Covid-19: Supply of ventilators Contents

1Preparedness for the pandemic

1.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

2.Ventilators are medical devices that assist or replace a patient’s breathing by moving pressurised air with adjustable concentrations of oxygen in and out of the lungs. Patients with COVID-19 who are admitted to hospital often have problems breathing. If their blood oxygen level is low, the hospital may give them: standard oxygen therapy using a loose-fitting mask; non-invasive ventilation where oxygen is delivered under pressure via a mask or helmet; or invasive mechanical treatment using a mechanical ventilator, which takes over a patient’s breathing—in this case a tube is placed in the patients mouth or nose, or through a small cut in the throat (tracheostomy). Patients may need more than one of these treatments during a stay in hospital. The specific treatment used is a judgement for clinicians.2

3.In the early stages of the pandemic, based on information available at the time, the NHS believed it could need far more mechanical ventilators than were available. From March 2020, the government made efforts to rapidly increase the number of ventilators available to hospitals in the UK. Its strategy included: purchasing ventilators from suppliers on the global market, led by the Department of Health & Social Care; and encouraging UK manufacturers to design and scale-up production of ventilators as part of the ‘ventilator challenge’, led by the Cabinet Office.3

4.In total the departments secured an additional 26,000 ventilators for the NHS at an overall cost of £569 million. However, the majority of these ventilators have not been used. As of 16 September, just 2,150 mechanical ventilators bought or built through the programmes had been distributed to NHS trusts because the anticipated demand for more machines at the peak of the crisis did not materialise. The Department and NHSE&I are currently distributing some of these devices to trusts to help with planning for potential future demand, however it remains uncertain whether all of the devices will ever be used.4

Preparedness

5.Pandemic planning exercises, run by the Department and other bodies in the past decade, aimed to help the UK prepare for a pandemic influenza and did not highlight a need for more ventilators or contain plans to increase ventilator numbers rapidly.5 Therefore, the Department acknowledged that following the World Health Organisation’s declaration of a “ public health emergency of international concern” on 30 January, there was no pre-existing plan in place for how to increase the number of ventilators available to the NHS. It also stressed that the NHS is “not run […] with spare capacity”.6

6.This lack of planning was compounded by the fact that NHSE&I did not know how many ventilators were already available to hospitals in England. NHSE&I explained that in February, there was no central data on the number of ventilators available as these purchasing decisions are made by individual NHS trusts rather than at a national level. While it knew that there were around 4,123 critical care beds available, all of which would have an ventilator assigned, it did not know what the remaining surge capacity would be.7 NHSE&I did not put out a call to trusts for this information until late February, some weeks after its modelling indicated a need of up to 59,000 ventilated beds. The survey revealed it had just 7,400 mechanical ventilators, far less than was needed. This included some that would not normally be used to treat patients in a hospital bed such as ventilators from ambulances.8

7.When we challenged the Department on why it did not begin its initial efforts to buy more ventilators until the 3 March, it explained that there was a “huge amount” of work done in February to understand the disease and to look at the capacity across the NHS in multiple areas.9 It added that while modelling throughout indicated that mechanical ventilation may be needed, it was events during February in Lombardy, an Italian region hard hit by COVID-19, that made it clear there was going to be a specific pressure on ventilators. It said that as soon as it was clear that there was going to be a “real need” to purchase additional ventilators it set up a team on 3 March. The Department also told us that while there is now a lot more information on the number of ventilators and other equipment required for the pandemic available, there are no plans to look at other areas where it lacks centralised data.10

Assessment of need

8.From February to April, NHSE&I’s estimate of how many mechanical ventilators the NHS would need in a worst-case scenario changed repeatedly. Its estimates were based on reasonable worst-case planning assumptions assured by the Scientific Advisory Group for Emergencies (SAGE), which provides scientific and technical advice to support government decision-makers during emergencies. On 12 February these estimates indicated a need of up to 59,000 beds with mechanical ventilators at the peak of the crisis and by 1 March, this had had increased to 90,000. On 24 March estimates reduced to a need of up to 17,500 by 13 April and again on 8 April to just 6,200 needed by early May.11 The Department explained that the reasonable worst-case scenarios, something it thought was only 5–10% likely to happen, reduced due to both the inclusion of the estimated impact of interventions such as social distancing in the models and a better knowledge of how the virus spread.12

9.However, when the programmes began in early-March, departments were looking at a potential need of up to 90,000 mechanical ventilators, far more than the 7,400 thought to be available. The Department acknowledged that it was never going to be able to increase capacity to this level, but aimed to raise it as much as possible to provide a buffer in case interventions such as social distancing were not as effective as anticipated.13 It was not until after the peak of COVID-19 hospitalisations on 14 April, at which point almost half (43%) of the 6,818 critical care beds with ventilators were unoccupied, that Ministers adopted official targets to make a total of 18,000 ventilators available to the NHS by the end of April and 30,000 by the end of June via both programmes.14 While the Department recognised that at this point it was evident that the NHS would be “well clear” in terms of the numbers required, it said that it consciously set higher targets to increase capacity for a potential second peak. The departments missed both of the targets, eventually reaching the 30,000 by 3 August.15

10.It is fortunate that the majority of the ventilators were not needed and that there is now additional capacity if they should be required in the future. Nevertheless, we are concerned that the Department was not able to give a clear explanation of how it now assesses whether the NHS has sufficient ventilators and other critical equipment for any future need. It told us that its approach to decision making has changed fundamentally since the initial crisis. It said that it has largely “moved away from mathematical models” and that decision making is now more strongly driven by the “situation of the day. It explained that it now uses daily data and the knowledge of how infection rates translate into the numbers of patients requiring hospitalisation and more intensive treatment to assess the situation at a point in time. However, it also emphasised that the number of ventilators the NHS will ultimately need will depend on the non-pharmaceutical interventions, such as lockdowns, that the government puts in place and the level of public compliance with the rules.16

1 C&AG’s Report, Investigation into how government increased the number of ventilators available to the NHS in response to COVID-19, Session 2019–21, HC 731, 30 September 2020

2 C&AG’s Report, para 1.1, Figure 1

3 C&AG’s Report, paras 1 & 2

4 C&AG’s Report, paras 8, 2.17 & 2.20

5 C&AG’s Report, para 2.2

7 Qq 42, 45

8 C&AG’s Report, paras 1, 2.7 & Figure 2

9 Q 43

10 Qq 44, 46

11 C&AG’s Report, paras 1, 2.7, 2.9 & Figure 2

12 Q 60

13 Q 60; C&AG’s Report para 2.7 & Figure 2

14 C&AG’s Report paras 2.12, 2.14 & Figure 2

15 Qq 62–64; C&AG’s Report paras 7, 2.16

16 Q 121




Published: 25 November 2020 Site information    Accessibility statement