1/23 Today is a key day to strengthen staff confidence on personal protection equipment (PPE). Hence this thread. Usual basis: we are not Government or @NHSEngland we are voice of NHS trusts. I'm also not a clinician or PPE expert and haven’t/don’t work on frontline.

2/23 You can find the full details of the basis of our public coronavirus comment here: https://nhsproviders.org/news-blogs/press-office. If you’re new to the topic of PPE, you can read my two previous thread here: https://threadreaderapp.com/thread/1241775402093338624.html and https://threadreaderapp.com/thread/1244186778489192448.html

3/23 Trust leaders clear nothing is more important than ensuring all frontline staff have the equipment they need when they need it. They’re doing all they can to ensure this happens, despite some significant challenges. Two issues – confidence in guidance & availability of kit.

4/23 On PPE guidance, frontline staff have expressed a number of concerns. They didn’t think guidance was adapting quickly enough to increasingly widespread prevalence of covid19. The guidance was also changed a month ago with what staff felt was inadequate explanation.

5/23 Previous PPE guidance felt very technical and staff felt it didn't cover the full range of health and care settings. And there was insufficient clarity on how guidance related to WHO guidelines which led to a strong sense at the frontline that it was somehow inferior.

6/23 Today, new updated set of guidance issued: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control. Three helpful things to address concerns. A. Guidance has been updated to reflect the latest understanding of covid19 (which is why guidance changed in March, but this could have been explained better).

7/23 B. New updated PPE guidance is presented in a clear and helpful way that frontline staff can easily refer to. Clear statement that guidelines are endorsed by WHO and indeed, in some areas, are considerably more stringent than WHO guidelines (e.g. use of FFP3 masks vs FFP2).

8/23 C. New guidance helpfully aims to be much more explicit about the full range of health and care settings where frontline staff work. It now, for example, explicitly covers ambulances, mental health and community settings, primary care and an individual’s home.

9/23 We would highlight four helpful updates in areas that trust leaders tell us have been causes of concern. Please note I am simplifying detailed guidance to provide short, layman type, explanation. Anything I say here is emphatically NOT a substitute for the detailed guidance.

10/23 A. Given prevalence of virus, new guidance allows health & care workers to assess risk to themselves, colleagues & patients in any situation. Where they suspect or do not know if virus is present, new guidance now goes much further in advising use of PPE than before.

11/23 B. Guidance is clear which procedures require high level PPE (such as aerosol generating procedures requiring FFP3 mask and full gown) and which require other precautions such as aprons, gloves and surgical masks for other forms of care.

12/23 C. Guidance clearer that kit which could cross infect patients - disposable aprons & gloves – must be changed after each patient. Kit primarily to protect staff – masks & eye protection – can, on many occasions, be used for whole sessions, enabling supply-sustaining reuse.

13/23 D. WHO endorses long held UK position on bare below the elbow being acceptable. National leaders also want to reinforce that this isn’t just about the kit. Just as important for staff to do good hand hygiene and put kit on / take it off properly to avoid spreading virus.

14/23 National leaders say guidance has been very carefully considered (hence frustrating delay) and is based on detailed, and most up to date, scientific evidence with Medical Royal Colleges backing. They therefore hope this will be sufficient to strengthen staff confidence.

15/23 This confidence vital because, to safeguard long term supply of equipment that every country is seeking to buy, health & care sector needs to consistently follow the new updated guidance. All frontline staff & leaders have role to play in ensuring this consistency of usage.

16/23 Second overall problem has been with availability of equipment. Key point is that today’s change in guidance will only strengthen confidence of frontline staff if it’s backed up by consistent and timely delivery of PPE equipment to where it’s needed.

17/23 National leaders tell us that this week’s audit of PPE stock availability confirms sufficient stock for short/mid term to provide all equipment health and care workers need if these guidelines are complied with. Shortages therefore mostly a distribution, not a stock, issue.

18/23 My previous twitter threads have covered the problems national NHS leaders have had with PPE distribution and logistics. Latest position below but deliberately split by trusts and rest of health and care as these have very different logistics demands and approaches.

19/23 Judging by the volume of concern on our real time comms channel with trust Chief Executives, trust level distribution problems have significantly improved, at pace. There are individual issues but these seem to get resolved fairly rapidly....

20/23 …Two exceptions are availability of visors and full gowns which remain constrained. Visors, for example, were not part of UK’s pandemic strategic reserve. But, as with everything on PPE distribution, national NHS leadership team tell us they are working hard to resolve.

21/23 However, national NHS leaders tell us they recognise that distribution problems for thousands of organisations in primary care (e.g. GPs), social care and voluntary sector, are proving difficult to resolve and taking longer to sort than problems faced by trusts we represent

22/23 National leaders tell us that they are working as fast as they can to resolve these issues (see previous threads). But this will take some time yet and we can therefore still expect to still see frontline testimony from these sectors highlighting shortages for a period.

23/23 Trust Chief Executives recognise frontline staff worry and anger over PPE and have been pushing hard for these issues to be resolved. From where we sit, national leaders working as hard as they can, with the support of @DefenceHQ, to resolve them.

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