'System failure' on personal protective equipment

If there is a public inquiry over the handling of the coronavirus, the provision of personal protective equipment to front-line staff could be a major theme.

The government has been put under major pressure by staff over the past four days because of delays to the delivery of vital equipment.

This left them at risk as they dealt with a flood of covid-19 cases described as “all-consuming” by one hospital chief executive (while another major trust declared a critical incident).

As Following The Money went to press, the effect of these shortages in terms of staff going off sick has yet to be seen — although, by the end of this week, that could change (there have been some reports of staff becoming infected in London).

The last two weeks have prompted a mammoth effort from local and national procurement teams to make sure clinicians have the PPE they need.

But, sadly, the bigger picture was what the Health Care Supply Association called a “system” failure (although it did not blame staff).

Numerous trusts, some of them very large, have turned to alternative suppliers to source this vital kit, in some cases spending hundreds of thousands of pounds. The situation has apparently been so dire in recent days that, over the weekend, the HCSA asked DIY shops to donate their PPE to local trusts.

The situations saw the army’s logistics teams called in over the weekend.

One finance director told Following the Money while orders could be placed, delivery did not always follow. Whether NHS Supply Chain’s shift from DHL to Unipart for its deliveries in 2018 was a factor remains to be seen.

Sources at trusts said on Monday the situation was now improving.

Meanwhile, those on central purchasing teams cited some specific issues with getting hold of PPE.

These included:

• A lack of manufacturers in the UK and other countries restricting exports;
• Some poor quality products arriving as buyers work in a hurry; and
• Some unjustified price rises from suppliers.

On Saturday, the Royal College of Physicians added to the outcry, asking the government to do everything in its power to make sure enough stock is available for front-line staff.

On Monday afternoon, the Royal College of Nursing called for the prime minister to take personal responsibility.

NHS Supply Chain and the Department of Health and Social Care maintain there are enough PPE stocks available in the national pandemic stockpile for everyone, although NHS England’s chief operating officer, Amanda Pritchard, admitted there have been “some local distribution problems” last Tuesday.

The government has since announced some fairly major changes intended to improve the situation. On the ordering side, NHS Supply Chain has said it has stopped “managing demand” — or “rationing” as some procurement leads called it — for PPE products. The DHSC said it shipped millions of masks and 10,000 bottles of hand sanitiser to London trusts on Thursday, with trusts outside of the capital receiving supplies on Friday and over the weekend.

A 24-hour hotline has been set up for trusts to order PPE whenever they need it. And customers can tune into daily supply chain webinars intended to provide updates on supply issues. But it’s worth noting these have had a mixed reaction among procurement leads so far.

Most notably, trusts may now see army personnel distributing and delivering PPE stock in what NHSE describes as a “military-sized” operation.

How much these moves will ease pressure on local procurement staff remains to be seen. HSJ sources indicate orders are being met, but several challenges remain on the horizon.

New measures may ease the acute pressure providers have faced in recent days — but it certainly won’t be business as usual for the foreseeable future.