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Between March and early August 2020, in response to the Covid-19 pandemic, the Department of Health and Social Care (DHSC) and Cabinet Office secured an additional 26,000 mechanical ventilators for use across the NHS, at a total cost of £569 million. In a report yesterday the Public Accounts Committee recognises this significant achievement and the hard work, collaboration, and commitment of individuals across both the public sector and UK industry. 

• Read the report summary
• Read the conclusions and recommendations
• Read the full report
• Read the full report (PDF)

But the UK Government lost a crucial month because it was “underprepared and reacted slowly” to the shortage of mechanical ventilators. There was no plan in place to source additional critical care equipment needed in the event of an emergency.

NHSE&I did not know how many ventilators the NHS already had, and when it finally put out a call to individual NHS Trusts for this information in late February - a month after the World Health Organisation announced a “public health emergency of international concern” on 30 January - it found that the NHS had around 7,400 mechanical ventilators:  far fewer than the 59,000 it then thought might be needed.  The Department began its initial efforts to buy more ventilators on 3 March, just over a month after the emergency was announced.

NHSE&I’s estimate of how many ventilators the NHS would need changed repeatedly: on 12 February initial estimates indicated a need of up to 59,000, by early March this had increased to 90,000, before reducing to 17,500 on 24 March and again to just 6,200 by 8 April. On 15 April, after the peak of COVID-19 hospitalisations, the Department set targets of 18,000 ventilators by 30 April and 30,000 by 30 June to prepare for a potential second wave. It missed both these targets but eventually reached 30,000 by 3 August. 

It is fortunate that the majority of the ventilators were not needed and that additional capacity is now available should it be required. However, the Committee is concerned that the Government’s targets were not effectively calibrated to need - and were not met.

Even in the extreme circumstances of the emergency, there must be clear protocols in place to ensure that public money is protected, and that any exceptions or changes to procurement are justified. Despite having to operate at speed, DHSC still had a duty to carry out full due diligence for all parts of the supply chain, and it is not clear that the Government’s checks were sufficient to provide that assurance.  

Chair's comments

Meg Hillier MP, Chair of Public Accounts Committee, yesterday said:

“The huge success, ultimately, of ensuring that no NHS patient who needed access to a ventilator was denied it should not be downplayed. But there is a strong sense that this came about much more by luck than design, and in fact it’s clear there was no design - DHSC incredibly had no plan for sourcing critical care equipment in an international emergency. It relied at first on an overseas market that was under great pressure and seeing prices increase exponentially because of the international nature of the pandemic. DHSC didn’t know what equipment hospitals already had, and its estimates of need fluctuated considerably as the pandemic progressed. Those targets that were set were universally missed.

“The extraordinary collaboration, hard work – and risk taking – that led to the successes of this operation cannot cover the fact that much of it would have been unnecessary had DHSC and the NHS had a better plan for what to do to fill gaps in critical equipment in an emergency – which in the case of Covid was for ventilators.  Every ventilator was purchased or built with taxpayers’ money and the right lessons must be taken, and applied, from this first step in the UK’s pandemic response. As treatment changes we need to be sure that the Government is learning lessons about how to react quickly to support the NHS.”

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Further information

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