NHS Hospitals Run Short of Aspirin After Cheap Generics

Twenty-six of 42 NHS trusts that answered a UCL stock request had run short of aspirin between December 2025 and March 2026. Co-codamol and the blood pressure tablet ramipril ran thin in the same freedom of information round. Dr Rodolfo Catena, an associate professor in operations and supply chain management at UCL’s Global Business School for Health, asked 184 English trusts for figures. Sixty replied.

The gaps sit in the cheapest part of the cupboard, where the health service has spent years driving prices down, and where most trusts still have no written plan if the next delivery fails.

Aspirin Ran Thin in 26 of 42 Trusts

Aspirin was the widest miss. Catena’s replies put disruption at 62% of the 42 trusts that answered on that drug, which hospitals use for pain and to cut the risk of blood clots. Thirteen of 42 trusts (31%) had run short of co-codamol, a paracetamol and codeine mix used for muscle pain, period pain and toothache. Seven of 43 (16%) could not get as much ramipril as they needed.

Nine trusts had trouble with two of the three medicines. One, Kent Community Health NHS Foundation Trust, ran short of all three. York and Scarborough Teaching Hospitals NHS Foundation Trust’s co-codamol supply had been disrupted since May 2025. The Royal Wolverhampton NHS Trust had trouble getting enough co-codamol for the 10 months between October 2025 and August 2026.

THE THREE DRUGS IN THE FOI

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 patients need timely access to suitable alternatives so care is not delayed.

The One Trust That Lost All Three

Kent Community Health does not hold a central stock of aspirin, co-codamol or ramipril. The trust told Catena that pulling tablet counts from 123 sites would breach the cost limit in the Freedom of Information Act, in a reply released on 12 June 2026.

It still logged four separate disruptions, then switched formulations rather than pause treatment. It has no central record of how many patients were moved.

KENT COMMUNITY HEALTH DISRUPTIONS

1. 7 August 2024: Ramipril 2.5mg tablets run short for 3 months; patients moved onto 2.5mg capsules.
2. 12 January 2026: Co-codamol 30/500mg tablets disrupted for 6 months; tablets still obtained through the gap.
3. 10 April 2026: Aspirin 300mg dispersible tablets run short for 1 month; the trust switched patients to 75mg dispersible tablets.
4. 23 April 2026: Ramipril 1.25mg capsules run short for 2 months; patients moved onto 1.25mg tablets.

The same reply said the trust raised no formal incident reports internally or with NHS England or NHS Supply Chain. It has no formal contingency or safety stock policy for these medicines, and it had not increased stocks as a precaution in the previous 12 months.

Hospitals Are Not Required to Sound the Alarm

Almost all of the trusts that responded (92%) said they had no contingency plan for supply problems. Some 82% said they had not reported the scarcities they were facing to NHS England. Catena wants NHS trusts put under the same duty that already sits on drug companies, so service bosses see disruption earlier.

The Department of Health and Social Care learns about national gaps mainly through manufacturers. Suppliers file through the Discontinuations and Shortages portal, known as DaSH, which launched in October 2020. Those filings are a legal duty on companies. They are not a census of what is missing on a ward.

WHAT THE ALERT SYSTEM ACTUALLY COUNTS

• Company filings: From January to June 2026 there were around 700 supply issue notifications, which DHSC said was lower than the same stretch in earlier years.
• The 2025 total: About 1,400 supply issue notices went in, down from about 1,900 in 2024.
• Stated causes: Manufacturing problems accounted for 62% of 2025 supply notices, with legal, regulatory, market and demand factors in 37%.
• The official caveat: DHSC says the figures should not be read as a measure of actual medicine shortages or of harm to patients.

That caveat is the hole in the risk register. NHS England has scored drug shortages at 16 out of 25, a medium risk, and wanted that score down to nine in October 2026. Catena argues the spread of basic-drug gaps makes that cut unlikely. Official notice totals can fall while hospital aspirin still runs out, because the portal never had to hear from the trusts holding empty tins.

Why the Cheapest Pills Keep Disappearing

Generic medicines, which cost little to make and fill most NHS scripts, are now the ones pharmacies and hospitals cannot rely on. The National Pharmacy Association, which represents about 6,000 independent community pharmacies, has said shortages of this severity are no longer limited to specialist treatments such as ADHD and epilepsy drugs.

On 28 January 2026 the NPA published a six-drug basket. For aspirin 75mg in a 28-pack, pharmacies paid wholesalers £3.97 while the NHS paid £2.18 for a 28-pack of aspirin, a loss of £1.79 a pack. For the blood pressure tablet irbesartan 150mg (28), the wholesale cost was £6.09 against an NHS payment of £1.68. Across those six drugs, the association put pharmacy losses at £5.8 million a month.

It is a scandal that all too often pharmacies are subsidising the cost of the nation’s medicines. It pushes pharmacies to the edge of closure and exacerbates chronic problems with medicine supply.

