Media and Political Bulletin – 15 June 2020

Media and Political Bulletin

15 June 2020

Media Summary

New Chair confirmed for Pharmacy APPG

Pharmacy Business, Radhakrishna NS, 13 June 2020

Pharmacy Business reports that pharmacy trade bodies have confirmed that an MP is set to stand as the new Chair of the All-Party Pharmacy Group (APPG).

National Pharmacy Association said in a statement that they have been “in contact with a number of parliamentarians across both Houses who have expressed a keen interest in getting involved with the APPG, including standing as Officers to help guide the Group.”

The APPG is not currently active as the re-registration of the group could not be done due to the COVID-19 restrictions.

Coronavirus: PPE stocks were in chaos . . . then army got a grip

The Times, Philip Aldrick, 11 June 2020

Philip Aldrick writes how getting PPE supplies to key staff during the pandemic proved a logistical challenge like no other. In his timeline he details how the country got to the stage of having a functioning supply chain in place – from the initial lack of coordination between the Cabinet Office, the DHSC, PHE, the NHS and its own supply chain arm; to the involvement of the army; and more recently the turn to private logistics companies.

Parliamentary Coverage

Government accelerates border planning for the end of the Transition Period

Cabinet Office, 12 June 2020

New border controls and procedures have been confirmed for 2021 as the Chancellor of the Duchy of Lancaster, Michael Gove, formally notified the EU that the UK will neither accept nor seek any extension to the Transition Period.

From 1 January 2021, the UK will have the autonomy to introduce its own approach to goods imported from the EU. Border controls will be introduced in stages to give businesses affected by coronavirus more time to prepare. See here for more details on the different stages.

Full Coverage

New Chair confirmed for Pharmacy APPG

Pharmacy Business, Radhakrishna NS, 13 June 2020

Pharmacy trade bodies have confirmed that an MP is set to stand as the new Chair of the All-Party Pharmacy Group (APPG).

The position is vacant since longstanding Chair Sir Kevin Barron MP has stepped down from parliament last year.

“We are delighted to confirm that an MP with significant experience in health policy has agreed to stand as the new Chair of the APPG in the AGM elections.” the National Pharmacy Association said in a statement.

“We have also been in contact with a number of parliamentarians across both Houses who have expressed a keen interest in getting involved with the APPG, including standing as Officers to help guide the Group.”

The APPG is expected to hold an Annual General Meeting (AGM) soon as the rules that mandated physical presence of at least five MPs in a room has recently changed to allow for virtual meeting.

The APPG is not currently active as the re-registration of the group could not be done due to the COVID-19 restrictions.

Trade bodies that support the APPG – the Association of Independent Multiple Pharmacies, the Company Chemists’ Association, the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee, and the Royal Pharmaceutical Society- said they will continue to work together to inform MPs of the work being done by the community pharmacies during the pandemic, and ensure their support for the sector until AGM elections are held and the APPG is re-registered.

Coronavirus: PPE stocks were in chaos . . . then army got a grip

The Times, Philip Aldrick, 11 June 2020

Tony Mannix, the boss of Clipper Logistics, remembers Sunday March 22 for two reasons. It was Mother’s Day, the eve of the lockdown, and it was the day he received the call that dragged him into the Covid-19 fightback. The call came from an industry contact of his, Neil Ashworth, a civilian working in the British Army’s Engineering and Logistics Staff Corps and a former supply chain director at Tesco.

Mr Mannix had been told that the Ministry of Defence was looking for a company to help distribute personal protective equipment to the health service. By then the provision of PPE was in crisis. Shortages were terrifying health workers and shaming politicians, who were struggling to pull a pandemic response plan together.

The government was in the midst of pivoting from its herd immunity strategy, first flagged on March 11, to lockdown. Modelling by Imperial College London published on March 16 had suggested that herd immunity would cost 250,000 lives and raised the prospect of the NHS being unable to cope.

Ventilator shortages became the immediate focus of attention and, on March 17, the Cabinet Office put out an emergency call to British industry. The other big concern was a lack of PPE and the risk that health service workers might be sent into the coronavirus war without protection — “throwing them to the wolves” as staff would later describe it. By the end of the week the government had moved a long way. Safety was paramount, the herd immunity strategy was ditched and the slogan “Stay home, Protect the NHS, Save lives” had been created.

