Aspirin shortages expose the NHS’s dangerous lack of planning

Few medicines are as ordinary as aspirin, which millions of people take every day to lower their risk of a heart attack or stroke. Alongside co-codamol for pain relief and ramipril for high blood pressure, it is among the most frequently prescribed medicines in the country. Yet a new Freedom of Information analysis from UCL’s Global Business School for Health shows that hospitals across England have been running short of all three. Of the 60 NHS trusts that responded, 62% reported shortages of aspirin between December 2025 and March 2026.

Co-codamol was disrupted at 31% of trusts and ramipril at 16%. And 92% of the trusts did not have a formal contingency plan for any of the three. When medicines this basic go missing this widely, the obvious question is why. Faced with empty supply cupboards, trusts did what the NHS so often does and coped. Patients were switched to different versions of the same medicine, and Frimley Health paid higher prices to keep ramipril in stock.

But in many cases trusts could not say how many patients had been switched, and some told us their records simply did not hold that level of detail. Every workaround was a sensible local decision, but it left the national picture of the supply network less clear. Four in five trusts had not reported a shortage to NHS England in the past year. Part of the reason is structural. Manufacturers have a legal duty to warn the Department of Health and Social Care (DHSC) about expected shortages, and that information then filters down to trusts each month.

The consequences are already visible in NHS England’s Operational Risk Register, which, when presented to the board in June, still rated medicine supply as a ‘medium’ risk, unchanged from the quarter before. The target to bring that score down by this month has now been missed. For everyday medicines, that gap carries particular weight because a shortage of aspirin or ramipril affects far more patients, far more quickly, than a disruption to a specialist drug.

Where patient exposure is highest, planning should be strongest. Our findings suggest it can be the opposite, at a time when trade wars and conflict along major shipping routes are making global supply chains more fragile by the year. These findings point to a wider problem. Senior NHS leaders spend so much time firefighting that little is left for long-term planning. Instead, supply chain resilience needs to be built over months and years by mapping the medicines with the greatest risk, building relationships with suppliers and planning stock before demand peaks.

That work only happens when leaders are given enough room to look beyond the next crisis. How the NHS buys medicines needs to change. The current method leaves little in terms of spare capacity or backup sources. Value-based procurement would reward suppliers for reliability, giving weight to delivery records, the spread of manufacturing sites and willingness to hold buffer stock. Change will not happen overnight, since procurement innovation takes time to bed in.

In the meantime, Trust leaders can act now by setting effective minimum stock levels for their highest-volume medicines and recording every switch. DHSC has already made resilient medicine supply one of its stated priorities, with a commitment to spot disruption earlier. That ambition is the right one. But early warning depends on giving leaders the opportunity to plan and act on challenges up ahead. ____________________ Dr Rodolfo Catena is an Associate Professor in Operations and Supply Chain Management at UCL’s Global Business School for Health.

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