Coronavirus (COVID-19): Personal Protective Equipment (PPE) - action plan

Section Two: Developments Since Start of Covid-19 Outbreak

The Challenge

1. At the start of the Covid-19 outbreak, there was sudden need for significantly more PPE in Scotland, particularly focused on NHS Scotland and social care settings. For example, in the week beginning 27 January 2020, weekly NSS National Procurement critical PPE shipments across Scotland totalled 5,649,635 items, however by week beginning 6 April this figure was 24,551,324^[6]. Shipments have been sustained at this high rate, as can be seen in Annex A.

2. Scotland's challenge was mirrored globally, putting immense pressure on key supply chains, as almost all of our PPE was imported at that point.

3. This challenge required a multi-faceted response from the Scottish Government, NSS, Public Health Scotland, employers, Unions, and others. There were seven key elements to our joint pandemic response, and a summary of each is below.

1) Development of Guidance on Appropriate Use of PPE

UK Infection Prevention and Control (IPC) Remobilisation Guidance

4. Throughout the pandemic the four UK nations have worked in collaboration to publish IPC guidance, including the requirements of PPE across health and social care^[7]. The guidance outlines key Covid-19 IPC measures such as the use of PPE, extended use of face masks and coverings, social distancing, and outbreak management, as well as new risk assessed care pathway scenarios to help guide the implementation of measures for safe and effective care and support.

5. Scotland's National Infection Prevention and Control Manual (NIPCM) has provided the evidence base for the UK IPC guidance which aligns with Standard Infection Control Precautions (SICPs) and Transmission Based Precautions (TBPs) with addition pandemic precautions. Recommendations for the appropriate level of PPE required for different settings have been integrated into the care pathways. The guidance continues to recommend the safest level of PPE to protect health and social care workers in line with contact and droplet precautions, or airborne precautions when an Aerosol Generating Procedure (AGP) is being undertaken.

Guidance for non-health and social care settings

6. All workplaces should consider the guidance for non-health and social care settings^[8]. It sets out the circumstances in which PPE may be required, based on a risk assessment.

2) Extended Role for NHS National Services Scotland

7. Prior to the Covid-19 outbreak, NHS Scotland had a robust PPE procurement system via NSS. There was a strong capability to supply standard PPE across territorial Health Boards and some special Health Boards. The Scottish Government managed a pandemic buffer stock that was held within NSS National procurement that contained a number of PPE items as well as medical products. During the Covid-19 response the scope of supply for NSS has broadened considerably, including work to support social care and primary care, as set out below.

Social care settings

8. For social care support, whether provision is in the public, independent, voluntary or not-for-profit sectors, the supply of PPE is primarily the responsibility of social care providers themselves. However, given the immense pressure on normal supply chains due to Covid-19, the Scottish Government has been providing top-up and emergency PPE from the national stock (via NSS) free of charge to ensure that staff, social care Personal Assistants and unpaid carers have what they need.

9. This PPE is being distributed through two routes:

• Local PPE Hub(s) in every Health and Social Care Partnership (HSCP) area, supplied by NSS, where providers and carers can access PPE if they cannot get it through their normal supply routes; and
• A central PPE support centre (via NSS) dedicated to urgent clinical need, that can be accessed in emergency situations and when neither normal supply routes nor the Hubs are able to meet a provider's or carer's needs.

10. Feedback from Health and Social Care Partnerships, social care providers, and carers centres is that the PPE Hubs and the PPE support centre have provided stability and consistency for the social care sector's access to PPE for the COVID-19 response. These arrangements were originally in place until October 2020, but have been extended until March 2021 to ensure continued stability and access to PPE in the social care sector over the 2020-21 winter period. Work is also currently underway with partners to explore options around potential longer term support for the social care sector in this regard.

Primary Care Settings

11. GPs, Community Pharmacists, dentists providing NHS General Dental Services and Community Optometrists have in the past been responsible for their own PPE supplies.

