Doctors and nurses treating Covid-19 patients face shortages of protective full-length gowns for weeks to come, it has emerged, as anger builds over the failure to stockpile the garments.
Critical shortages of the gowns have meant that some trusts have already had to make do with the best available alternatives as a result of the shortages, which forced a sudden change in Public Health England (PHE) guidelines on the use of gowns on Friday. Concerns are being raised within the NHS over why the gowns did not form part of the government’s pandemic stockpile.
It is understood shortages are already forcing some NHS workers to use the controversial new guidelines, which tell them to wear a plastic apron with coveralls should the specialist fluid-repellent gowns run out. Workers are also advised to reuse washed aprons.
Meanwhile, surgeons are being told by senior colleagues not to put themselves at risk should they be unable to wear a protective gown. Professor Neil Mortensen, from the Royal College of Surgeons of England, said surgeons should not risk their health if fluid-repellent gowns or coveralls could not be used. “We are deeply disturbed by this latest change to personal protective equipment (PPE) guidance, which was issued without consulting expert medical bodies,” he said. “After weeks of working with PHE and our sister medical royal colleges to get PPE guidance right, this risks confusion and variation in practice across the country.”
Health unions warned that staff could begin to refuse to work if they felt the new guidelines put them at serious risk of contracting the coronavirus. Sara Gorton, Unison’s head of health, said: “Managers must be truly honest with health workers and their union reps over the weekend. If gowns run out, staff in high-risk areas may well decide that it’s no longer safe for them to work.”
Last night, the British Medical Association (BMA) also warned that it would support doctors who refused to work with inadequate PPE.
“There are limits to the level of risk staff can be expected to expose themselves and their patients to,” said Dr Chaand Nagpaul, BMA council chair. “In the most extreme circumstances, if adequate protective measures are not in place, doctors can refuse to put themselves at risk of becoming infected, and inform their management to make alternative arrangements, and the BMA will robustly support its members who have to make this weighty decision.”
Niall Dickson, chief executive of the NHS Confederation, which represents various service providers within the NHS, said: “Once the weekend is over, you still have the same problem. It is not just hand to mouth in the hospitals. It is hand to mouth at the national level. Although we may get through this weekend, there may well be problems over the next few weeks.”
The anger over the revised safety advice comes after weeks of wrangling and delays over PPE for both NHS and care workers. Ministers have repeatedly attempted to grip the issue, but have been hampered by a global shortage and bottlenecks, with equipment ordered weeks ago still not arriving in full.
The government will attempt to gain control of the mounting PPE concerns by appointing Paul Deighton, the former chief executive of the London Olympics organising committee, to lead efforts to produce PPE for frontline health and social care staff in Britain. A military flight was also understood to be bringing in 84 tonnes of PPE equipment from Turkey, though it was unclear what the shipment contained.
The GMB union, which represents some NHS and ambulance staff, said trust in health secretary Matt Hancock was “draining away” after the decision to change official guidance. It also questioned the government’s assertion that the guidance was in line with the World Health Organization’s recommendations.
Saffron Cordery, the deputy chief executive of NHS Providers, which represents hospitals trusts, said the situation was now “critical and this is an extremely worrying situation”. She added: “We all hope that this temporary disruption to supply will be short-lived and that the gowns that were ordered a long time ago, and should have already arrived, start arriving consistently and reliably rather than in the current fits and starts.”
Government sources said that everything was being done to ensure PPE supplies were flowing, adding that there is huge global demand. They added that the government’s stockpiles were designed to tackle a flu pandemic and that the specific requirements of treating Covid-19 – a new virus – could not have been predicted. A spokesperson said the new guidance had been reviewed by the Health and Safety Executive and was in line with the WHO. They said the guidelines would only be needed “in exceptional circumstances”.
PPE issues also persist in the social care sector. Ministers have now put in place new plans to boost testing and PPE for care workers, but some care providers said their staff had been told to make trips of up to 90 miles to the nearest testing centre – practically impossible for those without a car. Some workers in Workington were directed to Gateshead, some in Scarborough to Leeds, and some in Bath to Worcester.
Meanwhile, some care home providers have already had to pay five times the normal costs for crucial PPE after being forced to seek private supplies. Sam Monaghan, chief executive of care provider MHA, said concerns were raised more than a month ago. “I’ve got a team dedicated to sourcing PPE, because the government stockpile has not been sufficient or consistent. This week, I had to make a decision on masks. They should’ve been 20p each. They were £1 each.”
A spokesman for the Department of Health and Social Care said that new plans were in place for supplying social care providers with PPE, managed through local groups. They said: “Every death from this virus is a tragedy and that is why we are working around the clock to give the social care sector the equipment and support they need to tackle this global pandemic.”
