§ 4.26 p.m.
§ Mr. Mike Thomas (Newcastle-upon-Tyne, East)I beg to move,
That leave be given to bring in a Bill to restrict the right of medical practitioners to prescribe drugs unless certain conditions have been met; and for connected purposes.There have been many benefits to society from new and powerful drugs developed in recent years, but there has been increasing concern at the adverse effects associated with many of these drugs and at the increasingly casual way in which they are sometimes prescribed by doctors.In preparing my remarks for this occasion, I discovered that in the year from October 1973 to October 1974 general practitioners issued nearly 17 million prescriptions for hypnotics, nearly 20 million for tranquillisers, almost 8 million for antidepressants, nearly 5 million for 1321 vitamins. Are we in such a situation that people need that level of prescription—indeed, the almost routine, mindless prescription—of drugs many of which have adverse effects?
We know that almost 3 per cent. of all admissions to hospital are due to adverse drug reactions, and we also know that another 2 per cent. or more of admissions to hospital can be traced to drug overdosage. However, even those figures probably understate the problem. We have yet to discover the proportion of patients who recover not from the effects of any drug which they have been prescribed but simply because those drugs are taken away from them once they have been admitted to hospital. In addition, 10 to 15 per cent. of patients develop adverse reactions to drugs during their stay in hospital. In respect of some drugs, particularly those used to treat heart disease, adverse effects can be seen is as many as 30 per cent. of patients receiving treatment in hospital. The drug that most frequently appears to cause adverse reactions is digoxin, a digitalis derivative.
Those effects are avoidable if doctors are made fully aware of the problems. I do not want to overdramatise the situation, but I should like to mention the case of one of my constituents who for over 10 years was prescribed one of the most potent steroids. She developed gross muscle-wasting and weakness, skin atrophy of such a severity that sheets of skin sheared off with a stroke of the hand, and severe bone atrophy resulting in a fractured thigh bone which required a surgical pinning operation for its repair. The patient also suffered high blood pressure and diabetes, and there were no therapeutic benefits whatever in respect of the arthritis from which she was suffering.
There is increasing concern at the cost of drugs and at the waste of many drugs. I believe that Parliament should take steps to control this area of public spending. Perhaps I could offer one further statistic to the House. It is now more expensive to pay for a general practitioner's drug prescriptions than it is to pay the general practitioner his salary. From the last figures I have unearthed, it appears that on average each practi- 1322 tioner is prescribing drugs worth about £12,000 per year.
In this area of activity, public education is important. My Bill aims to increase the level of education among the medical profession itself because I believe that that is an important consideration which is often forgotten. After all, it is the doctors who are supposed to know about these matters and who, in turn, should safeguard the public.
I should like to see doctors undertaking more drug related education. In recent years there has been a greater development of the specialism of clinical pharmacology. I am glad to see present in the Chamber my hon. Friend the Minister of State, Department of Health and Social Security, because I wish to draw attention to the report on this topic by the Royal College of Surgeons, on which we are awaiting with interest the Department's reactions.
There has been an increase in the number of journals available and in the amount of academic interest which is shown in this matter. My Bill aims to capitalise on that expertise by making it more readily available, in particular to general practitioners but also to medical practitioners in the round. My Bill would restrict the prescribing of medicines by fully registered medical practitioners to a small list of relatively safe, innocuous substances drawn up by the Medicines Commission. The medical practitioners would be restricted to providing those drugs and those drugs only, unless they fulfilled certain criteria.
The two main criteria are these. First, medical practitioners should attend a minimum of four full sessions a year on drug-related topics—under Section 63 of the Health Services and Public Health Act 1968—as approved by a postgraduate dean. Secondly, they should make their patients' records available for scrutiny by professional medical audit panels appointed by the regional boards so that any dangerous trends in their prescribing practices could be picked up and discussed with their professional colleagues.
I do not want to go into the routine detail which is set out in the Bill, but if we were to insist that, in addition to the 10 sessions that medical practitioners currently have to do to qualify for 1323 seniority payments, they should also attend four additional sessions on drug-related topics substantial benefits could be derived.
Each regional medical audit panel should consist, possibly, of four doctors—one clinical pharmacologist, one specialist in the discipline in question, one nominee from the regional medical committee and one nominee from the regional health authority—and two nonprofessionals, perhaps members of the community health councils in the area.
In addition to this educational provision, the Bill contains one further major provision. It provides that no doctor may prescribe for any patient whom he or his partners have not seen for three months previous to the writing of the prescription. The repeat prescription game is in danger of getting substantially out of hand. There are patients who receive the same medication month in, month out, year in, year out, without ever seeing a doctor. That sometimes suits the patients and it sometimes suits the doctor.
I have heard it said, although I have no concrete evidence of it, that some doctors even pre-sign their prescription forms and allow the receptionist to fill out the prescriptions. That may or may not be so, but it is not in a patient's interest to continue to receive a drug or series of drugs, sometimes one drug overlaid on another, often without proper instruction, unless the medical practitioner has thoroughly reviewed the case within the last three months.
I know that there will be concern in the medical profession about my proposals. The profession has already looked at itself in a number of these areas. Last year the BMA conference debated the question of the use of barbiturates but, against the wish of its executive, came down against any form of voluntary ban on the prescribing of barbiturates.
I am not proposing any bureaucratic interference in the rights of doctors to treat their patients as they think best, but the doctors will be criticised if they do not develop further educational provision. I he audit which I have suggested would be carried out not by civil servants but by professional colleagues.
1324 It is Parliament's duty to stop what is in danger of becoming a national scandal, and I hope that the medical profession will realise that unless a halt is called soon in this area the profession itself will be damaged by the developments that result.
