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Written Question
Antimicrobials: Drug Resistance
Thursday 14th March 2024

Asked by: Karin Smyth (Labour - Bristol South)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps her Department is taking to support research into anti-microbial resistance.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

The Department commissions research through the National Institute for Health and Care Research (NIHR) and welcomes funding applications for research into any aspect of human health, including anti-microbial resistance (AMR).

Over the last five years, the NIHR’s programme funding for AMR has totalled £88 million. This includes research that aims to reduce the need for antibiotics, optimising their use and supporting the development of new antimicrobials. This does not include NIHR infrastructure, which is fundamental to supporting all health research.

The NIHR has recently launched a competition for new Health Protection Research Units, in partnership with the UK Health Security Agency and academia, which will include multidisciplinary research to inform the prevention and control of AMR.


Written Question
Antimicrobials: Drug Resistance
Tuesday 12th March 2024

Asked by: Karin Smyth (Labour - Bristol South)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what progress she has made on delivering the UK 5-year action plan for antimicrobial resistance 2019 to 2024.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

A cross-Government, United Kingdom-wide delivery board monitors and oversees progress in delivering the National Action Plan on antimicrobial resistance (NAP AMR) for 2019 to 2024. The majority of the commitments in the NAP AMR have been assessed as either completed, or as on track for delivery.

Progress against the measurable ambitions in the NAP AMR is collated by the UK Health Security Agency, and reported to the delivery board. Significant progress has been made in further reducing antibiotic use in food producing animals, by 59% since 2014, and in humans, with an 8.8% reduction in overall antibiotic usage from 2014 to 2022. Progress has been slower in other areas, such as reducing the incidence of specific drug-resistant infections, due to the diverse nature of the underlying causes of these infections. Other key achievements from the NAP AMR programme over the past five years include:

- Piloting innovative ways of evaluating and paying for antibiotics on the National Health Service;

- Securing antimicrobial resistance commitments on several ministerial tracks during the UK G7 presidency in 2021; and

- £19.2 million investment into One Health Surveillance through the Pathogen Surveillance in Agriculture, Food and Environment Programme.

The Department has commissioned the Policy Innovation and Evaluation Research Unit (PIRU) at the London School of Hygiene and Tropical Medicine to conduct an evaluation of the 2019 to 2024 NAP AMR, to inform future policy development and implementation. Findings from the PIRU evaluation will be published following the peer-review process.

The forthcoming NAP AMR for 2024 to 2029 is under development, in consultation with a broad range of stakeholders across different sectors, and informed by the findings from the antimicrobial resistance Call for Evidence. This will set us on course for achieving our long-term ambitions, set out in the Government’s 20-year vision to contain, control, and mitigate antimicrobial resistance by 2040.


Written Question
Antibiotics
Wednesday 6th March 2024

Asked by: Lord Campbell-Savours (Labour - Life peer)

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the case for reviewing the expiry dates of antibiotics, including in respect of savings for public expenditure.

Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)

The Medicines and Healthcare products Regulatory Agency (MHRA), the Government agency responsible for ensuring that medicines and medical devices work and are acceptably safe, has not made an assessment on the case for reviewing the expiry dates of antibiotics.

Medicine expiry dates, including for antibiotics, are necessary to ensure that the safety and effectiveness of a medicine is maintained over its long-term shelf life. The active ingredient in many medicines can degrade over time resulting in a loss of potency or the formation of impurities in the product. Physical changes to a medicine such as discolouration, may also occur upon prolonged storage. Medicine expiry dates are supported by stability studies completed by the pharmaceutical company, which demonstrate that a medicine remains safe and effective throughout its shelf life. Any change to the expiry date of a medicine requires an independent review of the stability data by the MHRA.

Companies can and often do extend the shelf life of their medicines once the product is on the market, and as additional stability data become available. It is not possible, however, to extend the expiry date of all medicines unilaterally in the absence of supporting stability data.


