Doctors were left inadequately protected from COVID-19 owing to the lack of a proper procurement and distribution plan for PPE (personal protective equipment), the fifth report of the UK COVID-19 Inquiry concludes.

The ‘perilous’ state of the UK’s pre-pandemic PPE stockpile, combined with the absence of effective or scalable plans for sourcing and deploying equipment, meant healthcare staff were unable to protect themselves and their patients properly.

The findings come as the UK COVID-19 Inquiry today published its fifth report into the national response to the pandemic, with specific focus given to the role of procurement.

Citing multiple failures in planning and preparation, the report highlights the UK’s PPE stockpile was not ‘subject to an adequate system of management and oversight’, with the country entering the pandemic with shortages of PPE or with equipment either inadequate or expired.

It further adds organisations responsible for emergency procurement and distribution of protective equipment ‘were not ready for a pandemic’ and structures subsequently established by the Government proved ‘unduly complex, inefficient and unable to cope’.

The report also criticises the then UK government for its overreliance on using just-in-time contracts in an effort to source increasing amounts of PPE, at a time when surging demand around the world led to collapse in global supply chains.

In her introduction to the fifth report, inquiry chair Baroness Hallett said the rapid escalation of the pandemic had forced governments around the world into a scramble to obtain equipment to protect their populations and healthcare workforces.

She added, by entering the pandemic with a poorly maintained stockpile and subsequently failing to possess or implement procurement and distribution systems meant doctors and other healthcare staff faced shortages or were forced to use poor-quality and badly fitted PPE.

She said: ‘The stockpile of PPE and other equipment for the UK was inadequate to meet demand, and contracts held by the UK government to replenish stock failed, leaving the hospitals, care homes and GP surgeries that principally made up the health and social care sectors vulnerable to shortages.

‘The UK Government and devolved administrations were wholly unprepared to increase rapidly the scale and speed of their emergency procurement and distribution operations. As a result of this failure of planning, they had to improvise and establish new – and, until then, untested – emergency procurement and distribution systems.’

She added: ‘When confronted with the fundamental problems of which and how much equipment to buy, at what prices, and how it should be distributed, ministers and officials were not equipped with either the plans or infrastructure to enable them to respond with sufficient speed and efficiency.’

With the UK struggling to meet the rapidly surging demand for PPE during the early months of the pandemic, the report notes the then Government sought to expand opportunities for sourcing equipment by inviting the public and business sectors to contribute to supplies.

It warns by taking this untargeted approach, existing procurement systems were unable to cope with the sudden influx of offers for the provision of PPE, leading to the Government’s creation of the so-called VIP or ‘High Priority Lane’. Describing this VIP lane as ‘a misguided attempt to give priority to the most credible offers’, Baroness Hallett said it ultimately worsened efforts to obtain safe and effective protective equipment for frontline health service staff and it should not have been established.

She added, while the inquiry had found no evidence of corruption in the awarding of PPE contracts via the VIP lane, there were clear examples of ‘favourable treatment’ being given.

‘This [VIP lane] has undermined both the enormous efforts made by procurement officials to get PPE and vital medical equipment to where they were needed and trust in government procurement. Had there been more properly trained procurement staff and better technology, this could have been avoided.’

Along with poor quality or expired PPE, the report also notes concerns previously highlighted by the BMA that there had been inadequate efforts to fit test protective equipment or ensure PPE reflected the diverse needs of health service staff.

The report finds, while the Department of Health had been warned of the need to implement a rolling programme of fit testing for staff in advance of a future pandemic as far back as 2016, the Government or Public Health England had ultimately failed to take steps to ensure ‘the physical characteristics of the health and social care workforce’ were taken into account when stockpiling PPE.

Responding to the publication of today’s report, deputy chair of BMA council Emma Runswick said the ‘multiple failures and missed opportunities’ around procurement ultimately left doctors unprotected and patients exposed during the pandemic.

She said: ‘While the then prime minister [Boris Johnson] said he would do “whatever it takes” to secure PPE supplies once COVID-19 arrived, the reality is that what it actually takes to protect both staff and patients is to be prepared in the first place.

‘As the report describes in detail, the pre-pandemic PPE stockpile was far too small, much of it was reaching its use-by date and deteriorating, and there were no plans for how both procurement and distribution would work in a crisis on the scale of COVID-19.

‘This cost valuable time, resources and ultimately lives, once the pandemic was here. Tragedy on the scale we saw was avoidable.

‘What we saw unfold was an omnishambles; a scramble in procurement, supply and distribution, resulting in chaotic and slapdash approaches to try to get PPE to those who needed it.

‘Yet we know they often didn’t receive it. Time and time again, from the beginning of the pandemic, and right through the multiple waves of 2020, doctors and our colleagues were left without the PPE needed to protect them and their patients from a fatal disease.

‘This impact was uneven, with women and ethnic minority doctors either unable to access suitable fitting PPE, or indeed, facing greater pressure to work without proper protection. It is good therefore to see a recommendation from Baroness Hallet that PPE supplies must take into account the diversity of the health and social care workforce.’

Dr Runswick added that, while today’s report had accurately identified many of the failings that had already been cited by organisations such as the BMA, it was vital lessons and recommendations from Baroness Hallett’s findings be heeded in advance of the next global health crisis.

She said: ‘A new pandemic, as well as wider global risks in an increasingly hostile world, remain very real threats to our healthcare systems and the safety of our population. Yet we remain unprepared – both in terms of supplies like PPE but also in the state of the very buildings we work in, the facilities to provide critical care, and the staffing capacity we have to treat people.

‘Preparing for the next crisis is not a problem that can wait.’

While largely focusing on the logistics of the procurement processes used during the pandemic, the fifth module report also brought in the voices of doctors and other health professionals who were on the frontlines of the response to COVID-19.

These accounts, including one from GP partner and BMA member David Bailey, highlighted the effects on humans of the failings in PPE procurement and distribution, with Dr Bailey telling the inquiry how a shortage of protection had forced doctors and patients to devise makeshift PPE.

He said: ‘Early on, scrubs were not provided by the local health board, and ours were made by patients. We are a community practice covering approximately 14,000 residents across three villages, and the community came together making scrubs for us and homemade visors for eye protection.’

The report also highlights the words of NHS Nottingham and Nottinghamshire Integrated Care Board chief executive Amanda Sullivan, who recalled how doctors were forced to purchase their own PPE after the health service failed to supply them.

She said: ‘There were points during the early phases of the pandemic when CCG [clinical commissioning group] staff would be placing orders for gowns on Amazon. Senior staff would do this on their own credit cards and then claim back the money from the NHS COVID fund.

‘These online orders were hugely expensive. However, we were scrambling to plug the gap that [the] NHS Supply Chain and national pandemic stocks could not fill.’

In highlighting the shortcomings and failures of the UK’s procurement systems in the response to COVID-19, the report makes a total of 11 recommendations, which it concludes would leave the country far better placed and prepared in the event of a future pandemic.

To read the report in full, visit the COVID-19 Inquiry website