§ 10.26 p.m.
§ Mr. Greville Janner (Leicester, West)
I am glad to have the opportunity of raising this subject on the Adjournment tonight.
I welcome my hon. Friend the Under-Secretary of State for Health to the Dispatch Box and wish to say how happy I am to have someone on the Front Bench who, I hope, will be able to give a favourable reply in connection with a campaign which I have been pursuing without remission for four years. Unfortunately, during those four years more children have died through accidental poisoning as a result of dangerous drugs being left lying around and not in child-resistant containers and through ordinary household supplies. Others by the thousand have been hospitalised, resulting in terror both for them and for their parents and enormous cost to the National Health Service.
The problem is twofold. First it concerns medicines, some of which are so made that they look as if they are tempting sweets, such as those which I have here marketed by Calleys. Unless they are sold, as the ones I have are, in containers which prevent small children from opening them and swallowing the contents, they can, and often do, cause injury and on occasion death. The problem also concerns such ordinary substances as aspirin. Not long ago a child in Leicester took a bottle of aspirin from his mother's purse, swallowed the contents and died. There is no need for tragic accidents of this sort provided that action is taken at all levels.
The other area of concern is ordinary household products. Bleaches and poisons are left lying around within the reach of small children, often in containers which are exactly the same as those used for harmless substances, foods and drinks. There was a report in yesterday's Sunday Mirror of a white spirit being sold in a soft drinks bottle with a 812 screw top. The report stated that the drink bubbled when one shook it, just like lemonade, and the father of the child who had bought it said that he was horrified to realise that it lookedjust like a lemonade bottle—except for the label which a young child can't read".Next day his wife bought a replica of the bottle, this time containing lime juice, at a nearby supermarket.
There are therefore two problems—dangerous pills, such as travel sickness pills and tranquillisers, aspirin and antidepressants, which are to be found every day in millions of homes, and ordinary household products. The latest figures supplied by the Department last week show that in every year between 1968 and 1972 over 20,000 children were admitted to hospital suffering from poisoning or suspected poisoning.
Those figures include non-accidental poisoning, which is not separately identified. This debate concerns accidental poisoning, but perhaps my hon. Friend can give an indication of the number of poisonings which are regarded as non-accidental, so that those which are accidental can be separated. It is a horrifying fact that there is a statistically significant number of cases of deliberate poisoning of children under the age of five.
The latest figures I have for deaths caused by poisoning go back to 1951, and from then to 1971. In each year the range has been between 13 children, in 1964, and four, in 1971, who have died as a result of accidental poisoning. The figures, while not great compared with, for example, road deaths, are of avoidable accidents, and they can and should be avoided.
I pay tribute to Dr. Matheson, of the Leicester Royal Infirmary, whose efforts have produced a constant flow of statistics, which I drew to the attention of the previous Government time after time, of the numbers of children admitted to the Leicester Royal Infirmary suffering from accidental poisoning. The latest include weekly totals of 17, 14 and 12.
There is no need for their parents to be put in a state of terror, no need for the children to go into hospital with poisoning. The accidents are avoidable, provided the proper steps are taken. I have seen children with their parents in 813 the Leicester Royal Infirmary, and I know the fear that is caused
What we do not know is how many children who are sent home from hospital apparently cured have suffered, and continue to suffer, after-effects which cannot provably be attributed to the poisoning but result from it.
What can be done? First, care can be taken by the parents and those who look after children to keep dangerous substances preferably locked up, well out of the reach of small hands. They can use cabinets which can be bought to keep the pills and poisons in. In fact that is not good enough, because we know perfectly well, first, that people will not invest in expensive cabinets. Secondly, many people do not realise the risks. Thirdly, even if they do, people are careless, particularly sick people using pills. Fourthly, many people have to carry medicines with them in their handbags, medicines such as the bottle of aspirin which was in the mother's handbag in Leicester.
The answer lies first in care, as immaculate as possible, by the parent. Secondly, it lies in the use of child-resistant containers by all those who sell dangerous products. Such containers are sometimes available, but the first difficulty so far has been that pharmacists have been forbidden to sell child-resistant containers for National Health Service prescriptions. I am told that they break the law if they do so. It is illegal to sell, even at cost price, these containers which can save lives.
