(2) what the sources are of the supply of diamorphine used by the NHS;
(3) what criteria her Department uses to decide how much diamorphine the health service requires;
(4) whether she has been informed of a shortage of supply of diamorphine in any NHS hospital; and if she will make a statement.
The usage of diamorphine in the national health service in the community in England for each of the last five years is shown in the following table.
British national formulary chemical name Number of prescription items (Thousand) Net ingredient cost (£000) 2001 Diamorphine hydrochloride 95.9 3,287.1 2002 Diamorphine hydrochloride 96.0 3,312.0 2003 Diamorphine hydrochloride 98.6 3,686.4 2004 Diamorphine hydrochloride 102.9 3,974.2 2005 Diamorphine hydrochloride 60.8 1,802.9
British national formulary chemical name
Number of prescription items (Thousand)
Net ingredient cost (£000)
This information is taken from the prescription cost analysis (PCA) system, supplied by the prescription pricing division of the Business Services Authority (formerly known as the Prescription Pricing Authority (PPA)), and is based on a full analysis of all prescriptions dispensed in the community in England.
A comparable volume figure on the use of diamorphine hydrochloride in hospitals is not available, however estimates of the cost of diamorphine issued in hospitals in England is in the following table.
Estimated list price cost (£000) 2001 3,945.9 2002 3,898.4 2003 4,052.2 2004 3,808.8 2005 1,772.6
Estimated list price cost (£000)
This information is taken from the hospital pharmacy audit database supplied to the Department by IMS health.
Overall costs of diamorphine hydrochloride dispensed in the community and in hospitals are at a similar level. The cost figures may have fallen in recent years due to a reduction in price as well as a decrease in use.
The Department is aware that there is an ongoing shortage of diamorphine injection. This began in December 2004, when Chiron (now Novartis), one of the two suppliers of this product to the NHS, experienced problems at its manufacturing plant. The other supplier, Wockhardt UK, immediately increased its production but was unable to fill the gap. Chiron came back into production in July 2005, and both companies are now manufacturing to their full available capacity. However, supplies are limited and are likely to remain so for the coming months.
It is not possible to predict how much will be used in 2006-07, or how much diamorphine the NHS requires. There is a continuing shortfall of production against historic demand, and use will depend, to some extent, on availability of the product. It will also depend on whether doctors and other healthcare professionals maintain the prescribing and purchasing strategies established to cope with the shortage, following Departmental guidance issued in December 2004.
The Department is in close contact with both suppliers of diamorphine and is continuing to monitor the supply situation carefully.