NHS Trusts Ran Short of Aspirin Without Reporting It

Twenty-six of 42 NHS trusts that answered an aspirin question had supply gaps between December 2025 and March 2026. The same freedom of information round found gaps in co-codamol, a paracetamol-and-codeine painkiller, and in ramipril, a blood pressure tablet. Dr Rodolfo Catena, an associate professor in operations and supply chain management at University College London’s Global Business School for Health, wrote to 184 trusts and received 60 replies.

Those replies also show a quieter failure. 82% of the trusts that answered said they had not told NHS England about the scarcities they were facing, and 92% had no backup plan. The Department of Health and Social Care still rates ramipril as a known squeeze and has a national protocol in force. The wards, on this evidence, were not feeding that picture.

Aspirin Was Short at 26 of 42 Trusts

Catena asked about three cheap, high-volume medicines rather than specialist hospital-only products. Aspirin is used for pain and to cut the risk of blood clots. Co-codamol is used for muscle pain, period pain and toothache. Ramipril is an ACE inhibitor prescribed for high blood pressure. The percentages below are shares of trusts that answered each question, not of every trust in England.

FOI REPLIES ON THREE HOSPITAL MEDICINES

Nine trusts had trouble getting two of the three. Kent Community Health NHS Foundation Trust was the one that ran short of all three. York and Scarborough’s co-codamol line had been disrupted since May 2025. Royal Wolverhampton had trouble getting enough co-codamol for the 10 months between October 2025 and August 2026.

Frimley Health, which cares for people in Surrey, Berkshire and Buckinghamshire, paid higher prices for ramipril rather than risk a break that would hit patients, Catena found. That is a local workaround, not a national stockpile. Pharmacists have already called ordinary-medicine gaps a national crisis, with some patients going weeks without their usual tablets. A hospital that pays up can keep a line open. A hospital that does not has to switch strengths, chase wholesalers, or wait.

Kent Logged Gaps in All Three Drugs

Kent Community Health’s reply, released on 12 June 2026 after three emails dated 4 June, is the only full trust file in the public set. The foundation trust said it does not hold a central stock of aspirin, co-codamol 30mg/500mg or ramipril across 123 sites. It also said it had no formal backup or safety-stock policy, had not raised stock as a precaution in the prior 12 months, and had raised no formal incident reports with NHS England or NHS Supply Chain.

KENT COMMUNITY HEALTH SUPPLY GAPS

1. 7 August 2024: Ramipril 2.5mg tablets are disrupted for 3 months.
2. 12 January 2026: Co-codamol 30/500mg tablets are disrupted for 6 months.
3. 10 April 2026: Aspirin 300mg dispersible tablets are disrupted for 1 month.
4. 23 April 2026: Ramipril 1.25mg capsules are disrupted for 2 months.

The trust switched patients to other formulations where it could: ramipril 2.5mg tablets to 2.5mg capsules, ramipril 1.25mg capsules to 1.25mg tablets, and aspirin 300mg dispersible tablets to 75mg dispersible tablets. It said it still obtained co-codamol tablets through the disruption. It had no central count of how many patients were moved. That churn is exactly the kind of shift later national advice warned against, because other ACE inhibitors cannot absorb a sudden extra load.

Most Trusts Never Told NHS England

The FOI round is a sample of the willing. Sixty of 184 trusts replied, so the gaps it maps are a floor, not a census. Even inside that sample, the reporting line is thin. Catena argues that NHS England is wrong to treat drug scarcities on its operational risk register as only a medium risk to care, and he wants trusts put under the same duty that already sits on drug companies: warn the department when a break is coming.

WHAT THE REPLIES SHOW ABOUT REPORTING

• No backup plan: 92% of responding trusts had no contingency plan for supply problems.
• Unreported gaps: 82% had not told NHS England about the scarcities they were facing.
• Risk score: NHS England rates drug shortages at 16 out of 25 and had hoped to cut that to 9 by October 2026.

Whitehall’s main warning channel does not run through hospitals. The department is notified of supply issues and discontinuations mainly through the Discontinuations and Shortages portal, which launched in October 2020 and is built for pharmaceutical suppliers meeting a statutory duty. From January to June 2026 there were around 700 supply issue notifications, lower than the same stretch in earlier years. There were about 1,400 such filings in 2025, down from about 1,900 in 2024. The statistics page itself says those filings should not be read as a count of actual shortages or patient harm.

In 2025, manufacturers named production problems as the most common root cause, at 62% of notifications. Delays in the supply chain were cited in 19%, other manufacturing issues in 17%, and raw material or packaging shortages in 13%. Customer demand surges were named in 19%. A portal that records fewer company filings can sit beside hospital FOIs that describe empty lines, because the two systems are not looking at the same thing.

What a Serious Shortage Protocol Does

The department is not silent on ramipril. A health department spokesperson said it speaks regularly to NHS trusts and national clinical leads about medicine availability and knows ramipril is in limited supply, which is why it issued serious shortage protocols so patients in the UK can still get the medicine they need. The same statement said it is working with suppliers on ramipril, co-codamol and aspirin, that the vast majority of the UK’s licensed medicines are in good supply, and that the government is investing in UK medicine manufacturing.

SSP087, issued for ramipril 1.25mg capsules, has been live since 22 April 2026. Kent’s 1.25mg capsule gap began the next day. The protocol is UK-wide. Community pharmacists may restrict ramipril to one month when a prescription asks for more, if stock is there at all. It does not let a pharmacist swap the patient onto a different drug. The end date has been pushed twice and now sits at 30 October 2026.

