The Parliamentary Under-Secretary of State, Home Office (Lord Sharpe of Epsom) (Con)
My Lords, first, I offer my thanks to the noble Lord, Lord Butler, for securing this debate. If I may say, I hope that no noble Lords, including the noble Lord, ever have personal need on this particular subject. I note his points on the simplicity of making this statutory instrument and the delay in legislating, and I shall come back to that in a moment.
I want to start by stressing at the outset, as the noble Lord and others noted, that the Government recognise the importance of this issue and the value that independent prescribing by front-line health professionals, such as paramedics, brings to the National Health Service. Doctors and vets are generally able to prescribe medicines containing controlled drugs, with accompanying rights to administer and direct others to administer them. In addition, other healthcare professionals can undergo specialist training to prescribe, supply and administer controlled drugs. Paramedic independent prescribers are therefore distinct from other paramedics and will be able to prescribe medicines specified in the legislation.
I am grateful to the noble Lord, Lord Patel, for going into some detail in this regard, because it gives me an opportunity to expand the definition of “advanced paramedics”, and perhaps add some colour. The number is expected to increase in line with the recommendations of the new long-term workforce plan, as referenced by the noble Baroness, Lady Merron. This change in legislation supports that development. As has been noted, that will benefit both the patient and the wider healthcare systems.
All paramedics are required by law to register with the Health and Care Professions Council. In answer to the noble Baroness’s question, according to its register, as of March, there are 1,708 paramedic independent prescribers and 219 therapeutic radiographer independent prescribers in the UK. Paramedic independent prescribers are utilised in a wide range of settings, which can include, but are not limited to, things like emergency departments—same-day emergency care, air ambulances, GP surgeries, out-of-hours services, walk-in centres, community palliative care teams, virtual wards and hospital-at-home services, hospices and so on, as well as on general and specialised wards.
Independent prescribing supports an expectation that patients should be cared for and treated by the most appropriate healthcare professional to meet their needs where it is safe and appropriate. The main purpose of paramedic independent prescribers is to allow those working at an advanced level of practice to be able to independently assess, diagnose and treat patients in a single episode of care, rather than refer them on to another healthcare professional. This is in line with the example that the noble Lord provides, in that, under this new legislation, a patient with an acute onset of pain could be prescribed oral morphine by a paramedic independent prescriber rather than being referred on to a GP or otherwise.
With all that in mind, the Government are wholly supportive of the proposals to enable prescribing of the five specified controlled drugs by paramedic independent prescribers, which is why we accepted the recommendations of the Advisory Council on the Misuse of Drugs, or ACMD, last year. We intend to legislate to make this change alongside other changes relating to the use of controlled drugs in healthcare by podiatrists, therapeutic radiographer independent prescribers, and those acting under patient group directions. As the noble Lord points out, the changes can be achieved by a negative Statutory Instrument, and we intend to bring forward this legislation by the end of the year. I have become a master of obfuscation while doing this job, but there is no need in this case.
The prescribing and supply of medicines is a policy lead for Ministers at the Department of Health and Social Care, as has been noted, and it is governed by medicines legislation. In the present case, the drugs involved are controlled under the Misuse of Drugs Act 1971, which is the responsibility of the Home Office. The 1971 Act makes specified activities in respect of controlled drugs generally unlawful. But because many controlled drugs have legitimate uses in healthcare, the 1971 Act enables Ministers to provide exemptions that are set out in the Misuse of Drugs Regulations 2001.
Under the 1971 Act, Ministers are required to consult the Advisory Council on the Misuse of Drugs, an independent scientific advisory body, before making changes to drugs legislation. Therefore, there are two departments, the Home Office and the Department of Health, working together on issues connected to controlled drugs in healthcare, taking advice from the ACMD and through consultation. The ACMD provided advice to Ministers regarding the prescribing of controlled drugs by paramedics, as has been noted, in October 2019. The Home Office and the DHSC worked together to consider this advice. After the report was published, the Government were required to focus on addressing the threat of Covid-19, as I am sure noble Lords will understand. Alongside other pressures on healthcare, the topic of independent prescribing was not prioritised. As noble Lords will be aware, the Government responded, accepting the ACMD recommendations in September 2022.
I assure your Lordships that Home Office and DHSC officials are working on the necessary amendments to the legislation, and we intend to introduce them by the end of the year. Where I referred to parliamentary procedure in the letter mentioned by the noble Lord, I am afraid that that is just standard language; there is no particular attempt to confuse or, to use my earlier word, obfuscate. We are carefully working through the legal drafting to ensure that each of the professions will have clarity on their new rights and responsibilities so that they can confidently carry out their duties. These include such details as whether the professional can direct others to administer the specified controlled drugs; whether the professional can compound the drugs; and whether they are obliged to record information about their prescribing and, when required, furnish information about it.
In addition, technical amendments need to be made to ensure that the measures are effective: for example, to ensure that patients supplied with controlled drugs in accordance with a prescription from the professional are in lawful possession, and to ensure that interdependencies between the 2001 regulations and those for which the DHSC are responsible under medicines legislation are properly aligned.
In his speech, the noble Lord described these changes as simple. Although the amendments to be made may seem simple, the complexity of the 2001 regulations should not be underestimated. My officials tried to explain them to me the other day and they will cheerfully attest to the fact that I looked very confused for a very long time. Officials from the Home Office and the DHSC have worked alongside lawyers to draft these regulations over several months to ensure that they are accurate and aligned with medicines legislation. I hope it is clear that the Government understand the imperative of this work and are prioritising the legislation accordingly.
To answer a few specific questions, the noble Lord, Lord Hallam, asked whether the forthcoming ban on nitrous oxide will have any impact on healthcare. I can assure him that it will remain available in healthcare as a Schedule 5 drug, and that can also be achieved by a negative statutory instrument. I suspect that we may return to that next week.
The noble Earl, Lord Sandwich, asked me about patient safety in prescribing. Prescribing policy is a matter for the DHSC, but I will make sure that he gets a detailed response on that subject. I can say that benzodiazepines—forgive my pronunciation—are controlled under drugs legislation, with three novel benzos being added in 2021. I hope that he does not intervene on me to ask for clarification because I am not sure that I will be in a position to provide much.
The noble Earl and the noble Baroness, Lady Merron, asked about the safety of prescribing. The ACMD advised that prescribers will have comprehensive training, and existing auditing and sanctions processes will manage inappropriate prescribing, should it occur.
In closing, I thank Members for all their contributions to today’s discussion, which has been both instructive and insightful. I particularly thank the noble Lord, Lord Butler, for securing the debate. He is absolutely right to highlight this important topic. I also thank Mr Johnny Hood, senior advanced clinical practitioner, who wrote to both the noble Lord, Lord Butler, and me. I rudely did not reply to his letter, but I hope he is paying attention to this debate. I thank him for his letter, which I read and noted.
I have heard what has been said and I hope I have provided some clarity and reassurance around the current position. As I have set out, we fully recognise the significance of this issue and work is at an advanced stage to address it as soon as possible by the end of this year.