The government’s plan to distribute personal protective equipment (PPE) during the coronavirus pandemic was undermined because officials failed to stockpile gowns and visors despite warnings to do so, Whitehall’s spending watchdog has revealed. The report published on Friday by the National Audit Office (NAO) said this meant less than half of the expected pieces of certain equipment were handed out to frontline workers as the crisis developed. The only categories of PPE that increased in volume in the government’s stockpile between 24 January and 21 February, when ministers were acutely aware of the pandemic in China, were aprons and clinical waste bags. Health unions and senior MPs have been deeply concerned by the NAO findings, which also confirmed that 25,000 hospital patients were discharged to care homes at the height of the pandemic before testing became routine. About 300 UK health workers have so far died of Covid-19, and many NHS staff groups and families claim inadequate PPE played a key role in exposing them. Susan Masters, a Royal College of Nursing director, said the report shows nursing staff were severely let down. “Our members in working communities, care homes or hospitals, who have had trouble accessing the necessary protective equipment to keep them and their patients safe, will be alarmed to see that a vital opportunity to stockpile adequate equipment was missed,” she said. The report was released on Friday, hours after Matt Hancock, the health secretary, said the government had not ruled out the introduction of an enforcement mechanism if people failed to comply with the test and trace system. “We’re not ruling it out at the moment but we don’t think we need it,” he told the No 10 briefing, where it was announced that 41,279 people had died after testing positive for coronavirus in the UK - a rise of 151 since Wednesday. The NAO’s report into the readiness of the NHS and social care in England for the pandemic examined the government’s response to the pandemic since Chris Whitty, the chief medical adviser, confirmed the first cases of coronavirus on 31 January. The New and Emerging Respiratory Virus Threats Advisory Group (Nervtag) recommended in June last year that Public Health England should stockpile gowns and switch from glasses to visors when glasses next required reordering, the report said. In February, Public Health England had 83,000 gloves – so 41,500 pairs – 25,700 pairs of eye protectors, and 156,000 facemasks. By the end of April, none of these items were left, the report found. Auditors said that officials from the Department of Health and Social Care (DHSC) told them that the procurement of PPE had, until April, stuck rigidly to buying exactly what was needed at that time. “The department told us that the manufacture and supply of PPE has for many years been based on ‘just in time’ procurement and manufacturing principles,” the report said. They found that one in three homes for the elderly suffered coronavirus outbreaks and confirmed figures released last week by NHS England about the number of hospital patients discharged to care homes. NHS England and NHS Improvement advice at the time was to urgently discharge from hospital “all patients medically fit to leave” in order to free up bed space for coronavirus patients, auditors said. “Due to Government policy at the time, not all patients were tested for Covid-19 before discharge, with priority given to patients with respiratory illness or flu-like symptoms,” the report said. The advice was changed on 15 April but the NAO noted that, as of 17 May, one in three care homes had declared a coronavirus outbreak, with more than 1,000 homes dealing with positive cases during the peak of infections in April. Figures show that many care homes received little PPE from the government. While health settings received a third of the number of eye protectors required from central government, care homes received 5%; hospitals received three quarters of gloves required from central stocks, care homes received 8%; and care homes received no gowns from central stocks. The report also discloses that the government does not know how many NHS or care workers have been tested in total during the pandemic. Jeremy Hunt, chairman of the health and social care select committee and a former health secretary, said: “It seems extraordinary that no one appeared to consider the clinical risk to care homes despite widespread knowledge that the virus could be carried asymptomatically”. Meg Hillier, chair of the public accounts committee, said it showed that care homes were “at the back of the queue” during the pandemic. “Residents and staff were an afterthought yet again: out of sight and out of mind, with devastating consequences,” she said. Auditors concluded that the complicated nature of social care provision, including its “lack of” integration with the NHS, “made responding to the crisis more difficult in a number of ways”. Similarly, the number of institutions, both national and international, involved in acquiring PPE made the process more onerous. A DHSC spokesperson defended the government’s record, saying the numbers used for judging PPE supply in the NAO report were “misleading”. “The modelled PPE requirements presented in this report are theoretical worst case estimates – it is misleading to compare them to figures on centrally procured PPE, which do not account for equipment supplied through other routes or existing local stocks,” the spokesperson said. “Sixty per cent of care homes have had no outbreak at all, according to the latest Public Health England statistics.”