Medical Cannabis under Prescription

Debate between Julie Cooper and Jim Shannon

Monday 20th May 2019 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

This has been a very powerful and emotional debate that has moved Members on both sides of the House. It has also been characterised by anger and exasperation on both sides. I thank the Backbench Business Committee for selecting this subject for debate.

I pay tribute to my former, much-respected colleague, Paul Flynn, for his excellent campaigns on this subject. Somewhere, he will be cheering us on and I hope that he will have more to cheer about by the end of this debate, when we hear the Minister’s comments. I pay particular tribute to the right hon. Member for Hemel Hempstead (Sir Mike Penning) and my hon. Friend the Member for Gower (Tonia Antoniazzi); their unflinching commitment to this cause does them credit. Thanks is also due in no small part to the all-party parliamentary group, whose dedicated purpose is to

“help secure…access to natural cannabis for medical purposes in the UK under prescription from a medical professional.”

The group has worked tirelessly to that end, highlighting the barriers that exist and posing constructive suggestions to remove them.

As the hon. Member for Reigate (Crispin Blunt) rightly said, we are not concerned today with criminals and illegal drug supplies. We are not concerned with the use of recreational drugs. We are considering a most important health issue. I welcome the fact that at long last the Government accept that the therapeutic use of cannabis is a public health issue and not the business of the Home Office. I trust, therefore, that we will never again see parents in possession of medicinal cannabis products accosted and treated like criminals. I refer of course to the disgraceful treatment meted out to Teagan Appleby’s family.

Cannabis has long been known to contain active ingredients that could have therapeutic use in the treatment of many conditions, including muscular dystrophy, Parkinson’s disease, Crohn’s disease, cancer, AIDS, sickle cell disease and many more. International research and real-life experience in the UK have shown that the active ingredients CBD and THC, in combination, can provide relief for these conditions. There are also strong indications that these medicinal cannabis products can have a transformational effect in paediatric epilepsy cases. In the UK, though, we have been very slow to accept this and even slower to act to help those who could be helped.

Other powerful drugs with significant street values, such as heroin and diazepam, have long been available on the NHS under the supervision and control of qualified clinicians. Such drugs are extremely harmful in the wrong hands, but, subject to the existing controlled drugs regulations, these products can be used beneficially. In recent years, we have made some progress and have begun to accept that cannabis could and should be available in the same way. This changing attitude has most definitely been driven by increased public awareness of the suffering of individuals, many of them children.

[Jim Shannon]

Just to reiterate what the hon. Lady is saying, my young constituent Sophia has not been hospitalised with an active seizure in 10 months. I quote her mum:

“Our little lady just amazes us every day and we are very blessed to be in this position but we can’t help but think of the thousands of other children and adults that could need this right now!!!!!”

Does the hon. Lady agree that we must ensure that we are making progress? This debate is about progress and moving forward, so it is important for the Minister to do just that.

[Julie Cooper]

I am grateful to the hon. Gentleman for his intervention, and I absolutely agree. There is the potential to help thousands. We must move forward at the earliest opportunity.

Members have raised some powerful cases on behalf of their constituents—adults and children who could benefit. I want to mention the experiences of the Griffiths family. Mrs Griffiths asked me to help her nine-year-old son, Ben. Ben suffers with severe intractable epilepsy. This means that he has up to 300 seizures a day and has come close to death on more than one occasion. At the new year, Ben was admitted to Alder Hey Children’s Hospital, where, during an 18-hour period, he was observed to have 200 seizures. Ben’s parents asked whether he could have access to CBD and THC, but they were informed that Alder Hey has a blanket ban on medicinal cannabis products containing THC. Ben was discharged and his discharge letter stated that his parents had asked for an illegal drug.

In desperation, the family have turned to a private neurologist and, thanks to him, since January this year, Ben has been taking medicinal cannabis CBD and THC. His condition is much improved and yesterday he had only four seizures. His family tell me that Great Ormond Hospital and Professor Finbar O’Callaghan, the head of the British Paediatric Neurology Association, have acknowledged Ben’s improved condition, but the family are still unable to get an NHS prescription to supply the medicinal cannabis that he needs. The private prescriptions for his treatment are costing the family £2,500 a month. The family cannot continue to fund what is for Ben life-saving medication and they fear they will lose their son. Mrs Griffiths asked me: “How sick does our child have to get before the NHS will help him?” I know that question will go to the heart of everyone in the Chamber today. In relation to the high costs of private prescriptions for this medication, we are seeing the development of an unjust two-tier system where those who can pay get access to vital medication and those who cannot pay go without. That goes totally against the very principles of the NHS of which we are so proud.

