Vital antibiotics, hormone replacement therapy (HRT) and attention deficit hyperactivity disorder (ADHD) drugs are among those in desperately short supply this winter – with the NHS forced to pay over the odds to get drugs into Britain.
Leading British health experts backing a new report on post-Brexit problems in the health service, which has been shared with The Independent, have also highlighted recent problems obtaining antidepressants and medication for high blood pressure.
Professor Martin McKee, of the London School of Hygiene and Tropical Medicine, said the health of patients who rely on these day-to-day medications is being put at risk because of “very worrying” recurring shortages.
The NHS is unable to stockpile many of the scarcer drugs because they go out of date, and experts say post-Brexit red tape is making it harder to get life-saving drugs into the UK when they are needed.
Community Pharmacy England, which represents NHS pharmacists, said medicine shortages are “as bad as they have ever been”, explaining that the war in Ukraine and manufacturing problems overseas are to blame as well as Brexit.
Britain has experienced a major spike in drug shortages in recent years. According to the British Generic Manufacturers Association (BGMA), which represents drug manufacturers, the number of “high-impact” medicines with supply problems hit a two-year high of 10 in September.
The BGMA said that in September, 102 medicine products were listed as being in shortage – double that of the previous high in February 2022.
Shortages have affected a range of medicines “across the board” since Brexit, according to a report by the Independent Commission on UK-EU Relations, which points to costly new paperwork and new regulatory barriers as major factors.
Healthcare think tank the Nuffield Trust, which contributed to the report, said there was “significant evidence” to indicate that Brexit is having a negative effect on medicine supply as well as staff shortages.
The Brexit trade deal with the EU, which came into force in 2021, has meant extra costs because of customs declarations and other paperwork.
Some of the UK’s regulatory processes for medicines are no longer valid in the EU, making it more time-consuming and expensive for international medicine suppliers to deal with Britain – and creating delays and extra costs for the NHS.
The problem of medicines going out of date means that NHS managers and pharmacists cannot stockpile endless supplies of drugs they are likely to run low on.
Mark Dayan, Brexit programme lead at the Nuffield Institute, said: “There are more signs of shortages at pharmacists, and there are more notifications from companies expressing concern about supply.”
Mr Dayan did point out that medicine shortages are a “Europe-wide trend”, noting that there has been disruption to manufacturing in China, and that higher prices – a result of inflation – are creating problems across the continent.
But he said Brexit was a “contributing factor” for the particularly acute problems in Britain. “Brexit certainly isn’t helping. There is a general burden on getting goods to the UK, customs declarations, extra checks – it makes it more costly to get medicine into the UK.”
He added: “The UK is not in the [medicine] supply chain quite like it used to be. Some firms that might have had distribution hubs in the UK now have them in EU countries, like the [Netherlands and Belgium] or Germany.”
The Nuffield Trust said the number of price “concessions” granted to the NHS by the government – allowing it to pay extra for medicines in high demand during shortages – had jumped repeatedly since the Brexit vote in 2016.
The number of concessions was usually less than 20 a month before Brexit, according to the think tank’s research. In 2021, after the Brexit deal was implemented, concessions spiked to around 100 a month. Since the summer of 2022, the monthly rate has sometimes exceeded 150.
Tamara Hervey, professor of EU law at City, University of London, said there had been a “discernible negative effect” from Brexit on medicine supply. “For a supplier, it’s one set of paperwork for the whole of the EU, and a different set for Great Britain,” she said.
Professor Hervey said international suppliers have to deal with separate batch-testing rules – the paperwork required to show that medicines are being tested properly – when delivering to the UK and the EU after Brexit. “One hope is that the UK-EU could move towards mutually recognising batch-testing,” she said.
The Independent Commission on UK-EU Relations has called on Rishi Sunak to pursue the mutual recognition of batch-testing standards with the EU in an effort to ease some of the problems.
The commission’s director, Mike Buckley, said “the poor Brexit agreement we have is making things worse” for the NHS, which is already under strain. He added: “The health service has seen severe disruption to the supply of medicine and medical equipment, as well as access to skilled labour, since Brexit.”
Janet Morrison, the chief executive of Community Pharmacy England, said medicine shortages “appear to be as bad as they have ever been and are making life incredibly difficult for community pharmacies and their patients”.
She added: “In recent times, we have seen Brexit, the war in Ukraine, the impact of the Covid-19 pandemic ... all of these have put extra stress on the medicines supply chain, stretching community pharmacies financially and often causing unavoidable delays in patient care.”
Prof McKee said: “There are quite a lot of things Brexit is making worse for the NHS. The fact that there are extra problems managing medicines is very far from ideal. Medicines go out of date – so it’s not possible to stockpile everything, and it’s very difficult to match supply with demand when you have these problems in supply chains and non-tariff barriers because of Brexit.”
He added: “These shortages will cause anxiety. It’s having an impact on patients that is very worrying.”
Stephen Dorrell, who served as health secretary under John Major’s Conservative government, said: “It’s amazing to think Brexiteers thought it was a good idea to disrupt the supply chain and didn’t think medicine would be included. It’s another example of how we shot ourselves in both feet.”
Professor Kamila Hawthorne, chair of the Royal College of GPs, said: “We are now seeing, too frequently, shortages of a wide variety of drugs. This can be worrying and frustrating for everyone, as well as having the obvious and unacceptable effect of potentially damaging patient health.”
The president of the Royal Pharmaceutical Society, Professor Claire Anderson, said Britain’s medicine shortages are “more acute than they were due to various factors” – pointing to manufacturing problems and fewer production facilities.
Prof Anderson said the organisation wants to change regulations in England and Wales to “help ease medicine shortages”, calling on the government to let pharmacists tinker with prescriptions during shortages so that patients can be given different quantities or strengths.
A Department of Health and Social Care spokesperson said: “Medicine supply problems occur for a number of reasons, such as manufacturing difficulties, regulatory problems, supply of raw materials, sudden demand spikes or distribution.
“We have well-established procedures to deal with such issues, and work closely with industry, the NHS and others to prevent shortages and resolve any issues as soon as they arise.”