Scotland’s Medicine Supply Chain: What NHS Procurement Records Reveal About Overseas Dependence, Fuel Shortages and War

NHS Scotland recorded 83 hospital-medicine procurement supply failures, stock-outs and supplier withdrawals during 2025–26. Its national procurement organisation also disclosed that it does not routinely assess which medicines depend upon a single supplier, manufacturing site or country. The records expose the limits of information available about Scotland’s pharmaceutical supply chains as international conflict, fuel disruption and concentrated manufacturing present risks to the movement of essential medicines.

Before a medicine reaches a Scottish hospital or pharmacy, its ingredients may have been manufactured in one country, converted into a finished product in another, packaged elsewhere and transported through several international distribution networks. The company supplying the NHS may not manufacture the medicine itself, and apparently competing suppliers may depend upon the same overseas factory.

In September 2026, the organisation responsible for national hospital-medicine procurement in Scotland confirmed that it did not routinely assess medicines or active pharmaceutical ingredients according to dependence on a single supplier, manufacturing site or country of manufacture. The disclosure came alongside records identifying 83 procurement framework-lot instances involving supply failures, stock-outs or supplier withdrawals during the previous financial year.

The supplier records describe a range of interruptions. A manufacturer withdrew particular medicines because market prices no longer supported continued supply. Another supplier reported that an upstream business had entered administration. In a separate case, a company supplying prolonged-release injections to the NHS reported that its third-party manufacturer would provide no further fresh stock during 2026.

Those cases were not all caused by the same problem. Some concerned manufacturing, others commercial decisions, regulatory difficulties or the availability of ingredients. Nor do the 83 records establish that 83 different medicines became unavailable throughout Scotland or that patients went without treatment. They count procurement framework-lot events, including changes to contracted supply arrangements.

The same records raise a question about the information used to assess resilience before suppliers encounter difficulties. A contract may identify the company responsible for delivery without identifying whether its finished medicines and active ingredients originate from one factory or several independent sources. A second contracted supplier may offer little additional protection if both companies rely upon the same producer.

The UK Government maintains a separate global medicines supply-chain risk register and a tool intended to identify medicines exposed to disruption in particular countries. The Scottish procurement disclosure does not establish whether its National Procurement organisation receives that intelligence for individual contracts or how the information is incorporated into Scottish purchasing decisions.

Medicine shortages are also being monitored internationally. European authorities have introduced a common shortages platform, while the Organisation for Economic Co-operation and Development has examined concentrated manufacturing and gaps in information about pharmaceutical production. International conflict has interrupted medical logistics, and oil disruption can affect ingredients, packaging, shipping and deliveries.

Scotland’s medicine supply depends upon these international arrangements, alongside UK medicines regulation, Scottish NHS procurement, wholesalers, hospitals and community pharmacies. The available records show how several existing supply arrangements have been interrupted. They do not provide a comprehensive public account of the manufacturing dependencies behind every essential medicine or how long Scottish supplies could be maintained during a prolonged international disruption.

How Medicines Reach Scotland

Pharmaceutical supply begins before the manufacture of a finished tablet or injection. Active pharmaceutical ingredients provide the intended therapeutic effect. Those ingredients may be produced from chemical intermediates or biological materials manufactured at specialised facilities, sometimes in different countries from the factory producing the final medicine.

Finished medicines then undergo manufacturing, quality testing, packaging, batch certification and distribution. Depending upon the product, those activities can involve several companies and sites. The finished product must meet applicable regulatory standards, and changes to manufacturing processes or sources can require validation and approval before medicines may be supplied through an alternative route.

The Department of Health and Social Care’s 2025 medicines-resilience policy describes a global network involving manufacturing sites in countries including India, China, Germany, Italy, the United States and the United Kingdom. Its analysis of licensing information identifies the international distribution of active-ingredient and finished-product manufacturing, although the existence of a manufacturing licence does not establish how much stock any particular factory produces for Britain.

Pharmaceutical wholesalers provide another part of the chain. They purchase and distribute medicines, maintain stocks and supply hospitals and community pharmacies. Different manufacturers do not necessarily supply every wholesaler, and individual pharmacies may use different distribution arrangements. A medicine temporarily unavailable from one pharmacy’s wholesaler may still be available elsewhere without being subject to a national shortage.

