Select committee inquiry
COVID-19: Government procurement and supply of personal protective equipment
Closed
What the inquiry looked at
“In responding to the COVID-19 pandemic, public sector bodies have had to procure goods and services with extreme urgency. Under emergency laws brought in at the start of the pandemic crisis, the Cabinet Office - which oversees government’s buying policies - has changed some of the procurement rules for contracts relating to the government’s response to COVID-19. Concerns have been raised about some of these procurements, including around a lack of transparency. The NAO has now published two major reports, one on the way government has handled procurement during the COVID-19 pandemic , and one specifically on its procurement and contracts for personal protective equipment (PPE) , including: - How PPE was supplied to NHS and social care organisations before the COVID-19 pandemic started - What government did, between the pandemic emerging in other countries and arriving in the UK, to prepare for the provision of PPE in the NHS and social care organisations - How government responded when problems arose in the supply of PPE - The scale of problems in the availability of PPE throughout the emergency This inquiry will take evidence on both reports, examining the scale of Government’s COVID-19-related contracting, how procurement rules have changed and how the government is managing the risks associated with these changes. For a chosen sample of these contracts it will look specifically at who bought what, from whom, and at what cost, during the pandemic - and whether this is delivering value for taxpayers money in the crisis. In mid-December the Committee will hold two evidence hearings on the findings across both these reports. In the first hearing, the Committee will question representatives of frontline medical and care associations. In the second hearing, the Committee will question senior officials at the Cabinet Office and Department for Health and Social Care. If you have evidence on the issues raised in this inquiry please submit it here before 6.00pm on Monday 7 December.”
The committee's words, from the inquiry page on parliament.uk ↗.
What it found
In the committee's words, from the summary of Forty-Second Report - COVID-19: Government procurement and supply of Personal Protective Equipment ↗
The shortages of personal protective equipment at the front-line in the first wave of the pandemic was one of the biggest concerns in March and April 2020. As well as NHS front line workers there were others front-line workers who required high grade PPE – particularly in social care settings, which were mainly private businesses.
At each stage the Department for Health and Social Care maintain that no setting actually ran out of PPE. We heard compelling evidence from organisations representing front-line workers that stocks ran perilously low; single use items were reused; some was not fit for purpose and staff were in fear that they would run out.
Government thought it was well-placed to manage the COVID-19 pandemic because it had a plan and a stockpile of personal protective equipment. However, these were designed for an influenza pandemic and the plans, stockpile and PPE distribution arrangements were inadequate for a coronavirus pandemic. The NHS’s existing suppliers of PPE (mostly from overseas) could not increase supply quickly enough to meet the extreme demand and urgency of the global situation. As well as the urgent need to procure PPE, government also needed to procure a wide range of other goods and services quickly during the pandemic. By 31 July 2020, it had awarded over 8,000 contracts for goods and services, such as PPE and professional services, in response to the pandemic, with a value of £18 billion.
Government faced significant challenges in having to work at pace, using emergency procurement procedures, in a competitive international market. However, its failure to be transparent about decisions, publish contracts in a timely manner or maintain proper records of key decisions left it open to accusations of poor value for money, conflicts of interest and preferential treatment of some suppliers, and undermines public trust in government procurement and the use of taxpayers’ money. Between February and July 2020, the Department of Health and Social Care spent over £12 billion on 32 billion items of PPE. We are concerned that the Department has so far identified items worth hundreds of millions of pounds which are unusable for their intended purpose, putting the efficient use of taxpayers’ money at further risk.
Early in the pandemic, the Department of Health & Social Care lacked information on how much PPE was needed by health and social care providers and which ones had the greatest need. Its decision to prioritise hospitals meant social care providers did not receive anywhere near enough to meet their needs, leaving them exposed. Many workers at the front line in health and social care were put in the appalling situation of having to care for people with COVID-19 or suspected COVID-19 without sufficient PPE to protect themselves from infection.
The Cabinet Office is still too defensive about the lack of transparency over contract awards. We would welcome an honest understanding that, despite best endeavours in procuring vital equipment, it is necessary to be open and transparent about why decisions were made and contracts awarded.
What the government said
The government responded on 3 September 2021. The deadline was 10 April 2021.
Summary written by Accountability Index from the government's response.
The government states that it "agrees" with each of the Committee's recommendations on PPE procurement and supply, giving target implementation dates of April or July 2021.
- On the Boardman review, the government agrees, says work has begun on its 28 recommendations, and that the Cabinet Office published updated emergency procurement policy in January 2021.
- On stockpiling, the department says it "now holds a four-month stockpile of COVID-critical PPE" and "will make information available in due course" on its future approach to stockpile management.
- On lessons learned, the Cabinet Office and department "plan to complete the work by the end of July" so findings can be disseminated to the wider Government Commercial Function.
