Recommendations & Conclusions
6 items
2
Recommendation
Twenty-seventh Report - Covid-19: Suppl…
Not Addressed
It is not clear how the Department of Health and Social Care is assessing whether the NHS has enough critical care equipment for future demand. NHSE&I’s estimate of how many mechanical ventilators the NHS would need in a worst-case scenario has changed repeatedly: on 12 February initial estimates indicated a …
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It is not clear how the Department of Health and Social Care is assessing whether the NHS has enough critical care equipment for future demand. NHSE&I’s estimate of how many mechanical ventilators the NHS would need in a worst-case scenario has changed repeatedly: on 12 February initial estimates indicated a need of up to 59,000, by early March this had increased to 90,000, before reducing to 17,500 on 24 March and again to just 6,200 by 8 April. On 15 April, after the peak of COVID-19 hospitalisations, the Department set targets of 18,000 ventilators by 30 April and 30,000 by 30 June to prepare for a potential second wave. It missed both these targets but eventually reached 30,000 by 3 August. It is fortunate that the majority of the ventilators were not needed and that additional capacity is now available should it be required. However, given its targets were not finely calibrated to need and the extent to which its estimates of need have varied, we are concerned that the Department has failed to set out how it now assesses the scale of future need. It told us that it no longer does ‘mathematical modelling’, but looks at the day-to-day situation. It is vital that the Department is transparent on how it assesses whether it has sufficient stocks of not only ventilators but also of any other equipment required to treat COVID-19 as the pandemic evolves. Recommendation: The Department of Health and Social Care should write to us within one month of this report explaining its current methodology for assessing 6 Covid-19: Supply of ventilators whether it has all the equipment it needs to respond effectively to the pandemic.
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Government response AI summary
The government claims to agree with the recommendation and states it has implemented measures by purchasing and distributing medical equipment and establishing a national loan process, asserting the NHS has sufficient stock and processes. However, it does not explicitly explain its current methodology for assessing …
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HM Treasury
4
Recommendation
Twenty-seventh Report - Covid-19: Suppl…
Not Addressed
The ventilator challenge was an exceptional and far from traditional approach that offers some lessons for future programmes although they could not be applied wholesale under normal circumstances. The ventilator challenge was undoubtedly a significant achievement, involving a huge effort from industry across the UK. In total it produced around …
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The ventilator challenge was an exceptional and far from traditional approach that offers some lessons for future programmes although they could not be applied wholesale under normal circumstances. The ventilator challenge was undoubtedly a significant achievement, involving a huge effort from industry across the UK. In total it produced around 15,000 mechanical ventilators in just four months – around half the number now available to the NHS, and a volume that we understand would normally take years to produce. However, when examining what government can learn from the challenge, it is crucial to keep in mind that the exceptional circumstances in which it took place were, in part, responsible for its success. For example; the clear motivating goal to potentially save thousands of lives encouraged businesses to collaborate and work at pace; and an unusually low emphasis on cost meant that the Cabinet Office could fund the development of multiple devices until it became clear whether the design was viable or was needed to meet demand. Nonetheless, there are clearly some elements of the programme which could be replicable across future government programmes. For example, the NAO pointed to the steps the Cabinet Office took to control costs and its commitment to Covid-19: Supply of ventilators 7 transparency and accountability. Government’s requirement for private companies to collaborate is one example of how Government can use its spending power to improve learning and deliver cost savings and efficiencies. These lessons must be identified and shared more widely. Recommendation: As part of its treasury minute response, the Cabinet Office should work with participants to understand and ensure the right lessons from the ventilator challenge are learnt. It should publicise: • which lessons were unique to the circumstances; • which can be applied to future programmes. It should ensure these lessons are disseminated to the appropriate government departments or functions;
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Government response AI summary
The government's response focuses on revising contract management structures and improving operating procedures generally, rather than specifically addressing how it will learn, publicise, and disseminate lessons from the ventilator challenge.
