Prescription Only Medicines (Human Use) Amendment (No. 3) Order 2000

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Mr. Peter Luff (Mid-Worcestershire): I have some moral concerns about this issue, but it should not be decided on the basis of those concerns as I have no right to impose them on this decision. It is right that we should look at the practicalities, as this debate has done very well.

The Minister set out very well the science that led to the conclusion that she and the Government reached. I learnt as Chairman of the Select Committee on Agriculture, Fisheries and Food not always to trust scientists; they have their own agendas. But, more importantly, politicians must reach judgments on the basis of that science and not just allow those scientific conclusions to dictate their own conclusions.

I was struck by the research undertaken by one of my local newspapers about the attitudes of young people in Worcestershire. The concerns expressed by those young people encapsulate the points made by my hon. Friend the Member for Woodspring. A group of 16 and 17-year-old pupils was asked about the availability of emergency contraception in schools, not about availability over the counter. The concerns that they expressed were those that my hon. Friend described. The article states:

The group interviewed were immediately concerned that their peers would stop using barrier methods of contraception, which stop sexually transmitted diseases.

That is a major concern. I respect what the Government are trying to do on teenage pregnancy and education on such issues, but, in theory, those schoolchildren are right that the increased availability of emergency contraception will undermine that work.

This is a classic vox pop survey. Barji Kumar says that having the pill so readily available would encourage youngsters to have unprotected sex. He added:

You are supposed to take precautions beforehand and if people can just take this pill the morning after, I don't think they will bother.

We must keep that concern at the front of our minds. It is interesting that those children were concerned about their parents not being informed. Not all 16-year-olds are fully mature, and there is an argument for parents being informed of what happens to their children up to the age of at least 18, but that is another debate. [Interruption.] I am sorry that the hon. Member for Richmond Park (Dr. Tonge) finds that funny, but I think there is an argument. Parents are legally responsible for their children until they are 18, but not for their medical history at that age. There is a debate to be had on that.

Dr. Tonge: Does the hon. Gentleman agree that, whether a young person is mature, depends entirely on the young person?

Mr. Luff: I have a great deal of sympathy for that. Having a teenage daughter myself, I know exactly what the hon. Lady means.

The group interviewed was concerned—it is important that the Government reassure us on this point—that the easy availability of contraception, without access to medical history, would be a problem. It said:

If there was a family medical history of blood clots and the child didn't know, they would be put at risk by taking the pill.

That concern may be addressable, it may not be a fair concern, but it is one that this group of young people has. The group also said that it feared that the pill would be misused and that much better information should be available through chemists. I have a high respect for pharmacists, one is about to speak, my mother was one and her father was one. However, there is a problem about making information on sensitive and personal matters available to a young person over a pharmacy counter. It would be much better done in the privacy of a practice nurse's room or a GP's surgery.

Finally, the group was concerned about the number of times that the morning-after pill would be available. The hon. Member for Richmond Park made a powerful case about the cost and some of the practical implications of excessive use of the pill, but we should be concerned about using this particular method of contraception too often. I understand that it is intended for older women, but the practical reality is that it will reach younger women. As my hon. Friend the Member for Woodspring said, older women will buy for it for younger women, and younger women will trick pharmacists into selling it to them. We have to accept that the morning-after pill will, in practice, be used by 14 and 15-year-old women, not just 16-year-old women, and we must bear that in mind.

The balance was about right. The pragmatic decision to allow practice nurses to prescribe the morning-after pill would be a sensible next step. But the work done by The Droitwich Spa Advertiser and others convinces me that this measure is just one step too far.

5.10 pm

Sandra Gidley (Romsey): Members of Parliament may not be aware that, in the past few years, a steady stream of medicinal products that started off as prescription only products have been deregulated, in just the way that we are discussing, and they are now fully available through pharmacists. Many of those products carry with them protocols to which pharmacists must adhere, but it is by no means uncommon for a pharmacist to have to refer the patient to the GP. Patients do not always like that; they think that, because a medicine is available from a pharmacy, they should automatically be able to buy it. However, all good pharmacists will adhere to the protocols and refer back to the GP when necessary.

