NHS hit by ‘severe drug shortages’ due to Brexit red tape (www.independent.co.uk)

submitted 1 year ago by UKFilmNerd@feddit.uk to c/unitedkingdom@feddit.uk

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While the story says there is a European wide shortage of drugs due to manufacturing problems, war in Ukraine etc, the extra red tape now enforced for customs imports means it's become harder for the NHS to get the supplies of drugs it needs.

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[-] andthenthreemore@startrek.website 10 points 1 year ago

Wow. Leavetards are out in force in this thread.

[-] autotldr 3 points 1 year ago

This is the best summary I could come up with:

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 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.

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.

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.”

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.

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.

The original article contains 1,229 words, the summary contains 219 words. Saved 82%. I'm a bot and I'm open source!

[+] bernieecclestoned@sh.itjust.works -37 points 1 year ago* (last edited 1 year ago)

Doubt. Brexit 'red tape' is just an import form. They aren't that hard to figure out, especially as the majority of drugs are generics and are supplied from outside the EU anyway. Brexit just created a level playing field for all the pharma suppliers. I thought the EU wanted a LPF?

I think drug companies are quite keen to remain supplying one of the world's biggest drug buyers 👇

https://www.theguardian.com/business/2023/jul/08/revealed-pharma-giants-pour-millions-of-pounds-into-nhs-to-boost-drug-sales

UK should up it's manufacturing and broaden its supply chain to ensure supply. Especially as it's a Europe wide shortage and not brexit related. Kind of hard to import a drug if it's not available

[-] HumanPenguin@feddit.uk 17 points 1 year ago* (last edited 1 year ago)

You need a UK gov licence to import drugs into the UK. As we now need our own customs rather then the EU. This means the company doing so has to prove they meet all the UK standards. While those standards are currently the same as the EU. The licence still requires all the documentation to be provided separately. And translated. So def a bit more then a form.

The population of the EU is approx 448m (jan 1 23) the UK 67.7+m (23 no date) so the simple fact is where companies have a choice to sell. They have 6.5x the potential customers for exactly the same amount of documentation as the UK. Add the US 334m china 1425m india also 1425m (slightly more then china this year). And while we are far from the smallest nation of drug buyers. We are hugely down the list when it comes to actual money made by the drug companies dealing with us.

Our only advantage over the bigger nations is single payer. But that still in no way effects the work to make drugs legal in this nation. It actually makes it harder because other nations do not consider cost. They allow the insurance companies or paitent to make that choice. Our NHS via MHRA and NICE is forced to consider the cost per outcome when approving drugs for use in the UK. Meaning once a import licence is issued. The pharmacy companies importing and selling to the NHS are still limited in their ability to bid from suppliers.

UK should up it’s manufacturing

Def do not disagree. But their is limits to what we can make. Legally we need to licence drugs protected by patent law. And the drug companies will only do that if its profitable for them. The NHS already uses lots of generics when those patients have expired. Way more then the US from my own experience (so admittedly anecdotal). But many of the drugs used are still under patent. Many providing huge life style and length changes over older generic treatments available.

Drug patents are a strong system to break. Backed by international support. IE if we ignored our own laws on this. or changed them to disadvantage the drug companies. Other nation (mainly the US and EU) would be forced to sanction sales to the UK. Yes it sounds like a cartel. It really is though.

(edit when a company has the only ability to make one or two drugs that keep people alive, Its easy to threaten politicians with voter or funder death. And unfortunately the manufacture and formulation of many drugs is still protected by secrets as well as patients. This translates to. While MHRA knows how to make any drug you take. Doing so ost effectivly for some of the big ones. Takes help from the companies doing so. Or years of experimentation. Add the fact that those companies are the ones going to provide new drugs when invented. And politicians are validly worried about annoying them)

You may guess I used to work in the industry (long long before brexit). I worked writing the software system used by many drug companies to collect test data from lab trials. Used to submit to orgs like the FDA EMA and I assume now MHRA.

I agree Brexit is not everything. Heck so dose the article if you assume the tittle isd part click bait. NHS funding and Covid would be an issue without it.

But I can say that issues were happening with pharmacies i the UK having trouble competing on drug purchases just before COVID. Back in 2020 for the first 3 months while COVID was just rummers from china. I was hearing from old contacts that pharmacies were failing to fill many medications. Nice was publishing online reports n possible alternatives (often less effective) for docs to RX. Cancer treatments for chemo and ED injections were the huge ones that became 0 supply for a couple of weeks still 0 in the later case. But safety margin delays were happening throughout the drug catalogue. COVID hitting during that just made it harder.

