NHS: Transition Risk Register

Baroness Meacher Excerpts

Wednesday 18th January 2012 Lords Chamber

[Baroness Meacher]

I understand the Government’s reluctance to publish risk registers. Governments do not tend to be keen to publish documents that are going to be deeply embarrassing to them. However, will the Minister invite the Information Commissioner to identify key sections of the risk registers that really should be before the House of Lords before it undertakes its work on Report, and will the Government and the Minister comply with the Information Commissioner’s recommendations?

[Earl Howe]

My Lords, this issue turns on a disagreement between ourselves and the Information Commissioner about where the balance of public interest lies. Our view is that the balance of public interest does not lie in disclosure, and his view is the opposite. It would be likely, if we gave the Information Commissioner a second opportunity to look at this, that he would come to the same conclusion as before, so we have to let due process occur.

Health and Social Care Bill

Baroness Meacher Excerpts

Monday 19th December 2011 Lords Chamber

[Lord Hunt of Kings Heath]

If I were to say that I did not trust the Health Professions Council, that might be taken as rather pejorative, and I would not seek to do that. It has done a good job on the health professions it regulates. I simply do not feel that it is right for it to regulate social workers. I do not think that it is prepared for it. Its philosophy is not attuned to it. That is why, if the Government insist on going ahead, some protection needs to be given.

My final amendment relates to the name of the new HPC, the Health and Care Professions Council. I am puzzled why “social worker” is not in the title. Why was it felt that when bringing 100,000 people into this body, it was not thought worth putting “social worker” in the title. I do not think that Health and Care Professions Council can possibly describe a body that will regulate 100,000 social workers.

I hope that the Government will be prepared to consider the matter again. I know that they want to reduce the number of quangos and regulators, although, if the noble Baroness had been here for the Statement on the banking system, she would have discovered that all Governments start by having a bonfire of the quangos and then inevitably they start to grow again. We saw in the past few minutes a good example of the Government starting to grow some new regulators. In this case, I do not think that the issue of money comes into it—the cost of the balance sheet is taken off the public purse, because it will be funded by registering. Because I am satisfied that the General Social Care Council can fund this through fees which would be similar to those of the Health Professions Council, I hope that the Government will give this further consideration.

[Baroness Meacher]

My Lords, I support the opposition of the noble Lord, Lord Hunt, to Clauses 206 and 208 to 211 standing part of the Bill, and will also speak to Amendment 338B. The noble Lord, Lord Hunt, has elaborated these issues extremely comprehensively and powerfully. I want to avoid duplication and will therefore concentrate on a few specific concerns that, for me, are the most serious, although the matters raised by the noble Lord, Lord Hunt, are also important to me.

Social work carries onerous public protection responsibilities that, to my mind, differentiate it importantly from the other professions regulated by the Health Professions Council. One issue that highlights that problem is the registration of social work students referred to by the noble Lord, Lord Hunt. This and other key matters are left to regulation under Clause 208 without any clarification of what that will mean in practice.

It is important to bear in mind that social work students have direct and unsupervised contact with vulnerable people, including children, whose lives may be at risk. That is rather different from the contact that other professionals tend to have with individuals. Following an impact assessment, the GSCC, not surprisingly, concluded that compulsory student registration was necessary. At present, the GSCC makes grants to the universities providing social work training. Those grants are conditional on the registration of students. The result is that 95 per cent of students are in fact registered. I am not sure what happened to the other 5 per cent, but in essence it is a form of compulsory registration of students.

As a result, any serious complaint about the conduct of a social work student can be referred for investigation by the GSCC. Although the number of serious complaints is small, it is larger than that of complaints about other professions. It is very important that these individuals are picked up early before they can do any severe damage to young children, or indeed other children. If a student is found guilty of misconduct and dismissed from their course, they cannot simply go across to the other side of London or to Newcastle and register on a different course, as this will be picked up by the GSCC. However, that will be lost in the new system. This system of student registration seems to be an important safeguard in public protection.

As I understand it, the HPC is consulting on whether the registration of students should be purely voluntary, as it is in the other health professions regulated by the HPC and as mentioned by the noble Lord, Lord Hunt. The concern is that the consultation includes all the health professions, which of course will say that registration does not need to be compulsory, and indeed it does not for these other professions. Any social work professional will recognise the importance of the compulsory registration of students, but of course they will be outnumbered by all the other professions. As a result, social work registration is likely—in fact, almost certain—to become voluntary. I understand that Paul Burstow, the Minister in the other place, has some concerns about this. Can the Minister tell the Committee what progress has been made to ensure that social work registration remains, de facto, compulsory under the student arrangements?

It is worth flagging up that Northern Ireland, Wales and Scotland will continue to have compulsory registration of social work students, and England will be out of line if this provision goes ahead. As a result, inappropriate students—potentially dangerous social workers—will come across the border into this country and practise. Do we really want that to happen?

Another issue is the assessed and supported year in employment—the ASYE. This is not yet in place but has been recommended by the Social Work Reform Board and is supported by the GSCC. I understand that senior social work professionals do not expect the HPC to introduce the assessed and supported year for newly qualified social workers because they want a common system for all professionals, as alluded to by the noble Lord, Lord Hunt. This provision is not necessary for professionals without a public and child protection responsibility.

Again, there is a problem here because of the differences between social work on the one hand and all the other professions on the other. As someone who practised social work—albeit briefly and many years ago—I fully appreciate the importance of a year immediately following qualification when social workers carry a lighter case load and receive support with more hands-on supervision to enable them to consolidate their knowledge. You could say that this was all a bit heavy-handed if it were not for the public and child protection duties of these workers. However, it really is important that those people know what they are doing and that they do not miss high-risk cases.

The GSCC wants the assessed and supported year to be a registration requirement in the future. Northern Ireland has this system. Of course, this would need to be tied in with some control over the number of social work trainees, but in my view it is a very important matter. What are the Minister’s plans in this regard?

My third area of concern is the standard of social work training. Those at the head of the GSCC would agree that we need more, rather than less, rigorous regulation of social work training. Social work standards set by the Department of Health have already fallen over a period; certainly they are quite unrecognisable to me. I think all of us who are aware of the Baby P report would agree with that assertion. We can expect these standards to fall further under the HPC because, as the noble Lord, Lord Hunt, mentioned, the HPC has basic standards across all professions at roughly NVQ level 3—not a degree level and not, in my view, a sufficiently high level—and just a few generic standards for each profession. It is not looking for intellectual rigour and does not have practice standards. Its focus is on outputs, which we all recognise and think are a thoroughly good thing. However, we all know that outputs based on book learning without any fieldwork requirements will miss absolutely essential elements of effective social work professional practice. The Social Work Reform Board is setting higher standards but these will not be regulated. Only the most basic standards set by the HPC will have that regulatory framework.

The Government are, I believe, leaving it to the yet-to-exist College of Social Work to promote excellence in social work. The BASW is challenging the establishment of the college, I understand. Will it exist and, if it does, will it be delayed? If so, for how long? I gather that even when it does exist, the college will be toothless—it will have no powers to regulate training at all. It may set standards of excellence but it will have no powers to ensure that those standards are met. Does the Minister agree that social work standards need to rise, not fall? If so, will she agree to take away these concerns and consider how best to ensure meaningful progress on the issue? That is vital to the protection of children and to avoid more Baby P scandals, with huge embarrassment to the Government. I trust that the Minister will take this seriously.

Finally, I ask the Minister what will become of the GSCC code of practice for social care workers, which is another group altogether. It is important that this code of practice is retained as an element in the standards framework for social care. This is all about standards and the quality of provision. Will this code of practice be hosted by Skills for Care in the interim before any registration of these workers, or will it be lost? I reinforce the point made by the noble Lord, Lord Hunt, about the spurious financial justification for the abolition of the GSCC. I, too, understand that, financially, keeping the GSCC would stand up perfectly well—it could be self-funding on a similar basis to the HPC. I hope that the Minister will be able to explain this.

Very real risks arise from this planned merger. England will move out of line with its neighbouring countries, and we will reduce standards and safeguards in a profession at the front line of child protection. Is it really too late to rethink this high-risk plan?

[Baroness Pitkeathley]

My Lords, I have interests to declare other than being chair of the Council for Healthcare Regulatory Excellence in that I chaired the advisory body that led to the setting up of the General Social Care Council, and I was its first chair.

It is not for me to question the Government’s decision on these matters, but I draw your Lordships’ attention to the fact that neither the decision nor its implementation have been easy for those involved. I pay the warmest possible tribute to colleagues at the General Social Care Council and the HPC for the way in which they have dealt with this difficult situation. In particular, I acknowledge the role of the oversight group, which is chaired by Harry Cayton, the chief executive of the CHRE, and consists of colleagues from both organisations and other interested parties. However difficult those discussions may have been at times, the professionalism and commitment of those involved to the safety and interests of the end users of social workers’ work have been exemplary, as has been the commitment to ensuring that there should be as little disruption as possible to their functions during any transition period. Thanks to that professionalism, these reforms will allow for the greater integration of health and social care regulation through the renamed Health and Care Professions Council. Regulation by the HCPC—I shall have to get used to the new initials—will extend regulation to the competence of social workers, as well as to their conduct, and thus improve public protection.

I have some concerns about the proposals for the governance of the HCPC, as they do not reflect the general direction of travel in recent reforms across professional regulation. These have emphasised and focused the regulator’s governance and operations on the primary duty of public protection, not of professional representation. Historically, allowing reserved places for particular professionals in councils and committee structures was thought to be damaging to public confidence in regulators and in their decisions about standards and fitness to practise. These proposals might therefore represent a step backwards and not demonstrate good governance principles for professional regulation.

The HPC has a strong track record in taking on new registers, and has established quality assurance mechanisms to facilitate appropriate input from professional expertise, where appropriate. I hope that we shall be able to see that this is an important development, and one that protects all those professions, as well as, most importantly, the public, in the integration of social care and health in the way that we have been calling for in so many debates during the course of this Bill.

--- Later in debate ---

[Baroness Northover]

As the noble Lord will be aware, the figures provided by the General Social Care Council indicated that the costs would rise from £21 million to £25 million per annum, which would indeed cost about £250 per social worker. I realise that the council later revised this downwards, but the noble Lord knows as well as I do that those were the original figures based upon what the council estimated at the time. Even with the revision downwards, it was still not in line with the HPC, as I am sure the noble Lord is well aware.

However, it is extremely important to make sure that the arrangements that are in place regulate the social work profession properly and separate out the professionalisation of social work. The noble Lord will remember that he asked a question on this, and I drew the distinction for the medical profession with which the noble Lord, Lord Walton, will be familiar; the GMC regulates the medical profession, and the royal colleges do a fantastic job in promoting the profession and taking it further. The original arrangements that the noble Lord introduced were an earlier stage for social work, and the task now is to take it to the next level of development.

Regulation by the Health and Care Professions Council will bring social work regulation in England within the scope of the professional standards authority, with the added scrutiny that that will bring. It is our view that it would be wrong to require the Health Professions Council to move away from its tried and tested system of regulation solely for the social work profession.

[Baroness Meacher]

May I ask the Minister whether she agrees that the standards set by the HPC are just lower than standards that social workers are used to and require to do the job properly?

[Baroness Northover]

I am not sure that I would agree with that. If the noble Baroness bears in mind that the HPC will regulate the profession and that other means will be used to drive further forward the training standards and the education of the profession in conjunction with the regulator, it may very well be that those two things have become conflated and it is important that they are separated out.

