Applying finance skills to PPE (#DoingOurBit)

‘We wanted to do everything we could to support the Covid efforts,’ she says.

Most of the focus of her finance work is on efficiency, quality improvement, developing business cases and supporting the trust in implementing the mental health investment standard. There are parallels in her day-to-day work on efficiency and Lean system working and organising PPE, but she acknowledges it has been a huge change.

One of the biggest differences was in working patterns. In the early days 12-hour shifts were common, working seven days a week. ‘Finance staff are not used to working seven days a week and being on-call at weekends, but I am hugely proud of how the team has stepped up to the challenge. We haven’t had an incident where we have significantly run short of PPE to date. We have worked well with our system partners with fantastic communication with the acute trusts and local authorities in the STP area and we have shared PPE products as needed.’

As a community, mental health and learning disability services provider, the trust does not normally need large stocks of PPE. But, as virus cases grew in the early days of lockdown, it quickly became apparent that the trust was not set up for the receipt and storage of relatively large volumes of PPE supplies that were being pushed out by NHS Supply Chain. The range and volume of products received, such as face masks, aprons and gowns, was a significant increase in products from those routinely used by staff in the trust.

‘We weren’t set up in any way with a system for the storage and distribution of these products,’ Ms Mascia says. ‘We normally don’t use lots of consumables. I got involved through a combination of having the capacity to look at this, and being somebody who understands stock control – my knowledge of quality improvement and Lean, for example, helped. There was also a capacity shortfall in the trust’s procurement team as there were unfilled vacancies.’

Initially, her focus was on setting up a method of recording the stock received by the organisation and working with colleagues in logistics to identify the supplies that had come in.

‘We are a multi-site trust and products were coming into our corporate headquarters and to each of our three hospital sites. We initially worked with the logistics team to locate all the stock. NHS Supplies was putting products on pallets and delivering them to us with no record of what was being delivered. So, we had to work with the logistics team to check everything we had received and, as we didn’t have a central store facility, we had to find somewhere that logistics thought would be a suitable place for storage.’

Her small team of three encouraged logistics staff to record everything received, including quantities, on a simple Excel template. Each day they report opening and closing stock, together with deliveries received and supplies that have been sent to the care delivery points, in order to maintain an accurate stock record.

A spreadsheet is also being used to enable wards and departments to order PPE, such as surgical masks and gloves, from products listed as available in the central store. Orders are sent from the wards and teams to the appropriate operational hub, a network that oversees the work of individual services. The hub validates orders and ensures items are not being stockpiled and are appropriate for the service being provided. Approved orders are then sent to logistics for picking and delivery.

All this was largely achieved from home, working on the Microsoft Teams app. With her cost improvement hat on, she can see the potential for efficiencies to be gained or maintained. She adds: ‘It’s been good in terms of problem solving and doing things at pace, where in the past, sometimes, you would write a business case to implement change, tweak it a few times and then go through a lengthy sign off process before altering anything.’

The partnership trust is beginning to restore services but, with the threat of infection still strong, it will continue to need more PPE than before the outbreak. ‘We are using 25,000 gloves a week – at the start we were probably using half that amount. The need for PPE will remain so we need to think about how we restructure the management of PPE in the longer term. At the moment, we have people who are doing this role in addition to their day job and, as services resume, I certainly feel a pressing need to return to my core role.’

As well as ensuring the right personnel are helping to keep the supplies moving, the system must be resilient. ‘All staff working in trust buildings are now required to wear surgical face masks so we must keep on top of that in terms of how many we are using each week. If we have a second wave of infection, we need to ensure that we have a function that can ramp up again quickly.’

Though she is keen to get back to her substantive post, Ms Mascia values the experience.

‘It has been so rewarding for everyone involved. In finance you can feel a little bit disconnected from the front line. But this is very real. Every day we have a briefing with the incident room, with the hubs reporting on what they are doing in response to Covid. Hearing how they are caring for a Covid positive patient or that a patient is seriously ill makes this the most real experience of working for the NHS. This gives us a link to patient care and helps the team recognise how our efforts are having a direct impact on a clinician and their patients. 

‘This experience has provided great learning for all the team and has enhanced their skills and understanding of service pressures that will be of benefit when we all return to the day job.’