Personal protective equipment - future supply: consultation analysis

Part 1: Lessons learned

The consultation paper set out a list of seven key lessons learned about securing a PPE supply chain during the Covid-19 pandemic. This list included learning points such as: the need to ensure effective mechanisms for collaboration and communication between agencies; the need to reform stockpiling and buying approaches; and the need to establish long term and sustainable PPE supply for the primary and adult social care sectors.

1. Learning the lessons from the experiences of the Covid-19 pandemic was a key recommendation from Audit Scotland. As part of the PPE Futures Programme, the Scottish Government has undertaken work to understand the lessons learned from the Covid-19 pandemic. The Scottish Government has been working with various stakeholders to capture these lessons. Please indicate whether you agree with the key findings.

Levels of agreement with each lesson, among those who provided an answer, are shown in the following table:

There was widespread agreement with each of the seven lessons outlined in the consultation, with over nine in ten of those answering agreeing with each.

Agreement was generally very high among most sectors in relation to most lessons with a small amount of variation; the lowest level recoded was two instances of 78% agreeing. Table 1 in Appendix B details the agreement recorded by sector, but in summary:

• Local authorities including adult social care: All agreed with four of the seven lessons, with the lowest agreement (91%) for 'A reformed stockpiling and buying approach for pandemic PPE is required' (Q1.1).
• Private / third sector adult social care: All agreed with three of the seven lessons, with the lowest agreement (88%) for 'Cross public sector collaboration with the NHS on PPE supply issues should be considered as part of a future strategy' (Q1.3).
• NHS including hospital and community services: All agreed with three of the seven lessons, with the lowest agreement (91%) for 'A reformed stockpiling and buying approach for pandemic PPE is required' (Q1.1).
• Private / third sector providing essential public services: This sector typically recorded comparatively lower agreement, with the lowest agreement (83%) recorded for Q1.1 and Q1.3.
• Primary care independent contractors: All in this sector agreed with five of the seven lessons. 78% agreed 'A future strategy also needs to consider how private businesses and third sector organisations can be as prepared as possible for future pandemics to ensure that they continue to deliver essential public services' (Q1.5).
• Health and Social Care Partnerships (HSCPs): All agreed with five of the seven lessons. 82% agreed with Q1.5.
• Other public sector: The highest agreement recorded in this sector was 89% for five of the seven lessons. 78% agreed that 'We must build upon the progress made during the Covid-19 pandemic in terms of supporting new, domestic supply chains and the development of data modelling' (Q1.6).
• Membership / representative body: All in this sector agreed with five of the seven lessons. 83% agreed with Q1.5 and Q1.6.

2. Are there any other lessons learned that you think should be considered? If 'yes', please describe.

Almost four fifths (79%) of those answering Q2 stated yes, there are other lessons learned that should be considered. As shown in Appendix B, at least seven in ten respondents in each sector stated there were other lessons, ranging from 72% of private and third sector organisations providing essential public services, 73% of local authorities and 73% of private and third sector run adult care settings, to 91% of HSCPs and 100% of membership and representative bodies.

Open comments were provided by 125 respondents. Many of these reinforced or added to the key lessons learned set out in the consultation paper, particularly improving communication and collaboration and the importance of a domestic supply chains.

However, there were some suggestions for additional lessons to be learned. A common theme was a critique of allocation of PPE during the pandemic, with a call for this be more equitable in the future. Other lessons included: the importance of securing PPE which is suitable, appropriate and high quality; minimising PPE waste; and introducing measures to address PPE price inflation. More detail on the additional lessons suggested at Q2 is provided below.

Improved communication and collaboration

Building on the lesson outlined in Q1, the most prevalent theme evident in open responses to Q2 was recognition of the importance of effective collaboration and communication between all agencies involved in the procurement, management and distribution of PPE, including Scottish Government, NHS Boards, manufacturers and those in receipt of publicly procured supplies.

While a few respondents praised the Scottish Government's Covid-19 communication strategy, several others felt that clearer, more consistent and more frequent messaging was needed during the pandemic. Respondents suggested there was a lack of clear information on issues such as: Scottish Government and NHS advice on PPE requirements and procedures for different settings; how to access PPE; stock availability and shortages; and guidance on how to correctly use and dispose of PPE.