- On PPE quality, the department says its review of all PPE bought is "on course to complete by the end of June 2021" and it will write to the Committee by the end of July 2021 with findings.
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 22 October 2020 to 10 September 2021. The dashed mark is the deadline Parliament records for the government's response.
- Oral evidence 2 sessions
- Report 10 Feb 2021
- Government response 3 Sep 2021
- Correspondence 4 letters
What it recommended 11 recommendations · 18 conclusions
2While government had plans and a stockpile of PPE, this proved inadequate for the COVID-19...
Recommended (the committee's words)
While government had plans and a stockpile of PPE, this proved inadequate for the COVID-19 pandemic. The Department had a strategy for managing an influenza pandemic, which included a stockpile of PPE owned and managed by Public Health England. In March 2020, NHS England & NHS Improvement gave public assurances to the Health and Social Care Committee that the stockpile would be sufficient to manage the pandemic, but this confidence was misplaced since the stockpile held no more than two-weeks’ worth of most types of PPE. Furthermore, it did not hold all of the planned PPE, such as visors and gowns, and some of the PPE it did hold had expired or did not meet current safety standards. Government and its contractors also struggled to distribute the stockpiled PPE quickly. In response to these problems the Department created a parallel supply chain to buy and distribute PPE. However, because of the time lag between ordering PPE and it being available, this could barely satisfy local organisations’ requirements. Frontline staff in health and social care experienced shortages of PPE, with surveys by staff representative organisations showing that at least 30% of participating care workers, doctors and nurses reported having insufficient PPE, even in high-risk settings. Provider organisations attempted to buy PPE at short notice, in an overheated market, and COVID-19: Government procurement and supply of Personal Protective Equipment 7 found they needed to pay hugely inflated prices to suppliers they were unfamiliar with. The PPE from central government was sometimes not usable and providers told us that emergency helplines referred them to suppliers which did not have PPE. Recommendation: The Department must improve its approach to managing and distributing stocks of PPE to ensure the correct equipment gets to those who need it, when they need it. The Department should write to us by July 2021 to confirm that: • Stockpiles hold everything required as specified in the Depa
3The high-priority lane was not designed well enough to be a wholly effective way of...
Recommended (the committee's words)
The high-priority lane was not designed well enough to be a wholly effective way of sifting credible leads to supply PPE. Government’s PPE buying team, within the parallel supply chain, received over 15,000 offers to supply PPE. This cross- government PPE buying team set up a high-priority lane to separately assess and process high-priority leads that it considered more credible, which sat alongside an ordinary lane to process other leads. Leads that were considered more credible were those from government officials, ministers’ offices, MPs and members of the House of Lords but it is not clear why this assumption was made. The priority lane did not include organisations with expertise in the health and social care sector that had existing relationships with suppliers through their members or directly and were well-placed to assess the credibility of potential PPE suppliers, such as the British Medical Association. Around one in ten suppliers that came through the high-priority lane were awarded a contract compared with one in a hundred for the ordinary lane. There were no written rules to support those making referrals in deciding which leads to put forward. Some of those making referrals that were considered high priority, such as MPs, passed on leads on the basis that others would assess their suitability rather than vouching for the credibility of those offers. The same eight-stage process for assessing and processing offers was applied to both lanes, but the Cabinet Office and the Department accepted that leads that went through the high-priority lane were handled better. Recommendation: The Cabinet Office and the Department should by July 2021 publish the lessons it has learnt from the procurement of PPE during the pandemic for future emergencies and disseminate these lessons to the wider government commercial function. This should include guidance for determining what is considered a credible offer and how this is communicated to potential suppliers.
4The Department’s focus on supporting hospitals meant assistance to social care providers was neglected.
Recommended (the committee's words)
The Department’s focus on supporting hospitals meant assistance to social care providers was neglected. The pandemic has shown the tragic impact of delaying much needed social care reform and treating the sector as the NHS’s poor relation. This is an issue this Committee has raised concerns about before when we examined 8 COVID-19: Government procurement and supply of Personal Protective Equipment the Department’s approach to readying the NHS and social care for the COVID-19 peak, and in our earlier examinations of the interface between health and social care and on the adult social care workforce. The Department provided NHS trusts with 1.9 billion items of PPE between March 2020 and July 2020, equivalent to 80% of their estimated need. In contrast, it provided the adult social care sector with 331 million items of PPE, equivalent to10% of its estimated need. Social care representatives told us their usual suppliers could not provide PPE, in part because some of it was diverted to the NHS, and consequently some providers ran out of PPE. Some 25,000 patients were discharged to care homes from hospitals, some without being tested for COVID-19, even after it became clear that people could transmit the virus without having symptoms. This contributed significantly to the deaths in care homes during the first wave. Social care was only taken seriously after the high mortality rate in care homes became apparent. Key workers outside of health and social care, including transport and supermarket workers, security guards and taxi drivers, were not provided with PPE, yet doing so could have prevented them becoming ill or passing on the virus. Recommendation: The Department should write to the Committee by the end of April 2021 to explain how it will revise its emergency response plans so that they include who will be supported, how and when. This must give appropriate weight to all sectors of health and social care, as well as occupations outside these sectors which are also
5The Department does not know enough about the experience of frontline staff, particularly BAME staff.
