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Improving Hard to Source Items (HTSI) supply chain resilience during COVID-19 surge

Following the COVID-19 surge in demand for clinical consumables and services, we were tasked with finding alternative ways to procure hard to source items such as masks, filters, breathing circuits, exhalation ports and reservoir bags, improving the resilience of the supply chain.


The Hard to Source Items (HTSI) team sources timely and sufficient quantities of required equipment and consumables to complement conventional channels and safeguard against supply chain disruptions. COVID-19 led to a surge in demand for clinical consumables and services globally, with conventional procurement channels exhausted and struggling to meet demand. This was made worse by restrictions on border movements and local production capacity constraints such as workforce availability, raw materials and procurement mechanisms in place of usual trading conditions.

MLCSU’s Improvement Unit were rapidly deployed to support a dedicated global team put in place by the DHSC to consider alternative approaches, including sourcing items from international suppliers previously unknown to the NHS and looking at appropriate clinical alternatives.


The Improvement Unit were tasked with managing the largest product category range, NIV/CPAP and HEPA/HMEF filters, which included NIV masks, filters, breathing circuits, exhalation ports and reservoir bags totalling over 3 million individual items. With stocks rapidly depleting and the winter surge looming, the team liaised with British Embassy colleagues in Beijing and managed to:

  • Find suppliers
  • Track delivery of products into the UK keeping the NHS Supply Chain updated
  • Coordinate the validation of products through a rigorous due diligence process involving clinical scientists and gaining approval from the MHRA
  • Hand products over to the supply chain for distribution to Trusts for use by the most vulnerable COVID-19 patients in the event of a winter surge.


  • Sourced sufficient quantities of ICU consumables and equipment for COIVD-19 patients in preparation for the winter surge.
  • Secured approval from the DHSC and Cabinet Office to source millions of individual products from global suppliers and monitored their progress through to delivery into MoD airbases and warehouses.
  • Opened up new international markets and future supply chain channels previously unknown to the NHS.
  • Managed the technical, clinical and regulatory due diligence validation process of first-of-type items into the UK.
  • Produced documentation and communications for each product to encourage uptake of novel devices in NHS Trusts.
  • Forged strong relationships and built new networks of stakeholders by working collaboratively with the DHSC, NHSSC, MoD, MHRA, FCDO, external consultants, other CSUs and Trusts involved in the testing and adoption of the products sourced.
  • Contributed to the creation of the HTSI ‘playbook’ which outlined the scope, structure and processes of the HTSI team in the event of being mobilised at pace in the future.