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

Section Four: Ensuring a Resilient Supply of PPE for the Long Term

Introduction

1. From a position when there was effectively zero Scottish PPE manufacturing before the pandemic and we were fully reliant on imports, we have built a resilient PPE manufacturing sector in Scotland over the last few months. This was made possible in large part by the use of emergency procurement powers, alongside with our manufacturing partners' very welcome willingness to repurpose their capacity.

2. As we transition from the current emergency, future requirements will be met through business as usual procurement under the general principles of transparency and equality which generally mean awarding contracts through competitive tendering processes.

3. Our shared goal now is to move towards a long-term sustainable approach, where business as usual procurement in the NHS and wider public sector delivers the best value for taxpayers' money. We are also moving towards a more robust supply chain which can withstand whatever challenges emerge and where every user can benefit from a stable Scottish PPE manufacturing sector with the economic, employment and sustainability benefits this entails.

Understanding how supply and demand is changing

4. It is important to collate information on the emerging overall Scottish PPE demand picture in all sectors. Considerable work has been done to model demand across all sectors.

Modelling for Health and Social Care

5. Specialist analysts within the Scottish Government, NSS and partners have built a detailed model of demand for Health and Social Care, which is managed by NSS and kept under continual review as new information emerges.

Understanding the position more broadly

6. It is more challenging to model the multiple smaller supply chains in other sectors, although work has been done to understand this as best we can. The Scottish Government will continually assess the position across wider users and come to a view on the likely pressure points. More work is planned with stakeholders, including union representatives, to consider how we can best ensure that on-the-ground experience is understood and addressed at the most appropriate level.

7. As worldwide domestic manufacturing continues to change and develop in the light of the pandemic, we will need to continue to keep international conditions under review via market studies and consider where there are opportunities for Scottish manufacturers to flourish.

Working towards sustainable domestic manufacture of PPE

8. As set out in Section two, a considerable amount was done early in the pandemic to identify and support Scottish businesses to move into the manufacture of PPE and other goods and services required by NHS Scotland and other sectors.

9. Whilst working towards a sustainable manufacturing sector, our parallel ambition is also to ensure PPE remains affordable and offers good value for money for purchasers while maintaining our high standards.

10. As Figure 1 below shows, pre Covid-19 all PPE sourced by NSS came from manufacturers outside Scotland. Between March 2020 and August 2020, this began to shift as production was established in Scotland and wider UK manufacturers and capacity was increased. Over the winter period between October 2020 and March 2021, the balance will shift again, with nearly half of all PPE being supplied from Scotland. When gloves are removed from this calculation, over 90% of PPE is manufactured within Scotland.

11. Scotland's manufacturing capacity continues to move towards a sustainable self-sufficiency in many of the critical PPE areas generating employment and investment in our communities. This has also helped to build resilience for any potential future outbreak.

Scottish Procurement Policy

12. The most important part of any public procurement process is a clearly defined requirement confirming not only the volumes but the standard of product with an appropriate evaluation methodology that ensures the product is fit for the customer. Procurers have access to the Scottish Government's Sustainable Procurement Tools and guidance on how to take account of relevant considerations in procurement exercises. State aid considerations also need to be taken into account^[11].

13. The success of the domestic manufacture strategy and support for local suppliers was to a large extent predicated on procuring authorities' ability to utilise emergency procurement powers, and award contracts directly. We now need to consider the extent to which normal procurement processes can help achieve similar positive outcomes.

14. The Scottish Government has issued a Procurement Policy Note on supply chain resilience and diversity that advises public sector buyers of practical steps that should be taken to support supply chains and help reduce the risk of disruption to supplies caused by supply chain vulnerabilities and surges in demand^[12].

Fair work procurement guidance

15. The Scottish Government supports Fair Work and the Living Wage. We have published the following guidance covering fair work practices, including the Living Wage, in procurement:

• Statutory guidance on addressing fair work practices, including the Living Wage, in procurement^[13]
• Best practice guidance on addressing fair work practices, including the Living Wage, in procurement^[14]
• Fair work practices in procurement: toolkit^[15]

User Needs, Equalities, and Environmental Considerations

16. As PPE becomes more widely used in society and by organisations, it is vital that we ensure our approach to PPE is in line with the Scottish Government's objectives on equalities and the environment. We will build on the work and expertise partners have built up prior to the pandemic to continue innovation on PPE items, with the aim to overcome the challenges the increased use of PPE pose.

