Conclusions and recommendations
1.Government’s response to the need to very quickly procure PPE and other goods and services opened up significant procurement risks. Government made extensive use of emergency procurement regulations to procure more than £10 billion of goods and services without competition. For fast procurements where there is no competition, it is important that awarding bodies document why they have chosen a supplier and how any associated risks from a lack of competition have been identified and managed. However, there are examples where departments failed to document why they were using emergency procurement, why particular suppliers where chosen or how any potential conflicts of interest had been identified and managed. Transparency also helps to ensure accountability for procurement decisions, particularly when no competition is involved. However, the details of fewer than half of the contracts awarded before the end of July with a value over £25,000, had been published by 10 November, and only 25% were published on Contracts Finder within the government’s target of 90 days. In December 2020, the Cabinet Office published the Boardman review into its COVID-19 communications services contracts, which made 28 recommendations to improve the Cabinet Office’s procurement processes and the way government manages actual and perceived conflicts of interest. The Cabinet Office has accepted all 28 recommendations and committed to implementing most of them within six months. It is puzzling why the plans for emergency procurement did not include a stronger understanding of the need for transparency and proper record keeping from the outset.
Recommendation: Government should ensure all the Boardman review recommendations are applied across government departments and procuring bodies. The Cabinet Office should write to us by July 2021 outlining its progress in implementing the recommendations of the Boardman review and a timetable for implementing any outstanding recommendations.
2.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 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 Department’s plans.
- Stock is checked regularly and there is a process for monitoring and replacing stock before it is out-of-date.
- Stock is held in locations from which it can be distributed quickly when required
- There are contingency plans to secure new items of clinical equipment which may be needed at short notice
3.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.
4.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 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 at risk.
5.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 backgrounds and consider how this should be monitored and tackled in future – not just in a pandemic. It should write to us by July 2021 setting out the results of this work and how these lessons are being applied. This work should cover:
- How many health and social care providers ran out of each type of PPE during the pandemic.
- Why many health and social care staff reported shortages of PPE, whereas the organisations they worked for did not appear to report shortages.
- The extent to which (and reasons why) BAME staff were less likely to report having access to PPE and being tested for PPE, and more likely to report feeling pressured to work without adequate PPE.
- Whether there are any links between PPE shortages and staff infections and deaths (when the relevant investigations have completed), including the deaths of health and care workers who do not work in NHS trusts.
- Provider organisations’ and frontline staff views on PPE guidance.
6.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.
7.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 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.
8.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.
Published: 10 February 2021 Site information Accessibility statement