[Baroness Meacher]

Would the Minister be willing to write to me to explain how these things will work? As I understand it, some standards might be set elsewhere but the standards that will be regulated will be those of the HPC, which will be very low. The HPC is the one with the regulatory powers and therefore it will not regulate the higher standards that might be set, for example, as good examples by the college. It would be helpful if we could have an explanation of how that will work in practice.

[Baroness Northover]

I am more than happy to write to the noble Baroness. In the discussions that I have had with various organisations, including the HPC, that is not the conclusion that I come away with. I hope that she is reassured.

--- Later in debate ---

Following up on one or two other points on students, the General Social Care Council of course enforces its register of student social workers through the criteria of eligibility for an education support grant, which funds the practice placements of student social workers. The Health and Care Professions Council will not have that particular lever, but it will have other means, such as the council’s approval of pre-registration courses, through which the Health and Care Professions Council will be able to encourage student registration if, following consideration, voluntary registration is considered the most appropriate way.

[Baroness Meacher]

I wonder whether the Minister would consider that there should be a compulsory requirement. If the HPC is registering these courses, could it not be made compulsory that the course must register the students?

[Baroness Northover]

As I just said, the HPC is currently consulting. I strongly suggest that the noble Baroness feeds into the consultation her recommendations and the evidence on which they are based so that they can be properly considered.

The question was raised of how social workers might be linked to the wider reform programme. The Health Professions Council is represented on the reform board and will be able to contribute its expertise to the ongoing reform of social work. Moira Gibb, chair of the reform board, is also a member of the Social Work Regulation Oversight Group. Her professional expertise and knowledge is contributing to the transfer process. Many organisations on the HPC’s professional liaison group, which has developed draft standards of proficiency for social workers in England, are also on the Social Work Reform Board, which has ensured that the development of standards has been informed by wider developments in social work in England.

I hope that noble Lords will see that a lot of attention is being focused on trying to ensure that the change will operate as effectively as possible and will be in the interests of those with whom social workers work. It is exceptionally important that we protect the vulnerable people whom social workers look after, and we are acutely aware of that. On the basis of what I have said, I hope that noble Lords will not press the amendments in this group.

Health and Social Care Bill

Baroness Meacher Excerpts

Tuesday 13th December 2011 Lords Chamber

[Baroness Meacher]

My Lords, I rise to speak in support of Amendment 260EA which, as I understand it, seeks to maintain the essentials of the role of Monitor as set out in the 2006 Act. I support the extending of Monitor’s roles beyond those of foundation trusts. However, in response to the argument of the noble Earl, Lord Howe, that we need to change the functions of Monitor in order to achieve cost-effectiveness, improvements in quality and productivity in the years ahead, I would argue that with Monitor as it stands, together with the National Institute for Health and Clinical Excellence and the CQC—a great improvement on its predecessor—we have all the tools we need in the kitbag in order to improve our productivity, quality and cost-effectiveness.

I want to focus on one issue which I believe to be the greatest threat presented by these reforms to the improved quality and cost-effectiveness of the health service. There are two powerful reasons for avoiding the reorganisation of Monitor. The first is that if it ain’t broke don’t fix it. Monitor has been, in my experience, an extremely successful organisation, with one exception to which I will return. The second is that the main new ingredient is, indeed, the promotion of competition that has been addressed so effectively by other noble Lords. Although this will not be based on price, I have absolutely no doubt that it will drive financially driven decision-making.

I want to touch on these two points. Monitor is not broke, as it were. Having been on the receiving end of Monitor’s demanding regime for accreditation as a foundation trust service, I can vouch for the fact that Monitor has been the engine behind the transformation of inefficient organisations, run by boards with weak non-executive directors—who therefore offered very little professional challenge to the executive directors—weak financial systems and weak financial management. That is what we had, and that is what other trusts have had, prior to undergoing the rigorous process driven by Monitor to become foundation trusts. In my case, as chairman, I had no alternative but to get rid of my chief executive officer—no easy task but somehow this process enabled that to happen—and, indeed, to get rid of my non-executive directors. It was as simple as that. The same process continues to take place all over the country. I know this because others tell me. My belief is that we owe to Monitor, more than any other organisation with the possible exception of NICE, the fact that the NHS is now one of the most cost-effective health systems in the world, as the noble Lord, Lord Owen, has said very clearly. We should be proud of that.