NHS Scotland’s hospital medicines are purchased through national and local arrangements. National Procurement manages frameworks under which suppliers compete to provide specified medicines, strengths and presentations. NHS boards and hospital pharmacies then operate their own purchasing, inventory and treatment arrangements within the relevant systems.

Community pharmacies have separate contractual and purchasing arrangements. The national hospital-procurement records released in September do not represent every supply problem experienced by community pharmacies or patients collecting ordinary prescriptions.

UK medicines regulation requires manufacturers and licence holders to maintain quality standards, comply with relevant supply obligations and report actual or anticipated disruptions. These requirements provide national oversight, while the physical availability of medicines continues to depend upon manufacturing capacity, inventories and distribution.

What NHS Scotland’s Procurement Records Show

Freedom of information response 2026-3466 was published by Public Services Delivery Scotland on 19 September 2026. Its National Procurement function supplied records concerning medicines frameworks for Scottish hospitals, together with a shortages tracker and a schedule of supply failures, stock-outs and supplier withdrawals.

The schedule covered the financial year from 1 April 2025 to 31 March 2026. It contained 34 qualifying entries from a current terminations register and 49 from an archived list, giving 83 procurement framework-lot instances. Each qualifying source row or framework lot was counted separately, excluding entries identified as void or reversed.

The 83 entries do not represent a national count of medicines in shortage. A product available in several strengths may appear more than once, and a supplier withdrawing from one framework may leave other approved suppliers or alternative procurement routes available. The released records also do not identify the number of patients affected by each entry.

The therapeutic categories in the procurement schedule have their own limitations. Some labels do not correspond to the medicines’ usual clinical uses, and 49 archived entries have no therapeutic classification. The procurement categories cannot therefore be used as an independently validated measure of which medical specialties experienced the greatest supply problems.

The separate shortages tracker contains product descriptions, procurement references, suppliers, notification dates and the status of individual reports. Some medicines appeared repeatedly during 2025–26. Acetylcysteine infusion, for example, was entered more than once, as was anidulafungin infusion. Many entries were marked resolved by the time the document was released.

The records identify both repeated supply concerns and contract changes, but do not establish that every entry involved a completed stock-out at hospital level. Nor can the two registers be added together to calculate the number of Scottish patients who could not obtain treatment.

Where the Supply Chain Has Failed

The explanations supplied to National Procurement identify problems at different stages of pharmaceutical production and distribution.

On 3 February 2026, two records concerning propranolol 80mg and 160mg modified-release capsules attributed a proposed supply interruption to a bulk supplier entering administration. The problem concerned the viability of an upstream business rather than a confirmed physical shortage of the active ingredient itself.

Three further records dated 3 February concerned octreotide prolonged-release injections in 10mg, 20mg and 30mg presentations. The contracted supplier, Teva UK, explained that it depended upon a third-party manufacturer and had been told that no further fresh stock would be delivered during 2026.

The octreotide interruption occurred during a period when Teva’s long-acting octreotide products were also affected by manufacturing difficulties reported overseas. French endocrinology specialists identified a disruption involving production in Greece, while Canadian regulators recalled specified lots because of manufacturing-quality concerns. Those overseas findings do not establish that Scottish stock came from the same manufacturing facility or was subject to an equivalent recall.

Other Scottish records identify purely commercial reasons for withdrawal. A supplier of co-amilofruse tablets said that falling market prices had made continued supply commercially unattractive. Another reported that felodipine 10mg modified-release tablets were no longer commercially viable. A conestat alfa supplier referred to sustained financial losses and a change in commercial priorities.

These examples show why the security of a medicine supply cannot be measured solely by whether a factory is technically capable of producing it. Continued supply also depends upon companies remaining commercially willing and financially able to manufacture and distribute the product.

Only three of the 83 procurement records were explicitly flagged as involving active-ingredient, raw-material or bulk-supplier problems. Two were the propranolol entries involving the administration of an upstream business. Other records contained broader manufacturing explanations, while several archived entries lacked a supplier explanation altogether. The underlying causes cannot be divided into complete, independently verified categories from the available data.

A Common Painkiller Exposes the International Dependence

A separate Scottish Government freedom of information release documented how an overseas authorisation problem disrupted supply of co-codamol 30mg/500mg tablets during early 2026.

