Recommendations & Conclusions
14 items
5
Recommendation
Forty-Second Report - COVID-19: Governm…
Accepted
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, …
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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
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Government response AI summary
The government accepted the recommendation to better understand frontline staff experiences, including BAME staff, with a target implementation date of July 2021. It confirmed it is factoring evidence into engagement programs, continuously seeking feedback, and considering options for further qualitative insights, with an update to …
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HM Treasury
6
Recommendation
Forty-Second Report - COVID-19: Governm…
Accepted
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. …
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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.
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Government response AI summary
The government accepts the recommendation and commits to sharing details of its future PPE strategy by July 2021. This strategy will outline how ordered PPE will be used, how UK manufacturing will be incentivized, and how supply chain resilience will be ensured.
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HM Treasury
7
Recommendation
Forty-Second Report - COVID-19: Governm…
Accepted
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 …
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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.
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Government response AI summary
The government accepts the recommendation and commits to completing a quality review of all PPE by June 2021. It will report to the Committee by July 2021, detailing volumes, costs, and methodology for PPE that is unusable or unsuitable for its intended purpose.
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HM Treasury
8
Recommendation
Forty-Second Report - COVID-19: Governm…
Accepted
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
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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
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Government response AI summary
The government agrees with the recommendation and commits to writing to the Committee by the end of July 2021 to report on the number and financial value of contracts where it has recovered, attempted to recover, or is still seeking to recover costs for undelivered …
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HM Treasury
9
Conclusion
Forty-Second Report - COVID-19: Governm…
Accepted
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 …
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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
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Government response AI summary
The government agrees with an implied recommendation to learn lessons from PPE procurement. It will publish updated policy on emergency procurement, including guidance for selecting suppliers, by July 2021, disseminating these findings to the wider Government Commercial Function.
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HM Treasury
11
Conclusion
Forty-Second Report - COVID-19: Governm…
Accepted
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 …
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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
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Government response AI summary
The government detailed existing measures for PPE management, including maintaining a four-month stockpile, tracking stock, and conducting quality reviews. It stated that information on the future approach to stockpile management would be made available in due course, and a review of countermeasures for disease outbreaks …
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HM Treasury
12
Recommendation
Forty-Second Report - COVID-19: Governm…
Accepted
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 …
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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
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Government response AI summary
The government agrees with the recommendation and commits to sharing more details on its future PPE strategy, encompassing how it will use ordered PPE, incentivise UK-made PPE, and ensure supply chain resilience, with the Committee by July 2021.
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HM Treasury
15
Recommendation
Forty-Second Report - COVID-19: Governm…
Accepted
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 …
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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
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Government response AI summary
The government agrees to provide an update by the end of July 2021 on the number and value of contracts where it has successfully recovered costs, made efforts to recover costs, or is still seeking to recover costs for undelivered or substandard PPE.
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HM Treasury
16
Conclusion
Forty-Second Report - COVID-19: Governm…
Accepted
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 …
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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
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Government response AI summary
The government agrees with an implied recommendation and commits to completing a review of all PPE quality by June 2021. It will report findings to the Committee by July 2021, detailing which products are suitable for frontline use, and provide an assessment of costs for …
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HM Treasury
18
Conclusion
Forty-Second Report - COVID-19: Governm…
Accepted
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 …
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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
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Government response AI summary
The government agrees with an implied recommendation to improve PPE management and distribution. It confirms a four-month stockpile, increased UK manufacturing, a flexible logistics network, and processes for stock tracking and quality review, with further details on future strategy to follow.
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HM Treasury
20
Conclusion
Forty-Second Report - COVID-19: Governm…
Accepted
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, …
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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
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Government response AI summary
The government agrees with an implied recommendation and outlines its current and future PPE strategy, including increased UK manufacturing capability, holding a four-month stockpile, and developing a flexible logistics network to improve distribution and mitigate demand fluctuations.
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HM Treasury
22
Recommendation
Forty-Second Report - COVID-19: Governm…
Accepted
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 …
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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
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Government response AI summary
The government agrees with the recommendation and commits to writing to the Committee by the end of April 2021 with an update on its future approach for PPE management and a framework for responding to future shortages, giving appropriate weight to all health and social …
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HM Treasury
23
Conclusion
Forty-Second Report - COVID-19: Governm…
Accepted
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 …
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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
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Government response AI summary
The government agreed with the committee's recommendation (PAC Rec 4, not the provided committee text), committing to providing an update by April 2021 on how it will revise emergency response plans for health and social care, and is developing a framework for responding to future …
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HM Treasury
27
Conclusion
Forty-Second Report - COVID-19: Governm…
Accepted
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 …
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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
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Government response AI summary
The government states that mechanisms are in place through coroners, medical examiners, and the Health and Safety Executive (HSE) to investigate COVID-19 work-related deaths, and that HSE is currently undertaking these investigations.
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HM Treasury