At this stage I ought to mention Mid-Staffs, because this is, indeed, the one failure to which people refer. As I understand it, the problem was that Monitor at that stage had no information about quality, and the Healthcare Commission, which at that stage was responsible for quality inspection, did not pass data to Monitor. All those problems have been resolved, and they needed to be, because without the quality information, Monitor was ill-equipped to do the job it had to do.

I come now to my second point, which is about the promotion of money-based competition. I want to emphasise “money-based”, because I support competition, but it must be based on the quality of services to patients. The promotion of money-based competition and private sector provision of health services will be a detrimental and costly experiment. We have only to look to other countries, as the noble Lord, Lord Owen, has said, to realise that this is nothing short of a disastrous route forward. I refer to page 19 of the Department of Health’s document Protecting and Promoting Patients’ Interests: The Role of Sector Regulation. It states:

“Regulation and competition will always play an important role”.

I know that the word “competition” here means money-based competition: not price-based, but financially based or commercially based. It goes on to say that Monitor will,

“provide a fair playing field for all, regardless of ownership”.

I understand that the existing foundation trusts will remain as they are as long as they remain solvent. The document refers to patients wanting more choice. As we know, we can get any answer we want from surveys, as long as we ask the right questions. No patient would want more choice if they were aware of the costs and the appalling consequences of the dominance of the money motive in a commercial system. Patients want choice within the systems that we currently have.

I will not focus on the US, because we know that with health costs soaring towards 20 per cent of GDP and 30 million people excluded from remotely satisfactory health care, this cannot be a model to follow. However, Germany is held up as a good example of a health system which has worked with more competition in the system for a long time. I will start with an anecdote. A German orthopaedic surgeon we met on holiday a few years ago happily referred to the fact that he and his colleagues regularly undertake unnecessary operations if they are short of work. What was remarkable was that he seemed completely unembarrassed that this should be the case and that he should admit such a terrible thing to somebody who is used to working in a country with a national health service. It seemed completely normal; it clearly is.

I want to make available to your Lordships the more considered experience of one of the German consultants, Professor Priebe, who worked as a clinician in Germany for 17 years before emigrating—utterly disgusted with the German system—to the UK to work in the National Health Service. He gave me his comments and pleaded with me to make them available to the Government, because he is so alarmed at the thought that he escaped the German system to come over here only to be followed by something rather similar. I will try and draw on his comments as quickly as I reasonably can.

In Germany, the contractual agreement between commissioners and provider organisations define the funding arrangements. Clinical decisions are then strongly influenced by financial incentives. Computer-based algorithms have been developed to guide doctors on what diagnostic interventions and medical treatments patients should receive in order to maximise the income for the provider organisations. These algorithms consider the characteristics of the given patient as well as the characteristics of the broad category of patients with that particular diagnosis in order that the doctor achieves the,

“most profitable average treatment costs across a diagnostic group of patients”.

Is that really what we want in our country?

In Germany, evidence-based medicine and the interest of patients are much less important. In the UK in recent years, the emphasis has been more and more on evidence-based medicine; that is based, of course, on the professional work of NICE, which I have already referred to. If the drive towards competition threatens this ethos, Britain will lose something extremely precious. Competition not only reduce the flexibility needed to provide individualised effective care, but also requires ever-increasing documentation. Ministers often refer to the bureaucracy of the National Health Service, but if they had the experiences of the bureaucracies of other systems, they might be slightly less critical.

This documentation is supposed to ensure that clinicians can demonstrate that these income-generating interventions have indeed been provided. Commissioners mistrust the providers and require more controls and ever more documentation as well. This waste and inefficiency inevitably drives up costs.

