Throughout the coronavirus outbreak, there has been considerable – and widely reported – concern in the UK and worldwide regarding securing adequate and continuous supplies of Personal Protective Equipment (PPE). This article will look at the guidance around PPE, some of the challenges in getting access to sufficient PPE and what’s being done in response.
What is Personal protective equipment (PPE)?
PPE is designed to help protect an individual against health or safety risks at work and prevent the spread of infection. In health and social care settings, PPE includes a wide range of items, including protection for eyes and face, gloves, aprons and gowns, and respiratory protective equipment, such as masks or face shields. Different types of PPE are used, according to the level of risk, the setting or the procedure being carried out. It’s essential in ensuring a safe environment for the care of people with coronavirus and avoiding infection for those giving and receiving care.
Guidance on PPE
Core guidance on the correct use and types of PPE has been agreed jointly between all four UK nations. This also covers how long PPE should be used for and when it should be replaced. The First Minister confirmed in Plenary on 22 April 2020 his commitment to ‘observing and implementing’ this UK guidance. There is also more detailed advice on the use of PPE for individual settings: hospital, primary care, community and social care settings, and for paramedics, as well for non-healthcare settings such as businesses, prisons, ports and for funeral directors.
The core guidance has been updated in response to new issues emerging from the coronavirus outbreak. This includes the need for enhanced protection of patients in vulnerable groups undergoing shielding, but also guidance on the re-usability and extended use of some PPE items. The Welsh Government has stated that there is currently no need to re-use PPE in Wales, and the World Health Organisation has also published guidance on this issue. This outlines the situations in which it is inappropriate and appropriate to re-use PPE.
How is PPE distributed?
In Wales, the distribution of PPE is co-ordinated by NHS Wales Shared Services Partnership, working with the Joint Equipment Stores that service local authorities. The Welsh Government has also set up a webpage where health and social care organisations can request PPE.
What are the concerns?
The major concerns raised during the pandemic are about getting the right PPE supplied quickly enough. However, the supply of PPE can vary considerably across the UK, with different local pressure points; as health is devolved, Wales shares some UK-wide procurement , but also has its own approaches.
In England, NHS Providers have expressed concern about the shortage of a sustainable supply of protective gowns. A British Medical Association survey of its UK members reported that large numbers of doctors were expected to care for coronavirus patients with little or no PPE, with supply of gowns and eye protection as particular problems. A Royal College of Nursing survey, including around 900 members in Wales, reports that over half of those responding were being asked to work without the right PPE or to reuse single-use items. The Royal College of Anaesthetists has expressed concerns about PPE shortages, although it is unclear whether this is England-only. A survey of members of the Royal College of Physicians – the majority from England - reports that 26.5% were unable to access the PPE they needed.
Looking at social care providers, Wales TUC and BMA Cymru have stated that reliance on existing suppliers could lead to inconsistencies in the provision of PPE, and Unison Cymru Wales have reported their anxiety around what they term ‘the patchy provision of PPE in the care sector’. The Wales Carers Alliance have identified concerns arising from difficulties in accessing PPE for care workers and unpaid carers.
The Welsh NHS Confederation have welcomed the reassurance that in Wales PPE is available to everyone who needs it, but also noted that PPE should remain Welsh Governments’ main priority.
In a briefing on 21 April, the Minister for Health and Social Services stated that Welsh Government had "very real concerns" about the issue, and that although Wales had:
…enough of stocks of all items to last for a few days, partly because of the mutual aid we received from other UK countries, partly because of the UK supplies that have come in that we've got our population share from…we're not in a position to say that we have weeks and weeks of advanced stock on all of those items.
The Minister reported similarly to Plenary on 22 April that Welsh Government was working on a Wales and UK basis to secure robust supply arrangements, but that ‘the worldwide demand for PPE is creating an insecure and unpredictable market’.
In the Assembly’s Health, Social Care and Sport Committee on 30 April the Minister stressed that though there was enough PPE within the system, demand was likely to remain well above normal, and it was his ‘number one anxiety about keeping staff safe’.
How much PPE is needed?
The WHO have reported an acute worldwide shortage of supplies and ‘surging global demand’, with estimates indicating that 89 million medical masks, 76 million examination gloves and 1.6 million medical goggles are required for the coronavirus response each month, with significant increases needed in stockpiling and manufacturing. On 22 April the Minister reported (para.84) that some 48.3 million PPE items had been issued to healthcare staff and local authorities in Wales alone since 9 March.
Manufacturing and supplying PPE
Research for the Asian Development Bank reports that coronavirus has exposed the vulnerabilities of supply chains across many industries, including PPE. China is the major producer of PPE in the global trade network, and has experienced supply disruptions.
Wales and the UK have traditionally relied strongly on supplies from China and other Asian countries The Welsh Government has noted that it is not relying simply on established links, but taking a multi-pronged approach to ensuring sustainable PPE supplies, including:
- Working with other UK nations to pool procurement efforts, bring in new stocks and offer mutual aid in providing PPE;
- Procuring additional PPE supplies using the Welsh National Procurement Service;
- Continued international supplies, including masks from China and gowns from Cambodia;
- Increased working with Welsh businesses through innovation and new manufacturing routes, to produce PPE including faceshields and scrubs, with Wales approaching self-sufficiency in the latter.
This last strand may be an important outcome of the outbreak; the governments of both Wales and Scotland have indicated that there is a strong value in developing such self-sufficiency, which can have a positive impact on their respective economies. Welsh Government’s Deputy Minister for Economy and Transport has commented:
There are few positive stories as a result of this pandemic but bringing back overseas jobs producing critical medical equipment and anchoring them into our Welsh economy is most certainly one.
Article by Dr Paul Worthington, Senedd Research, National Assembly for Wales
We’ve published a range of material on the coronavirus pandemic, including a post setting out the help and guidance available for people in Wales and a timeline of Welsh and UK governments’ response.
You can see all our coronavirus-related publications by clicking here. All are updated regularly.
