Asked by: Tanmanjeet Singh Dhesi (Labour - Slough)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether he plans to undertake a review of guidance on the prescription of glucagon-like peptide 1 (GLP-1) agonists to patients with type 2 diabetes.
Answered by Will Quince
The National Institute for Health and Care Excellence (NICE) is the independent body responsible for providing evidence-based guidance for the National Health Service in England, in line with its established methods and processes.
NICE’s guideline on the management of type 2 diabetes in adults states that if triple therapy with metformin and 2 other oral drugs is not effective, not tolerated or contraindicated, switching one drug for a glucagon-like peptide 1 agonist should be considered for people who meet the specified criteria.
NICE is currently updating the drug treatment section of this guideline, which it expects to publish in December 2024. NICE also published final draft guidance on 8 September 2023 which recommends tirzepatide for treating type 2 diabetes alongside diet and exercise in adults who meet the specified criteria. Final guidance on tirzepatide is expected in October 2023.
Asked by: Jessica Morden (Labour - Newport East)
Question to the Ministry of Justice:
To ask the Secretary of State for Justice, how many drug overdoses took place in prisons from March (a) 2021-2022 and (b) 2022-2023 broken down by institution.
Answered by Damian Hinds - Minister of State (Education)
Between January 2021 and December 2021, a total of 2,273 incidents of self-harm were recorded that were linked to overdoses.
The total figure for January 2022 to December 2022 was 2,387 incidents linked to overdoses. Please see the accompanying table.
The data has been produced on a calendar basis to match published figures on method of self-harm. Information is reported for calendar rather than financial years to avoid the risk of identifying individuals in combination with published calendar year breakdowns of self-harm data.
We do not explicitly collect data on an “overdose” incident type. The data we have provided is based on the “self-harm” incident type. In particular, the data is based on self-harm categorised as “Self-Poisoning/Overdose/Substances/Swallowing” and subcategorised as “illegal drugs”, “own persons medicine” or “other persons medicine”.
The data provided is based on two main assumptions:
There will be other incidents involving the consumption of substances that are not included as they were not reported as self-harm by the prison and so would not have been captured in the provided data.
These figures have been drawn from the HMPPS Incident Reporting System and although care is taken when processing and analysing returns, the detail is subject to the inaccuracies inherent in any large scale recording system. Although shown to the last case, the figures may not be accurate to that level.
The data only includes self-harm incidents collated centrally; identifying any wider incidents that lead to a hospitalisation and have a connection to drugs would exceed the cost threshold as it would require reading through the text of each incident.
We are committed to doing all we can to prevent deaths from drug overdoses in prison. We have outlined in both our Prisons Strategy White Paper and the Government’s 10-year drug strategy ‘From Harm to Hope’ (2021) how we will achieve this.
All prisons have a zero-tolerance approach to drugs. Our £100m Security Investment Programme, completed in March 2022, introduced measures such as 75 additional X-ray body scanners and airport-style gate security. To prevent the smuggling of illegal drugs such as psychoactive substances through the mail, we have deployed 95 next generation drug trace detection machines. We are aiming for full coverage of public sector prisons by March 2024.
We are also increasing the number of Incentivised Substance-Free Living units, where prisoners commit to remaining free of illicit drugs with regular drug testing and incentives. We have more than doubled the number of these from 25 last summer to 60 now and we are aiming to reach up to 100 by March 2025.
Asked by: Lord Forsyth of Drumlean (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what proportion of the adult population are currently being prescribed antidepressants.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
Based on the latest available primary care dispensing data (Q1, 2023/24) we estimate that 15% of the adult population in England is prescribed anti-depressants.
We do not capture the clinical indication of a prescription, so there may be instances where these drugs are used for other conditions.
Asked by: Cat Smith (Labour - Lancaster and Fleetwood)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, with reference to the Answer of 27 January 2021 to Question 137239 on Prescription Drugs, what information his Department holds on the number of unique patients who have been prescribed drugs categorised under the drug groups (a) benzodiazepines including clonazepam, (b) z-drugs, (c) antidepressants and (d) opioids in the each of the last two years.
Answered by Will Quince
The methodologies used by the NHS Business Services Authority (NHSBSA) for calculating these statistics have changed since January 2021. Therefore, the below tables include data for each of the last five financial years to address the additional two-year datasets requested as well as reflect the new methodologies used.
The following table shows the number of unique patients who were prescribed benzodiazepines including clonazepam in each financial year 2018/2019 to 2022/2023:
Financial Year | Total number of unique identified patients - benzodiazepines including clonazepam | Percentage (%) of items where the patient has been identified |
2018/2019 | 1,545,014 | 95.27 |
2019/2020 | 1,497,077 | 95.97 |
2020/2021 | 1,368,092 | 97.16 |
2021/2022 | 1,339,417 | 97.23 |
2022/2023 | 1,324,792 | 97.21 |
The following table shows the number of unique patients who were prescribed Z-Drugs in each financial year from 2018/2019 to 2021/2022:
Financial Year | Total number of unique identified patients – Z-Drugs | Percentage (%) of items where the patient has been identified |
2018/2019 | 945,510 | 96.65 |
2019/2020 | 897,451 | 96.94 |
2020/2021 | 876,746 | 98.05 |
2021/2022 | 825,382 | 98.12 |
The following table shows the number of unique patients who were prescribed an antidepressant in each financial year from 2018/2019 to 2022/2023:
Financial Year | Total number of unique identified patients – Antidepressants | Percentage (%) of items where the patient has been identified |
2018/2019 | 7,590,802 | 97.92 |
2019/2020 | 7,856,297 | 98.21 |
2020/2021 | 7,909,516 | 99.10 |
2021/2022 | 8,359,838 | 99.14 |
2022/2023 | 8,563,148 | 99.16 |
The following table shows the number of unique patients who were prescribed opioids from financial year 2018/2019 to 2021/2022:
Financial Year | Total number of unique identified patients - Opioids (includes compound analgesics) | Percentage (%) of items where the patient has been identified | Total number of unique identified patients - Opioid Analgesics (excludes compound analgesics) |
2018/2019 | 5,935,454 | 96.65 | 3,036,777 |
2019/2020 | 5,730,095 | 96.94 | 2,971,092 |
2020/2021 | 5,525,899 | 98.05 | 2,883,897 |
2021/2022 | 5,589,348 | 98.12 | 2,927,983 |
Note: Our reply to the previous question predated the official statistics used here, and used a different classification of opioids using the standard classification used in the NHSBSA Data Warehouse. Comparable data is shown in the final column of the above table; this counts patients without including any prescriptions for compound analgesics such as co-codamol and co-dydramol.
