Quality issues found with ventilators ordered during pandemic

The Health Service Executive ordered over ten times the estimated number of ventilators clinically required in hospitals during the Covid-19 pandemic.

A report by the State spending watchdog, on the emergency procurement of ventilators by the HSE, shows it ordered 3,500 ventilators at a cost of €129m.

The report by the Comptroller and Auditor General (C&AG) which was published this morning, shows this was twice the number approved by the Department of Health.

The C&AG said €80m was paid to new suppliers the HSE had not previously done business with.

While some of these orders were cancelled, many of the ventilators that arrived were not fit for purpose

The report said quality issues emerged quickly after the first deliveries of devices from some of the new suppliers, with 41 of the 100 examined failing performance tests.

"HSE staff had no experience using any of the ventilator models being offered by the new suppliers."

The report found that many of the orders had no written contract and were with suppliers who had no experience in the field, and upon whom no due diligence was carried out.

Even when due diligence was carried out and red flags were raised, the report notes that purchases went ahead anyway.

Seamus McCarthy, Comptroller and Auditor General, warned that "[there] is currently no practical guidance available to public bodies on the use of advance payments" and recommends that this be addressed.

In this case, advance payments topped €80m - of which more than €30m has not been recovered.

The report documents orders "for almost 3,500 ventilators at a total cost €129m".

HSE clinical staff had already estimated that only "an additional 326 ventilators would be needed" to existing stock when the pandemic hit, early in 2020.

Despite this, when the health agency approached the Department of Health, it had "sanctioned the purchase of 1,900 ventilators at an estimated cost of €73.5m".

No business case was submitted to justify the massive outlay.

It appears that the department simply approved all the purchases the HSE had made, or was in the process of negotiating, the report finds.

Then, in March and April 2020, the HSE went ahead and ordered 3,500 ventilators.

This was "almost twice the number approved by the Department and over ten times the number the HSE estimated could be clinically used".

'Little or no experience' among suppliers

Many of the orders - for 2,200 units - went to new suppliers who "were not directly involved in the manufacture of ventilators and had little or no experience in the supply of those devices".

"No due diligence checks were carried out for four of the ten new potential suppliers to whom the HSE made advance payments," Mr McCarthy finds.

In these cases, "written contracts and/or purchase orders were not in place", with only "verbal contracts" agreed.

Where checks were carried out, they "flagged various financial and quality risks with the new suppliers" but the purchases went ahead anyway, with advance payments of €81m being made.

Of this, more than €8m will never be recovered, and while €50m has been returned to the HSE, it is still trying to claw back the remaining €22m.

Not one usable ventilator was received.

Many were not even delivered.

Those that were did not reach Irish quality standards, and were donated abroad.

India received 365 units worth €6.8m, and a further nine - worth €202,554 - were donated to health authorities in Nepal.

This accounts for the bulk of the more than €8m made in advance payments which "is irrecoverable".

"The HSE is currently pursuing refunds of €22.3m", the report notes

All 1,048 ventilators which the HSE deployed came from its "established suppliers" at a cost of €20.3m.

Chairperson of the Public Accounts Committee, Sinn Féin TD Brian Stanley, said that he is "very concerned" at the "damning" findings.

"As chair of the PAC, I will be asking the committee to write to the HSE for answers," he said.

Ventilators are medical devices used to deliver medical gas comprising of varying concentrations of oxygen into the lungs of critically ill patients, assisting them to breathe.

In early 2020, the World Health Organization set out the minimum technical specification of a ventilator to be used to treat Covid-19 patients.