Written Question
Antibiotics: Drug Resistance
Thursday 8th February 2024

Asked by: Ruth Jones (Labour - Newport West)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps she is taking with Cabinet colleagues to reduce the potential impact of increased antimicrobial resistance caused by the overuse of antibiotics on industrial farms on human health.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

The Government takes a cross-governmental, One-Health approach to antimicrobial resistance (AMR) as set out in the UK 5-year National Action Plan for antimicrobial resistance. Through the National Action Plan, activity is delivered across the four nations of the United Kingdom on human health, animal health, food, environment, research, and surveillance. The plan is available at the following link:

https://www.gov.uk/government/publications/uk-5-year-action-plan-for-antimicrobial-resistance-2019-to-2024

The UK is committed to reducing unnecessary use of antibiotics in animals to reduce the risk of the development and spread of AMR in animals and humans. The recently published UK Veterinary Antimicrobial Resistance and Sales Surveillance report shows that sales of antibiotics in food producing animals are at their lowest ever level, with a 59% reduction since 2014. The report is available at the following link:

https://www.gov.uk/government/publications/veterinary-antimicrobial-resistance-and-sales-surveillance-2022


Written Question
Sepsis: Health Services
Monday 8th January 2024

Asked by: Rachael Maskell (Labour (Co-op) - York Central)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, if she will take steps to develop a sepsis strategy.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

The current UK National Action Plan on Antimicrobial Resistance discusses how we have stewardship programmes in place for both primary and secondary care settings, comprising a range of activities and resources to ensure antimicrobials are used appropriately and to improve prescribing behaviours. A copy of the plan is available at the following link:

https://assets.publishing.service.gov.uk/media/6261392d8fa8f523bf22ab9e/UK_AMR_5_year_national_action_plan.pdf

Our stewardship activities are not just focused on reducing prescribing but also on ensuring timely treatment where rapid treatment with antibiotics is essential to save lives and reduce the long-term consequences of serious infection, for example from sepsis.

Since publication of the 2015 cross-system Sepsis Action Plan, we have increased the number of patients being screened and treated for sepsis and, importantly, through the combined sepsis and AMR Commissioning for Quality and Innovation, increased the number of inpatients who have a clinical antibiotic review between 24 and 72 hours, reducing the use of broad-spectrum antibiotics.


Written Question
Antibiotics: Drug Resistance
Tuesday 19th December 2023

Asked by: Daniel Zeichner (Labour - Cambridge)

Question to the Department for Environment, Food and Rural Affairs:

To ask the Secretary of State for Environment, Food and Rural Affairs, whether his Department is taking steps with Cabinet colleagues to help reduce the risk of antimicrobial resistance in humans arising from the overuse of antibiotics on farms.

Answered by Mark Spencer - Minister of State (Department for Environment, Food and Rural Affairs)

The Government takes a ‘One-Health’ approach to antimicrobial resistance (AMR) as set out in the ‘UK 5-year action plan for antimicrobial resistance 2019 to 2024’, which is underpinned by the UK’s 20-year Vision to Contain and Control AMR by 2040. Defra is a co-signatory with the Department of Health and Social Care on the 5-year National Acton Plan (NAP) and 20-year vision on AMR, and Defra leads on delivering the animal, plant and environment elements. The AMR NAP lays out the UK Government’s commitment to reducing unnecessary use of antibiotics in animals to reduce the risk of development and spread of AMR in animals and humans, while safeguarding animal health and welfare. A key component of this plan is to reduce the need for antibiotics, which is achieved through good farm management, biosecurity and disease prevention.

In the UK, we have a well-established antimicrobial use and resistance surveillance programme, which includes monitoring of sales and use of antibiotics in animals as well as routine monitoring of AMR in major food-producing species, healthy pigs and poultry. These surveillance programmes allow us to monitor progress and results are published every year in the UK Veterinary Antibiotic Resistance Sales and Surveillance (UK-VARSS) report.

The recently published UK-VARSS report shows that sales of antibiotics in food-producing animals are at their lowest ever level, with a 59% reduction since 2014. This highlights the success of the UK’s voluntary and collaborative approach between the Government and the farming and veterinary sectors to make sustainable reductions in antibiotic use while ensuring high animal health and welfare. The report also highlights that sales of highest priority, critically important antibiotics have reduced by 82% since 2014 and account for less than half a percent of total sales. This is to ensure that these medically important antibiotics are protected for use in humans.

