'Lives at risk': why is the NHS suffering drug shortages?

The NHS is experiencing "unprecedented" medicines shortages, with the number of drugs in short supply doubling in two years.

In December, 96 drugs were on a shortage list, according to unpublished figures from the Department of Health and Social Care (DHSC) seen by The Guardian. That number (down from a record 111 in October) has nearly doubled since January 2022, and includes treatments for cancer and diabetes. 

The DHSC has since issued supply notifications for 10 more products, including drugs for schizophrenia and, most recently, for epilepsy. Pharmacists claim that some patients' conditions are deteriorating as a result of the "unprecedented shortage", said the paper. A DHSC spokesperson said they did not recognise the figures provided to The Guardian by the British Generic Manufacturers Association (BGMA). 

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What the papers said

The Ukraine-Russia war has affected many countries' supply chains, said the London Evening Standard. More recently, Houthi attacks on shipping in the Red Sea – "a key shipping corridor for vital ingredients" – and retaliation by US and UK forces have raised concerns about "fresh market instability". But in the UK, it has become "worryingly normal" for hundreds of medicines to be affected by "pricing and other issues every month", said Janet Morrison, who leads Community Pharmacy England. The problem "is now worse than ever".

But shortages are not a new development, said The Guardian's chief reporter Daniel Boffey. About 92% of pharmacies experienced daily supply issues in 2022, according to a survey by Community Pharmacy England published last August – up from 67% the year before. The report found that 87% of teams believed "patient health was being put at risk". 

Nor is it "just a UK phenomenon", said Boffey. The most recent European Association of Hospital Pharmacists survey found that 95% of hospital pharmacists across 36 European countries experienced shortages last year. 

"Manufacturing issues are the most commonly cited cause of drug shortages," said three health experts from the University of Bradford on The Conversation. In 2022, these caused 60% of global medicine shortages. The UK relies on only one manufacturer for many drugs, "which can be a risky strategy".

Several shortages "made headlines" last year thanks to increased demand, said Forbes, including the type 2 diabetes treatment Ozempic for use as a weight-loss drug. This had "serious implications for many people with type 2 diabetes" in the UK, Douglas Twenefour, from the charity Diabetes UK, told the Financial Times.

Similarly, rising demand for ADHD medication and hormone replacement therapy (HRT) to treat menopause symptoms also led to shortages.

Every country was "hit by supply chain disruptions" during the Covid-19 pandemic, Martin McKee, European public health professor at the London School of Hygiene and Tropical Medicine, told the British Medical Journal. However, "as with most other walks of life, Brexit adds to the problems". 

Pressures on drug prices since 2016 have "exacerbated" the UK's shortages, Mark Dayan, Brexit programme lead at the Nuffield Trust, told The Guardian. This was "probably associated with the Brexit referendum pulling down the value of sterling". Being outside the single market has "added costs at the border", he said, resulting in "a drop in products passing into this country".

There are "problems peculiar to Britain" other than Brexit, said Boffey, including "a lack of joined-up planning and communication" between health service guidance, manufacturers and the government. 

Above all, a government scheme that caps the annual increase in NHS spending on branded medicines to 2% has "acted as a drag on investment". That cap goes up to 4% this year, but still amounts to "penny pinching". 

It is "perhaps little wonder", concluded Boffey, that patience with the system is "running out fast".

What next?

UK shortages of diabetes drugs will last until at least the end of 2024, the DHSC said this month. The government has advised that patients should not be prescribed Ozempic for weight loss, and approved Wegovy as an alternative. 

"Action is being taken to manage drug disruptions," said Breen, Silcock and Edwards. The European Commission has put initiatives in place requiring suppliers to report shortages earlier, and stock sharing between countries. This "should be positive for the global drug supply" – but "it's not clear if this will benefit the UK".

Strategic stockpiles "will also help mitigate possible shortages", especially for drugs that see seasonal spikes in demand, such as antibiotics. 

"Hopefully," they concluded, "with the measures the government and suppliers have already taken, this will mean fewer shortages in 2024."