NHS vulnerable to ‘fragile’ supply chains

The NHS has long been grappling with staff shortages and funding shortfalls but now another destabilising issue is coming to the fore: the vulnerability of its supply chain.

In today’s volatile world of tensions, tariffs and climate-related disasters, NHS stocks of vital medicines and equipment are increasingly under strain, and shortages are becoming more common.

Currently, a global shortage of bone cement has led to the postponement of scheduled knee and hip replacement operations across the country. For the people who have been waiting in pain to make it “to the front of orthopaedic surgery queue”, this is “a crushing blow”, Deborah Alsina of Arthritis UK, told The Guardian.

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Painkillers, aspirin and hearing-aid batteries

There is also a UK-wide shortage of the highest prescription-strength form of the painkiller co-codamol. It’s most commonly manufactured in India but the Indian government is “delaying the authorisation to import ingredients required to make the drug there”, said the BBC.

With shortages expected until at least June, the Scottish government is limiting supplies, and warning patients who are prescribed the pills to gradually reduce the number they are taking because stopping abruptly can trigger withdrawal symptoms such as headaches and nausea. Alternative treatment options will be offered to those affected but some health boards have said the expected uplift in demand for these alternatives may not be sustainable.

Some deaf people are “being forced to turn off their hearing aids” because of a nationwide shortage of certain hearing-aid batteries, said The Times. The shortage, first highlighted in November, is expected to be resolved by 16 March but “it’s not a good situation from a personal safety point of view if people are turning off their hearing aids”, Kay Fairhurst of Salford Disability Forum told the paper.

Britain is also “grappling with widespread shortages of aspirin”, said PA Media’s health editor Jane Kirby. Most pharmacies are reporting “significant difficulties” in sourcing the vital drug, which is used to help prevent blood clots, strokes and heart attacks in high-risk patients. Pharmacists are being “forced to tightly ration” their aspirin stock, with many withdrawing it from over-the-counter sales.

The government has blamed “manufacturing delays” for the shortage but pharmacy associations are also blaming the NHS payment model. “The prices paid for many medicines by the NHS are so low that manufacturers often prioritise supplying other countries instead, leaving the UK pushed to the back of the queue,” Leyla Hannbeck of the Independent Pharmacies Association told PA Media. And, even if they can order stock, pharmacies are left out of pocket: the aspirin shortage has pushed its price up to £3.90 a packet but the NHS will only reimburse pharmacies £2.18 a packet. These are “signs of a fundamentally broken pharmacy contract”, said Olivier Picard of the National Pharmacy Association.

‘Critical pinch points’

The UK depends on supply chains for antibiotics, vaccines and diagnostic tests that are “highly brittle and vulnerable”, The Centre for Long-Term Resilience think tank reported last year. These supply chains have “critical pinch points overseas”, and NHS reliance on a small number of manufacturers, often in China, “has never looked more fragile” in this time of “turning geopolitical tides”.

All of NHS England’s supply of gentamicin, an antibiotic used to treat serious bacterial infections, comes from two supplier factories in the same Chinese city. Any disruption to that city, or any geopolitical issue that causes an export ban between China and other countries, would “wipe out UK access to gentamicin”, the report warned.

The NHS supply chain is “exposed to vulnerabilities of unprecedented scale and complexity”, said global risk consultancy Marsh. Geopolitical tensions, the aftermath of the pandemic and disruptions to crucial shipping routes have “exposed the fragility of international supply chains, causing costly delays and supply shortages that reverberated across healthcare systems worldwide”.

Global tariffs, including on medical equipment and pharmaceuticals, have “introduced significant cost pressures on international trade flows”. The NHS has “felt these disruptions acutely”. There is an “urgent need to build a more resilient, agile and secure NHS supply chain”.