Government “lost a crucial month” in “underprepared, slow” response to shortage of ventilators for pandemic, say MPs
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Between March and early August 2020, in response to the COVID-19
pandemic, the Department of Health and Social Care (DHSC) and
Cabinet Office secured an additional 26,000 mechanical ventilators
for use across the NHS, at a total cost of £569 million. In a
report today the Public Accounts Committee recognises this
significant achievement and the hard work, collaboration, and
commitment of individuals across both the public sector and UK
industry. But the UK Government lost...Request free trial
Between March and early August 2020, in response to the COVID-19 pandemic, the Department of Health and Social Care (DHSC) and Cabinet Office secured an additional 26,000 mechanical ventilators for use across the NHS, at a total cost of £569 million. In a report today the Public Accounts Committee recognises this significant achievement and the hard work, collaboration, and commitment of individuals across both the public sector and UK industry. But the UK Government lost a crucial month because it was “underprepared and reacted slowly” to the shortage of mechanical ventilators. There was no plan in place to source additional critical care equipment needed in the event of an emergency. NHSE&I did not know how many ventilators the NHS already had, and when it finally put out a call to individual NHS Trusts for this information in late February - a month after the World Health Organisation announced a “public health emergency of international concern” on 30 January - it found that the NHS had around 7,400 mechanical ventilators: far fewer than the 59,000 it then thought might be needed. The Department began its initial efforts to buy more ventilators on 3 March, just over a month after the emergency was announced. NHSE&I’s estimate of how many ventilators the NHS would need changed repeatedly: on 12 February initial estimates indicated a need of up to 59,000, by early March this had increased to 90,000, before reducing to 17,500 on 24 March and again to just 6,200 by 8 April. On 15 April, after the peak of COVID-19 hospitalisations, the Department set targets of 18,000 ventilators by 30 April and 30,000 by 30 June to prepare for a potential second wave. It missed both these targets but eventually reached 30,000 by 3 August. It is fortunate that the majority of the ventilators were not needed and that additional capacity is now available should it be required. However, the Committee is concerned that the Government’s targets were not effectively calibrated to need - and were not met. Even in the extreme circumstances of the emergency, there must be clear protocols in place to ensure that public money is protected, and that any exceptions or changes to procurement are justified. Despite having to operate at speed, DHSC still had a duty to carry out full due diligence for all parts of the supply chain, and it is not clear that the Government’s checks were sufficient to provide that assurance. Meg Hillier MP, Chair of Public Accounts Committee, said: “The huge success, ultimately, of ensuring that no NHS patient who needed access to a ventilator was denied it should not be downplayed. But there is a strong sense that this came about much more by luck than design, and in fact it’s clear there was no design - 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. DHSC didn’t know what equipment hospitals already had, and its estimates of need fluctuated considerably as the pandemic progressed. Those targets that were set were universally missed. “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. Every ventilator was purchased or built with taxpayers’ money and the right lessons must be taken, and applied, from this first step in the UK’s pandemic response. As treatment changes we need to be sure that the Government is learning lessons about how to react quickly to support the NHS.” PAC report conclusions and recommendations 8. The Departments lost a crucial month because they were underprepared and reacted slowly to the shortage of mechanical ventilators. The Government’s previous pandemic planning exercises aimed to help the UK prepare for pandemic influenza and did not highlight a specific need for or contain plans to increase the number of ventilators available to the NHS. The Department acknowledges that the NHS does not run with any spare capacity. Therefore, when the World Health Organisation announced a “public health emergency of international concern” on 30 January, it is perhaps no surprise there were limited spare ventilators. But crucially there was also no plan in place to source additional critical care equipment needed in the event of an emergency. This lack of preparedness was compounded by the fact that NHSE&I did not know how many ventilators the NHS already had. It did not put out a call to individual NHS Trusts for this information until late February. It then found that the NHS had around 7,400 mechanical ventilators, far fewer than the 59,000 it then thought might be needed. The Department eventually began its initial efforts to buy more ventilators on 3 March, just over a month after the emergency was announced. Recommendation: The Department of Health and Social Care and NHS England and NHS Improvement should set out how their future plans for responding to emergencies will address:
9. It is not clear how the Department of Health and Social Care is assessing whether the NHS has enough critical care equipment for future demand. NHSE&I’s estimate of how many mechanical ventilators the NHS would need in a worst-case scenario has changed repeatedly: on 12 February initial estimates indicated a need of up to 59,000, by early March this had increased to 90,000, before reducing to 17,500 on 24 March and again to just 6,200 by 8 April. On 15 April, after the peak of COVID-19 hospitalisations, the Department set targets of 18,000 ventilators by 30 April and 30,000 by 30 June to prepare for a potential second wave. It missed both these targets but eventually reached 30,000 by 3 August. It is fortunate that the majority of the ventilators were not needed and that additional capacity is now available should it be required. However, given its targets were not finely calibrated to need and the extent to which its estimates of need have varied, we are concerned that the Department has failed to set out how it now assesses the scale of future need. It told us that it no longer does ‘mathematical modelling’, but looks at the day-to-day situation. It is vital that the Department is transparent on how it assesses whether it has sufficient stocks of not only ventilators but also of any other equipment required to treat COVID-19 as the pandemic evolves. Recommendation: The Department of Health and Social Care should write to us within one month of this report explaining its current methodology for assessing whether it has all the equipment it needs to respond effectively to the pandemic. 