Fibrodysplasia Ossificans Progressiva

Ronnie Cowan Excerpts

Thursday 7th September 2023 Commons Chamber

[Ronnie Cowan (Inverclyde) (SNP)]

I congratulate the right hon. Member for Hemel Hempstead (Sir Mike Penning) on securing the debate. I apologise if I stumble between illnesses, diseases and genomics; this is not my specialist subject.

Rare illnesses are collectively widespread. There are thousands of different rare diseases and illnesses, and each one can require highly specialised treatment. That means that people living with them can face the prospect of a long “diagnostic odyssey” before they are accurately diagnosed and able to access treatment. The various aspects of their treatment and care also often lack co-ordination. It is vital that we continue to strive for improvement and ensure that all those living with a rare disease get the right diagnosis faster, and can access co-ordinated care and specialist treatment.

The “UK Rare Diseases Framework” was co-produced by the UK Government and the devolved nations. It sets out the key priorities for the next five years for improving the lives of people living with rare diseases. Each nation committed to producing their own action plan based on how those key priorities will be implemented. The Scottish Government understand the importance of the framework and are committed to implementing the 51 commitments outlined within it. They also welcome the progress that has been made in Scotland in delivering genomic medicine and empowering patients through the UK’s rare diseases forum.

In December 2022, the Scottish Government published their “Rare Disease Action Plan”, which was developed through significant engagement with the rare disease community. Through their combined efforts, the Scottish Government will ensure that they are putting those living with a rare disease at the heart of policymaking, ensuring this meets the needs of the rare disease community in Scotland while reaping the benefits of a four-nation approach. The Scottish Government’s action plan sets out four key themes to implement the UK rare disease framework: ensuring patients get the right diagnosis faster; increasing awareness of rare diseases among healthcare professionals; better co-ordination of care; and improving access to specialist care, treatment and drugs. The Scottish Government remain fully committed to ensuring that there is continual improvement in supplying patient-centric care that is safe and effective for those living with a rare disease.

The genomic medicine landscape is developing rapidly. In the last five years we have seen the implementation of impactful genetic testing for a variety of conditions, which has helped to inform patient treatment, allowing patients to receive the right treatment at the right time. Pathogen genomics is also helping to deliver “precision public health” by guiding investigations of infection outbreaks, antimicrobial stewardship, better-targeted disease control, and infection surveillance.

The Scottish Government published “Genomics in Scotland: Building our Future” in March this year. The Scottish Government’s strategic intent is to deliver an equitable, person-centred, population-based genomics service and infrastructure for Scotland. This publication is the first in a series, setting out the Scottish Government’s strategic vision for Scotland’s genomics future. They will publish a series of documents in the future, explaining how they will deliver genetic services that will allow Scotland not only to treat disease but to prevent ill health before the prevalence of symptoms. Scottish physicians and scientists have been actively participating in the advancement of genomic medicine over the past three decades. Scotland has a great foundation to build on within the NHS laboratory network, but it is important that these laboratories are fit for the future, as we know that genomic medicine is on a steep trajectory.

Achieving the Scottish Government’s ambition of having a genomics ecosystem with the infrastructure to support it will require investment in rapidly evolving technologies, skills and facilities. The Scottish Government will be innovative and adaptive to change, working collaboratively through the triple helix approach with academia, industry and the public sector to harness the opportunities at their disposal and deliver an integrated approach to genomics across Scotland. Their genomics strategy aligns with their rare disease action plan, and they will engage with the Rare Disease Implementation Board, as well as key rare disease organisations such as Genetic Alliance UK, to ensure that the strategy is informed by those who will benefit most.

While I see the intent and acknowledge the money being spent, it is clear that far more money is required to fund the research that is needed. The UK Government have overspent tens of billions of pounds on the Ministry of Defence, Crossrail and HS2—and, ironically, PPE during a health crisis—which shows that the money is there, but it must be spent wisely. In Scotland, following the 2022-23 emergency budget review, genomics was allocated a revised budget of £5 million. Through the funding allocated so far in 2022-23, the Scottish Government have established the Scottish Strategic Network for Genomic Medicine and funded a genomics transformation team within the NHS National Services Division, led by a consultant clinical scientist and supported by clinical leads for rare disease and cancer.

Genomic medicine is an integral part of precision medicine and precision health. It can lead to earlier and more precise diagnoses, as well as more targeted prevention and management of diseases. Over the next five years, the genomics landscape in Scotland will be transformed as we work to ensure that patients have equitable access to timely, personalised and high-quality genomic medicine for a range of conditions, including FOP.

[Mr Deputy Speaker (Sir Roger Gale)]

I call the shadow Minister.

Medicinal Cannabis: Economic Contribution

Ronnie Cowan Excerpts

Thursday 20th April 2023 Westminster Hall

[Ronnie Cowan (Inverclyde) (SNP)]

I congratulate the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on bringing forward this debate. I put on record that I am a trustee of the charity Intractable Epilepsy, whose aim is to raise money to fund the purchase of medical cannabis for children with intractable epilepsy. Details are contained in the Register of Members’ Financial Interests.

It is appropriate that this debate is being held on 20 April. I wish a happy 4/20 to everyone—some people know what I am talking about. In March 2019, the then Health Secretary, the right hon. Member for West Suffolk (Matt Hancock), reassured parents of children living with life-threatening epilepsy when he said that medical cannabis would be made available on the NHS. Of course, that never happened. Instead, he threw the problem over the wall and left the health professionals to deal with it, and they have not.

I think I have raised the issue of the provision of medical cannabis 36 times in this place. Every time, the UK Government have ignored my plea and reverted to their default position of “cannabis is bad”. Their lack of knowledge is evident in the way that they confuse synthetics such as Spice and Mamba with marijuana. That is the background against which parents and guardians have constantly lobbied the UK Government to provide medical cannabis on the NHS. I have tried to support them as best I can.

Clearly, we were wrong in our approach, and I apologise to those children and their parents for my shortcomings. I appealed to the moral or ethical need. I appealed to the compassion that this Government repeatedly tell us they have. I have found today that what I should have done is make the economic argument instead, as the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale has done. The UK Government have ignored the parents struggling to raise the thousands of pounds required just to keep their kids alive, but once we start highlighting the potential for making money, their ears prick up. I am not criticising the right hon. Member; if that is what it takes to get the Government to engage, then so be it, because engage they must. People are suffering needlessly.

I went to great lengths in my Budget speech to highlight the benefits to the UK Government of supporting the hemp industry. Much of the argument about medical cannabis is the same, because it is the same plant that we are trying to grow. The UK Government’s insistence that cannabis is a class B drug under the Misuse of Drugs Act 1971 and in schedule 1 to the Misuse of Drugs Regulations 2001, and that all varieties are treated the same, means that we fail to understand that cannabis is a very complex plant with over 483 compounds. Because of the UK Government’s bias and ignorance, they have turned their back on the plant’s potential and known benefits.

In fact, the hemp plant has over 50,000 uses, and medical cannabis is only one. Finding markets for hemp would not be a problem. I allow myself the indulgence of reminding us all of some of those uses. It is estimated that a medium-sized economically viable establishment would employ 120 people. When hemp was widely grown back in the 16th century, in the enlightened days of King Henry VIII, it was used to manufacture rope and canvas for the King’s Navy, but we now know that we can make clothing, shoes, biodegradable plastic, insulation panels, food, paper, biofuels and medicine. Those products will sell and be profitable, and the Government could reap the benefits.

But the benefits do not end there. Hemp absorbs 22 tonnes per hectare of atmospheric carbon during its four-month growing cycle. Hemp produces four times the biomass of the same sized area of forest, which makes it a far more sustainable source of material. Hemp does not need pesticides, insecticides or fertiliser to grow in the UK. Hemp has natural anti-microbial properties, so it passively cleans the air in buildings. Hemp has a high capacity for moisture absorption, which allows for controlled atmospheres in buildings. Hemp construction materials act as a long-term carbon sink. One £60 million investment would create a facility that is capable of growing 32,000 acres per year. That would sequester over 207,000 tonnes of CO₂ per annum. That is the CO₂ photosynthesised by the hemp in its four-month growth and does not include the carbon sequestered into the soil or the net effect of replacing high embodied carbon products from international supply chains and their emissions.

As a wee bonus, hemp regenerates the soil that it grows in, so it would work well in crop rotation. It increases winter wheat and spring barley yields by 16% to 18% when they follow hemp in rotation. It cleans groundwater, by which I mean that it has a deep root mass that absorbs residual pesticides and insecticides from the soil, which prevents run-off into streams and rivers, and therefore avoids costly remediation by the water companies to achieve UK drinking water standards. The barrier to this industry raising the funding it requires is licensing. This is the licensing problem that, as far as I am aware, Hilltop Leaf, the company mentioned by the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale, is currently banging its head against. Hilltop Leaf wants to grow and expand. It has built the facility, but it cannot get a licence from the UK Government to allow it to expand.

The problem with licensing is the categorisation of cannabis. To make the cannabis industry a success, the Government have only to open their mind to the reality of what it is and distribute the appropriate licences to the appropriate growers. That will be possible only if cannabis is re-categorised. I welcome everything and anything that encourages the provision of medical cannabis, but the UK’s Government’s knowledge has to increase if they are truly to capitalise on the hemp plant and provide the good outcomes that are available. I would prefer the UK Government to come to the table driven by a desire to provide medicine for people suffering from a range of conditions—and we will need a supply chain from private companies to do that—but if they are drawn closer by the lure of tax revenue, so be it. But we cannot wait any longer. The patients who require medical cannabis to help them towards better lives have waited far too long for this Government to recognise their needs and act accordingly.

Finally, the argument that we need more research is no longer viable. The argument that cannabis is bad and that we cannot countenance its use is misplaced. Rather than standing on the sidelines shuffling their feet, it is now time for the UK Government to be proactive in funding and promoting the growth of the feedstock, the academic research and the production of the medicines, in providing and promoting the necessary training for GPs to allow them to prescribe, and in ensuring that the legal framework exists to allow those in the medical profession to carry out their duties, while protecting them and their patients, which by my reckoning would mean the involvement of the Department for Environment, Food and Rural Affairs, the Department for Business, the Home Office, the Department of Health and Social Care and—as there is no show without Punch—the Treasury. Minister, it is time to go to work.

--- Later in debate ---

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on securing this important debate, which would be considerably better attended if it was held on any other day, because I know from my inbox and from speaking to Members from across the House that there is considerable interest in this issue.

Although this is the first debate on this important topic that I have responded to as a Health Minister, I know that the House has debated medicinal cannabis at great length in the past, in good, constructive debates. I appreciate the depth of passion that hon. and right hon. Members from across the House have on this issue. I recently met members of the all-party parliamentary group for access to medical cannabis under prescription and, as mentioned by my hon. Friend the Member for Strangford (Jim Shannon), I visited one of Jazz Pharmaceuticals’s sites to learn more about the industry, the applications of its products—the medicines—and the challenges that it faces. I also learned about the huge opportunities for not just UK life sciences and UK plc, but, importantly, our NHS and patients.

I note that the interest from my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale is largely a constituency one; he talked about Hilltop Leaf. He has long championed investment in Scotland, particularly in rural and remote areas, where it has sometimes been a challenge in the past to attract certain high-skilled jobs. This issue is an example of that—and here, the investment would be accompanied by research capability. My right hon. Friend has eloquently and articulately made his case. I am very much alive to the fact that this is a complex issue, and complex issues rarely have simple solutions. I will try to respond to as many of the points that he and other hon. Members have made in the available time, which is reasonably substantial—in a Westminster Hall debate, it is rare to have more than seven or eight minutes in which to respond.

As my right hon. Friend pointed out, this issue crosses multiple Departments—the Department for Science, Innovation and Technology, the Department of Health and Social Care, the Department for Business and Trade and, vitally, the Home Office, which has been alluded to, and NHS England. There was mention of the calls to grow the UK CBD industry, and hemp farmers’ harvests. I am straying somewhat out of my health remit for a moment to polish off some of these points, in so far as I have the bandwidth to do so. I understand that the Home Office has no plans to permit cannabis cultivation without a licence—my right hon. Friend pointed to the licensing programme and the challenges thereto—or to remove the distinction between the industrial hemp regime and the standard cannabis cultivation regime. I cannot say anything more specific on that. As I hope my right hon. Friend will agree, it is well outside my area of knowledge and expertise, and my brief. However, I do understand, having done some rudimentary research and obviously from my conversations with Jazz Pharmaceuticals, that this relates to plants being grown outside versus inside, and the use of leaves and flowers specifically.

[Ronnie Cowan]

If the Minister is struggling to understand, I am more than happy to give him a copy of the report by the all-party parliamentary group on industrial hemp and CBD products called “A Plan for a Legal and Regulated UK Hemp and Cannabis Sector”.

[Will Quince]

I thank the hon. Member for that; I will gladly take a copy on the way out. I hope he will excuse the fact that I am not an expert in this field, but I will happily take that report as my weekend reading and read up on the subject. I certainly agree to take this up with my counterpart in the Home Office, as my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale requested, and I am sure he will, too. I will especially take away my right hon. Friend’s important points on licensing, and on how the Government can support companies that want to invest in the UK, or that are here and want to diversify their agricultural business, and want to get the licences required to grow these products.

[Will Quince]

I thank my right hon. and learned Friend for his intervention. I think we are probably in violent agreement on this point. I cannot specifically speak to regulation or licensing from a Home Office perspective. We are talking about a controlled drug; that may come as a disappointment to the hon. Member for Inverclyde, but it is—and is likely to remain, I hasten to add—a controlled drug. I will turn later to regulation from the perspective of the Department of Health and Social Care, but it is really important that there be consistency and coherence, and that we treat these products as we would any other medicinal product. However, my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale makes his point well, and I will raise it with Home Office colleagues.

More broadly on growing a UK CBD industry, I am of course aware of the growing consumer CBD wellness market. One only has to walk down any high street to see CBD products advertised in windows, and indeed in major supermarkets. DEFRA, which I did not mention, and the Food Standards Agency are taking action to regulate this side of the market. Importantly, that will protect consumers by ensuring that only safe, high-quality products are placed on the market. That is vital. Consumers will also be protected against misleading health claims. I was recently told about CBD products that come in aluminium cans, but in fact the CBD remains on the aluminium and is not contained in the product. That is just one example. This is a very complex area that I do not want to delve too much into, as it is very much a DEFRA and Food Standards Agency lead.

The Food Standards Agency is working closely with the Home Office on how CBD products are regulated, considering their composition and the possible presence of a controlled substance. This is very much a live issue, and I am told that the Home Office has sought the advice of the Advisory Council on the Misuse of Drugs. I understand that the Government intend to respond to the ACMD recommendations on this matter shortly.

My right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale and my right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright) both raised a point about regulatory barriers. Not that this reminder is needed, but it is perhaps helpful if I remind the House that cannabis- based medicines are controlled drugs and are therefore regulated by the Home Office, which is responsible for all controlled drug regulation legislation. Then there is the controlled drugs licensing regime, which supports cultivation, research and, where the issue crosses over into the health sphere, clinical trials in the UK. This licensing regime enables the possession, supply, production and import and export of those controlled drugs to support industry, pharmaceutical research and healthcare. However, more and more these products are being grown in the UK, including Jazz Pharmaceuticals, for use in research.

[Ronnie Cowan]

This time, when the ACMD makes recommendations to the Government, will the Government acknowledge and accept them? They have knocked back its recommendations a couple of times in the past, most recently over nitrous oxide.

[Will Quince]

The hon. Member tempts me—it is always tempting—to respond on behalf of another Government Department and Minister. I mentioned that because it is my understanding that the Government intend to respond to the report and the recommendations. I am not the responsible Minister, so it would not be appropriate to comment, but I will gladly point the hon. Member in the direction of the Home Office Minister who will have responsibility for responding, and will ensure that he has the opportunity to have a conversation with them.

