Healthcare: Controlled Drugs

Lord Butler of Brockwell Excerpts

Thursday 14th September 2023 Grand Committee

Asked by

[Lord Butler of Brockwell]

To ask His Majesty’s Government, further to the Written Answer by Lord Sharpe of Epsom on 24 July (HL9391), when they plan to introduce legislation to enable prescribing of controlled drugs by paramedic independent prescribers, as well as other changes to the use of controlled drugs in healthcare.

[Lord Butler of Brockwell (CB)]

My Lords, I want to thank the noble Lord, Lord Sharpe, for having raced from business in the Chamber in order to answer this short debate.

I start by saying that I need to declare no personal interest in the subject of the debate—my only interest is to try to do the world a bit of good. I should also declare that I have no difference of policy with the Government. The issue is this: the Government have said that, following the approval of the Advisory Council on the Misuse of Drugs, they will extend the list of drugs which paramedic independent prescribers and therapeutic radiographer equivalents may prescribe and administer to patients. These drugs include morphine, morphine sulphate and four other drugs.

This process has taken a considerable time. The advisory council submitted its approval in relation to paramedics in 2019—four years ago—and in relation to radiographers in 2020, three years ago. More than two years later, on 30 September 2022—nearly a year ago—the Minister of State in the Home Office wrote to the secretary of the advisory council and said that he had asked Home Office officials to commence the process for making these regulatory changes.

My purpose today is to ask the Minister to give us a date by which this will be done. I put two Written Questions to the Home Office, which the noble Lord, Lord Sharpe, has courteously answered. He has confirmed that the changes are capable of being made by statutory instrument, which the Government will bring forward

“as soon as possible, but this will remain subject to Parliamentary procedure”.

What is this parliamentary procedure? I am advised that it is a statutory instrument under the negative procedure, which means that the instrument comes into law without any parliamentary procedure unless someone dissents, which in this case is effectively unthinkable. So, the statutory instrument simply has to be drafted and laid.

The delay does not seem to be parliamentary procedure but the Home Office’s order of priorities. We know that Home Office lawyers have been very busy, but it is very difficult to understand why they have not been able to find time for this very simple instrument. I understand that the Advisory Council on the Misuse of Drugs approved the wording as long ago as 2019—four years ago. Home Office lawyers could simply take it out of their drawer. Equivalent amendments were required with respect to physiotherapists and podiatrists when these groups were given prescribing rights 10 years ago. They were made by the Home Office in a little over 18 months. Today, by comparison, paramedic independent prescribers have been waiting over five years for the necessary amendments to be made, and therapeutic radiographers have been held in limbo since April 2016—over seven years.

I said at the outset that I had no personal interest to declare, but that is not quite true. We all have a personal interest in this issue. I could describe to your Lordships a case study in which, in the absence of the changes we are discussing today, an advanced paramedic practitioner could not prescribe oral morphine to deal with an acute onset of pain without the patient having to have a further appointment with a GP, prescribing nurse or pharmacist. Following this statutory instrument, that paramedic would be able to prescribe oral morphine for the continuing treatment of pain. If I may make this personal, I do not welcome the prospect some time in the future of unnecessarily lying in acute pain which could be relieved by this simple statutory instrument. Nor do I want others to have to do so.

The statutory instrument offers a double whammy. It will both remove some unnecessary pressure on general practitioners, which the Government and all of us must surely welcome, and make available more immediate treatment for patients. If the Department of Health were responsible for this statutory instrument, I wonder whether it would have been made with more dispatch.

I am too long in the tooth to be fobbed off by statements saying that the Government will make the statutory instrument

“as soon as possible, but this will remain subject to Parliamentary procedure”.

I repeat that it is simple for the Home Office to make and lay this statutory instrument. It effectively requires no parliamentary procedure whatever. I hope the Minister will be able to clearly answer my question and say that the statutory instrument will be made forthwith, I hope by the end of the current Session.