Three suppliers experienced delays obtaining authorisation to import codeine active pharmaceutical ingredients into India, where the ingredients were needed to manufacture finished tablets for the UK market.

The Department of Health and Social Care warned Scottish officials that UK supplies would be constrained from early February into June. Estimated UK demand was approximately 1.2 million packs per month. During the week beginning 9 February, officials recorded approximately 681,848 packs available across suppliers, representing about 2.65 weeks of estimated national demand.

Other co-codamol formulations remained available, but officials warned that suppliers of those products could not necessarily meet all the additional demand created by switching patients from the affected tablets. Scottish health boards received prescribing advice, while UK authorities restricted parallel export and hoarding of the affected formulation to protect available domestic stock.

The shortage began with a regulatory authorisation difficulty affecting manufacturing in India. The documents do not show that a Scottish manufacturing plant failed, nor do they establish that every patient requiring co-codamol was unable to obtain treatment.

The case documents the dependence of a commonly used British medicine on an overseas manufacturing process and the procedures required when that process is delayed.

The Manufacturing Dependencies Scotland Does Not Routinely Assess

The September procurement FOI asked for assessments identifying medicines or active substances for which NHS Scotland depended upon a single supplier, manufacturing facility or country of manufacture.

Public Services Delivery Scotland responded that it held no such assessments and did not routinely examine medicines or active substances on that basis.

The response was made under section 17(1) of the Freedom of Information (Scotland) Act 2002, which applies where the requested information is not held.

The procurement organisation does maintain supplier and shortage records. Its response does not establish that no supply-risk monitoring exists within NHS Scotland. The missing assessments concerned particular upstream dependencies behind contracted medicines.

This contrasts with the UK Department of Health and Social Care’s published description of its global risk register. Established in 2020, that register uses manufacturing-location information and other evidence to identify medicines that are both clinically important and potentially exposed to supply disruption.

The department’s global dependencies tool is intended to identify where medicines are sourced and which products may be affected by events involving a particular region or country. Its risk assessments can consider manufacturing complexity, previous supply failures, the availability of alternatives and the consequences of switching treatment.

UK authorities also obtain information directly from manufacturers about available stocks, production problems, expected delivery dates and alternative sources. The information supports shortage management and decisions about clinical guidance, distribution and additional supply.

The Scottish procurement disclosure does not identify whether its officials have direct access to those tools, receive completed assessments from the UK Government, or incorporate the information into the evaluation of every hospital-medicine framework.

Scotland’s contract records can identify the company awarded a framework lot. The public evidence does not establish that the procurement organisation routinely maintains the underlying map of factories and ingredient sources upon which that supplier depends.

The International Pattern

Manufacturing concentration and incomplete information about upstream suppliers are being examined by other countries and international organisations.

In September 2026, the Organisation for Economic Co-operation and Development published an investigation into European medical supply chains. Its researchers examined injectable corticosteroids, seasonal influenza vaccines and influenza diagnostic tests, assessing the concentration of manufacturers and the availability of alternative sources.

The study found that 84 companies sold injectable corticosteroids in the European Union, yet individual national markets commonly depended upon only one or two suppliers for a particular medicine. It also identified 20 companies holding certificates associated with active pharmaceutical ingredients for injectable corticosteroids sold in the EU during 2024.

Those certificate holders were located across China, the European Union, India, the United States and Malaysia. The researchers could not establish the proportion of European supply produced by each site.

For some products, the number of companies marketing finished medicines therefore provided an incomplete picture of the underlying manufacturing capacity.

The United States also continues to record medicine shortages through its Food and Drug Administration and hospital-pharmacy reporting systems. Those measures use different definitions from the Scottish procurement records and cannot be used to rank Scotland directly against America.

The UK Department of Health and Social Care received approximately 1,400 medicine supply-issue notifications in 2025, down from approximately 1,900 in 2024. Permanent discontinuation notifications increased from around 400 to approximately 480 over the same period.

Manufacturing problems were cited in 62 per cent of UK supply-issue notifications in 2025. Legal, regulatory, market or demand factors were reported in 37 per cent, and logistics-related factors in five per cent. Suppliers could report more than one cause.

