The availability of personal protective equipment (PPE) for health and care staff both before and during the Covid-19 pandemic has become one of the most intensely debated issues of the crisis.
The National Audit Office (NAO) has now published the first official assessment of the supply and distribution of PPE in England by government organisations.
The government’s plan to distribute personal protective equipment (PPE) during the coronavirus pandemic was undermined because officials failed to stockpile gowns and visors despite warnings to do so. According to the National Audit office Report the ‘Just in time’ personal protective equipment procurement approach cost lives in care homes.
The report published on Friday by the National Audit Office (NAO) said this meant less than half of the expected pieces of certain equipment were handed out to frontline workers as the crisis developed.
The only categories of PPE that increased in volume in the government’s stockpile between 24 January and 21 February, when ministers were acutely aware of the pandemic in China, were aprons and clinical waste bags.
Concern about National Audit Office Report
Health unions and senior MPs have been deeply concerned by the NAO findings, which also confirmed that 25,000 hospital patients were discharged to care homes at the height of the pandemic before testing became routine.
About 300 UK health workers have so far died of Covid-19, and many NHS staff groups and families claim inadequate PPE played a key role in exposing them.
Susan Masters, a Royal College of Nursing director, said the report shows nursing staff were severely let down.
“Our members in working communities, care homes or hospitals, who have had trouble accessing the necessary protective equipment to keep them and their patients safe, will be alarmed to see that a vital opportunity to stockpile adequate equipment was missed,” she said.
Just in time method of procurement
The NAO’s report into the readiness of the NHS and social care in England for the pandemic examined the government’s response to the pandemic since Chris Whitty, the chief medical adviser, confirmed the first cases of coronavirus on 31 January.
The New and Emerging Respiratory Virus Threats Advisory Group (Nervtag) recommended in June last year that Public Health England should stockpile gowns and switch from glasses to visors when glasses next required reordering, the report said.
Auditors said that officials from the Department of Health and Social Care (DHSC) told them that the procurement of PPE had, until April, stuck rigidly to buying exactly what was needed at that time.
“The department told us that the manufacture and supply of PPE has for many years been based on ‘just in time’ procurement and manufacturing principles,” the report said.
They found that one in three homes for the elderly suffered coronavirus outbreaks and confirmed figures released last week by NHS England about the number of hospital patients discharged to care homes.
Figures show that many care homes received little PPE from the government. While health settings received a third of the number of eye protectors required from central government, care homes received 5%; hospitals received three quarters of gloves required from central stocks, care homes received 8%; and care homes received no gowns from central stocks.
The report also discloses that the government does not know how many NHS or care workers have been tested in total during the pandemic.
Jeremy Hunt, chairman of the health and social care select committee and a former health secretary, said: “It seems extraordinary that no one appeared to consider the clinical risk to care homes despite widespread knowledge that the virus could be carried asymptomatically”.
Auditors concluded that the complicated nature of social care provision, including its “lack of” integration with the NHS, “made responding to the crisis more difficult in a number of ways”.
Defence of the governments record
A DHSC spokesperson defended the government’s record, saying the numbers used for judging PPE supply in the NAO report were “misleading”.
“The modelled PPE requirements presented in this report are theoretical worst case estimates. It is misleading to compare them to figures on centrally procured PPE, which do not account for equipment supplied through other routes or existing local stocks,” the spokesperson said. “Sixty per cent of care homes have had no outbreak at all, according to the latest Public Health England statistics.”
Summary
The National Audit Office Report confirms that care homes were given a raw deal in the provision of personal protective clothing. The comparison between PPE supplied to the NHS and care homes provides confirmation of the government’s strategy to protect the NHS at all costs, and little thought given to the clinical risk of residents and staff in care homes and the need for PPE.
Lessons should be learned because the failure of the governments ‘Just in time’ personal protective equipment procurement approach that undoubtedly cost lives in care homes.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy