Access to Medicinal Cannabis

Baroness Warwick of Undercliffe Excerpts

Tuesday 9th April 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her comments and for setting out her personal experience. She obviously has expertise in this area which few of us in the Chamber can claim. The reason NHS England has put forward is that individual clinical expertise relating to an individual patient is of the utmost importance, even where the guidance might seem to contradict that judgment. That is why in the autumn we will be bringing forward NICE guidance that will look at the most up-to-date evidence which should, we hope, be of assistance. It is also why we are bringing forward the NICE process review in order to understand what barriers may be in place and to encourage clinically appropriate prescribing and try to assist with cases such as these.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, what Mrs Emma Appleby has done—and I praise her courage—is to show that, whatever relaxation there appears to have been or modification, which we all thought was likely to produce some positive results, in fact that really is not happening. People are being denied medication, with incredibly debilitating results. I have an interest in this because I have a young family member with stage 4 terminal brain cancer. He suffers from sickness as a result of chemotherapy which nothing else is able to help. He has been refused cannabis. The consultant will not prescribe it because he feels that there is not enough information from the Department for Health and Social Care for him to feel that he is justified in doing so and he does not know what the implications might be. I understand from another consultant that the BMA is in fact advising medical professionals not to prescribe it. What is the alternative for desperate relatives? Is it to buy cannabis off the streets not knowing what the quality is and facing the prospect of a criminal conviction? Speed is of the essence here, certainly for my family member. I hope that the Minister can say a little more about the way in which this is likely to progress and the speed with which it will do so.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question and for describing her personal experience. I emphasise that we must allow clinical decision-making in this. We have tried to encourage more experience in the system by putting out guidance through NICE based on the latest evidence, by providing Health Education England with the opportunity to bring forward training to share the best quality experience, and by putting through the process review so we can bring down any inappropriate barriers in the system. I hope that encourages the noble Baroness.

Brexit: Health and Welfare

Baroness Warwick of Undercliffe Excerpts

Thursday 29th March 2018 Lords Chamber

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I thank the noble Baroness, Lady Brinton, for raising such a key aspect of the impact of the EU’s withdrawal from the EU. As others noted earlier in the House, at 11 pm exactly one year from today the UK will leave the EU, but I have no doubt that we will be debating the complexities of a post-Brexit UK well beyond even the agreed 21-month transition period that will follow.

There is also no doubt that the UK’s decision to leave the EU will have many far-reaching implications for health and social care in England, and for the health of UK citizens living or travelling in EU countries. It was only when I began to look at this more closely that I realised just how many crucial issues still await clarification. There are the future arrangements regarding the European health insurance card; without EHICs, a disproportionate insurance burden will fall on the elderly and those with existing conditions. There is the question of access to healthcare for UK pensioners resident in EU countries and of cross-border co-operation in public health. I think particularly of food safety and housing, but there are many other areas. There is the continuation of the open border in Northern Ireland so that healthcare professionals can move freely to deliver vital cross-border health services. There is the damage to our research base and the international standing of our universities if they can no longer recruit and collaborate with European researchers and scientists. There is the damage to our ambitions for the UK to be a world leader in the sciences and medical research if we are not able to make good the significant loss in EU funding for R&D. There is the question of our continuing participation in the European Centre for Disease Prevention and Control, the UK losing out on clinical trials for new drugs if we are not part of the upcoming revised EU directive on clinical trials, and losing our ability to attract EU research funding or to access EU research funding sources such as Horizon 2020 and the European structural and investment funds. We do not know the extent of Brexit’s negative impact on the UK economy. Additional pressure on public finances will have a direct negative impact on the NHS and social care.

The list goes on and on, and it is depressing how little we and the country know with any degree of certainty. It is essential that health-related issues are put high on the agenda as we negotiate our future relationship with the EU. I want to focus on just a few concerns. Like the noble Baroness, Lady McIntosh of Pickering, I ask how we will maintain the NHS workforce, given its reliance on EU nationals, and how we will address the pressing issue of social care. I declare an interest as chair of the National Housing Federation. Then I will briefly consider what our withdrawal may mean for the regulation of medicines and our access to new drugs in the UK.

