Medical Cannabis: Alleviation of Health Conditions

Alex Norris Excerpts

Thursday 4th November 2021 Commons Chamber

[Alex Norris (Nottingham North) (Lab/Co-op)]

I thank the Backbench Business Committee for granting this important debate and the hon. Members for Inverclyde (Ronnie Cowan), for Edinburgh West (Christine Jardine) and for Reigate (Crispin Blunt) and my hon. Friend the Member for Gower (Tonia Antoniazzi) for securing it. I also thank the cross-party campaigners in this place beyond that group, including the hon. Member for South Leicestershire (Alberto Costa), the right hon. Member for Hemel Hempstead (Sir Mike Penning) and my hon. Friend the Member for Manchester, Withington (Jeff Smith), for all that they have done over the years to put it on the parliamentary agenda.

Progress in making cannabis-based medical products available to those who need them has been slow, so it is right that we have the opportunity to debate the frustrating lack of progress. As hon. Members have said, this is the second debate in two days, which I hope gives those watching confidence that we in this place are taking the issue seriously.

I associate myself with the remarks of the hon. Member for Inverclyde in his opening speech about the families who are dealing with incredible, unthinkable challenges and who handle themselves with such dignity and make such powerful cases. I hope—I feel—that we have done them justice today and will continue to do so. In particular, I hope that the Minister will touch on his points about the limiting factors in research.

The speech of the hon. Member for Reigate was a characteristic tour de force. I always stop to listen when he is talking about the issue, because he speaks with such power. He made the point that it is unacceptably cruel to take effective medicines away from a child, which we all agree with. He linked that to palliative care, and I share the view that we want people at the end of their life to get whatever treatment might make their final days the best that they can be. Actually, that applies to adults throughout their lives: if people are living in pain and do not have to be, I would want to do anything I could to avert that.

The hon. Gentleman spoke about the 2018 regulations and the sense that we thought they had solved it, as the right hon. Member for New Forest East (Dr Lewis) also said. The hon. Member for Reigate gave us a hopeful way forward by concluding that we need to be creative and solution-focused. The Opposition share that view—I do not think there is a lot of politics on this issue—and support coming together to find a practical, effective, safe and risk-aware solution.

My hon. Friend the Member for Manchester, Withington spoke in that spirit. He is fortunate to have been drawn in the private Member’s Bill ballot, which is precious for any right hon. or hon. Member. He is keen to work with the Government. I know him well and know the spirit in which he will work with them, so I hope the Minister will take that up. That private Member’s Bill would be a perfect vehicle to move the issue forward. His point that it is about not just epilepsy was well made. I double underlined the phrase that we need to give clinicians the “comfort to prescribe”, which was elegantly put. I completely support that goal and will come back to it.

The hon. Member for Edinburgh West spoke about her constituency case of Murray. Many right hon. and hon. Members will recognise similar cases in their surgeries. The daftness of that story is that the UK’s prescribing could grind to a halt on the basis of a single person retiring. Where else in the health service would that ever be the case or tolerated? It is an absurd set of affairs.

My hon. Friend the Member for North Tyneside (Mary Glindon) kindly facilitated the opportunity for me to meet her constituent, who is a doughty campaigner, as she says. To hear the impact on her constituent’s life, it is hard to understand why we are not doing everything we can to make sure that she can live with as little pain as possible. I will get on to the counterargument about the lack of evidence, but she is that evidence, because we know what her life was like before and after, so I find that argument hard to accept.

The common theme of the contributions has been frustration or, more positively, a desire to redouble our efforts in this area, which cuts both ways. There are opportunities in research, which I hope the Minister will talk about, with regards to epilepsy, long-term pain relief and mental health. We also need a stronger position on the regulation of products such as cannabidiol, which proliferate on the internet and can be found in various shops, in all sorts of forms, promising all sorts of things that are hard to establish. We need better regulation in that space.

When the Government accepted the therapeutic use of cannabis, it was met, as we have heard, with much relief from campaigners, such as the families of Billy Caldwell and Alfie Dingley, who has now gone 508 days without an epileptic fit thanks to his medicinal cannabis treatment. It has changed his life, but not everyone has been so lucky.

