Consultation outcome

Extending free PPE to the health and care sector

Updated 13 January 2022

Background

Prior to coronavirus (COVID-19), procurement of personal protective equipment (PPE) was not centralised. PPE was purchased locally by health and social care providers who had the autonomy to choose their own suppliers. Previously, health and social care providers sourced their PPE from a range of PPE wholesalers or manufacturers. This included NHS Supply Chain, a limited company currently owned by the Secretary of State for Health and Social Care, designed to help the NHS deliver clinically assured, quality products at the best value.

As the impact of the COVID-19 outbreak developed, global demand for PPE soared. This significantly disrupted PPE supply chains and the wholesale market for PPE. Health and care providers experienced significant difficulty acquiring PPE at an affordable price in the volumes needed to deliver services safely. With the wholesale market struggling to respond to this increased demand, and to ensure the viability of services in the face of soaring costs, government took a central role in the procurement and supply of PPE to health and care settings, many of which had never had the need for certain items of medical-grade PPE before.

The Department of Health and Social Care (DHSC) launched a new online portal to support over 50,000 primary care and social care providers with accessing their COVID-19 PPE requirements, free of charge. More than 58,000 eligible health and social care providers in England – including GPs, adult social care providers, dentists, orthodontists, optometrists and pharmacies – have been invited to register with, and order their COVID-19 PPE requirements through the online PPE portal, free of charge. Around 53,000 providers have registered, receiving over 4 billion items of PPE so far to support their COVID-19 needs.

DHSC also set up bespoke distribution routes via local authorities and local resilience forums (LRFs) for those services that could not be supplied through the portal and to distribute free COVID-19 PPE to other public sector services such as schools. Palliative and end of life care services, such as hospices, were supplied via regional hubs. While DHSC has supported other government departments to provide PPE to other public sector services during the pandemic, these non-health and care settings are out of scope for this consultation.

The PPE programme which runs these PPE supply and distribution routes, currently sits within DHSC but is due to transition to NHS Supply Chain by 31 March 2022. The current supply and distribution routes will continue until then.

Across these distribution routes, the PPE programme has distributed over 14 billion items of PPE to the frontline. The cost of this PPE is approximately £2.9 billion.

Context

DHSC is currently due to end its free, central PPE provision from 1 April 2022. At this point, health and care providers will need to purchase PPE from a supplier of their choice. However, given current case levels and guidance, we expect PPE usage to remain at COVID-19 levels beyond March 2022 putting significant upward pressure on health and care costs in the next financial year. We have sufficient stock centrally to continue to support providers to meet their COVID-19 PPE needs. The department is therefore considering whether to extend central, free provision.

PPE usage during COVID-19 has been largely driven by the changes in guidance produced by the United Kingdom Infection Prevention and Control (IPC) Cell which sits within NHS England and Improvement. The IPC Cell continually monitors and reviews emerging evidence and data and the guidance is amended accordingly if needed. The guidance forms the basis of primary and secondary care measures in both public and private healthcare settings and is also adapted to form the ‘How to work safely’ guidance for social care settings.

The IPC guidance is a response to the prevailing state of the pandemic. In response to COVID-19, PPE usage increased dramatically across all categories. Usage increased at least 3-fold compared to 2019 for all items and, in some categories, usage in one week during COVID-19 is the same as the total amount used in 2019. While the UK vaccination programme has been a success and restrictions are progressively coming to an end, the trajectory of the COVID-19 remains highly uncertain. We cannot therefore predict what, if any, changes will be made to the IPC guidance by 31 March 2022.

If IPC guidance does not recommend a change in PPE usage between now and 31 March 2022, then the same high volumes of PPE will continue to be used across the health and care system. Assuming that volumes do remain the same, the cost to the health and care sector, including DHSC, in 2022 to 2023 will be:

Scenario	Cost to the health and care sector in 2022 to 2023
Free PPE is extended for 12 months	£600million
Free PPE ends from 1 April 2022	£1.4 billion

The costs of ending free PPE are higher as we already hold stock centrally which would need to be newly purchased if free PPE were to end. While the department is exploring funding options, we cannot guarantee that the government will be able to support health and care providers with this additional cost. We do hold sufficient stock centrally to support health and care providers to meet their COVID-19 needs through 2022 to 2023. Therefore, if COVID-19 levels of PPE are still needed from 1 April 2022, then the department may need to extend the provision of free, central PPE to ensure services can meet their COVID-19 needs and keep frontline workers protected. However, this requires the department continuing to intervene in the PPE market in the UK which could have a negative impact on the businesses who operate in this market. This consultation therefore seeks stakeholder views on extending the current free provision.

