Drug Treatment Services

Alison Thewliss Excerpts

Tuesday 16th July 2019 Westminster Hall

[Alison Thewliss (Glasgow Central) (SNP)]

I am glad that the hon. Member for Manchester, Withington (Jeff Smith) secured this debate, because it is very timely for Glasgow and for Scotland more widely.

Let me start by saying that every single one of the 1,187 deaths last year is a tragedy—a tragedy for the families who lost a loved one and, as the hon. Member for Glasgow North East (Mr Sweeney) said, a tragedy because of the potential that was lost as a result of that person passing away. We should bear those people in mind whenever we talk about drugs policy.

Ideally, I want those people, who have an illness, to be able to get medical help as if they had any other illness. If they had cancer, we would not stigmatise the cancer drug that kept them well. That is what methadone does—it supports people and stabilises their lives.

[Luke Graham]

rose—

[Alison Thewliss]

I will not hear a word from the hon. Gentleman against that.

[Luke Graham]

It is not stigmatisation; it is data led. We saw information today that more people die from the use of methadone. I am not asking the hon. Lady to cancel anything; I am asking whether she will join me in calling for a review. We need a review of all our drug laws across the board. She knows that I agree with her on many aspects of this policy. I seek a review, not to cancel out or stigmatise.

[Alison Thewliss]

When the hon. Gentleman talks about methadone, the result is that he stigmatises it. That may not be his intention, but that is the result. He may have heard Kirsten Horsburgh from the Scottish Drugs Forum talking on “Good Morning Scotland” this morning about that being stigmatising for people. We need to get away from that stigma. We need to look towards treatment and harm reduction.

To that end, I and my SNP colleagues have argued for three years for a drug consumption room for Glasgow. That could go ahead as a pilot if the UK Government got out of the way and let us do it. It is three years since NHS Greater Glasgow and Clyde produced its “Taking away the chaos” report, the business case for that drug consumption room, which Saket Priyadarshi and his colleagues worked away on. That has been sitting there for three years. The UK Government are standing in the way of the life-saving intervention a drug consumption room would bring.

That drug consumption room would not save everybody—at the moment, it would be just for Glasgow—but it would make a huge difference to the people I know who inject in dirty bin sheds and back lanes and on waste ground yards from my office, time and again. It is the job of the rest of society to try to pick up the pieces of that—to pick up the discarded needles that are left behind. Those people would have the dignity of a drug consumption room within a few paces, where they could go to inject drugs, receive medical help and get support now, if the UK Government approved it. It is an absolute tragedy that that is not happening, and a huge source of frustration.

The hon. Member for Glasgow North East (Mr Sweeney) mentioned the Lord Advocate. The Lord Advocate is the Lord Advocate; we cannot intervene in the decisions that the chief legal officer takes on this. If he says that that is not within the law, that is his legal opinion. He is the chief legal officer, and that is his decision. It rests with the UK Government to make that change under the Misuse of Drugs Act 1971.

[Luke Graham]

Will the hon. Lady give way?

[Alison Thewliss]

I have already given way to the hon. Gentleman, and I am short of time.

The Misuse of Drugs Act is reserved. Where we have had powers in Scotland on alcohol, we brought in minimum unit pricing; on smoking, we brought in the end of smoking in public places. This is a medical intervention that we wish to pursue in order to save people’s lives. Glasgow, where it can, has applied for a heroin-assisted treatment programme; when that is up and running, it will be able to treat 60 people, but there are an estimated 400 to 500 people who inject publicly within Glasgow city centre alone. That medical heroin-assisted treatment programme is limited in size, scope and scale, because it is a treatment programme and people must be able to engage with that.

No doubt the programme will make a huge difference to those lives, but it almost goes without saying that if 394 people died in Glasgow last year, and it can only deal with 60 people at a time, it is not enough. It is clear that we need the entry level that drug consumption rooms will give, meaning that people can go in without any kind of barrier or stigma associated with seeking help, and are able to reach those treatment services. It needs to be an easy way for people to get in and get treatment within those services.

The Scottish Government are pursuing this. We are doing what we can. We have a new drugs taskforce, chaired by Professor Catriona Matheson from the University of Stirling, which is looking at all the things we do in the Scottish Government in the round and where improvements need to be made. Both I and the Scottish Government accept that improvements need to be made, but the UK Government also need to play their part.

I will mention organisations such as Turning Point Scotland in my constituency. They drive a van around as a needle exchange, but they know that as soon as they give that needle to somebody, that person is going around to the car park at the back, to inject in a dirty back lane. That is not good enough. Not one UK Government Minister has yet come to visit Glasgow to justify their position; I urge this Minister and any of her colleagues, whoever they may be, whenever the new Prime Minister eventually turns up, to come to Glasgow and tell me why this cannot be done.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I begin by sending my sympathies and those of the whole House to Chelsea’s family and friends. It is a reminder to us all of the seriousness of the subject we are discussing today. I also thank the hon. Member for Manchester, Withington (Jeff Smith) for securing this important debate.

Many of the hon. Members who have spoken are devoting their parliamentary lives to this issue, because they feel so strongly about it. They have raised questions that are a matter not only for me and my Department but for other ministerial colleagues, particularly those in the Home Office, and I will transmit the many challenges that have been set for me today to those colleagues.

We have made some progress in reducing drug dependency-related harms, but, as the hon. Gentleman pointed out, this is an ancient problem. We have made progress but we are not at all complacent, and events such as the death of a girl such as Chelsea remind us that there is much more to do. I have to work with other Government Departments, public health experts and local government to continue supporting people through recovery and to prevent them from ever taking up drugs in the first place.

We published a drugs strategy in July 2017 and it is being rolled out. We know about the serious health harms of drug use, including blood-borne viruses, overdose and death, which have been outlined in great detail by hon. Members. We know that the majority of people who need treatment for drug problems are also experiencing mental health issues. We know that drugs cost £10.7 billion a year in policing, healthcare and crime costs; it is estimated that drug-fuelled theft alone costs us £6 billion a year. There is both an economic case and a moral case for us all to act on this.

It is encouraging that drug use in England and Wales is lower now than it was a decade ago. In 2016-17, 8.5% of adults had used a drug in the past year, compared with 10.1% of adults in 2006-07. More adults are successfully leaving treatment than in 2009-10, and the average waiting time to access treatment is two days.

I will pick up on some of the points that hon. Members have made. On the drug-related death figures for Scotland, health is a devolved matter, but of course—[Interruption.] I am afraid I cannot hear what the hon. Member for Glasgow Central (Alison Thewliss) is saying.

[Alison Thewliss]

The Misuse of Drugs Act is not devolved.

[Seema Kennedy]

I will come on to that. However, health is a devolved matter. Any death is a tragedy, but the figures are really worrying. I understand that the Scottish Government have appointed Professor Catriona Matheson to head up a drug deaths taskforce, to look at the main causes of death and to examine how to save lives.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) raised the question where responsibility for public health should sit. Clearly, he thinks its sitting with local authorities is not right, but that is a broader question of public health commissioning that I do not know if we can get into here. However, he has a wealth of experience in this, and I will take away some of the points that he raised.

--- Later in debate ---

[Seema Kennedy]

I thank my right hon. Friend for that intervention.

[Alison Thewliss]

Will the Minister give way?

[Seema Kennedy]

Briefly, and then I must continue, because I want the hon. Member for Manchester, Withington to be able to make his concluding remarks.

[Alison Thewliss]

The Minister talks about there being no legal framework, but it is the job of the UK Government to provide that. If she wants any assistance, I have a 10-minute rule Bill still waiting to be heard that she could implement.

[Seema Kennedy]

As I say, that is a matter for the Home Office. I sense the hon. Lady’s frustration, but I am not responsible for that area. I have already said twice that I am happy to take that point away. Tabling business in the Chamber really is not my responsibility. I sense and am cognisant of the frustration in the House.

Under the 2017 drug strategy, we are involved in delivering actions across four themes: reducing demand to prevent drug use and its escalation; restricting supply; building recovery; and a new strand focused on global action, which is important. We need a partnership-based approach alongside the treatment system; other partners, such as the mental health and criminal justice systems, have key roles to play in securing the drug strategy’s aims.

I attend a cross-ministerial drug strategy board with Ministers from the Ministry of Housing, Communities and Local Government, the Home Office, the Ministry of Justice and representatives of Public Health England. Additionally, the Home Secretary has appointed Professor Dame Carol Black to lead a major review of drugs, looking at a range of issues, including the system of support and enforcement around drug misuse, to inform our thinking about tackling drug harms. Dame Carol will report later this summer.