Recommended (the committee's words)
The Department does not know enough about the experience of frontline staff, particularly BAME staff. The Department set up a daily process for gathering information about the PPE required by local organisations and maintains that its formal reporting arrangements did not identify any provider organisation, in health or social care, as having run out of PPE. Despite this, Care England is clear that some social care providers did run out of PPE, and representative organisations’ surveys showed staff reported PPE shortages. In a survey by the Royal College of Nursing many nurses reported being asked to reuse single-use items of PPE. Frontline staff found the multiple iterations of guidance confusing and were concerned that the guidance did not specify a high enough level of PPE to properly protect them. Black, Asian and minority ethnic (BAME) staff were more likely to report experiencing PPE shortages, feeling pressured to work without adequate protection, and not being fit tested for respirator masks. A third of BAME doctors reported experiencing PPE shortages compared with 14% of white doctors, Similarly, almost half of BAME nurses said that they had not been fit tested for respirator masks compared with 74% of white nurses. By October 2020, employers had reported 126 deaths and 8,152 diagnosed cases of COVID-19 among health and care workers as being linked to occupational exposure. The Department asserts that there is no evidence that these deaths were caused by PPE shortages, but confirmed that medical examiners will fully investigate the death of all staff within trusts to determine whether this has been the result of occupational exposure to the virus. Recommendation: The Department needs to better understand the experience of frontline staff during the first wave of the pandemic, and ensure lessons are learned so it can better respond in a future emergency. It should particularly focus on the different reported experiences of staff from different ethnic backgro
6We are concerned that the Department’s ordering of an enormous amount of PPE might compromise...
Recommended (the committee's words)
We are concerned that the Department’s ordering of an enormous amount of PPE might compromise government’s ambition to maintain a UK manufacturing base for PPE. Between February and July 2020, the Department ordered 32 billion items of PPE. It intended to build up a stockpile that could last four months. Based on the rate PPE was used between March and July 2020, the amount of PPE that the Department has ordered could last five years (with variations across different types of PPE). Government’s PPE strategy aims to build a UK manufacturing base so that there is a resilient domestic supply. But there is a risk that UK manufacturers of PPE will be unable to sell in the UK if the Department has over-ordered PPE supplies. The Department asserts that this does not mean that it has overordered, since the PPE it has ordered could be used to support primary care and social care and might also be needed for its testing and vaccination programmes and future waves of the virus. The Department has nonetheless committed to considering whether some of its PPE contracts could be reduced or cancelled, and whether it could share or sell some PPE. Recommendation: The Department, working with other government departments where necessary, should set out a plan by July 2021 that shows how it will: • Use the PPE it has ordered, covering how much will be given health and social care providers, stockpiled, cancelled, or sold in the UK or overseas. • Incentivise the NHS Supply Chain, trusts and other providers, to buy PPE which is made in the UK. • Ensure there is sufficient resilience in the supply chain where UK manufacturers cannot provide the necessary PPE.
7The Department has wasted hundreds of millions of pounds on PPE which is of poor...
Recommended (the committee's words)
The Department has wasted hundreds of millions of pounds on PPE which is of poor quality and cannot be used for the intended purpose. The urgent need for PPE meant it accepted more risks when buying PPE than it usually would. At the time of our evidence session, some 195 million items of PPE, equivalent to 10 COVID-19: Government procurement and supply of Personal Protective Equipment around 1% of those received to date, had been identified by the Department as being potentially unsuitable for their intended purpose. The Department hopes that some of this can be used for other purposes. It now estimates that only 0.4% of the PPE it has received failed to meet safety standards and therefore cannot be used at all and that 1.3% of items were not fit for the intended purpose. It has not yet estimated the amount of money that has been spent on potentially unusable items, but this will amount to hundreds of millions of pounds. The Department told us told us that its PPE contracts contain clauses which allow it to reclaim costs for substandard PPE or PPE that was not provided, but it could not tell us how many of these contracts it was pursuing or how much progress it had made. Recommendation: The Department should write to the Committee by July 2021 setting out how much of the PPE it ordered it has received and checked, and the volumes and costs of the PPE that (a) cannot be used at all; (b) cannot be used for its intended purpose; and (c) its methodology for determining the volumes and costs of PPE which it considers to be in each of these categories.
8It should also update us on the number of contracts (and their financial value) in...
