The public debate about personal protection equipment (PPE) for health and care workers is in danger of getting stuck in an unhelpful, seemingly irreconcilable, rut. The government is publicly quoting ever growing figures of how many millions of pieces of PPE are being delivered to the frontline. Frontline staff, and those representing them, are pointing with increasing frustration to multiple instances of PPE not being available when required. The reality is that both are right.
There is a huge NHS effort to supply PPE to the frontline but gaps remain. It would help if those gaps were publicly acknowledged and the reasons for them more clearly set out. It would also help if the work the NHS is doing to fill the gaps, overcoming major constraints along the way, was better understood.
The NHS hospital, ambulance, community and mental health trust leaders that we represent are responsible for 800,000 of the NHS’s 1.2 million staff. They are crystal clear. Nothing could be more important than every member of their staff having the right PPE when they need it. They will do everything they possibly can to ensure this happens.
There is a huge NHS effort to supply PPE to the frontline but gaps remain. It would help if those gaps were publicly acknowledged and the reasons for them more clearly set out. It would also help if the work the NHS is doing to fill the gaps, overcoming major constraints along the way, was better understood.
Was the UK as prepared as it should have been for coronavirus including holding the right levels of the right PPE equipment? It will be vital, when the time is right, to explore this question and learn lessons for the future. But given the urgency of the immediate challenges facing national NHS and trust leaders, it’s important to focus on today’s reality.
The UK has a national pandemic stockpile of PPE which, with the exception of gowns and visors, is well stocked. The issue has been the logistics of getting that equipment to frontline staff. Like every sector of the economy over the last decade, the NHS has centralised the buying and distribution of its core supplies, significantly increasing efficiency. That central supply chain, with its stable and predictable pattern of demand, has served the NHS well in normal times. But as soon as the pandemic hit, with demand for certain items of PPE increasing 5,000% overnight, that supply chain was overwhelmed.
National NHS leaders reacted with commendable speed and, with the help of the army and the UK national logistics industry, created an emergency distribution system to proactively deliver pallets of PPE from the national stockpile to trusts. Trust leaders tell us that, after an understandable time lag, the majority of their PPE needs are now being consistently met.
But gaps do still remain. There has been a shortage of face visors. Trust leaders know that their job is to do their best with the resources they have available. So they have been working with frontline staff to re-use visors and a burgeoning cottage industry of 3D visor printing has grown up overnight.
it is clear that national leaders, working closely with the Foreign Office and the Department of International Trade, are leaving no stone unturned to overcome these constraints. But the reality is that, for some trusts, over the last week, stocks of gowns have started to run critically low.
The shortage of clinical gowns over the last week has been more difficult to address as, to protect staff, the gowns have to meet a high technical specification. The constraints around securing gowns are a good example of the problems national NHS leaders are currently grappling with.
China is the only immediate high volume source of clinical gowns for a number of reasons. Specialised fluid repellent textile / treatment is needed, very high volume manufacturing capacity is required and other smaller source manufacturing countries are placing export bans on gowns. There is massive global competition for gowns, all concentrated on China.
National NHS leaders started buying stocks many weeks ago but the delivery of this stock is still erratic despite freight flights being increased to one every day. The Chinese have apparently been delaying consignments to conduct local testing before releasing stocks. There have been instances of stock being mislabelled with gowns seemingly arriving only to find, on opening, the boxes contained masks. Once actual stocks have arrived, they have to meet stringent safety tests with no guarantee that these will be passed.
From our conversations, it is clear that national leaders, working closely with the Foreign Office and the Department of International Trade, are leaving no stone unturned to overcome these constraints. But the reality is that, for some trusts, over the last week, stocks of gowns have started to run critically low.
Over the last 72 hours national and NHS trust leaders have been working extremely hard to address these shortages using a variety of different approaches. Talking to trusts yesterday and this morning many, but not all, of those facing shortages received vital overnight emergency deliveries of most of the last remaining national reserve stock of gowns. For some, this was literally just in time.
Public Health England approved the use of coveralls in place of gowns two days ago and we understand that there is a consignment of 200,000 coveralls due for release shortly. This consignment has been successfully tested for use by HSE.
Trusts are also providing mutual aid to neighbouring providers to ensure gown stock is shared appropriately wherever possible. This mutual aid is a key benefit of being in a National Health Service - trusts can identify where neighbours have problems and then help accordingly.
But these are last minute actions to prevent gown stock from running out and the stock position for a number of trusts still currently looks precarious. We understand that more gowns are scheduled to arrive shortly but, in the meantime, further emergency measures are being rapidly pursued.
The shortage of gowns is a specific, current, well defined, and well known, gap for trusts. There is one other key PPE gap that also needs greater public acknowledgement – the delivery of aprons, gloves, surgical masks and appropriate eyewear for the rest of the health and care workforce beyond trusts.
National NHS leaders will continue their massive efforts to fill current PPE gaps. But trust leaders believe that they should be included earlier in helping to find the solutions.
NHS Providers does not represent GPs, care homes and hospices. But it’s clear that the shortages of PPE have been more extensive, serious and difficult to overcome in these places. That’s due, to a very large extent, to the logistics of trying to deliver to over 50,000 different providers, compared to the 217 trusts we represent, all of whom have central storage facilities that can open 24 hours a day, 7 days a week to receive deliveries. National leaders tell us they are working as hard and fast as they can to solve these problems but it’s taking time. Trusts are helping by sharing as much PPE stock as they can.
What is the best way forward? National NHS leaders will continue their massive efforts to fill current PPE gaps. But trust leaders believe that they should be included earlier in helping to find the solutions. For example, if there is going to be a stock shortage of a particular item, then far better to know about it well in advance. Trusts then have more time to effect the solutions like the mutual support approach they’ve adopted for gowns over the last few days.
There’s always a risk to sharing potentially difficult information more widely, especially if it reaches the public domain and can be weaponised to attack. But fully enlisting the skill, commitment and ingenuity of trusts to solve PPE challenges is key. And then all those who want the NHS to succeed can join together in ensuring this happens.
This article was also published in The Guardian.