Why is the NHS short of some key drugs?

29 September 2015 The NHS is short of key pharmaceuticals, including those for some cancer treatments and pain relief for terminally ill patients. But why has this situation arisen and who is being affected?

What is the problem?The National Health Service has a long and complex supply chain that is supposed to ensure we get what we need when we are ill. But it's vulnerable to manufacturing difficulties in a global marketplace, or if companies decide to discontinue a line of drugs. That can mean with some products, patients have to go without, or are on reduced dosage.

Who is affected?

Those with certain sorts of bladder cancer have been the worst hit.

A factory in Canada that made much of the BCG vaccine used to treat these cancers stopped production in 2012 because of quality control problems.

It caused a worldwide shortage and in England has forced urologists to put patients on one-third of the dose normally recommended.

The pipeline for NHS drugs can be affected by supplies from global manufacturers

For some, including Neil Marnock 56, from Birmingham, diagnosed with the disease two months ago, BCG was the "gold star" treatment, but there wasn't enough at his hospital for him to have effective therapy.

"The only option really was to go for the removal of the bladder, along with the prostate gland and lymph nodes as a precaution to stop the disease spreading," he said.

About 10,000 people in the UK are diagnosed with bladder cancer every year.

What can be done if a factory on the other side world shuts down?

Some are questioning whether the government has moved quickly enough to explore alternative strains of the vaccine.

These are available in other countries, and urologists say they should be given a licence for use in the UK.

The Department of Health says it is working to minimise drug shortages

Mark Speakman, president of the British Association of Urological Surgeons, argues the British authorities have been too slow.

"We're disappointed with the level of action that we've seen up to now," he said.

"We haven't as clinicians been supported in bringing the unlicensed products in. They've certainly not moved fast enough in the eyes of our patients or of our members."The Department of Health told the BBC: "We work closely with the Medicines and Healthcare products Regulatory Agency, NHS England, the pharmaceutical industry and others in the supply chain to help prevent medicine shortages and to minimise the risk to patients on the rare occasions that issues do arise."

But is it not true that many new drugs are very expensive and the NHS cannot afford to fund them all?

It is not the new drugs that are affected.

And, manufacturers argue, some shortages could be the result of the Department of Health pushing down costs.

The department has mechanisms to control the price of the hospital drugs it buys from industry, be they patented branded medicines or cheaper generic alternatives.The British Generic Manufacturers Association argues that DoH drives too hard a bargain, leading to fewer companies tendering for contracts, which reduces supply resilience when there's a problem.

The department denies this, saying it offers good value for patients and a fair price for drug companies.But in some hospitals, shortages have become routine, according to Martin Shepherd who keeps a list of them in the hospital pharmacy he runs atChesterfield Royal Hospital in Derbyshire.

"We've currently got around 40 products listed," he said.

"The list has grown over the years and the thing that's changed particularly has been the length for which products become unavailable.

"The trend towards much longer delay in terms of being able to access products seems to have worsened."

So what are these other shortages then?

They come and go, but another critical one is clonazepam, an injectable form of drug, licensed for treating epilepsy, but used in palliative care for relief of nerve pain.

The drug manufacturer Roche has discontinued its supplies to the UK. It cites profitability and low demand as among the reasons and argues there are alternatives.

The injectable form now has to be imported from abroad, at a much higher cost. AtAshgate Hospice in Chesterfield, they've had to cut back on the use of injectable clonazepam by 80%, because the price has soared from 67p a vial to £33.

That in itself has caused shortages and, according to Dr Sarah Parnacott, palliative medicines consultant at Ashgate, it means more suffering for patients with terminal illness.

In November 2014, 58-year-old Lynn Barnes, an Ashgate Hospice patient, was spending her final days at her family home in Buxton.

GPs, nurses and other health visitors couldn't get hold of injectable clonazepam from local chemists. According to her son Lee Barnes, she was in agony.

"My mother was screaming out in pain she was so agitated," he said.

"No matter what we tried to do to try to make her comfortable, it had very little effect. She asked my father to kill her."

Mrs Barnes died from lung cancer, but Lee says her suffering could have been avoided if she'd had access to the right drug.

He said: "One of the things she was afraid of most was dying in pain. And we said, 'No, Mum, you'll be fine. You won't die in pain.' And in the end, it was the most horrendous death anybody could have seen."