Recommended (the committee's words)
It should also update us on the number of contracts (and their financial value) in which it is seeking to recover costs for undelivered or substandard PPE. COVID-19: Government procurement and supply of Personal Protective Equipment 11 1 Government’s approach to procurement during the pandemic
1On the basis of two reports by the Comptroller and Auditor General, we took evidence...
Concluded (the committee's words)
On the basis of two reports by the Comptroller and Auditor General, we took evidence from the Cabinet Office, Department of Health & Social Care (the Department) and Public Health England about government procurement during the COVID-19 pandemic and the supply of personal protective equipment (PPE).1 As part of our inquiry, we also took evidence from Care England, the British Medical Council, the Royal College of Nursing, and UNISON.
9Access to the high-priority lane was based on recommendations coming from government officials, ministers’ offices,...
Concluded (the committee's words)
Access to the high-priority lane was based on recommendations coming from government officials, ministers’ offices, MPs and members of the House of Lords. The NAO found that there were no written rules which determined the basis on which suppliers should be recommended for the lane, meaning that it was left to the judgment of individuals putting forward the leads. Committee members noted that when MPs passed on leads they were not necessarily based on personal experience or expertise in PPE procurement and therefore not in a position to vouch for the validity or credibility of the lead. The NAO found that the process did not clearly record information on referrals. The Cabinet Office confirmed that of the 47 suppliers which came through the high-priority lane and were awarded contracts, 12 were introduced from MPs, seven from Peers and 18 from officials. In five cases, the source of the referral was not known and one referral was put in the lane in error. Although the lane was established for more credible leads, the Department admitted that in practice it was a convenient way to make sure offers were getting picked up in a way that it could then explain back to MPs or others that they were being looked at.15
10The British Medical Association and the Royal College of Nursing told us that their organisations...
Concluded (the committee's words)
The British Medical Association and the Royal College of Nursing told us that their organisations did not have access to the high-priority lane, even though they were being contacted by, and therefore would have been able to put forward, credible leads based on the knowledge of their members. The British Medical Association also noted that suppliers which had contacted them, including suppliers trusted by doctors, tried the normal channels of reaching out to the Government but had “hit a brick wall”. Care England told us that it had similarly shared the details of potential suppliers but there had been no follow-through. The Department was unable to confirm whether the British Medical Association had access to the high-priority lane and committed to checking this.16 12 Qq 117–118, 134, 144, 272; C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, paras 10, 2.2, Figure 6 13 Qq 89, 149, 179, 191 14 Qq 179–188 15 Qq 179, 180, 182, 186; 191–192; C&AG’s Report Investigation into government procurement during the COVID-19 pandemic, paras 3.12–3.14, Figure 6 16 Qq 46–47; Qq 181–184 14 COVID-19: Government procurement and supply of Personal Protective Equipment Volumes of PPE procured
11Between February and July 2020, the Department ordered 32 billion items of PPE.
Concluded (the committee's words)
Between February and July 2020, the Department ordered 32 billion items of PPE. The Department told us that it was seeking to avoid shortages in the event of a potential second wave and had deliberately looked to build up a stockpile equivalent to four months’ usage across all lines of PPE. It also told us that the model this was based on was cautious and that other types of usage would increase. However, the NAO found that if PPE was to be used consistently at the rate it was used between March and July 2020 at the peak of the pandemic, about 503 million items per month, the PPE ordered could last around five years (with variations across different types of PPE). We asked how the Department would ensure that its stockpile was properly managed so that none of the PPE would be wasted or go out of date. The Department assured us that it was committed to ensuring this was the case.17
12Government’s PPE strategy aims to build a UK manufacturing base so that there is a...
Recommended (the committee's words)
Government’s PPE strategy aims to build a UK manufacturing base so that there is a resilient domestic supply. The Department explained that 70% of PPE (excluding gloves) that it expected would be supplied between December 2020 and February 2021 should come through contracts set up under the Department’s UK Make programme. It cited contracts for this programme as one of the reasons that the number of orders it made peaked in June, after the initial pandemic peak. We were concerned that this domestic production risked being undermined by surpluses of PPE and asked whether it would need to consider reducing its existing contracts. The Department explained that some of the PPE stocks were of items such as aprons and gloves which the sector used in high volumes, but accepted there was a bigger challenge for other types of PPE such as respirator masks.18
13The Department asserted that while it had deliberately secured a significant stockpile of PPE, it...
Concluded (the committee's words)
The Department asserted that while it had deliberately secured a significant stockpile of PPE, it was not clear it had over-ordered as the stock would be needed for the ongoing COVID crisis. It admitted that it did not have full information about how much PPE had been provided by suppliers outside the parallel supply chain. Additional PPE was also used by staff who were not treating known COVID19 NHS patients but were supporting the ‘reopening of the NHS’. It also told us that the PPE it had ordered can be used to support primary care and social care and might also be needed for the programmes to test people for, and vaccinate people against, COVID-19. Not all of the PPE purchased had yet been delivered and the Department told us it would consider whether some of its PPE contracts could be reduced or cancelled. The Department also said that it was looking at sharing or selling some PPE with its partners.19 The Department wrote to us after our evidence session and told us that to date it had, for a multitude of reasons, cancelled or curtailed contracts to the value of around £400 million.20 Problems with the quality of some PPE procured
14Not all of the PPE the Department bought can be used.
Concluded (the committee's words)
Not all of the PPE the Department bought can be used. The Department told us that only 0.5% of the 18 billion items of PPE it had received and checked so far had failed to meet clinical safety standards and therefore could not be used at all. However, this figure 17 C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, para 2.26; Qq 193–196, 232, 267–269 18 Qq 193–197, 270–271; C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, paras 4.5, 4.10 19 Qq 194–197, 248, 267–268 20 Letter from Department of Health & Social Care, 15 January 2021 COVID-19: Government procurement and supply of Personal Protective Equipment 15 is not complete, both because the calculation does not include PPE which the Department hopes to use for different purposes to that for which it was intended, and because much PPE is yet to be received or tested. The Department accepted that this figure would change as it finished its process of checking. The NAO report found that the Department had identified 195 million items of PPE that were unusable or potentially unsuitable, which would be around 1% of the items received to date.21 The Department explained that this included a wider group of products, including those which could not be used for their intended purpose but could be used in other ways.22 In its letter after our evidence session, the Department stated that its updated estimate was that 1.3% of the items bought were not fit for the original intended purpose and that 0.4% were not fit for any purpose. The letter did not provide information on the number of items tested to date.23
15The Department had not calculated the value of unusable or potentially unsuitable items but told...
Recommended (the committee's words)
The Department had not calculated the value of unusable or potentially unsuitable items but told us that it was currently undertaking work to estimate this and committed to coming back to us with a timetable for when this would be complete.24 It told us that it was investigating potential fraudulent activity and acknowledged that while the levels of fraud were very low, the costs could run to millions of pounds. It told us that its PPE contracts contain clauses which allow it to reclaim costs for substandard PPE or PPE that was not provided, but it could not tell us how many of these contracts it was pursuing or how much progress it had made. The NAO reported the value of potentially unusable items will amount to hundreds of millions of pounds.25
16The Department accepted that the urgent need for PPE meant it accepted greater risks when...
Concluded (the committee's words)
The Department accepted that the urgent need for PPE meant it accepted greater risks when buying PPE than it usually would. The Department maintained, however, that it did not ask the Health and Safety Executive to lower standards. It told us that it bought millions of FFP2 respirator masks which did not meet government’s published safety standards because it was concerned it would run out of FFP3 respirator masks. It explained that it was in discussions with the Health and Safety Executive about changing that standard to permit the use of these particular FFP2 masks. FFP2 masks of the type the Department bought were then not permitted to be used for their original intended purposes.26 21 C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, para 2.20, Q92 22 Qq 247–254 23 Letter from Department of Health & Social Care, 15 January 2021 24 Qq 252–254 25 Qq 92–102, 173–178, 249–251, 255–256; C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, paras 2.19–2.20 26 Qq 148–149, 176–177, 234–246; C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, paras 2.19–2.20 16 COVID-19: Government procurement and supply of Personal Protective Equipment 2 Government supply of PPE during the pandemic Government readiness for the need to supply PPE during the pandemic
17Government had a Pandemic Influenza Preparedness Programme and a stockpile of PPE for managing an...
Recommended (the committee's words)
Government had a Pandemic Influenza Preparedness Programme and a stockpile of PPE for managing an influenza pandemic, but not a coronavirus pandemic (such as COVID-19). Public Health England told us this was because the national risk register identified an influenza pandemic as the number one risk. Public Health England owned and managed the PPE stockpile for an influenza pandemic on behalf of the Department, and the Department also had a smaller stockpile of PPE to manage a ‘no deal’ exit from the European Union.27
18In March 2020, officials from NHS England & NHS Improvement publicly assured the Health and...
Concluded (the committee's words)
In March 2020, officials from NHS England & NHS Improvement publicly assured the Health and Social Care Select Committee that these stockpiles meant the country was well placed to manage the COVID19 pandemic. However, the NAO report found that the stockpiles provided no more than two-weeks’ worth of most types of PPE needed by the NHS and social care during the pandemic and did not hold all the PPE they had been expected to hold (such as visors and gowns). Some of the stockpiled PPE had also passed its expiry date or did not meet current safety standards. Furthermore, government (and its contractors) struggled to distribute the stockpiled PPE as quickly as the situation required.28
19The Department told us that it had not been complacent over the stockpiles, but that...
