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.
Was the UK as prepared as it should have been for coronavirus, including holding the appropriate 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 past 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 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 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. So they have been working with frontline staff to reuse visors and a burgeoning cottage industry of 3D visor printing has grown up overnight.
The shortage of clinical gowns over the past 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. Specialised fluid-repellent 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 is still erratic despite daily freight flights. 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, that 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 for International Trade, are leaving no stone unturned to overcome these constraints. But the reality is that, for some trusts, stocks of gowns have started to run critically low.
National and NHS trust leaders have been working extremely hard to address these shortages. Talking to trusts over the weekend, 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 has now approved the use of coveralls in place of gowns and we understand that a consignment of 200,000 is due for release shortly.
Trusts are also helping neighbouring providers to ensure gown stock is shared wherever possible. This mutual aid is a key benefit of being in a National Health Service.
But these are last-minute actions to prevent gown stock from running out, and the stock position for a number of trusts still looks precarious. We understand that more gowns are scheduled to arrive shortly but further emergency measures are being rapidly pursued.
The shortage of gowns is a specific, current, well-defined and well-known, gap. There is one other key PPE gap – the delivery of aprons, gloves, surgical masks and appropriate eyewear for the rest of the health and care workforce beyond trusts.
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 large extent, to the logistics of trying to deliver to more than 50,000 different providers, compared with the 217 trusts we represent, all of which have 24/7 central storage facilities. National leaders 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 PPE gaps. But trust leaders believe they should be included earlier in helping to find solutions. For example, if there is going to be a shortage of a particular item, then far better to know about it well in advance.
There is 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.
• Chris Hopson is chief executive of NHS Providers, the membership organisation for all of England’s 217 ambulance, community, hospital and mental health trusts
