Personal protective equipment - future supply: consultation analysis

Part 2: Preparing our PPE stocks for future pandemics

Part 2 of the consultation paper set out the Scottish Government's proposals for preparing Scotland's PPE stocks for future pandemics. Questions Q3 to Q5.1 covered the proposed national arrangements for PPE, Q6 explored the proposed sector-specific arrangements and Q7 and Q7.1 covered issues around payment mechanisms. Responses to these questions are analysed below.

National arrangements

3. Do you think that Scotland should have its own pandemic PPE stockpile? Please expand your answer if you wish.

Among those answering the closed question element of Q3, 80% agreed that Scotland should have its own pandemic PPE stockpile; 12% said no and 8% had no preference. HSCPs were most likely to agree (91%), followed by private and third sector run adult social care settings (88%). Around four fifths of most other sectors agreed. Other public sector organisations and membership and representative bodies were less likely to answer yes (both 67%), but were more likely to answer no preference (22% and 33% respectively) rather than no. A full breakdown of this and all other closed questions is in Appendix B.

The free text element of Q3 allowed respondents to expand their answer if they wished. Seventy-one respondents provided comments in response, which mainly detailed respondents' reasons for agreeing or disagreeing with the proposed PPE stockpile.

Reasons for agreement

Many respondents felt that a Scottish stockpile would help ensure Scotland has adequate access to PPE based on its own needs as distinct from the rest of the UK. This was the most common reason for agreeing with the proposal.

"The Scottish Government must maintain a stockpile that allows them to determine requirements for PPE independently of the UK government and have resources to be able to follow through on the delivery of this." – Action for Children

"It makes sense for Scotland to have its own stockpile that is more easily accessible to Scottish organisations and which is planned appropriately for a Scottish context, for instance mindful of the make-up of the social care sector in Scotland." – Scottish Care

The second most prevalent theme described by those who agreed with the proposal was the speed of supply that a Scottish stockpile could provide. Respondents suggested the stockpile could help to avoid or minimise the difficulties that some organisations experienced in securing timeous supply of PPE during the Covid-19 pandemic.

"A Scottish stockpile of PPE would offer the advantages of PPE being held at a more 'local' level which would potentially speed up response times if needed." – Aberdeenshire HSCP

"Local stockpiling and management of PPE supplies would avoid a repeat of the distribution issues which hindered the delivery of health and social care services during the Covid-19 pandemic." – Leonard Cheshire in Scotland

Some respondents argued that a Scottish stockpile could help to minimise wastage and ensure that PPE is used before its expiry date.

"It will also minimise waste and the need for revalidation as the stock can be managed and rotated through the standard supply routes." – Community Pharmacy Scotland

Another theme was that Scotland should have its own stockpile because health is a devolved matter. These respondents felt that the Scottish Government should have the power to manage Scottish PPE supplies.

The potential of a Scottish stockpile to benefit Scottish manufacturers by providing more opportunities for them to supply PPE was mentioned by some respondents, and more details about views on this issue are provided in the analysis of Q4.

A few respondents felt that a Scottish approach could be more cost-effective than, or mitigate against, international supply chains that can be volatile and unreliable. Another less commonly mentioned theme was a lack of trust in the UK Government's approach resulting from the 'High Priority Lane' for certain suppliers during the Covid-19 pandemic – an approach which was not used in Scotland.

Reasons for disagreement

Among the minority who were not in favour of the proposal, some felt that taking a UK-wide approach would offer greater buying power and value for money. This was the most common reason for disagreeing with the proposal.

"The four nations combined have greater purchasing power." – Individual

A few others felt there should be a UK-wide approach to stockpiling but did not explain why. Other reasons for disagreement, each mentioned by one respondent, centred on views that:

• stockpiling should be led by the UK Government;
• a UK-wide approach would increase the PPE supplies available across the UK;
• the ability to manufacture PPE in the UK would be enhanced by a UK stockpile;
• there are more users of PPE across the UK so there would be less wastage; and
• devolved administrations cannot be relied upon to manage a stockpile.

Other comments in opposition to stockpiling

Two respondents expressed opposition to the principle of stockpiling in general: one felt it could lead to users becoming protective of their own supplies and the other argued PPE might be wasted because future needs are difficult to predict.

