Recommendations & Conclusions
12 items
5
Recommendation
Twenty-seventh Report - Covid-19: Suppl…
Accepted
Both programmes succeeded in part due to cross-government working and the expertise of key individuals involved. It is clear that both programmes were successful in part due to the involvement of different government departments that were best placed to carry out specific functions, and the involvement of people with the …
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Both programmes succeeded in part due to cross-government working and the expertise of key individuals involved. It is clear that both programmes were successful in part due to the involvement of different government departments that were best placed to carry out specific functions, and the involvement of people with the right skills—something that is not always the case with the programmes we report on. For example, the Department for Health & Social Care was able to secure orders relatively quickly at a reasonable cost due to a significant effort from the Foreign & Commonwealth Office and the Department for International Trade in China, which had a better knowledge of the local market. Similarly, Cabinet Office used the Ministry of Defence’s Cost and Assurance Analysis Service to ensure that suppliers’ costs were reasonable. Cabinet Office also drew on external expertise where required. The government was fortunate that its Chief Commercial Officer, who led the ventilator challenge, had a background in running engineering and product development companies and was therefore well placed to develop and initiate the programme. The ‘technical design authority’, put in place to support decision making as part of the ventilator challenge, drew on the expertise of NHS clinicians, the Medical and Healthcare products Regulatory Agency and PA consulting (acting as a programme manager) in addition to other government departments including the Department for Business Energy & Industrial Strategy and the Ministry of Defence. Recommendation: The Cabinet Office should set out, as part of its Treasury Minute response, what lessons it has learnt from these programmes for how government will, in future, ensure that it identifies the skills it needs, where these skills are, and how it will get them in place quickly when a rapid response is required.
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Government response AI summary
The government accepts the recommendation and states that the Government Commercial Function is optimising skill development and deployment, with further activity underway to build commercial capability across government departments and the wider public sector, aiming to scale by March 2023.
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HM Treasury
6
Recommendation
Twenty-seventh Report - Covid-19: Suppl…
Accepted
The ventilator challenge produced intellectual property that should be exploited to maximise value for the taxpayer. The ventilator challenge produced a number of designs in a very short space of time, even though many did not go on to be manufactured. This was in part due to the Cabinet Office’s …
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The ventilator challenge produced intellectual property that should be exploited to maximise value for the taxpayer. The ventilator challenge produced a number of designs in a very short space of time, even though many did not go on to be manufactured. This was in part due to the Cabinet Office’s approach of fostering collaboration between small product designers and large manufacturers. There will be potential value in the intellectual property associated with these designs. Where it paid for a manufacturer’s design work as part of the challenge, the Cabinet Office tells us that it will get a royalty if in future a manufacturer uses the design to take 8 Covid-19: Supply of ventilators a unit to market. However, this currently relies on the goodwill of manufacturers to inform the Cabinet Office that they have used the design, as there is no plan or mechanism in place for it to monitor whether this occurs. Recommendation: The Cabinet Office should set out, as part of its Treasury Minute response, how it plans to maximise the value to the taxpayer from the intellectual property created through the ventilator challenge. This should include how it plans to: • use its learning from the ventilator challenge to set out how it could bring together small and large companies to develop workable and scalable products that the government needs in future; and • monitor whether intellectual property it owns is used so that it can achieve value for money for the taxpayer. Covid-19: Supply of ventilators 9 1 Preparedness for the pandemic
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Government response AI summary
The government accepts the recommendation, stating it has standard licensing terms for the ventilator designs it owns, though no revenue has been generated yet. It has also developed and shared a document outlining key innovation lessons from the Ventilator Challenge.
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HM Treasury
8
Conclusion
Twenty-seventh Report - Covid-19: Suppl…
Accepted
From February to April, NHSE&I’s estimate of how many mechanical ventilators the NHS would need in a worst-case scenario changed repeatedly. Its estimates were based on reasonable worst-case planning assumptions assured by the Scientific Advisory Group for Emergencies (SAGE), which provides scientific and technical advice to support government decision-makers during …
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From February to April, NHSE&I’s estimate of how many mechanical ventilators the NHS would need in a worst-case scenario changed repeatedly. Its estimates were based on reasonable worst-case planning assumptions assured by the Scientific Advisory Group for Emergencies (SAGE), which provides scientific and technical advice to support government decision-makers during emergencies. On 12 February these estimates indicated a need of up to 59,000 beds with mechanical ventilators at the peak of the crisis and by 1 March, this had had increased to 90,000. On 24 March estimates reduced to a need of up to 17,500 by 13 April and again on 8 April to just 6,200 needed by early May.11 The Department explained that the reasonable worst-case scenarios, something it thought was only 5–10% likely to happen, reduced due to both the inclusion of the estimated impact of interventions such as social distancing in the models and a better knowledge of how the virus spread.12
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Government response AI summary
The government agreed, outlining its purchase of thousands of ventilators and other equipment, and the implementation of a national loan process, asserting that sufficient stock and processes are now in place for trusts.
