Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether they will ensure the timely publication of the agenda, papers and minutes of the Public Health England Expert Group on Prescribed Drug Dependence.
Answered by Lord O'Shaughnessy
Public Health England (PHE) has been commissioned to undertake a public health evidence review of available data and published evidence on the problems associated with dependence, and the short term discontinuation or longer term withdrawal symptoms, associated with prescribed medicines.
PHE is aware of the importance and relevance of the experience of patients in understanding the issues. The review will include a call for papers which specifically identifies published accounts of the patients’ experiences, and this material will be specifically and deliberately focused on in the review. This process is distinct from a public inquiry, which would include individual testimony.
PHE is committed to publishing the agenda, papers and minutes of meetings of the expert reference group and the first set of these documents will be available during July 2018.
Asked by: William Wragg (Independent - Hazel Grove)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how much his Department has spent on dispensing smoking cessation products via the NHS in each of the last three years.
Answered by Steve Brine
Information is only available centrally on the cost of smoking cessation medication that has been dispensed to National Health Service patients using the FP10 prescription form. There are various other routes in which such medication can be supplied to a patient from the NHS including from community pharmacies via voucher schemes and a direct supply to patients from a Patient Group Direction.
Smoking cessation drugs are classified under section British National Formulary (BNF) 4.10.2, Nicotine dependence, using the BNF classification system prior to edition 70.
The following table provides the Net Ingredient Cost (NIC) of smoking cessation medication where they have only been dispensed in the community via an FP10 form in England in the specified years.
Year | NIC (£) |
2015 | 34,692,508 |
2016 | 29,263,595 |
2017 | 27,353,738 |
Source: Prescription Cost Analysis NHS Digital
Notes:
1. Prescription Cost Analysis (PCA) Data
Prescription information is taken from the PCA system, supplied by NHS Prescription Services, a division of NHS Business Services Authority, and is based on a full analysis of all prescriptions dispensed in the community i.e. by community pharmacists and appliance contractors, dispensing doctors, and prescriptions submitted by prescribing doctors for items personally administered in England. Also included are prescriptions written in Wales, Scotland, Northern Ireland and the Isle of Man but dispensed in England. The data do not cover drugs dispensed in hospitals, including mental health trusts, or private prescriptions. (Prescribers are general practitioners, hospital doctors, dentists and non-medical prescribers such as nurses and pharmacists.)
2. Net Ingredient Cost (NIC)
This is the basic cost of a drug as used in primary care. This is the cost at list price excluding VAT, i.e. the price listed in the national Drug Tariff or in standard price lists and is not necessarily the price the NHS paid. It does not take into account any contract prices or discounts, dispensing costs, fees or prescription charge income, so the amount the NHS paid will be different. NIC is used in Prescription Services reports and other analyses, as it standardises cost throughout prescribing nationally, and allows comparisons of data from different sources. The figures are in pounds.
3. BNF Classifications
The PCA system uses the therapeutic classifications defined in the BNF using the classification system prior to edition 70. Information on why a drug is prescribed is not available in this dataset. Since drugs can be prescribed to treat more than one condition, it may not be possible to separate the different conditions for which a drug may have been prescribed.
The primary purpose of the BNF is to provide information for clinicians. The format of the BNF was changed with Edition 70 (September 2015 - March 2016) to make it more user friendly. However the NHS Business Service Authority, who process dispensed prescription forms and collects dispensed prescribing data and produce the PCA data, continue to use the old BNF classification system to code medicines, which has become widely used in the United Kingdom as a classification to allow comparisons between drug groups. For example it is used to report cost and trend in medicines use and supports several NHS Digital official publications. The data are used in many NHS IT systems.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether they collect statistics on the numbers of long-term prescribed patients on (1) benzodiazepines and (2) Z-drugs; if so, what those statistics are; and if not, why not.
Answered by Lord O'Shaughnessy
This data is not collected centrally. Medicines data collected by NHS Digital does not contain patient related information, so is unable to identify statistics on the numbers of long-term prescribed patients on benzodiazepines and Z-drugs.