Other themes

While minimising wastage was given as a reason for both agreeing and disagreeing with the proposed stockpile, several respondents highlighted the importance of managing stockpiles effectively to ensure supplies are used before they expire, for example by rotating stock so that items with an earlier expiry date are used first.

Some respondents, including two who agreed with a Scottish stockpile, two who disagreed and two who expressed no preference, emphasised that, regardless of the location of PPE stockpiles, supplies should be shared among the four nations in the UK as necessary.

Similarly, regardless of the location of the stockpile, another theme was the importance of using UK PPE manufacturers to protect against volatility in international supply chains and to support UK companies.

3.1 Do you have a preference as to which organisations or sectors should be able to access the PPE pandemic stockpile? If yes, please expand on your answer.

Almost two thirds (64%) of those answering the closed question element of Q3.1 indicated they had a preference; the remainder (36%) said they did not. Responses varied considerably by sector: 91% of private or third sector organisations providing essential public services and 83% of membership and representative bodies had a preference, compared to 43% of private or third sector run adult social care settings and 33% of other public sector organisations. A full breakdown by sector is in Appendix B.

Suggestions for broad sectors that should have access

While a majority indicated they had a preference about access, the 110 open comments made at Q3.1 varied widely with no clear consensus evident on who should have access.

Many respondents gave broad suggestions for sectors that should have access to the stockpile. A prevalent theme was that the PPE stockpile should be available to all workers in essential services that have close contact with members of the public. These respondents explained that essential workers would include health and social care staff and those who could be at risk of infection in other important sectors that keep the country running in a pandemic such as retail, childcare, transport, courts and waste management. This view was particularly prevalent among local authorities including adult social care services, private and third sector adult social care services, and private businesses and third sector organisations delivering essential public services.

Many other respondents focused specifically on health and social care. A prevalent view - particularly among HSCPs, local authorities including adult social care, NHS services, and private or third sector organisations providing essential public services - was that all health and social workers should have access. Several other respondents specified that the stockpile should be open to all NHS workers or all social care providers. A suggestion that the stockpile should be available for frontline health and social care staff, i.e. those delivering close personal care, was another theme.

Local authority services and public sector organisations in general were also mentioned by some respondents.

Suggestions of more specific occupations that should have access

Other respondents gave more specific examples:

• Several respondents made comments related to the education, early years and childcare sector, with suggestions that the stockpile should be accessible for staff in schools and nurseries as well as registered childminders. Respondents classified as private businesses and third sector organisations providing essential public services were particularly likely to support providing PPE in education, early years and childcare settings.
• In health and social care, some - mostly primary care independent contractors - called for primary care services to have access. Some specified that the stockpile should be open to GPs, a few mentioned pharmacies or dentists, and one identified optometrists. Some specified that hospital staff should have access, and a few said the stockpile should be available to private hospitals or healthcare providers.
• Access for emergency services (fire, police and ambulance) was called for by some respondents.
• Some felt that care home staff should be able to source PPE from the stockpile, with one individual specifying that it should be open to private social care services including care homes.
• Another theme related to the stockpile being available to unpaid carers and personal assistants, and one respondent that sector suggested access should be extended to carer support organisations.
• Two respondents indicated that funeral services should be allowed to use the stockpile and other specific suggestions, each identified by one respondent, included: housing providers that deliver support; social work; individuals requiring care and support; hospices; small and medium sized businesses; larger corporations; and the private sector.
• One called for self-employed social services workers to have access to the stockpile.

Several respondents commented on the need to prioritise access to those sectors that need it most, with the consensus that health and social care is the highest priority.

Public, third and private sectors

Although the consultation did not ask respondents to comment specifically on whether the stockpile should be extended beyond the public sector to include third and private sector organisations, there was debate on this issue with no clear consensus. Some respondents said the stockpile should be open to the third sector and charities in general, while a few respondents specified that it should not be accessible for private sector organisations.

In health and social care specifically, two individuals felt that the stockpile should be available to NHS staff only and one specified that access for health and social care workers should be restricted to those delivering services on behalf of the NHS or local authorities. On the other hand, a few specified it should be accessible for private healthcare staff too. In childcare, a few respondents categorised as private businesses or third sector organisations delivering essential public services said that the stockpile should be open to third sector providers as well as the public sector.