The freedom of movement and mutual recognition of professional qualifications that come with EU membership mean that many health and social care professionals working here are from other EU countries. A recent King’s Fund report indicated that nearly 62,000 staff, or some 5.6%, of the 1.2 million total NHS workforce in England, and 95,000, or about 7%, of the 1.3 million workers in England’s adult social care sector have come from other EU countries. A recent report by Independent Age highlights that in the first part of 2016 alone, more than 80% of all migrant care workers who moved to England to take on a social care role were from Europe. The report posits a social care workforce gap of about 1.1 million workers by 2037 in the worst-case scenario of zero net migration following Brexit. In what I suggest is a more likely low-migration scenario, the workforce gap could be more than 750,000 people. But even if there were high levels of migration and the care sector became more attractive, Independent Age puts the social care gap at 350,000 people by 2037. The implications for older and disabled people are that far fewer will be able to access the care they need to live independent, meaningful lives.

Meanwhile, the most recent figures show that the NHS has gaps in nursing, midwifery and health visitors. Although the referendum result will not have been the only factor, it is nevertheless alarming that between October 2016 and December 2017, the number of nurses and midwives from Europe leaving the Nursing and Midwifery Council’s register increased by 67% compared to the previous year, while the number joining fell by 89%. The recent commitment and clarification that EU citizens currently working in the UK and UK citizens currently working in other EU countries will be allowed to stay has, we can only hope, provided some reassurance to those individuals, but it is clearly vital that we continue to persuade as many as possible to stay and continue their valuable contribution to the health and social care workforce, while we also take measures to increase the domestic NHS workforce and the attractiveness of the social care sector to British-born workers in the longer term.

We do not have much detail on what the UK’s policy on migration will look like post Brexit beyond the intention that after March 2019, migration of EU nationals will be subject to EU law. While we await the delayed White Paper, there are many unanswered questions about our future immigration policy, some of which we explored earlier today. I am concerned in particular that in future we might mirror the current non-EU system, which is focused on high-skilled labour rather than areas of shortages. Can the Minister assure us that providers of NHS care and social care services will retain the ability to recruit staff from the EU when there are not enough resident workers to fill vacancies? I note that the Migration Advisory Committee’s interim report on European Economic Area migrants to the UK was published earlier this week, ahead of its September final report. I wonder if the Minister would agree that a way forward would be to add specific occupations to the MAC’s shortage occupation list, which currently enables employers to recruit nurses and midwives from outside the EEA. Will he also agree that the Government will need to consider urgently how both the NHS and social care can continue to recruit lower-skilled workers from the EU and elsewhere who are less likely to arrive under systems focused on encouraging higher-skilled migration?

I should add that the context for considering the impact of Brexit on our health and social care workforce is the pressing need for funding reform of social care. Local authorities are struggling to make shrinking budgets meet the demand for care, which is growing as our population ages, with increasing complexity in their needs. Can the Minister confirm that the Government’s intention in the Green Paper on social care, due later this year, will be to find a long-term solution?

I also want to take a final minute to highlight, like others, the impact that our EU withdrawal may have on the regulation of medicines and clinical trials in the UK. EU legislation ensures a consistent approach to medicines regulation across its member states, and the UK is part of the European Medicines Agency, which operates this centralised authorisation system. The EMA, of course, recently announced that it will be moving from London to Amsterdam as a result of Brexit. Currently, companies can submit a single application to the EMA to be authorised to market their products in EU, EEA and EFTA countries. As a member of the EMA, the UK has first-tier market status, giving us priority in receiving new pharmaceuticals. With Brexit, the UK is expected to leave the EMA and seek then to “work closely” with it, while increasing the capabilities of our own national Medicines and Healthcare products Regulatory Agency. The EMA currently co-operates with other countries in this way, including Canada and Switzerland. But the concern here is that losing our tier 1 status would put us at the back of the queue for new medicines. In Canada and Switzerland, these typically reach the market six months later than in the EU.

There are so many areas where we need reassurance from the Minister. I hope he will be able to provide at least some concrete answers. Can he, above all, unequivocally tell us that he will do everything in his power to ensure that health-related issues are put high on the agenda as we negotiate our future relationship with the EU?