World Health Organization: Pandemics

Earl of Sandwich Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the financial support of the WHO from the Government is generous, and so is our support of COVAX. When it comes to the WHO, we are looking for stronger horizon scanning and early warning, higher-quality technical guidance that is tailored to different countries and resource settings, and greater co-ordination of governance and activity across the animal, human and environmental interface. This is a really clear manifesto. The Prime Minister has laid it out clearly, and we are using the G7 process to ensure that there is support for it across the G7 countries.

[The Earl of Sandwich (CB) [V]]

My Lords, do the Government fully recognise that most of the poorest countries, even states such as Vietnam, are still coping without any vaccinations? Does the Minister agree that much more attention must be paid to the support of local health services in the least developed countries? They are easily bypassed when there are major international health campaigns.

[Lord Bethell (Con)]

The noble Earl refers to the important role that the WHO plays. Of course, we are all frustrated sometimes with our multilateral organisations, but the noble Earl quite rightly alludes to the dependence that many countries have on the advice, counsel and practical support that organisations such as the WHO provide. That is why we want the WHO to step up to its responsibilities, why we have instituted a major reform programme recommendation, and why we are extremely hopeful that the WHO steps up.

Covid-19: Mental Health Services

Earl of Sandwich Excerpts

Thursday 2nd July 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, we remain committed to publishing a White Paper that will set out the Government’s response to Sir Simon Wessely’s independent review of the Mental Health Act 1983 and pave the way for reform of that Act. We will publish it as soon as possible. The Covid epidemic does nothing but incentivise us to move as quickly as possible on this.

[The Earl of Sandwich (CB) [V]]

My Lords, does the Minister share my concern that the data he kindly supplied in Written Answer HL5619 on 22 June shows an 11% increase in March in prescriptions for anti-depressants over the same month last year? Is he therefore considering urgent measures to increase the funding and availability of psychological therapies instead?

[Lord Bethell [V]]

My Lords, I am as concerned about the over-prescription of anti-depressants as the noble Earl and would much prefer people to take cognitive therapies than drugs wherever possible. As I mentioned earlier, we have invested in two major rounds of support for community groups to help those struggling with their mental health, and we are reviewing additional funding for those schemes. We will keep a careful eye on the prescription of anti-depressants, which we are all concerned about.

Psychiatrists: Referral Fees

Earl of Sandwich Excerpts

Thursday 7th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I do not know whether it is against the standards of the BMA. However, the General Medical Council is explicit in its guidance that doctors must not allow any financial interest—either the fact or the perception of it—to impact on the way they treat or refer patients, and they must declare any such conflicts or perceptions of conflicts to patients while treating them.

[The Earl of Sandwich (CB)]

Can the Minister confirm that Public Health England is now, finally, going ahead with its review of prescribed drugs and addiction to those drugs? Is he aware that the guidelines from NICE on this subject are very out of date, and will there be a parallel review of them?

[Lord O'Shaughnessy]

I can confirm that the PHE review is going ahead. I do not know whether there is a concomitant review on the NICE guidelines, and I will write to the noble Earl on that subject.

The Long-term Sustainability of the NHS and Adult Social Care

Earl of Sandwich Excerpts

Thursday 26th April 2018 Lords Chamber

[The Earl of Sandwich (CB)]

My Lords, I thank my noble friend not only for introducing this debate but for inviting me to join it. He knows that over the last few years I have brought up the subject of dependence on prescribed drugs, and I declare that I am a vice chair of the all-party group on that subject. This is a sad story, but today I am not going to describe the terrible effects of dependence on, and withdrawal from, medicines that have been recommended in good faith by doctors. Everyone here knows that most prescribed drugs are effective for most conditions but that many mistakes are made, and drugs are inappropriately prescribed for a variety of reasons. I have lived with the painful effects of withdrawal in my own family.

According to an authoritative article in the Spectator on 24 March, over 300,000 people leave their jobs every year because of mental illness. Paragraph 292 of the committee’s report says that two out of three of them receive no appropriate treatment. Psychiatric drugs are dramatically increasing in number and availability, and the BMJ has reported a related high risk of suicide. Prescriptions for antidepressants in England rose to 64.7 million items in 2016, which is an all-time high, according to NHS Digital, representing a 108% increase over 10 years. Another 15.9 million prescriptions were issued for benzodiazepines and Z-drugs.

This debate is about the future and, therefore, gives us the opportunity to dream. But I am not interested in chimera, only in the possibility of change and the dynamic of that change. Many would like to see a radical transformation of mental health policy so that it takes in human beings more individually instead of consigning them to the conveyor-belt of medicine. Mental health patients, while they have come more into focus, are still not given a wide enough choice or more attention from psychiatrists or better alternatives to medicine. The pharmaceutical companies have a powerful hold. Big pharma cannot be blamed for responding to demand, but it can be reminded of its corporate responsibility when it comes to promotion, research or the sponsorship of trials and surveys, and they should be more sensitive to the effects of their products on increasing numbers of the public.