The newly published third edition of the UK’s One Health report, a joint report from the Veterinary Medicines Directorate and the UK Health and Security Agency, brings together antibiotic use and resistance data for people and animals. Sales of antibiotics in 2019 show that approximately two thirds of antibiotics are used in people while one third are used in animals. This report demonstrates the Government’s One Health approach to tackling AMR to keep antibiotics working in both people and animals.

The UK is now in the process of developing the second five-year NAP, which will run from 2024-2029. This will build on progress made in the 2019-2024 NAP and set out challenging ambitions and actions for the next five years, which will set us on course for achieving our long-term national and international ambitions.


Written Question
Cholera
Wednesday 6th December 2023

Asked by: Lord Alton of Liverpool (Crossbench - Life peer)

Question to the Foreign, Commonwealth & Development Office:

To ask His Majesty's Government what assessment they have made of the cholera outbreak reported by the United Nations as affecting 27 localities across seven states with 78 associated deaths, with more than 3 million people estimated to be at risk by the end of the year.

Answered by Lord Ahmad of Wimbledon - Minister of State (Foreign, Commonwealth and Development Office)

Due to the ongoing conflict, Sudan continues to grapple with mass displacement, disease outbreaks and malnutrition. The health system has been overwhelmed by attacks on health facilities and the scarcity of medical supplies, equipment, health workers and operational funds. The World Health Organization (WHO) is supporting Sudan with cholera treatments (including antibiotics, oral rehydration solution, intravenous fluids and rapid diagnostic tests), in addition to providing direct support to cholera isolation centres. The UK is funding Water, Sanitation and Hygiene (WASH) and health activities in Sudan via the Sudan Humanitarian Fund, UNICEF, and the International Committee of the Red Cross (ICRC). With support from WHO and health partners, the Ministry of Health is coordinating efforts (in areas of the country that are still accessible) to scale up access to clean water and sanitation facilities, as well as ensuring affected and at-risk communities are aware of transmission risks and proper hygiene practices to reduce contamination risks and prevent further spread of the outbreak. We are supporting the Global Outbreak Alert and Response Network (WHO), and will deploy a Senior Epidemiologist to assist with coordination efforts to bolster the national response. We will continue to monitor the situation closely.


Written Question
Antibiotics: Drug Resistance
Tuesday 5th December 2023

Asked by: Henry Smith (Conservative - Crawley)

Question to the Department for Environment, Food and Rural Affairs:

To ask the Secretary of State for Environment, Food and Rural Affairs, what steps his Department is taking to help reduce the threat of antimicrobial resistance to human health from overuse of antibiotics on industrial farms.

Answered by Mark Spencer - Minister of State (Department for Environment, Food and Rural Affairs)

The Government takes a ‘One-Health’ approach to antimicrobial resistance (AMR) as set out in the ‘UK 5-year action plan for antimicrobial resistance 2019 to 2024’, which is underpinned by the UK’s 20-year Vision to Contain and Control AMR by 2040 . Defra is a co-signatory with the Department of Health and Social Care on the 5-year National Acton Plan and 20-year vision on AMR, and Defra leads on delivering the animal, plant and environment elements.

The UK is committed to reducing unnecessary use of antibiotics in animals to reduce the risk of development and spread of AMR in animals and humans. In the UK, we have a well-established antimicrobial use and resistance surveillance programme, which includes monitoring of sales and use of antibiotics in animals as well as routine monitoring of AMR in major food-producing species, healthy pigs and poultry. These surveillance programmes allow us to monitor progress and results are published every year in the UK Veterinary Antibiotic Resistance Sales and Surveillance (UK-VARSS) report.

The recently published UK-VARSS report shows that sales of antibiotics in food producing animals are at their lowest ever level, with a 59% reduction since 2014. This highlights the success of the UK’s voluntary and collaborative approach between Government and the farming and veterinary sectors to make sustainable reductions in antibiotic use whilst ensuring high animal health and welfare. The report also highlights that sales of highest priority, critically important antibiotics (HP-CIAs) have reduced by 82% since 2014 and account for less than half a percent of total sales. This is to ensure that these medically important antibiotics are protected for use in humans.