The point I was making is that the overall legislative framework on illicit drugs seeks to control harmful substances while enabling appropriate access to those drugs for legitimate medicinal research and, in exceptional cases, for industrial purposes. The example I touched on is Jazz Pharmaceuticals, which—I do not believe this is a secret—is providing a product for clinical trials here in the United Kingdom. That is something that I think we all welcome. I know that the legislation has recently been reviewed by the independent ACMD, which concluded that no legislative amendments are currently required, as there is not yet sufficient evidence that the law needs amending.

Turning to a key point of the debate—cannabis for medicinal use, which falls firmly within my sphere of influence—I am hugely moved by so many of the cases that I have heard about, and I will come back to the specific cases that right hon. and hon. Members have raised today. These are really difficult, because my overriding priority as a Health Minister must always be to ensure that patients have access to medicines that are proven to be safe and effective. That is the biggest challenge, and it is why I am committed—the hon. Member for Bristol South (Karin Smyth) rightly challenged me on this—to galvanising research in this area; that is key to unlocking so much of this debate.

The prospect of a future in which more licensed— I put the emphasis on “licensed”—cannabis-based products that are proven to be safe and effective can be prescribed on our NHS to help relieve suffering is genuinely exciting. That is where I desperately want us to get to as quickly as possible, but herein lies the problem. There are clinical concerns, which, having spoken to clinicians, I share, about the limited evidence on the safety and efficacy of unlicensed cannabis-based products. Only in a few cases have enough clinical trials been done to prove scientifically that the drug is safe and effective. However—I want to labour this point—progress is being made.

Let me turn to the cases of Sophia and Alfie, which were raised by the hon. Member for Strangford and my right hon. and learned Friend the Member for Kenilworth and Southam. I have two young children and am deeply moved by these stories. The debate around medicinal cannabis often centres on children with difficult-to-treat epilepsy, for whom I think the law was changed under my right hon. Friend the Member for Bromsgrove (Sajid Javid), when prescribing was made legal in November 2018. Of course, as right hon. and hon. Members have pointed out, that was to enable those children to access a product that their families believed would ease the symptoms of their desperately difficult-to-treat conditions, if a prescriber deemed it clinically appropriate.

I know acutely, because I have spoken to campaigners and members of the all-party parliamentary group, that there is disappointment that the law change did not relate to routinely being able to get these products, funded, on the NHS; that is rightly governed by a range of processes and procedures, to ensure the equitable distribution of funding. The NHS prioritises medicines that have proven their safety, quality, efficacy and cost effectiveness. Coming back to the heart of the issue—the hon. Member for Bristol South is right to push me on this—that is why research is absolutely essential, and I will talk about that a bit more in a moment. The Government have done all we can to remove legislative barriers, but it is now largely up to the cannabis industry to prove that its products are safe and effective for children.

[Ronnie Cowan]

What you are saying is that if I can afford to pay for a private prescription, I can access medicine that you are saying is not proven to be effective, because you are not going to allow its use on the NHS; it has to pass other tests. What about bedrocan? That is manufactured in the United Kingdom, so we do not have to import cannabis from the Netherlands anymore. Hilltop Leaf wants to grow and help to produce the product. The supply chain is already there for us, but you will not allow it to be prescribed. You will not train GPs, and you will not give them the legal framework to work in so that they can actually prescribe that for children on the NHS, but if I can afford to buy it privately, I can buy it privately.

[Will Quince]

The hon. Gentleman raises a fair point, but he raises it as if this is something new or novel; it is not. All medicines in this country are either unlicensed or licensed. For use and prescription in the NHS, they need to be licensed. That means that they have gone through both the Medicines and Healthcare products Regulatory Agency process and the National Institute for Health and Care Excellence process, which proves that they are safe, effective and—through the NICE element—cost effective. That is the difference here.

The “cost effective” factor relates to NICE. That is the reason I talk about why it is important that the cannabis industry steps up and proves that its products are safe and effective. I did not talk about cost effective; I am talking about safe and effective, because that element is through the MHRA. Let us not forget that many of these cannabis-based companies are multinational; they are not telling me that they cannot afford to go through the same process that any other pharmaceutical company can go through and has done to get their products prescribed through the NHS. Part of it is research and part of it is those companies stepping up and proving that their products are safe and effective for these children, more generally, through the MHRA process.

[Ronnie Cowan]

I am curious. What we have done is—

[Graham Stringer (in the Chair)]

Order. Can the hon. Gentleman return to parliamentary language in this intervention? I am not participating in this debate at all. The hon. Gentleman referred to “you” in his last intervention, so I would be grateful if he could return to normal language.

[Ronnie Cowan]

The Minister is saying that he is allowing a licence for a product to be manufactured in the United Kingdom, in East Kilbride, so that is okay. We are allowing it to be manufactured here in the United Kingdom—that is all right. We are saying that people cannot get it on the NHS, but it is okay for other people to have it. Surely it has passed all the tests that we need it to.

[Will Quince]

I do not want to labour the point, but the point is that it has not passed those tests. It is either a licensed product or an unlicensed product. To be licensed, a product must go through the MHRA process. That is something that these products have not done to date. Yes, they can be manufactured here and prescribed privately, at the risk of the doctor—the private general practitioner—but for a product to be prescribed on the NHS, it needs MHRA and NICE approval.

There are some exceptions to that, because the law was changed in 2018, as my right hon. and learned Friend the Member for Kenilworth and Southam referred to, for a specialist doctor or for some very specific conditions. He asked why there have been only three prescriptions. I did not know that that was the exact figure, but I will check; regardless, it sounds very low. I suspect that the reason is that the decisions are taken at the doctor’s own risk, and among general practitioners there is reticence to prescribe an unlicensed product that has not gone through the MHRA and NICE process.

--- Later in debate ---

[Will Quince]

Thank you, Mr Stringer. My right hon. and learned Friend makes a good point. When we meet the members of the APPG, it is very hard not to be moved and to want to do all in our power to bring about the change that people want to see. I have considered the calls to change NICE guidelines, which have recently reviewed the basis of these products, but I am afraid the guidelines are unlikely to change until the evidence base develops, and that will happen through clinical trials and evidence. That is why I say all roads lead back to building an evidence base and a clinical trials base. That is the crux of this debate.

In January, the National Institute for Health and Care Research issued guidance recommending that the NHS prescribe cannabidiol to patients with a rare, seizure-causing genetic disorder, which is, I think, the fifth condition for which a cannabis-based treatment has been approved by regulators and offered to NHS patients in England. I understand that the treatment is also available and approved in Scotland and Northern Ireland. The NHS now funds thousands of these medicines each year.

I mentioned Jazz Pharmaceuticals earlier. I am not sponsored by it; it just happens to be the manufacturer and provider that I visited. It is a good example of the trailblazers in this space that not only create, but undertake the research, manufacturing and—the key part—licensing of cannabis-based medicines. It has shown what can be done. The key is very much in the research.

My right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale mentioned consistency and coherence in policy, which is why it is key that we treat cannabis-based products as we would any other medicinal product that we wanted to prescribe on our NHS. There is an economic case as well, although that is not what drives the Government. My whole focus in this is what is right for our NHS and patients. I am aware that there is huge hope and patient demand for access to medicinal cannabis, and that it is claimed that it can help with an array of medical conditions from chronic pain to anxiety; I believe there is also research under way at the moment on how cannabis-based products might be able to help with psychosis. I very much hope that those trials are successful. That is the right approach.

To date, much of the evidence suggesting cannabis could be an effective medical treatment is anecdotal or observational. As I mentioned earlier, only for a handful of conditions have enough clinical trials been done to prove scientifically that the drug is safe and effective. However, I am acutely aware that there are thousands of patients who now pay to access those unlicensed products on private prescriptions. Having spoken with campaigners and members of the APPG, I also know that some patients believe that funding cannabis on the NHS will reduce overall healthcare costs by alleviating symptoms and reducing the extent of hospital visits and other treatments. I understand and hear that case, but—I apologise for labouring the point; I have to keep coming back to it—before any new medicine can be proven to be cost effective, it must be proven to be safe and clinically effective. That is why research is so essential.

The Labour Front-Bench spokesperson, the hon. Member for Bristol South, asked what steps we are taking. That is a challenging question, because it is a pioneering area of research. Following collaborative work with clinicians and patient representatives, the NIHR and NHS England have confirmed support for two clinical trials into early onset and genetic generalised epilepsy. If you will permit me, Mr Stringer, I would love to use this debate to highlight a tender opportunity that will be launched by University College London in the next few weeks. UCL is seeking a supplier to assist in a world-first randomised control trial comparing cannabis-based medicines containing CBD and THC in the treatment of drug-resistant epilepsies in adults and children. I hope that that tender process is successful and that UCL finds a commercial partner to supply products for the trials so that they can commence as soon as possible.

[Ronnie Cowan]

I have three kids and two grandkids. If one of them was suffering from intractable epilepsy and I had them on bedrocan, and they were either seizure-free or had the condition under control, I would not want to hand them over to a random control test where they might be fed a placebo and therefore incur more damage. Would the Minister?

[Will Quince]

That is a difficult question to answer. We need people to take part in clinical trials, which are the answer to so many of the challenges that we face in the health sphere. That is how we build the evidence base. I do not know what the study will involve in terms of the detail and the potential for a placebo, but I will put the hon. Gentleman in touch with UCL and those who are looking to run the trial so that they can give him a measure of comfort and reassurance. On his point more generally, the biggest risk is that the industry does not engage with the tender process. Notwithstanding the hon. Gentleman’s point, I hope that all right hon. and hon. Members here today will help me by amplifying my call for the cannabis industry to come forward and engage with this pioneering and world-first research. I have also committed to a roundtable with the all-party parliamentary group, and I invite all right hon. and hon. Members in the Chamber today to attend that, too, because it is very important that we hear all of the issues.

Once again, I thank my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale for securing this really important debate. I look forward to engaging with him and Members from all parties. To the point made by the hon. Member for Bristol South, I am absolutely committed to better determine why the cannabis industry is not, in the way that so many other pharmaceutical companies do, investing in the routine research required to prove that its products are safe and effective. I will of course explore how best to engage with industry on the issue. Until then, I implore companies to explore supplying their products to the UCL clinical trials. As I have said, they will be a world first and will give us the evidence that we need to determine whether the products should be funded in the NHS. I wish them every success. I genuinely hope that they provide that evidence base.

On the matters concerning the cultivation and licensing of cannabis and cannabis-based products, I will, as I promised my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale, raise that with my counterpart, the Minister for Crime, Policing and Fire, who I know will champion this cause, too. I thank all right hon. and hon. Members for their contributions to this afternoon’s debate.

Oral Answers to Questions

Ronnie Cowan Excerpts

Tuesday 19th July 2022 Commons Chamber

[Steve Barclay]

The House recognises how my right hon. Friend has championed this issue over many years. There can be few more emotive issues than the one she draws to our attention. Of course, in keeping with my predecessors, I would be very happy to engage with her on this important issue.

[Ronnie Cowan (Inverclyde) (SNP)]

T7. [R] I refer hon. Members to my entry in the Register of Members’ Financial Interests. I am asking specifically about intractable epilepsy. Three NHS prescriptions have been written for the appropriate medicine, so we have proven that that can be done and that the medicine can be provided free on the NHS. When can families and friends, who scramble every month to raise thousands of pounds to pay for private prescriptions, reasonably expect to receive this medicine on the NHS?

[James Morris]

I thank the hon. Gentleman for his question, and I deeply sympathise with patients and families who are dealing so courageously with the difficult conditions that he describes. The Government are taking an evidence-based approach to unlicensed cannabis-based products to ensure that treatments are safe and effective before they can be considered for routine funding within the NHS. Whether to prescribe cannabis for medicinal use must remain a clinical decision, and public funding arrangements apply, as they do for all other medicines. The Government remain committed to research and catalysing the generation of evidence to support the use of these products. The National Institute for Health and Care Research remains open—

Oral Answers to Questions

Ronnie Cowan Excerpts

Tuesday 14th June 2022 Commons Chamber

[Sajid Javid]

The right hon. Gentleman will know that I have visited the site and spoken to local members of the trust. It is a project that we support, and we are in the final stages of the final approvals.

[Ronnie Cowan (Inverclyde) (SNP)]

As was pointed out by the hon. Member for Lichfield (Michael Fabricant), this Government promised medical cannabis on the NHS 1,183 days ago. Since then, a child with epilepsy will have experienced, at a modest estimate, 35,490 seizures. We have free NHS prescriptions, which proves that the medicine exists and is approved for use in the United Kingdom. How much longer must those children suffer?

[Maria Caulfield]

As I have said, I met the Scottish Minister on this. Scotland is facing exactly the same problem. Where medicinal cannabis is licensed, 9,631 prescriptions have been issued in primary care and 58,000 in secondary care, thanks to my right hon. Friend the Secretary of State who changed the law at the time.

Government Action on Suicide Prevention

Ronnie Cowan Excerpts

Wednesday 8th June 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bone. I thank the hon. Member for Bristol East (Kerry McCarthy) for securing this debate on suicide prevention and for hosting the recent event, “Breaking the Silence”, during Mental Health Awareness Week. I have a feeling there will be many such meetings and conversations, to which I look forward. Awareness is something we often struggle with in Government, to ensure that people are aware of what we are trying to do and the consultations to hear their voices. That event was brilliant and put a spotlight on that. I also thank Bernard and Stephen, who came along. It was powerful to hear from them, as they marked the death of Joy Division singer Ian Curtis 42 years ago, as well as all the other personal experiences expressed there.

I very much agree with my shadow Minister that such personal experiences are so important. They are important in every aspect of my job, but none more so than in suicide prevention. I must admit that when I first saw that in my job title, it felt overwhelming. Every life lost to suicide is a tragedy. Everybody wishes they could go back and reverse time. It is so, so sad. We heard from the Speaker about his personal tragedies. Every single suicide is a tragedy, but every suicide is, on some level, preventable. That is what we are here for: to work towards preventing as many suicides as possible.

Sadly, like many here today, I know the pain of losing a family member—we lost my cousin Sallie, who I babysat for from a very young age. When someone takes their own life, it affects everybody. I thank Mr Pirie and Mr and Mrs Ritchie, who I have met before, for sharing their stories of Tom and Jack, and for coming up with constructive suggestions on how we can work to help other people who are in those situations, to improve our systems and to learn from those experiences. We know that the right support at the right time can provide hope and prevent a crisis, and can prevent a crisis from becoming a tragic loss of life. We look forward to continuing to work with Mr Pirie and Mr and Mrs Ritchie, and many others.

[Ronnie Cowan (Inverclyde) (SNP)]

I wonder whether the Minister will address gambling-related harm. This is a complex issue—we all get that—and it will require cross-departmental co-operation to find some sort of solution. There is an imminent opportunity coming along—there is a White Paper on gambling reform due, I am told, within weeks. Will the Minister engage with the Department for Digital, Culture, Media and Sport and help it to understand the issue, so that it can strongly regulate gambling, which would help to alleviate the number of gambling-related suicides?

[Gillian Keegan]

The hon. Gentleman has my assurance that I will definitely work cross-Government, with the Under-Secretary of State for Digital, Culture, Media and Sport, my hon. Friend the Member for Mid Worcestershire (Nigel Huddleston) who actually sits in the office next door to me—he finds it very difficult to escape. I think that answers the questions from the hon. Member for Bristol East about whether there are ongoing conversations, which will also continue into the future.

I am happy to visit Paul’s Place. As the hon. Member for Liverpool, Walton (Dan Carden) knows, I am often back in Liverpool, visiting my parents and friends. The first visit I made in this role was actually to James’ Place, also in Liverpool, which was set up by a constituent of mine, Clare Milford Haven, who set up the charity after the tragic death of her son, James. We met in Liverpool, but she was a constituent of mine down in Chichester. Every time I go to one of these places, I learn—every time. There are so many families trying to help the next family avoid the tragedy of losing a loved one.

I also met Tim, Mike and Andy—the 3 Dads Walking. They have done a fantastic job, walking round the whole country. They came to tell me the stories of their three daughters, Sophie, Beth and Emily, who all tragically died by suicide. They told me about the number of people who came out to take part as they walked around the country. There is that saying, “Walk a mile in someone’s shoes.” They were walking a mile together, talking about their experiences. They said that many people had never spoken about their experiences before, because they still felt there was some stigma attached to it. One of the fantastic things about having these conversations is the de-stigmatisation of not only suicide, but mental health conditions in general.