The army had been drafted in to assist with PPE delivery in late February and soon realised that the supply chain was being overwhelmed. To ease delivery pressures, the directors developed a plan but it needed the political sign-off. With the government struggling to keep up, no decisions were being made.

“Everyone seemed to think it was someone else’s problem,” one source close to the talks said. Between them the Cabinet Office, the Department of Health and Social Care, Public Health England, the NHS and its own supply chain arm could not reach an agreement. Eventually, in frustration, the army took control.

“They are trained for a crisis so they get things done. They made things happen,” one person involved said. Another said: “The army got a grip of stuff.”

It was then that the Ministry of Defence made contact with Mr Ashworth to get the ball rolling.

He recommended Clipper, a fast-growing logistics group that specialises in online retail, to his MoD contacts and they told him to recruit the company.

Clipper, whose workload had fallen because of the lockdown and consequently had some spare capacity, was only too happy to take on the PPE contract. It would work with the army and Unipart, the NHS’s core logistics partner, which was having to handle 220,000 order lines a day — 90,000 more than usual — as calls came in for everything from food, beds, ventilators, syringes and materials for the new Nightingale hospitals.

Winter spikes in demand of about 20 per cent are expected. But the health service supply chain had never before experienced a 70 per cent spike. At the same time, Unipart was losing staff to the virus. At the peak, one in ten on its NHS contract were ill or self-isolating.

Once it was drafted in, Clipper had a warehouse and 70 vehicles up and running within four days.

The protective equipment crisis had begun a month earlier, when the authorities were still claiming to be “extremely well prepared”. In a letter to NHS suppliers on February 11, with Wuhan in lockdown, Steve Oldfield, the Department of Health and Social Care’s chief commercial officer, told suppliers to examine “the requirements in the case of an expanded outbreak in the UK” and to be prepared to ration PPE “in the event of excessive or unusual ordering patterns”.

Within nine days rationing had started as health service trusts started stockpiling in preparation for an outbreak. The problem was obvious. PPE inventory in the core supply chain was typically three weeks’ supply. With more in shipment, there was a maximum of five or six weeks’ worth of stock either in Britain or en route.

But that was for normal levels of demand and demand was exploding.

The first response of Supply Chain Co-ordination Ltd, the private company that oversees the NHS Supply Chain, was to tap the pandemic stockpile, which it manages on behalf of Public Health England and is handled by Movianto, another private logistics group. Technically, the stockpile is only triggered when the World Health Organisation declares a “pandemic influenza” and Covid-19 is not flu. Even the declaration of a pandemic on March 11 was not enough to release the stockpile under the rules, but by then Public Health England had taken matters into its own hands and ordered Movianto into action.

In late February Movianto began moving PPE from the pandemic stockpile into the core supply chain. At one point, it was shipping 800 pallets a day, with each pallet able to hold 120,000 aprons.

The army began shifting packages from the Movianto stockpile to GP surgeries, care homes and dentists. About 200 squaddies were also made available to Unipart to help in the warehouses and loading trucks. By then the supply chain was coming under fierce criticism because PPE was getting where it was not needed and not where it was. “Hospitals were demanding against their fear, not their needs,” one insider said.

The problem was exacerbated by the fact that only half of non-pharmaceutical supplies come through the in-house NHS supply chain. The rest are sourced from private companies, which compete to offer hospitals a better price. As global demand for PPE surged many of the private providers struggled to fulfil orders, pushing more work towards the health service supply chain, which was simply expected to pick up the slack. Sourcing protective equipment was proving increasingly difficult as countries competed for it and supplier nations imposed export restrictions.

Britain has never run out of supplies “but only because a demand limiting function was imposed”, one senior source said. Rationing is hated by supply chain managers as a sign of failure because their job is to deliver what is ordered.

With the help of NHS X, in charge of digital transformation of the health service, allocation is now being run by artificial intelligence. NHS X has recruited a private technology company to build a machine-learning algorithm that anticipates demand using daily hospital situation reports.

The identity of the company is a secret.

With both an AI-led demand control system and Clipper’s parallel dedicated PPE supply chain in place, the worst logistics issues appeared to have been resolved. Sourcing remained fraught, best illustrated by the disastrous order of unfit equipment from Turkey in mid-April, but the stock was getting to where it was needed. Official figures showing that NHS deaths were no higher than their age-related counterparts in the general population suggested that the PPE did get through. But then another crisis struck.