10. Despite having to operate at speed, the Department of Health and Social Care still had a duty to carry out full due diligence for all parts of the supply chain. In early March, initial attempts by the Department to secure additional mechanical ventilators through its normal NHS supply chain routes did not produce sufficient devices to bridge the gap between the available stock and what was needed. From 13 March, alongside the ventilator challenge, the Department concentrated its efforts on purchasing ventilators directly from overseas manufacturers and distributors with the help of the Foreign & Commonwealth Office and the Department for International Trade. The Department says it did its best to confirm that sellers had CE marked ventilators available for sale and were credible organisations, but that it had not fully looked into the organisations supplying parts for the ventilators that it bought. We recognise that the Department had to operate at pace in the face of increasing global competition and the anticipated imminent spike in cases. But Departments are required by the procurement regulations to carry out due diligence on the organisations they buy from and if this is not done thoroughly, the Department puts itself at risk of funding organisations which may be involved in, for example, bribery and corruption or modern slavery. The Department did write to us one month after our evidence session to say that it had carried out ‘open source checks’ on Chinese suppliers and that it had complied with UK procurement regulations. However, it is not clear to what extent open source checks are sufficient to provide assurance over the full supply chain. Recommendations: The Department of Health & Social Care should set out in its Treasury Minute response its view of the risk resulting from the speed of its due diligence on its purchase of ventilators and how it is ensuring that its due diligence procedures for future procurements cover the full supply chain during emergency procurement. This should include how it will minimise the risk of contributing to modern slavery and meet other legal requirements. The Cabinet Office should also set out what updates it plans to make to its guidance to help departments meet this requirement during emergency procurements. 11. The ventilator challenge was an exceptional and far from traditional approach that offers some lessons for future programmes although they could not be applied wholesale under normal circumstances. The ventilator challenge was undoubtedly a significant achievement, involving a huge effort from industry across the UK. In total it produced around 15,000 mechanical ventilators in just four months – around half the number now available to the NHS, and a volume that we understand would normally take years to produce. However, when examining what government can learn from the challenge, it is crucial to keep in mind that the exceptional circumstances in which it took place were, in part, responsible for its success. For example; the clear motivating goal to potentially save thousands of lives encouraged businesses to collaborate and work at pace; and an unusually low emphasis on cost meant that the Cabinet Office could fund the development of multiple devices until it became clear whether the design was viable or was needed to meet demand. Nonetheless, there are clearly some elements of the programme which could be replicable across future government programmes. For example, the NAO pointed to the steps the Cabinet Office took to control costs and its commitment to transparency and accountability. Government’s requirement for private companies to collaborate is one example of how Government can use its spending power to improve learning and deliver cost savings and efficiencies. These lessons must be identified and shared more widely. Recommendation: As part of its treasury minute response, the Cabinet Office should work with participants to understand and ensure the right lessons from the ventilator challenge are learnt. It should publicise:
12. Both programmes succeeded in part due to cross-government working and the expertise of key individuals involved. It is clear that both programmes were successful in part due to the involvement of different government departments that were best placed to carry out specific functions, and the involvement of people with the right skills – something that is not always the case with the programmes we report on. For example, the Department for Health & Social Care was able to secure orders relatively quickly at a reasonable cost due to a significant effort from the Foreign & Commonwealth Office and the Department for International Trade in China, which had a better knowledge of the local market. Similarly, Cabinet Office used the Ministry of Defence’s Cost and Assurance Analysis Service to ensure that suppliers’ costs were reasonable. Cabinet Office also drew on external expertise where required. The government was fortunate that its Chief Commercial Officer, who led the ventilator challenge, had a background in running engineering and product development companies and was therefore well placed to develop and initiate the programme. The ‘technical design authority’, put in place to support decision making as part of the ventilator challenge, drew on the expertise of NHS clinicians, the Medical and Healthcare products Regulatory Agency and PA consulting (acting as a programme manager) in addition to other government departments including the Department for Business Energy & Industrial Strategy and the Ministry of Defence. Recommendation: The Cabinet Office should set out, as part of its Treasury Minute response, what lessons it has learnt from these programmes for how government will, in future, ensure that it identifies the skills it needs, where these skills are, and how it will get them in place quickly when a rapid response is required. 13. The ventilator challenge produced intellectual property that should be exploited to maximise value for the taxpayer. The ventilator challenge produced a number of designs in a very short space of time, even though many did not go on to be manufactured. This was in part due to the Cabinet Office’s approach of fostering collaboration between small product designers and large manufacturers. There will be potential value in the intellectual property associated with these designs. Where it paid for a manufacturer’s design work as part of the challenge, the Cabinet Office tells us that it will get a royalty if in future a manufacturer uses the design to take a unit to market. However, this currently relies on the goodwill of manufacturers to inform the Cabinet Office that they have used the design, as there is no plan or mechanism in place for it to monitor whether this occurs. Recommendation: The Cabinet Office should set out, as part of its Treasury Minute response, how it plans to maximise the value to the taxpayer from the intellectual property created through the ventilator challenge. This should include how it plans to:
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