14.We recognise that important steps towards tackling AMR have been made in the past five years. Professor Mike Sharland, Chair of the Government’s Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare Associated Infection, told us that the UK is ahead of many other countries in even having an AMR strategy in place, and Lord O’Neill gave us his view that progress was now being made in many of the areas his review highlighted. Two of the targets set out by the Government in response to Lord O’Neill’s report relating to reductions in antibiotic use in both humans and animals have now been met. However, little progress has been made in some other very important areas.
15.Both Professor Dame Sally Davies and Lord O’Neill told us that strong, visible political leadership at the highest levels is urgently needed. Lord O’Neill argued that in previous years, “Britain had a fantastic voice, power and influence globally on this topic … ”. Asked if we were losing that leadership role, he replied that in his view, we were.
Under the Cameron Government, it was a top-five policy priority. I am not aware of it being publicly mentioned in any international forum by any of our leading Cabinet Ministers, never mind the PM, since.
He went on to argue that “policymakers around the world are seemingly presiding over an accelerating car crash.”
16.Professor Dame Sally Davies told us
I would like more visible and active Government leadership, not just from our Department and the Prime Minister… we need it from DEFRA around animals and the environment, and from DFID continuing its global work … and the Foreign Office as well.
17.When asked what her sense was of how important AMR was at the top of the DHSC and NHS England, she said ‘it is recognised.’ She went on to ask for our support in prioritising AMR more widely across government.
18.Dr Susan Hopkins, a Deputy Director of Public Health England leading on healthcare associated infections and AMR, highlighted the priority and leadership that has been given at an official level, by Professor Dame Sally Davies herself. Her evidence also gave insight into the difficulties faced in prioritising AMR amongst other disease areas also competing for funding, particularly given that AMR is perceived as a ‘future threat’ rather than ‘a serious threat right now’:
I think it is given a lot of priority. Dame Sally has really championed the issue. There has been a lot of discussion and a lot of momentum behind the AMR strategy. I think funding could always be greater across all the areas. There are many different disease areas that are equally demanding of attention and funding so the money has to be spread out. Obviously antimicrobial resistance is a future threat, particularly for this country, compared with a serious threat right now. I think we have given it substantially more funding in the last five years than we did before that, but we will need to continue with at least that, if not more, funding if we are to tackle the problem in the future.
19.Dr Sheuli Porkess, Deputy Chief Scientific Officer at the Association of the British Pharmaceutical Industry, suggested that AMR should be a key priority in the NHS 10 year plan.
20.Professor Dame Sally Davies was clear that more funding was needed in this area. However, she argued strongly for a central, cross-Government budget:
You will not solve this from the Department of Health and Social Care budget. This is a wicked problem that is cross-sectoral. It takes in animals and the environment. It will have to be solved with Treasury funding rather than funding from the Department of Health and Social Care, and no one country can do it on its own.
21.The DHSC minister with responsibility for AMR, Steve Brine, rejected Lord O’Neill’s assessment that the UK has lost its international presence on this issue and told us that the Prime Minister had raised the issue herself in a number of international forums, including last year’s G20 summit. We welcome the minister’s recent work on this issue at the G20 summit in Argentina. However, he also told us that he had had no official inter-ministerial meetings on the subject of AMR with his opposite number in DEFRA, DFID or with the Prime Minister during the 15 months he has held the portfolio for this issue.
22.Antimicrobial medicines are critical not only in treating infections but also in enabling safe childbirth, as well as healthcare interventions that we take for granted, such as surgery, transplants and cancer treatments. Without them, quite simply, modern medicine will be lost. Yet diseases are rapidly becoming resistant to existing antimicrobial drugs, and there are insufficient new drugs being developed to replace them. This makes AMR a critical risk for current as well as future generations.
23.The evidence we have received has suggested that despite the severity of the threat posed by AMR and its potential to affect every area of healthcare, AMR is now struggling for priority and needs political leadership at the highest level of Government. The fact that no inter-ministerial meetings have been held to discuss AMR in the past 15 months speaks not only of a lack of priority, but also of a lack of join-up across Government to tackle this.
24.Two of the Government’s key advisers on AMR have independently called for ‘more visible and active Government leadership’ on this issue. We therefore urge the Prime Minister to work closely with her relevant ministers to raise the profile of AMR both at home and on the international stage. Given the severity of the threat, AMR needs to be firmly established as a ‘top five policy priority’ for the Government as a whole, drawing together the work of DHSC, DEFRA, DFID, the Foreign Office and BEIS. A dedicated budget should be made available to enable work in this area to make more rapid progress across all relevant departments.
Published: 22 October 2018