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.