In July 2018, the chief medical officer published a report declaring that there was conclusive evidence of the therapeutic benefit of cannabis medicinal products and she recommended that the whole class of cannabis medicinal products be rescheduled under the misuse of drugs regulations. The Home Secretary listened and, on 1 November 2018, the Government took action to reschedule cannabis for medical purposes. This was a very welcome step, making it legal for doctors on the specialised register to prescribe unlicensed whole-plant cannabis products for medicinal use in the UK. On that day, hundreds of families across the country celebrated, believing that this meant that they would have access via the NHS to medicinal cannabis. Sadly, that has not been the reality. Not one single NHS prescription has since been written for whole-plant medical cannabis and the hopes of many have been cruelly dashed.

Ironically, changing the legal status of medicinal cannabis has actually made the situation worse. Prior to that change in legislation, the Home Secretary had the power to grant special licences to make medicinal cannabis available. The Home Secretary no longer has that power. Now supplies are conditional on both clinical sign-off and a funding agreement, and that is not happening. I know that the Minister and the Secretary of State want to resolve the problem. I also know that the Secretary of State has met some of the affected families and has promised to help them. But the clock is ticking. The End Our Pain campaigners are absolutely clear that this is a matter of life and death. It is now two months since the Secretary of State met the families and, in that time, not one single NHS prescription has been written for medicinal cannabis that contains both CBD and, crucially, THC. There are many good intentions, but the Department’s implementation procedures following the rescheduling of medicinal cannabis are not fit for purpose.

The Secretary of State has said repeatedly that he cannot overrule the judgment of clinicians, and of course we do not expect him to do so. We do, though, expect that he recognises that these are exceptional circumstances of great urgency and urgent special action is required. It is clear that the procedures are not working and we cannot rely on a “business as usual” approach. As my hon. Friend the Member for Manchester, Withington (Jeff Smith) said, we need a bespoke solution. We need an acknowledgement that cannabis is a special case. We need a broader analysis of the evidence for the efficacy of medicinal cannabis that brings together worldwide research with the experience of patients and families in the UK who have benefited from using medicinal cannabis. While NHS England investigates the causes of the blockages in the implementation process, the NHS needs to step in to meet the costs of private prescriptions.

We need improved education and support for medical practitioners with regard to medicinal cannabis. The current guidance for prescribing medicinal cannabis needs to be changed to support and protect prescribing clinicians who prescribe, following best practice, in the best interests of their patients. We need the Department of Health and Social Care and the NHS to stress that medicinal cannabis is legal and that there is an expectation that it will be prescribed in the same way as any other unlicensed medicine when appropriate. We need a guarantee on funding. We need to know that everyone right across these islands, wherever they live and whichever CCG governs the healthcare in their community, has access to funded products where appropriate. Good intentions on their own are not good enough: we need urgent action.

Women and Work

Debate between Julie Cooper and Jim Shannon

Wednesday 14th March 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Redditch (Rachel Maclean) on securing the debate and setting the scene so very well. I will give some stats, then some information about my own office and where I stand.

In the period October to December 2017 in the UK, 15.1 million women aged 16 and over were in employment. The employment rate was 70.8% for women, compared with 79.7% for men; 8.8 million women were working full time and 6.3 million part time; and 42% of women in employment were working part time compared with 13% of men—so part-time work for women is far above the norm elsewhere.

The most common sectors of employment for women are health and social work, accounting for 20% of all jobs held by women at September 2017; wholesale and retail, 14%; and education, 12%. Around 78% of jobs in the health and social work sector and 70% of jobs in the education sector were held by women. Around 20% of small and medium-sized enterprises with employees were led by women, and it is good to see that happening. As the hon. Member for Redditch, as a former employer, said, there is a lot more that we can do to encourage that, and I look to the Minister for his thoughts.

Men are more likely than women to be involved in total early-stage entrepreneurial activity, which includes owning or running a business less than 3.5 years old. At February 2018, 29% of directors of FTSE 100 companies were women and at the next stage down, in the FTSE 250, 23% of directors were women.

In 2010 I was elected here, my wife came over and she got a wee fridge magnet. It was a famous quote from Margaret Thatcher, which we all know: “If you want something said, ask a man; if you want something done, ask a woman.” My wife put that on the fridge for a purpose—I am wondering whether there is a message there that she is trying to tell me—and I am reminded of it every day because it is still there.

The contribution of working women is incredible when added to the fact that many have main care of their children and also run their household—that is something that has to be recognised. As a proud employer of six staff, I must highlight that five of the six are women. One is a lady in her 50s with her children raised who works part time and minds her grandchildren part time, and for whom I provide flexible working. A lady in her 40s with her children mostly grown works full time for me, and another in her 40s works part time. Another lady, in her 30s, with a two-year-old and a three-year-old, works full time doing my speeches and press—as I am sure hon. Members know, I keep her very busy on speeches, and she does a lot of overtime. On her return home, it is not unknown for her to email documentation and speeches to me for the next day at 12.30 in the morning. That is the sort of person she is, and she does it because I have given her flexible hours and she likes doing it. I do not press her about anything, letting her do it as she sees fit. A girl in her 20s also works for me four days a week.

I therefore have a staff with different ages, from different backgrounds and at different stages of their lives, and yet one similar purpose links them all together—not just my office—which is that they wish to work, and work very hard. That is what they do. I might well have lost one of my best workers when my parliamentary aide had two maternity leaves within one year, but we had the discussion of how to make changes to make things happen so that she could be a great mother and still be great in her job. I made it clear that I was willing to work with her to make it work. She has been back at work for more than a year, but I have learned that family comes first—I always believed that anyway—and that she is more than capable of holding everything together. I did not penalise her for her maternity leave, but became flexible to ensure that I did not lose a great worker.

[Julie Cooper (Burnley) (Lab)]

Does the hon. Gentleman agree that one of the barriers to promoting women’s full contribution in the world of work is the sufficient supply of quality childcare?

[Jim Shannon]

I am glad the hon. Lady mentioned that, because childcare is very important. For many ladies in my constituency, the availability of and access to childcare mean that they are able to work.

I have another great example of a working women in my mother. She is at pains to let us know—my mother tells this story about when I was born, which was a long time ago—that she was in the shop working again within 48 hours of giving birth. My mother must be a very strong lady. We owned a shop and she worked beside my dad every day. She ran our home and the shop, she helped in the church, and she regimented us with the ability of a sergeant-major or indeed a general, but at the same time she gave us a wonderful example of love and care.

I pay my staff the same wage whether they are men or women. Sadly, however, somewhere along the line as a society some people determined that it is acceptable to pay different wages for the same job, due not to job performance or ability, but to gender. I want to say clearly: that is unacceptable to me. I want to see the same wages for men and for women, so let us say that together and get it right.

Yes, there is the potential for a member of staff to take maternity leave or request flexible working hours to suit a family when they are female, but in today’s society men are just as able and willing to take care of their children, and rightly so. The gender pay gap does not simply apply in the BBC or Hollywood; we see it day in and day out, and it is not right. I would take great exception to anyone who decided that my granddaughters were worth less because they are girls—they are strong, bright, courageous and ready to take on the world, and in this day and age they should be allowed to do so without discrimination, based on their ability and not solely on their gender. That is the way that it should and must be, and we have a role to play. I am willing, as the Member of Parliament for Strangford, to do my bit to make that happen.

Preventing Avoidable Sight Loss

Debate between Julie Cooper and Jim Shannon

Tuesday 28th March 2017 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I thank the hon. Member for Wealden (Nusrat Ghani) for securing this important debate, which is long overdue. I also pay tribute to the excellent work that she does on the APPG to reduce sight loss; I was privileged to attend a recent meeting, and she is doing sterling work, for which I applaud her.

We are fortunate also to have the expertise of the hon. Member for Twickenham (Dr Mathias); I am sure that we were all interested to hear her expert opinion. We also heard very human stories from hon. Members representing constituents all over the country. They made very powerful cases. As I said, a debate on this subject was long overdue. Given the scale of the problem, to which many hon. Members alluded, the fact that it barely gets a mention in Parliament from one month to the next is quite shocking.

It has been said already, but is worth stressing, that more than 2 million people in the UK are living with sight loss. This is not a problem that affects a small number of people; it is a major problem. One in five people over 75 and one in two people over 90 are living with sight loss. With regard to the impact on the wider NHS, every year there are 2.6 million GP appointments for eye-related conditions and 270,000 accident and emergency visits for acute eye problems. And the problem is not going to go away. We have heard that the number of over-85s will double over the next two decades and that problems with sight loss are also set to double. Research by the Royal College of Ophthalmologists shows that there has been a 37% increase in eye clinic attendances in the UK over the past 10 years, and demand is growing year on year, making it the specialism with the second highest out-patient attendance. New treatments as yet unimagined will inevitably add to that demand.

For me and, I am sure, most Members in the Chamber, the most alarming statistic is that more than 20 people go blind unnecessarily every month in England. That is 20 people who did not need to lose their sight. It is a really shocking statistic. Many Members, including the hon. Member for Motherwell and Wishaw (Marion Fellows) and my hon. Friend the Member for Great Grimsby (Melanie Onn)—I only represent great Burnley—have alluded to the horrors of blindness. Particularly affected are the elderly, people with dementia and people suffering from diabetes.