The newly published third edition of The UK’s One Health report, a joint report from Veterinary Medicines Directorate (VMD) and UK Health and Security Agency (UKHSA), brings together antibiotic use and resistance data for people and animals and sales of antibiotics in 2019 show that approximately two thirds of antibiotics are used in people whilst one third are used in animals. This report demonstrates the UK Government’s One Health approach to tackling AMR to keep antibiotics working in both people and animals.


Written Question
Midazolam
Friday 1st December 2023

Asked by: Andrew Bridgen (Independent - North West Leicestershire)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, with reference to the guidance by NICE entitled Covid-19 rapid guideline: managing symptoms including at the end of life in the community, NG163, published on 3 April 2020, by what process (a) that guidance was commissioned and (b) the NHS decided (i) to procure Midazolam for use in (A) end-of-life and (B) other patient care and (ii) the quantity of Midazolam it would procure in each of the last four years.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute for Health and Care Excellence (NICE) guideline NG163 published in 2020 was commissioned as part of a programme to provide rapid guidance on the management of affected patients with COVID-19. Several of NICE’s COVID-19 rapid guidelines were incorporated into a single guideline for the management of COVID-19 in children and adults (NG191), which was last updated in June 2023.

Early in the pandemic, NHS England convened a National Clinical Group comprising senior specialist clinicians and relevant specialist pharmacists to develop priority medicines lists for critical care, end of life care and antibiotics and these were kept under review as the pandemic and subsequent clinical knowledge evolved. As part of this process, midazolam was identified as a priority medicine for use in both critical care as an alternative to propofol in the sedatives category, and end of life care as a first line medicine in the anxiety category.

The following table shows the quantity of midazolam procured by the National Health Service in England using NHS England procurement frameworks for use in secondary care in each of the last four years to 2023/24:

Financial year

Quantity of packs

2020/21

587,003

2021/22

482,458

2022/23

415,512

2023/24

229,693

It is not possible to differentiate between Midazolam use in end of life and other patient care. This data excludes procurement for use in primary and community care.

In primary health care, procurement is undertaken by retail pharmacies on an individual basis, based on their perception of future demand needs or in direct response to prescriptions received from patients. There is no centralised procurement process for primary care and therefore there is no information that is relevant to the question asked.

Health is largely a devolved matter, and decisions on the procurement of medicines in Scotland, Wales and Northern Ireland are therefore a matter for the Scottish Government, Welsh Government and Northern Ireland Executive respectively.


Written Question
Cystic Fibrosis: Medical Treatments
Wednesday 29th November 2023

Asked by: Lord Weir of Ballyholme (Democratic Unionist Party - Life peer)

Question to the Department of Health and Social Care:

To ask His Majesty's Government what new treatments or strategies are planned to support sufferers of Cystic Fibrosis through the NHS.

Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England commissions 47 specialised cystic fibrosis centres for adults and children across England, in addition to supporting the optimal monitoring of patients with cystic fibrosis at home, and best practice in remote consultations.

Through these centres, NHS England provides a range of innovative treatments including inhaled therapies such as nebulised antibiotics. Since 2019, thousands of people with cystic fibrosis have been able to benefit from licensed treatments, firstly Orkambi and Symkevi and then Kaftrio, following its marketing authorisation in 2020. Access to these treatments is provided under the terms of a commercial agreement reached between the manufacturer, Vertex and NHS England, with the full support of the National Institute for Health and Care Excellence (NICE).

Within the agreement between NHS England and Vertex, there is a flexible commercial mechanism to ensure continued access for patients already receiving any of the licensed treatments following the conclusion of a full NICE evaluation.

On 3 November 2023, NICE published a consultation on draft guidance that did not recommend these treatments as a cost-effective use of National Health Service resources. This draft is an initial step in the review of these medicines and does not affect patients’ continued access to these medicines on the NHS in any way. Eligible children and adults with cystic fibrosis can continue to receive ongoing treatment and be initiated onto treatment with these medicines, as clinically appropriate.

On 15 November 2023, the Medicines and Healthcare products Regulatory Agency approved a new licence extension that will mean children as young as two years old with cystic fibrosis are eligible to receive Kaftrio.

NHS England anticipate that as many as 600 children could benefit from this latest approval under the terms of the existing commercial agreement negotiated with Vertex in 2019. NHS cystic fibrosis centres across the country have plans in place to ensure that all children eligible today can be provided long term access to this life-changing treatment.