One of the things I have learned as Minister for Mental Health is that anybody can have a mental health issue at any point in their lives. One, two or three things happen that they were not expecting, and anybody can be in that situation, but everybody can recover and manage their mental health. If I can achieve one thing in my role it would be for everybody to really understand that and for us to put the services in place to address it—that is what I hope to do.

I recognise that the last two years have been exceptionally difficult. They have impacted on the mental health and wellbeing of many people, and many will have experienced harmful or suicidal thoughts. The shadow Minister for Mental Health, the hon. Member for Tooting (Dr Allin-Khan), raised the concern that too many people are having to resort to A&E in a crisis. That is why mental health service providers worked across the country at pace during the pandemic to establish a 24/7 urgent mental health helplines for anybody of any age in crisis. Those services are now operational in every area of England, handling 230,000 to 250,000 calls each month. That service was not there before the pandemic; we have tried to respond and to respond quickly.

The long-term plan also committed to increasing the forms of provision for those in crisis, including safe havens and crisis cafés, providing a more suitable alternative to A&E. We know we need to do that. There are some excellent examples throughout the country, including the Evening Sanctuary at the Mosaic club in Lambeth.

Oral Answers to Questions

Ronnie Cowan Excerpts

Tuesday 1st March 2022 Commons Chamber

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

The hon. Lady is absolutely right, which is why we are working cross-departmentally to bring forward a mental health strategy. It is also why we have put in place mental health recovery funding specifically for the recovery from the pandemic, which has had a terrible effect on children’s mental health.

[Ronnie Cowan (Inverclyde) (SNP)]

The Secretary of State is on record saying:

“Making medicinal cannabis available on prescription will benefit the lives of ill patients currently suffering in silence. There is nothing harder than seeing your loved ones in pain”.

Since he said that, there have been three prescriptions for medical cannabis on the NHS. They are important, because they set a legal and medical precedent that it can happen, and it can happen now. Currently, however, if I can afford it, I can buy it, but if I cannot, I cannot. When will he address that anomaly?

[Sajid Javid]

The hon. Gentleman will know that for medicines to be generally available on the NHS, they have to be deemed safe and effective by the independent medical regulator. That requires trials to take place and that is where the focus should be. Those who want those medicines to be more easily available should encourage the companies that produce them to have trials and the NHS will support them in doing so.

Medical Cannabis: Alleviation of Health Conditions

Ronnie Cowan Excerpts

Thursday 4th November 2021 Commons Chamber

[Ronnie Cowan (Inverclyde) (SNP)]

I beg to move,

That this House has considered the matter of the use of medical cannabis for the alleviation of health conditions.

I would like to start by paying tribute to the mums and dads, brothers and sisters, grandparents, guardians, extended families and friends who have campaigned diligently, respectfully and passionately to bring about the reform in access to medical cannabis that they so desperately desire. Many are full-time carers, with all the pressure and time constraints that that entails, yet they have found the time and the commitment to energise a campaign—a campaign that far too many politicians and medical professionals have turned a blind eye to.

I would like to thank the Backbench Business Committee for supporting me in bringing this debate forward today. I would also like to thank those Members who have reorganised their diaries and travelling arrangements to be here today. There are a number of MPs who would normally be here today to debate a subject that is close to their hearts, but for a variety of reasons, not least COP26, they are not. I guarantee they would all support any move by this Government to make it easier to access or research medical cannabis. I have never heard any MP argue against those objectives. There is confusion about drugs in general, which tempers some people’s desire to speak out, but the provision of medicine to sick people is not an issue.

[Catherine West (Hornsey and Wood Green) (Lab)]

I congratulate the hon. Gentleman on securing cross-party support for this debate. On research, does he agree it is encouraging to see the potential curative effects of various elements of this drug, as we call it, in treating very serious forms of epilepsy?

[Ronnie Cowan]

It is great to see that research has now been undertaken, and I have a list of five or six projects looking at medical cannabis across a range of different medical conditions, but there is still the issue that many academic organisations cannot get access to the cannabis or hemp plants they require because they are graded as category 2, which keeps the plants out of their hands. The paperwork and processes they have to go through to access the raw product are prohibitive, and recategorisation from category 2 to category 4 would aid the research of a host of academic establishments.

Why are we not making it easier for people to access medical cannabis? Why are people who would benefit from medicine derived from the hemp plant being denied that opportunity? Why can some medicines be purchased on private prescription only? Why are we not making medicines that are widely available in other countries available in the United Kingdom?

[Margaret Greenwood (Wirral West) (Lab)]

I congratulate the hon. Gentleman on securing this debate. He is making some important points. One of my constituents lives with progressive myelopathy of uncertain cause that affects his mobility and causes him to suffer brain fog, exhaustion and almost constant pain, which he has described as feeling like “hot wires” being pulled through muscles and skin. Does the hon. Gentleman agree there is real urgency to this issue because of people like my constituent who are suffering on a daily basis?

[Ronnie Cowan]

Of course I agree, and I understand the difficulty in which the Government find themselves, particularly the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), who is new in post. We need solid research that proves the efficacy of medicines, but behind that we have people who are living with these extreme conditions, day in, day out, for an awfully long time. We have been slow to get to this stage, so there is every reason why the Government should accelerate the research in such cases.

Over the last week or so I have met representatives from the Multiple Sclerosis Society and End Our Pain, and over the years I have heard representations from a much wider range of organisations and individuals that see medical cannabis as at least part of the solution to their or other people’s health issues. There are two licensed cannabis medicines, Epidiolex and Sativex, which are both made by GW Pharmaceuticals. There is nothing wrong with these medicines, but they are isolates, or very nearly, and isolates simply do not work as well as full spectrum products, and they have more side effects.

A full spectrum cannabis product contains all the different cannabinoids and terpenes found in that strain, whereas an isolate product contains only one chemical, such as cannabidiol in Epidiolex. There is published evidence that the full spectrum products are twice as good as the licensed Epidiolex in the treatment of seizures.

Then there are the unlicensed cannabis products that account for virtually all privately prescribed products. Unlicensed products are not routinely prescribed by NHS clinicians, but they can be prescribed by a specialist doctor on the General Medical Council’s specialist register. There are now about 10,000 private prescriptions, 60% for pain, 30% for anxiety and similar conditions such as post-traumatic stress disorder, and 10% for other conditions including neurological conditions, such as epilepsy and MS, and some cancer and gastrointestinal disorders such as Crohn’s. It is clear that medical cannabis can aid a wide range of conditions.

All imported products are imported because the Home Office has been slow in granting cultivation licences for high-THC plants in the United Kingdom, and matters are made worse by the cumbersome import process. Three years and three months after the current Secretary of State for Health and Social Care, while he was Home Secretary, changed the law to allow prescriptions for medical cannabis, we still have only three NHS prescriptions.

As I mentioned in yesterday’s Westminster Hall debate, and it is worth repeating, Hannah Deacon, whose son Alfie is in receipt of one of those NHS prescriptions, has written to the Health Secretary three times to ask him to help, as he promised her he would in writing when he was Home Secretary, but all three letters have been ignored. Why, three years and three months later, are there so few NHS prescriptions?

Basically, doctors are not trained in cannabis medicine, although several teaching programmes are now available. However, the main barrier is the rather unhelpful guidance produced by the National Institute for Health and Care Excellence, which has looked at cannabis as if it were a pharmaceutical product, but it is not. We need better guidance written by people who understand the plant, not by those who understand only pharmaceutical medicine.

We also need acceptance of the validity of real-world evidence. The British Paediatric Neurology Association recently reviewed its guidance on prescribing medical cannabis in cases of intractable epilepsy, about which I have a number of serious concerns. If a family go ahead with a private prescription for medical cannabis, the guidance appears to say that the NHS paediatric consultant should insist that the private paediatric consultant takes on 24/7 care.