3.2 Do you have a view on how much the organisations or sectors that share the PPE stockpile should contribute to its costs? If yes, please expand on your answer.

Over half (55%) of those answering Q3.2 indicated that they held a view on how those sharing the stockpile should contribute to its costs. Views were very mixed by sector. Nine out of ten (89%) other public sector bodies and three quarters (77%) of private or third sector organisations providing essential public services said they had a view. Conversely, just under two fifths of primary care independent contractors (39%) and private or third sector run adult social care settings (38%) held a particular view.

While many respondents indicated they held a view, those views were mixed. There were open responses to Q3.2 from 90 respondents. Comments were fairly evenly split between those who felt organisations using the stockpile should contribute to the costs, and those who argued that the Scottish Government should fund the stockpile, either for all organisations or for certain sectors. Given the diverse views evident in the open comments, there was also little consistency in views within sectors.

Organisations using the stockpile should contribute to costs

Among the respondents who felt organisations should contribute to the costs of the stockpile, the most prevalent opinion was that organisations should pay an amount proportionate to their size. These respondents argued that each organisation's share should be calculated based on factors such as the number of staff, service users, and/or the amount of PPE used.

"It would need to be based on each sector's overall requirement." – South Lanarkshire Council

"Financial contribution should be a direct reflection on PPE requirements and usage." – North Ayrshire HSCP

Some respondents said that organisations should contribute a share of the cost but did not specify how much or how each body's contribution should be calculated. In general, it was unclear if respondents felt organisations should cover all or part of the stockpile's costs. A few felt the entire cost should be met by organisations, while some suggested the cost should be reduced or subsidised so that organisations only paid a proportion of the costs.

Several respondents highlighted that any cost for items of PPE charged to organisations should be fair, with mitigation against profiteering among suppliers.

"I would be happy to pay for the PPE required just not at inflated costs." - Individual

PPE should be provided at no cost for all organisations using the stockpile

Many respondents felt that central government should cover the cost of the stockpile. Respondents argued it would not be fair to expect organisations to pay for PPE which is needed during a pandemic – as opposed to anticipated regular activities - and that central funding would help to ensure parity of access and enable services to be delivered in line with infection prevention and control guidelines.

"This is for the good of all, not just those who need the PPE. So therefore the cost should be covered by the taxpayer." – Individual

"The costs of creating and managing a PPE stockpile should be dealt with at a national level and should not be borne by individual social care providers, otherwise the overhead costs of delivering social care will increase." – Coalition of Care and Support Providers Scotland

"Cost should be met by Scottish Government." – Dumfries and Galloway Council

PPE should be provided at no cost for certain sectors

Several respondents argued that PPE should be provided at no cost for certain sectors but that other sectors should contribute to the cost. Some specified which sectors should pay, and the consensus among these respondents was that public sector services, or private or third sector organisations working on behalf of the public sector, should not have to pay. The National Carers Organisations advocated that PPE should be made available to unpaid carers at no cost.

Potential disparities which would need to be addressed were noted by a few respondents, for example if a private sector nursery was charged for using the PPE stockpile while a local authority nursery was not.

"If providing NHS services then this should be maintained as public funded." – Optometry Scotland

"For social care services which deliver care on behalf of the public purse, PPE stockpile costs should be factored into public funding mechanisms on an ongoing basis." – Scottish Care

Two respondents suggested that organisations that deliver a combination of public- and private-funded services should have to pay a share proportionate to the balance of their public and private work.

"If income is derived 100% from NHS services it should be provided free. If income e.g. from a dental practice is 50% NHS, 50% Private then they should pay 50% etc." - Healthcare-2-U Limited

Another theme related to ensuring that the same price is charged to all organisations regardless of their sector. One commented on the different VAT arrangements for private providers compared to public bodies and the impact this can have on PPE costs.

4. Do you think that public sector organisations working together with the NHS to buy PPE together would help support the Scottish PPE manufacturing base?

