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House of Lords

Wednesday, 17 March 2010.

3 pm

Prayers-read by the Lord Bishop of Ripon and Leeds.

Health: Prescription Drugs


3.06 pm

Asked by Lord Patel

The Parliamentary Under-Secretary of State, Department of Health (Baroness Thornton): My Lords, medicine supply problems can occur for a number of reasons, including manufacturing, regulatory problems and parallel trading. The Government work with drug companies, wholesalers and pharmacies on an ongoing basis to minimise the risks to patients.

Lord Patel: My Lords, over the past 12 months, 48 different medicines have been reported to be in short supply so that patients cannot get access to them. Some of these medicines are critical. A parallel market has developed, practised by pharmacies, wholesalers, dispensing doctors and even NHS hospitals. Eighteen hundred licence holders are allowed to export medicines out of the UK. What urgent plans do the Government have to stop this parallel market? We know that existing regulations do not seem to work, while regulations in some EU countries forbid some of the practices that exist in the UK.

Baroness Thornton: The noble Lord will know that parallel trading is a legitimate activity, but we take a very dim view of any NHS organisations indulging in it. We are concerned about whether it is having the effect on the supply of medicines that the noble Lord mentions. I am pleased to report that my right honourable friend Andy Burnham and the Minister, Mike O'Brien, held a summit with UK pharmaceutical supply-chain stakeholders to discuss concerns about the supply of medicines and agreed a package of urgent actions to address this issue to ensure that our patients continue to get the care that they need when they need it.

Lord Soley: I believe, from when I chaired the Intergovernmental Organisations Select Committee on pandemics, that we in the UK stockpile drugs, so am I right in saying that we always have significant amounts of drugs available? We have an impressive reputation around the world for our drugs supply, but we have to keep stockpiles as well as meeting domestic needs.

Baroness Thornton: My noble friend is right that there are stockpiles-the expression is "buffer stocks"-of essential medicines that we are building up for use in the event of pandemics or other major disruptions. The problem, as I am sure noble Lords will appreciate,

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is that feeding them back into the supply chain at the moment could have the opposite effect from what was intended, as it might encourage greater exporting. We are concerned not to increase the problem of parallel trading.

Lord Mawhinney: My Lords, the Minister has just told us that the Government take a dim view of this practice and the shortage of drugs. What does a "dim view" mean in reality? Who is held to account?

Baroness Thornton: We think that it is unacceptable and contrary to acceptable professional behaviour for any hospital to be taking part in this. We were aware of some anecdotal reports that hospitals were trading in medicines, so the Chief Pharmaceutical Officer wrote to all chief hospital pharmacists in July 2009 and to the NHS chief executive and Monitor in February. Hospitals and NHS organisations are in absolutely no doubt that we regard this practice as unacceptable.

Lord Cunningham of Felling: My Lords, does my noble friend accept that this is a particular problem for doctors' practices in rural areas, where they do their own dispensing and where often no other source of treatment is available for patients? Will she take an urgent and close look at this aspect of the problem?

Baroness Thornton: My noble friend raises an important point. This matter was discussed at the summit that I referred to and is being addressed by the stakeholders and partners that took part. He is quite right. I will undertake to ensure that we are taking action on rural pharmacies and I will write to my noble friend about it.

Baroness Barker: My Lords-

Baroness O'Cathain: My Lords-

Lord Hunt of Kings Heath: It is the Liberal Democrats' turn.

Baroness Barker: Will the noble Baroness explain how the outcomes of the summit will ensure that the supply chain of medicines in this country, which requires pharmacists to be able to receive medicines within 24 to 48 hours, will be resolved and restored?

Baroness Thornton: The participants in the summit were the Association of the British Pharmaceutical Industry, the British Association of Pharmaceutical Wholesalers, the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and the Medicines and Healthcare Products Regulatory Agency, or MHRA. They agreed with my right honourable friend the Minister a more explicit duty on manufacturers and wholesalers to ensure the supply, a series of targeted inspections by the MHRA, tougher standards for the issuing of licences for medical wholesalers and the development of a best practice guide on how supply difficulties should be dealt with by doctors, pharmacies, wholesalers and manufacturers.