Foregrounding User Views and Needs, and Equalities Considerations

17. We now know more about people's experiences using PPE in tackling the Covid-19 pandemic. Anecdotally, especially earlier in the pandemic, we did hear concerns that some PPE did not fit well or feel comfortable, and these concerns seemed to come particularly from women and Black and Minority Ethnic (BAME) individuals.

18. This requires active consideration at both individual and system level: solutions need to be found for individuals, and we need to make sure there is a suitable range of PPE available for everyone.

19. If a specific piece of PPE is not appropriate for an individual then they will need an alternative: in many cases there will be a similar product available that will be better for them, as PPE is available in different sizes and made by different manufacturers. Close liaison with local Health and Safety and infection control can work out other solutions that are possible, that will still maintain the required levels of staff safety.

20. At national level, where there are a range of sizing options available for items like gloves, then NSS National Procurement buys and makes available a wide range, making it easier to ensure that everyone can get items that fit.

21. Some items have been found to be widely useful across our diverse workforce, and we need to make sure there is a steady supply of those – that would include, for example, FFP3 masks that can demonstrate a high "fit rate"^[16]. A contract has been agreed with a Scottish based company to support the supply of vital Type IIR masks, visors, and FFP3 masks for Scotland's health and social care until summer 2021, through our national contract PPE supplier^[17]. This partnership means we are getting FFP3 masks to a specification that aims to provide a high 'fit rate' for NHS Scotland. Our supplier is also providing teams of expert fit tester to help our hospitals introduce these new products quickly.

22. Work is also ongoing to continuously improve users' comfort, and the supply chain has been reviewed by NSS National Procurement in detail to ensure resilience through multiple equipment, location and resilient sourcing options (mostly from within Scotland/UK).

23. The use of PPE will continue to be supported by up-to-date, evidence-based guidance which will reflect lessons learned, and the Scottish Government will ensure that all policies and procedures developed as a result of this Action Plan have been appropriately assessed for their equality impact.

24. The UK Government, in its September 2020 publication PPE strategy: stabilise and build resilience^[18], also acknowledges the challenges that have been expressed by some women and BAME individuals who rely on PPE. We note that the Deputy Chief Nursing Officer for England has launched a project to gather the robust evidence and the data needed to understand any problems and take action – this is welcome, and the Scottish Government will work with the UK Government wherever possible to share relevant data gathered and ensure lessons learnt are shared.

25. We are aware that the requirement to wear masks when delivering care puts some barriers in place for communication: this is especially challenging for people who rely on reading facial expressions, and people with hearing difficulties. In order to address these communication barriers, we are working with Scottish companies to support innovation on the development of transparent masks that offer the wearer the same protection as current fluid resistant surgical masks.

Disposal and reusability

26. Disposal of PPE is part of normal clinical waste procedures, and Public Health Scotland has issued guidance on disposal of items for those caring, for example, in home settings^[19].

27. It is important to explore the potential for using more environmentally sustainable and reusable PPE, such as re-usable visors, launderable gowns and re-using sanitiser bottles whilst being mindful that its primary purpose is to control infection. NSS National Procurement have already introduced AGP Gowns which can be laundered and these are now widely available throughout hospitals. Across all PPE commodities we are actively pursuing initiatives to introduce reusable items, subject to strict clinical assessment, to reduce the environmental impact of PPE products.

28. An Innovation & Reuse Working Group is currently being established to focus on pursing opportunities for reuse and innovation, both as a demand reduction strategy and to reduce the environmental footprint of PPE use. This will be a collaborative group, which will include Scottish Enterprise, National Services Scotland, National Manufacturing Institute Scotland and the Scottish Government. There will be clinical input to ensure compliance with infection control measures as well as consultation with unions as appropriate.