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Working collaboratively, NHS Shared Services and other public services overcame early challenges to provide health and care bodies with the required PPE without running out of stock at a national level.
The Welsh Government and NHS Wales Shared Services Partnership (Shared Services) procured and supplied Personal Protective Equipment (PPE) for frontline staff in very challenging circumstances. They put good arrangements in place to manage risks which helped to avoid some of the problems reported in England. However, Shared Services did not publish contract award notices for all its PPE contracts within the required 30 days of them being let.
The challenge facing the NHS and social care at the start of the pandemic was stark. The stockpile developed for a flu pandemic was inadequate for a coronavirus. Global supply chains had fragmented as countries competed for scarce supplies and some imposed export controls.
Before the pandemic, NHS Wales would typically spend around £8 million annually on PPE. During 2020-21 the total amount expected to be spent on PPE for Wales is over £300 million. While this is a big increase, we estimate the Welsh Government has received £880 million through the Barnett formula as a result of spending on PPE in England.
Public services across Wales worked in an increasingly collaborative way to understand what PPE was needed and a range of bodies were involved in sourcing PPE globally. Shared Services has taken on an expanded role in securing PPE for the wider NHS, including independent contractors in primary care (GPs, dentists, pharmacies and optometrists) and the whole social care sector, including private providers.
Shared Services had issued 630 million items of PPE as of 8 February 2021. Shared Services data shows that, nationally, stocks did not run out. Stocks of some items – visors, certain face masks and surgical gowns - fell below two days at points in April 2020. At times, Wales drew on mutual aid from other countries but ultimately gave out significantly more than it received. The health and care system is now in a much better position, with buffer stocks of most items and orders due on key items where stocks are below the current target of 24 weeks of supply.
Staff surveys by the Royal College of Nursing and British Medical Association suggest confidence in the supply of PPE grew shortly after the start of the pandemic, and there are still some concerns. While we cannot be sure how representative these views are, some frontline staff have reported experiencing shortages of PPE. In some cases, staff concerns relate to the fact that they want a higher level of PPE than required under the guidance.
Shared Services balanced the urgent need of getting PPE to frontline staff with the need to manage significant financial governance risks. These risks included dealing with new suppliers, having to make large advance payments and fraudulent and poor-quality equipment being offered. An expert financial governance group looked at riskier contracts. Unlike the position in England, our report finds no evidence of priority being given to potential suppliers depending on who referred them.
Due diligence checks could not always be carried out to the level they would outside of a pandemic due to time pressures. However, for each contract we reviewed, evidence shows key due diligence checks were undertaken.
Shared Services did not meet requirements under emergency procurement rules to publish its contract award notices within 30 days. Shared Services told us that its staff needed to prioritise sourcing PPE and that there were other administrative reasons for delays.
Recommendations in the report centre around:
Procuring and supplying PPE in these times has been far from business as usual. The challenges, risks and pressures have been higher and a huge individual and collective response has been needed.
NHS Shared Services, working with others, has responded well to develop and maintain the national stock and to supply health and care bodies. However, despite competing pressures, Shared Services should have moved more quickly to publish details about the contracts it let.
While the overall picture painted by my report is relatively positive given the difficult circumstances, we cannot ignore the views expressed by some of those on the frontline about their own experience. There are also lessons for the Welsh Government and Shared Services to learn – about preparing for a future pandemic as well as addressing some current challenges.