Henry Gregg, chief executive, National Pharmacy Association

An NPA survey found that two thirds of pharmacies made a loss in 2025, and that 72% of owners had used personal savings or remortgaged to stay open. In June 2026 the same body said 98% of pharmacies had seen patients visit several shops in a day to fill one script, 96% felt the situation posed a serious risk to patient safety, and 83% of teams had faced abuse or anger when a prescribed medicine was missing.

Trusts that can pay more still find stock. Frimley Health NHS Trust, which cares for people in Surrey, Berkshire and Buckinghamshire, paid higher prices for ramipril rather than risk a break in supply. That is a local patch on a national price, and it leaves poorer budgets waiting in the same queue.

Ramipril Capsules Stay Rationed Until October

Ramipril is not a rare hospital-only product. It is a first-line blood pressure tablet, and the state has already admitted the 1.25mg capsules are in serious shortage. SSP087 for ramipril 1.25 mg capsules has been in force UK-wide since 22 April 2026 and now runs to 30 October 2026. Where stock exists, pharmacists may supply only one month at a time.

On 7 September 2026 the Department of Health and Social Care issued Medicine Supply Notification MSN/2026/043, a Tier 2 (medium impact) alert. Ramipril 1.25mg, 2.5mg, 5mg and 10mg capsules are in limited supply until the end of October 2026. Tablets remain available but cannot cover extra demand. Other ACE inhibitors and ARBs are still on the market, yet routine switching is not advised because those alternatives are used far less, and a wave of switches could empty their lines too.

WHAT PHARMACIES WERE TOLD TO DO

• Check home stock: Ask patients if they already have a month or more, and delay a fill if they do.
• Limit new supply: Order in line with usual demand and keep new issues to one month.
• Short-dated 5mg: Consider buying short-dated 5mg stock from wholesalers and tell the patient the expiry date.
• Prescribers: Do not write more than one month until the gap closes, and switch class only when it is clinically necessary.

The patient group sitting behind those rules is larger than the hospital FOI. Oxford Population Health researchers, led by medical statistician Wenyu Liu, analysed clinic readings from 1.4 million adults in the Our Future Health programme who enrolled between 2022 and 2025. The paper, in BMJ Public Health, found 37% had hypertension at the World Health Organization threshold of 140/90 mmHg or higher, or were already on blood pressure drugs. For 59% of those with hypertension, the condition was undetected. Among people already taking treatment, 50% still had readings at or above 140/90. Prevalence ran from 15% of 18- to 39-year-olds to 71% of people aged 80 or older, and was 42% in men against 29% in women after age standardisation.

While hypertension is largely a “silent killer”, the current approach to detecting and treating high blood pressure is not fit for purpose.

Wenyu Liu, medical statistician, Oxford Population Health

A drug used to treat a condition that most people with it do not know they have is a poor candidate for a multi-month shortage. Missed tablets do not announce themselves in the way a missed painkiller does.

216 Price Concessions in September Alone

Hospital FOIs and community pharmacy pricing are two views of the same squeeze. When a pharmacy cannot buy a medicine at or below the Drug Tariff price, DHSC can grant a price concession for that month. Community Pharmacy England said on 25 September 2026 that this had produced 216 price concessions for September, including aspirin 75mg dispersible tablets in a 28-pack at £2.76.

A concession is not a shortage count. It is a Whitehall patch that says the published tariff is below what wholesalers are charging. Cardiovascular generics have been filling that list. The same month’s paperwork still had to carry ramipril, aspirin and a long tail of other everyday tablets whose factory price no longer matches what the NHS set.

Pharmacists hunting stock across several shops, and hospital buyers paying over the tariff to keep ramipril moving, are answering the same signal. The cheap generic market is no longer clearing at the price the contract assumes.

Most Wards Have No Backup Stock Policy

A health department spokesperson said the department speaks regularly to NHS trusts and national clinical leads about medicine availability, knows ramipril is in limited supply, and issued serious shortage protocols so patients can still get what they need. The department 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 to manage disruptions where they occur.

Those measures sit beside Catena’s returns. 92% of the trusts that answered him had no contingency plan. Four in five had not told NHS England they were short. Kent Community Health, the one trust that lost all three drugs, holds no central stock across 123 sites, filed no incident reports, and has no safety stock policy for the next gap.

The cheap end of the medicines list was supposed to be the easy part of the NHS. It is the part now arriving empty.

Disclaimer: This article is news reporting on hospital medicine supply and published health data. It is for information only and is not medical advice, a diagnosis, or a guide to starting, stopping or switching any medicine, including aspirin, co-codamol or ramipril. Readers who cannot obtain a prescribed medicine, or who are worried about blood pressure or pain control, should speak to their pharmacist, GP or hospital team before changing how they take treatment. Stock figures, shortage protocols and concession prices reflect the documents and statements cited and can change as suppliers and NHS bodies update them.