Last week, it was announced that the government is facing a high court legal challenge for refusing to launch an urgent inquiry into the failures to provide enough PPE to keep frontline health and care workers safe.
While I’m not in the position to say that the government ought to face legal action, I believe it is vital that lessons are learned from its response to the pandemic.
The government must ensure that care providers are never again faced with the impossible decision of cancelling visits to vulnerable people due to a lack of available protective equipment.
When will the message finally get through that if vulnerable people in our communities are left without care, the entire health system will collapse?
Failings in the supply chain
At the peak of the crisis, every home care provider in the country was struggling to get hold of adequate volumes of PPE to be confident that they could continue to provide care across just a few weeks and, in some cases, days.
But the national supply chain simply wasn’t built to cope in a crisis situation and providers have been left to rely on private suppliers, many of which are still hiking their prices up to extortionate levels or diverting their stock to the NHS.
One of the country’s biggest domiciliary care providers, City and County Healthcare, compared the feeling of having dangerously low levels of PPE stock to “being in a lifeboat, waiting to be rescued”.
“We had one person spend two hours with the designated wholesalers in the government supply chain yesterday and managed to acquire 1,000 aprons. We do 60,000 community visits a day,” the provider’s CEO James Thorburn said in April.
He explained that the company was having to reserve its PPE stock for higher-risk cases.
“If we use it up now in lower-risk scenarios, as some local authorities have asked us to do, what’s going to happen is we will run out and that will stop care, creating much more harm,” Thorburn said.
Weathering the storm alone
With little government support, care providers were left to weather the storm alone, some even resorting to crowdfunding to cover PPE costs and turning to local schools, engineers and seamstresses to produce masks and visors.
The government opened up a PPE portal to small providers last month, but those who have been invited to register with the service have been told it should only be used as an emergency top-up system.
Even when the portal has been used, care businesses have been left disappointed by the speed of the service and the number of items delivered to meet demand.
The Department of Health and Social Care states in its guidance that providers can order one combined pack, containing 100 IIR masks, 400 aprons and 800 gloves (400 pairs), per week.
But one Oxfordshire-based provider that carries out 1,500 care visits per week told HCI that it was supplied with only 50 masks, 100 pairs of gloves and 200 aprons.
Colin Webb, managing director of St Katherine’s Care, based in Lincolnshire, also explained how his company has been left to its own devices. Speaking two weeks ago, he said: “Our carers have been fabulous in sticking to the rules and we have kept them supplied with whatever they have needed, but at a very significant cost to the company. We did get, in mid-March, a delivery of 300 masks from our local authority, but that’s the extent to which we have had help in this direction.
“Neither have we relied on any organisation to help us source PPE – our experience has been a little patchy, if we’re honest. Even the new NHS web site, the PPE portal, has not covered itself in glory – I registered first thing this morning and have not yet had the email to verify and confirm my registration.”
In some cases, councils have stepped up to deliver PPE supplies to providers in their area, free of charge, but even they have warned that shortages of equipment remain an ongoing concern.
Lack of clear guidance
A lack of clear and consistent guidance on the correct use of PPE has also been an issue.
The United Kingdom Homecare Association, which represents which more than 2,000 care providers, condemned the government in April for an “intolerable delay” in releasing guidance that takes the needs of home care provision into account.
Revised guidance was finally published on April 28, and though this was an improvement on documents previously published, UKHCA warned that there was still a “massive gap” between the supply of PPE and the expectations set out in the guidance.
The government is working to secure new PPE contracts with suppliers from around the world and has ramped up domestic production in recent weeks. It has also temporarily scrapped tax on PPE purchased by care providers, businesses and charities, which has helped alleviate pressures.
But the crisis isn’t over yet, and there are still underlying issues around the national supply chain structure that need addressing. Meanwhile, PPE costs continue to rise, putting long-term pressure on provider’s finances and fuelling concerns about mass insolvencies in the sector.
Vulnerable people are also continuing to cancel their care visits out of fear they will catch coronavirus because they believe their carers don’t have the appropriate PPE. Such cancellations may have cost lives.
As leaders in the sector have said time and time again, the government must commit to additional funding, over and above what it has already committed, to support care providers’ response to the pandemic.
But it must also learn from the impact that limited supplies of PPE has had on care providers if they have any hope of navigating a second wave, saving lives and protecting the NHS.