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Baroness O'Cathain: My Lords, according to the Minister, we were first worried about this in July 2009. The summit was held 15 days ago. Has there been any marked improvement over the last 15 days, as this is obviously an urgent problem?

Baroness Thornton: As I said in my original Answer, the supply of medicines has to be dealt with all the time and interruptions in supply can be for a variety of reasons. It has become apparent only over the last period that parallel trading, which is to do with the relationship of the pound and the euro, has become a particular issue that we particularly need to address. It is too soon to say what the effect of the summit will be, because it was only a few weeks ago, but I will certainly let the noble Baroness know.

Baroness Finlay of Llandaff: Is there a link between the department's early warning systems and the specialist medical groups so that alternative guidance can be enacted quickly, such as happened when diamorphine supplies ran out at very short notice and the specialist society rapidly produced alternative guidance? No patient complaints were received then because no patient was left in pain through a lack of diamorphine supplies.

Baroness Thornton: The noble Baroness points to a good example of how the system can work in different ways. We have officials who spend almost all their day making sure that the supplies of medicines are in the right place at the right time for the patients.

Baroness Masham of Ilton: My Lords, had some of the drugs that were sold on to other countries-these drugs may be for people with rheumatoid arthritis and cancer-already been bought by the National Health Service before being sold on?

Baroness Thornton: I am not absolutely certain about the answer to that question. Certainly, there is a list of 40 medicines, but that is 40 medicines out of tens of thousands of licensed medicines and out of millions of prescriptions. They include drugs for some of the conditions that the noble Baroness mentioned. I am not absolutely certain whether these were sold on by the wholesalers or the manufacturers direct. I will undertake to ask that question.

Health: Dementia


3.15 pm

Asked By Baroness Greengross

The Parliamentary Under-Secretary of State, Department of Health (Baroness Thornton): My Lords, the Government have just completed the first full year of implementing the five-year National Dementia Strategy (NDS) to transform services for people with dementia. Progress has been made in many areas. Most recently, noble Lords may have noticed a public awareness campaign, including television adverts, designed to reduce the stigma associated with dementia.

17 Mar 2010 : Column 596

Baroness Greengross: I thank the Minister for that encouraging reply. However, yesterday the Public Accounts Committee came out with some rather worrying figures. By the end of this month, every primary care trust and local authority will be required to have in place a joint action plan to implement the dementia strategy and to account for the money that has been allocated. It also reported that research into dementia has fallen by 7 per cent. Will the Minister give me an idea of the Government's response to this?

Baroness Thornton: It was always envisaged that the first two years of the dementia strategy would be gearing up, as it were, for full implementation. Sixty million pounds has been made available to PCTs in the first year. We are assessing how that is spent and what it is spent on, and will report back on that. We are piloting and evaluating a variety of different projects. I was very surprised to learn that research funding had fallen because the money is there to spend on research. We need a volume of applications for dementia proposals to come forward so that research can be undertaken. My honourable friend Phil Hope has set up an advisory group on dementia research which we hope will develop practical ways of working together to increase the volume and quality of dementia research. I hope that when we have this discussion in a year's time I will be able to report an increase in research spending.

Baroness Turner of Camden: My Lords, why are people with dementia staying too long in hospital? Does the dementia strategy recognise this problem and how to resolve it?

Baroness Thornton: The House has discussed this matter several times. We certainly recognise the need to improve the quality of care for people with dementia in general hospitals and to improve the training of those who deal with people with dementia in hospitals. This is one of the seven priority areas for urgent action in the dementia implementation plan.

The Earl of Onslow: My Lords, the Alzheimer's Research Trust, of which my wife is president and in which I take a very serious interest, has produced figures in the very recent past showing that the cost of Alzheimer's to society as a whole is a staggering £23 billion. I am not sure whether I have remembered that correctly, but the figure is astronomical. It is going to get worse because people with Alzheimer's are living longer and need carers. The relatives of those with Alzheimer's cannot earn a living because they have to be carers. This research to find out what to do and to be aware of the cost is essential. Is the noble Baroness aware of that? I hope that she is.

