Interesting thread from Chris Hopson, CEO of the organisation which represents NHS Trusts, who explains why it is now clear that some trusts will run out of gowns.
First published in April 2020.
NHS Providers are not the government or NHS England, we are the voice of frontline trusts.
Why is the NHS running out of gowns? The greatest risk of running out of stock in a pandemic is usually if the pandemic stock reserve runs out before the items ordered once the pandemic started begin to arrive consistently and reliably. This is what has happened with gowns.
National leaders tell us that, at the moment, and with the exception of visors, gowns are the only item in the pandemic stock reserve that they are concerned will run out in this way. Aprons, fluid repellent masks, gloves, FFP2/3 masks, etc. currently look fine.
Our dialogue with national leaders, and the views of the trust CEOs working alongside those leaders, is that no stone has been left unturned since the pandemic started to secure the right stocks of gowns but for the reasons set out in this Guardian article – the gowns that were ordered weeks ago and should have already arrived are currently only arriving in fits and starts.
Is protective equipment getting to NHS staff on the coronavirus frontline? Here’s the truth. / The Guardian
What has been done to solve the growing shortage of gowns? National and local NHS leaders have worked well together in a six-part approach:
1. Carefully allocate remaining stock to trusts most in danger of running out;
2. Trusts carefully manage stocks;
3. Mutual aid – trusts with a bit of stock to spare helping their neighbours;
4. Get fantastic support from police, fire, vets, local councils who’ve provided their stock;
5. Use coveralls (gowns with hoods);
6. Do everything possible to get new stock, e.g. emergency last minute deals and asking other near neighbouring countries for help. National leaders say latter shows we have been in better position than others.
For context, the WHO recommends that gowns should be worn at all times when dealing with Covid 19 patients for all medical staff, cleaners and visitors. pic.twitter.com/TGbDhnLoky— Lewis Goodall (@lewis_goodall) April 17, 2020
The first five steps have worked well for the last week but we have now reached the point where national stock of fully fluid repellent gowns and coveralls exhausted. So some trusts will run out of this type of gown/coverall in the next 24-48 hours.
Trust leaders and NHS Providers asked national leaders, on several phone call meetings last week, to prepare a clear public plan should a trust run out of gowns so everyone knew what was happening and what next steps would be, especially frontline staff...
No-one wants to be in this position and has done everything to avoid it. But much better to have a public plan than pretend the problem doesn’t exist or ignore it. National leaders developed this plan at pace and effectively.
Trusts will continue to try and follow the six-step in approach outlined above. But if they run out of gowns they will then follow the agreed plan. This is best summarised as “provide the highest level of protection possible with the equipment available.”
For example the new guidance published tonight says to use “disposable, non-fluid repellent gowns or coveralls with a disposable plastic apron for high-risk settings and aerosol generating procedures (AGP) with forearm washing once gown or coverall removed.”
Considerations for acute PPEpersonal protective equipment (PPE) shortages, 17 April 2020. / Gov.uk
This is clearly not ideal but it is the best available option given the circumstances. National leaders tell us that a number of other European nations have had to do the same given the global shortages of gowns. Hopefully this temporary supply disruption will be short-lived.
In the meantime, trust leaders will do everything they can to ensure every member of frontline staff has the highest possible level of protection equipment, where such equipment is required.
An obvious question for any Coronavirus public inquiry is why there were insufficient stocks of gowns (and visors) in national reserve. We understand this is connected to what type of pandemic (e.g. winter flu vs Coronavirus type pandemic) reserve was configured for.
Tweets posted on 17 April 2020 by @ChrisCEOHopson.