Opening statement made by BMA, 03 March 2025

1. Poor procurement and distribution of vital healthcare equipment and supplies meant healthcare staff had to care for their patients with scarce resources, inadequate equipment and the ever-present danger of a potentially deadly virus, often without the protection they so desperately needed.   

2. This had a devastating and lasting impact on staff and patients alike, causing stress, anxiety, moral injury, infection, long term disease and sadly death.   

3. This statement covers the procurement, distribution and the experience of the end-user in relation to PPE, testing, ventilators and oxygen. 

PPE

4. The quantity and quality of PPE supplies was woefully inadequate, with over four in five respondents to a BMA survey stating that they did not feel fully protected during the first wave.   

5. There were severe shortages of PPE across all healthcare settings, particularly in the early months. Healthcare staff were forced to go without PPE, reuse single-use items and use handmade or self-bought items. One GP in Northern Ireland told the BMA “We were sent 6 pairs of gloves and 6 aprons in an envelope approximately 3 weeks after the start of lockdown”.  

6. Some Inquiry witnesses have stated that the UK never ran out of PPE, and that the problems were with the distribution rather than overall quantities. It will be important for the Inquiry to fully explore both of these issues. And yet the bottom line remains that healthcare staff did not have access to the lifesaving PPE they needed, when they needed it.   

7. In some cases, PPE was defective and failed to meet safety requirements. Some of these faulty items reached frontline staff, with numerous reports of face mask straps breaking. Ultimately, billions of pounds worth of PPE arrived unfit for purpose and had to be destroyed.  

8. Many BMA members reported feeling pressured to work without adequate protection. They lived in constant fear for their own lives, and the lives of their patients, colleagues and loved ones.   

9. Many healthcare workers, including over 50 doctors, tragically died, and it cannot be emphasised enough that these deaths were not inevitable.  

10. Large numbers of staff developed Long Covid, and they continue to experience the devastating personal and professional effects, with many unable to work or train, losing their careers and livelihoods as well as their health.  

11. Adverse impacts were also disproportionately experienced by women, ethnic minority staff, and those with a disability or long-term health condition.   

12. There are many factors that contributed to these failings, but for present purposes the BMA highlights just three of the main causes:   

13. First, pandemic planning for PPE was inadequate. The focus on pandemic influenza rather than preparing for a wider range of threats meant that stockpiles were primarily comprised of Fluid Resistant Surgical Masks, rather than Respiratory Protective Equipment, which protects from aerosol transmission. Alongside this, the UK’s ability to supplement PPE stockpiles in times of crisis was compromised by a reliance on ‘Just in Time’ contracts and a lack of domestic manufacturing capacity.  

14. Second, there was a failure to procure adequate and appropriate PPE as a direct result of flawed Infection Prevention and Control (IPC) guidance which failed to recommend adequate protection against aerosol transmission despite longstanding scientific understanding of the level of protection required in these circumstances. This failure was influenced by the critical shortage of Respiratory Protective Equipment in early 2020. Further, once the IPC cell recommended that Respiratory Protective Equipment was not required for routine care of Covid-19 patients it stubbornly refused to revise its position later in 2020 when there was increasingly strong evidence for aerosol transmission and at a time when the easing of supply constraints would have made it possible to procure the necessary quantities of respiratory protection, but for the limitations imposed by the guidance. These mutually reinforcing influences – the initial shortages which led to flawed guidance followed by the stubborn refusal to change the flawed guidance - worked together to leave staff severely unprotected throughout the pandemic.  

15. Third, the failure of government leaders to act quickly to secure adequate stocks of PPE, including the failure to participate in the joint EU procurement scheme, and processes that were characterised by delay, lack of transparency and a lack of due diligence – notably in the use of a High Priority Lane.  

16. At a time when frontline staff had been risking their lives working in an under-resourced and unsafe system, BMA members felt particularly let down by reports of these failures and the significant amounts of money wasted.   

Staff safety was also affected by a lack of access to testing 

17. The initial limited capacity to test at the scale needed, combined with shortages of tests themselves and the UK Government making relatively little use of the pre-existing NHS laboratories caused delays in identifying cases and likely meant that staff unwittingly transmitted Covid-19 to patients and colleagues. It also impacted staff capacity at this critical time due to self-isolation.  

Ventilators 

18. Procurement processes for this equipment were inefficient and inadequate, and resulted in the provision of ventilators that were unsafe, unsuitable and unfamiliar to staff, which led to the need to transfer patients to different hospitals due to a lack of critical care capacity.   

19. Time and money were also wasted on new ventilator prototypes which were never ultimately purchased, despite the fact that there were ventilator models that were already approved by the MHRA.   

20. All of this led to localised shortages of ventilators, especially in London during March 2020, in response to which, anaesthesia machines, which are only designed to be used for a few hours at a time, were repurposed and used as substitutes for ventilators. The necessity of this measure highlights the critical gap in capacity at the height of the first wave.   

21. Such shortages also had significant impacts: they affected patient care; and they also exacerbated the atmosphere of stress and uncertainty for staff, at an already incredibly challenging time.  

Oxygen 

22. The pandemic exposed significant vulnerabilities in the UK's medical oxygen supplies to hospital wards, which had never been subjected to the strain they were under during the peaks of the pandemic in 2020 and 2021.  

23. The risk of a sudden loss of oxygen pressure within hospital oxygen delivery systems was a major concern and to reduce the risk of this happening, delivery flows were maximised and staff were told to ration oxygen by reducing target oxygen saturation levels in patients, which contributed to stress and moral injury. One Resident Doctor in England told the BMA that “it was mostly luck that our oxygen supplies didn’t fail”.  

24. This highlights an important structural issue. Aged hospital estates are a key strain on oxygen levels and it is crucial that hospital estates are upgraded to ensure they can deliver high-flow piped oxygen when the next pandemic hits, so that this life-saving resource is readily accessible at the levels required when needed most.  

In conclusion 

25. Millions of pounds of public money were wasted through rushed and ill-thought-through procurement during the pandemic, including PPE that never reached healthcare staff and ventilators that never reached patients.   

26. Procurement and distribution of healthcare equipment are not just bureaucratic processes; they are a lifeline, that provides critical protections and supplies to ensure the safety of those who work in the system and those they care for.  

27. The failure to do this has impacted the physical and mental health of healthcare staff, and the lack of transparency, robustness and value for money has damaged their trust and confidence in the systems that should have protect them and their patients. Trust will not return easily, and the Inquiry’s recommendations in this module will be a vital part of the journey to rebuild it.   

28. The BMA respectfully requests that the Inquiry focusses on issues and evidence that will:   

• First, lead to better protection for healthcare staff, including through a reliable, diverse supply of PPE available to suit all staff and for a range of potential pathogens.   
• Second, improve patient care and reduce staff moral injury through better supplies of key equipment such as ventilators and the ability of NHS estates to supply oxygen at scale in future emergencies.   
• Third, reform procurement and outsourcing processes to ensure greater transparency, efficiency, and accountability, and   
• Fourth, increase domestic manufacturing capacity for PPE and other key healthcare supplies.