I acknowledge the concerns about the funding of public health services, and that local authorities need to make difficult choices about how they spend their money to be able to continue providing effective drug treatment services. Local authorities will receive £3.1 billion in this financial year, ring-fenced exclusively for use on public health, including drug addiction. In addition, we are investing more than £16 billion for public health over the five years to the end of 2020. It is a condition of the public health grant that local authorities have regard to the need to improve the take-up and outcomes from drug and alcohol misuse treatment services. Public health funding is a matter for the next spending review, in which it will be looked at in the light of the best available evidence.

Social Media and Health

Alison Thewliss Excerpts

Tuesday 30th April 2019 Commons Chamber

[Carol Monaghan (Glasgow North West) (SNP)]

rose—

[Alison Thewliss (Glasgow Central) (SNP)]

rose—

[Mr Speaker]

I call Alison Thewliss.

[Alison Thewliss]

Thank you, Mr Speaker. My tactic of wearing a dress so big I can hide a colleague behind it is working.

Will the Secretary of State look at the harm that celebrity endorsements on social media can do to young people? The Empowered Woman project in Scotland highlighted how Marnie Simpson of “Geordie Shore” had been plugging Thermosyn diet pills, which are marketed as “skinny caffeine”. When I asked the Secretary of State for Digital, Culture, Media and Sport about that, he said that the UK Government were looking at

“user-generated content, not necessarily commercial activities”—[Official Report, 8 April 2019; Vol. 658, c. 73.]

Celebrity endorsement veers into the commercial area, however, and has a very significant effect on young people in terms of body image and eating disorders.

[Matt Hancock]

My colleague the suicide prevention Minister is looking at this area, particularly endorsements of cosmetics, and I am sure she would be very happy to talk to the hon. Lady.

Access to Medical Cannabis

Alison Thewliss Excerpts

Monday 8th April 2019 Commons Chamber

[Matt Hancock]

Yes. My heart goes out to the hon. Lady’s constituent and her family. One of the purposes of the evidence gathering that we are doing, and of the calls of the national institute for trials, is to provide the evidence on which the NHS could routinely provide those medicines. At the moment, we have the ability for specialists to prescribe in the interim, but I want to get the evidence base in place for the longer term.

[Alison Thewliss (Glasgow Central) (SNP)]

One of my constituents—one of many who has been in touch with me about this issue—has multiple sclerosis and found previously that cannabis helped his symptoms immensely, but he does not want to break the law and he cannot get a prescription. What would the Secretary of State advise him to do?

[Matt Hancock]

If the hon. Lady will write to me with the case, we will get a second opinion from a clinician who may be able to make that prescription.

Oral Answers to Questions

Alison Thewliss Excerpts

Tuesday 26th March 2019 Commons Chamber

[Matt Hancock]

Yes, of course, I would be very happy to meet my hon. Friend and talk about her constituent’s concerns.

[Alison Thewliss (Glasgow Central) (SNP)]

I am wearing purple today for Epilepsy Day. What assessment has the Secretary of State made of the causes of ongoing shortages of epilepsy medications? What action is being taken to address those problems and what impact will Brexit have on the supply of those medicines?

[Matt Hancock]

I, too, am wearing purple—purple socks in my case—to support this important campaign. Of course, we have done enormous amounts of work across the NHS. I pay tribute to the NHS and to suppliers for working to ensure that, whatever the Brexit outcome, there will be the continued supply of medicines, but there is one thing that the hon. Lady can do if she really wants to make sure that we put this issue to bed once and for all—vote for the deal.

Leaving the EU: Health and Social Care

Alison Thewliss Excerpts

Tuesday 19th March 2019 Westminster Hall

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is an absolute pleasure and a privilege to serve under your chairmanship, Mr Bone. I thank my hon. Friend the Member for Argyll and Bute (Brendan O’Hara) for his thorough and passionate account of why a clear focus on the health and social care system is so important. That will be true beyond Brexit, but Brexit is our immediate concern, which is why we must give it serious attention.

The NHS does fantastic work. I had the privilege of working for four years in Argyll and Bute, covering the hospital there as a forensic psychologist. Rural hospitals in Argyll and Bute are excellent and innovative in their practice. Even 10 to 15 years ago, when I was working there, we were grappling with the internet and how to engage in therapy on timescales that would best suit patients. The use of technology in those rural areas was innovative, and I commend the NHS staff I worked with, many of whom still work there, for their work to provide fantastic patient care.