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HM Treasury
9
Conclusion
Twenty-seventh Report - Covid-19: Suppl…
Accepted
However, when the programmes began in early-March, departments were looking at a potential need of up to 90,000 mechanical ventilators, far more than the 7,400 thought to be available. The Department acknowledged that it was never going to be able to increase capacity to this level, but aimed to raise …
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However, when the programmes began in early-March, departments were looking at a potential need of up to 90,000 mechanical ventilators, far more than the 7,400 thought to be available. The Department acknowledged that it was never going to be able to increase capacity to this level, but aimed to raise it as much as possible to provide a buffer in case interventions such as social distancing were not as effective as anticipated.13 It was not 7 Qq 42, 45 8 C&AG’s Report, paras 1, 2.7 & Figure 2 9 Q 43 10 Qq 44, 46 11 C&AG’s Report, paras 1, 2.7, 2.9 & Figure 2 12 Q 60 13 Q 60; C&AG’s Report para 2.7 & Figure 2 Covid-19: Supply of ventilators 11 until after the peak of COVID-19 hospitalisations on 14 April, at which point almost half (43%) of the 6,818 critical care beds with ventilators were unoccupied, that Ministers adopted official targets to make a total of 18,000 ventilators available to the NHS by the end of April and 30,000 by the end of June via both programmes.14 While the Department recognised that at this point it was evident that the NHS would be “well clear” in terms of the numbers required, it said that it consciously set higher targets to increase capacity for a potential second peak. The departments missed both of the targets, eventually reaching the 30,000 by 3 August.15
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Government response AI summary
Although the committee's item was a conclusion, the government states it agrees with a recommendation (which was not present) and that it has already implemented measures, detailing past purchases of ventilators and other equipment, and the establishment of a national loan process to ensure sufficient …
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HM Treasury
10
Recommendation
Twenty-seventh Report - Covid-19: Suppl…
Accepted
It is fortunate that the majority of the ventilators were not needed and that there is now additional capacity if they should be required in the future. Nevertheless, we are concerned that the Department was not able to give a clear explanation of how it now assesses whether the NHS …
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It is fortunate that the majority of the ventilators were not needed and that there is now additional capacity if they should be required in the future. Nevertheless, we are concerned that the Department was not able to give a clear explanation of how it now assesses whether the NHS has sufficient ventilators and other critical equipment for any future need. It told us that its approach to decision making has changed fundamentally since the initial crisis. It said that it has largely “moved away from mathematical models” and that decision making is now more strongly driven by the “situation of the day. It explained that it now uses daily data and the knowledge of how infection rates translate into the numbers of patients requiring hospitalisation and more intensive treatment to assess the situation at a point in time. However, it also emphasised that the number of ventilators the NHS will ultimately need will depend on the non-pharmaceutical interventions, such as lockdowns, that the government puts in place and the level of public compliance with the rules.16 14 C&AG’s Report paras 2.12, 2.14 & Figure 2 15 Qq 62–64; C&AG’s Report paras 7, 2.16 16 Q 121 12 Covid-19: Supply of ventilators 2 The government’s approach to securing ventilators The credibility of suppliers
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Government response AI summary
The government agrees with the recommendation and states it has implemented it, assuring themselves that the NHS has the right processes and sufficient stock of medical equipment to respond to the pandemic, through direct purchases and a national loan process.