The Government is concerned about the impact of long term use of prescription drugs. The Department has commissioned Public Health England (PHE) to undertake an evidence review to better understand the scope of the problem of prescribed drug dependence. As part of this review PHE will attempt to estimate the number of people affected, including through prescription data collected by NHS Business Services Authority.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what guidance they have issued on the duration of time they consider appropriate in describing "long-term prescribing" in relation to benzodiazepines and Z-drugs.
Answered by Lord O'Shaughnessy
The Department has not issued any guidance.
The Department has commissioned Public Health England to undertake an evidence review to better understand the scope of the problem of prescribed drug dependence.
The review will bring together the best available evidence on: prevalence and prescribing; the nature and likely causes of dependence or withdrawal among some people who continue to take these medicines; and effective prevention and treatment responses for each indication.
Asked by: Lord Luce (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether GPs are being advised to carry out regular medication reviews for patients who are prescribed painkillers for chronic pain, in particular patients who are prescribed opioids; and if not, why not.
Answered by Lord O'Shaughnessy
Information on the number of people in England currently addicted to prescription opioids is not collected centrally. The Government is concerned about the impact of long term use of prescription drugs. The Department has commissioned Public Health England (PHE) to undertake an evidence review to better understand the scope of the problem of prescribed drug dependence.
The review will bring together the best available evidence on prevalence and prescribing; the nature and likely causes of dependence or discontinuation syndrome among some people who continue to take these medicines; and effective prevention and treatment responses for each condition for which they are prescribed. There are no plans to extend the remit of the PHE evidence review to over the counter painkillers.
The National Institute for Health and Care Excellence (NICE) published the guideline Controlled drugs: safe use and management in April 2016 which covers systems and processes for using and managing controlled drugs safely in all NHS settings except care homes. The guideline includes recommendations to improve working practices to comply with legislation and aims to reduce the risks associated with controlled drugs, including dependency, overdose and diversion. The NICE guideline provides authoritative guidance that reflects the latest available evidence and will allow healthcare professionals, including general practitioners, to make informed decisions about the prescription and optimal use of medicines which have the potential to cause dependency. A copy of the NICE guideline is attached.
The recently-updated national clinical guidelines for drug misuse and dependence have specific guidance about pharmacological management of dependence on benzodiazepines and z-drugs, including prescribing regimens, detoxification, adjunctive therapies and monitoring. A copy of these guidelines, Drugs misuse and dependence: UK guidelines on clinical management is attached.
Asked by: Lord Luce (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, in view of the consumption of codeine for pain relief, whether they have any plans to extend the remit of the Public Health England inquiry into prescription drug addiction and dependence to include over the counter painkillers.
Answered by Lord O'Shaughnessy
Information on the number of people in England currently addicted to prescription opioids is not collected centrally. The Government is concerned about the impact of long term use of prescription drugs. The Department has commissioned Public Health England (PHE) to undertake an evidence review to better understand the scope of the problem of prescribed drug dependence.
The review will bring together the best available evidence on prevalence and prescribing; the nature and likely causes of dependence or discontinuation syndrome among some people who continue to take these medicines; and effective prevention and treatment responses for each condition for which they are prescribed. There are no plans to extend the remit of the PHE evidence review to over the counter painkillers.
The National Institute for Health and Care Excellence (NICE) published the guideline Controlled drugs: safe use and management in April 2016 which covers systems and processes for using and managing controlled drugs safely in all NHS settings except care homes. The guideline includes recommendations to improve working practices to comply with legislation and aims to reduce the risks associated with controlled drugs, including dependency, overdose and diversion. The NICE guideline provides authoritative guidance that reflects the latest available evidence and will allow healthcare professionals, including general practitioners, to make informed decisions about the prescription and optimal use of medicines which have the potential to cause dependency. A copy of the NICE guideline is attached.