Two weeks ago there was an extraordinary meeting when seven all-party parliamentary groups came together to look at health and social care. I am fortunate enough to have been the chair of the all-party parliamentary group on disability since the 2015 general election. The chairs of the all-party groups were there and we brought in carers and service users to speak about their concerns. There is growing concern in Parliament about the NHS, and about the implications of a no-deal Brexit, particularly on medicines regulation and our ability to staff hospitals and provide excellent care, as we always have. It was an important and informative meeting and I suggest to the Government that a further meeting might come out of it, with the all-party group chairs, to hear the views of the service users and carers who attended, and to take forward some of their recommendations. They are on the frontline and know what happens day to day in our services. I am sure that they will be extremely informative and constructive if they have an opportunity to meet the Minister.

When I was a member of the Health and Social Care Committee, we conducted an inquiry into Brexit, medicines, medical devices and substances of human origin. A particular concern was raised about our ability to lead on research trials, and about patients’ ability to participate in trials, particularly on diseases that are perhaps less common but where there is a need to pull in subjects or participants from a huge area such as the EU. Currently, patients here can participate in such trials, and we can also lead on some of them. That has brought some of the best scientists and researchers to the United Kingdom. I would be interested to hear from the Minister how we will ensure that continues. Also, how will our constituents continue to have access to such important trials, rather than having to wait until some way down the line to get new and innovative medications?

During that inquiry, the Select Committee urged the Government particularly to look at regulatory alignment and the implications of no deal. We raised concerns about the lack of references to Brexit in the Department’s single departmental plan. It would be useful to have an update from the Minister on that work, which I am sure is ongoing. There was also some concern about protecting the UK’s position globally in relation to pharmaceuticals. On the matter of full membership of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, reassurance was sought that that matter would be taken up at the earliest opportunity. It would be extremely helpful if the Minister gave an update on that.

The Select Committee recommended negotiating a close relationship with the EU, including associate membership of the European Medicines Agency, and supported the Government’s intention in that respect. Our report stated:

“Failure to achieve an ongoing collaboration would signal the triumph of political ideology over patient care.”

I say firmly to everyone involved, from all parties in Parliament, that patient care must be placed firmly before political ideology. The NHS is one of our most prized institutions—for everyone across the United Kingdom—and must remain so. Our overriding message was that almost all the evidence received suggested that

“the UK should continue to align with the EU regulatory regimes”

for medicines and devices. An update from the Minister would be helpful.

The hon. Member for Coventry South (Mr Cunningham), who is not currently in his place, made an interesting intervention about predatory procurement. I understand that we do not want to be alarmist in Parliament, but patients bring such concerns to us, so reassurance from the Minister would be helpful. The hon. Member for Henley (John Howell) spoke eloquently about his constituency and talked about diabetes and cystic fibrosis. Many constituents go to their Member of Parliament seeking reassurance about the implications of Brexit for their medicinal needs. The hon. Gentleman also spoke about mental health, which we cannot speak about enough in Parliament, because for many years it was never broached. I am the Scottish National party’s spokesperson on mental health, so I thank him for raising it, because I consider it important for it to be mentioned in as many debates as possible. It has an impact in every part of our lives, and if we are to provide holistic care it must have parity with physical health in all we do.

My hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) spoke about medicinal isotopes. There is a huge pharmaceutical industry presence in my constituency, and I have been in touch with those businesses in the past month. There continue to be grave concerns about alignment and regulation for the industry. I think it is the continuing uncertainty that puts such a burden on businesses.

My hon. Friend the Member for North Ayrshire and Arran also said that one in five GPs are EU nationals and talked about our heavy reliance on workers from the EU, who do a fantastic job in the NHS. A number of witnesses to the Health and Social Care Committee told us just the same. We of course do not want to lose their valuable skills and expertise. They have built bonds with patients—or, if they work in the social care sector, with the people they care for—over a long period of time, and that cannot be overestimated. We must never undervalue their contribution. They need their place to be secure. Many of those workers do not earn over the £30,000 threshold, so we need a specialist case to ensure that the expertise stays in the country to support those vulnerable constituents of ours who need it.

Something that was repeatedly raised with the Select Committee—the hon. Member for Strangford (Jim Shannon) also mentioned this—is the fact that we have come to rely on high levels of staffing from the EU and elsewhere. It has been mooted that if we cannot attract staff from the EU, we could attract them from India or perhaps Africa. Those places in particular need their trained staff, and something must be done about training for young people in this country who want to go into health and social care settings.