Financial incentives and competition encourage commissioners to accept less costly patients. The providers are inclined to do the same. Here is another major fault in the system. As a result, patients with severe and chronic disorders become disadvantaged. It is no accident that mental health services are relatively well funded in this country, when compared to these competition-based systems, though I should emphasise that even in the UK, mental health remains the Cinderella of the health service.

Financial incentives also lead to the prescription of useless treatments—my anecdote makes the point—and the over-provision of services. Apparently, this is widely known across the German system. The providers then argue for the funding for all these unnecessary operations and superfluous services.

Competition and fragmentation of local service systems create the need for more referrals and associated paperwork and further increased costs. There are multitudes of downsides from these financially driven systems. Our consultant concludes that,

“most of these downsides of a more market orientated system appear to be intrinsically linked to the promotion of competition in health care and to having a system based on independently negotiated contracts rather than one controlled by agencies that are directly accountable to the public”.

In this country, we know from other sectors that markets do not work. The name Jarvis will mean something. Jarvis was, of course, the private maintenance company for the rail companies. Jarvis was found negligent following various rail disasters and, of course, Jarvis no longer exists.

Do we really want to generate these risks of negligence in the health sector? Surely not. I realise that at this point in time, the plan is not to go all the way down the rail route, but the direction of travel is extremely clear and I have no doubt that that is where we shall arrive unless there are safeguards within this Bill to prevent it. Some may point to the apparent savings achieved by fundholder GP practices. The evaluators apparently found, however, that GPs bumped up their prescription costs immediately before becoming fundholders by going to special drugs only to return to generic prescribing once they became GP fundholders.

NHS: Front-line and Specialised Services

Baroness Meacher Excerpts

Thursday 13th January 2011 Lords Chamber

[Baroness Meacher]

My Lords, I, too, applaud the noble Lord, Lord Turnberg, for initiating this debate. I am sorry that I was not aware of it until rather late in the day, hence my having been slotted into the gap. I must apologise to the House for that. I want to raise two questions which have perhaps received less attention than others. Before doing so, however, I want to set out two examples of the direct implications for services of organisational change. The first concerns the major rationalisation of the acute sector, particularly in London, which was inherited by this Government. The aim of that rationalisation was to reduce the considerable excess supply of hospital beds, particularly in London, in order to make the absolutely essential savings to enable the NHS to balance its books and to improve radically its productivity. These major changes have been put on hold awaiting the completion of the development of the GP consortia arrangements. The failure to make those rationally-argued changes in a timely manner will have direct implications for the funding of front-line services.

My second example is local. I am not in any way suggesting criticism of the organisation or individuals concerned, but the commissioning changes are already inevitably distracting managers from their day-to-day essential decisions, again with severe adverse consequences. A particular trust with which I am associated, and I declare an interest, has to cut its budget by 4 per cent each year for three years—by £10 million a year. To achieve that, two very significant rationalisations were evaluated and planned, but the PCT’s approval is essential before we can go ahead. If those vital savings are delayed—and they are being delayed, as we will not have the PCT decision in time—then we will have to turn away from those well planned changes. The risk is that we will have to make quick cuts on front-line services. Those are my concerns about organisational change and its direct impact on front-line services.

I have two questions. The first concerns the planned removal of the power of the National Institute for Health and Clinical Excellence to determine whether a specific—

[A noble Lord]

Two minutes.

[Baroness Meacher]

Two minutes? I am sorry; nobody warned me about the two minutes. I will very quickly raise the questions. The first is about the power to determine whether a specific drug or treatment may be given under the NHS—I am now completely thrown, but there is a concern about the loss of that power of NICE. The second question concerns the role of Monitor as the regulator and the removal of its compliance framework under the new proposals, as I understand them. It is an excellent provision under the old system, which we are going to lose. I have concerns about that and look forward to the Minister’s response.