These are formal notifications rather than a measure of patients going without medicine. Scotland’s 83 procurement framework-lot records, UK supplier notifications and international shortage counts describe different events.

What an Oil Shortage Would Do to Pharmaceutical Supply

Pharmaceutical production depends on energy and transport, while certain ingredients, solvents and packaging materials are derived from petrochemical industries.

Petroleum and natural gas supply chemical feedstocks used across manufacturing industries. Plastics made from those inputs are used in medicine containers, blister packaging, syringes and medical equipment. The extent to which a particular medicine depends on such inputs varies according to its composition and manufacturing process.

Finished medicines may travel through several countries before arriving in Scotland. Ingredients are transported to factories, products move to packaging and testing facilities, and completed batches enter international distribution networks. Road diesel, marine fuels and aviation fuel support different stages of that movement.

A shortage of oil would not automatically stop every pharmaceutical factory. Manufacturers may hold reserves of ingredients and packaging, have access to alternative suppliers or be able to change freight arrangements.

Prolonged disruption can nevertheless affect several stages together. Higher fuel prices may increase the cost of chemical inputs and transport. Restricted availability of diesel may reduce delivery capacity, while interruptions to shipping or air services can delay ingredients or finished products.

These pressures can be particularly consequential for inexpensive medicines where production and distribution costs form a substantial part of the final selling price. Scotland’s procurement records already show manufacturers withdrawing products for commercial reasons, although those withdrawals were not established as consequences of the 2026 Middle East conflict.

Scotland’s geographical distribution introduces additional transport requirements. Medicines reaching rural and island communities may depend upon journeys involving road freight, ferries or aviation. Even where medicine remains available at a mainland warehouse, interruption of the final delivery route can affect local availability.

Products requiring temperature-controlled transport have additional handling requirements. Extended journeys may require alternative validated distribution arrangements, and any deviation from approved temperature conditions must be assessed before the product can be used.

What War Has Already Done to Medical Logistics

International conflict can affect medicine production and distribution without involving the countries where patients receive treatment.

Factories can lose electricity, materials or staff. Transport routes may close, airspace restrictions can prevent flights, and shipping companies may divert vessels or change schedules. Warehousing and customs arrangements can also be disrupted.

In March 2026, the World Health Organization reported that operations at its global health-emergencies logistics hub in Dubai had been temporarily halted by insecurity, airspace closures and restrictions affecting access through the Strait of Hormuz.

At that time, WHO reported that approximately US$18 million in humanitarian health supplies could not be accessed, while another US$8 million in shipments could not reach the hub. More than 50 emergency supply requests from 25 countries were affected.

These were humanitarian supplies, not medicines procured for NHS Scotland. The disruption demonstrated how manufactured medical products could become inaccessible because of transport and logistics conditions rather than a failure to produce them.

In Ukraine, the WHO-led Health Cluster has documented attacks affecting warehouses containing healthcare supplies. Those incidents have disrupted storage, distribution and access to medicines in areas affected by war.

The UK Government’s medicine-supply resilience policy identifies geopolitical instability, cyber incidents, logistics interruptions, export restrictions and energy disruption as potential threats to pharmaceutical supply.

The Scottish procurement records do not demonstrate that war caused the 83 framework-lot incidents recorded during 2025–26. The supplier explanations identify a mixture of commercial, manufacturing, regulatory and upstream problems, several of which arose independently of the international conflict.

What Happens if Fuel Deliveries Fail in Scotland?

Medicine distribution within Scotland depends on wholesalers, transport providers, NHS supply arrangements and local inventories. A medicine held in a UK distribution centre must still reach the hospital, pharmacy or other healthcare service where it is needed.

The UK Government maintains a National Emergency Plan for Fuel covering severe disruptions to oil and petroleum-product supplies in Great Britain.

The plan includes reserve tanker arrangements, emergency oil-stock measures and powers to prioritise fuel distribution. Its Commercial Distribution Scheme can prioritise road diesel for vehicles supporting essential supply chains, including health and food.

Other measures include a Bulk Distribution Scheme for critical services and designated filling stations for qualifying emergency or essential-service vehicles.

The strongest measures are intended for serious national shortages and are not automatically activated because fuel prices increase or ordinary commercial deliveries encounter difficulties.

Scottish health boards and resilience organisations are expected to maintain their own business-continuity arrangements. NHS Scotland’s emergency-preparedness guidance covers disruptions involving utilities, transport, access, suppliers and other essential services.

The published national procurement records do not establish how many days of essential medicines each Scottish hospital or pharmacy holds or how long its deliveries could continue during a prolonged interruption of road diesel, ferry fuel or other transport services.

Stockholding conditions may differ by medicine, contract and healthcare organisation. The procurement FOI does not provide a complete Scotland-wide inventory of those arrangements.

Does Scotland Hold Emergency Medicine Reserves?

The UK Department of Health and Social Care describes an eight-week supplier-held buffer-stock requirement introduced by NHS England in 2022 for specified hospital-medicine frameworks.

The quantity is calculated against previous purchases and is intended to provide protection against fluctuations in demand and shorter supply interruptions.

Those requirements apply to relevant NHS England medicines procurement arrangements. They are not evidence that every medicine in England has eight weeks of reserve stock or that the same contractual conditions automatically apply to Scottish hospital frameworks.

The Scottish procurement disclosure did not provide a comprehensive assessment of stockholding requirements across NHS Scotland’s medicine contracts.

Additional reserves can provide time for alternative supplies to be arranged, but holding more medicines also involves storage costs, shelf-life constraints and the possibility of products expiring before use.

The UK Government warns that uncoordinated stockpiling can worsen international shortages when multiple health systems attempt to purchase unusually large quantities at once.

Different medicines also require different approaches. An inexpensive, stable tablet may be suitable for longer storage, while a product with a short shelf life or refrigeration requirement can present greater costs and logistical demands.

Who Is Responsible for the Supply Chain?

Medicine supply involves both reserved and devolved responsibilities. Pharmaceutical regulation, manufacturing authorisations and the principal statutory system for supplier notifications operate at UK level. The procurement, storage, allocation and distribution of medicines are devolved matters within the NHS arrangements of Scotland, Wales and Northern Ireland.

The Department of Health and Social Care’s medicines-resilience policy expressly identifies procurement, storage, allocation and distribution as devolved. It also records continuing arrangements through which UK authorities and devolved governments coordinate responses to medicine shortages.

The Medicines and Healthcare products Regulatory Agency oversees licensing, safety, quality and manufacturing regulation. The UK Government receives statutory notifications of anticipated and actual supply problems and coordinates responses where shortages affect several parts of the country.

The Scottish Government is responsible for NHS Scotland’s health-service arrangements, including medicine procurement policy, shortage guidance and coordination with NHS boards.

National Procurement, within Public Services Delivery Scotland, manages national frameworks for medicines supplied to Scottish hospitals. NHS boards and pharmacy services retain operational responsibilities for local stock, purchasing and the clinical management of patients.

Scotland’s Chief Pharmaceutical Officer participates in the UK-wide Medicines Shortage Response Group. A separate Scottish group, previously described as operating alongside the UK arrangements, was confirmed in a March 2026 Scottish Government FOI response as not operating at that time.

The Scottish Government continued issuing medicine-supply guidance and participating in national shortage-management arrangements. The FOI did not establish why the Scotland-specific group ceased operating or when its functions were transferred elsewhere.

What Scotland Could Do to Increase Supply Security

Scotland’s devolved responsibilities provide scope to examine the security of hospital-medicine procurement and distribution without changing UK pharmaceutical licensing law.

National Procurement already holds information identifying suppliers and framework arrangements. The September FOI establishes that it did not routinely produce the requested assessments of dependence on single manufacturing sites, suppliers or countries.

A fuller dependency assessment would require information about the companies producing ingredients, the facilities manufacturing finished medicines, the degree of independence between suppliers and the availability of approved alternatives.

Some of that information exists within the UK Government’s global supply-risk monitoring system. The published Scottish material does not establish how extensively it is exchanged with National Procurement for Scottish hospital contracts.

Procurement conditions can also affect resilience. Contracts may establish delivery obligations, inventory requirements, reporting arrangements and the consequences of failing to supply. Additional qualified suppliers could reduce exposure where they operate independent manufacturing facilities or obtain ingredients from different sources.