[Alison Thewliss (Glasgow Central) (SNP)]

My hon. Friend makes a good point, but she will be aware that many people who have qualifications are currently not allowed to work by the Home Office. Two of my constituents worked in a care home and it would have loved to have them back, but the Home Office says no. Does she share my frustration that the Government say one thing on the one hand, and then something else on the other?

[Dr Cameron]

My hon. Friend makes an excellent point. Things have to be joined up exactly so that we can provide the continuity of care that patients need so much. There are thousands of excellent, high-achieving students who particularly want to study medicine, as well as psychology, occupational therapy and other occupations that are badly needed to support our NHS and our community health services. We must invest in these young people as we go forward. That point was made strongly by the hon. Member for Strangford, who is always an extremely good advocate for his constituency.

I look forward to the Minister’s response on social care, on medicines regulation and on the other issues we have spoken about. My hon. Friend the Member for Glasgow East (David Linden) also expressed concern about social care and those working in care homes. We must make that a more attractive occupation for people coming from school. I did it for a few years before going into clinical psychology; it is a rewarding occupation where carers build a real bond with those they care for. I ask the Minister to meet the APPGs, and I say to him very sincerely that we want to collaborate in a constructive way.

--- Later in debate ---

[Julie Cooper]

I absolutely agree. We cannot dismiss concerns just because we do not like their implications; it would be irresponsible to do so. Delivery into the UK is currently a just-in-time service for the pharmaceutical industry, for many of the reasons I have mentioned. It is true that in the long term, there is some manufacturing capacity in the UK and we could change the way we get our supplies, but that is not going to happen overnight. It would take a considerable amount of time, given the stringent safety requirements involved in the manufacture of safe medicines, for us to be able to do that.

I am not convinced that we have sufficient supplies or that sufficient steps are in place to ensure an uninterrupted supply. People, including those who rely on insulin, are legitimately worried. Breast cancer care organisations have raised the issue of access to radioactive isotopes needed in the vital treatment of breast cancer. It would be irresponsible of them not to raise that. It is extremely worrying, given that we have only 10 days until the UK leaves the EU, that there are still no arrangements in place. There is no doubt that the UK will need time to establish new supply chains, which is perfectly possible. It is not scaremongering. [Interruption.] I thank the Minister for the comments he has just made from a sedentary position, but we are not convinced. It we were to leave without a deal, the effects would be catastrophic.

[Alison Thewliss]

The hon. Lady is absolutely right that we should be worried. Just last night, the Government made changes to the human medicines regulations to bring in a serious shortage protocol, under which Ministers would be able to add medicines to a list and designate a shortage. In practice, it will mean that pharmacists can replace prescribed drugs with others at the pharmacy if there is a shortage. Does that not illustrate what she is saying?

[Julie Cooper]

The hon. Lady makes a really important point. I would be the first to speak up for the skills of community pharmacists, but that measure is a passing of the buck. It does not put the interests of patients and their safety first and foremost, which is very worrying.

I move on to the life science industry and research, which several Members have touched on. The UK is a world leader in life sciences and a major centre for research. The sector employs 220,000 people and attracts some of the finest research talent in the world. Four of the world’s top six universities for the research and study of clinical and health topics are based in the UK. Biotech company clusters and partnerships are found across the country, making up the largest biotech pipeline in Europe. It is a fact that the UK has been the recipient a bigger share of EU research funding than any other EU nation. It is hard to overstate the importance of the EU to the biomedical sector in the UK and the health outcomes for British patients. Shared initiatives—such as the “New Drugs for Bad Bugs” programme, which aims to tackle antimicrobial resistance—in which pharmacologists from across the EU work together for mutual gain are incredibly important for the future. As we leave the EU, we risk losing the benefits that arise from being a hub for world-class research. The investment, the talent and the infrastructure, including jobs, are all at risk. The removal of those benefits has begun, and arrangements are already in place to relocate the European Medicines Agency from London to Amsterdam.

Time is short, and there are many issues of concern about this subject. One key concern is workforce. I agree with the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), and I thank our NHS staff for the tremendous work that they do. I pay tribute to the excellent service that we still enjoy, in spite of the many challenges. It is because of that excellent service that we feel so passionate today; we do not want to lose it. I also put on record my thanks to the care workers, especially those who have helped me to look after my mum. It just so happens that they come from Poland and Latvia, and they are amazing, but their status is at risk.

