Supply chain crisis leads to breathing equipment shortage

Delays to delivery of equipment have meant hundreds of patients across the UK with conditions including motor neurone disease, chronic obstructive pulmonary disease and obstructive sleep apnoea are unable to be discharged safely and provided with vital equipment in a timely manner.

Patients with these conditions are issued with breathing machines called continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) to use at home. These pump air through a mask patients wear at night and are designed to stop a person’s airway collapsing or narrowing while they are asleep, whilst ensuring they continue breathing.

As hospitals cannot discharge them safely without a machine, patients are spending longer in hospital, leading to greater pressures on beds and staff.

Members are reporting two-week delays before patients can leave hospital due to shortages of respiratory machines or accessories. This follows reports this week that delayed discharges are putting pressure on beds in trusts in Cheshire and Merseyside, Blackpool, South East London, Gloucestershire, and Bristol, North Somerset and South Gloucestershire.

Those living with the conditions at home are also suffering, with one trust reporting 48 patients on a waiting list for a machine who are not only constantly fatigued but are running an increased risk of suffering a heart attack or stroke without the vital treatment.

Without a breathing machine, those with jobs involving operating machinery or driving are too tired to work. Reports are emerging that although the NHS prioritises those with an occupational need, the breathing machine shortage is worsening HGV driver shortages across the country. 

Though no patient deaths have been reported as a result of the shortage, physios have raised alarms over the lack of machines severely affecting some patients’ quality of life.

Deliveries have been delayed by the ‘perfect storm’ of computer chip and container shortages, post-Brexit chaos at ports across the UK and overseas manufacturing shutdowns due to Covid-19.

Some shipments of breathing machines have being held by UK customs for several weeks with HMRC unable to advise on when equipment will be released. This was on top of shortages caused by one of the nation’s largest suppliers, Philips Respironics, issuing a worldwide field safety notice on its CPAP machines in June because of a foam part that might degrade and become toxic, potentially causing cancer. A spokesperson for Philips Respironics said they had not yet started its repair and replacement programme in the UK, which was due ‘imminently’.

The Association of Chartered Physiotherapists in Respiratory Care (ACPRC) said reports from members indicated the scale of the problem is large and growing.

ACPRC chair Ema Swingwood said: ‘Clinical services are already stretched due to the impact of the ongoing pandemic.

The shortages and delays in acquiring vital equipment are impacting availability of beds, flow through the hospital systems and creating delays in discharge.

'More importantly patients’ quality of life may be impacted. The situation is placing huge stress on our dedicated teams across the UK.’

As there are few UK based manufacturers of the breathing equipment suitable for use in the home setting, supplies have to be sourced from overseas. Supply chain issues have been creating delays of delivery of this equipment and the associated consumables for many months worsened by the pandemic and the Suez Canal blockage.

A spokesperson for Philips Respironics said the pandemic had sparked increased demand for respiratory products, patient monitoring solutions, as well as telehealth solutions.  The spokesperson added: ‘The supply chain issues/disruptions that we are experiencing mainly involve electronic component shortages (e.g. computer chips) and shipment capacity (port congestion and container shortages). We are working with suppliers and governments to ensure we minimize the impact in the healthcare supply chain and prioritize life-saving modalities like ours.’

ACPRC chair Ema Swingwood added: ‘Something must be done to address these supply chain issues before this becomes a crisis of desperate proportions. The care of these complex and vulnerable patient groups must not be compromised.’

The latest shortages follow reports from physios that trusts around the UK were experiencing shortages of mobility equipment including walkers, sticks and crutches, with some NHS patients having to buy their own. One trust was told to expect shortages until the end of March 2022, with many others being asked by suppliers to run campaigns calling for the return of unused equipment.