All figures included above are correct as of 5 September 2023 and could be subject to revision once audited reports are published.
Asked by: Simon Lightwood (Labour (Co-op) - Wakefield)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, when his Department plans to publish a (a) response to the consultation on hub and spoke dispensing and (b) timetable for the implementation of secondary legislation.
Answered by Neil O'Brien
We are finalising our response to the consultation and the timetable for bringing forward the implementing of the legislation and our aim is to publish this as soon as possible. The timetable for bringing forward the implementing legislation will be dependent on the availability of Parliamentary time across the four nations.
We are committed to pursuing legislative changes to level the playing field and enable all community pharmacies to make use of hub and spoke arrangements.
Asked by: Stephen Morgan (Labour - Portsmouth South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, pursuant to the Answer of 30 June 2023 to Question 190974 on Prescription Drugs: Side Effects, whether his Department has made an assessment of the potential merits of conducting an assessment of the potential impact of prescribed medications that have a known side-effect of weight gain on trends in the level of (a) adult and (b) child obesity.
Answered by Neil O'Brien
No specific assessment has been made.
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, whether he plans to assess the safety of the Government’s policy of charging patients for a further prescription for recalled or faulty medicines.
Answered by Will Quince
The National Health Service (Charges for Drugs and Appliances) Regulations 2015, as amended, set out the legislative position on the supply of medicinal products by pharmacies to patients and the relevant charges to be applied in England. They specify that a charge should be applied ‘per quantity’ of medicinal products. Furthermore, Part XVI of the NHS Drug Tariff, concerning notes on prescription charges, clarifies that unless a completed declaration of entitlement to exemption or remission is made on the prescription form, a charge is payable for each medicinal product supplied. Therefore, when a prescription only medicine is recalled and replaced with an alternative prescription item a patient must pay the applicable prescription charges unless they are exempt from NHS charges. There are no plans to change this.
The exemptions in place result in around 89 per cent of all prescription items in England being dispensed free of charge, and prescription pre-payment certificates can be used to cap the cost of prescriptions.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of long-term and permanent harm caused by the use of benzodiazepines, Z-drugs and antidepressants.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The safety of medicines on the United Kingdom market are continuously monitored by the Medicines and Healthcare products Regulatory Agency (MHRA). There are currently no plans to conduct any further reviews into the harms associated with benzodiazepines, Z-drugs and antidepressants, however, any new data would be carefully considered. Details about the possible risks and side effects are outlined in the product information available for each medicine.
Benzodiazepines and Z-drugs are authorised for short term use, two to four weeks, and should not be used long term due to the risk of dependence and subsequent withdrawal reactions. Healthcare professionals have been reminded of these risks by the MHRA, the Department and professional bodies which have highlighted the extensive warnings about the risks of dependence, the need to limit prescribing and advice about gradual withdrawal.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government how they will measure the effectiveness of actions set out in 'Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: Framework for action for integrated care boards (ICBs) and primary care', published on 2 March.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The framework for action sets out five actions for integrated care boards (ICBs) to consider to further reduce inappropriate prescribing of high-strength painkillers and other addiction-causing medicines, like opioids and benzodiazepines.
ICBs should take a population health management approach using data on primary care prescribing and health inequalities to monitor implementation of the actions. This includes looking at data on access to services, patient experience feedback and outcomes for communities within the integrated care system that often experience health inequalities.
There are several data resources used to give insights to ICBs and foster improvement at the local level, with data being available on an Opioid Prescribing Comparators dashboard. This dashboard can be used to review up-to-date data, highlight variation, and support local work to reduce harm from the prescribing of dependence and withdrawal forming medicines, as well as equip users with the tools for ongoing monitoring. The dashboard will be continually reviewed and updated with more metrics and views. More data is also available on duration of treatment of opioids, benzodiazepines, and z-drugs, as well as the number of patients prescribed a dependence forming medicine who have received a structured medication review.
Asked by: Cat Smith (Labour - Lancaster and Fleetwood)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, with reference to the report by NHS England entitled Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: framework for action for integrated care boards and primary care, published in March 2023, what plans he has to assess the effectiveness of that framework for action.
Answered by Neil O'Brien
The Department does not collect data on levels of dependence on and treatment for dependence on prescribed drugs. The National Institute for Health and Care Excellence (NICE) has published a range of evidence-based guidance that includes recommendations for the National Health Service on the use of benzodiazepines, z drugs and anti-depressants based on an assessment of their benefits and longer-term health impacts. The guidance ‘Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults’ which is available at the following link:
www.nice.org.uk/guidance/ng215
The Department has no current plans to assess the publication’s effectiveness of ‘Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: Framework for action for integrated care boards (ICBs) and primary care’.