WHAT SSP087 AND THE SEPTEMBER NOTICE SAY

• The capsule cap: SSP087 limits ramipril 1.25mg capsules to one month’s supply where stock exists.
• The wider notice: A 7 September 2026 medicine supply notification, MSN/2026/043, said ramipril 1.25mg, 2.5mg, 5mg and 10mg capsules are in limited supply until the end of October 2026, classed as Tier 2, medium impact.
• The tablet warning: Tablets remain available but cannot take extra demand, and routine switches to other ACE inhibitors or ARBs are not advised because those products are used far less.

A protocol that rations a single capsule strength is a holding pattern. It keeps remaining packs spread across more patients. It does not restock a hospital cupboard, and it does not capture aspirin or co-codamol. The same “medium” label Catena disputes on the risk register also sits on the September ramipril notice. A spokesperson for the Society for Acute Medicine, which represents hospital doctors, said medicine shortages can disrupt treatment and add pressure for clinical and pharmacy teams, and that the work is resilient supply chains, timely communication and access to suitable alternatives so care is not delayed.

Pharmacies Spend Hours Hunting Everyday Stock

Hospital FOIs landed in a market that community pharmacies have been living with for months. The National Pharmacy Association, which represents about 6,000 independent community pharmacies, warned on 18 June 2026 that shortages were among the most severe GPs and pharmacists had seen, and that they now often involve commonly dispensed painkillers, blood pressure tablets and epilepsy medicines, not only specialist lines. Its survey found that 89% of pharmacies were unable to dispense a medicine daily in the prior year because of supply issues.

NPA SURVEY OF PHARMACY OWNERS, 2026

• Pharmacy hopping: 98% encountered patients who had visited several pharmacies in a day to source a prescription in the last year.
• Safety call: 96% felt the current situation posed a serious risk to the safety of their patients.
• Anger at the counter: 83% of pharmacy teams faced abuse or anger from patients when a prescribed medicine was unavailable.

Olivier Picard, chair of the National Pharmacy Association, said the figures match what pharmacies and GPs have been dealing with for many months, with shortages more frequent, longer, and more disruptive for patients.

These shortages are some of most severe the UK has experienced.

Olivier Picard, Chair, National Pharmacy Association, 18 June 2026

The association wants an emergency taskforce of manufacturers, wholesalers and clinicians, and a change in law so pharmacists can make simple swaps, such as a tablet for a capsule, when that is clinically safe, instead of sending the patient back to the GP. Professor Victoria Tzortziou Brown, president of the Royal College of GPs, said the college, with safeguards, supports pharmacists making limited changes when a medicine is unavailable and a safe alternative is in stock. Kent’s hospital reply already shows that kind of swap happening behind the scenes, without a public count of who was moved.

On 29 September 2026 the department’s September price-concession list, circulated by Community Pharmacy England, still included aspirin 300mg dispersible tablets, a 32-pack at £1.09, and several ramipril strengths. Those entries are a price patch for community contractors, not a delivery promise to a ward. The hospital story and the high-street story are the same cheap tablets, seen from two doors.

High Blood Pressure Meets a Thin Ramipril Supply

Ramipril is a poor medicine to run short of in a country that is already missing most of its hypertension. Oxford Population Health researchers, writing in BMJ Public Health on 23 September 2026, analysed clinic readings from Our Future Health on 1.4 million adults in England enrolled between 2022 and 2025. They used the 140/90 mmHg threshold. 37% of participants had hypertension. For 59 percent of hypertension undetected cases, there was no prior diagnosis and no blood-pressure drug.

Among people already on treatment, 50% still had readings at or above 140/90 mmHg. After age adjustment, hypertension was more common in men than in women, 42% against 29%. The share rose with age, from 15% in 18- to 39-year-olds to 71% in people aged 80 or older. Wenyu Liu, the statistician who led the analysis, said the current approach to finding and treating high blood pressure is not fit for purpose.

A national protocol that caps ramipril capsules at one month, and a hospital FOI in which 7 of 43 trusts could not get as much ramipril as they needed, sit on top of that undetected pool. The people already on the tablet are the ones who feel a gap first. The larger group has not even been offered it.

NHS England Still Rates Shortages at 16

NHS England has given drug shortages a score of 16 out of 25 on its risk scale and had an ambition to reduce that to 9 by October 2026. Catena said the spread of the gaps he found makes that cut unlikely. Improving supply-chain resilience is also listed as a priority for the health department. The FOI does not prove that every ward in England is out of aspirin. It does show that among the trusts willing to answer, winter aspirin gaps were common, backup plans were rare, and most of those gaps never went up the line that is supposed to set the score.

SSP087 still runs to 30 October 2026. The September ramipril notice uses the same medium-impact tier. Catena’s fix is a reporting duty on trusts to match the duty already on companies. Until that exists, a risk register can improve on paper while a community trust with 123 sites, no central stock and no incident reports keeps switching strengths in silence.

Disclaimer: This article is news reporting on NHS medicine supply, freedom of information replies and official shortage notices. It is for information only and is not medical advice, a diagnosis, or an instruction to start, stop or switch any medicine. Readers who are worried about a prescription should speak to a GP, pharmacist or other qualified clinician before changing treatment. Figures and shortage statuses reflect the FOI replies, department notices and association surveys cited here and can change as stock and protocols move.