COVID-19: Supply of ventilators
Closed
What the inquiry looked at
“This inquiry continues our work on the government’s response to the Covid-19 pandemic, focussing on the NAO’s investigation into the supply chains and procurement of ventilators. The NAO report will set out the facts about the government’s spending on efforts to rapidly increase the number of ventilators available to the NHS in response to COVID-19. It will cover both the ‘Ventilator Challenge’ intended to encourage UK manufacturers to design and build ventilators, and the purchase of ventilators on the world market. The Committee will take evidence from senior Cabinet Office, Department for Health & Social Care, and NHS officials on the report’s findings in mid-October. In advance of that hearing, we are calling for evidence from industry and health and medical experts on how Government has managed this particular aspect of its response to the pandemic. If you have evidence on this, please submit it below by Thursday 8 October.”
The committee's words, from the inquiry page on parliament.uk ↗.
What it found
Between March and early August 2020, in response to the COVID-19 pandemic, the Department of Health and Social Care (the Department) and Cabinet Office secured an additional 26,000 mechanical ventilators for use across the NHS at a total cost of £569 million. We recognise this as a significant achievement and a reflection of the hard work, collaboration, and commitment of individuals across both the public sector and UK industry. Due to the public health pandemic, both Departments prioritised speed over cost and took on more risks than is normal. That approach paid off in this situation although there is no guarantee that it always would.
We recognise that the pace and nature of the emergency presented challenges, but it is nevertheless important that there are clear protocols in place to ensure that public money is protected as far as possible, and that any exceptions or changes to procurement are clearly identified and justified.
We are concerned that the Department had no plan before the pandemic for how it might increase critical care equipment in the event of an emergency. This lack of preparedness was exacerbated by the fact that it did not know how many ventilators were available to the NHS to begin with. As a result, the Department did not start its programme to secure additional ventilators until 3 March, despite the World Health Organisation announcing a ‘public health emergency of international concern’ on 30 January.
Once the programmes to boost the supply of ventilators began, the departments worked quickly in the context of increasing global competition and the impending threat of demand that could far outstrip the existing supply. Fortunately, initial estimates of the worst-case scenario that around 59,000 ventilators might be needed in the spring of 2020 did not come to pass, so the government set targets based on building resilience for a potential second wave. While it was late in meeting its ultimate target of 30,000 ventilators by the end of June, NHS bodies are not aware of any point when a patient who needed a ventilator was unable to get one. It is however concerning that the Department could not clearly set out how it assesses whether the NHS now has the ventilators and other equipment it needs as the pandemic continues.
There are undoubtedly lessons to be learned from the success of this rapid procurement and manufacture of ventilators. But it is also crucial to keep in mind that aspects of the ventilator challenge, an initiative led by Cabinet Office to encourage UK manufacturers to design and scale-up production of ventilators, would not be replicable in its entirety in normal times. That programme depended on the uniqueness of the situation, the clear motivating goal of saving thousands of lives that aligned private and public sector interests, and an abnormally large budget and tolerance for taking risk. It is important that the right lessons are identified and shared with other government departments for use in future programmes.
What the government said
The government responded on 25 March 2021.
The government states that it agrees with each of the six Committee recommendations, giving target dates for some and describing others as already implemented.
- On emergency preparedness, it agrees (target implementation: Summer 2021) and notes that strategic reserves have been created, and that once COVID pressures have subsided it "would expect to review stockpile levels".
- On due diligence, it agrees, saying checks were "appropriate to the circumstances faced" and that the ability to conduct thorough checks was "more limited" in March and April 2020. The Cabinet Office will publish an update to Procurement Policy Note 01/20 (target: February 2021).
- On lessons from the ventilator challenge, it agrees (target: June 2021). Lessons will be captured as a case study and incorporated into a Sourcing Playbook due in "Spring/Summer 2021".
- On intellectual property, it agrees and describes the recommendation as implemented. It states the government owns a number of ventilator designs but that licensing "has not resulted in any revenue to the government" to date.
Read the government's response ↗ Read the report ↗ Report an error
How the inquiry ran
Each dot is a dated item listed on this page, from the inquiry's opening on 24 September 2020 to its close on 25 March 2021.
- Oral evidence 12 Oct 2020
- Report 25 Nov 2020
- Government response 25 Mar 2021
- Correspondence 16 Mar 2021
What it recommended 10 recommendations · 12 conclusions
2It is not clear how the Department of Health and Social Care is assessing whether...
3Despite having to operate at speed, the Department of Health and Social Care still had...
4The ventilator challenge was an exceptional and far from traditional approach that offers some lessons...
5Both programmes succeeded in part due to cross-government working and the expertise of key individuals...
6The ventilator challenge produced intellectual property that should be exploited to maximise value for the...
1On the basis of a report by the Comptroller and Auditor General, we took evidence...
7When we challenged the Department on why it did not begin its initial efforts to...
8From February to April, NHSE&I’s estimate of how many mechanical ventilators the NHS would need...
9However, when the programmes began in early-March, departments were looking at a potential need of...
10It is fortunate that the majority of the ventilators were not needed and that there...
11From 3 March, in response to the anticipated shortage of ventilators, the Department began to...
12From 13 March the Department, therefore, stepped up its efforts to purchase ventilators directly from...
13We recognise that given the circumstances the Department had to move quickly.
14The Cabinet Office’s ventilator challenge, which encouraged UK businesses to develop new ventilators from scratch...
15However, it is important to remember that the challenge did not take place under normal...
16Nevertheless, there are clearly elements of the challenge which could be applied to future programmes.
17In any government programme, departments should aim to work collaboratively across government and to involve...
18For example, the Department explained that both the Department for International Trade and the Foreign...
19The Cabinet Office also drew on external expertise where required.
20From the outset, Cabinet Office’s strategy was to support a number of both new and...
21In total the Cabinet financed 18 devices from 17 challenge participants over the course of...
22Designs are a type of intellectual property (IP), which if protected, can provide value for...
Evidence
Oral evidence sessions 1
- 12 Oct 2020COVID-19: Supply of ventilators5 witnesses, listed belowparliament.uk ↗
Who gave evidence 5 witnesses
- Alex ChisholmChief Operating Officer Civil Service and Permanent Secretary, Cabinet Office
- David WilliamsJournalist, Daily Mail
- Emily LawsonChief Commercial Officer, NHS England and NHS Improvement
- Gareth Rhys WilliamsGovernment Chief Commercial Officer and Non-Executive Director, Crown Commercial Service
- Sir Chris WormaldPermanent Secretary, Department of Health and Social Care