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HM Treasury
13
Recommendation
Twenty-seventh Report - Covid-19: Suppl…
Accepted
We recognise that given the circumstances the Department had to move quickly. However, regardless of the circumstances, government regulations require departments to carry out due diligence on the organisations that they buy from and exclude organisations that do not comply with various environmental, social and labour laws”.20 The Department told …
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We recognise that given the circumstances the Department had to move quickly. However, regardless of the circumstances, government regulations require departments to carry out due diligence on the organisations that they buy from and exclude organisations that do not comply with various environmental, social and labour laws”.20 The Department told us that it did its best to confirm that ventilators were the correct specification and that sellers were credible—this included looking into suppliers’ financial records, any investigations they had been part of, and anything published about them. When asked specifically whether it had, for example, looked into the issue of modern slavery in its supply chains, the Department said that it was not aware of any links to modern slavery as far as the manufacturers of the devices were concerned. However, it acknowledged that it had not looked at exactly where every component in the machine was produced at the time. The Department agreed to check back through its wider supply chains as far as it could to establish whether any links to modern slavery existed. It cautioned that certain aspects of the supply chain may be difficult to investigate.21 The Department wrote to us one month after the oral evidence session, having considered the matter further. It stated that it and the British Embassy in Beijing had worked closely with external due diligence service providers, to carry out open source checks on Chinese suppliers of ventilators procured during the peak of the pandemic, It said that this due diligence included public records and media checks designed to flag legal, political or reputational risks, including on modern slavery, and assured us that procurement processes were all in line with UK 17 Qq 50–51; C&AG’s Report, paras 3.2, 3.3 18 C&AG’s Report, para 3.10 & Figure 4 19 Qq 66,79 20 The Public Contracts Regulations 2015, sub section 7 21 Qq 71, 74–75 Covid-19: Supply of ventilators 13 procurement regulations during this
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Government response AI summary
The government accepts the recommendation, stating that while urgent circumstances limited due diligence in some cases, most purchases used standard processes. It assures that past checks were appropriate and future needs for rapid emergency procurement will be reduced due to increased capacity and improved horizon …
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HM Treasury
14
Conclusion
Twenty-seventh Report - Covid-19: Suppl…
Accepted
The Cabinet Office’s ventilator challenge, which encouraged UK businesses to develop new ventilators from scratch and increase the production of existing products or modified designs, was undoubtedly a significant achievement. In total, it produced around 15,000 mechanical ventilators in the space of just four months, over 1.5 times the number …
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The Cabinet Office’s ventilator challenge, which encouraged UK businesses to develop new ventilators from scratch and increase the production of existing products or modified designs, was undoubtedly a significant achievement. In total, it produced around 15,000 mechanical ventilators in the space of just four months, over 1.5 times the number available to the NHS at the start of the pandemic. The Cabinet Office estimated it would normally take a decade to produce this amount and described it as a “terrific response” from British industry and designers.23
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Government response AI summary
The government agreed and committed to updating the Sourcing Playbook by Spring/Summer 2021 to incorporate Ventilator Challenge lessons, which will also be captured as a case study for risk training and knowledge sharing sessions.
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HM Treasury
15
Conclusion
Twenty-seventh Report - Covid-19: Suppl…
Accepted
However, it is important to remember that the challenge did not take place under normal circumstances. Ventilator Challenge UK, the consortium of businesses that worked together to produce the Penlon ES02 ventilators, described the process as “working against a backdrop of life or death urgency”.24 The Cabinet Office acknowledged that …
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However, it is important to remember that the challenge did not take place under normal circumstances. Ventilator Challenge UK, the consortium of businesses that worked together to produce the Penlon ES02 ventilators, described the process as “working against a backdrop of life or death urgency”.24 The Cabinet Office acknowledged that the scale and urgency of the task meant that designers and manufacturers involved in the challenge came together “in the most collaborative way” it had ever seen and that the Cabinet Office team were working “12 hour days, seven days a week for 14 weeks.”25 The Cabinet Office also explained that the focus of the programme was maintaining public health and that there was therefore a low emphasis on cost. This meant that it was able to fund multiple devices until it became clear whether or not the ventilator would be needed to meet demand.26
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Government response AI summary
Although the committee's item was a conclusion, the government states agreement with a recommendation (which was not present in this item) and outlines a plan to update the Outsourcing Playbook by Spring/Summer 2021 to incorporate ventilator challenge lessons, capture them as a case study for …
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HM Treasury
16
Recommendation
Twenty-seventh Report - Covid-19: Suppl…
Accepted
Nevertheless, there are clearly elements of the challenge which could be applied to future programmes. For example, the Cabinet Office told us that it took a number of steps to ensure that suppliers costs were reasonable, such as working on an open-book basis using the Ministry of Defence’s Cost Assurance …
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Nevertheless, there are clearly elements of the challenge which could be applied to future programmes. For example, the Cabinet Office told us that it took a number of steps to ensure that suppliers costs were reasonable, such as working on an open-book basis using the Ministry of Defence’s Cost Assurance Analysis Service and working with participants to cancel orders for parts that weren’t needed or selling them on the open market. It also showed commitment to transparency and accountability, maintaining sufficient records of the programmes rationale, key spending decisions it took and the information it had to base it on.27 Skills and expertise
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Government response AI summary
The government accepts the recommendation and aims to update the Outsourcing Playbook by Spring/Summer 2021 to incorporate ventilator challenge lessons as a case study for risk training, ensuring these lessons are disseminated to government departments.
