Documents reveal deep concern over Ireland's spending on PPE during pandemic

HSE said PPE markets extremely volatile and Ireland was ahead in securing key supplies

The HSE said the PPE markets were “volatile, complex and uncertain”. It said additional and secondary supply lines had to be opened at pace. Photograph: Alan Betson

The HSE said the PPE markets were “volatile, complex and uncertain”. It said additional and secondary supply lines had to be opened at pace. Photograph: Alan Betson

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Last Wednesday, the Minister for Health, Stephen Donnelly, told the Oireachtas health committee the Health Service Executive would spend €920 million on personal protective equipment (PPE) this year.

However, official documents show that behind the scenes over several months there has been serious concern among senior officials and Ministers regarding expenditure on PPE supplies.

The Department of Public Expenditure maintained that at one stage in the summer the HSE had spent at least €120 million more than the authorised levels set by Cabinet.

HSE chief executive Paul Reid. The provision of adequate PPE supplies was a key concern among HSE leaders at the start of the pandemic. Photograph: Tom Honan
HSE chief executive Paul Reid. The provision of adequate PPE supplies was a key concern among HSE leaders at the start of the pandemic. Photograph: Tom Honan

The documents reveal that shortly after taking up office last summer, Donnelly asked the Cabinet “to regularise the financial sanctioning position of the HSE with respect to the procurement of PPE”.

He told HSE chairman Ciarán Devane on August 21st that most of the expenditure on PPE up to that point had not been in compliance with the agreed sanctioning process.

Devane said in reply that the HSE’s procurement operation had acted swiftly and decisively to the pandemic and “resulted in Ireland being ahead of many larger healthcare systems in securing key supply lines”.

Key concern

The provision of adequate PPE supplies was a key concern among HSE leaders at the start of the pandemic.

In an average year the HSE spent about €15 million on PPE. However, 2020 was not an average year and the international market was anything but normal as countries competed against each other.

The HSE had been told by the World Health Organisation that globally the demand for PPE was 100 times the normal rate and prices were up to 20 times higher. At the same time it was supplying greater quantities to an increased number of facilities.

From mid-February the HSE started to provide PPE to GPs, out-of-hours services, university medical facilities and the Defence Forces. Later, more than €27 million in PPE would be provided to nursing homes.

The HSE entered into a major contract to secure significant stocks from China, based on an original Government approval for it to spend about €208 million.

On April 23rd it told the Health Budget Oversight Group, which comprises officials of the HSE, Department of Health and the Department of Public Expenditure, that an additional €48 million would be necessary.

The Department of Public Expenditure said the Government on April 26th agreed an overall provision of €251.8 million.

HSE chairman Ciarán Devane said the HSE’s procurement operation had acted swiftly and decisively to the pandemic. Photograph: Alan Betson
HSE chairman Ciarán Devane said the HSE’s procurement operation had acted swiftly and decisively to the pandemic. Photograph: Alan Betson

In May the HSE told the Department of Health it would need more.

The then Department of Health secretary-general, Jim Breslin, said that, given the scale envisaged, a further Cabinet decision would be needed.

Breslin told HSE chief executive Paul Reid he appreciated the extreme pressure it was facing but that securing official sanction was crucial.

He said “flash” reports on health spending circulated within Government indicated PPE expenditure already was running ahead of sanctioned levels.

Breslin wanted assurances the HSE was operating within official sanctions and, if it was not, that this would be corrected.

Authorisation

On June 17th the Department of Public Expenditure told Breslin that as of early days of that month the HSE had actually spent €371 million on PPE while the Government had authorised only €251 million. It said the Government had to authorise any such expenditure in advance, that a business case with options had to be submitted and Ministers could not be left “with a binary choice” to accept or reject a scenario set out by the HSE.

The HSE said the PPE markets were “volatile, complex and uncertain”. It said additional and secondary supply lines had to be opened at pace.

On June 26th the HSE sought a further €574.4 million on PPE to secure stocks until the end of 2020 or early 2021.

Part of the money was for surgical masks, which had become increasingly important as the National Public Health Emergency Team in late April had recommended that these be worn in significantly more circumstances.

Reid said this had “placed enormous pressure on HSE supply lines”.

He said that with strong support from the Department of Foreign Affairs and IDA Ireland and following a personal political intervention by then taoiseach Leo Varadkar, a deal had been reached with a South Korean company against the backdrop of an export ban on such products in that country.

Reid said in early July that IDA Ireland had advised that “in order to maintain the benefits of this exemption and to maintain the benefits of the commercial and political relationship between Ireland and South Korea” an initial batch from this order had to be secured urgently.

On July 27th the Cabinet agreed to provide additional funding of up to €670 million to regularise spending of €509 million already incurred or committed by the HSE and to cover estimated additional expenditure of €161 million to meet the cost of procuring PPE.