A lack of “clinical engagement” in procurement decisions during the early months of the Covid-19 pandemic contributed to staff being given equipment that was “not fit for purpose”, the UK Covid-19 inquiry has been told.
Professional lead for infection prevention and control at the Royal College of Nursing (RCN), Rose Gallagher, told the inquiry yesterday that it was “imperative” for frontline clinical staff to be involved in decision making around procurement of personal protective equipment (PPE) during any future pandemics.
“It was actually really upsetting for those nurses and for us to find that the clinical voice was completely absent”
Rose Gallagher
“In a future incident it is absolutely imperative that frontline healthcare workers are involved,” Ms Gallagher said, who was giving evidence to module 5 of the UK Covid-19 Inquiry, which is covering procurement.
“Those people who use PPE, who have received education in its use about donning and doffing – it’s absolutely critical that they are involved in decisions about what is bought,” she said.
Ms Gallagher said a lack of involvement of specialist procurement nurses in PPE procurement early in the pandemic contributed to frontline staff being given PPE that was “not fit for purpose”.
She told the inquiry that through its call centre and online platform the RCN received more than 3,500 queries related to PPE in March of 2020.
The RCN heard from nurses about faulty PPE, including out of date masks where the material had degraded so much that nurses wearing them were inhaling loose fibres, leading to incidents of respiratory irritation.
They also heard many nurses report concerns over not being able to access FFP3 respirator masks that they had been fit-tested for.
One nurse told the RCN: “So far, we have had four different types of mask from two different manufacturers. None have been clinically acceptable. They simply do not fit.
“I’m aware that contracts have already been signed to purchase. When I fed back to the cabinet office that they don’t fit, I was told any mask was better than nothing.”
Ms Gallagher contacted NHS England in July 2020, flagging concerns that the team responsible for procurement of PPE did not include any clinicians, in particular specialist procurement nurses.
“I became aware of this towards the end of June 2020 and immediately raised it on behalf of specialist procurement nurses because we knew the value that nurses could bring to the selection of products,” Ms Gallagher said.
“It was actually really upsetting for those nurses and for us to find that the clinical voice was completely absent,” she said.
“This reflects people’s belief that the guidance was not fit for purpose”
Danny Mortimer
Ms Gallagher said that specialist procurement nurses were well-placed to make good decisions around which products the NHS should buy.
“These nurses are not only expert in how products are used, but they also know how clinical practices change and adapt over time,” she said.
“During the pandemic, to have these items of PPE delivered to their trust that were clearly not fit for purpose, to see the huge amount of waste that occurred as a result of that was actually really distressing to nurses.
“They knew that if they had been involved at an earlier stage in assessing products that were coming to the UK, they may have been able to avoid a lot of that waste.”
Ms Gallagher also told the inquiry about the shortages of PPE that frontline staff experienced in April and May 2020, revealed by two surveys of RCN members.
The April survey found a “significant number of members” who reported being asked to re-use what had been designated as single-use PPE
“To be asked to re-use single-use PPE, which was there for their protection, was a significant cause of concern,” she said.
In May some improvements in the PPE supply had been noted, but more than a third of respondents to the RCN survey felt pressure to care for individuals with possible or confirmed Covid-19 without adequate protection.
And 56% of respondents from minority ethnic backgrounds felt pressure to work without the correct PPE, Ms Gallagher told the inquiry.
“Staff were so concerned around what they perceived as a lack of PPE, predominantly masks,” she said.
“They knew that they would have to remove all their PPE to go to the toilet, or to take breaks, so they actually put off going to the toilet because they were so concerned that they would deplete the stocks, or that their colleagues coming into the next shift might not have enough PPE.
“The considerations around how much PPE you use, for a shift, not just on paper but actually in real-life, on and off constantly during the day, they felt that was just not taken into account.”
Ms Gallagher added that many RCN members felt that the supply of PPE was being determined by Infection Prevention and Control (IPC) guidance instead of the needs of nurses on the frontline.
Danny Mortimer
Deputy chief executive of the NHS Confederation, Danny Mortimer, also told the inquiry about staff facing an inadequate availability of PPE throughout 2020.
Mr Mortimer told the inquiry that 83% of respondents to a survey of GPs in early 2020 reported that they didn’t have proper access to masks with a filter, which he said showed that demand for those masks was higher than the guidance suggested.
And 73% reported a lack of adequate access to goggles and visors.
“This reflects people’s belief that the guidance was not fit for purpose and that they were having to set higher standards for themselves and their colleagues,” Mr Mortimer said.
He said that in the early months of the pandemic there was a “profound sense of anxiety” in NHS trust leaders about the overall availability of PPE, but also about the availability of equipment that was most appropriate.
“There was a lack of confidence in the supply, but also the guidance,” he said.
Read more from the UK Covid-19 Inquiry
