Healthcare: Controlled Drugs

Lord Patel Excerpts

Thursday 14th September 2023 Grand Committee

[Lord Patel (CB)]

My Lords, it is a pleasure to follow the noble Lord, Lord Butler of Brockwell. I thank him for initiating this important debate. Like him, I hope it will result in the Government bringing in much-needed legislation to allow advanced paramedic practitioners to prescribe some of the controlled drugs in Schedules 2 to 5. I will speak briefly in support of the noble Lord. I may repeat some of what he said, but do not apologise for doing so because it is worth emphasising.

I thank the College of Paramedics and the House of Lords Library for their detailed, informative briefing on allowing paramedics to prescribe controlled medicines. I recognise the need to look at expanding prescribing by other health professionals, such as radiographers, as have been mentioned, and widening the list of drugs that can be prescribed by them. However, I shall confine my comments today to paramedics.

There is a misconception that highly trained, efficient paramedics work only in ambulances and are not allowed to prescribe and administer medicines, including some controlled drugs. Paramedics are now deployed in a whole range of healthcare settings, from emergency departments to GP practices, out-of-hours services and general and specialised wards. Some 25% of paramedics now work in wider healthcare settings. They are a versatile, experienced and valuable part of the healthcare system. There are more than 1,500 advanced paramedic practitioners, and the workforce plan recently published by the Government has the ambition to expand this workforce considerably in future.

Once qualified as an independent prescriber, a paramedic can prescribe any drugs, except controlled drugs such as morphine sulphate, as has been mentioned, Diazepam, Midazolam and codeine phosphate. Qualified paramedics can and do work independently in making the correct diagnosis. If the treatment involves giving controlled medicines, she or he has to seek assistance from another prescribing healthcare professional. This results in delay in care, disturbs the work of both professionals and increases the risk to patient safety.

I will give some real examples—the noble Lord, Lord Butler of Brockwell, already gave one such. A young man, having fallen off his bike, is brought to the emergency department by ambulance. He is in considerable pain and, after initial tests, the advanced paramedic practitioner makes a correct diagnosis of a closed tibia and fibula fracture. The advanced practitioner knows what he has to do next but is unable to prescribe morphine to alleviate the pain and has to seek assistance, disturbing the work of other clinicians, who have to leave the patient they may have been looking after to help the paramedic. This delays treatment and creates possible patient safety issues.

Another such example is a young woman, a known epileptic, who is brought by ambulance having had seizures at home. The practitioner is unable to prescribe prescribed drugs such as intravenous lorazepam to control the young woman’s epileptic seizures.

Another example is a young man with a shoulder injury who is brought in by ambulance. The paramedic makes a correct diagnosis of a dislocated shoulder and is competent to treat the patient. However, before she or he can perform the manipulation of the shoulder, they must seek the advice and assistance of another health professional to administer a mild anaesthetic such as midazolam. Being unable to prescribe and having to seek assistance means that the treatment is delayed and the young man remains in pain; this risks the dislocation causing more shoulder damage, with possible long-term effects.

Legislation, possibly introduced as a statutory instrument, as already mentioned, is urgently needed to allow highly trained, experienced advanced paramedics to prescribe some controlled medicines. Such legislation is a long time in coming. The concept of paramedics prescribing was consulted on in 2015. As the noble Lord, Lord Butler, mentioned, in 2018 legislation to approve the concept was accepted. In October 2019, the Advisory Council on the Misuse of Drugs approved the list of drugs that advanced paramedics could prescribe, which was also approved by the MHRA. Apparently, a letter was sent to the Home Office in 2019, so we have been waiting since then for the Home Office to approve and bring in the legislation.

I know that the noble Lord, Lord Sharpe of Epsom, is sympathetic to the proposals from the correspondence I have seen which others have had with him. I hope he will surprise us when he responds by telling us when the legislation will be brought forward—I hope before 7 November or soon after. Whenever it is, I cannot imagine that Parliament will do anything other than promptly approve it.

Once paramedics are able to prescribe some of the medicines in the controlled list of drugs, patients will benefit from prompt treatment, and it will free up the time of other clinicians and improve patient safety. If there is no action from the Home Office, I hope that the noble Lord, Lord Butler of Brockwell, will continue to badger the Government on a regular basis. He will have my support.