Hon. Members have talked about the existing challenges in the workforce, and rightly so. We already have a workforce crisis in the NHS and in social care. There are many reasons for that, including some that have already been mentioned: we do not train enough staff; we put up barriers to training, including the removal of bursaries; and working conditions and pay are often not what they should be, as the hon. Member for Strangford (Jim Shannon) said. There is no doubt that making it more difficult for EU health professionals and EU carers to work in the UK will not help the situation we face.

The scale of the contribution from the EU cannot be underestimated: 5.6% of the total NHS workforce come from the EU. In addition, we already have 100,000 care workers from the EU working in this country, and we know to our shame that we currently have 1 million vulnerable people with unmet care needs. I appreciate the points that the hon. Member for Henley made about the excellent work in his constituency, but I point out to him that the majority of care for vulnerable people is delivered in their homes—or not delivered, in many cases, which is a massive problem for us.

To replace the EU NHS staff and the contribution that social care workers from the EU make would be extremely costly to the NHS. It certainly will not be a saving to the nation. The worst situation we could face would be if the Government failed to prevent a no-deal situation. There are ways of coping with all the other areas, given time and a transition period. I am keen to stress to the Minister that this is not about scaremongering, but about sensible concerns and a reassurance that sensible provision is in place.

I want to touch on future trade deals. People rightly raise concerns that many of the current problems experienced in both health and social care have arisen as a direct result of the fragmentation and privatisation of provision following the Health and Social Care Act 2012. There is a risk that future trade deals will add to the problem of privatisation.

In the months leading up to the referendum, the people of this country were promised that there would be a Brexit dividend for the NHS, and the figure of an additional £350 million per week—surely the biggest exaggeration of the Brexit campaign—was irresponsibly promoted. However, the reality is that in the light of the Government’s own predictions of low economic growth, there will be less funding for the NHS after we leave the EU. The Government are also very clear that if we leave the EU next week with no deal, the economic cost to our nation will be even greater.

It is our duty to respect the result of the referendum, but as public servants it is our highest duty to ensure that our constituents’ standards of health and wellbeing are protected. The NHS is regularly cited by the British public as one of the greatest achievements of—I have to say—a Labour Government. Brexit was sold as a way to protect the NHS, and no matter how misguided that promise was, as servants of the people we must deliver on it. Protecting the NHS is also the will of people, as they have shown in many elections.

To protect the NHS and to respect the will of the people, can the Minister provide assurances on the specific points that have been raised today? Can he confirm that the Government will rule out no deal and minimise the potential for negative impact on the NHS and social care sectors? Can he demonstrate that he is not ignoring the legitimate concerns raised today and out there in the community, from Members of this place, from patients and their representatives and from healthcare professionals? Can he demonstrate that the Government are listening and have sensible provisions in place, and that they will take every step to avoid a no-deal Brexit next week?

Human Medicines (Amendment) Regulations

Alison Thewliss Excerpts

Monday 18th March 2019 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

We are discussing changes to the Human Medicines Regulations 2012. I welcome the implementation of the falsified medicines directive, with its provisions on unique identifiers and anti-tampering devices. I also welcome the change to allow nasal naloxone to be used to deal with opioid overdose. But snuck in among those perfectly reasonable measures is the serious shortage protocol. That deals with prescription-only medicines and highlights what we face with Brexit coming in 11 days.

Forty-one million packets of drugs a month go from the UK to the EU, and 37 million are imported into the UK, including almost all insulin—the UK does not produce insulin to a large extent. There are many other drugs that the UK does not produce. We have previously and in this debate raised the issue of radioisotopes, although this clearly does not apply to that. There will also be problems with the supply chain of raw chemicals to produce drugs in the UK and with processes such as batch testing for UK exports into the EU, because the EU will not recognise batch testing not carried inside the EU. One of the key words missing from the withdrawal Act that was scattered throughout the Chequers deal, if we can call it that, is “frictionless”. Do a word search. It is not there. We have been discussing this matter in the context of no deal, but there will be issues regarding the supply chains in making drugs and moving drugs around even if the Government’s withdrawal agreement goes through.

Bizarrely, section 8 of the explanatory memorandum to the regulations claims:

“This instrument does not relate to withdrawal from the European Union.”

As we would say in Scotland, “Aye, right.” It continues that:

“if withdrawal from the European Union were a contributing factor to a serious shortage…a serious shortage protocol could be used”.