I would also like to see more CCGs waking up to the reality of the consequences of mental ill health, and especially the perils of withdrawal. My noble friend Lady Murphy touched on this. There are very few services for those withdrawing from prescribed medicines, and most of them are voluntary and fragile. In fact, Mind in Camden is threatened with closure this summer because of Camden CCG’s withdrawal of funding. Camden is the only London borough that offers this service through Mind, and it is available only to Camden residents. I understand that, perhaps because of negative publicity, the CCG is considering a new configuration of this service. There is even a risk that it will be merged with illegal drug addiction services, something that specialised charities avoid. But it raises a major question: should not the NHS be encouraging voluntary initiatives, especially at a time when prescriptions for antidepressants and dependence on them are rising? I know of another charity in Cardiff which closed for similar reasons. This is no national network; there are only a small number of these initiatives and their local CCGs should be backing them up, not swallowing them up.

The Minister may say that millions are being spent on mental health, but it is certainly not in this area of mental health. The support of voluntary agencies in every sector is surely an important, even vital, alternative to statutory funding at a time of austerity. One short-term solution would be a national helpline. We cannot leave this to the wish list of the future reorganised NHS or the recommendations of the review now being undertaken. It is viable and is needed now. I understand that it is being seriously considered behind the scenes, but I again urge the Minister to let us know whether it is actually going to happen.

Another important issue is the degree of public understanding of the effects of overprescription. On 24 February, the president of the Royal College of Psychiatrists and a colleague wrote in the Times that for,

“the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment”.

This statement has appalled a large number of psychiatrists and patients who have lodged a complaint with the RCP, including some who have experienced withdrawal effects for between 11 months and 10 years. Even the Royal College’s own survey of 800 users found that withdrawal symptoms generally lasted for up to six weeks, with a quarter reporting that anxiety lasted more than three months. If even one of our leading institutions can mislead Times readers on a matter of public safety, what hope do the Government have of explaining these things to the general public? It is well known that antidepressants are on the increase, and the NHS has to deal with the consequences. I know from a Question asked by the noble Lord, Lord Hunt, last month that the Minister is well aware of this issue and knows that Public Health England is conducting a year-long review of policy. He may argue that this is looking to the future, but he will also know that there have been reviews before, that the responsible Ministers have changed three or four times under the last two Governments and that the problem is happening now. Some immediate measures are essential before the end of that review. I much look forward to hearing his comments.

Prescription Drugs: Dependence

Earl of Sandwich Excerpts

Monday 19th March 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is absolutely right. It is not just about getting people off these drugs who are wrongly on them, it is about making sure that they do not go on them in the first place unless that is absolutely necessary for their treatment.

[The Earl of Sandwich (CB)]

Is the Minister aware that there is a dispute between the Royal College of Psychiatrists and a significant group of academics, doctors and patients over the length of antidepressant withdrawal? Does the Minister agree that substantial research is needed quite urgently, including on withdrawal protocols, to ensure that patients can withdraw safely and slowly? I declare an interest, having experience of this in my own family.

[Lord O'Shaughnessy]

The noble Earl highlights a very important issue, and I reassure him that the review will look not only at the nature and causes of dependence on the drugs in scope, which include antidepressants, but at the correct and most evidence-based treatments for withdrawal.

Mental Health Services

Earl of Sandwich Excerpts

Monday 19th October 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness makes a very strong point that people with mental health problems who are in prison should be entitled to exactly the same care as people who are not in prison, and the extent to which that is not the case should be addressed. It is an issue that I will certainly take up outside the House.

[The Earl of Sandwich (CB)]

My Lords, I am sure the Minister knows about the ill effects of many very common prescribed drugs, which can contribute to mental illness. I have experience of that in my own family. However, is he also aware that there are no significant government services for those mental health patients? Will he follow the lead of the BMA, which is preparing a document right now on that subject?

[Lord Prior of Brampton]

I am not aware of the report being prepared by the BMA but I will certainly be very interested in seeing it, reading it and discussing it with it.

Health: Talking Therapy

Earl of Sandwich Excerpts

Tuesday 3rd December 2013 Lords Chamber

[The Earl of Sandwich (CB)]

Does the noble Earl share my concern about the overprescription of psychiatric drugs? Can he think of anything to do about this apart from encouraging CBT and talking therapies?

[Earl Howe]

My Lords, the noble Earl is right. I share his concern, and I think it has been a widespread concern across the mental health community. Nowadays, the guidance given to doctors is much broader than the guidance that was given some years ago. It embraces the talking therapies in particular and it seeks to avoid the overprescription of sometimes very strong pharmaceutical products.

