Procurement of Covid ventilators 'underprepared and slow'

24 November 2020

The UK government was “underprepared and slow” when procuring critical ventilators for Covid at the start of 2020, according to the Public Accounts Committee (PAC).

A report by the PAC found the Department of Health and Social Care (DHSC) was late in its response to the shortage of mechanical ventilators and had “no plan for sourcing critical care equipment in an international emergency”.

Despite the World Health Organisation announcing the coronavirus a “public health emergency of international concern” on 30 January, the NHS did not know how many ventilators were in circulation and didn’t request the data until the end of February, according to the report.

As a result of this “unpreparedness” and a further lack of sourcing plans, the DHSC delayed the start of buying ventilators by “a crucial month”.

The report follows an inquiry by the PAC into the government's response to Covid, with a focus on the NAO’s investigation into the procurement of ventilators, which found estimated losses of £115m as speed of delivery and success was prioritised over risks and costs.

The DHSC and Cabinet Office collaborated between March and August to procure an additional 26,000 mechanical ventilators for £569m, said the PAC.

The report said estimates of the required quantity of ventilators changed “repeatedly” from initial estimates on 12 February of up to 59,000, to up to 90,000 in early March. Eventually target figures were settled on of 18,000 by 30 April and 30,000 by 30 June.

The PAC said it was “fortunate” that these weren’t needed as both targets were missed, and 30,000 ventilators were procured by August 3 instead. 

Meg Hillier, chair of the PAC, said the lack of emergency procurement plans meant the NHS’s ability to meet patients’ needs “came about much more by luck than design”.

She said: “DHSC incredibly had no plan for sourcing critical care equipment in an international emergency. It relied at first on an overseas market that was under great pressure and seeing prices increase exponentially because of the international nature of the pandemic. 

“The extraordinary collaboration, hard work – and risk taking – that led to the successes of this operation cannot cover the fact that much of it would have been unnecessary had DHSC and the NHS had a better plan for what to do to fill gaps in critical equipment in an emergency – which in the case of Covid was for ventilators.”

She highlighted that as taxpayers’ money was being used to fund Covid public procurement operations, the government must continue to learn from first responses.

The report requested that the DHSC write to the PAC within a month to show its methodology for assessing stock levels to ensure it has all the equipment required to respond effectively to the pandemic.

Due to the initial unpreparedness, the PAC has also recommended that the DHSC, NHS England, and NHS Improvement outline how future emergency plans will ensure an “adequate register of critical equipment” is kept, and data can be collated quickly. Other areas that need addressing are protocols for rapid procurement, and the need for additional capacity in NHS supply chains in case of an unexpected influx of demand.

Concerns were also raised over whether “full due diligence” was carried out across ventilator suppliers’ supply chains, and while the DHSC confirmed that ‘open source checks’ were undertaken on Chinese suppliers, the PAC was unsure to what extent these provided “sufficient assurance”. 

The PAC has asked the DHSC to outline risks of fast-tracked due diligence in emergency procurement of ventilators, how it will minimise risks and ensure audits of future procurements cover the full supply chain.

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