recommended PPE to be used by healthcare workers within one metre of a patient with possible or confirmed covid-19 including staff working in hospitals, primary care, ambulance trusts, community care settings, care homes.”

It illustrates how the UHL and GSTT advice goes beyond the current national line.

The letter also gives an update on PPE supply, which has faced huge problems ongoing through last week. “We are now confident that all logistical issues are being solved,” it says.

Responding to the letter, NHS Providers chief executive Chris Hopson, who has been among those repeatedly calling for clearer guidance, said: “National NHS leaders say it will be important that trusts support staff in following this guidance, so PPE kit is used appropriately, and the NHS can ensure the right equipment is available to all, both now and in the future.

“Alongside this clarification, it’s vital that NHS national leaders ensure continuous, uninterrupted, supply of all the items needed for staff to be able to follow this guidance.

“Taken together, this will hopefully be the reset moment on PPE that we all need and that trust leaders have been calling for over the last week.”

A spokesperson for UHL said: “The safety and wellbeing of our patients and staff is our top priority and we are doing all we can to protect them. National Public Health England guidance is the driver for our policies, recognising that this is subject to change as the situation and evidence evolves.”

A Northampton General Hospital Trust spokeswoman added: “Here at NGH we are committed to doing all we can to protect our staff and patients.”