23 April 2020

The PPE supply chain isn’t working – it’s time to send in the Generals

By

The Government is currently on the rack over its apparent inability to provide personal protective equipment for all who need it on the front line of the pandemic. Junior ministers heaped on the airwaves like sandbags of impermeable rhetoric are unequal to the task of defending this position.

On Tuesday morning, Local Government Minister Simon Clarke was asked on Radio 4s Today programme when he expected a much-heralded consignment of PPE to arrive from Turkey. His answer, that the RAF had gone to get it but he had no idea when or possibly if it would all ever arrive here, encapsulates the PPE problem: In many hospitals, care homes, GPs surgeries, prisons, it is always winter and never Christmas. 

Quite why we are reliant on other countries to fabricate hospital gowns, face visors, gloves and aprons from (admittedly complicated) bits of plastic and cloth is a question that is never properly answered. The list of essential PPE runs to less than half a dozen items.  We’ve now got some of the Turkish consignment, but the unravelling story of their procurement is a masterclass in bureaucratic obfuscation and confusion. If you’re looking for more surreal in this mess, we’ve still got some spare.

At the same time as Mr Clarke was promising foreign jam tomorrow on Radio 4, the Daily Telegraph revealed that our domestic manufacturers, fed up with no response from central government on their willingness and ability to provide the stuff, were now exporting it to EU countries. You could make this up, but you’d have to be drunk.

Even if partially true, it’s simply not good enough for public bodies or ministers to imply the reasons for shortage are partly due to improper use or lack of recycling. We need those caring for us to feel psychologically as well as scientifically protected from this virus. That might mean that there is an element of wastage in use that can’t be avoided and ought to be priced into PPE sourcing and distribution. 

Morale is just as critical in these extraordinary times as the ever-changing PPE guidance from Public Health England. Research is showing that working at close range with infected patients in care homes or hospitals who heavily shed the virus almost certainly exposes workers to worse illness and higher mortality than infections acquired in the community. If these people refuse to work in environments they perceive to be unsafe for lack of the right equipment, we are sunk.

The Government has performed late but well on the national lockdown and has done wonders on creating critical care capacity from a standing start in the newly created Nightingale hospitals. Quite apart from the facile arguments over joining EU schemes that haven’t delivered any of these machines anywhere, it also looks like we have finally created a domestic supply chain for ventilators with skill and ingenuity. Capacity is being maintained in our hospitals. We don’t have food shortages. We are starting to see an improving picture on mortality and hospitalisations.

Some key things Government is doing are working, much to the chagrin of social media conspiracists anxious to convince us that it doesn’t care about the very demographic that helped return them to power and consists of their loved ones too.  Yet these gains are being squandered on amateurish performances on PPE and testing, the two priorities that will get us through and out of this pandemic in time to save the economy. 

The UK chemical and pharmaceutical sector is our second biggest manufacturing industry. 185,000 people are employed in this country alone. We have 13,000 textile enterprises employing 50,000 people across the country. Knitting these two sectors together in a strategic way would surely provide the capability we need to supply the whole country with the capacity it needs to protect the vulnerable.

We don’t need solutions that start in foreign countries where demand has pushed prices up and quality down, we need to repurpose our domestic capacity, by requisitioning it if necessary, to create a dependable supply chain. The excuse that this is a global challenge is wearing pretty thin when we have hundreds of thousands of furloughed workers who could be quickly retrained and redeployed to meet the challenge.

What about the hundreds of thousands of unused NHS volunteers who could help with assembly and distribution of equipment.  I’ve also written before about prison industries with huge fabrication capacity lying fallow with a literally captive workforce who could be deployed (and redeemed) in a national PPE plan.

There are many signs that small enterprises, like the little boats in the Dunkirk evacuation are using ingenuity and skill to do their bit. In Northern Ireland, for example Bloc Blinds Ltd has stopped making blinds altogether and in partnership with a packaging specialist is making medical face shields. David Nieper, a Derbyshire based luxury womenswear fashion firm, is now focused on making 5,000 sets of scrubs for NHS foundation trusts. There are an uplifting number of ‘little platoons’ at work providing what’s needed. But the customer list varies from individual hospitals to care homes to local government to the cabinet office and on.

There have been repeated stories of manufacturers approaching the Cabinet office to offer their services in manufacturing PPE only to be either not answered at all or drowned in bureaucracy. The Cabinet office delivery plan, launched inexplicably late on April 15, states there are 58,000 customers for PPE located across four settings within England and three separate UK devolved administrations. Nobody doubts that the supply chain is profoundly complex but there are demonstrably too many moving parts between factory and frontline worker. The idea in the guidance for example, that Local Resilience Forums, partnerships of local statutory and voluntary organisations with different remits and priorities, are best placed to referee on the rationing of PPE arriving in localities isn’t necessarily attuned to national priorities. These sorts of entities work very well in co-ordinating a local response to flooding but aren’t right for a decisive national support response to a global pandemic.

There is only one trusted organisation built for the task of creating, maintaining, and delivering this sort of supply chain in extremely adverse conditions where command and control of logistics are essential. It’s no coincidence that the man who drove the creation of London’s Nightingale hospital for 5,000 potential Covid patients in 10 days was a Colonel in the Army medical services. This extraordinary feat of logistical planning was only possible because it was driven not as a bureaucratic abstraction but by people who have the know-how, the authority and the organisational discipline to make things happen. Specious ministerial soundbites about ‘ramping up’ and ‘core priorities’ have undermined public trust because so little tangible ever actually flows from them. If you lose the message, you lose the public at a time when national solidarity is absolutely critical. Col Boreman was refreshingly direct in describing how he got the job done.

‘We literally got a phone call, arrived here, met up with the NHS about nine days ago, sat around a table and basically did what you always do, We draw up a plan, over a brew, and then from that you start to build up a plan and create the product.’ 

I wonder if he can be persuaded out of retirement?

This week’s appointment of Paul Deighton the former director of the 2012 Olympics by Government to drive PPE delivery feels like a tokenistic response doomed to sink without trace into a morass of undelivered promises. What actual authority will he have? Who works for him? How long will his designated task of ‘redesigning and streamlining’ of the supply chain take? I’m not for a moment criticising his success in delivering a world class sports event, but this is a challenge that needs to be truly nationalised in the one organisation with the muscle and credibility to achieve results fast. 

The abject failure of the supply chain for PPE is a problem we should be throwing Generals at. In this instance, war metaphors are absolutely appropriate. Having virtually nationalised the economy in order to save it, we should do the same, temporarily, for the design, fabrication and distribution of PPE. The army has within it, medical, technical, engineering, communications, transport and personnel capability under one green roof to mobilise credible domestic PPE supply chain that truly works end to end. 

Not all Covid 19s threats can or should be solved with more centralisation or by deploying the military. But this issue was born for the sort of leadership our armed forces are renowned for. For the first time, yesterday afternoon, the Defence Chief of Staff, Sir Nick Carter was at the daily government press conference, explaining what the military is doing to help fight the virus – and it can do so much more with the politlcal backing to take unilateral control of PPE.

As Sir Nick said in an earlier newspaper interview, ‘Defeating the coronavirus pandemic requires a whole of nation effort and the mobilisation and re-direction of resources at unprecedented levels.’  It’s time to ditch the rhetoric on PPE and come out fighting.

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Professor Ian Acheson is a former prison officer and Senior Advisor to the Counter Extremism Project.

Columns are the author's own opinion and do not necessarily reflect the views of CapX.