A photo already submitted to an exhibition featuring people working on the frontline shows nurse Aimée Goold with marks on her face after a shift wearing a PPE mask designed for men. Picture Credit: Facebook
SPECIAL REPORT by Bill Heaney
The Cabinet Secretary for Health, Jeane Freeman, appeared before the Holyrood Health and Sport Committee on Thursday to answer MSPs’ questions on the Scottish Government’s handling of the Covid-19 crisis.
Especially the disastrous procurement of PPE for frontline workers and the purchase of face masks which were designed for men and handed out to women and other NHS workers on the frontline.
Thousands of words, revelations and explanations, were spoken in public before it was announced by the convener, Labour MSP Lewis Macdonald, that the meeting was going into secret session.
This was contrary to the commitment given by First Minister Nicola Sturgeon that she wanted to be open, honest and transparent with the public in relation to how this crisis is being handled by her government.
She stressed then that we were all in this together and that politics should not be brought into the debates surrounding it.
The First Minister must know that you cannot be open, honest and transparent when you close an important meeting, exclude the press and public and cut off the virtual coverage of what’s going on.
Especially when the most controversial issue, the procurement of PPE for the Frontline NHS staff and local government and private care homes and the initial failure of the government to get hold of it, was at the top of the agenda.
Jeane Freeman was accompanied by Paul Cackette, director of the Scottish Government’s PPE unit, and Mike Healy, interim deputy director of health resilience. Ms Freeman said: “The safety of our essential front-line workforce is an absolute priority for all of us. We are continuously looking to improve supply and distribution of the protective equipment that is so vital in the fight against the Covid-19 virus.
“Since March, we have delivered more than 160 million items of PPE: 117 million items to the acute sector, 35.1 million to social care and 8.1 million to community care.
“Our job is to ensure that everyone who needs PPE gets the right PPE, at the right time and in the right circumstances. What constitutes the right PPE is, of course, defined by clinical guidance that is relevant to the scenario in which an individual works.
“Protecting the people who work in hospitals and care homes and as unpaid carers, along with those who work in other sectors that we support, is a priority.”
However, she added, it was important to recognise that, at the outset, the normal way of working in the health service in Scotland was to supply PPE to the health service, with other employers being responsible for their own workforce.
“Other employers” are private care homes, dentists and the like.
She added: “That has now changed, as supply chains in social care and to local authorities have in some respects failed, and we have stepped in to ensure that supplies are nonetheless maintained, for the staff, the patients and the residents involved.”
Ms Freeman went on to talk about the challenges this change had caused, but she and her officials were never asked to explain why the required PPE was not in place from the very start of their having to deal with the pandemic.
There was a great deal of self-congratulations which could easily have turned into back slapping had social distancing not been in place – “I place on record my thanks to my senior officials, to NHS National Services Scotland and to health boards for their close work together to manage the supply of PPE to front-line workers,” Ms Freeman said, making it sound as if the government had scored a great success in this matter. In fact, this was something which attracted the most public criticism.
Convener Lewis Macdonald cut in: “Last week, you estimated that we would need something in the order of 83 million masks, 108 million aprons and 111 million sets of gloves over the next 12 weeks. Broadly speaking, are you still working to those ballpark figures? Are you confident that you will be able to maintain that level of supply over the 12 weeks?”
Ms Freeman said she was – “Those are broadly the right numbers. An issue for us in modelling demand is that although that is relatively straightforward for us to do for the hospital setting, because we can easily get figures from each [health] board on what they currently hold and match that against what we have in the stockpile, it is more difficult to get the volume of stock that is held in the 1,083 care homes and for social care.
“The demand modelling is constantly evolving as we feed in the data about what is held as stock in individual settings and what we know that we have in our national stockpile.
“Overall, we have taken the precautionary approach, on the basis that we will always need PPE, so if we order more than we eventually need for the current situation, it will not go to waste—we will continue to need it. Of course, that produces a financial pressure that we have to manage, but I think that the precautionary approach is the right one to take.”
In other words, she said that if a similar situation arose again in the future, the government would be ready for it this time.
Looking at the figures for today, she added, and taking into account orders in hand that we are confident about, the stock levels in individual health boards that we know about and what we have in our national distribution centres, we appear to have stock of the IIR mask that will take us through to November this year at the latest, and stock of hand sanitiser that will take us to July.”
The supply of FFP3 masks was “challenging”. They did not run out of them, but that is no longer the case, because “the supply chain is now much more secure”.
On badly fitting face masks that were purchased for workers who are at least 80 per cent women, Jeane Freeman said: “We also invested in machines that provide an objective assessment of whether masks fit properly.
“FFP3 masks are exceptionally uncomfortable to wear. They produce skin irritation and indentations on the face because they fit so snugly, as they have to do.
“We invested in those machines to ensure that individual staff members have confidence that their masks fit properly. Every health board area has one—I think that we have 18, which includes one in NSS that is ready to replace any that might fail.
“The machines provide objective evidence as to whether the mask fits, which provides additional assurance.
“We invested in those machines because we recognised the concerns and the need for people to be confident that masks fit.
“The masks are used in the most serious situations in which aerosol-generating procedures are taking place and there is close engagement, so staff members are most at risk of the virus entering their body. The machines are critical to ensure that staff have confidence that their masks fit.
“Another point is that the masks are, by and large, designed to fit the male face. I cannot think of another way to put that. Overall, men have different face shapes and sizes compared to the majority of women.
“At the moment, there is nothing that we can do about that, but we will log the problem to see whether it can be addressed through the design, manufacture and supply of masks so that fewer mitigating measures have to be taken for women when masks do not fit properly.
“In some instances, that happens because the masks were not designed to fit the shape of the female face.”