1/15 Lots of recent focus on PPE so posting another, up to date, thread. Usual basis: we are not Government, we are not NHS England and we are not responsible for PPE stocks, delivery and usage. The full basis for all our public coronavirus comment here: https://nhsproviders.org/news-blogs/press-office

2/15 The role of @NHSProviders is to set out what trusts need and their current concerns. But we can also draw on our detailed continuous dialogue with national leaders. Particularly, for this thread, our discussions over the last 48 hours on the issue of clinical gown supply.

3/15 Trust leader position simple. Nothing more important than staff having right PPE when needed. Trust leaders will do everything they can to make this happen. Central purchasing/distribution/pandemic reserve controlled by national leaders. All work together as one NHS team.

4/15 Trusts tell us, through our real time electronic communications channels,
that, with exception of gowns and visors, they are now regularly receiving the right PPE when they need it. They welcome the huge national effort to get to this point.

5/15 Trusts recognise distribution problems persist in primary, social care & voluntary sectors (not represented by @NHSProviders). Trusts have been helping wherever they possibly can. National leaders tell us they’re working as hard & as fast as possible to resolve these issues.

6/15 However there are critically low levels of stock of gowns in some trusts. High volumes of gowns and visors were not held as part of national pandemic PPE strategic reserve, so stocks of both items now running short. Trusts finding it easier to solve visor issue (e.g. reuse).

7/15 All have worked extremely hard over last 48 hrs to address immediate gown shortages using variety of different approaches. Talking to trusts this morning many, but not all, trusts in shortage received vital overnight emergency delivery. For some, literally just in time.

8/15 @PHE_uk yesterday approved principle of use of coveralls in place of gowns https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-personal-protective-equipment-ppe#main-changes-to-previous-guidance. We understand that a significant consignment of coveralls is due for release shortly, post sign off. This consignment has been successfully tested for use by HSE.

9/15 Trusts are also providing mutual aid to neighbouring providers to ensure gown stock is spread appropriately wherever possible. This mutual aid is a key benefit of being in a National Health Service where trusts can identify where neighbours have problems & help accordingly.

10/15 But, these are last minute actions to prevent gown stock running out. The stock position for a number of trusts for the next few days still looks precarious. We need sustainable supply. All are working hard to achieve this within massive constraints….

11/15 ...We are told that China is the only, real, immediate, high volume, source of gowns given fluid repellent textile needed. There is massive global competition for gowns. Freight of stocks purchased weeks ago is still erratic despite flights to UK being increased to 1 a day.

12/15 Arriving stocks also have to pass stringent safety tests, which is not always guaranteed. From our conversations, it is clear that national NHS leaders, working closely with @foreignoffice and @tradegovuk are leaving no stone unturned to overcome these constraints.

13/15 The gown supply issue of the last few days has rightly focussed attention on ensuring the sustainability of PPE supply. Obviously this isn't top of anyone’s mind when PPE is not consistently available wherever and whenever it is needed...

14/15 ...But the greatest overall PPE risk is probably running out of stock altogether at some point. The new guidance published on April 2 is backed by rigorous science. Everyone following this guidance will, crucially, help secure future PPE supply.

15/15 However, as the most recent issues around gowns show, trust leaders and staff also need clear, open and transparent information on risks. If there is a risk of stock shortage, it's much better to flag this early than rely on last minute emergency rescue.