Although the Government clearly pulled out all the stops to increase its procurement of vital medicines and medical equipment (including PPE) during the first wave of the COVID-19 pandemic, the HDA feels that a lack of understanding of how the pharmaceutical supply chain operates, at the highest levels of some Government departments involved, hindered these efforts. In many ways, it felt from the outside that Ministers took it upon themselves to bring in new advisers, without seeking out some of the best existing capabilities.
In effect, the Government wasted significant time and resources in sometimes attempting to create parallel supply chains when instead the NHS could have engaged with, and listened to, existing supply chain experts at an earlier stage. The existing healthcare supply chain has proved time and time again to be robust, resilient and highly effective. As a result, the HDA and its members were often brought into discussions late and either had to operate within sub-optimal systems created specifically for COVID, or attempt to further redesign the suggested processes to better fit the operational reality.
NHS procurement of vital medicines, particularly in the first few months of the pandemic, presented substantial challenges to healthcare distributors as different parts of the NHS and different UK Governments operated in separate silos. Communication between different institutions appeared minimal, with both duplicative and contradictory data capture requests and processes being put in place, usually resulting in an increased burden on healthcare distributors. Consideration should therefore be paid to establishing more general contractual arrangements between distributors and the Government to allow for the timely distribution of Government-owned stock.
The significant differences in the initial approaches adopted by the four nations of the UK also resulted in some uncoordinated responses to the pandemic, increasing the complexity and burden on healthcare distributors.
In addition to the overlapping requests and asks, the decision-making processes by some authorities was often slow and their individual responsibility allocation was uncertain at times. Sometimes, local decision-making was left to HDA members, who always aimed to put patients first. It was unclear who the over-riding authority was at times.
Moreover, the extensive use of external consultants by the Government did sometimes slow decision-making down, rather than speeding them up through extra capacity and capability. This risk is particularly acute in the highly regulated and complex medicines supply, where a seeming lack of understanding of how pharmaceutical supply chains efficiently operate result in inaccurate or duplicative requests by the external consultants.
The issues surrounding PPE procurement are well documented, yet the lack of availability of Public Health England (PHE) procured PPE for HDA wholesalers to supply to community pharmacy was perhaps overshadowed by the urgent issues faced by secondary care. This is to say, that the centralised PPE procurement for community pharmacy operated by Public Health England faced considerable challenges with low levels of stock availability and miscommunication by PHE/NHSE&I that suggested that HDA members had dramatically more PPE stocks available than was actually the case.
The management of PHE’s PPE stockpile also produced a number of operational challenges for HDA members, as the sales events that were used to release stock onto the market were conducted with very short notice and often did not include the expected volumes, causing issues with pharmacy customers who expected to be able to order more PPE from their usual wholesalers.
Going forward, consideration should be paid to engaging healthcare distributors in the management of Government PPE stockpiles, given their expertise in balancing supply and demand, and equitably distributing healthcare products.
Equally, at the beginning of the pandemic when the Government signed high value contracts for PPE supply with companies who had little, if any, experience of procuring PPE, engaging healthcare distributors who have long-standing expertise in procuring products from around the world was seemingly not considered. Due to the lack of transparency over this early procurement of PPE, it was impossible for the HDA and members to offer their support in these efforts, as it was unclear what the Government’s strategy was. Even when furnished with a priority Cabinet Office PPE email address, HDA member companies did not receive replies to their offer of using tried and tested supply capabilities.
The Healthcare Distribution Association (HDA UK) represents those businesses who supply medicines, medical devices and healthcare services to patients, pharmacies, hospitals, doctors and the pharmaceutical industry. HDA UK members operate across the four nations of the United Kingdom enabling a safe, efficient and high-quality supply chain for the healthcare sector. They are responsible for distributing over 90% of NHS medicines and provide wholesaling services including working capital, stock management and IT systems to their supply chain partners. The HDA and its members are at the forefront of the constantly evolving healthcare supply chain, which is seeing innovative practices and technologies make new services possible for manufacturers and to those who dispense medicines, reflecting the needs and choices of individual patients.