THE NHS was in crisis before the pandemic hit us. It was working on a just-in-time basis rather than just in case. 

It was running on good will, with staff shortages, lack of equipment, poor facilities, lack of connectivity and alarming levels of systemic racism. 

All of this amid rising levels of health inequality across society.

The NHS supply chain has itself been privatised; a privatisation that has left us unprepared for a pandemic. 

Procurement and logistics in our NHS have been outsourced to a chaotic mish-mash of private contractors. 

There are 11 key outsourced procurement contracts and four levels of profit-taking before equipment arrives at the hospital or care home.

One of the key companies involved, along with DHL, Unipart, Deloitte and Clipper Logistics, is Movianto which won a £55 million contract in 2018 to provide a stockpile of equipment, mostly PPE, in case of a pandemic. 

Anecdotal evidence from its own staff indicates that the company was chaotic and short-staffed and that the stockpile was mostly out of date.

The Covid-19 pandemic has presented an opportunity for the government to allow its capitalist friends a feeding frenzy off our NHS. 

We have seen many examples of this in the procurement of PPE and equipment supply, in testing and track-and-trace systems alone.

In April a mega contract of £108m was awarded to Pestfix, a family-run pest control company with assets of £18,000 for the procurement of personal protective equipment for the NHS. 

A £2m contract went to Double Dragon, a small company with no premises and no phone number which describes itself as a wholesaler of tea and coffee. It is now claiming to be a certified supplier of medical grade equipment to the NHS.

Testing site contracts have gone to Deloittes, Serco, Sodexo, Mitie and others. The track-and-trace system has, by any measure, been an unmitigated disaster. 

If it were not for the pandemic then the huge problems with outsourcing the NHS supply chain might not have been brought to public attention in such a stark way. 

Now that they have, we need to act, urgently.

The procurement of goods for the NHS should itself be a function of the NHS, not an additional profit stream for private contractors which have not delivered an efficient or effective system. 

NHS staff and patients deserve a supply chain that puts people before profit, which takes responsibility instead of abdicating it, and which prioritises long-term planning and community safety. 

And, of course, all NHS services, including logistics and procurement services, must be kept off the table in any international trade agreements.

The stark reality of this approach is that hundreds of health and social care staff have lost their lives during the pandemic. 

How many could have been saved if we had not outsourced these vital services? A full public inquiry must find the answers.

Annette Mansell-Green is director of trade union and public affairs at the British Dietetic Association.