That is the thinnest fig leaf I have ever seen in my whole life.

The documents talk about the Minister or Ministers being able to add drugs to the serious shortage protocol list. Who is meant by “Ministers”? Is it the devolved Ministers in Edinburgh and Cardiff, or are we merely talking about all the junior Ministers and the Secretary of State here in Westminster? Health is devolved, and the use of drugs and the diseases dealt with vary across the UK. It is important that health is not pulled back away from devolution. I would like that to be clarified, particularly when the Minister suggests that this is not a short-term solution, but envisaged as a long-term solution for shortages.

I accept that shortages can arise, but normally they are few; normally it is possible to get access to information about what is causing them, making it easier to come up with solutions. However, as has been said, the review will take place only after a year, which is quite a long time for a protocol to be in place. It would be useful to send information on what replacements could be used to the GP or prescriber, rather than to the pharmacist. If it is known that there is a national shortage, why wait until the point of dispensing the drug? Tell GPs. Tell non-GP prescribers. Do not leave it to the last minute, when someone is in the pharmacy. That is the issue: the shortage protocol gives pharmacists the power to override the prescriber. Predominantly, that is a GP, but not necessarily.

I say to other Members that pharmacists can change the strength, but not the dose. If someone is on a 10 mg tablet and is used to taking one 10 mg tablet, they may be given two 5 mg tablets. That may seem innocuous, but an elderly, vulnerable or slightly confused patient who knows that they take one tablet every morning might end up taking half the dose they require. Even worse is if they are given a larger dose that they are meant to cut in half. That is much more complex. The number of tablets patients have to take could cause confusion.

The statutory instrument talks about quantity. At the moment, patients are usually given eight weeks of a prescription and pay a prescription charge. If they only get four weeks of their medication, will they get the second four weeks without paying another prescription charge or will prescription charges be doubled? That is not an issue in Scotland, but it is certainly an issue here in England.

[Alison Thewliss (Glasgow Central) (SNP)]

My hon. Friend is speaking very knowledgably about dosage. Many of my constituents are on methadone prescriptions. They need to get the correct amount of prescription or it can have very real consequences for relapse and how they are able to live their lives. Does she agree that protections need to be put in place for groups for whom removing the dose could have severe consequences?

[Dr Whitford]

It is critical that the patient’s dose is not changed or put in danger. The management of any condition is dose sensitive. We cannot go down to homeopathic doses of antibiotics or blood pressure medication—that would be crazy.

Pharmacists can give a different form, such as liquid, solid or capsule. Again, for some patients that will not be a problem; for others, it will. The hon. Member for Newton Abbot (Anne Marie Morris) mentioned generic drugs. Generally, NHS prescribers use generic drugs as the default to save money. However, I have had patients who had appalling side effects from the generic form of tamoxifen, but not from the non-generic brand. There always has to be a right for GPs to say, “In this case, I will use the brand.”

The most important bit of this statutory instrument is that it allows a change to a completely different drug. It may be a drug that is approved by a panel sitting somewhere in London with the colleges, who say that it is a reasonable replacement for the other drug, but that does not take into account the fact that patients are all individuals. I can tell you that they are all individuals.

Pharmacists are very knowledgeable—in Scotland, we have had community pharmacists for over a decade and they contribute massively—but they work to their own protocol, they work within limits and they do not have access to the patient’s notes. Therefore, they cannot see that the patient has been on a drug in the past and had terrible side effects. They will replace with a protocol drug, but what about the responsibility? Why is this happening right now?

It suggests to me that the Department of Health and Social Care is expecting massive shortages, to the point where the simple act of picking up the phone and saying to the GP, “I don’t have drug A. Would drug B be reasonable for Mrs Smith?”, is somehow impractical. I find that very worrying. It may be that Mrs Smith has had six drugs to control her blood pressure. Drug 2 and drug 5 caused her to faint or have blackouts, but the pharmacist does not know that.

Epileptics have been mentioned. The issue with epileptics is that any change can destabilise their epilepsy. They are therefore never prescribed by generic, but are prescribed by brand to avoid precisely that.

Eurotunnel: Payment

Alison Thewliss Excerpts

Monday 4th March 2019 Commons Chamber

[Matt Hancock]

The settlement is £33 million. Of course, there are lawyers, and legal time was also needed inside the Department. That happens all the time in order to try to make sure that we can keep people safe, which is the whole purpose of this exercise.