Scope

This consultation covers all health and care settings. There are non-health and care settings who currently receive the free, central provision but these are out of scope of this consultation. The table below sets out which user groups are in scope:

User group	In scope?
NHS trusts or foundation trusts (acute trusts, ambulance trusts, community trusts and mental health trusts)	Yes
Community health and care	Yes
Dentists and orthodontists	Yes
General practice	Yes
Pharmacists	Yes
Optometrists	Yes
Mental health services	Yes
Palliative and end of life care, including hospices	Yes
Adult social care (residential care, domiciliary care, shared lives services, supported living, extra care, day services, personal assistants and unpaid carers)	Yes
Independent sector providers delivering NHS care	Yes
Other government departments	No
Non-health and care local authority services (for example, domestic violence shelters, rough sleeping shelters)	No
Children’s social care	No

Potential options

The department is considering the following 2 options for the current free provision of PPE beyond the current end date of 31 March 2022.

Option 1: extend free PPE for 12 months

The first option is to extend the central, free provision for all items of PPE already provided for free under the current scheme. For some customers (not NHS trusts) who currently receive their free PPE via distribution routes other than the PPE portal, these routes may need to change, and customers onboarded to the portal.

We propose extending for 12 months. As we do not expect the key drivers of extending to have changed until at least the end of the 2022 to 2023 financial year, we will likely need to consider another extension further down the line if we extend for a shorter period of time. However, extending now for 12 months provides certainty over the whole financial year.

Potential impacts of this option:

• impacts on the PPE market: this would involve continued government intervention in the PPE market, continuing to limit other actors in this part of the market

• impact on health and care providers: this would remove the cost burden from providers of purchasing PPE for the length of the extension, reducing the risk of non-compliance with IPC guidance, and mitigating against reduced provider viability. This would ensure health and care workers are protected while COVID-19 remains prevalent. This would also mitigate against potential increased costs from some services being pushed onto the users of these services

Option 2: no extension of free PPE beyond 31 March 2022

The second option is to end the central, free provision of PPE on 31 March 2022. From 1 April 2022, health and care providers will need to purchase their own PPE and will be free to choose their own suppliers.

Potential impacts of this option:

• impact on the PPE market: government would no longer be intervening in the PPE market

• impact on health and care providers: this option would increase the cost burden on providers. The department is considering potential funding options to help mitigate this. However, this funding would only be available for PPE in line with IPC guidance and cannot be guaranteed. However, if providers were to bear the entire cost, there is a risk of non-compliance with IPC guidance if providers cannot afford the additional cost. There is also a risk that some adult social care services may become unviable if funding is unavailable

The evidence gathered from the consultation will help inform our decision, including whether the same approach should be applied to all types of health and care providers.

Consultation questions

Question 1

To what extent do you agree that free PPE should be extended beyond 31 March 2022 for 12 months?

• strongly agree

• agree

• neither agree nor disagree

• disagree

• strongly disagree

• don’t know

If you wish, please explain your position and provide any supporting evidence (preferably no more than 500 words).

Question 2

Are there other options you think we should consider?

• yes

• no

If ‘yes’, please describe alternative options and why these might be helpful and provide any supporting evidence (preferably no more than 750 words).

Question 3 (for hospices only)

Hospices currently receive free PPE via a series of regional hubs which are largely reliant on volunteers, rather than via the PPE portal or local authorities or LRFs. Instead, hospices could use the PPE portal to access their COVID-19 PPE needs from 1 April 2022. To what extent do you agree that the regional hubs should be stood down and hospices onboarded to the portal?

• strongly agree

• agree

• neither agree nor disagree

• disagree

• strongly disagree

• don’t know

If you wish, please explain your position and provide any supporting evidence (preferably no more than 500 words).

Question 4

Do you have any other views related to this consultation that you would like to express?

• yes

• no

If ‘yes’, please explain (preferably no more than 500 words).

The consultation runs until 11:45pm on 31 October 2021.

Please respond using this survey

Alternatively, you can email PPE.strategy@dhsc.gov.uk.