Access to Salbutamol Inhalers

Gillian Keegan Excerpts

Monday 29th November 2021 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve under your chairmanship, Mr Hosie. I will start by acknowledging the tragic death of Lauren Reid, aged just 19 with so much to live for, having achieved so much already, and to offer my sympathies to her mum Elaine and her family and friends. I also thank my hon. Friend the Member for Don Valley (Nick Fletcher) and all those who signed this petition for ensuring that this issue has been brought to the attention of the House, and thank all Members who have taken part in today’s debate.

On 25 August the Government responded to the petition, which seeks wider availability of non-prescribed salbutamol inhalers. I will build on that response in my speech. Asthma inhalers are a mainstay treatment for patients with acute asthma. Ready access to prescribed inhaler can save lives in an emergency. The safe sale and supply of prescribed medicines, including inhalers, is carefully and thoroughly regulated in the UK, through the Human Medicines Regulations. Some medicines are classified as prescription only because they could result in harm if used without medical supervision, even if used correctly, or they are frequently used incorrectly and may cause harm as a result. Prescription inhalers are in that category.

The Medicines and Healthcare products Regulatory Agency, as the licensing authority in the UK, has advised that exemptions can be made in the relevant Human Medicines Regulations, and that any such change would depend on the careful and thorough review of evidence supporting it. As the hon. Member for Strangford (Jim Shannon) says, we need to do that very carefully and ensure that safety is at the heart of everything. We would need to ensure that the benefits of such a change would outweigh any risks, and any change would also depend on the advice of our independent expert advisory committee, the Commission on Human Medicines.

I am pleased that the MHRA met my hon. Friend the Member for Don Valley on 25 November to provide detailed advice on the type of information needed to support a change. I understand that the discussion focused on the evidence needed to enable a full assessment of benefits and risks by the MHRA and the CHM. I hope my hon. Friend found that helpful.

For the benefit of the House, and for the record, I will give some detail. A full assessment would need evidence clearly showing the intended benefits, including an outline of the magnitude of the issue, such as how many people are affected by serious asthma attacks and the locations where having such medicine available would be of the greatest benefit. The evidence would also need to consider any risks and how they could be managed—for example, that the medicine could be stored, handled, and used safely in an emergency.

Once adequate information is collected, the MHRA seeks independent advice from the CHM. At that stage, it would also consider guidance to stakeholders on the safeguards that would need to be in place. Feedback from a public consultation would be considered before a final decision on implementing any legislative change. The MHRA welcomes any submission of evidence from interested parties and is committed to ensuring that the UK becomes an even greater place to develop, manufacture and supply medical products, and that, most importantly, we have continued access to safe medical products.

As many hon. Members have mentioned, an amendment was made to the Human Medicines Regulations in October 2014 to allow schools to procure and store non-prescribed salbutamol inhalers. At that time, the potential advantages and disadvantages were tested through pilot schemes placing inhalers in some schools and tracking their usage. Information was collected by surveys of patients, teachers and schools, and was analysed by the MHRA and CHM.

The Health and Safety Executive owns guidance on reducing the risk of asthma in the workplace. The Department will be looking further into this matter, along with HSE and MRHA. Once that information-sharing exercise has taken place, the Department will be in a better position to decide whether further action needs to be taken. It will explore commissioning research to examine this issue further.

I have heard the concerns in this House, and indeed among the wider public, about this issue. I thank all those who have taken part in this debate, and mostly the 102,058 people—patients, stakeholders, and families of asthma sufferers—who signed the petition.

I will also update the House on additional public health measures that we have put in place to improve outcomes for people with asthma. The 2019 NHS long-term plan sets out commitments and objectives for the NHS for the next 10 years. It includes respiratory disease as a national clinical priority and aims to improve outcomes for patients, including those with asthma. The respiratory interventions proposed in the NHS long-term plan include early and accurate diagnosis of respiratory conditions, because the earlier diagnosis of conditions may prevent avoidable emergency admissions for asthma. Pharmacists in primary care networks will undertake a range of medicine reviews, including educating patients on the correct use of inhalers.

Since 2019, several initiatives and publications have been announced in support of the long-term plan. NHS England and Improvement’s national patient safety team has prioritised work on asthma as part of the adoption and spread safety improvement programme. That will support an increase in the number of patients in acute hospitals receiving every element of the asthma discharge care bundle from 38% to 80% by March 2023.

Since April, the academic health science networks in England, in partnership with the patient safety collaboratives, have been working with provider organisations to improve the uptake of all elements of the asthma care bundle for patients admitted to hospitals in England. Compliance with the elements of good care, as described in the bundle, is measured as part of the national asthma audit. The care bundle includes actions that should help to reduce the number of patients who are readmitted following discharge and ensure that all aspects of the patient’s asthma care are considered. The bundle assesses inhaler technique and includes care follow-ups. Those interventions should prove more beneficial than relying on emergency use inhalers to provide temporary relief.

To the question asked by the hon. Member for Strangford, the Department works closely with the MHRA, the pharmaceutical industry, NHS England and Improvement and others operating in the supply chain to help to prevent shortages. The team has advised that there are currently no shortages in the supply chain.

I would like to take a moment to remember Lauren and to send our sympathies to her family and friends. I thank all those involved in bringing forward this important debate. I hope that what I have set out demonstrates our commitment to the issue. We want to facilitate changes that will protect public health, so we will look into it with the relevant bodies. We are working hard to ensure that asthma care improves for all, as outlined in the NHS long-term plan, and that asthma sufferers have access to the best care available.