The Long-term Sustainability of the NHS and Adult Social Care

Earl of Sandwich Excerpts

Thursday 26th April 2018 Lords Chamber

[The Earl of Sandwich (CB)]

My Lords, I thank my noble friend not only for introducing this debate but for inviting me to join it. He knows that over the last few years I have brought up the subject of dependence on prescribed drugs, and I declare that I am a vice chair of the all-party group on that subject. This is a sad story, but today I am not going to describe the terrible effects of dependence on, and withdrawal from, medicines that have been recommended in good faith by doctors. Everyone here knows that most prescribed drugs are effective for most conditions but that many mistakes are made, and drugs are inappropriately prescribed for a variety of reasons. I have lived with the painful effects of withdrawal in my own family.

According to an authoritative article in the Spectator on 24 March, over 300,000 people leave their jobs every year because of mental illness. Paragraph 292 of the committee’s report says that two out of three of them receive no appropriate treatment. Psychiatric drugs are dramatically increasing in number and availability, and the BMJ has reported a related high risk of suicide. Prescriptions for antidepressants in England rose to 64.7 million items in 2016, which is an all-time high, according to NHS Digital, representing a 108% increase over 10 years. Another 15.9 million prescriptions were issued for benzodiazepines and Z-drugs.

This debate is about the future and, therefore, gives us the opportunity to dream. But I am not interested in chimera, only in the possibility of change and the dynamic of that change. Many would like to see a radical transformation of mental health policy so that it takes in human beings more individually instead of consigning them to the conveyor-belt of medicine. Mental health patients, while they have come more into focus, are still not given a wide enough choice or more attention from psychiatrists or better alternatives to medicine. The pharmaceutical companies have a powerful hold. Big pharma cannot be blamed for responding to demand, but it can be reminded of its corporate responsibility when it comes to promotion, research or the sponsorship of trials and surveys, and they should be more sensitive to the effects of their products on increasing numbers of the public.

I would also like to see more CCGs waking up to the reality of the consequences of mental ill health, and especially the perils of withdrawal. My noble friend Lady Murphy touched on this. There are very few services for those withdrawing from prescribed medicines, and most of them are voluntary and fragile. In fact, Mind in Camden is threatened with closure this summer because of Camden CCG’s withdrawal of funding. Camden is the only London borough that offers this service through Mind, and it is available only to Camden residents. I understand that, perhaps because of negative publicity, the CCG is considering a new configuration of this service. There is even a risk that it will be merged with illegal drug addiction services, something that specialised charities avoid. But it raises a major question: should not the NHS be encouraging voluntary initiatives, especially at a time when prescriptions for antidepressants and dependence on them are rising? I know of another charity in Cardiff which closed for similar reasons. This is no national network; there are only a small number of these initiatives and their local CCGs should be backing them up, not swallowing them up.

The Minister may say that millions are being spent on mental health, but it is certainly not in this area of mental health. The support of voluntary agencies in every sector is surely an important, even vital, alternative to statutory funding at a time of austerity. One short-term solution would be a national helpline. We cannot leave this to the wish list of the future reorganised NHS or the recommendations of the review now being undertaken. It is viable and is needed now. I understand that it is being seriously considered behind the scenes, but I again urge the Minister to let us know whether it is actually going to happen.

Another important issue is the degree of public understanding of the effects of overprescription. On 24 February, the president of the Royal College of Psychiatrists and a colleague wrote in the Times that for,

“the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment”.

This statement has appalled a large number of psychiatrists and patients who have lodged a complaint with the RCP, including some who have experienced withdrawal effects for between 11 months and 10 years. Even the Royal College’s own survey of 800 users found that withdrawal symptoms generally lasted for up to six weeks, with a quarter reporting that anxiety lasted more than three months. If even one of our leading institutions can mislead Times readers on a matter of public safety, what hope do the Government have of explaining these things to the general public? It is well known that antidepressants are on the increase, and the NHS has to deal with the consequences. I know from a Question asked by the noble Lord, Lord Hunt, last month that the Minister is well aware of this issue and knows that Public Health England is conducting a year-long review of policy. He may argue that this is looking to the future, but he will also know that there have been reviews before, that the responsible Ministers have changed three or four times under the last two Governments and that the problem is happening now. Some immediate measures are essential before the end of that review. I much look forward to hearing his comments.