Baroness Thornton: We certainly are. The overall annual economic burden of dementia is estimated to be £14.3 billion a year. This is a huge cost. The direct cost to the NHS is £8.2 billion a year. I pay tribute to the work of the Alzheimer's Society, which is a very important partner in the delivery of a dementia plan. Its reports have helped to point us in the right directions as regards the major priorities for research, as has the Alzheimer's Research Trust.

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Baroness Howe of Idlicote: My Lords-

Lord Ashley of Stoke: My Lords-

Lord Hunt of Kings Heath: Let us hear the noble Baroness first, then my noble friend.

Baroness Howe of Idlicote: Can the Minister give us any idea of how high a priority will be given under the dementia plan to carers' need for respite when their caree, as it were, is living exclusively at home?

Baroness Thornton: We know that carers play a vital role, and supporting them is a very important priority. That is why we launched the 10-year cross-government strategy to support carers. The noble Baroness will be aware that the new national care service White Paper, which will be with us shortly, addresses the issue of carers and how we can best support them in the very important work that they do in supporting not only people with dementia but a very large range of elderly people and those with other disabilities.

Lord Ashley of Stoke: When my noble friend says that progress is being made, can she be more specific?

Baroness Thornton: In the first two years we have appointed a clinical director, so the leadership that we require at hospital, local and regional level is very close to being in place. We have 40 demonstrator sites, which are where social services and healthcare services work together to produce local plans on the best way of dealing with people with dementia. Those are in place and will roll out in the fullness of time next year. We have also issued guidance on commissioning services for people with dementia. Noble Lords will be aware that we also commissioned the anti-psychotics report that was published in November last year, and are deciding what to do with it. Those are four areas where progress has been made.

Gypsies and Travellers


3.22 pm

Moved By Baroness Whitaker

The Parliamentary Under-Secretary of State, Department for Communities and Local Government & Department for Work and Pensions (Lord McKenzie of Luton): My Lords, Her Majesty's Government remain committed to bringing security of tenure to local authority Gypsy and Traveller sites and to do this by implementing Section 318 of the Housing and Regeneration Act 2008. Statutory instruments will be laid as soon as parliamentary time is available.

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Baroness Whitaker: I thank my noble friend for that Answer. I know he intends to be helpful, but does he agree that the promise to give security of tenure-crucial to the education and health of Gypsy children-has just been dropped off the list of things to be done before the election because no one thinks that it matters enough? My noble friend has got two other statutory instruments under the same Act this afternoon. Does he also acknowledge that a very simple statutory instrument, a quarter of a page long, could speedily be brought in to cover just this one point, thus incidentally, also satisfying the letter from the Joint Committee on Human Rights?

Lord McKenzie of Luton: My Lords, I acknowledge the role that my noble friend plays as an effective and consistent campaigner for the rights of Gypsies and Travellers. I share her disappointment that it is not going to be possible to bring forward this statutory instrument before the general election but emphasise that the Government remain committed to doing so. As to the alternative proposition, that we could achieve what is required by a fairly straightforward and shorter instrument, the Government's view is that it would not have allowed the changes to assignment and the others requested in the consultation we undertook to be applied retrospectively to existing agreements once the Mobile Homes Act was applied to those agreements. We do not believe that the alternative is effective.

Lord Graham of Edmonton: My Lords, does the Minister acknowledge that there continue to be great disparities between those who live in bricks and mortar houses and those who live in mobile homes or on caravan or Gypsy sites? Can he give an assurance that despite the pressures on the department the interests of those who live on Gypsy sites will be borne in mind? Will he give a commitment to try to iron out the disparities between those who live in bricks and mortar houses and those who find their housing by other means?

Lord McKenzie of Luton: My Lords, the purpose of the consultation on these proposals was to seek to align the position of Gypsies and Travellers on local authority sites with other caravan dwellers on private sites or in park homes. That is the particular consistency we are seeking to achieve through these propositions.

Lord Avebury: My Lords, first, can the noble Lord give any examples, other than that of the case of Connors, where the Government have ignored a judgment of the European Court of Human Rights for six years, after having been reminded three times by the Joint Committee on Human Rights? Secondly, on the second question put by the noble Baroness, has the Minister had a chance to look at the draft statutory instrument we sent him just before the House convened, and why does he say that it is impossible to deal solely with the question of security of tenure to enable us to comply with the judgment?

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