Lack of surgical gowns for medics 'a disaster in waiting', say NHS bosses

Hospitals across England are running out of the surgical gowns needed to treat patients with Covid-19 and do not know when fresh supplies will arrive, two secret NHS memos reveal.

Senior NHS leaders in London who were warned about the shortage in an email on Thursday evening say they are “alarmed” and that the lack of gowns is “a disaster in waiting for staff health”.

The grim picture of serious shortages of personal protective equipment (PPE) is underlined by a separate letter sent on Thursday morning to intensive care nurses at the Royal Free hospital in London warning them bluntly that “we will no doubt run out of items over the weekend”.

Surgical gowns are vital for protecting staff who are performing procedures on patients infected with the disease that might spread it to them, such as putting someone onto a ventilator, taking them off again or resuscitating them, for example using CPR if they have had a heart attack.

The memo to the bosses of hospital trusts and clinical commissioning groups in London read: “There are no immediate stocks of gowns due in the national supply chain over the next few days and we are unsighted on when further deliveries will be made.”

Full-length surgical gowns play a vital role in keeping staff safe while they manage confirmed Covid-19 cases because they stop droplets of infection from getting onto the doctor or nurse’s normal clothing and leaving them or colleagues at risk of them getting into their mouth, nose or eyes.

Symptoms are defined by the NHS as either:

• a high temperature - you feel hot to touch on your chest or back

• a new continuous cough - this means you've started coughing repeatedly

NHS advice is that anyone with symptoms should stay at home for at least 7 days.

If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home.

After 14 days, anyone you live with who does not have symptoms can return to their normal routine. But, if anyone in your home gets symptoms, they should stay at home for 7 days from the day their symptoms start. Even if it means they're at home for longer than 14 days.

If you live with someone who is 70 or over, has a long-term condition, is pregnant or has a weakened immune system, try to find somewhere else for them to stay for 14 days.

If you have to stay at home together, try to keep away from each other as much as possible.

After 7 days, if you no longer have a high temperature you can return to your normal routine.

If you still have a high temperature, stay at home until your temperature returns to normal.

If you still have a cough after 7 days, but your temperature is normal, you do not need to continue staying at home. A cough can last for several weeks after the infection has gone.

Staying at home means you should:

• not go to work, school or public areas

• not use public transport or taxis

• not have visitors, such as friends and family, in your home

• not go out to buy food or collect medicine – order them by phone or online, or ask someone else to drop them off at your home

You can use your garden, if you have one. You can also leave the house to exercise – but stay at least 2 metres away from other people.

If you have symptoms of coronavirus, use the NHS 111 coronavirus service to find out what to do.

Source: NHS England on 23 March 2020

Some hospitals are responding to what bosses fear will be a shortage of the gowns lasting until at least the end of next week by trying to adapt boiler suits bought from DIY shops and ponchos usually worn at outdoor events as adequate replacements. Others are reclassifying certain areas of care as low-risk rather than high-risk in an attempt to conserve supplies.

The Royal Free is finding it impossible to ensure it has adequate supplies despite its ICU – one of the biggest and most admired in the NHS – playing a key role in the fight against Covid-19 and it being a regional centre for treating infectious diseases.

The two memos, both seen by the Guardian, contradict repeated assurances by ministers and NHS bosses that they are getting on top of the widespread shortages of PPE that have produced panic and fear among frontline staff. A lack of gowns, aprons, face masks and visors has been implicated in the growing number of NHS doctors, nurses and other staff dying after contracting Covid-19.

Downing Street on Thursday sought to reassure alarmed staff that the NHS is improving the supply of PPE by disclosing that 33m items were delivered to hospitals, GP surgeries and other places of care alone on Wednesday. In all, 600m pieces of PPE have reached the NHS frontline over the last month, No 10 insisted.

The shortage of gowns in particular is worrying hospital bosses as they are a vital element of the full PPE which NHS staff are meant to wear when undertaking any aerosol-generating procedures, in which a patient may expel droplets from their mouth or nose.

One hospital chief executive said: “There simply aren’t enough gowns in hospitals going into Easter weekend, despite there being thousands of patients in intensive care units and other areas of hospitals with Covid-19, and we are going to have to cover the guts of a week with no new gowns. This is a disaster in waiting for staff health.

“This is a massive problem because the new guidance on PPE that Public Health England (PHE) brought out last week says that staff working in high-risk areas full of Covid patients need to covered below the elbow. That’s a reversal of the ‘bare below the elbow’ policy that’s been adopted across the NHS since MRSA emerged as a problem.

“As chief executives we said to PHE: ‘If you’re going to use the guidance to require NHS staff to wear gowns more often then you had better ensure that there are always plenty of them available’. They said they would. But here we are without enough gowns this weekend.”

On Wednesday, Chris Hopson, the chief executive of NHS Providers, said that it was a national problem and that he had had “reports from a number of trusts that their supply of clinical gowns is getting tight”. However, the memo sent to London bosses appears to undermine national NHS leaders’ pledges to Hopson that “there are sufficient stocks of gowns already in the system … further deliveries of gowns [are] scheduled to arrive shortly”.

NHS England and ministers have insisted that shortages of PPE are due to “local distribution issues” rather than inadequate supplies and that they have scaled up deliveries over the past three weeks, often using army trucks to help. However, NHS staff groups say that problems persist despite those efforts.

The Royal College of Nursing this week told the Commons health select committee that nurses “are facing impossible decisions between their own or their family’s health and their sense of duty”.

The Doctors’ Association UK (DAUK), a network of grassroots medics, said the lack of gowns was a potential “disaster”.

“Employers have a legal obligation to provide the correct level of protective equipment to their employees when they are engaged in hazardous work.

“[NHS staff] should always be wearing the correct PPE for any given situation. Not knowing when vital PPE stock will be available signals the need for the government to urgently get a grip of the situation to protect the frontline”, said Dr Rinesh Parmar, DAUK’s chair.

“News of these reports represents nothing short of a disaster for the NHS and its employees. It corroborates what the DAUK has been hearing from frontline doctors for weeks and contradicts the line that this is a simple distribution issue.”

An NHS supply chain spokeswoman said: “We recognise that some trusts have low stocks of gowns and we are working hard with NHS England and NHS Improvement and across government as part of a central team to ensure those with the greatest need are prioritised to receive deliveries.”

Noting that it was crucial all PPE meets safety standards, she said that 119,000 gowns had been delivered in recent days, with more expected soon.