Of needles, haystacks and the procurement of PPE

Most of the focus over the last month or so in the blog has been on the procurement of ventilators by the UK Government (#ventilatorgate) and how, in my view, the rules have been broken.

There is, however, another elephant in the room and that is the personal protection equipment (PPE) procurement 'process'. I have been staying out of the discussions up till now on purpose. For the most part I see it not as a problem of procurement, at least in the legal sense and the facts are harder to come by than with the ventilators. But the last few days have provided some food for thought and a push for me to look into it.

The Institute for Government published yesterday a great explainer on how procurement is conducted within the NHS, including the issues surrounding PPE. The overall answer here is that procurement is hard and trying to buy supplies the whole world is also trying to secure at the same time makes it pretty much impossible.

That is, as far as I can tell today, the big take home message about PPE: once the original supplies were exhausted, replacing them is becoming ever more difficult. As someone said on twitter a couple of days ago, you can't buy what is not for sale. The sorry saga of the RAF plane waiting in Ankara for a consignment that might or might not arrive is simply the corollary of the whole situation.

Therefore, in this instance, I think procurement and how it was approached (until recently) are not to be criticised, unless we want to go into a more strategic discussion if this is the kind of purchase that should be left to individual CCGs (200+) or should be in the hands of NHS England (and the Wales/Scotland) at all times. Between centralisation and devolution of procurement my pendulum tends to swing towards the former rather than the later, and the set up of the NHS Supply Chain Co-ordination Ltd in 2016 tried to alleviate this. But this is not a hill I want to die on today, especially as hospitals are probably able to secure lower amounts of PPE with a bit of luck.

State of play

The last week or so brought plenty of news and movement in terms of how PPE procurement is being handled. On April 15th, the Health Secretary announced a new PPE plan and on April 19th Lord Deighton was announced as being 'brought in to boost PPE production'. About procurement, the first included the following:


The immediate question on my mind is "why then"? Why was it not done earlier *before* the whole world was scrambling for PPE? Naturally I do not know the answer but I do have the impression this is mostly rearranging the decks on the sinking PPE Titanic. There is simply not enough PPE going around the world that this new unit can buy. It is a red herring.

The appointment of Lord Deighton is, potentially more interesting and damning for the Government. With all the legal caveats I have exposed before, potential producers of ventilators were probed in mid-March to join a 'national effort' to produce ventilators in the UK. By then, the EU had already got the ball moving on the JPA for the procurement of, among other things, PPE. And that, by itself, will be enough to significantly affect the possibility of new PPE being procured.

Meanwhile, it is only on April 19th that the Government deems appropriate to prioritise new production of PPE via the domestic industries. Again the key question is "why then"? I will be brutal in my assessment and go out on a limb stating that solving the issue of PPE is not as sexy as the ventilators (machines! Kit! Hardware! Gadgets!) and as a mere consumable, that is something that should be dealt by those lowly front line procurement professionals. By the time the lack of PPE became a national scandal warranting the attention of politicians, it was too late to solve it via traditional procurement mechanisms.

And, as with the idea of designing new ventilators from scratch, whatever the outcome of this production effort will take too long to make an immediate difference (although I think it will make a difference at some point, whereas the newly designed ventilators won't).

That brings me to the title of this blogpost about needles and haystacks.

Opening the floodgates, loosing the needles in the haystack

There are good reasons why procurement follows procedures and is subject to principles such as transparency. One is that you get to know who is offering the goods and services you want to buy and through the procedure you have the opportunity to check the potential supplier against a number of metrics. It also entails a degree of opportunity and transaction costs which, like a stake on a poker table, force the economic operator to make at least a modest investment.

More or less at the same time of the ventilator industry call, a similar call was made for PPE (I think). By making a completely open call for people to help out, the Government opened the floodgates of information, contacts, leads and offers directly into the workflow of frontline procurement people. Can you imagine what is to be flooded with random offers coming via email and having to sift through all of them? It is the procurement equivalent of having to go through your spam folder and checking all emails to see which ones are legitimate.

The results are visible. Way too many leads, not enough staff. Too much chaff and fly by night operations of hazy middlemen. A haystack too big to parse through in time to find the real needles that might not been available via the traditional procurement channels. But those tend to require an approach different from the cookie cutter procurement done of a catalog or a database. Plus, how many real needles would be available to provide PPE *at scale* as required by a centralised effort?

That effort, valiant as it might be, needed to be done *outside* the traditional procurement channels and not funneled into them. This, for me is the second critical error done by the Government when it comes down to the procurement of PPE (the first, sitting out on the JPA). The time where we needed an effort to stitch together different suppliers (pun intended) was, once more, weeks ago. Perhaps, not as early as the ventilators but surely by mid-March when it was obvious the demand for PPE would explode and new supplies would be needed.

The time when someone with Lord Deighton's remit was needed, was 4-6 weeks ago. But again, PPE is not sexy and swamping procurement officers with low quality leads seemed a good enough effort to get the media monkey out of the Government's back.

In the meanwhile, good luck Lord Deighton. Our NHS staff (frontline and otherwise) need that PPE.