CGP0020

Written evidence submitted by Leonard Cheshire’s

1. About Leonard Cheshire

1.1.      Leonard Cheshire is one of the UK’s leading charities supporting disabled people. We support individuals to live, learn and earn as independently as they choose, whatever their ability and to play our part in creating a fair and inclusive society. Led by people with experience of disability, we are at the heart of local life — providing opportunity, choice and support in the communities we work in. This includes providing social care through supporting living and registered care homes - caring for nearly 3,000 disabled people at 120 Leonard Cheshire services - and supporting disabled people with educational and employment opportunities. This response has been informed by this experience in procuring safety PPE for our staff and the people we care for in delivering care services.

1.2.            We have previously outlined the fragmented response from UK Government, local authorities and health bodies to the Covid-19 pandemic. We have fed in our experiences as a care provider as well as surveying disabled people and their carers about the impact of the Covid-19 pandemic with over 1,100 responses.[1]

2. Executive Summary

2.1.            The Government’s approach in the Covid-19 pandemic – and the lack of preparation in advance of the outbreak of the virus in the UK – caused increased risk when it came to protecting our staff and the people that Leonard Cheshire provides care for. The scarcity of available PPE in the market prompted prices that soared rapidly. Leonard Cheshire also had to contend with inadequate advice and guidance on what PPE to purchase and conflicting advice from various UK Government and regulatory bodies. Leonard Cheshire faced risks regarding the ethical practices of suppliers and their PPE products and financial risks due to requirements for immediate payments to suppliers and managing cashflow. The organisation also faced challenges in storage and the logistics of delivering PPE to our services. 

2.2.            The issues that Leonard Cheshire faced regarding financial insecurity and systems failure in the face of the pandemic has been amplified by the long-standing underfunding of the social care system.[2] It is all-the-more apparent that action is urgently needed to deliver social care services which are accessible and affordable for those who need it to live full and independent lives. In particular: 

2.2.1.    Disabled people have often been treated as an afterthought during the pandemic, with PPE supplies not available to care homes, Covid-19 testing not being easily available to disabled people in care homes, and disabled people experiencing reductions to their social care packages in the community throughout this crisis. There is a need for parity between health and social care. 

2.2.2.    There was a lack of preparedness from public health bodies to manage this crisis, and a disjointed approach between Public Health England and devolved public health bodies This has led to confusing and often contradictory guidance between the countries of the UK, resulting in staff time being taken away from frontline services to comply with the differing guidance nationwide. 

2.2.3.    Covid-19 has exacerbated the funding strain being experienced by care providers due to the additional costs that providers are facing in delivering services. Local Government Association have indicated that councils experienced a funding gap this year of £6bn beyond the £3.2bn provided by government in the first three months of the pandemic. Leonard Cheshire spent £2.8 million in March 2020 alone on purchasing enough PPE to protect our staff and the 3,000 disabled people who live in 120 residential homes and independent living facilities. Prior to the UK Government’s introduction of free PPE to care homes on 1st October 2020, Leonard Cheshire was spending £95 per customer per week. By our estimations, Leonard Cheshire has funded approximately 95% of the PPE we have sourced.

2.3 Recommendations

2.3.1      The PPE portal requires a great deal of improvement. It is difficult to use and cannot be accessed on a central basis. Each service is required to submit a request related to its own PPE needs. The amount of PPE that can be ordered is restricted and so still does not bear any relation to any assessment of needs in care services. It also does not provide any gowns or better-quality masks that are required needed if a resident is diagnosed with Covid-19 or if Aerosol Generating Procedures (AGP) are required. We are concerned that, should an outbreak occur in a residence, the PPE portal could not respond to provide required resources.

2.3.2      We are concerned that guidance around visits to care services continues to be inconsistent. Advice must be evidence based and must be integrated with the lockdown and tier systems in order to be effective and alleviate confusion.

2.3.3      Fully available PPE and rigorous safety standards must be put in place as a mandatory requirement before visits to care services are permitted.

2.3.4      We welcome testing that would enable family and friends to visit residents in our care services. However, we have serious concerns regarding the delivery of this testing in care homes when extended beyond the pilot phase. Disabled people must not be an afterthought in the roll-out of testing and the delivery of the Covid-19 vaccine programme. There must be proper consideration and planning regarding how this will be managed in care services e.g. increased demand on staffing, training etc and where and how it can take place safely.