Such arrangements involve financial consequences. Maintaining spare manufacturing capacity or larger reserves can increase procurement costs, while competition based heavily on price may produce lower immediate expenditure without necessarily providing independent backup production.

Scotland also has pharmaceutical and biotechnology manufacturing capabilities within its wider life-sciences sector. Expanding local production of selected medicines or ingredients could provide another supply source where facilities, qualified personnel, regulatory approval and commercial demand make production feasible.

Domestic production would not remove every international dependency. Scottish manufacturers may still need imported ingredients, specialist chemicals, packaging and equipment. Additional manufacturing within Europe or elsewhere could also improve resilience where it provides an independent alternative to existing suppliers.

For medicine distribution, NHS boards and resilience partnerships can examine how essential products would reach hospitals and pharmacies during interruptions to road diesel, ferry services or international freight. Those arrangements can be tested against actual routes, stock levels and transport requirements rather than assumed from national policy alone.

The UK Government’s fuel emergency arrangements provide a further response mechanism in serious circumstances, but their activation depends on the nature and scale of disruption.

The Information Scotland Still Does Not Publish

NHS Scotland’s procurement records identify suppliers, reported shortages and contract disruptions. The UK Government publishes manufacturing-risk policies, supplier notifications and arrangements for responding to shortages. Scottish health authorities publish medicine-specific guidance and statistics covering prescriptions dispensed in the community.

These records do not provide a single public measure of how many Scottish patients experienced delayed prescriptions or treatment interruptions because of a medicine shortage during 2025–26.

Nor do they establish the proportion of Scotland’s hospital-medicine procurement contracts dependent upon one manufacturing facility, the share of critical medicines reliant upon a particular overseas country or the duration for which all essential medicines could continue to reach Scottish healthcare services during a prolonged fuel emergency.

The Department of Health and Social Care’s global risk register provides a mechanism for identifying manufacturing vulnerabilities at UK level. The September Scottish procurement response establishes that the specified dependency assessments were not routinely held by National Procurement. The public documents do not show how those two arrangements are connected for every medicine purchased by Scottish hospitals.

Scotland’s medicines will continue arriving through international manufacturing, packaging and distribution networks, supported by UK regulatory arrangements, devolved procurement, suppliers, wholesalers and NHS services.

The published procurement records identify what happened when particular contracted supplies were interrupted. The wider manufacturing and transport dependencies behind all of Scotland’s essential medicines remain less fully visible in the records released to the public.

Sources

FOI 2026-3466 — National Procurement in Relation to the National Frameworks for the Supply of Medicines to NHS Scotland Hospitals. Public Services Delivery Scotland, 19 September 2026. Original FOI disclosure and appendices.

FOI 2026-3466, Appendix 1 — Medicines Frameworks. National Procurement, September 2026. Original framework schedule.

FOI 2026-3466, Appendix 2 — Shortages Tracker FY25–26. National Procurement, September 2026. Original shortages tracker.

FOI 2026-3466, Appendix 3 — Supply Failures, Stock-Outs and Supplier Withdrawals FY25–26. National Procurement, September 2026. Original supplier-disruption register.

Materials Relating to the Supply Shortage of Co-codamol: FOI Release. Scottish Government, 29 April 2026. FOI 202600509103. Original correspondence and briefing documents.

Managing a Robust and Resilient Supply of Medicines. Department of Health and Social Care, updated 15 August 2025. Includes the global risk register, manufacturing dependencies, supplier notifications, stockholding and the division of devolved and UK responsibilities. Original policy paper.

Medicine Supply Disruption Statistics, UK: Data to June 2026. Department of Health and Social Care, 5 August 2026. Official statistics.

Strengthening the EU’s Medical Supply Chains. Organisation for Economic Co-operation and Development, 22 September 2026. Original OECD investigation.

Health Impact of the Escalation of Conflict in the Middle East. World Health Organization, March 2026. Original WHO statement.

Summary of Response Tools in the National Emergency Plan for Fuel. Department for Energy Security and Net Zero, updated 16 April 2024. Official emergency fuel arrangements.

Procurement — Supply Chain Resilience and Diversity: SPPN 9/2020. Scottish Government, updated March 2025. Scottish procurement guidance.

Preparing for Emergencies Guidance — Business Continuity Management. Scottish Government, 2023. NHS Scotland preparedness guidance.