I am extremely concerned that this is a further attempt to make private prescribing so burdensome as to deter private prescribers. No private prescriber will have the infrastructure to provide this level of wraparound care. My concerns are further increased as this appears to have happened to one family already, and I have a letter supporting my concerns. I am pretty sure that washing their hands of patients in this way is not legal. Will the Minister immediately examine this issue and seek clarification from the BPNA that this is not the interpretation, and will she insist that the guidance is removed or changed?

Many barriers would be broken if general practitioners were allowed to prescribe, and a recent survey shows that a quarter of GPs would be happy to do so. That would require a simple change of the necessary statutory instrument under the Misuse of Drugs Regulations 2001 and would not require parliamentary time. I notice that, as of today, a leading UK insurer is now offering insurance cover at rates not dissimilar to normal cover for doctors prescribing medical cannabis.

To make this easier, there should be a focus on where the evidence lies for prescribing indication-specific, medicalised, pharmaceutical-grade cannabis. We must build on the legitimacy and efficacy of these medicines through the implementation of structured approaches to prescribing, which would help the UK healthcare system to be more inclined to prescribe cannabis sensibly.

In our debates in this place on refusing access to immigrants, health and safety in the workplace, poverty and welfare, I have heard the question many times: “Does somebody have to die before we take action?” Well, people are dying and people are living in unnecessary pain and discomfort.

I have four questions for the Minister. Will the Government recognise the value of real-world evidence, such as the research of Drug Science—including Project Twenty21—as proof of the efficacy of medical cannabis and stop insisting on randomised controlled trials, which are particularly unsuitable for rare forms of epilepsy in children? Do the Government have any plans to conduct a health economics analysis to investigate the cost-effectiveness of medical cannabis? Will the Government meet the costs of prescriptions for children requiring Bedrocan’s Bedrolite or similar products? And if a child was suffering from an epileptic seizure and the Minister had the medicine in her hands, would she administer it? I am sure the answer to the last question is yes, so will she please help to put that medicine into the hands of those who care for these children?

Finally, access to medical cannabis will someday be the norm. We need to confront the obstacles that exist today and clear the path for better access tomorrow.

--- Later in debate ---

[Ronnie Cowan]

A vital point was made there about who should be prescribing this. Dr Martinez, the retiring private prescriber of medical cannabis, has written to the Secretary of State for Health and, on the group she prescribes for, she said:

“I know that a majority of the GPs dealing with this group of children wish to prescribe, but, in order to do so, this requires a change of policy from the Health Department because it is CBD medication which has been treated differently to other controlled drugs.”

The solution is there. I get the point that parents can agree to a waiver, but they should not have to. This can be changed, and the Secretary of State for Health has been asked to do this by a consultant.

[Alex Norris]

That is very handy timing from the hon. Gentleman because I was just about to make that point. Following that retirement, Robin Emerson, the father of Jorja Emerson—he is behind the Jorja Foundation and has been campaigning tirelessly—has written to the Secretary of State and the Prime Minister asking them to intervene, but my understanding is that he is yet to receive a reply. I hope the Minister will commit to that being immediately addressed because this is very important indeed.

I will make a couple of final points before I finish. I listened very carefully to what the Minister said in the debate yesterday—we are in a novel position of having them on consecutive days, which is helpful—and it is clear that the Minister considers it a clinician issue rather than a political one, but that is not working at the moment. We are in a strange situation of there being so much concern about the nebulous long-term effects of these prescriptions that that is seen as better than, say, leaving a child fitting 100 times or more a day. It is rather like not throwing a rope to a drowning person for fear of their burning their hands on it. I find that hard to imagine, but we are in such a situation.

I fear that merely putting this at the door of clinicians is defending the status quo. I feel that we in this place do have agency and, indeed, a responsibility to act. I hope to hear from the Minister that there is going to be a greater drive from the Department to encourage clinicians. My hon. Friend the Member for Manchester, Withington offered suggestions on the training that I know is out there, and again I am keen to hear what we can do to have that picked up more reasonably.

Across this debate and the debate yesterday, clear themes have emerged: better research, or perhaps creative research, as the hon. Member for Edinburgh West said; better engagement with clinicians, again with the points my hon. Friend the Member for Manchester, Withington made; and, for goodness’ sake, immediate relief for families in the system now. They are going through things we would never tolerate for ourselves or would absolutely hate for ourselves, and I feel we that have a real responsibility to step that up.

I think there is broad consensus on this, and we now need to come together on a flexible solution to do it. Just as the SNP spokesman, the hon. Member for Stirling (Alyn Smith), said, we will support the Government if they bring that forward. This is something I think we all share, and the families are watching us and waiting for us to do it.

--- Later in debate ---

[Maria Caulfield]

I take my right hon. Friend’s point. I will come on to that, and to timelines for the research that is in progress. Many of the products that we are talking about have not been licensed by any licensing authority across the world, including the Food and Drug Administration, the European Medicines Agency and our domestic MHRA. This is not just a UK problem; it is not the UK Government who are holding this back.

As I said yesterday, I encourage manufacturers of these products to invest in clinical trials. Part of the Department’s work is providing funding for the National Institute for Health Research, which is actively opening its arms to charities, academics, researchers, manufacturers and third-sector organisations. Funding is available for clinical trials, if anyone wants to come forward with one, be it a randomised control trial, an observational study, a randomised control trial without a placebo arm, or a phase 1, 2 or 3 clinical study. The MHRA is willing to provide advice and support to any potential applicants who want to conduct a clinical trial or seek a licence for their medicines. There is funding and support; we need researchers to come forward with clinical trials.

[Ronnie Cowan]

A lot of research institutes are restricted in what they can do because they are trying to access a category 2 product. If it was category 4, life would be a lot simpler for them.

[Maria Caulfield]

The hon. Gentleman makes an excellent point, and going forward we perhaps need to unblock some of the blockages in that area. I take that point on board.

Clinical trials and the licensing process provide evidence and information that doctors rely on to support their treatment decisions. Many clinicians have fed back that they are reticent to prescribe these products until there is more evidence, because ultimately they are responsible for their patients when it comes to a treatment’s safety and effectiveness. Doctors are particularly unwilling, given the THC element of cannabis products; there is some emerging data and evidence of harm, particularly to children, including effects on the developing brain and heart. That is why the evidence base is so crucial, but I am happy—I say this especially to the hon. Member for Manchester, Withington, who sponsors the Medical Cannabis (Access) Bill—to consider what blockages could be unblocked to speed that process up.

Doctors are right to be cautious when prescribing any product if they are not confident in the evidence base. As I said yesterday, I am clear that prescription remains a clinical decision, as does prescription of any medication. It would be inappropriate for the Government to force clinicians to prescribe a medicine, but we will try to unblock some of the licensing blockages.

Let me highlight some of the studies that are starting to take off. This might have been mentioned, but from 1 April we have the establishment of clinical trials for NHS England and the NIHR. We have introduced a national patient registry, which will record patient outcomes, with a view to its being rolled out across the devolved Administrations. It is England-only at the moment. We are aiming to record the data of those who receive the medicines, and to consider side-effects, efficacy and a whole range of issues, in order to support clinicians working with patients, and to start to build an evidence base.

In addition, a randomised control trial is being set up. It has three arms, which will include one arm with CBD or THC, and one arm with a placebo. We expect it to open fairly soon. Those looking to access these drugs—children in particular—will be able to do so in a blinded way and can take part in the study. If the data come through relatively quickly, that will open up opportunities to submit evidence to the MHRA.

[Ronnie Cowan]

Who would offer a child who is on medication that stops them having 100 seizures a day a random test that potentially contains a placebo?

[Maria Caulfield]

I take the hon. Gentleman’s point, but many children are not accessing this medication, and this is a route to that. As I explained in yesterday’s debate, clinical randomised control trials with a placebo arm have extremely strict rules, and if one arm of the study is showing incredible progress and doing better than the other arms, the study must be stopped, patients unblinded, and everyone switched to the arm that is doing the best. In some circumstances, that has enabled people to access drugs under clinical research in a much quicker way. It does have some advantages.

--- Later in debate ---

[Ronnie Cowan]

I thank everyone who attended the debate and spoke. I want to pull the Minister back to one thing that I asked about. Will she please look at the most recent information from the BPNA? If I am interpreting that correctly, it will make prescribing more difficult. I hope I am wrong, but she has far more medical experience than I have.

