ADuring the height of Covid-19, many countries found themselves short of essential medicines. As well as for Covid-related medical complications – such as patient admissions for respiratory and related symptoms – hospitals did not always have the required stocks of critical drugs for a range of illnesses. Factories producing drugs were closed; international shipping was disrupted; hospitals were coping with unprecedented circumstances; and it all added up to a dilemma that received widespread attention. But the problem was not a new one. While Covid amplified the exposure, medicine shortages have been with us for some time. And with events like Brexit and the pandemic, alongside major geopolitical shifts, scarcities are more evident. Every year there are reported drug shortages, from oncology drugs to antibiotics, chemotherapy agents to even intravenous (IV) fluids, basics used in public hospitals every day. On the Measures for Improved Availability of Medicines and Vaccines (MIA) project, we have been part of an international team looking at what can be done to solve this problem. We have identified cost-effective supply chain interventions, such as stockpiling medicines, changing the way you buy them or, thinking about the capabilities of the medicine supply system as a whole. The UK part of the project has had three aspects, each bringing valuable insights and opportunities for change within the UK medicine supply system. EXISTING CAPABILITIES We looked at the situation from preBrexit to post-Covid to see how the UK medicine supply system dealt with overlapping crisis events, and how it developed capabilities to respond. There are different types of uncertainty. Brexit was foreseeable, we knew it was coming. Covid, we did not see coming. These two things also overlapped. Based on cross-country research, it emerged that the UK had done better on medicine supply than many other European countries during Covid. Looking at how this happened and what lessons were learned was an important aspect, and some of the measures organisations were taking during Brexit helped in the initial pandemic response. For example, the UK Government asked manufacturers to stockpile medicines to be able to respond to a possible no-deal scenario. This meant during the first wave of the pandemic, they had some of these medicines in stock. We could also see the evolution from the UK Government and the National Health Service (NHS) constantly firefighting as a reactive approach to dealing with the crisis, to having firefighting as one of several measures for dealing with disruptions. Organisations became more proactive and strategic. There are lessons here for supply in many areas. What happens with the housing crisis in different parts of Europe, for instance. There are the same fundamentals in terms of learning and building capabilities leading to something that is going to be much more sustainable and viable in the long-term. BUILDING RESILIENCE The second area we have looked at is what we call “contracting for resilience” – how to change the way the NHS buys medicines in the hospital care sector in the UK. Presently, if you look at the tenders and the contracts used to buy medicines in public hospitals, it is all about price and cost efficiency and not resilience in the supply chain. There is a desire to change that to give more weight to supply chain resilience. We have engaged with stakeholders within NHS England, the UK Government Department of Health and Social Care (DHSC), and industry associations to see how this can become a reality. For example, so far the NHS makes contract award decisions without thinking of things like how robust the supply chain is, whether there is a dual source for supplies including for active pharmaceutical ingredients (APIs). There is a tension between making supply chains more resilient and working with tight budgets. One of our key findings has been what the NHS and medicine suppliers are trying to do to reconcile these competing priorities – investments in resilience and affordability. One good 20 |
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