As we have heard, the product has been discussed by the Committee on Safety of Medicines and the proposal has been out to public consultation, at which stage any pharmacist with an interest could have had an input into the process; finally the Medicines Commission has approved the deregulation of the product. Given that the Conservatives' mantra is that we should trust the teachers to teach, I fail to understand why they do not trust the health professionals to examine the health aspects of deregulating Levonelle.

Dr. Fox: Will the hon. Lady give way?

Sandra Gidley: No.

Dr. Fox: It is customary to give way in Committee.

Sandra Gidley: All right then.

Dr. Fox: I am grateful to the hon. Lady for giving me the chance to point out a fact of which she may not be aware. It is Conservative party policy to deregulate a wider range of medicines than are currently deregulated; we are very much in favour of that. The question is whether regulations are being followed in the particular cases mentioned. She will be aware of the cases that the Royal Pharmaceutical Society is to investigate. In her opinion, exactly what level of investigation and supervision of pharmacists should there be when this sort of product is put on the market?

Sandra Gidley: I did not quite understand the question. Pharmacists are professionals and they will follow the protocols. We always have people investigating to make sure that procedures are followed properly and that there is no problem. The Royal Pharmaceutical Society has inspectors who investigate what is going on in pharmacies. I believe that we are a strongly regulated profession. Despite the fact that I heard earlier that there was no intention to cast aspersions on pharmacists, I feel demeaned by the comments of the shadow Secretary of State for Health. The strict protocols that are in place will be followed, which will ensure that important information is not missed.

It has been said that pharmacies are not always especially private. Well, women do have a right to choose: if they do not think they have enough privacy at a pharmacy, they will not go to one. The truth is that many pharmacies have quiet areas and some have private consulting rooms at the side of the dispensary—I had one in the last pharmacy in which I worked. It is easy to take someone into a quiet confidential area and have a fairly in-depth discussion. I will not go into it here, but the Committee would be quite surprised to hear what some people are ready to admit to a pharmacist. I cannot condone any pharmacist not following the guidelines. I trust the Royal Pharmaceutical Society to investigate any case in which there is evidence that the guidelines have not been followed.

It has been said that usage will increase, but I fear that those who say that have not done their research correctly. In 1998, Glasier and Baird showed that there was no increase in the frequency of use of emergency contraception, even if kept at home; and that women were not likely to stop using long-term methods of contraception either. That research appeared in the New England Journal of Medicine. More recently, in 2000, in the British Journal of Family Planning published a called ``Repeated use of hormonal emergency contraception by younger women in the UK'', the conclusion of which specifically addresses that point, saying:

The results of our study disprove the notion of widespread repeated use of emergency contraception and hopefully will reassure GPs and others that provision of an emergency contraception service does not result in failure to initiate regular contraception or abandonment of regular contraception.

The writers support widespread access to emergency contraception as an integral component of a comprehensive family planning service.

The distinguishing feature of the product that we are debating is that some people object to its use on moral grounds, but we should not take such considerations into account. The moral argument is for another time and place. The product is available as contraception and it does not make any difference whether doctors are supplying it, nurses are supplying it or pharmacists are supplying it. The outcry is just a mischievous move to create media interest at a time when we should be allowing the health professionals to get on with the job.

5.16 pm

Yvette Cooper: I welcome the points made by the hon. Member for Richmond Park about the safety of the product, the importance of improving access, especially for older women, and the product's potential to reduce the number of abortions. I also welcome the points made by the hon. Member for Romsey about the ability of pharmacists, as trained health professionals, to do the job.

The hon. Member for Mid-Worcestershire (Mr. Luff) raised a number of concerns, the first of which relates to access for under-16s and 16 to 18-year-olds without parental consent. Access to contraception and emergency contraception is governed by a legal framework that has been in place for the past 15 years; that framework, rightly, remains completely unchanged and by the order or by the introduction of the product, which applies to over-16s.

The hon. Gentleman also mentioned privacy and the importance of having a private area in which to discuss these matters. I refer his attention to the remark made by the hon. Member for Romsey that the customer will choose where to go and decide what level of privacy is required. I doubt that many pharmacists would be embarrassed discussing these issues in the middle of the pharmacy. The most recent survey of community pharmacies shows that 90 per cent. of pharmacies have an area in which advice can be given out of earshot of other customers, so we should not underestimate existing provision.

 

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Prepared 24 January 2001