There was broad agreement among those answering Q4 that the proposals would help support Scottish manufacturing; 77% agreed, 8% disagreed and 15% expressed no view. At least three fifths of most sectors agreed, ranging from 65% of private or third sector run adult social care settings and 67% of other public bodies, to 96% of local authorities including adult social care. Membership / representative bodies were, however, less likely to agree (40%), but the remainder (60%) did not express a view, rather than disagree.

4.1 Do you think that public sector organisations working together with the NHS to buy PPE together would help Scotland to be more resilient in the event of a future pandemic?

The results of Q4.1 were very similar to Q4, albeit with slightly higher levels of agreement. Nearly four fifths (79%) of those who answered agreed that the proposals would improve future resilience, 10% disagreed and 12% had no view. Agreement by sector ranged from 60% among membership / representative bodies (with the remaining 40% not expressing a view), 67% among primary care independent contractors and 71% of other public sector bodies, to 91% among HSCPs and 96% of local authorities including adult social care.

4.2 For public sector respondents: Would your organisation be willing to participate in a collaborative buying approach for pandemic PPE with the NHS?

While Q4.2 was intended for public sector organisations, respondents from multiple sectors answered. Among all those who answered, 45% indicated that their organisation would be willing to participate in collaborative buying, 10% stated they would not and 45% had no view. As shown in the following table, willingness varied considerably. The highest agreement was recorded among public sector organisations – 89% of HSCPs and other public sector bodies, and 68% among local authorities including adult social care settings. Less than half of other sectors indicated they would be willing to collaborate, with one in five (21%) of private or third sector adult social care not willing.

Base	n=	Yes	No	No preference
All answering (%)	124	45%	10%	45%
- HSCPs	9	89%	0%	11%
- Other public sector (e.g. justice services, education)	9	89%	0%	11%
- Local authorities inc. adult social care	22	68%	5%	27%
- Private / third sector providing essential public services	21	43%	10%	48%
- Primary care independent contractors	12	33%	17%	50%
- Private / third sector adult social care	19	32%	21%	47%
- Membership / representative body	4	25%	0%	75%
- NHS inc. hospital and community services	19	21%	5%	74%

4.3 Please detail any other views that you have on the proposed cross public sector collaboration with the NHS on pandemic PPE supply.

Sixty-three respondents answered this free text question. Comments focused on the proposed collaboration, the challenges involved, and factors that would help make collaboration a success. There were also comments about environmental considerations and arrangements for public sector organisations not taking part in the collaboration.

Potential benefits of collaboration

Several respondents observed that the proposed collaborative approach could help achieve best value in the procurement of PPE. There was a view that, by acting collaboratively, the organisations involved could achieve economies of scale and negotiate cost discounts that they could not get if acting alone.

"More buying power enables cheaper costs." – NHS Forth Valley

"Cross public sector collaboration would provide numerous benefits, including increased buying power to achieve the most economically advantageous price point." – Bluetree Medical

Another theme was that cross-sector collaboration could provide logistical advantages for smaller organisations. Larger organisations may have storage facilities and distribution networks that would make it easier for smaller bodies to store and access PPE.

Some respondents commented that a collaborative approach would help to ensure access to PPE across all sectors. This view was expressed primarily by local authority services and private and third sector organisations that provide essential public services.

Opportunities for Scottish or UK manufacturers to provide PPE were mentioned by a few respondents. A small number argued this could create a more resilient supply chain.

Other potential benefits of collaboration, each identified by one respondent, included:

• a deeper understanding of Scotland's usage of PPE;
• keeping the population safe by ensuring access to PPE across the public sector;
• enabling access to higher quality PPE;
• reduced panic buying; and
• learning from collaboration on PPE could be applied to the supply of other items in the health and social care sector.

Challenges

Respondents identified several challenges associated with cross-sector collaboration. Most commonly, some referred to a perception that the NHS was given priority during the Covid-19 pandemic and, as a result, respondents from sectors outwith the NHS (including local authorities, carers and personal assistants, other public bodies and private and third sector organisations) were unsure if they would receive equal treatment in any collaborative arrangement.

"Until the public sector is recognised as being as important as the NHS, there is scepticism that any collaboration mutually benefits both. Too many times during the pandemic we saw the NHS funnel stock for their own purpose, leaving others (often with no supply chains or routes) exposed." – Individual

"If I thought that collaboration with NHS would benefit social care I would agree but I think it would not go in social care's favour." – Abbey Care Services

Some noted that the public, private and third sectors all require access to PPE and that it will be important to consider how to prioritise access to PPE where necessary.

