Asked by: Lord Mawson (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what percentage of adults in England currently receive prescriptions for anti-depressants.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Medicines Used in Mental Health statistical release includes information about prescribing in England for medicines classified within the British National Formulary section 0403, as antidepressant drugs. There were 6,873,381 total identified patients, aged 18 years old and over, in quarter two of 2024/25.
The Office of National Statistics (ONS) publishes population statistics for England on the ONS website. The estimated mid-year population for people aged 18 years old and over in England in 2023 was 45,691,677.
Based on the latest published data, the number of adults, those aged 18 years old and over, in England who received a prescription for antidepressant drugs in the quarterly period of July to September 2024 was 15% of the estimated 2023 mid-year population.
Asked by: Lord Mawson (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what was the cost to the NHS of anti-depressants in each of the past ten years; and how many they prescribed in each of those years.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Prescription Cost Analysis (PCA) provides the total number of prescription items of each medicine dispensed in the community in England. The following table shows the total number of items prescribed, based on information within the PCA and using British National Formulary Section 0403 for antidepressant drugs that have been dispensed in England regardless of where prescribed, as well as their net ingredient cost (NIC), for each calendar year from 2014 to 2023, and from January to November 2024:
Calendar year | Total number of items | Total NIC |
2014 | 57,149,109 | £265,008,698.97 |
2015 | 61,021,662 | £284,746,655.27 |
2016 | 64,703,639 | £266,562,024.17 |
2017 | 67,530,457 | £235,076,089.51 |
2018 | 70,873,979 | £202,526,719.66 |
2019 | 74,814,621 | £201,729,659.16 |
2020 | 78,866,866 | £352,682,885.77 |
2021 | 82,620,542 | £288,099,249.84 |
2022 | 85,404,864 | £224,648,497.13 |
2023 | 88,469,803 | £230,013,659.86 |
2024 | 84,251,563 | £207,585,360.44 |
Total | 815,707,105 | £2,758,679,499.78 |
The NHS Business Services Authority does not hold a single cost to the National Health Service. Total NIC is the amount that would be paid using the basic price of the prescribed medicine and the quantity prescribed, before any discounts, dispensing costs, or fees. It also does not include other costs to the NHS, such as those associated with purchasing or storing these medicines. The basic price is given either in the Drug Tariff or is determined from prices published by manufacturers, wholesalers, or suppliers.
Asked by: Lord Mawson (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what was the cost to the NHS of prescribing tablets to patients aged over 70 in each of the past ten years; and what assessment they have made of any unintended consequences of those patients combining multiple tablets.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Prescription data is collected by the NHS Business Services Authority (NHSBSA) for the operational purpose of reimbursing and remunerating dispensing contractors for the costs of supplying drugs and devices, and providing essential and advanced services, to National Health Service patients.
The following table shows the total net ingredient cost (NIC) for prescription items with an oral route of administration, dispensed to patients aged 71 years old and over, for the financial years 2015/16 to 2023/24, and from April to November 2024/25:
Financial year | Tablet | Capsule | Liquid, solution, suspension, drops | Other formulations |
2015/16 | £1,128,000,000 | £336,000,000 | £155,000,000 | £35,000,000 |
2016/17 | £1,138,000,000 | £325,000,000 | £156,000,000 | £35,000,000 |
2017/18 | £1,211,000,000 | £273,000,000 | £146,000,000 | £34,000,000 |
2018/19 | £1,252,000,000 | £239,000,000 | £144,000,000 | £35,000,000 |
2019/20 | £1,423,000,000 | £254,000,000 | £148,000,000 | £38,000,000 |
2020/21 | £1,570,000,000 | £263,000,000 | £158,000,000 | £40,000,000 |
2021/22 | £1,581,000,000 | £250,000,000 | £164,000,000 | £45,000,000 |
2022/23 | £1,723,000,000 | £267,000,000 | £189,000,000 | £46,000,000 |
2023/24 | £1,742,000,000 | £279,000,000 | £218,000,000 | £49,000,000 |
2024/25 | £1,091,000,000 | £173,000,000 | £190,000,000 | £13,000,000 |
This answer is based on information extracted from the NHSBSA Data Warehouse, using all drug products where there was an indication of an oral route on the NHSBSA’s drug database.
The NHSBSA does not hold a single cost to the NHS. Total NIC is the amount that would be paid using the basic price of the prescribed medicine and the quantity prescribed, before any discounts, dispensing costs, or fees. It also does not include other costs to the NHS, such as those associated with purchasing or storing these medicines. The basic price is given either in the Drug Tariff or is determined from prices published by manufacturers, wholesalers, or suppliers. For branded medicines, the cost to the NHS will be partially offset by the statutory scheme and voluntary scheme.
The Medicines and Healthcare products Regulatory Agency continuously monitors the safety of medicines on the United Kingdom’s market and ensures the product information, which includes the patient information leaflet supplied with each pack of medicine, reflects what is known about the medicine, and provides information to support the safe use of the medicine. This includes information about the risks to particular groups of patients such as the elderly, details of possible side effects, and if action is needed to seek medical advice and information about the risk of interactions with other medicines, and the action that is needed to minimise the risks.
Asked by: Lord Mawson (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of any unintended consequences of taking anti-depressants.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Unintended consequences, such as potential side effects, associated with taking antidepressants are outlined in the Product Information provided with each pack of medicine. The safety of all medicines is kept under continuous review by the Medicines and Healthcare products Regulatory Agency, and the product information is updated as needed to reflect what is known about the medicine. The product information is designed to support but not replace the clinical conversation between the prescriber and patient on the benefits and risks of pharmacological treatment.
Asked by: Lord Mawson (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the effectiveness of anti-depressants in treating (1) mild, (2) moderate, and (3) severe, depression.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
A number of anti-depressant products have been licenced by the Medicines and Healthcare products Regulatory Agency (MHRA). These medicines are prescription only, and must only be prescribed by a healthcare professional.
Each individual product is assessed for its efficacy and safety in a specific indication prior to the issuing of a marketing authorisation. Only when the benefit-risk analyses have been shown to be positive in relation to quality, safety, and efficacy, will a product obtain an approval.
The Product Information for each product will include not only the details of the indication, but will also include posology, or the dose recommendations, contra-indications, a list of known side-effects, and a reference to the Yellow Card Scheme, for reporting new side-effects. Safety is regularly monitored in order to detect any safety signal not recorded during the clinical trials and once the drug is available to a wider population.
Details of products approved by the MHRA, including therapeutic indications, can be found by searching ‘antidepressant’ on the MHRA website, which is available in an online only format.
The effectiveness of the product, which is measured post-authorisation, is considered by the National Institute for Health and Care Excellence (NICE), and other learned bodies, for the development of clinical guidance.
It should be noted that non-pharmacological alternatives may also be recommended to a patient, however this a decision for the healthcare professional.
The NICE is the independent body responsible for translating evidence into authoritative guidance and best practice for the health and care system. NICE guidelines provide recommendations in terms of both the effectiveness and cost-effectiveness of interventions and services, and National Health Service organisations are expected to take them fully into account in designing services that meet the needs of their local populations.
The NICE has published guidance on the treatment and management of depression in adults which provides recommendations on the use of antidepressants and non-drug treatments for depression.
Asked by: Lord Mawson (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what research they have undertaken on the (1) cost, and (2) effectiveness, of non-drug related approaches to treating depression.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Department, through the National Institute for Health and Care Research (NIHR), funds a range of research to improve the health outcomes for people with depression. This includes research into the clinical and cost-effectiveness of non-drug related approaches to treatment of the condition.
For example, the NIHR has funded research that demonstrated that mindfulness cognitive therapy delivered by a practitioner is an effective alternative to, and more cost effective than, cognitive behavioural therapy for adults with mild to moderate depression, providing alternative treatment options.
In addition, the NIHR is currently funding a £1.5 million randomised controlled trial to test the clinical and cost effectiveness of artificial intelligence (AI) driven care for depression symptoms in comparison to current practice, stepped care, which starts with less intensive treatments, followed by more intensive treatments for patients for whom the initial treatment fails. AI driven stratified care, which involves targeting treatment towards groups of patients based on key characteristics, could improve the evidence on how to decide which non-drug related approaches, like psychological therapy, may be most effective for each individual, and help to plan and deliver more effective clinical services.
The NIHR welcomes funding applications for research into any aspect of mental health, including non-drug related approaches to treating depression. Applications are subject to peer review and judged in open competition, with awards being made based on the importance of the topic to patients and health and care services, value for money, and scientific quality.
Asked by: Lord Mawson (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they will take to address the reported increase in community pharmacies having to dispense NHS prescriptions at a loss.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
When market prices rise and pharmacies cannot purchase products at or below the Drug Tariff NHS reimbursement price, the Pharmaceutical Service Negotiating Committee (PSNC) can request the Department to reconsider this price. If a new reimbursement price is issued this is known as a concessionary price, which is established using real time data from suppliers to generate prices that are reflective of the overall market.
Furthermore, the Department assesses the overall medicine margin, the difference between the reimbursement price and the price the pharmacy was charged by the supplier, through an annual 'medicine margin survey'. This data is used to calculate the average amount of medicines margin retained during the year. All products that receive a concessionary price are looked at in detail in the margin survey. If underpayment has occurred, it will be made good to pharmacy contractors through margin adjustment.
As part of the ‘Community Pharmacy Contractual Framework 5-year deal: year 4 (2022 to 2023) and year 5 (2023 to 2024)’, which is available in an online-only format, the PSNC and the Department are reviewing the current concessionary price arrangement.
Asked by: Lord Mawson (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what support they will provide to community pharmacy teams, if any, who are (1) dealing with an increasing number of medicines shortages, and (2) spending increasing hours sourcing medicines to ensure that patients do not go without.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
Medicine supply problems can occur for various reasons; for example, due to manufacturing difficulties, regulatory problems, problems with the supply of raw materials, sudden demand spikes or from issues which are related to the distribution of the product.
The Department has well-established procedures to deal with medicine supply issues and works closely with the Medicines and Healthcare products Regulatory Agency, the pharmaceutical industry, NHS England and others within the supply chain to help prevent shortages and to ensure that the risks to patients are minimised when they do arise.
One of the tools we use to support pharmacists to manage supply issues are serious shortage protocols (SSPs), a standard procedure used frequently to manage medicine supply issues. They are a safe and effective way to ensure that medicines continue to be available for everyone who needs them, while saving time for patients, pharmacists and prescribers.
Issuing a SSP allows pharmacists to legally supply a specified alternative medicine, removing the need for the patient to return to the prescriber which saves time in general practitioners practices and inconvenience for patients.
Asked by: Lord Mawson (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to address community pharmacists experiencing daily shortages of medicines.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
Medicine supply problems can occur for various reasons; for example, due to manufacturing difficulties, regulatory problems, problems with the supply of raw materials, sudden demand spikes or from issues which are related to the distribution of the product.
The Department has well-established procedures to deal with medicine supply issues and works closely with the Medicines and Healthcare products Regulatory Agency, the pharmaceutical industry, NHS England and others within the supply chain to help prevent shortages and to ensure that the risks to patients are minimised when they do arise.
One of the tools we use to support pharmacists to manage supply issues are serious shortage protocols (SSPs), a standard procedure used frequently to manage medicine supply issues. They are a safe and effective way to ensure that medicines continue to be available for everyone who needs them, while saving time for patients, pharmacists and prescribers.
Issuing a SSP allows pharmacists to legally supply a specified alternative medicine, removing the need for the patient to return to the prescriber which saves time in general practitioners practices and inconvenience for patients.
Asked by: Lord Mawson (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what plans they have to review the current medicines price concession system.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
When market prices rise and pharmacies cannot purchase products at or below the Drug Tariff NHS reimbursement price, the Pharmaceutical Service Negotiating Committee (PSNC) can request the Department to reconsider this price. If a new reimbursement price is issued this is known as a concessionary price, which is established using real time data from suppliers to generate prices that are reflective of the overall market.
Furthermore, the Department assesses the overall medicine margin, the difference between the reimbursement price and the price the pharmacy was charged by the supplier, through an annual 'medicine margin survey'. This data is used to calculate the average amount of medicines margin retained during the year. All products that receive a concessionary price are looked at in detail in the margin survey. If underpayment has occurred, it will be made good to pharmacy contractors through margin adjustment.
As part of the ‘Community Pharmacy Contractual Framework 5-year deal: year 4 (2022 to 2023) and year 5 (2023 to 2024)’, which is available in an online-only format, the PSNC and the Department are reviewing the current concessionary price arrangement.