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16 Jun 2009 : Column 39WH—continued
We are concerned about the high concurrence of drug dependency and mental health problems and believe that more must be done to tackle underlying mental health problems. There should be greater focus on the provision of mental health services. We supported the roll-out of crisis resolution teams, early intervention
and assertive outreach. In what has been an apolitical debate, I am sorry to say that mental health services still do not get the priority that the depth of suffering demands on many issues, including resources, waiting times, quality assurance mechanisms and health outcomes. When there is a concurrence of drug dependency and mental health, it must be addressed.
We support more use of talking therapies and cognitive behavioural therapies, rather than the prescription of medicines for mental illnesses. However, people can wait for up to two years for those treatments. I understand that 86 per cent. of people with schizophrenia do not receive such treatments. The Minister will recall that in October 2007, the then Secretary of State announced a £170 million pledge for talking therapies. Has all that money been spent, and if so, how? How many of the additional 3,600 therapists have been recruited? In 2004, the Government announced that they would locate employment advisers in GP surgeries to assist people in tackling their mental illnesses and returning to the workplace. How many have been appointed? When does he expect the national outcomes measurement project, which will result in standardised outcome measures for mental health, to be fully operational?
Do the Minister and his civil servants agree with the report’s recommendation that further research should be undertaken into the scale of the problem of prescription and over-the-counter drug misuse, and into the long-term impacts of such addiction? If so, when will the research funding allocation be made and when does he envisage the research being completed?
I shall reiterate some points made by other hon. Members. On pack sizes, the British Medical Journal has reported that fewer people have been admitted with, or have died from, paracetamol poisoning since the pack size was reduced. How far has the Medicines and Healthcare products Regulatory Agency got in considering a reduction in pack sizes for medicines that contain codeine?
What stage have the Government reached in their consultation on the point of sale of medicines? The Minister will recall that the pharmacy White Paper proposed changes to the sale point of medicines to correct the anomaly that makes it possible to buy paracetamol at a petrol station, but not at a GP surgery. Has that consultation been completed? If so, what decisions have been taken about increasing access to over-the-counter medicines and when were they taken? The hon. Member for Leeds, North-West rightly said that pharmacists should receive additional information to enable them to look for and recognise the symptoms displayed by people who misuse prescription or over-the-counter medicines.
Will the Minister confirm what progress has been made on the barcoding system that was mentioned in the excellent report? Has the pilot shown that barcoding reduces the availability of counterfeit products? Will that measure be rolled out more widely?
I will not reiterate the points that have been made on internet pharmacies. That issue is extremely complex, especially given the international element. It would be helpful if the Minister explained what progress the Department is making on that.
The Department should consider a few other areas that were highlighted in the report. First, it should look at research into depression. There is a clear link between
depression and the misuse of prescription and over-the-counter medicines. Secondly, we should have more clinical trials in this country. Hon. Members will be aware of the reluctance of pharmaceutical companies to enter into clinical trials in this country for a variety of reasons. We must have a broader representation of such trials in this country. Thirdly, as I mentioned earlier, attention should be given to the fact that the majority of misusers are female.
The lack of a pain management strategy often leads to misuse. Clearly, there should be public education about the harm that can be caused by the misuse of the illicit drugs we are discussing and by mixing them with other illegal and legal drugs such as alcohol. That information and education must be accessible and understandable for those at whom it is targeted. Far too often, such information is inaccessible, particularly for those who are digitally excluded. We must find ways of taking information to people and patients, rather than waiting for them to access it.
As hon. Members have mentioned, the Government should also consider the potential benefits of alternative treatments. However, such provision must be relevant to the circumstances of each patient.
The report makes it clear that there should be greater focus on this issue. I hope that in the time they have remaining, the Government will provide that focus.
12.07 pm
The Minister of State, Department of Health (Phil Hope): I congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on securing this important debate. As hon. Members have said, he has taken a keen interest in this issue over many years, not least through the all-party parliamentary drugs misuse group, which he has chaired with great distinction over the last 10 years. I was unaware that he would be standing down from that role today. I put on record our thanks and congratulations to him on the excellent job he has done. He has been determined through his efforts to raise the profile of addiction to prescription and over-the-counter medicines. He will be a hard act to follow.