3. How was PPE supplied to NHS and social care organisations before the COVID-19 pandemic started?

3.1 As a social care provider, Leonard Cheshire had no supply issues prior to COVID-19. There was no shortage of PPE: in fact, from Leonard Cheshire’s experience, it was a very competitive market. Prior to Covid-19, Leonard Cheshire did not have any experience in the purchasing or sourcing of face masks as the precautions involved regarding the virus was the first requirement for this equipment. We purchased gloves, aprons and alcoholic hand sanitiser prior to the pandemic. However, this has extended to a much greater scale in weekly purchase since the outset of Covid-19. In the main, the organisational spend was around cleaning and janitorial supplies. PPE could be ordered at a service level from a national contract in place. This was according to 30-day payment terms and immediate or often weekly deliveries of PPE orders were standard prior to the pandemic.

4. How did the Government respond when problems arose in the supply of PPE?

4.1 The main interventions made by the UK Government to respond to problems in the supply of PPE were the National Supply Line, the Local Resilience Forum and the Infection Control Fund. [3] However, these mechanisms were not effective and only materialised in securing very limited PPE supply for Leonard Cheshire. In early April we were advised to make contact with Local Resilience Forums who would start distributing PPE supplies. Only two Leonard Cheshire services received a small amount of supplies through the Local Resilience Forum channel.[4]

4.2 The extension of the Infection Control Fund - intended to support care homes to provide enhanced infection control measures - is an essential and welcome step.

5. The scale of problems in the availability of PPE throughout the emergency

5.1 In Leonard Cheshire’s experience, we did not observe any preparations in securing a sustainable PPE supply - or meaningful intervention of any kind – in developing resources for social care providers by the Government between the pandemic emerging in other countries and arriving in the UK. This lack of action was a central cause of the crisis faced by social care providers in securing PPE resources and providing safe care, particularly during the first stage of the pandemic.

5.2 Disabled people have all too often been an afterthought in public policy making during the pandemic – in access to PPE and testing. Leonard Cheshire’s experience has shown that: 

5.2.1      Social care providers struggled to source and secure PPE to protect their staff and customers. This has resulted in Leonard Cheshire spending £2.8 million on purchasing PPE in March 2020 alone, often at inflated prices, to keep our 5,000 strong workforce and 3,000 disabled people living in our 120 care homes and independent living facilities safe. 

5.2.2      Routine testing for care workers was introduced far later than was the case for NHS staff. Testing in care homes was also not automatically extended to disabled people in England as it was to older people and those with dementia. Initially, disabled people could only get a Covid-19 test if they were symptomatic. We worked with Laura Trott MP to raise this issue with the Government and on 8th June the Department for Health and Social Care expanded the care home testing portal so that all adult care home settings could access tests.[5] However, since then, the Government’s announcement that weekly tests will be available in England for care workers and residents again only applies to the over 65s and people living with dementia. 

5.3 Phase 1 (March – April 2020): Leonard Cheshire’s social care procurement team found that it was almost impossible to secure PPE due to the NHS ringfencing of supplies and available PPE was very scarce. Suppliers, including our preferred supplier Blueleaf, confirmed this and were not able to supply us with either the PPE order that we had purchased from them pre-Covid or the face masks needed for safety in the pandemic.

5.4 We therefore had to use all available resources to contact a range of non-standard suppliers. This included contacting closed gyms, shops, nail salons, hairdressers to identify any access points. PPE supplies that we managed to source came at a huge premium. New supply channels established in the pandemic, for example products being air freighted in from China and other parts of Asia, meant that delivery lead times couldn’t be guaranteed and led to additional exposure to risks and financial insecurity as suppliers would only supply on upfront payment and delivery to a single location address.

5.5 Phase 2 (April - June lockdown): The Government established an NHS supply chain helpline. This call handling service directed social care providers to initially four and subsequently five national suppliers. However, the helpline did not operate as a supply chain line and suppliers often told us either that they were not able to supply PPE to Leonard Cheshire. In fact, when we found that there was an available supply of PPE on the helpline, it was more expensive than we could source ourselves. As a result, the supply chain helpline did not enable us to effectively source PPE.

5.6 In order to be able to provide safe care for our clients and residents – and a safe working environment for our care staff - we had to identify new sources of PPE supply. We had to make very quick buying decisions with immediate payments to not lose the supply line to competing customers. This involved taking financial risks around due diligence of suppliers and products.