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HM Treasury
1
Conclusion
Twenty-seventh Report - Covid-19: Suppl…
Not Addressed
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department), the Cabinet Office and NHS England and NHS Improvement (NHSE&I) on the government’s efforts to increase the number of ventilators in response to COVID-19.1
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On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department), the Cabinet Office and NHS England and NHS Improvement (NHSE&I) on the government’s efforts to increase the number of ventilators in response to COVID-19.1
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Government response AI summary
The government response provides an introduction to ventilators and the context of the pandemic, rather than engaging with the committee's concluding statement about taking evidence.
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HM Treasury
11
Conclusion
Twenty-seventh Report - Covid-19: Suppl…
Not Addressed
From 3 March, in response to the anticipated shortage of ventilators, the Department began to purchase as many ventilators as it could using existing NHS supply chain framework agreements, which are designed to ensure competitive pricing. It explained that as part of these initial efforts, it discussed the possibility of …
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From 3 March, in response to the anticipated shortage of ventilators, the Department began to purchase as many ventilators as it could using existing NHS supply chain framework agreements, which are designed to ensure competitive pricing. It explained that as part of these initial efforts, it discussed the possibility of speeding up the manufacture of devices available through the framework, but found that this was not possible as the devices are normally built at the point of order and have complex supply chains. By 12 March the Department had managed to order an additional 2,400 mechanical ventilators. However, it recognised that this still left a ‘huge deficit’ in terms of what it thought would be needed.17
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Government response AI summary
The government reiterated that most devices were purchased through standard framework agreements with due diligence, without addressing the committee's observations on the challenges of increasing manufacturing speed or the initial 'huge deficit' in supply.
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HM Treasury
12
Conclusion
Twenty-seventh Report - Covid-19: Suppl…
Not Addressed
From 13 March the Department, therefore, stepped up its efforts to purchase ventilators directly from overseas with significant help from the Foreign and Commonwealth Office and the Department of International Trade in China.18 The Department told us that while it was somewhat ahead of other countries in moving to international …
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From 13 March the Department, therefore, stepped up its efforts to purchase ventilators directly from overseas with significant help from the Foreign and Commonwealth Office and the Department of International Trade in China.18 The Department told us that while it was somewhat ahead of other countries in moving to international procurement, there was soon “huge competition” for devices as other countries quickly followed based on what was happening in Lombardy, Italy. We heard that this involved large daily price changes and that the Department was “gazumped” on several occasions as it would not go above certain price thresholds.19
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Government response AI summary
The government stated that most devices were purchased through standard framework agreements with due diligence, which did not address the committee's observation regarding intense competition and price volatility in overseas procurement.
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HM Treasury
18
Conclusion
Twenty-seventh Report - Covid-19: Suppl…
Not Addressed
For example, the Department explained that both the Department for International Trade and the Foreign and Commonwealth Office helped it to purchase ventilators directly from China, which it viewed as the largest untapped market for ventilators. Both departments played a substantial role in assessing offers, which meant that the Department …
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For example, the Department explained that both the Department for International Trade and the Foreign and Commonwealth Office helped it to purchase ventilators directly from China, which it viewed as the largest untapped market for ventilators. Both departments played a substantial role in assessing offers, which meant that the Department was able to secure orders relatively quickly and at a similar level to normal market prices.30 Similarly, the Cabinet Office sought advice from the Ministry of Defence’s Cost Assurance and Analysis Service as part of its process to gain assurance that suppliers’ costs were reasonable. It told us that this approach mean it spent an average of £10,000 excluding VAT on the ventilators that were manufactured, which it said was comparable to those bought on the open market.31
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Government response AI summary
The government stated that most devices were purchased through NHS standard framework agreements with full due diligence checks, without addressing the committee's observations on successful inter-departmental collaboration or effective cost assurance.
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HM Treasury