The hon. Member for Blaenau Gwent (Mr. Davies) spoke movingly of the impact his mother’s experiences had on his family and the wider community. My hon. Friend the Member for Newport, West (Paul Flynn) and the hon. Member for Leeds, North-West (Greg Mulholland) talked about constituents who have come to them with experiences of misuse and about how they have responded to them. The hon. Member for Leeds, North-West also highlighted the complexities and dilemmas in this difficult area of policy.
The hon. Member for Boston and Skegness (Mark Simmonds) has clearly read the pharmacy White Paper because he has been reading it back to me. I am pleased about that and was grateful to hear his suggestions. He will be glad to know that the White Paper is being implemented as we speak and that many of his thoughts about the role of pharmacies and pharmacists are part of Government policy.
For the Government, it is important to address all drug addiction, including addiction to prescription and over-the-counter medicines. We want to make it clear that tackling drug misuse of any kind is a Government priority, and we have made massive strides in reducing
the harm that drug misuse can do to individuals and to society as a whole. We have made a substantial investment in drug treatment through the pooled drug treatment budget that has been allocated to primary care trusts on behalf of local drug partnerships. In the past 10 years, investment has increased from £142 million in 2001-02 to £406 million in this financial year. Of that sum, £24.7 million has been earmarked specifically to support treatments for young people.
We are committed to getting drug misusers off their drugs of addiction, and we are supporting drug users in working towards that goal. As we have heard today, drug addiction can be a long-term, chronic, relapsing condition that requires treatment over an extended period. Independent research shows that drug treatment is one of the most effective treatments in the NHS. For every £1 we spend on drug treatment, we make a saving of £9.50 for society as a whole. Some 83 per cent. of those treated in 2007-08 either completed treatment successfully or were still in treatment on 31 March 2008, so we are keeping 78 per cent. of people in treatment for at least 12 weeks because we know that staying in treatment for 12 weeks has a lasting and positive impact on reducing the harms associated with addiction and that it is a key measure of effective treatment.
In the three years from 2007 to 2010, we are investing £54.3 million of new funding, over and above the pooled drug treatment budget, to fund the expansion of in-patient detoxification and residential rehabilitation services to help drug users to beat their addiction. The hon. Member for Blaenau Gwent spoke of his worries about cuts to public spending affecting this area. As I have just described, the Government have invested considerable extra money in drug treatments and dealing with the causes and effects of addiction, and we will continue to make that investment. The hon. Member for Boston and Skegness said that he did not want to introduce a discordant party political note into the debate, but perhaps he should suggest to his hon. Friends on the Opposition Front Bench that his party’s pledge to cut public spending on health, education and other public services by 10 per cent. would have a devastating impact on the NHS services that we seek to deliver. I am pleased to tell the House that we have recently made available an additional capital sum of £11.8 million in the current year to enhance further the quality of drug treatment services.
The all-party group on drugs misuse has made several recommendations on issues such as training for medical professionals, awareness among prescribers about the potential for dependency and the need to monitor prescribing practices. Let me address the specific concerns that my hon. Friend the Member for Bolton, South-East has raised. We have a new national initiative to improve the training of all future doctors regarding substances of misuse. In 2007, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), then the Minister for Public Health, launched the “Substance Misuse in the Undergraduate Medical Curriculum” guidance document for all medical schools. That innovative work was funded by the Department of Health and was produced with the agreement of all UK medical schools and all the key national bodies involved in undergraduate medical education. It describes the core substance misuse curriculum that has been agreed and that should be used for the comprehensive training of medical students, and it has now been published and widely distributed.
The project is now in its final phase of implementation, and further Department of Health funding is being made available to all the medical schools in England, over the next two years, to incorporate the curriculum into all the schools’ training programmes. As a result, on qualification, medical students should be able to demonstrate awareness of the range of substances that can be misused, including prescription and over-the-counter medicines, and should be able to describe the principles of good prescribing. The impact of that will be significant. Some 6,000 new doctors qualify each year, and it is estimated that the combination of undergraduate training and continuous professional development training will, over the next 10 years, ensure that approximately 60,000 doctors are better equipped to deliver competent practice in substance misuse.
