Thread by @lewis_goodall

Spent the day talking to PPE suppliers/medical staff

The picture which emerges is an English procurement system which has major issues at both national and local level

Not all these problems began during this crisis, some seeds sown a v long time ago

This is what's happening

First though we need to remember that not everywhere has problems

We need to remember that those which do don't have problems in everything

and that the govt is right there is a huge demand surge

That said...

there's no getting away from it, talk to PPE suppliers about the English NHS procurement system and they groan

It's a problem at the both national and local level

At the local level, we now have what you might say is an absurd situation where NHS trusts are competing against each other, sometimes in price terms, to secure PPE.

The situ in England doubtless made worse by Lansley reforms of 2012 Trusts now a patchwork of sovereign bodies.

Spoke to Colin Cram, procurement expert: "bottom line is NHS England’s procurement processes are in total chaos, have been for 10 years and now people are dying because of it. Scotland/ Wales don’t have the same problem, nothing to do with size, they’re just better organised."

Then there's local bureaucracy. Suppliers want payment upfront and need decisions straight away, authorisation processes in various trusts means that's impossible - it often has to go through a chain of people which takes days, so they keep missing the opportunity to buy more

There is and has been some centralisation because of this crisis.

But manufacturers haven't had much luck there either

Some talk of a Whitehall system which is opaque and unresponsive

Spoke to a supplier today who was in position to offer 10 million facemasks to NHS

He tried govt email, didn't hear back

Tried again, didn't hear back

Got in touch with his MP, he put him in touch with DHSC directly

Nothing

In the end it was too late, contract went abroad

I spoke to several Welsh firms who have refashioned what they do and are now successfully supplying Welsh NHS

They're keen to land English orders but responsiveness slower from UK govt

Only hearing from UK govt now, weeks after starting Welsh supplies

Not all hunky dory in Scotland/Wales and England obviously but greater centralisation in S/W and a streamlined procurement system in those places are a couple of the reasons why they haven't downgraded PPE advice and England has

Once again- some hospitals don't have a problem. In those which do, staff feel bleak. They say they're being asked to choose between their own safety and their patients'.

Interestingly some I spoke to have come to dislike the talk of them as "heroes/angels" for this reason

Even worse for those in social care who don't have the loud voices of the doctors/nurses.

Worse, I've been told that some care home managers are telling staff not to use PPE because it "interferes" with their duties/they want to stockpile.

medical staff in England feel let down by Public Health England/govt, not just because they've changed the advice but because they do so whilst maintaining that downgraded PPE advice is definitely safe: "How can they possibly know that? And if so, why was it higher in 1st place?"

Lots more on this on tonight's @BBCNewsnight-BBC2, 10.45pm

One other thing- fraud. The "chaos" as Cram puts it in English procurement, means trusts are becoming vulnerable to fraud and dodgy companies selling goods which aren't up to spec or which are never delivered. quality control is much weaker because of the decentralised model.