Opinion. While NHS funding and tory attitudes to cost saving is the cause. The increased workload in supply to a relatively small market buy international standards. Is why many in demand drugs became easier to sell for more elsewhere. Not having to submit extra documentation to sell to one nation when 26 others were also looking for supplies has forced UK pharmaceutical to compete harder. And the fact that the UK MHRA requirements are identical to EMA means trying to buiy outside the EU means even more work for the suppliers.

[+] bernieecclestoned@sh.itjust.works -6 points 1 year ago* (last edited 1 year ago)

The population of the EU is approx 448m (jan 1 23) the UK 67.7+m (23 no date) so the simple fact is where companies have a choice to sell. They have 6.5x the potential customers for exactly the same amount of documentation as the UK.

It's not that simple though, the supposed panacea that is the single market is just that. You can't just sell into the single market, you need sales and ops for each country.

In Germany, around 90% of medicines that obtain marketing authorisation from the European Medicines Agency (EMA) are available to citizens while in Lithuania, for example, it is only 20% of the approved drugs.

Another major problem is the length of time it takes for a drug to appear on the national market after EU registration.

Germany is again the leader in this respect, with a waiting time of around 100 days. At the other end of the spectrum is Romania, where the procedure can take up to 900 days, or 2.5 years. In the Czech Republic, the average time for the whole process is around 1.5 years.

https://www.euractiv.com/section/health-consumers/news/a-single-market-for-medicines-would-be-no-panacea-pharma-companies-warn/

[-] HumanPenguin@feddit.uk 5 points 1 year ago* (last edited 1 year ago)

And we are not on the high side. Nice dramatically restricts drugs available to the NHS. If you have ever had to fight to get Nice approval you will understand I fave hence my retirement at 50.

But you are still forgetting the main point. EMA allows the nations under it to move drugs around. If ou need a drug in one nation. That your helth service dosent want to provide. You can buy it yourself and import from another EU nation. As we could in 2019. Now you cabnnot unless MHRA also covers it. So any drug created since 2020. Requires 2x the paperwork to even give you the option to buy. And even then. If Nice dosent support it. You cannot cross EU borders into the UK without getting a licence to import. So Even if you pay a private doctor to RX it legally getting it into the UK is harder then any other EU nation where the EMA accepts it. Some phamacies may do it for you. But not most of the big ones. London has a few that specialise in it for forign citizens visitinglong term.

just so you know back in 2000 that was multiple simi trucks of paperwork because at that point FDA and EMA would not take digital records.

It is still 100s f gigabytes of data for each drug. Needing to be formated for each agency.

As I said single payer is our only advantage, As even most EU nations have universal not single payer healthcare. But sales is still a relatively small part of the cost. Certification represents a huge part of all drug costsP Grooving it dose what you say and that the side effects are within reason at multiple levels haveing to interpret the results as each agency wants. And answer seperate questions from each agency before they will certify your drug as suitible for theie citizery. Is by far the largest cost after actual testing on animal subjects. independent of data analysis and presentation human subject testing is actually cheaper when it happens.

[-] bernieecclestoned@sh.itjust.works -4 points 1 year ago* (last edited 1 year ago)

But you are still forgetting the main point. EMA allows the nations under it to move drugs around

Not during shortages, the Single Market doesn't force anyone to share anything

If ou need a drug in one nation. That your helth service dosent want to provide. You can buy it yourself and import from another EU nation. As we could in 2019.

Without a prescription?

Now you cabnnot unless MHRA also covers it. So any drug created since 2020. Requires 2x the paperwork to even give you the option to buy.

The MHRA did the vast majority of the certification for the EMA...and the UK is still using the EU law and EMA to approve most medications

But, while the UK still relies on ema decisions, it has approved new cancer drugs more quickly

Brexit was also hailed as an opportunity for the UK to innovate alongside international partners, and here the UK has made progress. A number of schemes to fast-track promising drugs have borne fruit: in 2021, four innovative new cancer drugs were approved in the UK via an international scheme, Project Orbis, coordinated in the US with other non-EU partners. Additionally, the national Early Access to Medicines Scheme, which allows UK medics to prescribe before formal MHRA approval, saw another four medicines fast tracked for patients.

https://www.imperial.ac.uk/business-school/ib-knowledge/health/post-brexit-medicine-approvals-what-we-know

And the UK has the 7th largest share of the global pharma market. Do pharma suppliers not bother with approvals in Japan or Canada either?

[-] HumanPenguin@feddit.uk 5 points 1 year ago

Nor dose the UK. But your argument is not shortage drugs it was that germany helth agency supplies more then others. If you go to germany and buy drugs. No one can legally stop you crossing the French border. If you pay a priv doc in germany you can buy what ever is available to sell.

I can tell you right now. Brexit fucked that up for me and many others. And has given us fuck all in return.

