COVID-19: Health service here faced PPE shortages in early days of pandemic

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Northern Ireland’s health service faced shortages of PPE equipment for workers throughout the early days of the Covid pandemic, a new audit office report has found.

The report by auditor general Kieran Donnelly said that there was less than one week’s supply of most items available throughout most of March 2020.

He said that work is required to improve demand modelling and develop responsive and flexible supply chains for the future.

The early days of the pandemic in 2020 brought a huge increase in demand for sourcing and procuring PPE equipment, vital in helping control the spread of infections in health and social care settings.

The report stated: “Overall demand for PPE increased sharply, rising by 429% in comparison to 2019.

“The need for specific items also spiked by between 3,700% and 16,500% for items only previously used on a limited basis.

“At the same time, intense global demand meant supplies became very limited.”

In Northern Ireland, equipment for the health and social care (HSC) sector was purchased by the Business Services Organisation’s Procurement and Logistics Service (BSO PaLS), an arm’s length body of the Department of Health.

The auditor’s report said that while individual independent care sector (ICS) providers bought their own PPE before the pandemic, extreme difficulties in securing equipment meant that the sector has been supplied with PPE free of charge through BSO PALS from mid-April 2020.

Nearly £400 million of PPE was purchased by BSO PaLS between January 2020 and April 2021, compared with £3 million spent in 2019.

The report stated: “The early stages of the pandemic saw a dramatic rise in demand for core PPE, the total number of items required each month by the HSC and ICS sectors increased by 429%, from the 6.3 million items used by HSC providers in 2019 to 33 million items between March 2020 and May 2021.

“Faced with hugely increased demand and supply constraints, BSO PaLS initially struggled to build sustainable PPE stocks.

“Its existing contracts proved incapable of providing reliable supplies, and it held less than one week’s supply of most items throughout most of March 2020.”

The report highlights “clear evidence of PPE shortages across the HSC sector and ICS nursing and residential homes well into April 2020, particularly for FFP3 (respirator) masks”.

It stated: “As supply pressures eased, the total number of core PPE items delivered to healthcare providers increased, from 17 million in March 2020, to an average of 32 million items every four weeks between late April 2020 and May 2021.”

The report said that supplies amongst ICS providers improved significantly following the department of health’s mid-April 2020 decision to routinely provide them with PPE free of charge.

But it added that that the Royal College of Nursing and Independent Health & Care Providers (IHCP) considered improvements “were only secured after extensive lobbying, and, according to IHCP, only after Covid-19 cases began escalating in care homes”.

Similar to the rest of the UK, procurement of PPE in Northern Ireland involved the use of Direct Award Contracts (DACs, contracts let without competition) to purchase items.

The report said that, by April 2021, £371 million of PPE was purchased using through DACs.

It added that the HSC sector also incurred very high costs early in the pandemic, with average pre-Covid prices increasing by 957% for gowns, and 1,314% for Type IIR masks.

The report said that despite referring 60 high cost cases to the Competition and Markets Authority in May 2020, BSO PaLS bought £127 million of PPE from these suppliers to secure urgently needed equipment.

It said that BSO PaLS stated that no potential offers were “fast-tracked”, and all had to pass quality and specification assessments prior to purchase.

Mr Donnelly said: “This report reflects and recognises the enormous challenges facing the health service, particularly at the outset of the Covid-19 pandemic.

“As the need for PPE was rising dramatically, so was global demand and the health sector here was under immense pressure to identify new sources and secure orders.

“Although there were clearly initial supply shortages, over 2,000 potential leads were investigated, and 45 new suppliers engaged between January 2020 and April 2021, from whom over 600 million core PPE items have been ordered.

“It is clear that the unprecedented response to Covid-19 has extended to all parts of our health service, including those working in procurement, and I would like to pay tribute to their efforts.”

He added: “At the same time, it is important that the lessons identified in my report are also learned.

“In addition to the need for improved contingency and emergency planning to avoid a repetition of any supply shortages, there should have been less reliance on uncompetitive procurement processes, better controls for managing potential conflicts of interest, and more comprehensive documenting of decisions over high-cost procurements.

“It is also important that there is greater clarity over longer-term procurement and funding arrangements for PPE provision to the independent care sector.”

A spokesperson from the Department of Health said: “The department welcomes today’s report from the Northern Ireland Audit Office, highlighting the enormous challenges that faced the health service at the outset of the Covid-19 pandemic.

“Today’s Audit Office report details the scale of the work by the Business Services Organisation’s Procurement and Logistics Service in securing PPE supplies for Northern Ireland’s health and social care system.

“The department welcomes the tribute from the Comptroller and Auditor General to the efforts of those working on PPE procurement in the pandemic.”

Northern Ireland’s health service faced shortages of PPE equipment for workers throughout the early days of the Covid pandemic, a new audit office report has found