Healthcare: Controlled Drugs

Lord Allan of Hallam Excerpts

Thursday 14th September 2023 Grand Committee

[Lord Allan of Hallam (LD)]

My Lords, we are grateful to the noble Lord, Lord Butler of Brockwell, for pressing this issue for some time now, not just in this debate but in previous Questions, because it is frustrating when a policy decision has been taken that will bring benefits to people but its implementation is held up for months or even years for want of a technical change to regulation. It seems entirely misplaced that we have an important policy decision yet, as the noble Lord described very accurately, something quite trivial—drafting an instrument and getting it before us—is holding up that change.

It might be helpful to put this change into the wider health context to understand the weight of that frustration and why it is ringing alarm bells. This specific change to prescribing paramedics is in a context of changes to prescribing rules more generally. There is a recognition among policymakers of all parties and none, and among the health and care professional community, that there is a need for innovation in working practices, especially those practices around prescribing. That is essential if we are to meet the demand for health services, even if we keep putting more resources in. Resources on their own will not provide the answer; it is the kind of innovation where we use a broader group of healthcare and allied professionals to deliver services that will enable us to meet that growing demand. Prescribing is one of the key areas where innovation is happening and cost-benefit analyses are being constructed for potential changes to the prescribing model.

On the benefits side, these accrue to individual patients, who can have easier access to the drugs they need. The noble Lord, Lord Patel, elegantly set out the kind of situations in which an individual patient would certainly benefit from the change being considered—the paramedic being able to prescribe controlled drugs. However, we all will indirectly benefit if healthcare professionals can work in the most efficient way and professional A does not have to ask professional B to take time out to prescribe the drug that professional A could have prescribed themselves. The whole system benefits with that increased efficiency, as well as the individual who is immediately at risk.

There are of course some potential risks to individuals and society from any of these changes. Again, the noble Earl, Lord Sandwich, set out for us the kind of problems that can occur if drugs are prescribed inappropriately. We need to bear that in mind and that is why, with any of these changes, the analysis should look at those risks and the things that need to be put in place to manage and mitigate them. That is precisely what has happened here, with the report we had as far back as 2019 from the Advisory Council on the Misuse of Drugs, and other work that has taken place. People have looked at the benefits and risks of the change and concluded that the benefits significantly outweigh the risks, and therefore that we should proceed. That process has happened as it should, by looking at things within the full context. Now all we need is that enabling regulation.

I hope the Minister is going to explain to us today, first, why it has taken so long and why we are forced, in a sense, to bring him here to answer rather than it having just appeared on the Order Paper at an earlier date; and, secondly, whether he can point to a resolution in the near future. The noble Lord, Lord Butler of Brockwell, used the word “forthwith”, which was a novel take on this. I have heard that things will happen in due course or shortly. These are all terms of art, rather than precise dates, in government-speak. Forthwith is one that I like, as it conveys even more of a sense of urgency, but the noble Lord was right that better than any of these formulations would be a date. Having “12 October” is better than “shortly” or “soon” or any such formulation. I hope the Minister will be able to offer us a date.

I would also like to raise with the Minister a specific question, which I hope he can touch on in his remarks. Have the Government given any consideration to the impact on healthcare professionals of making nitrous oxide a class C controlled substance, which the Government are doing through a statutory instrument that I think will come before us next Tuesday? Again, it is interesting to note that the Government managed to produce that instrument in double-quick time, even though it goes against the advice of the Advisory Council on the Misuse of Drugs, while here we have one which is aligned with that council’s advice but has taken much longer. The noble Lord, Lord Butler of Brockwell, may have put his finger on it when he said that if this regulation was owned by DHSC it would have proceeded much faster, because if the change in regulating controlled substances is one the Home Office wants for its own policy agenda, it seems to be able to do that much more quickly than if it is being asked to assist the Department of Health. That is a shame, in what is supposed to be an era of joined- up government.

I have looked at the Explanatory Memorandum for the instrument that will be debated next week. It says that the impact for the public sector of this classification relates only to law enforcement and criminal justice, with no effect on anyone else. I hope that is true and that the Government have done all the work needed to ensure that healthcare professionals and those in allied professions who use nitrous oxide quite widely will not experience any change to their practices, or their ability to use nitrous oxide, post the reclassification. However, the fact that we are debating this today around other class C controlled substances, such as diazepam, suggests to me that there is some complexity. When I read some of the background notes, I understood that there are NICE guidelines and specific exemptions, so it is a very complex world where health service regulation and Home Office regulation come together.

As I say, I hope that the Home Office has done its homework and that when we classify nitrous oxide as a class C controlled substance, the Minister will be able to assure us that no health professional or allied professional needs to worry about that and that there will be no negative implications. If not, and if changes will be required pursuant to that reclassification, I hope he can indicate that those are in hand and nitrous oxide will not suddenly fall into this area, with some professionals being unable to prescribe it as and when they need to, as with the other substances we are talking about. I hope the Minister will have answers to this, as well as that crucial answer of a date when the changes that were already agreed so long ago might come into force.