"Needs to be prioritised to safeguard people." – Edinburgh HSCP

Other challenges, each identified by one or two respondents, included:

• a feeling that cheaper PPE could be accessed through other supply chains (2);
• the variation in quantities and types of PPE needed by different organisations (2);
• ensuring that public sector organisations which opt out of the collaborative arrangements can demonstrate they have adequate alternative arrangements in place to protect service users and staff (2);
• a fear that Scottish or UK manufacturers may be unable to meet demand for PPE (1); and
• that this approach could reduce opportunities for small or local PPE providers (1).

Success factors

Some respondents suggested factors that would help to make the collaboration a success. Two emphasised the importance of supplying quality and effective PPE, while each of these points were made by one respondent:

• flexibility is required to meet the differing needs of different pandemics;
• the collaborative approach needs to be incorporated into procurement policy to ensure it happens in practice;
• a unified procurement process among buyers would help to achieve best value;
• a need for clear communication pathways and PPE guidance;
• a suggestion that public bodies could access PPE through NHS National Services Scotland via PECOS (an electronic procurement system used by health boards and other public sector organisations), while private and third sector organisations that provide or support public services could be invited to join a framework agreement.

Environmental and sustainability considerations

Another theme in responses to this question was environmental and sustainability considerations. Some respondents highlighted the need to: minimise wastage; dispose of equipment in a responsible manner; source PPE from domestic suppliers where possible; consider how PPE could be recycled or integrated into a circular approach; and/or use existing supply chain partners as distributors to reduce carbon footprints.

"Net zero, zero waste, circular economy needs considered." - Individual

"Both the Scottish Government and the NHS have sustainability commitments that predate the pandemic but which the significant increased use of PPE will impact upon. Reshoring our manufacturing has not only made it more resilient, but it has also made it more sustainable. We are now working with NHS Trusts and Heriot Watt University to develop a circular economy for PPE, so that old products can be collected from the NHS and then turned into energy and the raw materials for new products, including more PPE." – Globus Group (Alpha Solway)

5. Should the Scottish Government have a role in supporting the private businesses providing an essential public service and the third sector with their PPE supply in the event of a future pandemic? If 'yes', please describe what role that should be.

Almost four fifths (79%) of those answering Q5 stated yes, the Scottish Government should have a role in supporting private businesses providing an essential public service and the third sector with PPE in a pandemic. Of the remainder, 8% said they should not and 13% had no preference. A majority of those answering in all sectors agreed, though the proportion answering yes varied considerably. Views were most mixed among other public sector bodies (56% yes, 22% no, 22% no preference) and primary care independent contractors (61% yes, 17% no, 22% no preference). Around four fifths or more of most other sectors agreed, including 79% private or third sector run adult social care settings and 87% of private or third sector organisations providing essential public services. All (100%) membership and representative bodies felt the Scottish Government should have a role.

The open element of Q5 asked respondents to describe the role that they think the Scottish Government should have in supporting private and third sector organisations with their PPE supply in a future pandemic. Comments were received from 95 respondents, including some who expressed no preference or felt that the Scottish Government should not assist these organisations. Responses focused on reasons why the Scottish Government should support private and third sector organisations, the extent to which the private and third sector should pay for PPE, as well as suggestions about the Scottish Government's role and the types of support it could offer.

Reasons for supporting private and third sector organisations

Many respondents argued that the Scottish Government should help private and third sector organisations access PPE to protect staff and service users throughout society. This view was expressed by respondents from various sectors but was particularly prevalent among private and third sector organisations providing essential public services.

"It should be about doing the right thing and keeping everyone safe." – Aberdeen City HSCP

"If providing a service, [organisations] should be provided with suitable PPE." - Individual

Several respondents felt that the Scottish Government should provide support with PPE to ensure continuity of service for private and third sector organisations during a pandemic.