There is no possible justification for such a law or regulation. I hope that my hon. Friend may find it possible to alter it. That would cost the country nothing and it would save lives and health. It would be a first step in the direction of recognising that the chemist or pharmacist who sells such containers at cost price is performing a public service. He certainly should not run the risk of being penalised as a result.
Secondly, the containers must be developed. They are being developed, and the British Standards Institution is doing its best to produce proper standards. There are various drafts. I have with me the latest draft for development of reclosable containers. It 814 is totally incomprehensible to a layman. I had a very nice letter from the chief technical officer, which is also incomprehensible to me. But I am sure that my hon. Friend, with the enormous and highly-skilled staff in his new work, will be able to understand it and know what needs to be done. What is certain is that the BSI is anxious to do more and is willing to submit to pressure. I hope that the Minister will take such steps as are necessary to achieve a standard as swiftly as possible.
Meanwhile it is not good enough to say, as my hon. Friend's predecessor did, that we should not make child-resistant containers compulsory until they are 100 per cent. effective. If we save 90 per cent. of the injuries, accidents and deaths, it is infinitely worth achieving. It can be done, and it can be done at minimal cost.
There are many child-resistant containers available, and I have a number with me which I fear it would be improper to demonstrate. But it would be correct to draw attention to a comparison between the ordinary screw-top bottle which any child can open, the lid of which can fall off, which, after all, still has to be produced and paid for, and which consists of plastic or glass with a plastic top, and a simple twist-and-turn top supplied with children's orange-flavoured aspirin by Messrs Bayer. The aspirin costs more, but the bottle can cost very little more. The cost of requiring poisons to be put in containers of this kind would be more than compensated for by the saving to the National Health Service as a result of some 20,000 children fewer being admitted to hospital, occupying beds, receiving medical treatment, having nursing care and taking the time of doctors. This is totally leaving out of account the human element, which is far more serious.
Happily, by almost common consent, the present Government appear due for a long life. Having taken over a bankrupt economy, if we are talking in terms of costs, they will have to cope with the resources available. In this case the resources required are minimal. The lives and illnesses which can be saved are very substantial in number.
Apart from the ordinary twist-and-turn variety of container top, there are many others. Some people say that they may 815 present problems to arthritic patients. That is true. But there are ways in which there could be dispensations when dispensing to elderly people. In fact, very little difficulty is involved for arthritics with the ordinary child-resistant container. Even with arthritic hands it is possible to open most containers by gentle pressure against the body. There is no reason why these containers should not be brought in as swiftly as possible.
I want now to consider the ordinary household bleach. I suggest that bleaches, poisons and spirits should always be dispensed or sold only in the kind of container which requires a double action to open. There would be a cost to the manufacturer, some of which would no doubt be passed on. But the amount involved is minimal. The hon. Member for Gloucester (Mrs. Oppenheim) told me today that Johnson's already produce many of their products in these canisters. It can be done.
The selling of spirit in lemonaade bottles should be made unlawful. The dispensing by hardware traders of dangerous poisons in throw-away bottles which used to contain lemonade is to put into the hands of parents substances which can and are likely to cause injury or death to children, bearing in mind that children regard bottles of this kind as containing a treat. There is no reason why this practice should not be forbidden.
Most parents are careful. Unfortunately, laws have to be designed to assist those who are not. Few of us are careful all the time. In all branches of the law designed to protect people, whether one deals with factory legislation, the protection of employees or any other kind of legislation, one has to look after the forgetful, the elderly, the careless, the tired and the ill. In this case we have to look after the majority of us. At some time any one of us may be careless.
We must look after our children, but we need a bit of help from the new Government. I hope that the new Minister will give an indication that help will be made available.
§ 10.40 p.m.
§ The Under-Secretary of State for Health (Dr. David Owen)
My hon. and learned Friend the Member for Leicester, West (Mr. Janner) has shown a long and 816 continued interest in the subject of accidental deaths from poisoning in children. I think that the whole House will be grateful to him for raising this subject tonight. He has shown in this cause the same concern and compassion that he has shown in many other causes.