The second area that my hon. Friend the Member for Bolton, South-East talked about was awareness. The Medicines and Healthcare products Regulatory Agency, which monitors the safety of all medicines in the UK, is working with over-the-counter trade associations on a package of measures to support the safe and effective use of codeine, and advice on that will be sought from the Commission on Human Medicines. In addition, strengthened patient information and warnings about the risks of addiction and overuse were introduced in 2005 for medicines containing codeine and dihydrocodeine. At the same time—for the benefit of the hon. Member for Boston and Skegness, who asked about this—a voluntary agreement was reached with manufacturers to restrict the size of over-the-counter packs to 32 tablets.
The MHRA, in association with its expert group on patient information, has reviewed patient information for the products that are most often subject to abuse or misuse, such as laxatives and sleeping aids, and has produced best practice advice on minimising the risk of abuse or misuse. The MHRA uses a variety of methods to collect information on the safety of prescription and over-the-counter medicines, and health care professionals and patients are encouraged to report suspected adverse drug reactions to it via the yellow card scheme. Also, there is a legal requirement on pharmaceutical companies to report reactions to their products. If action is needed to address safety concerns or problems of misuse and dependence, a number of regulatory options are available, such as withdrawing the product from the market or amending the labelling and patient information leaflet that accompanies a medicine to warn health care professionals and patients about such risks—a point was made about labelling earlier. Similarly, the legal status of medicines may be changed.
Paul Flynn: Is the Minister satisfied with the yellow card scheme? Only half a dozen adverse reactions to Vioxx were reported here, but the United States, which has a more rigorous way of measuring adverse reactions, decided that there had been 144,000 heart attacks and strokes as a result of using Vioxx, and it was therefore banned in this country and in America. Had we depended on the yellow card scheme, we would never have discovered the danger of that simple painkiller. Do we not need to improve the current system?
Phil Hope: My hon. Friend raises an excellent point about comparisons between strategies that work in different countries. These matters are never quite comparable, but I shall certainly draw his concerns about the efficacy of the yellow card scheme to the attention of the Minister of State, Department of Health, my hon. Friend the Member for Lincoln (Gillian Merron), who has responsibilities for public health and this area of policy.
Several hon. Members have expressed concerns about the internet and how people obtain prescription drugs. We know that some people obtain benzodiazepines and other medicines through internet pharmacies, from abroad and by other illicit means. The MHRA continues to monitor internet activity and takes action against any identified breaches of legislation, where possible. The safety, quality and efficacy of medicines purchased via the internet cannot be guaranteed, and their effects on patients cannot be monitored, which is why we control tightly the supply of medicines and prescription-only medication in the UK. The MHRA has warned that online supplies of medicine may well pose risks to consumer health, and recommends that prescription-only and pharmacy-only medicines should be obtained through registered pharmacies.
Action is also being taken through designated internet days of action, which are organised and conducted on a number of dates during the year. They involve working alongside international regulators with the specific aim of taking down websites that act illegally. More such days of action are planned throughout 2009 and beyond.
On the question of prescribing and monitoring, we are using a number of mechanisms to promote and support high-quality, clinically effective prescribing and medicines management right across the NHS to ensure patient safety and to help improve patient care and service delivery. We have made sure that prescribers have access to a wide variety of impartial, trustworthy information resources to support their prescribing, including resources from the British National Formulary, National Prescribing Centre information and advice, and guidance from the independent National Institute for Health and Clinical Excellence. Such resources will assist prescribers in making clinically cost-effective prescribing decisions. A wealth of information is available through the National Library for Health and various academic and professional journals. NHS prescribers also have access to advice from the network of local drugs and therapeutics committees, and from PCT pharmaceutical advisers.
It is an obvious thing to state, but no medicine is 100 per cent. risk free. However, we expect individual prescribers to be aware of the potential for addiction and to ensure that medicines are prescribed appropriately depending on a patient’s individual needs. In exercising their professional and clinical judgement, prescribers should always consider the available guidance and the best practice that is shared within the prescribing community. At a more local level—this has been raised in the debate—pharmaceutical advisers, who are mainly pharmacists, are employed by strategic health authorities or primary care trusts with the common aim of encouraging and securing rational and cost-effective prescribing and providing a source of advice and support for prescribers in their area. There are now more than 1,200 advisers, many of whom conduct face-to-face reviews with GPs and carry out reviews of prescribing activity.
In this country, primary care trusts and their pharmaceutical advisers have very effective electronic information systems for prescribing in general practice. They routinely monitor detailed prescribing information and can easily identify unusual or excessive prescribing by individual doctors. Such a system further supports the monitoring of the quality and safety of prescribing and is another important factor that contributes to improving practice in this area. The General Medical Council has produced guidance for doctors to ensure that proper standards in the practice of medicine are maintained, including in relation to the prescribing of medicines. If the proper standards are not maintained, the General Medical Council has the power to remove a doctor’s right to practise medicine.
A fourth area mentioned by my hon. Friend the Member for Bolton, South-East was research. The 2008 drug strategy highlighted the importance of further research in the drugs field to boost our understanding of addiction and to identify opportunities for new forms of treatment or prevention. Since then, work has been under way to develop a cross-Government research programme on drugs. Our analysis in the Department of Health has revealed—I think that my hon. Friend pointed this out—the need for additional information about dependence on prescribed drugs and over-the-counter drugs.
I am pleased to have this opportunity to let the House know that, starting next month, resources have been identified in the Department to undertake a review of the information that we already have. That review will identify the key gaps in data and consider what additional work needs to be taken in hand, and it will take the points made in the report of my hon. Friend’s all-party group on drugs misuse very seriously; indeed, it will also take seriously the points made by him and other hon. Members today.
On treatment, in line with what my hon. Friend seeks, primary care trusts are responsible for deciding on the provision of treatment and services that reflect local needs and priorities, including in relation to tranquilliser addiction.
I also want to talk about the availability of other treatments in providing support for mental health problems. In response to the point made by the hon. Member for Boston and Skegness, I can tell the House that the Government are investing significantly in the Improving Access to Psychological Therapies programme—IAPT, as it is known—to widen the range of treatment available for people with common mental health problems. The
hon. Gentleman was critical of the funding and the support that has been provided for mental health services. Let me tell him that mental health services have received a 44 per cent. increase in funding and only a few months ago—just before Christmas—the World Health Organisation commended highly the strategy for mental health services in England and said that it was one of the best in Europe.
I will not accept any criticism from the hon. Gentleman and his party about the work that we have been doing to support and invest in mental health services. IAPT offers a range of NICE-approved therapies, including guided self-help, counselling, cognitive behavioural therapy, behavioural activation and exercise. Annual funding is rising to £173 million in the third year—2010-11—to train 3,600 extra therapists and treat 900,000 more people in those three years. This Government are proud of that record of investment and progress, which will make a real difference to supporting people with mental health problems. Those services can be provided in primary care, secondary mental health services or secondary substance misuse services depending on need.
The current range of measures that I have described might, in part, explain the fall that we have seen in benzodiazepine prescribing over the last decade. I am grateful to my hon. Friend the Member for Bolton, South-East for noting that in the all-party group’s report. In terms of over-the-counter medicines abuse, it is likely that the range of measures and safeguards that we have established in the UK have contributed to our having fewer problems than other countries. I recognise that, considering the size of these problems, the evidence is limited and I assure my hon. Friend that I am not complacent about such an important issue. I will, of course, draw to the attention of the Minister of State, my hon. Friend the Member for Lincoln, my hon. Friend’s request for a meeting with him and other officers of the group to present the findings of the report. I am sure that she would be delighted to meet him—although it is a bit naughty of me to say so on her behalf because she is not here—to learn about and discuss these issues in more depth.
I hope that what I have highlighted today reassures my hon. Friend the Member for Bolton, South-East and, indeed, the whole House that, as a Government, we are determined to do all in our power to minimise drug dependency in all its forms. This debate has been very useful in highlighting these important matters, and I congratulate the all-party group and my hon. Friend on securing the debate and presenting the findings of the group’s report here today.
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