O’Neill Review

Kevin Barron Excerpts

Tuesday 7th March 2017 Westminster Hall

[Sir Kevin Barron (Rother Valley) (Lab)]

I congratulate the hon. Member for Thirsk and Malton (Kevin Hollinrake) on securing this very important debate. We will all be aware that the World Health Organisation says that antibiotic resistance is one of the most significant threats to safety in Europe. Resistance is driven by overusing and inappropriately prescribing antibiotics, and it leads to higher medical costs, prolonged hospital stays and increased mortality. The aim of appropriate use is to ensure that patients receive the treatment that is most likely to treat their condition without increasing antimicrobial resistance. That includes ensuring that courses of antibiotics are completed and are not prescribed unnecessarily, and reducing the spread of infection through vaccines and other early interventions.

One area that is often overlooked is dentistry, which accounts for up to 10% of all antibiotics prescribed in the UK. It is essential that dentists play their part in reducing antibiotic prescribing, and I believe that they are willing to do that. The British Dental Association tells me that many patients are not aware that antibiotics cannot cure decay or dental abscesses and that surgical intervention and painkillers are more often the appropriate treatment for tooth-related pain. The briefing sheet that the BDA sent me gives this good example:

“Hundreds of thousands of patients show up at GP surgeries and A&E departments every year with dental pain, but these places are not equipped to help them, and they are sent home with antibiotics to tide them over until they can arrange to see a dentist.”

There should be awareness of that throughout the medical profession.

I agree with Lord O’Neill’s statement that diagnostic technology needs to be improved to ensure that antimicrobials are used appropriately. I am no expert in this area, but the chair of the review board called on the Governments of rich countries to ensure that, by 2020, all prescriptions for antibiotics will be on the basis of surveillance information and a rapid diagnostic test where one is available. The review recommended a diagnostic market stimulus to support the diagnostic technology market. The Minister is not in the Chamber at present, but I hope that the Government will look at diagnostics.

The Government must also look at the factors that have hampered investment in antibiotic development, particularly the low commercial returns on investment. With high costs and long lead times for developing new medicines, there is a need to create an attractive environment for companies to invest in antibiotic development, in order to increase research and development. The current system of antibiotic reimbursement does not provide companies with a fair return on investment. That is driving companies out of the anti-infection market.

Pharmaceutical companies and Government are developing a delinked domestic reimbursement model. That will remove the incentive for companies to promote antibiotic sales, which can accelerate the development of resistance. The proposed model will deliver a return on investment for antibiotics that is delinked from the volume of sales. It will also encourage the appropriate use of new antibiotics by ensuring that they are prescribed based on clinical need and in line with stewardship goals.

I see the time, Mr Streeter, and I am about to conclude. A delinkage model is proposed in the O’Neill report, and we must put our minds to it, but it is very much for the future. What we have to examine now is how we manage patients’ expectations on when antibiotics are and are not appropriate. We should be doing that daily in all parts of the health service.