§ 4.34 p.m.
§ Mr. Robert Adley (Christchurch and Lymington)I was concerned when I saw on the Order Paper a proposal to restrict the right of medical practitioners to prescribe drugs. I ask the House to think carefully and to reject the proposal put forward by the hon. Member for Newcastle-upon-Tyne, East (Mr. Thomas). With respect to him, it sounds like another piece of dogmatic, theoretic, Socialist nonsense.
I do not dispute that too many drugs are being prescribed in this way. But that has more to do with the level of prescription charges than anything else, and the thought of audit panels being set up fills me with alarm. The hon. Gentleman referred to a small list of relatively safe drugs. What he proposes is a dangerous practice which would put even more power into the hands of the administrators. Since the reorganisation of the National Health Service, many hon. Members on both sides of the House feel that it is the over-burdening of the administration of the medical profession which is the greatest problem. The setting up of audit panels on which doctors would serve—rather than treating their patients—strikes me as an unhelpful method of cutting down on administration.
The idea of setting up audit panels to scrutinise patients' needs smacks of "1984". We already have from the Government State-only health proposals. If the hon. Gentleman's proposal were to see the light of day we should end up with State-only prescriptions. I suppose the next step is State-only illness and a person will not be allowed to be ill unless he is suffering from an illness laid down by a panel and agreed to be a proper illness.
Like the hon. Gentleman, I am not medically qualified, but I had a chance this morning to do a little homework on the subject. I looked up Practitioner 1325 for October 1974, in which Dr. Hamilton states:
It is, of course, impossible to be dogmatic as to the most suitable choice of drug for the individual patient, but certain principles obtain. The most effective drug is usually the one with which the doctor is most familiar.My understanding of the position is that no two doctors use the same medicine in exactly the same way and that they find from experience which medicines produce the best results in their hands. Any attempt to restrict the doctor in his choice of medicines would prevent the individual practitioner from using his optimum therapy, which would not be in the interests of patients.There is also the problem of side effects from the drugs which would be administered in the way suggested by the hon. Gentleman. Emergencies often occur from side effects, and side effects themselves presuppose that the individual circumstances of the patient have caused the side effects. What would follow the introduction of such a proposal? Would litigation follow the administration to a patient of a drug that happened to be unsuitable for him although it had been declared to be suitable by the audit panel and the regional health authority? Would the Secretary of State for Social Services be facing a charge of being responsible for administering the wrong treatment on the basis of the audit panel and the arrangements laid down by Parliament?
I am glad that the Minister of State is present, because I have had an opportunity of looking briefly at some of his words, which I imagine are of considerable importance, because the Minister of State has more experience than I or the hon. Member for Newcastle-upon-Tyne, East in this matter. At Question Time the Minister said:
the cry often goes up about clinical freedom, and we must accept that that is a valid argument."—[Official Report, 24th February 1976; Vol. 906, c. 177.]In answer to my hon. Friend the Member for Surrey, North-West (Mr. Grylls), who asked about drug prescription, the Minister of State said:
"I believe that we should carry the medical profession with us on this."—[Official Report, 24th February 1976; Vol. 906, c. 178.]
§ The hon. Member for Newcastle-upon-Tyne, East produced no evidence that he was asking to introduce the Bill specifically at the request of a responsible body of the medical profession. The medical profession has taken a sufficient bashing in the past two years without having its freedom further restricted in this way. Doctors are finding that their skills are not being rewarded financially and they are emigrating. Doctors are disgruntled about the Government's attitude over pay-beds.
§ The right hon. Member for Blackburn (Mrs. Castle), who, mercifully, has been relieved of her position, could not be considered to be leading us towards a happy doctor-patient relationship. No one would prescribe her as a cure for anything. She could guarantee only high blood pressure, conflict and confrontation.
§ However well intentioned the Bill may be, it is nevertheless a bad Bill. The road to hell is paved with good intentions.
§ The Government's rent legislation resulted in shortages of rented accommodation and people staying in hotels at Gatwick Airport costing £600 a week. That was an example of well-intentioned legislation resulting in unfortunate side effects. This Bill would also have unfortunate side effects.
§ Whilst not doubting the hon. Gentleman's motives, I appeal to the House to take no action until more evidence is produced that this is what the medical profession wants. I ask the House not to give the hon. Gentleman leave to bring in a Bill which would remove from doctors the freedom to practise medicine to the best of their ability.
§ Question put, pursuant to Standing Order No. 13 (Motions for leave to bring in Bills and nominations of Select Committees at commencement of Public Business) :—
§ The House divided: Ayes 105, Noes 104.
1327| Division No. 122.] | AYES | [4.43 p. m. |
| Atkins, Ronald (Preston N) | Buchanan, Richard | Cocks, Michael (Bristol S) |
| Atkinson, Norman | Callaghan, Jim (Middleton & P) | Cohen, Stanley |
| Bates, Alf | Cant, R. B. | Concannon, J. D. |
| Beith, A. J. | Carmichael, Neil | Conlan, Bernard |
| Bidwell, Sydney | Cartwright, John | Corbett, Robin |
| Buchan, Norman | Clemitson, Ivor | Crawshaw, Richard |
| Cryer,Bob | Howells, Geraint (Cardigan) | Perry, Ernest |
| Davies, Denzil (Llanelli) | Hoyle, Doug (Nelson) | Richardson, Miss Jo |
| Dempsey, James | Hughes, Robert (Aberdeen N) | Robinson, Geoffrey |
| Doig, Peter | Hughes, Roy (Newport) | Roderick Caerwyn |
| