The Logistics of Buying PPE from China

There is nothing simple about purchasing in this environment. This is not a normal purchasing environment, and it's really important that people understand that — this isn't business as usual. A lot of people are questioning why the NHS can't just increase its purchasing and get the job done, and it's not that simple.

There are so many challenges. The first to note is that the existing infrastructure in this country is designed to operate in normal market conditions, and it's very polished at doing that — it's a tightly honed operation. But the circumstances that operation now finds itself in are completely not business as usual.

So the first thing to talk about is: where is the stock? There is some stock on the ground in the UK. It's very limited and it's incredibly expensive. Then there is an enormous, seemingly never-ending supply in China, where it's very cheap but where there are enormous hurdles to purchasing. And particularly for a conservative organisation like the NHS — which is rightly conservative, because that's the best way to guarantee high standards and quality — the fraughtness of trading with China is incredibly challenging.

First of all, you have to understand there is a market with fraud at play. We actually think most people supplying things of questionable quality are doing so in good faith. There's a fear of a lot of profiteering, and maybe there is some of that. But there's a real question of how you know that what you're buying is the right quality. Then there's the Chinese government's involvement, and they are changing the rules — last week the rules changed two or three times in one week. As procurers, we had to quickly understand those new rules and adapt all our processes. To give you an example, as of the rule change on Thursday or Friday last week, we have to provide 18 different pieces of documentation for one purchase. So the hurdles are substantial, and having fluent Chinese speakers who are also international trade experts on the team is a definite advantage.

And the prices are changing. While we're gathering our 18 documents, the incredible demand means people are bidding up prices under your nose — what you think you're spending suddenly isn't what you're spending.

You have to juggle all of it. Our Chinese-speaking procurers will frequently have to stay up all night to secure stock at a price we've been quoted in real time and get a contract signed. And then there are the shipping challenges — actually getting stuff onto a flight and off the ground. So it's definitely not as simple as getting onto Amazon and ordering some PPE.

You're absolutely right about the team. We have the advantage of Chinese-speaking people with very strong connections and contacts, so I can't compare our experience to what it would have been like without them — but I imagine it would be much more challenging. One of the advantages is that most suppliers have minimum order quantities that are eye-watering, but because we have those strong connections, we have much more flexibility to buy smaller quantities that are within the sights of our crowdfunding.

If we didn't have that capability, we'd be struggling. We're not generally finding ourselves in bidding situations too often — we did this week, and so we made a decision. We closed a deal with the one supplier where we felt we were in a bidding war, and then moved to focus on other suppliers. So you don't have to operate in that environment. But I suspect that if we didn't have the skill on our team that we have, we might find ourselves struggling a lot more.

That's an extremely difficult question to answer, because what none of us really know is what's sitting in those warehouses. To that extent, their guess is as good as mine. But I can speak to the fact — and I won't name trusts — that we've had conversations with trusts who told us they're tearing their hair out, because they know the stock is there but they're struggling to meet the scale of demand within the time frames for dispatch. They've quietly said to us: if you guys can just get in there — you know which teams don't have equipment, you know what they don't have — just go for it. Just help. Because they recognise there's an agility we have that they don't.

So I think it's a bit of both. There is some lack of supply, and there is some dispatch hurdle. Those existing infrastructures are conservative, polished, finely honed — but they weren't designed for this situation. I think it's wrong to level criticism at those systems for not rapidly adapting into a different type of organisation than they were set up to be, because it's a big infrastructure to re-engineer to meet a completely different level of demand.

I spoke to a humanitarian aid expert who said: this is a humanitarian crisis, let's be really clear. And if you look around the world at how systems cope with humanitarian crises, it's always the case that the existing infrastructure struggles to change its way of operating to meet a type of demand it's not faced before. I like to think of ourselves as part of the solution to a complex problem that's been thrust upon us, rather than one created by us. The big system can move big supply in a fairly orchestrated way, and it is doing that — we know the gaps are reducing. But to expect it to be gap-free and flawless straight off the bat is unrealistic. That's why you need organisations like ours to fill in those gaps and be there when supplies fail.

Before last week, we were identifying need through social media. We'd broadcast our website, which has a "request PPE" button on it, and a lot of people hearing about us on social media were forwarding it to doctors they knew who didn't have what they needed. So it was very organic. We were using social media to target lots of high-profile doctor organisations, and one of them — the Doctors Association — we've now entered into an official partnership with.

The Doctors Association are doing something amazing. They spent quite a lot of time highlighting the gaps and talking about the problem, and then rapidly realised what they really wanted to be was part of the solution. So they've developed an app, and I'd strongly encourage anybody out there facing a gap to please use it to register their needs. They've chosen to work with us and with Let's Beat COVID as their dispatch partner — they feed the need through to us, and we meet it through our capabilities. In terms of scale, they launched the app last week and had over a thousand doctors register their needs within the space of a week.

Bear in mind this is a self-selecting sample — people who've already declared they don't have enough PPE. But amongst them, more than one in three had no eye protection. Considering we believe the eye is one of the routes of transmission, this is absolutely terrifying to me. Of the people doing aerosol-generating procedures, one in four also had no eye protection at all. So this is driving our purchasing plan right now, and a key focus for us is eye protection. On outerwear, from that same data set, about 75% don't have any long-sleeved gowns. We spent a lot of Easter trying to get sleeved protection to people. And again, of those doing aerosol-generating procedures, almost half don't have long-sleeve protection.

The NHS is inundated with suppliers. We did try to help them at the very beginning with the national supply, but the bureaucratic hurdles to getting involved at that level are astronomical. They must have heard from thousands and thousands of suppliers, and nobody has the bandwidth to vet every single person offering to help. I think it's the same at the government level — I don't think they'd have the bandwidth to process requests from teams like us.

And on "can't the government just solve the problem by throwing money at it?" — hopefully during this interview I've brought alive the concept that this isn't just a money problem. It's not that the NHS hasn't got enough money to buy what it needs, or that the government isn't throwing enough money at it. It's more about infrastructure. It's more about capability and reactiveness. What we're doing is a synergy — it's meant to be a support, a help. It's part of the constellation of solutions, and one which needs its own funding stream.

That's exactly right. It's about agility and responsiveness, and the fact that we've been able to design ourselves from the ground up. When the government and the NHS designed their procurement and delivery systems, they were designed for a very explicit purpose — and it's big and very hard to change rapidly. We had the advantage of coming into this specifically to tackle the problem of on-the-ground shortages, which is usually an emergency: people on their last box of supply, with replacements not yet arrived. We designed ourselves specifically to address that, which means we're fit for purpose. We have a very clear mission and we've structured ourselves to deliver against one objective: processes that let us go very rapidly from finding out about a need to turning it into a delivery. Everything inside our structure is designed to meet that objective. That's not true of the NHS procurement system, and that's why we're complementary.

We're not instead of them — that would be ridiculous — and we're certainly not competing. People have asked us that: well, you're fundraising, aren't you competing, aren't you undermining? We're not undermining, we're helping, we're synergistic, and we offer something different. We offer a different approach to the problem, which lets us come at it from a different side and provide real-time solutions.