But again its a invalid argumnt anyway. Because the issue is. The NHS germany and every health care agency in the world. Rarely if ever buys drugas directly from astrazenica or phizer GSK etc. (covid was a unique exception) They buy them from huge drug import companies that then sell them to local pharmacies. Who order what they need based on customer load and expectations. The warehouses in the EU are not selling to the warehouses in the UK. Because the paperwork and licencing to do so is a fuck sight more then just a form. It is staff who understand the drugs filling in that form. Who are simply not needed to sell to 26 other countries.

It really is not complicated to understand why that cost has become higher due to brexit. As I say other things are included. But the brexit extra paperwork is the big reason companies want more money to sell to the UK then to just ship to an other health agency in the EU.

While at the same time we gain no ability to buy from out of EU nations that we did not have before brexit. Because they need even more paperwork. Because every single drug they sell needs to prove it meets MHRA standards rather then just the post 2019 ones. Meaning more staff who now have to be trained in filling even more UK specific forms that tgese ware houses have no need for when selling in their own demain. Add to that how fucking expensive for both ends it is if that import licence gets filled in wrong. (as we saw happen over covid multiple times).

And it really only take very minimal understanding of market economics to see why the NHS is having issues and having to ask the gov to authorise higher payments for popular drugs.

As I keep saying. Brexit is a cause not the only one. The way our NHS is funded (underfunded compared to most other nations) has a huge hit. But the extra work of filling forms and providing data evidence to support those forms is something that has to come from somewhere. And why should pharmacutical warehouses in the EU fund it just because a tiny % over 50% of the UK had fuck all idea how this all worked when they voted.

Those who voted for it have to accept the cost of their choice.

[-] bernieecclestoned@sh.itjust.works -1 points 1 year ago

But the extra work of filling forms and providing data evidence to support those forms is something that has to come from somewhere

Yep. But forms can be automated and policy can be written to make the UK more attractive for pharma

While at the same time we gain no ability to buy from out of EU nations that we did not have before brexit

Other than things like Project Orbis?

https://www.gov.uk/guidance/guidance-on-project-orbis

[-] C4d@lemmy.world 5 points 1 year ago

Project Orbis is about approval (and it seems like a good idea). It isn’t about supply or cost.

[-] HumanPenguin@feddit.uk 5 points 1 year ago

PS you know cross border prescriptions were legal in the EU. Doctors in the UK could write me an RX and I could take it to Germany to fill. Was a common thing for many who often had to work cross borders. For thing the NHS covered it was easy and needed for my insulin etc. But for things not covered under NICE. Most NHS GPs will be happy to schedule a private appointment and write a non NHS rx. It really was not that uncommon pre brexit. With pre 2020 medication it can still be done. As most Chemists in the world recognise the need for travel (UK tends to require london as our chemists are often tied to NHS supply lines). The issue now is. It is illegal for me to bring medications back in any supply. Such checks did not exist pre brexit.

[-] bernieecclestoned@sh.itjust.works -3 points 1 year ago* (last edited 1 year ago)

Doctors in the UK could write me an RX and I could take it to Germany to fill.

So, just a £500 round trip to get a script filled?. The number of people doing that must be minuscule

Was a common thing for many who often had to work cross borders

So not common at all then.

[-] HumanPenguin@feddit.uk 5 points 1 year ago

Not uncommon in the UK. Much less so pre brexit as so many companies moved there operations out of the UK. But yes 1000s of people I the UK worked in the EU on and of related to their job. So not a majority. But far from uncommon. And ferries to the EU cost about were very often cheaper then trains in the UK. Heck even plans often are but those cheep flights don't tend to be regular. Ferries are easy ways to get to the EU cheap and often.

And within the EU land mass. The open borders make it a drive or often only a freaking bus ride. Copletely invalidating all you bullshit about how the EU ain't as open as claimed. Just because indevidual governme ts are not forced to share. Because the EU dose not remove soverienty as brexiters keep bullshitting. In no way indicates that cross border deals were not much easier then you claim.

And you while travelling to the EU was way cheaper then 500. Closer to 100 in petrol and ferry feels when booked in advance. 500 is only a huge cost every few months for the poorest in the UK. Most with an above minimum wage jobs have and will spend that hor helth needs.

So no that sort of cost in no way indicates it was rare.

Maybe you need to get out of your bubble a bit. A sizable % of people far from rich are able to spend money on thing that help them work healthier.

[-] C4d@lemmy.world 4 points 1 year ago

Close to home think Gibraltar and Northern Ireland. Further afield - I work with people who regularly travel for tasks that require an on-site presence and who have long term health conditions.

Probably more common than you think.

this post was submitted on 06 Nov 2023

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