On February 4th last year a face mask protecting against airborne particles, known technically as an FFP2, could be obtained for 50c. Within a week, as the Covid-19 pandemic loomed larger internationally, the cost had increased by 720 per cent to €4.10 per mask.
This example is set out in a new report by consultants KPMG as the backdrop against which the Health Service Executive – supported by other parts of the Irish State – sought to secure supplies of vital protective equipment for staff in hospitals and other healthcare settings.
The HSE in normal times would spend €15 million annually on personal protective equipment (PPE). In 2020 it spent nearly €1 billion. Staff who had very limited experience at using emergency procurement arrangements suddenly had to source goods and supplies in enormous volumes, frequently from suppliers on the other side of the world they had never before dealt with while competing in a hyper-competitive market.
At the start of the pandemic, the HSE had difficulties in even trying to work out how much PPE it would need as there was little or no robust epidemiological data available to conduct detailed procurement or demand planning exercises.
Some planning scenarios, for example, suggested it would need 130 million gloves, while another indicated 30 million gloves would be required.
The report says the HSE managed to secure unprecedented levels of PPE in the first few months of last year. However, it suggests there were times when it was a close-run thing as to whether there would be sufficient stocks available.
It says there were periods at the beginning of 2020 when some requests for PPE had to be rationed to an extent based on available stock not being adequate to fully meet demand.
But while sufficient PPE was obtained and a significant new storage and distribution network established, the report suggests that on occasion traditional procurement rules were not always followed. It suggests also in some cases due diligence could not be carried out and sometimes when urgent decisions had to be taken it appeared the HSE opted for a policy of seeking forgiveness subsequently when it did not have time to look for permission in advance.
It points to the issue of face masks which were needed in unexpectedly larger numbers – more than 300 million more than previously approved – after National Public Health Emergency Team guidance was updated in April 2020.
The HSE ordered more masks on May 8th. This was retrospectively approved by the Department of Health in July.
Tensions
This type of incident, of course, forms the background to the tensions within parts of Government last year over HSE spending on PPE. In fact, it was this row that ultimately prompted Minister for Health Stephen Donnelly to write directly to HSE chairman Ciarán Devane looking for the new report on sourcing, management and usage of PPE which was sent to the Department of Health in recent days.
The Irish Times reported last December that the Department of Public Expenditure had at one point maintained the HSE had spent about €120 million on PPE over and above the amount sanctioned by the Cabinet.
Donnelly told Devane at the end of August that most of the expenditure that had already occurred or which had been committed up to that point “has not been in compliance with the agreed sanctioning process”.
The HSE said on Thursday: “Despite global shortages in medical supplies, on a scale never before experienced, our procurement team managed to ensure that our staff had a steady supply of PPE when other countries were not so fortunate.”
KPMG urges the HSE to review the sufficiency of the “emerging viral threat programme” specifically in relation to PPE procurement. It also recommends PPE for all healthcare settings should be procured centrally.