12. There has been a significant change in the level of PPE requirement for all those groups in the months since March, and to meet their needs, NSS National Procurement has been supplying PPE to these primary care independent contractors and continues to do so. We need to ensure that these vital community services are properly supplied for the winter, so the Scottish Government has agreed that PPE will continue to be provided free of charge to these primary care independent contractors to support NHS activity through to 31 March 2021. Options for distribution routes are being discussed and trialled at present across all contractor groups.

3) Development of Scottish PPE Manufacturing

13. In the spring, the Scottish Government and partners began rapid, ground-breaking joint work to build a Scottish PPE supply chain. As well as identifying offers of support that could supply high volumes of approved PPE and sanitiser products as quickly as possible, a multi-agency team (including colleagues from the NHS, Scottish Enterprise, SDI, and the National Manufacturing Institute Scotland, operated by University of Strathclyde) worked with businesses to increase Scottish capacity to make key products. Many Scottish businesses helped this national effort by diversifying to ensure a secure supply of NHS essentials. This work ultimately ensured we had adequate stocks of all PPE items going to all our front line services during the emergency period^[9].

14. This successful work over the past six months has illustrated how government can act as a catalyst for supply chain development in areas of strategic interest. That's why, in our Programme for Government 2020-21^[10], the Scottish Government committed to roll out Supply Chain Development Programmes across key sectors of the economy, where we see genuine sustainable economic potential. These will be targeted at existing and prospective suppliers based in Scotland, and enhance participant companies' fitness to compete for public contracts, help to secure best value for taxpayers and help Scottish suppliers to grow and compete globally.

4) Support and Engagement with Other Workplaces (public, private and voluntary sectors)

15. In addition to NSS National Procurement there are a number of well-established supply chains managed through existing procurement frameworks servicing local government, central government, social care and higher and further education.

16. Across multiple places of work, detailed work has been done involving national and local Government, employers, unions and employees to develop sector-specific guidance on working in the context of Covid-19. More information on this is at Annex B.

5) Delivery of Third Party PPE Contract

17. Organisations providing essential services to the public – including voluntary sector organisations, funeral directors and many others – that need to buy PPE, but are unable to source it, may be eligible to access help via our third party framework contract.

18. The Scottish Government has established this framework to provide PPE for purchase. Eligible organisations can purchase PPE from this supplier when they are unable to secure PPE supplies through existing channels or where they need to supplement existing supply chains to deliver essential public services.

19. This service broadly covers those organisations that cannot access the three established procurement routes for PPE for health and social care (NHS National Services Scotland); local government (Scotland Excel) and Higher and Further Education (Local Government and Advanced Procurement for Universities and Colleges). There are already over 600 organisations registered to use the framework, including central government organisations.

20. Further information on this for potential users of the contract is at Annex C.

6) Establishment of PPE Strategy and Governance Board and Other Groups

21. The PPE Strategy and Governance Board was established in May 2020 and meets on a fortnightly basis. It brings together PPE demand and supply expertise from Scottish Government Directorates and public sector organisations. The Strategy and Governance Board manages a range of specific actions which sit under this Action Plan. Through this winter and beyond, it will consider any emerging issues and identify solutions, including if there should be any reports from sectors on difficulties in securing PPE.

22. This group connects to a range of other groups, such as the Single Point of Contact (SPoC) Strategic Group, to ensure that full consideration is given to operational, clinical and engagement issues; this reflects the complexity of this issue and the many sectors involved.

7) Work with the Rest of the UK

23. We have worked with the UK Government and administrations in Wales and Northern Ireland to maximise efficiencies and collaborate where it makes sense to do so. This includes co-operation on the procurement and distribution of PPE across the UK as part of the Four Nation PPE Plan first launched on 10 April 2020. The Department of Health and Social Care's PPE strategy was published on 28 September and welcomed by the Scottish Government. The strategy emphasises that mutual aid and cooperation across and between all four nations has been a key part of ensuring PPE gets to where it is needed.