[Alison Thewliss (Glasgow Central) (SNP)]

The reality is that the Secretary of State is engaged in deflection. We are now in a situation where this country risks running out of vital medicines for each and every one of our constituents because of this Government’s relentless pursuit of a no-deal hard Brexit that will ruin this country. Is it not the case that this money that we are having to pay out is emblematic of the chaos in this Government and the incompetence of this Government and that our constituents will go without medicine because they cannot get their act together?

[Matt Hancock]

If the hon. Lady really, really believes what she just said, it is incumbent on her to vote for the deal.

Health and Social Care Committee

Alison Thewliss Excerpts

Thursday 28th February 2019 Westminster Hall

[Dr Paul Williams]

I absolutely join the hon. Lady in commending the breastfeeding peer support workers in Totnes, and those in many other parts of the country—I have met some in my constituency, too. There is a common theme: when services are reconfigured and new services are put out to tender, the people who have devoted a lot of time and effort as volunteers can find themselves excluded. That is partly because of the nature of commissioning and tendering.

The Royal College of Paediatrics and Child Health gave us compelling evidence about breastfeeding. In the United Kingdom, we have some of the lowest breastfeeding rates in the whole of Europe, and there are wide socioeconomic disparities. Investment in breastfeeding support is crucial.

[Alison Thewliss (Glasgow Central) (SNP)]

I will pick up where the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston), left off. I saw from the report that there was extensive consultation with Mumsnet. Why is there not a more specific recommendation in the report for more comprehensive breastfeeding support? What the hon. Gentleman says is correct, but it would have been good to see it in the report. During the Committee’s visit to Blackpool, were the cuts to the Breastfeeding Network’s star buddies programme mentioned? That service was lost in 2017.

[Dr Williams]

I thank the hon. Lady for those questions. One of the Committee’s early reports of this session was about childhood obesity. We made specific recommendations in that report that we have not necessarily repeated in this one.

We saw many wonderful things in Blackpool. We did not learn about the specific service to which the hon. Lady refers, but we did learn that many services have come under a lot of financial pressure. Even though there was some Big Lottery investment for transformation, services still needed to be cut, which sounds counterintuitive.

Oral Answers to Questions

Alison Thewliss Excerpts

Tuesday 15th January 2019 Commons Chamber

[Mr Speaker]

We are all very impressed by how well connected the Minister is. He is obviously on first-name terms with these illustrious individuals—[Interruption.] Indeed, I am sure they are thrilled to befriend the Minister—no reason to doubt it.

[Alison Thewliss (Glasgow Central) (SNP)]

Scotland’s childhood obesity plan recognises breastfeeding as the best start to life for babies. Will he look at that in his plans and ensure that the support is available to allow women to breastfeed for as long as they wish to?

[Steve Brine]

Yes, we will. We recognise that it gives a good start in life. Working with my colleague the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), I will meet one of the groups in that area to talk about it shortly. I know the hon. Lady chairs the infant feeding all-party group, and I am happy to talk to her about that at any time. We see it as an essential start in life.

NHS Long-term Plan

Alison Thewliss Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

I entirely understand the hon. Gentleman’s argument. He is a reasonable man who makes reasonable arguments, and I will take it up with Mike Richards, who is running the screening review. I will ask Mike to write to him specifically on that point and to take it into account.

[Alison Thewliss (Glasgow Central) (SNP)]

As the chair of the all-party parliamentary group on infant feeding and inequalities, I am glad that the long-term plan has a commitment to improving maternity services in England. The announcement on 30 December said that the UK Government are

“asking all maternity services to deliver an accredited, evidence-based infant feeding programme in 2019 to 2020, such as the UNICEF Baby Friendly initiative”.

What does the Secretary of State mean by “such as”? UNICEF Baby Friendly is the gold standard, as recognised by Scotland and Northern Ireland, which have 100% accreditation, but England has only 60% accreditation. Does he also acknowledge the need for community-based infant feeding support, such as peer supporters and health visitors, because it cannot just stop at the hospital door?

[Matt Hancock]

I pay tribute to the hon. Lady’s work as chair of the all-party parliamentary group on infant feeding and inequalities. She makes a strong and passionate case for breast feeding. I do not want to let the best be the enemy of the good. The proposal she cites is a proposal from the NHS. Of course, if other such services come forward, why should we be against it? I want to be clinically led in this area, but I very much support the thrust of her argument.