We developed a covid vaccine in under a year, and rolled it out across the country to massive numbers of people, and it was free to those who needed it. I ask that we bring the same sense of urgency to this debate. To all the parents and others watching the debate—I know they are watching, because they have been texting me since I sat down an hour and a half ago; many of the questions I put to the Minister came from parents from around the United Kingdom—I say: thank you for driving this campaign forward. I hope that it does not end here, and that the fight goes on—hopefully in an amicable fashion. I hope we can all do better for all of you.

Question put and agreed to.

Resolved,

That this House has considered the matter of the use of medical cannabis for the alleviation of health conditions.

Adjournment

Resolved, That this House do now adjourn.—(Gareth Johnson.)

Medical Cannabis under Prescription: Children with Epilepsy

Ronnie Cowan Excerpts

Wednesday 3rd November 2021 Westminster Hall

[Ronnie Cowan (Inverclyde) (SNP)]

I congratulate the hon. Member for South Leicestershire (Alberto Costa) on securing the debate. It is great to see a Minister from the Department of Health and Social Care responding today, because for far too long we have been talking to the Home Office about these issues. I believe that the Minister is an ex-nurse, if there is such a thing; perhaps it is “Once a nurse, always a nurse.”

Yesterday in Portcullis House, family members came to tell us their heart-rending stories, yet again. As we politicians listened, the feeling of, “What can we do?” sank into us. We went over to No.10 Downing Street and delivered a letter—another letter—explaining the situation to the Prime Minister. During the course of the day I talked to a number of parents, and one of them asked me a question that I have been asked many times, but every single time it hits home: “What would you do if it was your child? What would you do if your child was suffering 30 seizures and more a day? Would you reach for the rulebook, or reach for the medicine— if you could afford it, because right now, in this country, if you cannot afford it, you are not getting it?”.

There have been only three NHS prescriptions, as was mentioned, despite the now Health Secretary promising to do everything he could to help. I am fascinated by that; three means that there is precedent. We have broken the dam. If there were none, it would be a different argument—but there have been three. Why not 30? Why not 300? Why are we still scrambling around for these things? Hannah Deacon, who has been mentioned often in this debate, and whose son Alfie is in receipt of one of those NHS prescriptions, has written to the Health Secretary three times asking him to help, as he promised to do when, as Home Secretary, he wrote to her. All three letters have gone unanswered. Some politicians are hiding behind medical professionals, and some in the medical profession are hiding behind politicians. The parents of these children have no place to hide. They have to manage the reality of the situation day in, day out. We need progress. We need to accept the validity of real world evidence. Asking kids to take part in trials with a placebo is abhorrent.

Many barriers would be broken if GPs were allowed to prescribe medical cannabis. At the moment, they cannot initiate prescriptions but can follow up. Cannabis is largely a GP medicine, given its efficacy in GP conditions such as pain and anxiety. It would be of enormous help to allow GPs to initiate prescriptions. A recent survey showed that about a quarter of GPs would be happy to prescribe it. This would require a simple change to the relevant misuse of drugs statutory instrument; it would not require parliamentary time.

I look forward to tackling this issue in much more detail tomorrow in the Chamber. I hope that we can investigate all the problems, and ultimately come up with solutions. We have talked round and round this subject for a long time. Three years and three months on from a promise by the UK Government to make medical cannabis available, we are still no further on. It is a crying shame that these people are still living in hope—living, I have to say, in desperation at the situation they find themselves in. They are looking to us politicians to do something about this. In my privileged position, I am sick to death of having to say to those people that we are no further forward.

Please, Minister, take on board what we have heard today. Politicians are asking the Minister, cross-party—a very rare thing—to look at the situation and do what she can, now and in the longer term. On what could be done now, if there was a fund that we could reach into to pay for these prescriptions, that would be a massive step forward, including for the parents and guardians of these children, who, day in and day out, are asking us to do something for them.

--- Later in debate ---

[Maria Caulfield]

There are concerns, particularly around the THC element, that there could be some effect on the developing brain and on heart conditions. Research is needed not just on the effect of the drugs, but on their safety.

I want to point out that the Government have made funds available for good-quality research. That does not have to be done by the manufacturers; it can be done by charities, clinicians or researchers. A range of people can come forward to carry out clinical research. The MHRA—

[Ronnie Cowan]

Will the Minister give way?

[Maria Caulfield]

I will not; I have only a couple of minutes left.

The MHRA is well equipped to provide advice to any applicants wishing to conduct clinical trials.

[Maria Caulfield]

I have literally got two minutes left.

Currently, 13 trials are ongoing across the United Kingdom. In the previous 12 months, six of the other trials of cannabis-based products were completed, so some research is coming through the pipeline to help with that evidence base. I want to touch on one—the randomised clinical control trial mentioned by my hon. Friend the Member for South Leicestershire.

It is true that one study has three arms, one of which is a placebo. Having worked in clinical research myself, I reassure my hon. Friend that there are strict ethical guidelines for any clinical research. If someone is allocated to the placebo arm but it is clear when monitoring the research that one arm is doing significantly better than another, the trial has to be unblinded. Anyone on a placebo arm is automatically put on the arm that is doing best. I worked on clinical research for breast cancer, when we were trying to get Herceptin licensed, and for some patients that was the quickest way to get the drug. If there is clear evidence that one arm is working far better than others, patients can be moved on to that arm. It is a way of fast-tracking the drug for licensing.

I reassure Members that I absolutely understand the issue. The Government have changed the law to allow use of medical cannabis, but unless we give clinicians the confidence that the drugs, first, work—a feeling that they do seems to be the consensus in the Chamber—and, secondly, have a safety profile, they will not prescribe them. We can debate it forever in the House, but the clinicians have to be convinced. The way to do that is to get the product licensed, and the way to do that is to get good-quality research that the MHRA can look at to feel confident in licensing that drug.

The Government’s view is that there is funding for such research. My commitment to Members present today is that I will work with other colleagues to see whether we can speed up applications for research, encouraging them to come forward. For many Members, that is not the answer that they wanted to hear; they want me to stand up and say, “The drugs will be available tomorrow and we have people to prescribe them.”

[Ronnie Cowan]

We have to re-categorise cannabis from schedule 2 to schedule 4. That will open the gateway to medical research. Right now, it is hard for a lot of medical researchers to gain access to the product in the first place.

Dame Carol Black’s Independent Review of Drugs Report

Ronnie Cowan Excerpts

Wednesday 27th October 2021 Westminster Hall

[Ronnie Cowan (Inverclyde) (SNP)]

Thank you for allowing me time to speak, Ms Fovargue. I congratulate the hon. Member for Liverpool, Walton (Dan Carden) on securing the debate.

Having read Dame Carol Black’s “Review of drugs part two” several times now and having listened to her present and answer questions on the report, I find myself increasingly frustrated, not with Dame Carol Black, but within myself. The inadequacies of the existing system are laid bare for all to see in the report. Crucial areas that must be addressed are explained and, as we have heard, 32 recommendations are detailed. Drug treatment, recovery support, funding, commissioning, diversion, employment, housing, mental and physical health, prevention, intervention and research—the report has recommendations on them all. It is right and proper that we tackle drug policy in that way. Patching will not do; we need reform on a grand scale, put into the hands of the people best placed to make it effective.

For too long, drugs have been designated as a matter for the judicial system, and our health services have been left to pick up the pieces. The report puts health at the heart of the solution and should be commended for doing so. However, apart from making recommendations, there is nothing that the report or I can do. That is the cause of my frustration. Dame Carol Black is absolutely clear that if the UK Government start to pick and choose which of her 32 recommendations to implement, it will not work. I applaud her for saying that. Too often we make do and mend with policies that have been ripped up and rewritten.

The Misuse of Drugs Act 1971 is a case in point. For 50 years, it has made the situation worse, but to expect the UK Government to have a sudden blinding flash of understanding and compassion would be naive. They will not implement many of the recommendations; they will pick a few, dress up a few others, pay lip service to some and ignore the rest. I say that with confidence and a heavy heart: confidence, because the UK Government just do not get the issue of drug addiction and harm—while the administration of the area continues to be held in the Home Office, the situation will not improve—and a heavy heart, because as people in the drug rehabilitation community keep telling me, “You keep on talking and we keep on dying.”

