O’Neill Review

Maggie Throup Excerpts

Tuesday 7th March 2017 Westminster Hall

[Kevin Hollinrake]

I defer to my hon. Friend’s in-depth knowledge in this area. I recognise my father’s habits in taking antibiotics when he felt a bit unwell—he had a little cupboard in the corner of his lounge. That is a problem, and that is why we need to improve the education on treatment of illnesses for which people are prescribed antibiotics.

The point about antibiotic resistance spreading is that it can be spread in so many ways: on aeroplanes; in our water; from contact with unwashed hands of people who carry bacteria resistance; coughing and sneezing; and from animals to humans. Some Members may have come across the excellent BBC Radio 4 drama “Resistance” —the first episode was aired on Friday and the second episode is this Friday—which talks about the transference from animals to humans. That means we must tackle this problem both in agriculture and in our health services.

Bacteria do not recognise national borders, so, as many hon. Members have already pointed out, this is a global problem. We would think that with those apocalyptic visions of the future we would be spending an awful lot of money on tackling this issue, but that is not the case. About $100 billion is spent every year on cancer research, but only about $5 billion is spent every year on tackling antimicrobial resistance. The reason for that is the commercial return that large pharmaceutical companies will get from bringing forward a new antibiotic to tackle this issue. Almost by definition, any new drug is held as a last line of defence, so there is not a significant commercial return for the pharmaceutical companies who we rely on for such new drugs. About $50 billion a year is spent on antibiotics but only about $5 billion a year is spent on patented antibiotics, which is equivalent to one cancer drug. It is a better commercial activity to be involved in cancer research and cancer drug development than in antimicrobial resistance. There has been a huge reduction in the number of pharmaceutical companies involved in research and development—in 1990 there were 18 and in 2010 there were only four—and no new classes of antibiotic drugs have been developed in the past 25 years.

Of course, the O’Neill review has studied that and come up with clear and compelling recommendations such as rapid diagnostic testing, which the right hon. Member for Oxford East (Mr Smith) referred to. Yesterday we had a Twitter debate, which was interesting, listening for an hour to people’s experiences. Many clinicians got involved in that particular Twittersphere, and we trended nationally at one point, which was certainly a new experience for me. One thing that came across was the pressure that clinicians were under to prescribe antibiotics to people who felt ill. Obviously, if we had diagnostics that could show people that they did not carry something that could be treated by an antibiotic, they would be much less likely to put that pressure on doctors.

[Maggie Throup (Erewash) (Con)]

My hon. Friend makes a good point about educating patients so that they appreciate that they do not have to come out of the GP surgery with a prescription in their hand if a diagnostic test can be carried out to prove that antibiotics will not work in their case.

[Kevin Hollinrake]

That is right. I had a test myself at a drop-in session in Portcullis House that showed me that I was not ill—I did not think I was ill, but they told me that I was not, which was reassuring. Again, we need to ensure that prescriptions are given when they will be effective. One other area that we do not seem to have control over at the moment is the online sale of antibiotics: whether through UK-based pharmacies or those based overseas, it is too easy to access drugs without a proper prescription.

The second key point that the O’Neill review highlights is the need for a global public awareness campaign so that people are aware of the issues. Again on Twitter yesterday, a student who had undertaken some analysis said that 80% of the people she had spoken to had no awareness of antibiotic resistance. We need a significant national and international effort to draw public attention to the problem. As people have already said, we need a reduction of usage in agriculture. That is clearly set out in the O’Neill review as one of the four main recommendations.

--- Later in debate ---

[Maggie Throup (Erewash) (Con)]

I congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) on securing this important debate. I will focus on Lord O’Neill’s call for antibiotic prescriptions to be informed by a rapid diagnostic test “wherever one exists” by 2020. Such tests do exist and have for probably at least 25 years. I know that because I tried to launch such a test previously. At that stage it was about better prescribing, but it is now more about tackling the huge problem of antimicrobial resistance, which Dame Sally Davies has said is as big a risk as terrorism and climate change.

Why are we still only talking about these point-of-care and diagnostic tests, which could make a huge difference? I think it is partly due to the way that in vitro diagnostic tests are block funded through centralised hospital labs. In Scandinavia, point-of-care tests are a lot more widespread, including for C-reactive protein—CRP—and funding is decentralised. There is not yet a mechanism for such tests to be funded in the UK. It is so important to look at how such tests will be funded, whether they are to be used in a GP surgery or local pharmacy. It has been calculated that £56 million could be saved in prescribing and dispensing costs alone if point-of-care tests were introduced, as they can be vital in deciding whether to prescribe antibiotics.

Let me explain. High levels of C-reactive protein are found in somebody with a bacterial infection. The level is normally only slightly raised when the patient has a viral and not a microbial infection. When my hon. Friend was tested, the results showed that he was either healthy or had a viral infection. Point-of-care CRP tests are available and can be carried out by GPs, practice nurses and community pharmacists, and they take just four minutes to determine whether a patient needs antibiotics or not. It sounds very simple, and it can be. As I said earlier, patients feel they have only had their money’s worth from a GP appointment if they come out with a prescription, but studies have shown that giving them a point-of-care test can also leave them feeling satisfied and as though they have had their money’s worth. In one study, 90% of respondents felt reassured by a point-of-care CRP test if they were not prescribed an antibiotic.

The tests are very simple. Patients have their finger or thumb stabbed and a small drop of blood is taken. It is then tested within four minutes, while the patient waits in the doctor’s surgery. Lots of studies have shown a reduction in antibiotic prescribing, including by 30% in one and 23% in another project, which was cost-neutral; the cost of carrying out the tests versus prescribing is very effective. I am mystified as to why we have this problem yet are not tackling it with tests that are already on the market, which is in line with current National Institute for Health and Care Excellence guidelines. I ask the Minister: why can we not change the funding streams for these tests to make sure that they are carried out exactly where they are needed?