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Internal document seen by the Guardian shows low supplies for heart, cancer and anti-epilepsy drugs
The NHS is running short of dozens of lifesaving medicines including treatments for cancer, heart conditions and epilepsy, the Guardian has learned.
An internal 24-page document circulated to some doctors last Friday from the medicine supply team at the Department of Health and Social Care (DHSC), headed “commercial-sensitive”, listed many drugs currently hit by shortages at the NHS.
The document warned: “This information is confidential to the NHS, please do not upload to websites in the public domain.”
The document listed 17 new drug shortages identified last week including drugs for cancer, Parkinson’s, mental health problems and some eye conditions. It also identified ongoing issues with 69 different types and doses of medication including antibiotics for tuberculosis, diamorphine, various cancer drugs, heart condition drugs, Hepatitis vaccines and anti-epilepsy drugs. Eight drugs have been discontinued and supply issues with over 20 drugs, where there were previous shortages, have now been resolved.
The document said that because there are shortages of many licensed medicines, in some cases unlicensed versions may be imported although “lead times vary”.
While shortages of some drugs have been reported previously, doctors have said that the breadth of conditions identified in the list obtained by the Guardian was “unprecedented”.
The document told doctors that some patients would have to be prioritised over others for some lifesaving drugs, a form of drug rationing.
In some cases the document recommended breaking tablets in half, in others finding a way to share dwindling supplies.
While some drugs for which there are shortages have alternatives which could be prescribed, others did not. Switching patients from one drug to another is not always straightforward or safe.
The document stated that in some cases switching drugs would require increased clinical supervision, something which adds to the workload of already hard-pressed doctors.
Dr Nick Mann, a GP in Hackney in London, said: “This situation is absolutely unprecedented. Previously we would have one or two or three drugs that would go offline for a while, but this is something on a different level. It is going to render the day-to-day treatments that doctors provide very difficult.”
The report described one drug for stomach and pancreatic cancer which has no date for resupply provided by the manufacturer and “no alternative supplies of UK licensed [drugs] … are available to support this gap in supply. You may wish to consider the following as a priority: patients completing a course of treatment and those already booked for surgery.”
For procyclidine, a Parkinson’s drug out of stock until March 2020, the document said that doctors should “consider sharing remaining stock locally with the support of your regional procurement lead”.
For a type of eye drops that are currently unavailable the document stated that the Royal College of Opthalmologists “has provided clinical guidance to support local prioritisation of remaining supplies”.
In the case of Relpax, a migraine drug, which is in short supply, there was a recommendation to break the higher dose tablets in half although the document admitted “there are no data on halving or crushing them to deliver a 20mg dose”.
Rachel Cooper, the director of the health initiative at the anti-corruption network Transparency International, said: “Shortages of medicines risk price distortion at the expense of health budgets, disrupt patient drug regimes and can undermine public health objectives. The public deserves full transparency of pricing structures and the reasons for and financial implications of drug shortages.”
Mann added: “The scale and scope of this list from DHSC of currently unavailable prescription medicines is extremely alarming. Beyond Brexit stockpiling and manufacturing diversions, and parallel exporting, there appears to be a change in pharma companies’ behaviour causing a potentially dangerous level of instability in previously reliable, standard treatments.
“This massive increase in supply failure is new, and the reasons for it need to be urgently identified and addressed to prevent inevitable harms to patients. Some treatments, like those for epilepsy, are not interchangeable. Such shortages will have a high risk of harm to patients.”
Dr Tony O’Sullivan, a retired paediatrician and the co-chair of Keep Our NHS Public, said: “The Health Department’s guidance includes an unprecedented list of drugs unavailable or in short supply. Patients and clinicians alike should be on high alert when the advice includes how to ‘share stocks’ to make them last, to ‘prioritise’ patients already on specific treatments including cancer rather than a new patient and effectively how to ration so many vital drugs. Drug companies’ behaviour must be controlled. We must urgently protect the NHS from further risks of loss of control of drug prices and supplies from trade deals with the USA and that requires returning it to a wholly public service.”
A spokesman at the Association for the British Pharmaceutical Industry said: “For new on-patent medicines there is an agreement between the government and pharmaceutical companies to cap NHS spending growth on branded medicines at 2%, with anything over this paid back to the government. Manufacturers know that any medicine shortage is extremely worrying for the people affected by it and they do everything they can to prevent medicine supply problems occurring and to resolve them quickly if they do happen.”
A spokeswoman for the Royal Pharmaceutical Society said: “Medicine shortages are an increasing problem. A range of factors are responsible for shortages, such as manufacturing problems, global demand for medicines and fluctuations in the exchange rate. At the moment pharmacists are working incredibly hard to get the medicines patients need. Pharmacists spend hours tracking down stock and working together to help patients.”
The DHSC has been approached for comment.
Drug shortages revealed in the list
- Cyanide poisoning drug: the sole supplier is experiencing long term out of stock issues.
- Diamorphine: “insufficient stock to cover full forecasted demand in both primary and secondary care”.
- Anti-epilepsy drug: “Patients should normally be maintained on the same brand. However … will be out of stock … until March 2020”.
- Tuberculosis medication: two suppliers are out of stock, a third has some stock “but is unable to support any uplift in demand”.
- Dementia drug: need to change type and frequency of dose, which could be confusing for dementia patients.