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HM Treasury
17
Recommendation
Twenty-seventh Report - Covid-19: Suppl…
Accepted
In any government programme, departments should aim to work collaboratively across government and to involve people with the right skills from the outset. Yet this is not something we always see in the programmes we report on.28 In this case, we heard how the departments’ efforts to involve government departments …
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In any government programme, departments should aim to work collaboratively across government and to involve people with the right skills from the outset. Yet this is not something we always see in the programmes we report on.28 In this case, we heard how the departments’ efforts to involve government departments that were best placed to carry out specific functions contributed to the programmes’ success.29 22 Letter from Second Permanent Secretary, Department of Health and Social Care, to PAC Chair, dated 9 November 2020 23 Q84; C&AG’s Report, Figures 3 & 10 24 Ventilator Challenge UK consortium (SOV0002) 25 Qq 57, 126 26 Q85, C&AG’s Report, para 16 27 Q85, C&AG’s Report, paras 25, 4.20 28 See for example, Committee of Public Accounts, Seventy-Eighth Report of Session 2017–19, Improving government planning and spending, HC 1596; paras 13–15 29 Q 77 14 Covid-19: Supply of ventilators
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Government response AI summary
The government agreed and committed to optimising skill development and deployment within the Government Commercial Function, with a target of March 2023 for scaling up capability building and assessment across the wider public sector.
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HM Treasury
19
Conclusion
Twenty-seventh Report - Covid-19: Suppl…
Accepted
The Cabinet Office also drew on external expertise where required. We heard that the Chief Commercial Officer happened to have a background in running engineering and product development companies that meant he was well placed to develop and initiate the programme. Additionally the Cabinet Office’s ‘technical design authority’, put in …
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The Cabinet Office also drew on external expertise where required. We heard that the Chief Commercial Officer happened to have a background in running engineering and product development companies that meant he was well placed to develop and initiate the programme. Additionally the Cabinet Office’s ‘technical design authority’, put in place to support decision making as part of the ventilator challenge, drew on the expertise of NHS clinicians, the Medical and Healthcare products Regulatory Agency and PA consulting (acting as a programme manager) as well as other government departments; it also drew on data from device-testing experts.32 The Cabinet Office emphasised that it believes it was having cross-functional teams working on the project from the beginning that “really proved successful”.33 Intellectual property
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Government response AI summary
The government agrees with the recommendation (which it interpreted from the conclusion) and commits to optimising skill development and capability building in the commercial space across government, with a target date of March 2023 for achieving scale.
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HM Treasury
22
Recommendation
Twenty-seventh Report - Covid-19: Suppl…
Accepted
Designs are a type of intellectual property (IP), which if protected, can provide value for the owner.36 The Cabinet Office told us that it owns the IP for the designs it paid for and that it either owns all or a “substantial chunk” of the IP for the majority of …
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Designs are a type of intellectual property (IP), which if protected, can provide value for the owner.36 The Cabinet Office told us that it owns the IP for the designs it paid for and that it either owns all or a “substantial chunk” of the IP for the majority of the designs it could have made but chose not to. We asked the Cabinet Office how it plans to maximise 30 Q 77; C&AG’s Report para 3.10 31 Q 85 32 Q 48; C&AG’s Report, paras 15, 4.8 & 4.10 33 Q 126 34 Q 126; C&AG’s Report, para 4.3 35 C&AG’s Report, paras 4.8–4.12 & Figure 6 36 GOV.UK, ‘Intellectual property and your work’, accessed 28 October 2020 Covid-19: Supply of ventilators 15 the value of the IP that it owns. It told us that, where it paid for a manufacturer’s design work as part of the challenge it will get a royalty if a manufacture uses the design to take a unit to market.37 However, while it acknowledged that this was something it would need to check on, it told us that there was no set process in place to do this and that it currently relies on the goodwill of manufacturers.38 In response to our wider concerns that the government is in the habit of giving away technology without seeking to gain value from it, Cabinet Office agreed that it would look at how government contracts consider the issue of intellectual property.39 37 Qq 90, 135 38 Qq 136–138 39 Q 139 16 Covid-19: Supply of ventilators
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Government response AI summary
The government accepts the recommendation, stating it owns ventilator designs and has standard licensing terms, although this has not yet generated revenue. It has also developed and shared a document outlining key innovation lessons from the challenge.
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HM Treasury