Health: Prescription Drugs

Earl of Sandwich Excerpts

Thursday 11th July 2013 Lords Chamber

Asked by

[The Earl of Sandwich]

To ask Her Majesty’s Government what changes have been made in the training of junior doctors and nurses in the long-term effects of prescription drugs and in the availability of services to those suffering from addiction to and withdrawal from such drugs.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, recent changes to key documents governing the training of doctors have strengthened the requirements for their training in the long-term effects of prescribed drugs. The training of student nurses, due to the introduction of new educational standards, has been strengthened. Services to treat dependants, including for addiction to medicines, are commissioned locally. Information on changes to the availability of services locally to those suffering from addiction to and withdrawal from prescribed medicines is not collected centrally.

[The Earl of Sandwich]

My Lords, prescribed medicines can be every bit as dangerous as hard drugs, and the length of withdrawal can be much longer—up to three or four years, as I know from personal experience. Their victims lead a half-life and are out of the range of the NHS, with only the voluntary services to help them. Despite what the Minister has just said, which is encouraging, does he agree that the training being given to the younger generation of doctors and psychiatrists, and even the older ones, is still inappropriate and inadequate? What can the Government do to strengthen this training and to reinforce what the voluntary sector is already doing?

Suicide

Earl of Sandwich Excerpts

Tuesday 23rd April 2013 Grand Committee

[The Earl of Sandwich]

My Lords, I thank noble Baroness for this opportunity. It seems that we are all supporters of the Samaritans, which is a wonderful organisation.

As the Minister knows, a member of my family has suffered for four years from acute withdrawal from benzodiazepines, especially sleeping pills given to him during periods of overwork and stress. He still suffers from burning sensations, tinnitus, agoraphobia and occasional suicidal tendencies that have confined him to his room—mostly unable to work or help his family.

This group of patients is still beyond the reach of the National Health Service. They are living in a policy “no-man’s land” because there are hardly any statutory services available or even people who are aware of their condition. Friends and family feel helpless and, in fact, are unable to help beyond informal counselling. There are dangerous moments when no one seems to be able to do anything. In this sense, the urban community has failed much more than the rural one.

Those who suffer first addiction and then withdrawal from prescribed iatrogenic drugs cannot look to their GPs or local clinics like other patients, because it was their doctors who prescribed the pills in the first place. The patients may have desperate thoughts of going to A&E as their last resort, until they remember that they will only be referred to a psychiatrist who will put them back where they started. The only slender threads of hope may be online, with the next e-mail from a fellow sufferer, or via a helpline to one of the saintly withdrawal charities such as CITAp in Liverpool, Recovery Road in Cardiff, the Bristol & District Tranquiliser Project or MIND in Camden, which is the only voluntary service available in London, but only to those who live in Camden. Some of these charities take thousands of calls a year, and I have no doubt that the Samaritans take many more similar calls from the same people.

I declare an interest as the vice-chair of the All-Party Parliamentary Group for Involuntary Tranquiliser Addiction. We are a small core group of about 12 active MPs and Peers. With occasional help from the media, we have been able to bring this issue to the attention of successive Ministers. The BMA held a useful seminar recently. I am glad to say that the present Health Ministers are now well aware of the risks, because it is known that 1 million people or more are taking benzodiazepines long term, not short term, and that their doctors are not stopping them. The Minister will remember all the arguments that we put forward during the Health Bill, and they remain valid today. These include the obvious need for greater awareness among doctors and junior doctors of the risks, good practice in the voluntary sector, better NICE and NTA guidelines, more understanding of the general protocol of withdrawal from prescribed drugs, and the need for a stronger national policy backing up the confusing new local health agenda. I went to see Public Health England only this afternoon and was encouraged that the new health and well-being boards and CCTs will have this subject in their list of priorities, but it will need a lot of encouragement.

Equally important is the need for the department to shift its spending priorities and its drugs agenda just a little way away from illegal drugs towards prescribed drugs. It is really the Samson and Goliath story. Almost all the knowledge in the National Treatment Agency is about methadone and alternatives to heroin, and about counselling. There is very little knowledge of the dangerous effects of prescribed benzodiazepines, SSRIs and Z-drugs, unless they coincide because people are using them with heroin. The US has much more experience. Changing the dosage of Prozac, for example, can trigger suicidal tendencies immediately. There is a black box warning of this in the United States.

We have now reached a critical point with all the new NHS changes. The voluntary agencies have high expectations that the Government will take these various points to heart, recognise the good practice that is out there and give it their fullest support. As the noble Baroness, Lady Buscombe, said, co-operation rather than competition is absolutely vital in this field.

NHS: Walk-in Centres

Earl of Sandwich Excerpts

Thursday 11th October 2012 Lords Chamber

[Earl Howe]

In many areas that is an entirely valid observation. Commissioners are saying to GP practices that they expect them to respond to the needs of their local patient populations. If Saturday opening makes sense in that context, they should seriously consider it.

[The Earl of Sandwich]

The Minister knows that there are patients who are suffering acute symptoms from prescribed-drug addiction and withdrawal, as well as from taking illegal drugs. Some of those people are in great distress. Where should they go now in the NHS if they suffer these acute symptoms?

[Earl Howe]

My Lords, if they are acutely ill and it is an emergency, they should go to an A and E department.