Health and social care workers could be asked to volunteer to look after people with Covid-19 without wearing protective equipment in the event of extreme shortages, according to proposals seen by the Guardian. Councils oversee a range of services which require PPE but which are outside the NHS supply chain. These include care homes, pharmacies, mortuary and funeral services, children’s homes and community mental health services. While these services have access to the national PPE stockpile there are sometimes shortages of key items. The PPE situation in NHS hospitals has improved since the start of the pandemic but gaps in community provision continue. Southampton city council has drawn up an ethical framework document to help councils plan for further waves of the pandemic. One proposal contained in internal documents marked “sensitive” from a council planning to adopt the Southampton blueprint, shows that in the event of extreme shortages using PPE that has not been approved by regulators could be considered. In the event of having no PPE available at all, staff could be asked to volunteer to care for people who have or may be infected with Covid-19, without protective equipment. The document suggests that health and care workers who have already had Covid-19 may be suitable volunteers for this high-risk practice although it states that staff should not be put under undue pressure and that human rights legislation should be taken into account. The Unison senior national officer Gavin Edwards condemned the proposals. He said: “Expecting care staff to work without safety kit would be a short-sighted and dangerous gamble. There would then be little, if anything, to stop the spread of the virus to staff, the people they care for and the wider community.” Jasmine Ho of Med Supply Drive, a group of doctors responding to requests to source PPE for staff in hospitals and community settings, said 81% of its requests had come from community and social care providers. “Some of the people who contact us requesting PPE sound quite desperate,” said Ho. “There is a strong likelihood that there will be a second wave of Covid and we should be prepared. We find it unacceptable that more than 200 healthcare workers have died. In this local authority guidance it is incredibly irresponsible to be thinking about asking people to volunteer to work without PPE in a situation where none is available.” Dr Jenny Vaughan, law and policy lead at the Doctors’ Association, said: “Nobody should be put at unnecessary risk just for going in and doing their job. We simply don’t know if having a positive antibody test confers safety and if it does, for how long. Asking staff, when there is no PPE, to expose themselves to risk in this way is not acceptable.” Councillor Lorna Fielker, cabinet member for health and adult care at Southampton city council, said: “We recognised in light of the national pandemic there would be significant challenges for government in ensuring local areas had sufficient PPE to protect their key workers.
“Southampton city council developed a robust and transparent framework that can be used by other local authorities and partner agencies … to help them determine how they can prioritise and allocate PPE, in the event that PPE supply is insufficient to meet demand. “The framework is informed by ethical principles and advises organisations to consider the limits and level of risks to all staff (including, but not limited to, health and social care staff) if the organisation is not able to provide appropriate safety and protection in relation to PPE. “The framework acts as guidance, has not been used to date and is only to be used as a last resort by local authorities and partner agencies.” Debbie Chase, interim director of Public Health at Southampton city council, added: “Southampton city council and the strategic coordinating group for Hampshire and the Isle of Wight took proactive steps to develop a carefully considered, ethically informed and transparent framework to support decision-making, in consultation with a range of stakeholders, including trade unions. “The prioritisation framework was developed in April during the national shortage of PPE and submitted to the secretary of state for health and social care as evidence of the unacceptable reality of what we were having to plan for. It highlighted that the potential actions contained in the framework would not be considered appropriate or safe, and recommended that PPE shortages needed to be addressed at a national level. “We have a duty to plan for the reasonable worst-case scenario – in this case a situation whereby we were unable to fulfil at least minimal obligations to provide appropriate safety and protection in relation to PPE. The framework explicitly states that working in conditions without adequate PPE cannot be imposed on staff, and that we would not, in any circumstances, pressure staff to provide care or services without adequate PPE.” This article was amended on 4 June 2020 to add the response from Debbie Chase, interim director of Public Health at Southampton city council.