Don’t let the government’s over-egging of the numbers fool you – PPE still isn’t reaching the frontline

Just as clinicians have a ‘duty of candour’ with patients and their families, we should expect the same from our leaders

One of the abiding memories of 2020 will be the way the British public rallied around the NHS, protecting the service so that it could do the same for everyone else.

Each week, “clap for carers” has given vivid expression to the high esteem in which our doctors, nurses and care workers are held. Lockdown – tedious and frustrating though it is – has shielded the NHS from a disaster, where there would have been many more desperately ill patients than there were beds.

But what remains unclear is to what degree this country was prepared for a pandemic in the first place. The British people of all political persuasions are united in their desire to defeat the common enemy and are willing the government to succeed in its endeavour. No one doubts that ministers want to get protective equipment to staff on the frontline, not just in hospitals but in GP surgeries, dental surgeries and care homes too. Nevertheless, the facts remain indisputable, too often PPE is not reaching the professionals who desperately need it.

At the Royal College of Surgeons (RCS) of England, we have worked with the government to produce guidance so that professionals know when to wear which items of protective equipment. In April, we also conducted two surveys of surgeons and surgical trainees to track whether supplies allow that guidance to be followed.

We found that while 79 per cent of surgeons and surgical trainees continue to conduct urgent and emergency surgery – saving the lives of road accident victims, people with appendicitis, and those in urgent need of cancer treatment – a third say they still do not have access to an adequate supply of PPE. The supply picture was unchanged between the beginning of the month and the end.

The most acute shortages are of the items most needed to keep viral droplets out of surgeons’ systems, namely respirator masks, which keep the virus out of our noses and mouths, and the long-sleeved gowns which stop us getting splashed with potentially lethal fluids.

By counting each disposable glove separately, the government has boasted of supplying the NHS with one billion items of PPE. Remember, a single box contains 100 disposable gloves. These glib soundbites, therefore, appear more impressive than they actually are and hide harsh realities like the difficulties clinicians have getting the available PPE to fit properly.

More than a quarter of the clinicians we surveyed said they were not confident their PPE had been “FIT-tested” to an adequate standard. Wearing a full facial protection (“FFP”) mask without testing the seal and the fit, is of roughly equivalent use to sending a cyclist out with a helmet so loose it will fall off their head if they have an accident.

If the public at large feels isolated at present, the most isolating, lonely frame of mind of all is that of a doctor who knows they aren’t wearing the right protective equipment but is faced with a patient in dire need of help.

We are sworn by the General Medical Council (in a modern version of the Hippocratic oath) to “make the care of your patients your first concern”. Without adequate protective equipment, healthcare workers everywhere are facing impossible dilemmas. At the RCS, we have had no choice but to warn our members not to put themselves at risk. To save lives, we too must stay well.

The medical and caring professions have rushed to the aid of the country when it has needed us most: trainees have entered service early; retirees (often in high-risk groups themselves) have come back to work. In return, we ask that government levels with us about when and how they realistically expect to untangle the PPE conundrum – getting supplies flowing to every corner of the country.

Just as clinicians have a "duty of candour" with patients and their families – meaning we must be open about the risks people face from treatment and honest if something goes wrong – we should expect the same from government.

In time, we deserve to know how the UK found itself in this position on PPE, not to apportion blame but to make sure this does not happen again. While we can’t yet know why errors were made, we do know their consequences. Six weeks into the national battle against coronavirus, our leading soldiers are still marching towards the sound of gunfire without the armour they need.

Sue Hill is a consultant vascular surgeon and Vice President of the Royal College of Surgeons of England