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A hospital trust chief executive has warned that its waiting list could increase by 15% each month after a no-deal Brexit as a result of problems with the supply of medical goods, including medicines.
And as hospital pharmacists prepare for the UK to leave the EU without an agreement, less than three weeks before Brexit is due to happen, a chief pharmacist at a trust in Liverpool has told The Pharmaceutical Journal that the trust is increasing its stock of “critical antibiotics” after it had previously reduced stock in response to the ‘Carter Review’ in 2016.
The government wrote to hospital trusts in August 2018, urging them not to stockpile medicines locally as manufacturers were being asked to maintain a six-week stockpile of drugs in UK-based warehouses.
However, in a Brexit memo from David Rosser, chief executive officer of University Hospitals Birmingham, to the trust’s board of directors, he said that the trust is “not able to assure the board that the supply of medical stocks will be adequate for our operational needs”.
He continued: “Indeed, there are already credible reports that pharmacies are experiencing greater supply problems, with a doubling of the number of medicines on the ‘shortage of supply’ list.”
In the memo dated 24 January 2019, he added: “It seems inevitable that the trust will need to curtail some surgical/interventional activity if there are supply problems caused by a no-deal Brexit.
It was possible that this could result in “complete curtailment of all elective activity”, he warned, and he said that postponing “most or all non-urgent surgical and interventional activity” would “significantly” impact patient waiting times.
“At our current rate of operating, this could see our waiting list size increase by 15% of its current size each month.”
He added that this could “potentially [cause] increasing mortality whilst awaiting surgery”.
University Hospitals Birmingham declined to comment on the memo.
Chief pharmacists at hospitals around the UK have been preparing for Brexit. Alison Ewing, chief pharmacist at the Royal Liverpool University Hospital NHS Trust, told The Pharmaceutical Journal that her trust had increased its supply of “critical antibiotics” to last “not more than two weeks”.
She said that following the release of the Carter Review, “one of the areas where we were really efficient was with stock holdings — we scored highly on stock control at the Royal — but this is now proving to be a disadvantage; we don’t have any leeway in the system”.
The review, which was released in 2016, recommended that trusts reduce their medicines stockholding from an average of 20 days to 15 days, to “save £50m”.
In light of government guidance advising trusts not to stockpile, Ewing said the trust was “not stockpiling, just having a bit extra”.
“Antibiotics are absolutely crucial,” she said. “We’re only looking at those at the moment.”
Ewing’s concerns about medicines supply were echoed by Anne Davies, chief pharmacist at Epsom and St Helier University Hospitals NHS Trust, who said: “The supply chains are already very fragile, so most of the effort is taken into maintaining our supplies of our current drugs.”
But she warned that the impact of Brexit is “really unknown”, making it “very difficult to put any concrete planning in”.
Chief pharmacists in London, the West Country and Liverpool who spoke to The Pharmaceutical Journal said they have been “fully involved” in Brexit planning at their trust.
Jon Beard, chief pharmacist at Taunton and Somerset NHS Foundation Trust, said his trust has “some plans to share medicines between local hospitals should they go out of stock in emergency situations”, but added that they “aren’t envisaging any problems”.
He added, however, that the trust “will be doing exercises later this month to see how we might cope with different shortages and difficulties”.
Medicine shortages are among “suggested exercise scenarios” that NHS England sent trusts to help them assess the impact of the UK leaving the EU.
The scenarios outlined in the document, which was attached to Sandwell and West Birmingham Hospitals NHS Trust’s February 2019 board papers, include preparing for a variety of medicines supply chain issues, workforce issues and waste disposal problems.
They are described in the document as “an interim measure to start the process of checking your preparedness for potential impacts of the UK’s departure [from the EU]”.
One such scenario asks the trust to consider the impact of increased prices of imported medication.
“In order to save money and maintain services to patients, cheaper alternatives have been sourced and GPs etc. have been asked to prescribe these lower-cost drugs,” the document says. “However, patients are not responding to the alternative medication and re-attendances are on the increase putting extra burden on staff and budgets.”
The document then asks the trust to consider “the potential short-, medium- and long-term impacts” in relation to reputation; staff welfare and morale; and patient care.
Another scenario suggests trusts prepare for “issues with importing medicines and other products that require a temperature-controlled supply chain (cold chain)”.
“Medicines, such as insulin, and human tissue, which is only available from overseas, are facing delays at ports with limited or no cold chain storage facilities,” the document proposes. “Due to the ongoing issues with supplies issues, the UK stockpile of these medicines are low.”
It adds that as delays persist, “increasing proportions of the orders are being discarded due to concerns over the maintenance of the cold chain”, and asks trusts to consider the “impacts from this situation” and what actions the organisation take.
NHS England said the document had been developed in line with preparations for all scenarios in the same way as each other government agency.
Sandwell and West Birmingham Hospitals NHS Trust has been approached for comment.