Accidental deaths from poisoning in children under five years of age fortunately constitute only a very small proportion of the total deaths in this age group. In 1972 19 children died from medicinal poisoning, which represents a death rate of six per million. But that is 19 children too many.
Thankfully, only a small number died. Yet, as my hon. and learned Friend said, a very much larger number are treated in hospital each year for poisoning or suspected poisoning. Admissions rose steadily from 1964 to 1968, but since then they have stabilised at the considerable and worrying total of about 16,000 per year.
This increase may not be wholly attributable to increases in the number of incidents, but may and probably does reflect increased caution on the part of parents and general practitioners when any case of poisoning is even suspected. Some confirmation of this is provided by the reduction in the number of days that these children spend in hospital, which over the decade has fallen from 3.5 days to 1.3 days. That is a fairly substantial reduction.
What are the medicines that are chiefly responsible for these hospital admissions? My hon. and learned Friend mentioned aspirin, which stands out as the largest single cause and reflects the frequency with which it is found in the home. Antidepressants and iron preparations, which are not so commonly found, also provide a large number of admissions, but almost every medicine that presents any hazard to children has on occasions been taken by accident. I am not covering domestic poisons and other aspects, but they too have occasioned serious accidents.
Clearly there can be no room for complacency. I assure my hon. and learned Friend that I am aware of and share his concern. Nobody can have children of his own without having seen and felt the panic of suddenly realising that one's child might have got at a bottle of medicine. I am prepared to examine anything 817 which can reduce the risk of accidental poisoning.
The Medicines Commission was consulted on this matter last year. It in turn appointed a working group to consider all aspects of the presentation of medicines relating to child safety, including the use of child-resistant containers. I understand that that working group will be reporting to the Medicines Commission shortly.
My hon. and learned Friend concentrated his speech, as he has devoted his activity generally, to the use of child-resistant containers as a means of reducing the number of child poisonings. Such containers can be either reclosable or non-reclosable. In the reclosable types a novel form of closure is provided which can be removed only by some unusual procedure. Non-reclosable types consist of some form of strip, bubble or blister pack in which each tablet or capsule is separately enclosed.
The use of child-resistant, reclosable containers has been widespread in the United States for some time. I admit that, unfortunately, we do not at present seem to know enough about their experience. I am trying to collect together all the information possible from the United States and other countries.
The introduction on to the British market of containers for which child-resistant properties were claimed prompted the Department of Health, in association with the Pharmaceutical Society of Great Britain, to approach the British Standards Institution to find out whether a British standard for such containers could be produced.
My hon. and learned Friend mentioned that in 1973 the institution produced drafts for the development of both types of container. These were not British standards but were issued on a provisional basis so that experience in applying the provisions could be obtained. The working group of the Medicines Commission will be commenting on the drafts. Clearly the Department will have to take carefully into consideration any advice that it gives.
The BSI drafts, although based on standards for child-resistant containers adopted in the United States of America, provide performance requirements for both reclosable and non-reclosable containers. The children are each given a container of the type under test and 818 are requested to open it. If after five minutes the child has failed to open the container, a visual demonstration is given of the correct method of opening it and a further five minutes is allowed. In the case of non-reclosable containers, each child is given a packet or strip providing at least 20 placebos in unit packages and is allowed 10 minutes in which to open the packages and extract the placebos.
The adults when testing reclosable containers are each given a container of the type under test, together with whatever instructions on opening and properly re-closing the container will appear in or on the container, and are allowed 10 minutes in which to read the instructions and open and properly reclose the container. These are obviously fairly complex. In the case of non-reclosable containers, adults are allowed five minutes in which to open a unit package.
Reclosable containers are considered to meet the required standard if 85 per cent. of the children are unable to open them prior to the visual demonstration and 80 per cent. are still unable to open them after it, and if at least 90 per cent. of the adults were able to open and re-close them without a visual demonstration within the required time. This meets one of the points mentioned by my hon. and learned Friend. We are not requiring 100 per cent. safety. Non-reclosable containers are considered to meet the required standard if at least 85 per cent. of the children are unable to obtain more than five placebos in the required time and adults are able to obtain at least one.