While all the focus was on the health service, the virus was devastating care homes, which now account for more than a quarter of all deaths and where carers are twice as likely to die from the virus as both the general population and NHS staff. The care sector is largely a private operation with more than eight in ten beds owned by for-profit companies for local authorities. It was the care home providers’ responsibility to source PPE.

By early April it was clear they were in big trouble. It was also clear the government did not have a plan to match claims made on March 20 by Jenny Harries, England’s deputy chief medical officer, that there was “a perfectly adequate supply of PPE” and pressures had been “completely resolved”. About 25,000 care homes had received limited supplies from the pandemic stockpile in February, but that was largely it.

When Clipper’s parallel PPE supply chain was set up, it was designed exclusively for the NHS. It was not until the second week of April, with public concerns about care homes at fever pitch, that the government asked it to build a whole new supply chain for the social care sector as well.

The challenge was enormous, expanding Clipper’s logistics network from 233 hospital trusts to 58,000 smaller care homes.

With its experience in online retail logistics, Clipper was well placed to deliver the service but the solution, built with the army, was complex. Ebay was enlisted to create a purchasing portal and a specialised central PPE procurement unit was established to source items. Clipper distributes to the Royal Mail, which delivers to the care home door. It took a week to get the pilot going for a network that Mr Mannix later said would normally take “six weeks to four months” to build. By May 5, it had delivered 400,000 pieces of protective equipment. Sir Nick Carter, chief of the defence staff, said it was the “greatest logistical challenge” in his 40 years of service.

It took almost four months but a functioning supply chain is now in place, albeit one with no pandemic stockpile in reserve. The NHS Supply Chain is said to have 100 new suppliers of PPE from around the world as well as more domestic producers, which are contracted to produce two billion items, more than the 1.6 billion pieces delivered since the pandemic began. “Using our PPE distribution network we will continue to ensure supplies reach the front line quickly and effectively,” a spokesman said.

How the NHS supply chain works

The NHS Supply Chain, the in-house network that supplies healthcare products, services and food but not drugs to the NHS, is a complicated beast.

DHL Life Sciences managed the whole area between 2006 and 2018, when a new structure broke the supply chain into 13 contracts, mostly with private companies. The new system is overseen by Supply Chain Coordination Ltd (SCCL), a company owned by Matt Hancock, the health secretary, on behalf of the Department of Health and Social Care.

Eleven of the 13 contracts are for procurement, with each provider responsible for sourcing a specific set of goods. PPE falls into three of those, two managed by DHL and one run by the Collaborative Procurement Partnership, owned by four NHS trusts.

The twelfth contract is IT, run by DXC Technology, another private company.

The thirteenth and largest of all is the £730 million logistics contract that Unipart took over from DHL in February 2019. Stock levels are jointly decided by SCCL and Unipart and enough to cover three weeks’ demand.

The new system is designed to use the NHS’s massive buying power to drive down prices for the £6 billion spent every year on hospital consumables and save the NHS £2.4 billion by 2023.

The strategy was proving a success when the outbreak struck. But the increased stock was being run through the same seven warehouses as before, with an eighth yet to be built, in Bury St Edmunds. The increase in demand without increasing capacity has raised questions about whether the supply chain was already overstretched. Unipart and NHS Supply Chain reject the suggestion.

Unipart said it had created more capacity by improving the performance of its warehouses. An NHS Supply Chain spokeswoman said: “For stocked deliveries on time, in January on a year-to-date basis, we achieved 99.77 per cent and for delivered service levels, 99.81 per cent. Our customer satisfaction score was consistently at 8.3.”

Media and Political Bulletin – 15 June 2020

From Factory to Pharmacy

As part of our mission to build awareness, understanding and appreciation of the vital importance of the healthcare distribution sector, we developed an infographic explaining the availability of medicines. It identifies the factors that can impact drug supply, as well as the measures that HDA members undertake day in, day out to help mitigate the risks of patients not receiving their medicines.

See the Infographic

Apply to become a Member

Membership of the HDA guarantees your organisation:

  • Access to leading policy and industry forums of debate and discussion
  • Invitations to a range of networking industry events organised through the year, including an Annual Conference and a Business Day
  • Representation on HDA working parties, including the Members’ Liaison Group
  • A daily Political and Media Bulletin and HDA Newsletters
  • Access to HDA policy documents and all sections of the HDA website
  • Branding and marketing opportunities
Apply Now

Already a Member?