"If the private business is delivering essential services on behalf of the NHS or HSCP e.g. community pharmacies, dental practices etc, then there should be support in place to protect and maintain those essential services." – Primary Care Community Pharmacy Group

Views about whether private and third sector organisations should pay for PPE

Similar to responses to Q3.2, there were mixed views about whether private and third sector organisations should pay for PPE. Some respondents felt that the Scottish Government should provide PPE to private and third sector organisations for free, and one suggested that PPE should be incorporated into the value of contracts agreed between the Scottish Government and these organisations.

"Make it free at point of use, similar to NHS and fund nationally." – Clackmannanshire and Stirling HSCP

Several others, however, believed that private and/or third sector organisations should not access PPE for free. Only one argued that these organisations should cover all the cost of their PPE, but a recurring theme was a need for private and third sector organisations to contribute a share of the cost of the PPE they use. It was not always clear from the comments if respondents felt that both private and third sector organisations should pay, but where a preference was specified, some said private businesses should pay and one specified that third sector organisations should.

"Private businesses can draw on this stock to support their services – however they should contribute to the cost." - Joint response from East Ayrshire Council and East Ayrshire HSCP

"This should be made available free to the NHS and local authorities and for payment to private care providers and third sector organisations." – Unite Scotland

Suggestions for the types of support that the Scottish Government could offer

Several respondents suggested that the Scottish Government could help private and third sector organisations to access equipment at a fair price. There were comments about inflated prices for PPE during the Covid-19 pandemic and suggestions that the Scottish Government could help to access reduced prices in any future pandemic. This view was expressed by local authorities and NHS services but was particularly common among private and third sector organisations providing essential public services.

"Being able to source PPE at a lower cost than we can and in bulk orders would help us registered childminders greatly. Supply and demand meant we were having to pay upwards of £38 a box of gloves during the pandemic which our costings couldn't sustain." – Vicki Allan Childminding Service

"Ensuring availability at a fair price." - Individual

Similarly, some felt the Scottish Government could offer subsidies or financial support to help reduce the cost of PPE for private and third sector organisations.

"The Social Care Sustainability fund was made available by Scottish Government during the Covid-19 pandemic to support with direct-related additional costs. Something similar would be welcomed by the sector to sustain organisations." – Edinburgh HSCP

Another theme was that the Scottish Government could support domestic manufacturers to produce PPE, reflecting the responses to Q4. There was a feeling that this could help enhance the availability of PPE in Scotland as well as having wider economic benefits.

"The Government could provide funding to ensure materials and machinery suitable for switch to manufacturing PPE items." – Ayrshire College

"I think supporting PPE manufacturing business within Scotland could boost the economy as well as support future need of PPE." – Little Scallywags Nursery

It was also suggested that the Scottish Government could help to ensure that all sectors that need PPE have access to it.

"The Scottish Government should ensure that PPE is available for all businesses to purchase in the event of a future pandemic." – Aberdeen City HSCP

A few respondents felt that the Scottish Government should take a lead role in co-ordinating the supply of PPE across the country, while a small number said it would be helpful if the Scottish Government could provide guidance on which suppliers to source PPE from.

"As the representatives of the population, they should control all aspects in ensuring the supply of PPE." - Individual

Other suggestions for support, each mentioned by one or two respondents, that the Scottish Government could offer included the following:

• guarding against impropriety in the supply chain i.e. making sure that companies involved in the supply of PPE are not connected with politicians) (2);
• ensuring the PPE supplied is high quality (2);
• guidance on the type of PPE required (1);
• co-operating with the other nations in the UK on PPE supply (1);
• providing prompt payment for private and third sector organisations to aid their cashflow (1); and
• building up a comprehensive understanding of PPE requirements in social care (1).

5.1 If you answered 'yes' to Question 5, do you have an opinion on how this should be funded? If 'yes', please expand on your answer.

Just under half (47%) of those answering Q5.1 indicated they had a view on how support for PPE supply for private businesses providing an essential public service and the third sector should be funded; 24% said no and 29% said they had no preference. Private or third sector organisations providing essential public services were most likely to say they had a view (62%). HSCP were least likely to have a view (22%, with 44% stating no preference).

There were 71 responses to Q5.1, which asked respondents how Scottish Government support for private and third sector organisations with PPE should be funded. Similarly to Q3.2, there were mixed views about whether PPE costs should be covered by the Scottish Government or the organisations accessing the stockpile.