[Jim Shannon]

I have a very good friend back home in my constituency who has diabetes. He decided to go for laser treatment to correct his short-sightedness and, as a result, he lost sight in both eyes. There can be complications for diabetics who try to improve their sight. For my friend, that became a horror story rather than a good story. People who are diabetic need to take special cognisance of the possibility of complications before they do anything. I apologise, Mrs Gillan, for intervening for a wee bit longer than usual.

[Julie Cooper]

I am grateful to the hon. Gentleman for that important intervention. Diabetes brings its own special problems, which we need to be widely aware of and build into any future strategy.

Some 20 people every month in this country—one of the richest countries in the world—go blind unnecessarily; it is not because we lack the ophthalmic expertise to save sight. On the contrary, we have many leading centres of excellence. Indeed, the Manchester Royal eye hospital that serves my constituency is one of the finest centres in the whole of Europe. People are going blind because capacity in the service is failing to keep pace with demand. For many eye conditions, including glaucoma and macular degeneration, early diagnosis and regular treatment are vital if sight is to be retained. For example, if glaucoma is diagnosed early, good sight can be retained, but in the overstretched and under-resourced system that we have now, 17% of those diagnosed lose their sight.

Currently, fewer than half the patients requiring multiple appointments are seen within the optimum timeframe, and the statistics given by my hon. Friend the Member for Great Grimsby about the effect on her constituents are truly shocking. Research shows that more than half a million appointments in England were cancelled by eye departments in 2015-16. It is therefore not really surprising that the Royal National Institute of Blind People reports that 50% of the incidences of blindness could have been avoided. It is undoubtedly a source of misery for the individuals affected, causing untold suffering, restrictions on lifestyle and a host of missed opportunities. In addition, as has been referred to, it places massive additional pressures on social care services and the wider NHS. I think that we all agree, on both sides of the House, that services need to improve.

There are already many examples of pockets of good practice—deploying mobile units and the multi-skilling of staff—where experts are desperately trying to compensate for a lack of resources to deal with increased demand. Clearly, the knowledge that demand will continue to grow means that there cannot continue to be business as usual. The clinical professionals have identified four areas that need to improve. They have said clearly that there is a need for an overall strategy—a direction from above and from Government. It is significant, as the hon. Member for Wealden pointed out, that in Zimbabwe there is a national strategy to prevent sight loss and retain sight, but in England we do not have such a strategy—I am shocked. The professionals also call for improved access to data to make their job easier and more efficient; to avoid duplication and ensure that they have access to the best possible information about their patients in a timely fashion.

In addition, the professionals call for services to be provided locally. That is particularly important because many of the patients are elderly. The current system of geographically distanced centres seems to be in direct contradiction to the aims of the five year forward view, which asks for treatments to be delivered locally. Current financial constraints must also be reduced to increase capacity. That makes sound economic sense, as we heard from the hon. Member for Motherwell and Wishaw, because it is estimated that the failure to tackle this problem actually costs the UK economy a shocking £28 billion—no wonder the parliamentary researchers got the figure wrong. Like me, they probably could not believe the figure when they saw it; £28 million sounds like a lot, but the cost to the UK economy of failing to act on this issue is actually £28 billion.

I want to pick up on some of the other points made by hon. Members today, most notably on prevention. Early diagnosis and prevention are extremely important, and it is a fact that in many areas across England school eye tests are becoming a thing of the past. Most of us will have had our eyes tested in school as children and had difficulties picked up then, but many areas are choosing not to commission such tests. In deprived communities, such as those in my constituency, many people simply cannot afford eye tests that are charged for and therefore choose not to prioritise them. As eye sight deteriorates with age, many people make do with cheap, over-the-counter spectacles. The point has been powerfully made that people do not just visit their optometrist so that they can read more efficiently; they also need to check and make sure that there are no early signs of other diseases. That is really important.

I totally agree with the point made by the hon. Member for Twickenham about treatment. How can an expert look a patient in the eye knowing that a treatment is potentially being developed but that, for reasons of resources, in one of the richest countries in the world, it is not a priority for us? I ask the Minister to consider all these points. STPs have been mentioned, and they are an exciting opportunity to address some of the issues raised today. Like the hon. Member for Wealden, I have looked at many of the STPs for many reasons; worryingly, even in the ones that do mention sight loss and eye care services, it is a passing mention—a tick-box exercise—and I hope that the Minister will address that. Today we look to the Minister to outline the action that the Government will take to address the many issues that have been raised, and to address what has become a national scandal.