Healthcare: Controlled Drugs

Baroness Merron Excerpts

Thursday 14th September 2023 Grand Committee

[Baroness Merron (Lab)]

My Lords, I too would like to thank the noble Lord, Lord Butler of Brockwell, for giving us the opportunity to air what we should not have to air, which is the need for the legislation for this important change. I would also like to pay tribute to his elegant tenacity on the subject, which is important in improving the provision of health care. The Government are failing to do that because they have not brought forward the necessary legislation. The noble Lord also set out clearly the background to what is a very long and winding road over many years which brings us to a position I am sure the Minister would rather not be in. It is a somewhat uncomfortable position, because it is so obvious that this should be done; all the agreements and approvals are in place, and yet we wait.

I am glad that the Minister has confirmed on a number of occasions that legislation will be brought forward as soon as possible and that this could be dealt with by statutory instrument. When it does come before us again, I hope that what the noble Earl, Lord Sandwich, said about the need to confirm that full consideration has been given to patient safety will be taken into account. The noble Earl helpfully flagged up a number of points, which I would regard as advanced warning to the Minister.

I agree with the point made by the noble Lord, Lord Butler of Brockwell, emphasised by the noble Lord, Lord Allan, that if this matter was sitting with the Department of Health and Social Care it would have been dealt with—I feel sure of that. The Minister shakes his head, and I am sure we will have an explanation later as to why that is not the case, but that is the feeling in the room, and for good reason. As the noble Lord, Lord Patel, explained, paramedics do not just work in ambulances, and what they need is the tools to do the job that is before them.

NHS England also states that advanced paramedics who have undergone additional master’s level training are increasingly taking on roles in varied critical settings. As the noble Lord said, these include GP practices, minor injuries units, urgent care centres and A&E, and they are prescribing in such settings. This aligns with the NHS long-term plan’s emphasis on multi-disciplinary care, which includes the aim to relieve pressure in accident and emergency units and to provide immediate care for people wherever they are. To have this change in legislation would be a considerable contribution to that.

Why do we need to go down this road? It is worth reiterating some of the points that have been made. I too was grateful to the Lords Library for the briefing it provided and was interested to read the 2021 study in the British Paramedic Journal. It reported that paramedics who participated in this study, and who had

“longer experience in primary care, out-of-hours or house calls or with an extended remit to provide end-of-life or palliative care”,

described not being able to prescribe controlled drugs as a “limitation”. I am sure that the Minister, who is a Home Office Minister, has heard many debates in the Chamber in which his ministerial colleague in the Department of Health and Social Care was pressed on why we cannot see change to existing staff practices in order to provide better healthcare. Indeed, the NHS workforce plan, which we have long called for and which has finally appeared—with its limitations—will be successful only if the question of how people can do their jobs is looked at. Here is an opportunity to equip people to do their job.

In answering a Written Question put to the Department of Health and Social Care in December last year, the noble Lord, Lord Markham, described who could prescribe beyond doctors and dentists. He gave a list of professions, referred to as non-medical prescribers in this case, and they included physiotherapists, therapeutic radiographers and so on. Interestingly, the Care Quality Commission lists the great benefits in this extension to non-medical prescribers, so there is a lesson to be learned here. The CQC talks about the enablement of “quicker access … to medicines” for patients, making the

“best use of the range of skills of healthcare professionals”,

and addressing “demand and workforce issues”. I say to the Minister: these are all things we have been pressing for in the Chamber, and which I think Ministers would also like to see. Here we have an opportunity to get on and meet that requirement.

I have a few questions for the Minister. As we have discussed, experienced paramedics have had prescribing powers since 2018. What assessment have the Government made of the success of this, and what can be learned from implementing the extension? Crucially, can the Minister tell us how much discussion has been had on this matter with the Department of Health and Social Care, as it seems to have fallen between the two departments? How many paramedics currently hold independent prescribing powers? Do the Government have any plans to encourage more paramedics to access prescribing training? What consultation have the Government undertaken, or will they undertake, on how to roll out these changes?

In a study on the introduction of prescribing for paramedics, those who had begun prescribing expressed concern about confusion in multidisciplinary settings about the different prescribing powers that colleagues possessed. What work can the Government and the NHS do to ensure clarity throughout the health service so that current powers and the new powers, when they are introduced, are clear to all clinical colleagues?

As the Minister knows, there is one main thing we would like to hear: the date when this matter will finally be dealt with. I hope he can offer us that today, with clarity, and that he will also explain to noble Lords present and the many people outside who are waiting for his response why there has been this delay. I look forward to his response.

Queen’s Speech

Baroness Merron Excerpts

Thursday 12th May 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I thank the Minister for introducing today’s debate on the Motion on the humble Address. It is an honour to be opening for these Benches and significant for me personally, as I gave my maiden speech on the second day of the debate on the gracious Speech last year, which perfectly mirrors the timing of this debate. I start by expressing gratitude from these Benches to His Royal Highness the Prince of Wales for delivering the gracious Speech. We send our warmest wishes to Her Majesty the Queen, whose service to this country has been and remains extraordinary.