The Scottish Government should fund the PPE

The most common theme was that the Scottish Government should fund, at least partially, the cost of PPE for private and third sector organisations in a pandemic. This view was particularly prevalent among private and third sector organisations providing essential public services, local authority services, private and third sector adult social care services and NHS services.

"By central government from public purse." - Individual

"As a key player in NHS Primary Care, we feel that the supply of PPE should be included in the overall pandemic expense and supplied at no cost. It must be remembered that community pharmacy teams take on a risk in delivering face to face care during the pandemic and should have the right to the full protection of PPE with no cost issues included." – Community Pharmacy Scotland

Several respondents from various sectors argued that the Scottish Government should fund all PPE costs for private and third sector organisations, while a few felt it should pay a share. In some cases, it was not clear if the respondents felt the Scottish Government should cover all the costs or just some. A small number said costs should initially be met by the Scottish Government to ensure that all organisations who need PPE have access to it, before potentially charging organisations once the supply chain is secure.

Some respondents suggested how the Scottish Government could fund the support. A common theme was covering the costs through general taxation and two felt that large companies in particular should be taxed to fund the PPE. A few stated that PPE costs should be included in the value of contracts agreed between the Scottish Government and private and third sector organisations. One suggested establishing a pandemic contingency fund with the level of contribution per organisation set by the Scottish Parliament.

Private and third sector organisations should fund their own PPE

Several respondents argued that private and third sector organisations should fund the PPE they use, at least in part. This view was expressed by respondents from various sectors but was particularly common among NHS services. There were mixed opinions as to whether the organisations should cover all or a share of the costs.

"Private business to pay for their own PPE, either directly to suppliers or through Scottish Government." - Individual

"Yes, it is essential everyone has the PPE to stay safe but there should be a cost attached to this." – Aberdeenshire HSCP

As in Q3.2, there was a view that, if private and third sector organisations pay for PPE, the amount they pay should be in proportion to their size and/or amount of PPE used.

There were some comments about specific sectors that should pay for PPE. A few specified that private businesses should fund their PPE, with one specifying that private organisations outside the health sector should pay. Another said that private and third sector care homes should fund their own PPE.

Support for PPE manufacturers

A very small number of respondents suggested that the Scottish Government could provide financial support to PPE manufacturers to help minimise prices.

Sector-specific arrangements

6. Do you agree with the proposed pandemic PPE supply arrangements for your organisation or sector? If no, please describe what you believe should change.

The consultation paper outlined the pre-pandemic process in place for a variety of sectors, and then presented the proposed approach for the future. Nearly three fifths (59%) of those answering Q6 agreed with the proposed pandemic PPE supply arrangements for their sector; 17% disagreed and almost one quarter (24%) had no preference. However, agreement varied considerably by sector as shown in the following table.

Broadly, public sector organisations were more likely to agree, with around four fifths doing so and most of the remainder expressing no preference. Around half of other sectors agreed, but of particular note are the 31% of primary care independent contractors who disagreed and the lower level of agreement (41%) among private or third sector organisations providing essential public services.

Base	n=	Yes	No	No preference
All answering (%)	150	59%	17%	24%
- Local authorities inc. adult social care	9	83%	13%	4%
- HSCP	19	82%	0%	18%
- NHS inc. hospital and community services	22	78%	9%	13%
- Other public sector (e.g. justice services, education)	4	78%	11%	11%
- Private / third sector adult social care	9	52%	17%	30%
- Membership / representative body	19	50%	17%	33%
- Primary care independent contractors	12	50%	31%	19%
- Private / third sector providing essential public services	21	41%	27%	32%

The open follow-up to Q6 asked those who did not agree with the arrangements what they felt should change. A total of 38 open comments were received, which included some respondents who agreed or did not express a view. Many responses to this question did not directly address the proposed PPE supply arrangements, and, although there were some favourable comments about the proposed sectoral arrangements, there were no clear suggestions for changes to the proposed arrangements.

More information

Although the consultation paper outlined the proposed approach for different sectors, the most common theme in responses to Q6 was a request for more information. Two respondents identified specific aspects of the proposals that they would like more information about.