Health: Addiction to Prescribed Drugs

Baroness Meacher Excerpts

Wednesday 6th October 2010 Lords Chamber

[Baroness Meacher]

My Lords, I thank the noble Earl, Lord Sandwich, for creating the opportunity to raise important issues relating to the over prescribing of benzodiazepines and other prescribed drugs. The noble Earl referred to the huge numbers of patients who remain addicted to these hypnotic drugs for decades, and set out graphically the side-effects and symptoms of withdrawal. It will not surprise some noble Lords, least of all the Minister, that for me this debate raises the possibility that regulating rather than criminalising medical marijuana use might help to reduce the pressure on GPs to prescribe benzodiazepines. Has the Government’s review of dependence on and withdrawal from benzodiazepines considered this possibility? If not, will the Minister extend the review to assess the possible benefits and savings from a medical marijuana use policy in terms of the reduced use of costly and dangerous prescribed drugs?

We know that benzodiazepines prescribed for anxiety can, over time, exacerbate anxiety rather than alleviate it. We also know that elderly people on benzodiazepines are more likely to suffer falls and broken hips than other elderly people. Would cannabis be a safer option for people in constant pain or other discomfort who have difficulty sleeping? No GP should recommend cannabis for people with anxiety—I wish to be quite clear about that. They should be recommended for cognitive behavioural therapy, a well-tried and highly successful treatment.

International research, however, shows the considerable medical benefits of cannabis for a wide range of ailments and I shall mention a few. I could go on and on about this but I will not, your Lordships will be glad to hear. Benzodiazepines have no such benefits. Patients with respiratory complaints, for example, who are prescribed cannabis in other countries to help them sleep, and who use a vaporiser for the smokeless delivery of cannabis, show meaningful improvements in respiratory function; not only do they sleep better but they recover, at least to some degree, from their respiratory disease. Cannabinoids, a key ingredient of cannabis, which would be enhanced in a regulated system of MMU, can grow new brain cells, researchers tell us, fight brain cancer, aid mental health and reduce inflammation. Again these matters need elaboration but there is no time tonight.

So what is the international experience of medical marijuana use? In at least 14 US states and Washington DC, covering more than 20 per cent of the population, the law stipulates that individuals who receive a recommendation from a medical doctor for marijuana use for medical purposes are allowed, in most cases to grow, and in all cases to possess and use, limited amounts of the drug. The law also protects caregivers who are involved in those activities.

In Canada, the medical marijuana access programme was established after a ruling by the Ontario Superior Court concluded that the blanket prohibition of cannabis use violated constitutional rights for individuals who could derive medical benefits from marijuana use. In 2003, another ruling of a higher court required the Government to establish a government-sponsored supply of marijuana for medical use. This is crucial. It has been estimated that 40 per cent of patients in these other countries prescribed marijuana suffer from serious illnesses such as cancer, AIDS, glaucoma, epilepsy and multiple sclerosis. The remainder have ailments such as anxiety, sleeplessness, ADHD and assorted pains. How many of such patients in this country, where cannabis is illegal even for medical use, are prescribed benzodiazepines or equally dangerous prescribed drugs? Will the Minister include an exploration of this issue within the review?

The Minister may think that such a step would run counter to the UN conventions and the United Nations Office on Drugs and Crime. I can reassure the Minister that every step away from the criminalising of drug use towards a health-based approach is in line with UNODC policy. That august body, which is responsible for the UN drugs conventions, issued a ground-breaking discussion paper in March arguing for the first time that UN conventions need to be reinterpreted, leaving behind the criminalising policies in relation to drug use of the past 50 years. The new executive director of the UNODC, none other than a Russian, Mr Fedotov, in his first statement on taking office, reaffirmed the commitment of his organisation to promoting a health-based focus on drug use policy across the world.

Many patients are suffering unnecessarily because of the misguided drug use policies of the past 50 years in this country. The coalition Government are looking for significant opportunities for public sector cost savings which deliver improvements in public experience. The drugs policy is probably the most fruitful candidate for making a major contribution to public sector savings in a constructive way which will benefit our communities. The introduction of a medical marijuana use policy would be a valuable start. I hope the Minister will agree.