That is not Dame Carol Black’s fault. As my hon. Friend the Member for Edinburgh East (Tommy Sheppard) mentioned, Dame Carol’s remit was deliberately precise. She was not allowed to recommend any new legislation, which in effect neuters her report. How can she be expected to identify improvements for a system that is tied up and gagged by the law if she cannot suggest some changes to the law? Dame Carol Black, however, had a good go at that by recommending a new structure for the mechanics of government which, if it were allowed to function, could within itself produce the required legislation. I am sure that Dame Carol Black would be happy with the outcome: she feeds in all the good ideas and the UK Government put them through a mincer, come up with a solution that she proposed, and implement it, taking the credit.

To be honest, I would be more than happy if that happened, but I just cannot see it, because one recommendation is the creation of a new central drugs unit. According to the report, that unit should be placed

“in whatever department or joint arrangement seems appropriate”.

Unless that Department is the Department of Health and Social Care, it is a non-starter.

The intransigence of the Home Office has been a feature of this UK Government, and I cannot see that changing any day now. I expect warm words for Dame Carol Black’s report, which could be seen as progress, but I do not expect that the UK Government will do anything other than launch inquiries, form committees, divert responsibility and talk about budgets and constraint. However, I am pleased that we have a Minister from the Department of Health and Social Care present, because historically the UK Home Office is where good ideas go to die.

At the start of Dame Carol Black’s report, as has been said already in the debate, but it is worth repeating— I love this quote—she states:

“Government faces an unavoidable choice: invest in tackling the problem or keep paying for the consequences. A whole-system approach is needed”.

She is absolutely correct. I say to the Minister, go on: agree to all 32 recommendations, fund them and put the power of implementation into the appropriate Departments, proving me 100% wrong—please.

Medicinal Cannabis

Ronnie Cowan Excerpts

Monday 6th September 2021 Commons Chamber

[Sir Mike Penning]

We are not reinventing the wheel, as my hon. Friend says: we started this but are now lagging behind the rest of the world. The product is slightly different—the oil has different forms of THCs in it. The Minister used to be my Parliamentary Private Secretary all those years ago—how the mighty fall, and how the mighty have risen up the greasy ladder—and she is passionate about trying to help on this, but it is not about Epidiolex; it is about the particular product being prescribed actually working, and it is normally to do with the levels of THCs.

I think this problem might be to do with the terrible word “cannabis” that we use in this country. This is not anything to do with cannabis, really; I wish we could invent another name for it and just say “oil with TCHs in it”, because that would eradicate much of the fear that there is at present—and it is not just fear, it is dangerous to the argument.

[Ronnie Cowan (Inverclyde) (SNP)]

I feel a little sorry for the medical profession, because a slight correction should be made. Fifty years ago in the Misuse of Drugs Act 1971 we pretty much classified cannabis as a poison. That is why the medical profession has not felt confident enough to use it, test it and research it; it simply could not. Now we are saying, “You guys have got to catch up and catch up quick,” and the Government have a role to play in facilitating that. Research is kicking off now, which is great, but although some say the medical profession should have been doing that for all these years, it could not do so because this place stopped it. On the right hon. Gentleman’s last point, let us call it “medical hemp”.

[Sir Mike Penning]

I completely agree on the medical profession and know exactly where the Home Office stood when I was at the Department. I would love to say that the whole of the Home Office and my civil servants in the narcotics part of it were thrilled by what I said in Westminster Hall all those years ago, but I can assure colleagues that they certainly were not, to say the least; fortunately, I had covered my back with the Home Secretary.

We need to move on from this, however. This is not about reform of the 1971 Act. It is about whether there is a group of children who we know get benefit from this, and whether, as we all know from our constituency postbags, there are other conditions that could also benefit from this type of oil with a THC product in it. That is where we are struggling.

We need to roll back this debate and talk, as I did at the start of my speech, about children—children who deserve the best possible start in life and just happen to have been born with a medical condition that the medical profession, in its infinite and great wisdom, has not quite got an answer for. This product is part of the answer, although it only alleviates the condition. As parents have said to me on many occasions, it does not take away the condition but it does let the children live a life as close to normality as possible; it is not normal, because it involves dropping oil on a little boy or girl’s tongue on a daily basis, but it is as normal as we can get.

--- Later in debate ---

[Ronnie Cowan (Inverclyde) (SNP)]

Thank you very much for calling me, Mr Deputy Speaker. I just jumped up quickly before you changed your mind! [Laughter.]

I thank the hon. Member for Edinburgh West (Christine Jardine) for securing this debate, which has been great; we were looking forward to a 30-minute Adjournment debate, a battle through and a quick exchange of views, but because nobody cares that much about national insurance contributions amendments, we have been given this extra time. I will not take too much more, because a lot has been covered by the previous speaker and there is no point going over old ground. I would genuinely like to say that at 9.10 on a Monday evening there is nothing I would rather be doing on my birthday than fighting the cause of something I truly believe in.

On 19 March 2019, the then Secretary of State for Health and Social Care said that medical cannabis “would be made available”. If I had heard those words as the parent of a child who would have benefited, I would have been thinking that it was going to be made available. I would not be expecting to jump through hoops or to have to raise thousands of pounds to pay for it. My hopes would have been raised. A child with such a condition would, typically, have 30 seizures a day and so over 900 days we are talking about 27,000 seizures. If they had had medical cannabis, we could be talking about zero seizures. However, it will be made available some day. After this time, the general frustration in this Chamber is, “Why are we still talking about it?” We have said this a number of times in Westminster Hall, and here and there, and we know everything that has been said today.

I am genuinely glad that the Minister has informed us that we are now manufacturing some of these medicines here in the UK, as that is a big step forward. However, we are still reliant on private prescriptions and, as was pointed out earlier, the main provider of those is about to retire. Yet again, if I was a parent in that situation, would the sword of Damocles not be hanging over me? This is the same idea as what happened when we left the EU—we could not get the medicines in and we had to have an extension to January, to July and now to next year. That is a ticking timebomb hanging over those young lives that we just do not need to have there. The long and short of it is that people who cannot afford it or cannot raise the funds for it—during covid, raising funds for many a charitable cause has been incredibly difficult—simply go without. They go without and so there are 27,000 seizures because they have to go without a medicine that they know is available and know would do the job for their child. It should not be this way. In less time, we have developed, tested and rolled out a covid vaccine throughout the United Kingdom. The vaccine did not exist, it had to be tested, and we have done it. It concerns me that these kids are less of a priority.

What are the UK Government going to do? How will they finally going create a legal framework in which GPs are comfortable writing prescriptions for cannabis-based medical products? If we could do that, it would be a game-changer. I am not playing politics with this issue, but I have contacted the Scottish Government, and in Scotland if people get an NHS prescription, the Government will pay for it. The same thing has to apply down here, so let us facilitate that. Let us go to doctors, explain what it is we are asking them to do and give them the confidence to stand up and do it. If a senior clinician can do it, a GP can do it.

[Tonia Antoniazzi]

The point the hon. Gentleman is making is really interesting. With covid, we have seen so many families really struggle and their children have been hospitalised—we are talking about such vulnerable children—so his point is so valuable. I thank him for all his work on this issue because together, across party lines, we will take this issue forward.

[Ronnie Cowan]

I thank the hon. Lady very much. The point that this is very much a cross-party issue should not be missed. We are not going to split down party lines or fall out over this. We will fall out over other things—I am absolutely sure of that—but this issue has strong cross-party support. I look around the Chamber at the Members present and I know the different politics we have, yet we are united behind this cause. The Government should take real note of that. I know they have a working majority of 80 or so, but people in the Conservative party are rightly backing this issue.

I shall not keep the House any longer. I fully acknowledge that the past 20 months have been incredibly demanding for the Department of Health and Social Care. We all get that—we all appreciate what has been done during that time—but the time for talking is well and truly over and the time for action has well and truly arrived.