By Fiona Grahame

There have been many posts on social media recently from people having difficulty obtaining their usual medications from pharmacies across Scotland.

The Orkney News will never publish unsubstantiated reports or those based on rumours. When we post factual articles we include links to reports and other sites so that readers can check them out for themselves and make up their own minds. We also publish a diversity of views which people send into us. This article is one of those – in it I am sharing my opinions.

It is only a matter of weeks now until the UK leaves the EU and it is looking more likely than ever that this will be with no deal being agreed. For many months advice and information has been published by both the UK and the Scottish Government about preparations being made for Brexit and in particular if there should be no deal reached.

Supply of Medicines and Medical Devices

The Orkney News has many articles published about what will happen with the supply of medications and medical devices with Brexit.

These include:

growing concerns from readers:Letter: No Confidence in Supply of Medicines Post Brexit

a link to the UK Government’s latest advice: Letter to suppliers – continuity of medicines medical products 26 june 2019.pdf.

Scottish Government advice: Update on Medical Supplies Post Brexit

and asking the Health Secretary in the Scottish Government, Jeane Freeman directly about the supply of medicines and medical devices. NHS Orkney: “Really good things are happening. Let’s promote the good stuff.”

Most politicians do try to give honest answers and the responses we have had on medical supplies were, I would like to think , based on the information there was at the time.

Given that Brexit has not happened yet – and some people are still convinced that it never will – why are people having their regular medications substituted and is this due to Brexit or to something else?

Stockpiling

UK Agencies were advised to stockpile and have enough supplies for 6 weeks – this was based on a leaving the EU date of the end of March. They have continued to stockpile.

All no-deal preparedness plans should therefore contain a mix of the following, depending on each company’s specific situation:

– Secured capacity for rerouting freight away from the short straits after no-deal exit day, in order to avoid the worst restrictions on flow outlined above.
– Stockpiling product above and beyond business-as-usual inventory levels; as a default, this is recommended as six weeks’ stock above business as usual inventory, the same as last time.
– Assurance on the readiness of a company’s logistics and supply chains to meet the new customs and border requirements for both import and export (sometimes referred to as “trader readiness”).

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for products with a short shelf life or where production constraints mean stockpiling is not possible, for example, medical radioisotopes, we ask for alternative air freight plans to be made. Department of Health and Social Care

The UK Government’s Department of Health and Social Care  Medicine Supply Team “has well established procedures to deal with medicine shortages and works closely with MHRA, the pharmaceutical industry, NHS England, the Devolved Administrations and others operating in the supply chain to help prevent shortages and to ensure that the risks to patients are minimised when they do arise.”

The Department’s Medicine Supply Team is to be alerted of any supply issues. Ministers can also issue serious shortage protocols that, where appropriate, enables community pharmacists to supply against a protocol i.e. to issue a substitute medication instead of the medication indicated on the prescription without going back to the prescriber first.

The supply of medicines is the responsibility of the UK Government’s Department of Health and Social Care however, the Scottish Government also has a responsibility to ensure the health and well being of the People of Scotland. The measures taken to ensure the continuity of medical supplies is agreed to by both the UK and the Scottish Government.

Three-quarters of the medicines we use in the UK and over half of the clinical consumables come either directly from the EU trading bloc or through it. Given that we are still trading freely with the EU are the shortages we are experiencing now caused by Brexit ? – clearly not as we are still an EU nation.

Are they caused due to stockpiling? possibly but why are people who have been on the same medication for years now being switched to an alternative which may cause them some adverse reaction if the UK started stockpiling months ago in preparation for leaving on 29th of March?

Medical shortages in the EU

In 2016 the EU set up a task force  ‘to improve continuity of supply of human and veterinary medicines across Europe.’

Its key priorities include:

• looking at ways to minimise supply disruptions and avoid shortages by facilitating approval and marketing of medicines using the existing regulatory framework (for example by work sharing and reduced timetables when possible);
• developing strategies to improve prevention and management of shortages caused by disruptions in the supply chain (for example developing guidance for companies on reporting of shortages);
• encouraging best practices within the pharmaceutical industry to prevent shortages;
• improving sharing of information and best practices among EU regulatory authorities to better coordinate actions across the EU;
• fostering collaboration with stakeholders and enhancing communication of supply problems to EU citizens.

In July 2019 guidance was also published by the EU on how governments can best communicate to the public if there are issues around continuity of supply. good practice guidance communication public medicines availability issues_en

It is a key recommendation that any shortage of a medicine which affects a whole country (rather than just a local one) should be communicated to the Public. i.e. the Government (UK or Scottish) should let the public know if there is an actual shortage of this medicine. 

Communication to the public needs to be timely and up-to-date to ensure effective planning…. publication should occur once the shortage has been confirmed by the MAH and recommendations have been agreed (if applicable). European Medicines Agency

There are some current shortages of medicines occurring across the EU which are not Brexit related and there is a list of these produced: Shortages catalogue

The UK List can be accessed here: Shortages, Discontinuations and Patent Expiries

If you click on some of the other countries in the EU’s Shortages catalogue you will see it is not an issue confined to the UK.

Communication

Patients in Scotland have been getting their regular medications substituted.

Post Brexit supplies will be affected if there is a no deal because the free movement of goods will no longer be there and delays in transportation will occur.

If there is a deal there will be a transition arrangement which will ease the issues around continuity of supply.

People are quite rightly genuinely worried about shortages in medical supplies post Brexit. Using the genuine fears of these people, however, to push a political agenda is appalling but that is what some users of social media are doing right now. It is causing great distress and affecting the mental well being of those who are worried about their individual medical needs.

What is completely lacking in all of this situation is clear communication from all those concerned with the distribution of medicines – from pharmacies, to health boards, to Ministers of Health and to both the Scottish and the UK Governments.

This is an outright dereliction of duty to the public.

If there are medical shortages give a clear explanation – either at a local level or nationally – as to what these are, how long it may last and what is being done to address the shortage.

Simply replacing a patient’s medication with a substitute without consultation, giving reasons why the action is being taken, is contrary to the excellent professional guidance which has been published and agreed to. Patients who have been asking questions about continuity of supply have been given conflicting information by their elected representatives who more than not try to fob them off with platitudes. Lack of information is as damaging to the public’s trust of politicians as misinformation.

I stated at the start of this article that I believe most politicians to be honest – what, however, I do not have is trust in those we elect to represent us. That is why asking questions of them and not giving up till you get an answer is so important.

For anyone who has had their medication changed and who has not been given a clear and/or satisfactory reason why , I would urge them to write to the Health Minister in the Scottish Government, Jeane Freeman, to their local MP, MSPs and to us here at The Orkney News.

Let’s start getting some answers as to why there appears to be a shortage of medical supplies which up until now have been available.