Hospitals could face shortages of drugs during the second wave of Covid because some of the medicines stockpiled for Brexit have already been used, NHS bosses have warned. NHS Providers, which represents hospitals in England, said problems associated with Brexit could conjure a “perfect storm” of problems this winter that could undermine care, including flu, bad weather, workforce shortages, a resurgence of Covid and an epidemic of burnout among staff. “All of the issues we feared about Brexit remain. None of those have gone away because we are in a pandemic. It’s important to remember drug supplies could be compromised”, said Saffron Cordery, the organisation’s deputy chief executive. “What we were relying upon in Brexit was a supplies stockpile. I would suggest we have eaten into that stockpile because of Covid. We need to think about what the stockpiles are looking like.” She urged ministers to be open about drug shortages, to help NHS trusts prepare for them. Her remarks come after recent reports of a shortage of remdesivir, an antiviral which has been found to be effective in patients with Covid-19. “We saw problems with supplies during the first wave of Covid, for example of anaesthesia drugs because of high levels of ventilation. Going into a second surge, securing respiratory drugs is a particular priority”, added Cordery. “The main supply routes for drugs have been through Europe, both in terms of red tape and logistics, as they’ve come from mainland Europe to the UK through ports. This could all change suddenly with a no-deal Brexit.” The Department of Health and Social Care declined to say if any of the drugs in the Brexit stockpile have already been used. A DHSC spokesperson said : “We hold a range of stockpiles for a variety of medicines, including crucial treatments used to treat Covid-19 patients to help ensure there is uninterrupted supply. “As part of our contingency plans we have also asked suppliers to stockpile at least six weeks’ worth of medicines, as part of a robust and flexible multi-layered approach which also includes re-routing supply chains and being ‘trader ready’.” Meanwhile, surgeons have called for some hospital beds to be reserved for patients awaiting planned operations even if a second surge of Covid disrupts normal services again. The call by the Royal College of Surgeons of England (RCSE) comes amid mounting concern about patients who are in the huge backlog of care that built up in the spring, when the NHS suspended many diagnostic and treatment services, especially surgery. “Patients waiting for operations cannot be left behind indefinitely by the Covid crisis. Many are in serious pain, with their conditions deteriorating while they are on the list”, said Prof Neil Mortensen, the college’s president. “As the virus becomes more prevalent again there is a real risk of a tsunami of cancelled operations unless surgical beds are funded and protected. That means building up theatre capacity and designating beds exclusively for those who need an operation”, he added. The college said hospitals had not begun providing 80% of normal services by the end of September, despite indication from NHS England that they should. And on Monday, David Nicholson, the chief executive of NHS England until 2014, warned in the Health Service Journal that it would take hospitals years to get back to undertaking pre-pandemic numbers of operations. An RCSE survey of almost 1,000 surgeons found that only one in seven (14%) can treat the same number of patients as before the coronavirus crisis hit, with the maximum having fallen from four in a session to two or three, because of the need for social distancing, regular cleaning of operating theatres and the time it takes staff to put on personal protective equipment and take it off again.