The must-read stories and debate in health policy and leadership.

A huge financial reckoning is coming at some point this year, when the NHS and government realises just how much has been spent on protective personal equipment during the covid response.

Spending data from Liverpool University Hospitals Foundation Trust has revealed huge mark-ups in the prices it paid for PPE at the height of the pandemic – with key items routinely costing up to 10 times the normal price.

The trust, which is one of the largest in the country, spent £3.3m spending on PPE during April, the bulk of which went on face masks and gowns.

The data suggests 225,000 FFP2 facemasks were bought for an average price of £4.90, which is almost 10 times higher than the 50p value it assigned to the same facemasks it received from NHS England.

Around 114,000 IIR facemasks were bought for an average price of 86p, compared to the 20p value assigned to the NHSE stock, and around 392,000 gowns were bought for an average price of £4, compared to a 50p valuation, the data suggested.

Several procurement directors suggested the prices were par for the course. One said: “At the peak there wasn’t really such a thing as a bad deal. Delivery costs are included in the prices and air freight is very expensive…. sea or rail takes four to eight weeks so were no good.”

Another said: “I think you could literally go to any trust and find terrible deals in April. Chief executives were saying ‘do whatever you need to do’ to get PPE in. Some staff had died from covid and junior doctors were on the verge of walking out. We were all desperate.”

One peak or two?

There’s a lot of talk about local lockdowns but sometimes it is hard to see the peak of a covid outbreak until it is over.

That may be the case in parts of East Kent where a surge in positive tests in Ashford in mid May seems to have contributed to a high number of deaths at East Kent Hospitals University FT in June. For one week – 19 to 25 June – the trust had 8 per cent of all hospital deaths in England.

The trust has suggested this was a second peak but in reality the first peak never ended. There has scarcely been a day in April, May and June when the trust did not have at least one death. It’s grim reading but there is also a question over whether a disproportionate number of cases were acquired within the hospital.

The good news is that community cases seem to be waning which should feed through to fewer cases in hospital and ultimately to a decline in the number of deaths.