"We would seek more clarity as planning progresses around how social care providers would opt-in to the collaborative purchasing arrangement." – Scottish Care

"It is noted that 'Additional arrangements will be put in place for those not part of the proposed arrangements, either by choice or because they are in the private sector (providing an essential service), third sector or are individual carers.' Details must be made available as to what these additional arrangements will be." – Scottish Association of Social Work

Comments in favour of the proposals

There were some comments in support of the proposed arrangements. A few respondents supported the proposal for organisations to have access to the stockpile in an emergency situation.

"We agree with primary care contractors having guaranteed access to an emergency stockpile in the event of a future pandemic to ensure they can maintain a significant level of service." – Royal Pharmaceutical Society

"We also agree that third sector and private sector organisations should be able to access emergency PPE in a pandemic regardless of whether they have taken part in the national procurement system." – Coalition of Care and Support Providers Scotland

Other positive comments, each made by one respondent, focused on:

• the equitable nature of the proposals;
• staff not having to pay for their own PPE; and
• the proposals offering best value and high quality PPE.

Other themes

Respondents raised various themes not directly related to the question. Some reflected on difficulties they had experienced in accessing PPE during and/or since the Covid-19 pandemic.

"The supply of suitable equipment is very basic need during a pandemic. Our members weren't looking for full contamination suits for all, just basic, but fit for purpose, equipment, and they were failed." – Unite Scotland

"There is no supply chain for us as a private children's nursery." - Jaybees Childcare Ltd

Some respondents emphasised the importance of PPE being provided at no cost to the services that need it, while a few highlighted the need to treat different sectors and services in an equitable way. Some respondents specified that access should be available to certain groups, which align with the suggestions reported in the analysis of Q3.1.

Finally, one HSCP had concerns around their organisation's procurement processes, in which there are separate arrangements for NHS and local authority staff.

PPE payment mechanisms

7. Do you agree that a mechanism (or mechanisms) should be found by which the cost of pandemic PPE is appropriately split between the organisations that are using that PPE?

Almost two thirds (64%) of those answering Q7 agreed that mechanisms should be found to split the cost of pandemic PPE; 16% disagreed and 17% had no preference. Most sectors were broadly supportive of the proposal, ranging from 61% of primary care independent contractors and 67% of other public sector bodies to 91% of HSCPs. Respondents from private or third sector adult social care settings were split in their views; 38% agreed, 29% disagreed and 33% had no view. While only 20% of membership or representative bodies agreed, the remainder were more likely to have no view (60%, with 20% disagreeing).

7.1 What payment mechanism or mechanisms would be most appropriate in your view?

A total of 82 comments were received in response to Q7.1. Most of these, however, did not refer to payment mechanisms directly. Rather, they largely focused on whether the Scottish Government or organisations using pandemic PPE should pay for it, with the views shared aligning closely with those already outlined in the analysis of Q3.2 and 5.1.

Recharge

Where respondents made comments related to payment mechanisms, the most common suggestion was a recharge system, where the Scottish Government would charge or invoice organisations for all, or a share of, the cost of the PPE they have used. Several respondents across many sectors favoured this approach, describing it as fair and equitable and helping to ensure that organisations only pay for the PPE they use.

"Recharge for what each organisation has used would seem fairest." – Clackmannanshire Council

"It would be fairer to recharge after PPE has been procured to base costs on supply required for each sector/organisation." – Association of British Dispensing Opticians

"Re-charging organisations following procurement of PPE would be the most fair/equitable process." - Individual

Other suggestions

Other suggestions for payment mechanisms, each made by one respondent, were:

• a fund that organisations would contribute to before accessing PPE when needed;
• direct debit;
• a levy based on the volume of PPE used per organisation;
• a standing contribution based on staff numbers and potential use of PPE; and
• voluntary contributions.

Regardless of the payment mechanism used, many emphasised that the amount organisations pay should be based on their actual use of PPE, or be proportionate to the size and scale of the organisation. Other themes, mentioned by some respondents, included highlighting that the payment mechanism should not be cumbersome for organisations, and a suggestion that the amount organisations pay should include a charge to help cover storage and procurement costs.

Finally, one respondent suggested that organisations which do not wish to be part of the overall stockpile arrangements should be able to purchase PPE from the stockpile at an elevated cost, if they have difficulty accessing PPE elsewhere.