It’s becoming increasingly difficult for the Welsh NHS to secure access to the medicines it needs. Economic instability, disrupted supply chains, and growing demand are making medicines more expensive and shortages more common.
Maintaining the supply of medicines to the UK is a reserved matter and the responsibility of the UK Government. However, given powers and responsibilities for healthcare are generally devolved, managing the impact of any disruptions to that supply is the responsibility of the Welsh Government.
It can be a worrying experience for patients to struggle to get hold of the medicines they’ve been prescribed.
A special report on the UK’s medicines shortages recently published in The Pharmaceutical Journal warned:
Medicines shortages are a huge concern for pharmacists, with many spending hours each week sourcing alternatives. Moreover, the shortages are increasingly putting patients’ lives at risk.
With pressures mounting across the NHS, issues with the cost and accessibility of medicines are an additional stressor on a health system that is still recovering from the pandemic.
Rising medicine costs put pressure on NHS budgets
The Minister for Health and Social Services, Eluned Morgan MS, recently highlighted the increasing costs of medicines to the Senedd’s Health and Social Care Committee. She said that the cost of medicines has increased by 11% since 2021.
With health boards across Wales having to find savings to reduce predicted overspends, the Minister explained that this rise in medicine costs puts extra strain on already stretched budgets.
A BBC Wales investigation found the cost of omeprazole, commonly used to treat conditions related to excess stomach acid production, and the second most commonly prescribed item by GPs in Wales, has risen from 80p a packet to £2.80 in the past 18 months. BBC Wales estimate that this alone could add £500,000 to costs across the Welsh NHS.
Serious medicines shortages become a frequent problem
In the run up to Brexit, concerns were raised about potential disruption leaving the EU single market could cause to the UK’s medicine supply. As a precautionary step to mitigate this risk, the UK Government introduced Serious Shortage Protocols (SSP), in addition to other measures.
If there is a shortage of medication then the UK Department of Health and Social Care has the authority to issue a SSP. These protocols offer guidance to community pharmacists, allowing them to provide alternative options when faced with a prescribed medicine shortage.
SSPs are intended to be used in “exceptional and rare” situations when there is a serious shortage. Since they were introduced, one or more SSP has been in effect each month, with the number issued peaking in 2022, according to research by The Pharmaceutical Journal.
Manufacturers struggle to meet increasing demand
In October 2023, the Welsh Health Minister issued a statement on “significant supply issues” affecting a number of medicines due to increasing demand.
Examples include:
- In December 2022, the UK Government issued SSPs for penicillin after a rise in cases of invasive Strep A caused shortages in pharmacies.
- A global shortage of Diabetes medicine Ozempic is affecting patients in Wales and unlikely to be resolved until June 2024. Diabetes UK claim that this shortage is “partly due to a surge in off label prescriptions of the drug semaglutide being issued for weight loss”.
- There have been ongoing shortages of Hormone Replacement Therapy (HRT) treatments, with several SSPs issued in 2022 and 2023. In a statement in May 2022, the Minister said there had been a “more than 90% increase” in prescriptions for HRT since March 2015.
- The Welsh Government published a medicines shortage letter in September 2023 after supply disruptions affected a number of medications used to treat attention deficit hyperactivity disorder (ADHD). The letter said that, “supply disruption of these products is caused by a combination of manufacturing issues and an increased global demand”.
The Association of the British Pharmaceutical Industry say that medicines manufacturers and suppliers “take their responsibilities very seriously and are accountable to UK regulators should supplies of their products become unavailable”.
A global problem or a consequence of Brexit?
A research report by the Nuffield Trust highlights some particular issues faced by the UK since Brexit, which could explain consistent problems with medicine shortages. This includes new paperwork at the Great Britain–EU border and diverging regulatory processes that make the UK a less attractive place to manufacture medicines. The report describes a “perfect storm” of global factors overlapping with problems created by leaving the single market.
However, the Nuffield Trust found evidence of similar medicines shortages in the UK, France, Germany and Italy since the pandemic, and also blames rising global prices for commodities, which have increased the cost of the manufacture and transport of medicines.
An Organisation for Economic Co-operation and Development (OECD) working paper on medicine shortages found that “medicine shortages have become increasingly common in a number of countries in recent years and the COVID-19 pandemic has exacerbated the situation”. The report highlights the complexity of global medicine supply chains and limitations of data, complicating understanding of the issue.
The challenge for the Welsh Government
A key challenge for the Welsh Government is that increasing prices and medicines shortages may have their root causes in global issues or UK-level politics, but their impact is felt by patients and healthcare professionals working in the Welsh NHS.
Article by Angharad Lewis, Senedd Research, Welsh Parliament