The recently-updated national clinical guidelines for drug misuse and dependence have specific guidance about pharmacological management of dependence on benzodiazepines and z-drugs, including prescribing regimens, detoxification, adjunctive therapies and monitoring. A copy of these guidelines, Drugs misuse and dependence: UK guidelines on clinical management is attached.
Asked by: Lord Luce (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government how many people in England they estimate are currently addicted to prescription opioids, excluding cancer patients.
Answered by Lord O'Shaughnessy
Information on the number of people in England currently addicted to prescription opioids is not collected centrally. The Government is concerned about the impact of long term use of prescription drugs. The Department has commissioned Public Health England (PHE) to undertake an evidence review to better understand the scope of the problem of prescribed drug dependence.
The review will bring together the best available evidence on prevalence and prescribing; the nature and likely causes of dependence or discontinuation syndrome among some people who continue to take these medicines; and effective prevention and treatment responses for each condition for which they are prescribed. There are no plans to extend the remit of the PHE evidence review to over the counter painkillers.
The National Institute for Health and Care Excellence (NICE) published the guideline Controlled drugs: safe use and management in April 2016 which covers systems and processes for using and managing controlled drugs safely in all NHS settings except care homes. The guideline includes recommendations to improve working practices to comply with legislation and aims to reduce the risks associated with controlled drugs, including dependency, overdose and diversion. The NICE guideline provides authoritative guidance that reflects the latest available evidence and will allow healthcare professionals, including general practitioners, to make informed decisions about the prescription and optimal use of medicines which have the potential to cause dependency. A copy of the NICE guideline is attached.
The recently-updated national clinical guidelines for drug misuse and dependence have specific guidance about pharmacological management of dependence on benzodiazepines and z-drugs, including prescribing regimens, detoxification, adjunctive therapies and monitoring. A copy of these guidelines, Drugs misuse and dependence: UK guidelines on clinical management is attached.
Asked by: Ronnie Cowan (Scottish National Party - Inverclyde)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps his Department is taking to reduce the number of people who overdose on prescription opioids.
Answered by Steve Brine
The Government is concerned about the impact of long term use of prescription opioids. The Department has commissioned Public Health England to undertake an evidence review to better understand the scope of the problem of prescribed drug dependence.
The review will bring together the best available evidence on prevalence and prescribing; the nature and likely causes of dependence or discontinuation syndrome among some people who continue to take these medicines; and effective prevention and treatment responses for each condition they are prescribed for.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether they have plans to mandate NHS England to ensure that community advice services are established to provide advice to patients suffering from the impact of long-term use of dependence forming medication.
Answered by Lord O'Shaughnessy
There are no plans to mandate NHS England to establish community advice services for this purpose. The Government is currently developing its approach to the mandate to NHS England for 2018-19, in light of the extra £2.8 billion to 2019/20 provided through the Autumn Budget to support the National Health Service. Both NHS England and Healthwatch England are involved in its development as statutory consultees.
The Department has commissioned Public Health England to undertake an evidence review to better understand the scope of the problem of prescribed drug dependence. The review will bring together the best available evidence on prevalence and prescribing; the nature and likely causes of dependence or withdrawal among people who continue to take these medicines; and effective prevention and treatment responses for each indication.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether they intend to mandate NHS England to commission services locally for patients who are suffering from the impact of long-term use of dependence forming medicines.
Answered by Lord O'Shaughnessy
Local authorities are supported by Public Health England to develop tailored responses to existing and emerging drug misuse in their area and, in conjunction with the National Health Service, to address specific concerns about addiction to prescribed and over the counter medicines.
The Department has commissioned Public Health England to undertake an evidence review to better understand the scope of the problem of prescribed drug dependence. The review will bring together the best available evidence on prevalence and prescribing; the nature and likely causes of dependence or withdrawal among some people who continue to take these medicines; and effective prevention and treatment responses for each indication.
The Government is currently developing its approach to the mandate to NHS England for 2018-19, in light of the extra £2.8 billion to 2019/20 provided through the Autumn Budget to support the NHS. Both NHS England and Healthwatch England are involved in its development as statutory consultees.