5.7 Errors in guidance on PPE equipment: Leonard Cheshire experienced issues with poor guidance which impacted on the organisation’s financial resources. We received conflicting advice and guidance from Public Health England and the local Care Quality Commission, among others. Initially, there was no guidance around the need for mask fit testing.  However, in early July, this new information was issued at short notice. Releasing this updated information in this way created a high and competitive arena regarding the need appointing a mask fit testing provider, purchasing mask fit testing kits and consumables, services, mask fit testing kits and replacements hoods.

5.8 A great deal of misinformation or poor guidance resulted surrounding the requirements and safety criteria of PPE masks:

5.8.1      KN95 masks: Leonard Cheshire was initially advised to buy KN95 masks in bulk. However, we were subsequently alerted to the fact that the product was ineffective against the virus.[6] By our assessments this resulted in circa £100,000 wasted.

5.8.2      The Fire Service advised of SAMSTROM masks and filters for clients with Aerosol Generating Procedure requirements.  We spent circa £130k on these, to again be informed by mask fitting testers that they were ineffective.  We are making use of them, albeit they are an expensive alternative.

5.9 Phase 3 – currently: At Leonard Cheshire, we have developed a great deal more knowledge internally as well secure, trusted and high-quality supply lines. The pricing for PPE has dropped considerably since the earliest stages of the pandemic. Ongoing issues in securing PPE remain however in the availability of specialist fitted 3M masks, the shortage of nitrile gloves and suppliers still requesting either 100% or 50% payments immediately/ upfront.

5.10         The NHS PPE Portal has been set-up to address social care providers’ PPE needs, and all of Leonard Cheshire’s services have been registered with this system. The NHS PPE Portal has proven, however, to be a difficult, clunky system and process and our teams continue to have log-on issues in accessing it. The quota levels involved in the Portal are not in line with the weekly PPE requirements of Leonard Cheshire’s services. Our needs are not consistent with the system’s in-built quota or with the resulting delivery of PPE supply. We are currently only achieving on average 70% of what our services need to manage the spread of the virus and comply with current UK Government guidance.

5.11         The PPE portal requires a great deal of improvement. It is difficult to use and cannot be accessed on a central basis. Each service is required to submit a request related to its own PPE needs. The amount of PPE that can be ordered is restricted and so still does not bear any relation to any assessment of needs in care services. It also does not provide any gowns or better-quality masks that are required needed if a resident is diagnosed with Covid-19 or if AGP procedures are required. Relying on this system alone would not enable sufficient access to resources should an outbreak occur in a residence.

5.12         PPE supply issues and the impact on visitors to care residences: In phase 1, there was not enough PPE to make provision for visitors. Despite improvements as the pandemic progressed, access to PPE supply in the social care sector was still extremely limited and PPE supply was reserved for visitors who were visiting Leonard Cheshire’s clients at end of life. Initially, guidance around use of masks for visitor to social care services was minimal. We are concerned that guidance around visits to care services continues to be limited and inconsistent. Advice must be evidence-based and must be integrated with the lockdown and tier systems so that it is effective and to alleviate confusion.

5.13         Fully available PPE and rigorous safety standards must be put in place as a mandatory requirement before visits to care services are permitted. There has been recent progress in UK Government pilots of testing for care home visitors.[7] We welcome testing that would enable family and friends to visit residents in our care services. However, we have serious concerns regarding the delivery of this testing in care homes when extended beyond the pilot phase. Disabled people must not be an afterthought in the roll-out of testing and the delivery of the Covid-19 vaccine programme. There must be proper consideration and planning regarding how this will be managed in care services e.g. increased demand on staffing, training etc and where and how it can take place safely.

5.14         We have previously highlighted the severe pressures facing social care staffing during the pandemic. The LGA has estimated additional staffing costs due to the pandemic to be £1.018 billion from the early stages of the pandemic to the end of September 2020.[8] This covers the increased staffing costs across care homes, supported living and home care and incorporates the costs of recruiting workers to cover for staff who are off sick or self-isolating. Leonard Cheshire launched its own recruitment drive to backfill roles during the pandemic. We also redeployed staff to work in our care homes to fill temporary vacancies caused by staff self-isolating and set up a PPE distribution network, operated by re-deployed staff. In total, 1204 out of 5,000 staff members have been required to self-isolate. 

December 2020