SUPPLY CHAIN ISSUES Staffing issues
During the pandemic we have seen an exceptional response from suppliers in trying to protect production and supply. From additional production sites to additional staff and 24-hour shift patterns, the response should be applauded. The pandemic has not gone away, nor has the expected absence rate due to other illnesses or personal issues. Therefore, some of these measures are now showing signs of ineffectiveness, and burnout cannot be ignored within these professions. Similar to measures taken to protect the healthcare workforce, each manufacturer will have measures implemented to preserve their workforce and the production line. This impacts on the productivity of manufacturing sites, the supply chain, and therefore the receipt of goods.
Minimising the risk
Not all point-of-care tests are available in the local laboratory, and reverting to laboratory testing will provide additional pressure on pathology services.
with a tired, burned-out workforce looking for alternative work. COVID has not gone away, so the impact of infections within the workforce remains an issue with company policies demanding isolation of staff even if they are asymptomatic.
Freight costs
The price of fuel has undoubtedly hit the supply chain. The rise in costs has been attributed to processing crude oil, rather than the cost per barrel. The soaring cost of energy is interlinked with the cost of fuel. Global manufacturing and distribution relies heavily on energy and fuel, in turn affecting the supply chain. Unfortunately, vendors are hit hard and those costs have to be passed on to the consumer, or novel supply routes have to be adopted either in the interim or long-term. Either way, the customer and end user are likely to bear the impact of the disruption, either through delays or increased costs.
Customs delays With so much stock passing through multiple territories and their respective customs processes, the delays being experienced by end users is easily understood. A delay in production in one territory will lead to further delays in
transport through subsequent territories. For instance, a product manufactured in the Far East may travel through European distribution centres before reaching the intended country. Products requiring refrigeration or freezing during transport are then at risk due to the extended time taken to transport them. Primary providers need to ensure cold chain procedures are met – if they aren’t met those items will be destroyed, leading to further shortages. Additional checks such as those being experienced within the UK due to Brexit are likely to compound the issue.
Quality assurance With changes in raw materials comes the risk of quality assurance issues. We must also ask ourselves if products made from different raw materials are of the same specification to those that were first adopted. There have been many reports of products being manufactured that have not been released for market use, potentially indicating additional problems with quality acceptance. There have been instances reported where entire lot numbers of products have been destroyed, pushing back availability dates and leading to back orders across multiple product lines.
Often the production of the item is in one country, quality assurance in another, and distribution centres in yet another country
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One way of minimising the risk of service interruption is mutual aid. Developing relationships with other service providers, either in the locality or as part of a wider network, means that an agreement can be in place to share stock in times of crisis. This requires trust and a mechanism for reimbursement of the products shared. Procurement teams can also identify alternative consumables to existing supplies. There may be some verification work on the performance of alternatives, but would result in additional options to preserve the service. In discussion with clinical teams, managing demand for point-of-care tests affected by supply chain interruption might be necessary. Although this is a decision not taken lightly, it will ensure testing capacity is retained for the patients most in need. This requires good communication and potentially executive and/or medical director sign off, depending on responsibilities within the governance structure. Stock may be centrally controlled and issue limited on a case by case basis.
Another way of limiting consumable use, especially with test strip/single-use cartridge technology, is to reduce the frequency of quality control (QC) testing. This must be done in a safe way by reviewing overall QC performance within the service before making any changes. Devices that show stability may allow for a relaxing of the frequency of testing. A risk assessment should be produced and a narrative explaining the rationale. Supply interruption may also offer an opportunity to re-educate users. Testing volumes can easily increase and go unchecked year by year unless the point- of-care service providers regularly review test numbers. This is often monitored
SEPTEMBER 2022
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