This debate covers hugely important areas of British life that we, as a nation, are proud of and that we on these Benches, along with Members from across your Lordships’ House, are determined to protect. It covers everything from our justice system to our rights as individuals, including our right to dissent and to challenge when justice is not done, all the way through to our exceptional cultural sector, and the prospects and fortunes of our local football teams. My noble friend Lord Ponsonby will respond to the debate and focus in greater depth on the justice, constitutional and home affairs aspects, but I will make some opening remarks.

It is disappointing that so much of what is in front of us now has already been promised and announced time and again by Ministers—often multiple times over multiple years—but with a failure so far to deliver. On action for victims of crime, a Bill has been promised in not one, two or even three Queen’s Speeches, but in four, as well as in three manifestos. Even now, the Bill we are again promised is only in draft form. National security legislation has been promised since 2019, after being recognised as a necessity through the cross-party Intelligence and Security Committee. For years, Members across the political spectrum have called on the Government to act against corruption and illicit Russian money being laundered through the UK. We welcome the inclusion of an economic crime Bill, but have to put the question: why has it taken an international crisis for this Government to act?

The much-delayed Online Safety Bill, which must be about recognising that in today’s world online is the front line when it comes to keeping our children safe and protecting people from fraud and abuse, is finally before us, but with an outline that leaves very much still to be achieved.

On football governance, action is urgent. The Government’s briefing says that governance has not kept pace with development and reform is needed, yet they have confirmed that they do not expect a regulator to be in place until 2024.

Your Lordships’ House will of course work to scrutinise what is finally promised and to make the long-awaited legislation the best it can be, but it is disappointing to say the least to find that the Government are playing catch-up on issues as vital as these as well as on many others. There is a continuous thread: the Government seem to have the wrong focus at the wrong time.

On the Home Office and issues of justice, victims of crime are being badly let down in this country, with record court backlogs, rising crime and low prosecution rates and a huge number of victims losing faith in the system altogether. Yet, for example, despite the very real level of public concern, there is no much-needed Bill to tackle violence against women and girls. Instead the Government plan to focus on reducing the British public’s right to challenge when the justice system fails them.

Turning to DCMS, this is the Session when your Lordships’ House will finally get to scrutinise the Online Safety Bill, but that legislation does not appear to be as fit for purpose as we hoped. The Joint Committee on the draft Online Safety Bill brought forward a series of important recommendations. Some have been incorporated into the current legislation but the Government need to go further if reality is to match many years of rhetoric. Sadly, the numerous delays to this legislation have in the interim allowed tens of thousands of children to be exposed to online abuse and millions of internet users to fall victim to online scams. With most of the provisions unlikely to enter into force until 2024 or beyond, those numbers are likely to increase further, something on which I hope the new chair of Ofcom, the noble Lord, Lord Grade, will wish to take a view.

Elsewhere, the Government are insisting on selling off a national asset in the form of Channel 4, despite widespread opposition within the creative industries and on the government Benches in both Houses of Parliament. We can remind ourselves that Channel 4 was established under the former Prime Minister Margaret Thatcher. It does not cost the taxpayer a penny. Despite the claims by DCMS, it is already able to compete with the likes of Netflix. It has developed the UK’s most popular free streaming service and demand is likely to increase as paid-for services, such as Netflix, lose subscribers. The privatisation element of the media Bill will undoubtedly take up a significant amount of parliamentary time. If, as seems likely, the sale of Channel 4 leads to a lower volume of programmes being commissioned, the impact will be to level down the creative output and negatively affect jobs across the UK’s nations and regions.

A wide range of smaller Bills has also been promised by DCMS, from data reform to digital markets and I look forward to seeing further detail on them. The Culture Secretary’s fixation with Channel 4 means that other DCMS initiatives have had to be put on the back burner. An independent regulator for football will not be in place until 2024 at the earliest, as I have said, and we still wait to see the Government’s plans for the reform of gambling regulation. Once again, there are many consequences to this. It is likely that the Government’s inaction in these areas will mean that more football clubs, their fans and communities will suffer because of inadequate governance arrangements and ever more individuals, both children and adults, will be exposed to gambling-related harms.

On this latter point, we are in the middle of a perfect storm. The shift to online gambling, the increased cost of living and the continued financial impact of the pandemic have come together to create the conditions in which gambling harms to individuals and, by extension, to their loved ones unfortunately continue to thrive. I note that in 2020 the Government launched a welcome review of the Gambling Act, acknowledging, correctly, that too many people are experiencing significant harm from gambling while the industry has changed enormously since the passing of the Act in 2005, yet today we find that we continue to wait for something to be done while people’s health and well-being are damaged, when we know that more could be done to tackle avoidable harms. An overwhelming majority of the public want action on sports governance and gambling while opposing government intervention in the affairs of Channel 4. In that sense, how can the Government possibly say that they are focusing on the priorities of the British people?

I know that your Lordships’ House will do its very best, as it always does, to improve the Bills before it through scrutiny. That starts with this debate, which began yesterday and continues today. I look forward to hearing from noble Lords. However, this gracious Speech is notable not just for what is in it but more so for what is not. The Government had an opportunity through this gracious Speech to give people what they need to manage their day-to-day lives and to thrive. I am sorry, but this opportunity has not been taken.