Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, with reference to the guidance by NICE entitled Covid-19 rapid guideline: managing symptoms including at the end of life in the community, NG163, published on 3 April 2020, by what process (a) that guidance was commissioned and (b) the NHS decided (i) to procure Midazolam for use in (A) end-of-life and (B) other patient care and (ii) the quantity of Midazolam it would procure in each of the last four years.

The National Institute for Health and Care Excellence (NICE) guideline NG163 published in 2020 was commissioned as part of a programme to provide rapid guidance on the management of affected patients with COVID-19. Several of NICE’s COVID-19 rapid guidelines were incorporated into a single guideline for the management of COVID-19 in children and adults (NG191), which was last updated in June 2023.

Early in the pandemic, NHS England convened a National Clinical Group comprising senior specialist clinicians and relevant specialist pharmacists to develop priority medicines lists for critical care, end of life care and antibiotics and these were kept under review as the pandemic and subsequent clinical knowledge evolved. As part of this process, midazolam was identified as a priority medicine for use in both critical care as an alternative to propofol in the sedatives category, and end of life care as a first line medicine in the anxiety category.

The following table shows the quantity of midazolam procured by the National Health Service in England using NHS England procurement frameworks for use in secondary care in each of the last four years to 2023/24:

It is not possible to differentiate between Midazolam use in end of life and other patient care. This data excludes procurement for use in primary and community care.

In primary health care, procurement is undertaken by retail pharmacies on an individual basis, based on their perception of future demand needs or in direct response to prescriptions received from patients. There is no centralised procurement process for primary care and therefore there is no information that is relevant to the question asked.

Health is largely a devolved matter, and decisions on the procurement of medicines in Scotland, Wales and Northern Ireland are therefore a matter for the Scottish Government, Welsh Government and Northern Ireland Executive respectively.