Concluded (the committee's words)
The Department told us that it had not been complacent over the stockpiles, but that COVID-19 was a novel virus and it learned more about it over time. Unlike influenza, COVID-19 can be passed on by people who are not showing symptoms of the illness. The Department explained that this meant government needed to provide PPE to a much larger group of people to stop the spread of the virus. It also said that while there were vaccines and antiviral medication available for managing influenza, this was not the case with COVID19, and that government did not have the gowns needed for managing COVID-19 because its infection control policy had been to use aprons rather than gowns.29 The experience of frontline organisations
20Almost all the PPE was manufactured abroad and had to be shipped, flown or put...
Concluded (the committee's words)
Almost all the PPE was manufactured abroad and had to be shipped, flown or put on a train to the UK. This meant it took a long time to be delivered. Therefore, despite the creation of the parallel supply chain, the time lag between ordering PPE and it being available, the Department could barely satisfy local organisations’ requirements.30 Representatives of the frontline of health and social care sector told us they experienced various problems accessing the PPE they needed, and in some cases could not access it 27 Qq 109–110, 116–118, 120, 146; C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, Figure 3 28 Qq 13, 120, 145–146; C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, paras 8, 1.8–1.9, 1.14, 1.16, Figure 4; House of Commons Health and Social Care Committee, Oral evidence: Coronavirus – NHS Preparedness, Session 2019–2021, HC 36, 17 March 2020, Qq 129–132 29 Qq 144–147 30 C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, paras 13 and 2.22, Figure 9 COVID-19: Government procurement and supply of Personal Protective Equipment 17 at all. The British Medical Association and the Royal College of Nursing told us that, in March and April, the PPE they ordered by providers through the NHS Supply Chain was not provided and when government did eventually provide PPE it provided only tiny amounts. Care England explained that providers had to buy their own PPE at hugely inflated costs, buying from suppliers they were unfamiliar with and running the risk of being sold substandard PPE. The British Medical Association provided one example of paying £150 for five respirator masks which, as shown in the NAO report, would have cost around £1 each in 2019. Care England told us that the situation within the social care sector was even worse than the NHS, with established supply chains being disrupted and reports of PPE being redirected from social
21The Department explained that its formal reporting arrangements did not identify any provider organisation, in...
Concluded (the committee's words)
The Department explained that its formal reporting arrangements did not identify any provider organisation, in health or social care, as having run out of PPE completely. It monitored the risk that social care could run out within 48 hours. It told us the national supply disruption emergency helpline, which was available from mid-March, would supply immediately to any organisation which would run out within 24 hours.32 The Department told us it had put in place a process to understand the PPE available to local organisations. This included daily calls with NHS regional officers (who in turn were liaising with individual trusts), with local resilience forums and with government’s emergency helpline. We asked whether the Department triangulated this with information from the trade unions whose members may have reported a very different story about shortages. The Department noted it did have conversations with the Royal College of Nursing and the British Medical Association “at times”, but its main source of information on access to PPE was the process of daily calls.33 It acknowledged that its reporting mechanism for understanding how much PPE social care providers held was not all that it would have liked at the start of the pandemic but told us its data improved from around May.34
22We have previously noted that the COVID-19 pandemic has shown the tragic impact of delaying...
Recommended (the committee's words)
We have previously noted that the COVID-19 pandemic has shown the tragic impact of delaying much needed social care reform and integration with health, and instead treating the sector as the NHS’s poor relation.35 Between March 2020 and July 2020, the Department provided NHS trusts with 1.9 billion items of PPE, equivalent to 80% of their estimated need. Over the same period, it provided 331 million items to the adult social care sector, equivalent to 10% of its estimated need. Of the total PPE distributed between March and July, trusts received 81% and adult social care 14%.36 The Department told us that this imbalance was a consequence of the arrangements for supplying PPE 31 Qq 8–10, 13–14, 17–18, 22, 29, 34, 37, 38, 40, 46, 66–67, 122 32 Qq 125–128 33 Qq 140–143, 156; C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, paras 2.5–2.6 34 Qq 131, 142–143, 156; C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, paras 2.5–2.6 35 House of Commons Public Accounts Committee, Readying the NHS and social care for the COVID-19 peak, Session 2019–2021, HC 405, 29 July 2020, para 3 36 C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, para 19 18 COVID-19: Government procurement and supply of Personal Protective Equipment before the pandemic. Prior to the pandemic, social care providers tended to buy their PPE directly from wholesalers, while trusts tended to buy from the NHS Supply Chain. The Department told us its intention therefore was to provide PPE to social care providers as an “emergency top-up” when their usual suppliers could not provide it, rather than the Department becoming their main supplier. But social care representatives told us that providers were unable to get PPE from their usual suppliers or from the Department, and consequently providers reported shortages.37
23Care England and the British Medical Association told us that the contingency planning process for...
Concluded (the committee's words)
Care England and the British Medical Association told us that the contingency planning process for a pandemic appeared to focus on the NHS at the expense of the social care sector despite some of the most vulnerable people being in social care. Care England told us this lack of planning included discharging 25,000 patients from hospitals into care homes, some without first testing them for COVID-19, even after it became clear that people could transmit the virus without ever having symptoms. In our report Readying the NHS and social care for the COVID-19 peak we previously highlighted that for around one month NHS trusts had been told to discharge medically-fit hospital patients before there was a policy to test patients for COVID-19 before discharging them to care homes. It considered this had contributed to the 20,000 deaths of people in care homes during the first wave of the pandemic. Care England told us that it was only after the high number of deaths became clear, that there was recognition that people in care homes were at the frontline of the pandemic.38 Care England also highlighted the high mortality rates among people with learning disabilities and told us domiciliary care and learning disabilities services appeared to be of a lower priority than other types of care when PPE was being distributed. The Department told us that it had now set up an e-portal, and that over 80% of eligible social care providers, including care homes and domiciliary care agency, and primary care providers had registered to use it to obtain free PPE.39 The experience of frontline staff
24Witnesses from organisations representing staff working in health and social care told us that providers...
Concluded (the committee's words)
Witnesses from organisations representing staff working in health and social care told us that providers received unusable PPE from central government. The Royal College of Nursing told us of instances where it had received masks on which the elastic was rotten, goggles which took significant amounts of time to assemble and were later recalled for being unsafe, and of opening a box of gowns to find insects inside. It also told us that it had received stock with stickers with dates showing the products had passed their expiry dates, and new stickers replacing these, with no explanation of any process to assure that the equipment was still safe. It noted that frontline staff were faced with unfamiliar-looking PPE and lacked confidence whether it was safe, and they were sometimes very frightened as a result. UNISON agreed that similar experiences were causing distress and anxiety to frontline workers.40 In its letter to us after our evidence session, the Department stated that it had recalled and quarantined 40 million items of faulty PPE.41
25Staff representative organisations ran surveys in which frontline staff reported not having the PPE they...
Concluded (the committee's words)
Staff representative organisations ran surveys in which frontline staff reported not having the PPE they needed. The British Medical Association, the Royal College of 37 Qq 11, 17, 37–38, 66–67, 121, 123 38 Qq 11–12, 17, 23–24, 37, 66, 123; House of Commons Public Accounts Committee, Readying the NHS and social care for the COVID-19 peak, Session 2019–2021, HC 405, 29 July 2020, para 9 39 Qq 71–72 131, 194 40 Qq 14–16, 29–33, 39 41 Letter from Department of Health & Social Care, 15 January 2021 COVID-19: Government procurement and supply of Personal Protective Equipment 19 Nursing, the Royal College of Physicians and Unison ran surveys that showed at least 30% of participating doctors, nurses and care workers reported having insufficient PPE, even in high-risk settings.42 Among the survey findings was that 51% of nurses reported being asked to reuse single-use items of PPE in a high-risk setting; 33% of Black, Asian or other minority ethnic (BAME) doctors felt they did not have the PPE they needed, compared with 14% of white doctors; and 49% of BAME nurses reported being fit tested for a respirator mask compared with 74% of white nurses.43
26We asked about the experience of BAME staff and whether this had been different to...
Concluded (the committee's words)
We asked about the experience of BAME staff and whether this had been different to that of their white colleagues. The British Medical Association told us that its surveys showed between two and three times as many BAME doctors as white doctors felt pressured to work without adequate protection. It also told us that it called for BAME staff to be given risk assessments in early April, when it became clear that COVID-19 was having a disproportionately high impact on staff from BAME backgrounds. But information from its members suggested that risk assessments were not being carried out until the end of May. The Department said that, since the initial PPE shortages, it had worked hard to listen to the concerns of BAME colleagues and ensure that all staff have a risk assessment. It also explained that it had a respirator mask fit-testing project and worked hard to ensure it could provide PPE in a range of sizes, so that everybody could get the PPE they needed.44
27By October 2020, employers had reported 8,152 diagnosed cases of COVID-19 and 126 deaths as...
Concluded (the committee's words)
By October 2020, employers had reported 8,152 diagnosed cases of COVID-19 and 126 deaths as being linked to occupational exposure among health and care workers.45 The British Medical Association and Unison asserted that the Department should investigate whether PPE shortages contributed to staff infections and deaths from COVID19. The Department told us that there was currently no evidence to show that shortages of PPE had contributed to staff deaths, but that that investigations were ongoing. It told us that all deaths in trusts are investigated by medical examiners, who refer to the Health & Safety Executive any cases where there is a chance that work-related exposure led to the death. The Health & Safety Executive will examine these cases, and the Department told us it awaited the outcome of this investigation and would act on its findings.46
28Witnesses representing the health and social care sectors raised a number of concerns about the...