Bailey Williams has been denied access to medicinal cannabis for his epilepsy and his parents are forced to raise £1,200 a month for his treatment. The mother of 11-year-old Teagan Appleby spends about £2,000 a month to treat her daughter’s Lennox-Gastaut syndrome, as she has not received a prescription. In the time that she has been taking that treatment, she has to go to hospital only once—when it ran out. That is the impact on her life.

I think of my constituents and how few, if any, could spare £2,000 a month. Of course, all of them, and I daresay all of us, would go to whatever lengths necessary for our children—that is the tragic paradox—but it is not acceptable. We are letting people down on an issue that we thought we had resolved.

In 2018, cannabis-based products were rescheduled. Guidelines were produced by the National Institute for Health and Care Excellence and three products got through: Epidyolex for rare forms of epilepsy, Nabiximols for multiple sclerosis-related spasticity and Nabilone for side effects from chemotherapy. The regulations said that initial prescriptions must be made by a specialist medical practitioner and, in all cases, would be considered only when other treatments were unsuitable or had not worked.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

The hon. Gentleman is making an excellent point. Does he agree that the psychological pressure and stress of having to campaign constantly and raise money at that level is simply unfair? My constituent Lisa Quarrell has had to raise thousands of pounds for her child Cole Thomson and has been under that stress continually for years. It is time for us to work collectively to overcome any hurdles to achieving success.

--- Later in debate ---

[Alex Norris]

I have seen the fundraisers online, as other hon. Members will have. When people have to raise that amount of money each month, they must not be able to do anything else and they must live with that anxiety constantly. We want to relieve people of that as far as we can.

We know that the number getting through has been dreadfully low. The previous Minister said in February that 413 unique eligible patients had been identified, but no estimate had been made of the number who had received prescriptions. End Our Pain believes that only three prescriptions have been issued on the NHS—goodness me, that is not what we thought it would be three years ago. If the Minister has more up-to-date information, we would be keen to hear it, but there is definitely a sense that it is not going anywhere near far enough.

Last year, a Care Quality Commission report found that a meagre 6.5% of cannabis-based items were prescribed on the NHS. Again, that is a paradox because we are told that there is real anxiety about prescribing it, but if people pop it into a search engine, they can find an awful lot of private treatments that do not seem anxious at all—there seem to be fewer shy bairns there. I am not sure that that is quite the defence that those who use it think it is.

It is a matter of justice if people are missing out or are left with the horrendous choice between paying over the odds for medication and suffering. The founding principle—the settled political point—of the national health service is that we do not tolerate that or think that people’s access should be based on their ability to pay, but we are tolerating that here, so I hope we can do better.

[Dr Julian Lewis]

I have been looking at the Hansard of yesterday’s debate—there is an opportunity for the Minister to refer to it when she makes her remarks—and I see that one of the main points she made yesterday was the fact that there is insufficient evidence on the safety aspects and the possible harm effects. Given that families are paying all this money and finding other ways of getting the cannabis-based products, would it be a way forward if families were asked to sign a waiver if it were prescribed, so that the people doing the prescribing would be protected against any subsequent action if in fact something went wrong? It might be for the family to take that decision on the balance of benefit and harm.

[Alex Norris]

I am grateful for that intervention. I am slightly torn in the sense that I have absolutely no doubt that families would take it on that basis, but as a former trade union official, I would never have advised a member to sign away their rights. I think that is what we are getting at when the hon. Member for Reigate says that we have to come up with something creative that means we can clear this hurdle, and that is one such option.

Let me link that back to a previous intervention by the right hon. Member for New Forest East on opiates—if you will briefly indulge a thought experiment, Mr Deputy Speaker. If the reverse were true and we routinely prescribed cannabis-based products to deal with pain issues, would anybody really be advocating at the Dispatch Box that we should instead swap them for opiates and that they would be a better alternative? I think the answer to that is an obvious one, and that should be guiding our thinking.

[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.