Ministers must have plan to avoid PPE shortage if coronavirus second wave hits, MPs warn

Hard-hitting report warns that writing off £13.4bn of NHS trusts’ historic debts has not resolved their financial problems

Ministers must have a plan in place by the end of the summer to deliver sufficient supplies of personal protective equipment (PPE) for a potential second wave of coronavirus in the UK this winter, an influential House of Commons committee has said.

The cross-party Public Accounts Committee said it was “extremely concerned” by shortages of PPE experienced by health and care workers during the first wave of Covid-19 and did not believe the government was treating the issue with sufficient urgency.

Warning in a report that ministers do not have a “clear understanding” either of the equipment needed or how to distribute it – particularly to the fragmented care sector - the committee set a 7 September deadline for the Department of Health and Social Care to outline how it will provide reliable and easily accessible supplies if coronavirus flares up again.

The report also warned that Health Secretary Matt Hancock’s decision at the start of the Covid crisis to write off £13.4 billion of NHS trusts’ historic debts would not resolve the health service’s underlying financial problems.

The pandemic has underlined the need for a coherent plan to allow the NHS to get its finances in order and cut waiting lists after coronavirus is brought under control, it said.

Committee chair Meg Hillier said: “The government conducted a large pandemic practice exercise in 2016 but failed to prepare. The previous committee warned on the lack of plans to ensure access to medicines and equipment in the social care sector in the event of a no-deal Brexit but, again, the Government failed to prepare.

“There must be total focus now on where the problems were in procurement and supply in the first wave, and on eradicating them.

“The pandemic has thrown the deep, long-term underlying problems in NHS capital and financial management into stark relief. There is no room and must be zero tolerance for allowing the underlying funding problems to continue.”

DHSC told the committee’s inquiry that stocks of PPE for health or social care never ran out at a national level during the pandemic, but admitted there had been an “enormous challenge” to distribute the right equipment to the right locations in time.

Before the epidemic, only around 35-40 per cent of PPE was sourced nationally, with regional and local healthcare bodies and care homes purchasing their own stocks. DHSC told the inquiry that this system was not sufficient to cope with the surge in demand during the crisis, and new arrangements had to be put in place. This involved the department supplying 50,000 customers across health and social care, compared to 240 NHS trusts before the pandemic.

At the time of the inquiry, DHSC said it had yet to make decisions on how to build up the resilience of its supply chains, but said that there was no imminent possibility of stepping up UK production to the point that it can replace international markets as the source of the vast majority of its PPE.

The committee said it was “extremely concerned by widely reported shortages of PPE for clinical and care workers during the first wave of the Covid-19 pandemic” and said the government was “still not treating this with sufficient urgency”.

“It is ‘absolutely vital’ that the same problems do not happen again in the event of a second wave, but uncertainty still prevails around future provision of local PPE across the health and social care sectors,” said the committee.

“Within two months of this report the committee expects DHSC to clarify its governance arrangements and outline when it expects to have a predictable supply of stock and ready access to PPE supply within the NHS and care sectors.”

Meg Hillier (PA)

In response, a DHSC spokesperson said: “We do not accept these claims. We have been working around the clock to deliver PPE to the frontline throughout this global pandemic, working with industry, the NHS and the armed forces to create a distribution network to supply over 58,000 settings.

“Two billion items of PPE have now been delivered and almost 28 billion items have been ordered from UK-based manufacturers and international partners to provide a continuous supply, which will meet the future needs of health and social care staff.”

The department had responded to offers from 15,000 suppliers to supply PPE to required safety and quality standards and now has sufficient contracted supplies for foreseeable demand in most product areas, said the DHSC. Around 20 per cent of all PPE will be manufactured in the UK by the end of the year.

The PAC said that the decision to write off £13.4bn in loans still left NHS trusts with an ongoing annual financial deficit which reached a total of £827 million in 2018/19.

Performance on the 18-week waiting time standard in 2018/19 was at its worst since 2009/10, before the arrival of Conservative-led governments. And the number of people on waiting lists reached a historic high of 4.23 million at the end of March 2019 - believed to have swollen further as a result of cancelled operations during the coronavirus crisis.

By October 2019, trusts reported an estimated total maintenance backlog of £6.5 billion, of which £1.1 billion was high-risk, indicating that not doing the maintenance meant an increased risk of harm to patients. And the report voiced concern that vacancies for 40,000 nurses and 9,000 medical staff could present a risk to the delivery of the government’s long-term plan for the NHS.

“The pandemic has highlighted the need for the NHS to continue its efforts to fundamentally transform services to ensure that it can meet rising demand in the future while maintaining vital service standards,” said the committee’s report.

“In order to get to that position, the NHS needs to have a coherent plan for how it will function after the peak of the COVID-19 crisis.”

“The Covid-19 crisis should not be used as an excuse not to address long-standing issues which we have highlighted in our previous reports such as workforce shortages, coherent and aligned capital investment strategies, tackling trust deficits and at the same time, remaining ready to deal with any future peaks in the pandemic.”

The DHSC spokesperson responded: “We will continue to give the NHS whatever it needs and protect it for the future – we have written off £13.4 billion of NHS hospital debt, recently announced another £1.5 billion of capital investment and we will deliver 50,000 more nurses by end of this parliament.”