Earlier this week the Health Service Journal exposed an NHS Trust that showed us just how big a problem drug shortages are and how this situation has developed. According to the HSJ, the Royal Surrey County Hospital Foundation Trust made “tens of millions” of pounds last year through exporting drugs for a profit which were purchased at discounted prices for NHS use only. Paul Biddle, the foundation’s finance director, claimed that they were always encouraged to be ‘entrepreneurial’ by Monitor, the hospital regulator. So what does this episode tell us about how ‘patient-centric’ our NHS really is?
Firstly, there is a potential issue with the regulation which we can expect to read more of in the coming weeks. A spokesperson for Monitor distanced the regulator from the scandal, commenting: “So long as the drug trading does not affect UK patients or the ability of the trust board to focus on their core responsibilities this is not an issue on which we would take a view.” This will not be acceptable to many patients, who rely on a robust system that ensures their medicines are available, of which Monitor is one part. While the Department of Health ruled in July last year that parallel exporting was ‘wholly unacceptable’, there is clearly no system to stop the practice which cash-strapped trusts could likely continue without sanctions or limits. The problem for patients is a very real one, as there are now more than 40 branded and generic medicines in short supply in the UK, including drugs for schizophrenia and cancer which patients simply cannot do without.
The Royal Surrey County Hospital Foundation defends itself by commenting that: “At no time were drugs supplied which were on the Purchasing and Supply Agency list of drugs in short supply.” Even so, drugs are sold at a discount to the NHS on that basis that they are used for treating NHS patients only. When cases like this emerge, it may yield short term financial gain for individual trusts but in the long term can only damage the NHS as a whole. For one thing, pharma companies would surely be entitled to review their discounting arrangements if their drugs are being sold for profit?
Speaking strongly on the issue, Dr Richard Barker, director-general of the Association of the British Pharmaceutical Industry, said: “It beggars belief that a NHS hospital is seeking to profit by selling abroad medicines being made for UK patients… Manufacturers in the UK are doing all they can to get supplies to where they are needed – in pharmacies, surgeries and hospitals. Actions like those of the Royal Surrey County Hospital and other speculators totally undermine these efforts.”
The issue is not a new one, and the ABPI has previously had to explain that the blame cannot be placed at the door of the pharma industry. However, many people who see the pharma companies as profit-hungry enterprises are likely to suspect the industry has a part to play in all this. This wasn’t helped by a BBC News item broadcast on Monday highlighting these uninformed and completely unsubstantiated accusations against the industry (later withdrawn when challenged). It seems there has never been a more important or opportune time to communicate the complexities of pricing simply, clearly, and reliably inform the public of the role of the pharma industry within this.
Parallel exporting is not true to the principles of the discounting arrangement, neither is it true to the commitment of the NHS to put patients first. As Dr Barker summarised, “Like everyone else involved in the supply chain, their first duty should be to patients in the UK. All sides should be working together to ensure medicines being made for patients in the UK actually reach them.”
Tags: ABPI, Dr Richard Barker, drug shortages, drug trading, exporting, Monitor, pharmacy, Royal Surrey County Hospital Foundation Trust