Criticism of PPE allocation

Another common theme among responses to Q2 was criticism of the allocation of PPE during the pandemic. Some respondents felt that hospitals were given priority access to PPE at the expense of primary health care and social care services. A few raised concerns about the challenges that GPs faced in accessing FFP3 masks throughout the pandemic, despite being exposed to suspected Covid-19 cases on a daily basis.

"The early battles some sectors of health and social care had in convincing others that their need for PPE was equivalent (in terms of protecting vulnerable people from the effects of Covid-19) to other sectors, was a sad and traumatic period. Both the NHS and Social Services care for the vulnerable and should be recognised accordingly." – Individual

"It must be emphasised that GPs, particularly rural GPs, deal with acutely unwell patients, cardiac arrests and trauma and are at risk from aerosol generating procedures. My practice never received a single FFP3 mask from the health board, despite multiple requests, and was reduced to buying these on eBay. This is not acceptable." – Individual

Several respondents felt that greater efforts should have been made to create more equitable access to PPE across different sectors, calling for parity of access for all essential workers. Examples of essential services which remained operational throughout the pandemic but faced challenges in accessing publicly procured PPE were noted by respondents. These included: childcare providers and early years services; hospices; private care homes; unpaid carers; refuse collection services; and funeral homes.

Importance of domestic supply

Continued development of domestic supply chains, as outlined in Q1.6, was encouraged by some respondents, who described the benefits of having UK-based PPE manufacturers and suppliers. These included:

• expedited access to PPE supplies;
• greater self-sufficiency and less reliance on global supply chain (which was under huge strain during pandemic);
• contribution to UK economy, including the creation of jobs; and
• reduced impact on the environment as international transportation not required.

However, a few urged caution over relying on a small number of domestic suppliers, noting that this limits competition and may lead to inflated prices, and could also leave the NHS in a precarious position if one of the domestic suppliers were unable to meet demand.

Prioritisation of quality and suitability of PPE

Some respondents criticised the quality and suitability of the state-provided PPE they had access to during the pandemic, for example ill-fitting masks and low-quality alcohol gels. They asked for the quality and appropriateness of PPE to be prioritised when procuring supplies. Some called for more user-testing and others felt a PPE Quality Assurance scheme should be considered.

A few thought that consultation with PPE experts, designers and manufacturers should be undertaken to improve the usability and cost effectiveness of the PPE procured by the Scottish Government and NHS.

Addressing PPE cost inflation

The volatility of the PPE market during the pandemic was discussed by some respondents, who described the significant increase in unit costs for items of PPE as exploitative and profiteering. They encouraged the Scottish Government to consider introducing measures to limit suppliers' ability to sell PPE at inflated prices, for example through price caps or fixed pricing.

Reducing PPE waste

Some respondents criticised the amount of PPE that was wasted during the pandemic due to being expired or supplied in excess. They suggested ways to reduce the amount of PPE being wasted or disposed of, including: implementing strict stock rotation protocols in storage facilities; designing an ordering system for PPE; and introducing means for unused PPE to be returned. Others noted that procuring higher quality and more durable PPE which is less likely to deteriorate over time will result in less waste.

"I am a GP practice manager. We repeatedly received plastic face guards during 2020/21 despite not using them. We asked for them not to be sent out to us and were told there was no mechanism to stop this… Please have a method of specifying what PPE we need at the time instead of assuming we need all items." - Kilmarnock Road Surgery

Other lessons learned

A small number of other themes were each raised by a few respondents.

• General reflections on how the Covid-19 pandemic exposed the unpreparedness of the nation for crisis, and the need for better preparation for future pandemics.
• A few felt that regulations should be introduced which require care homes and social care providers to have adequate infection prevention and control procedures and supplies in place.
• There were calls for greater consideration of the PPE needs of equality groups, e.g. people with hearing difficulties may require clear masks to enable them to lip read, appropriate PPE and guidance is required for those wearing head scarves.
• A few concerns were raised over the transparency of government PPE contracts, with some calling for information to be made publicly available about successful contractors' relevant experience, profit margins and links to those in positions of authority within government.