Concluded (the committee's words)
Witnesses representing the health and social care sectors raised a number of concerns about the PPE guidance issued by government. The Department told us that it held conversations with the Royal Colleges (and with the NHS and public health services of the UK nations) about the PPE guidance issued.47 The British Medical Association told us that, in March, the government guidance differed from the guidance of the World Health Organization: in particular government guidance did not recommend the use of eye protection in GP practices. Government did revise its guidance to recommend eye protection in early April. The NAO report stated that PPE guidance had been updated 30 times by 31 July, and the Royal College of Nursing highlighted that the frequency of changes was difficult for a provider organisation to manage and that the changes were 42 Qq 7–8, 11, 17, 49, 62, 142–143; C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, paras 18, 3.19–3.21, Figure 16 43 Q 49; Royal College of Nursing, Personal protective equipment: Use and availability during the COVID-19 pandemic (national survey results), 18 April 2020; C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, para 3.26 44 Qq 53–57, 260–261 45 C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, paras 3.22–3.23, Figure 17 46 Qq 53, 276 47 Q 142 20 COVID-19: Government procurement and supply of Personal Protective Equipment often issued late on a Friday with providers required to implement them from Monday. Care England and UNISON were concerned that the language of the guidance was not relevant for social care, and UNISON told us that government guidance permitting the re-use of masks led to many social care workers being required to wear the same mask for an entire 12-hour shift, which they felt was unsafe. The British Medical Association said it had concerns around the guidance for PPE use dur
29By the end of June, 44 Transport for London workers had lost their lives to...
Concluded (the committee's words)
By the end of June, 44 Transport for London workers had lost their lives to COVID19. We asked representatives of health and social care staff organisations about the provision of PPE to non-healthcare key workers, such as taxi drivers, cleaners, transport, supermarket and security workers. The British Medical Association considered that these workers deserved to be protected and noted that failing to protect them led to more hospitalisations and increased the pressure on the NHS. The Department told us it would consider providing PPE to a wider group of people, such as key workers, as part of its pandemic planning if the evidence suggested that this would be effective. It also noted it had provided PPE guidance for some groups of workers, such as police and prison officers, during the first wave of the pandemic, and provided PPE to the Home Office and the Ministry of Justice.49 48 Qq 20–21, 26, 69, 73–75, 82; C&AG’s Report The supply of personal protective equipment (PPE) during the COVID-19 pandemic, paras 17, 3.3–3.7, Figure 14 49 Qq 24, 79–80, 277–278 COVID-19: Government procurement and supply of Personal Protective Equipment 21
Evidence
Oral evidence sessions 2
- 14 Dec 2020COVID-19: Government procurement and supply of Personal Protective Equipment5 witnesses: Alex Chisholm, David Williams, Gareth Rhys Williams, Jonathan Marron, Michael Brodieparliament.uk ↗
- 10 Dec 2020COVID-19: Government procurement and supply of Personal Protective Equipment4 witnesses: Dr Chaand Nagpaul, Dr Emily McWhirter, Gavin Edwards, Professor Martin Greenparliament.uk ↗
Who gave evidence 9 witnesses
- Alex ChisholmChief Operating Officer Civil Service and Permanent Secretary, Cabinet Office
- David WilliamsJournalist, Daily Mail
- Dr Chaand NagpaulChair, Council of the British Medical Association
- Dr Emily McWhirterRetired Nurse, Royal College of Nursing
- Gareth Rhys WilliamsGovernment Chief Commercial Officer and Non-Executive Director, Crown Commercial Service
- Gavin EdwardsSenior National Officer for Social Care, UNISON
- Jonathan MarronDirector General for Primary Care and Prevention, Department for Health and Social Care
- Michael BrodieChief Executive, NHS Business Service Authority
- Professor Martin GreenChief Executive, Care England
Correspondence 4 letters
- 10 Sep 2021Correspondence from Sir Chris Wormald KCB, Permanent Secretary, Department of Health and Social Care, re PPE Procurement and Supply, dated 27 July 2021
- 10 Jun 2021Correspondence from Public Accounts Chair Meg Hillier to Sir Chris Wormald KCB, Permanent Secretary, Department of Health and Social Care, re Following on from COVID-19: Government procurement and supply of Personal Protective Equipment, dated 28 May 2021
- 20 May 2021Copy letter sent to various PPE Suppliers in connection to the inquiry COVID-19 Government procurement and supply of protective equipmentFrom committee
- 14 May 2021Correspondence from the Department of Health and Social Care on the Committee's 42nd report of Session 2019-21 - COVID-19 Government Procurement and Supply of Personal Protective Equipment