The BSI recognises that to obtain a reliable assessment of the child-resistant qualities of containers the methods of test proposed in the drafts must be conducted under the supervision of an impartial and appropriately qualified expert and the results evaluated by an impartial and competent authority. It proposes that the Department should be consulted before packages are submitted to test on the appropriate procedure to be followed.
The proposed involvement of the Department means that we must clearly first await the advice of the Medicines Commission's working group on medicines in relation to child safety. I assure my hon. and learned Friend that this is not just a holding reply. Having established this working group, it would be 819 absurd not to wait until I have heard its comments and evaluated it's advice.
A far more immediate issue to which my hon. and learned Friend rightly drew attention, is that the arrangements for dispensing under the National Health Service have the effect of restricting the freedom of parents who choose to have medicines dispensed in child-resistant containers. Pharmacists buy the containers which they use through normal commercial channels, and they are paid a container allowance of 1p per National Health Service prescription, to which my right hon. Friend the Secretary of State proposes that a 10 per cent. increase should be added with effect from 1st January 1974. This allowance is based on the average cost of containers actually used by a sample of chemists in periodical surveys.
One would expect child-resistant containers to be at least marginally more expensive, though I accept what my hon. and learned Friend said, that this may be open to doubt if they are mass-produced. If so, a pharmacist who uses them for NHS dispensing would not be adequately recompensed unless we agreed to increase the container allowance for that purpose, and this raises the central issue of the Department's involvement in listing and standards. Some parents, however, are obviously willing to pay a few pence for a child-resistant container themselves, but the pharmacist is debarred, under his statutory National Health Service terms of service, from charging for the containers used in dispensing. I am prepared to look urgently into the possibility of modifying this restriction.
Accordingly, I have asked officials of my Department to consult the Council of the Pharmaceutical Society of Great Britain, the Central NHS (Chemist Contractors) Committee and the British Medical Association about the professional and practical implications of a change which would allow pharmacists, if so requested, to dispense a National Health Service prescription in a child-resistant container and to charge for it. In this way we might at least start to gain experience with the use of child-resistant containers which we lack at the moment.
Whether in the future child-resistant containers should be supplied under the 820 NHS or not, we should always remember that this is the last line of defence. I am sure my hon. and learned Friend would be the first to say that we must continue to impress on the public, and particularly on parents of young children, the fact that nearly all medicines are dangerous when taken in large quantities.
§ Mr. Janner
Before my hon. Friend leaves the question of the chemist, may I thank him for the first move that his Department has made in the last five years in this respect towards bringing some satisfaction to parents and to the pharmaceutical profession. I hope that the pharmaceutical profession will welcome this move with open arms and will help the Department to achieve results. It is only the first step, but it is welcome and I thank my hon. Friend.
§ Dr. Owen
I am grateful to my hon. and learned Friend. It is meant as a first step and I hope it will mean that we can gain experience. Obviously I cannot enter into reasonable and fair consultations if I prejudge the issue by stating my own feeling, but I hope that the mere fact that I have agreed to undertake discussions urgently is an indication that I believe that this restriction should be lifted if at all possible, and it certainly would be my intention to pursue that in the hope that we can get agreement.
As my hon. and learned Friend knows, we must ensure that parents recognise that whatever the containers, however safe they may be, the safest way of avoiding children taking medicines which are dangerous is to ensure that the children are unable to get at tablets out of a bottle. We should take the utmost care to ensure that all bottles and containers are kept out of the reach of children. This applies not only to medicines but to domestic poisons which are so frequently in use and which are so frequently kept on the floor near to children.
My hon. and learned Friend has drawn the attention of the House to an issue of great importance. His concern is shared by the Government. We will do what we can, but there are limits to how fast we can go. I am certain that my hon. and learned Friend will continue to press me. I hope, anyhow, that the steps we have instituted and the experience that we may well be able to gain 821 from other countries will enable us to take measures which will reduce not only the number of children who unfortunately die as a result of accidental poisoning but also that much greater number of children who have to enter hospital for emergency treatment as a result of having taken a drug or chemical.
822 With that assurance, I hope my hon. and learned Friend will conclude that this Adjournment debate has been worth while.
§ Question put and agreed to.
§ Adjourned accordingly at eight minutes to Eleven o'clock.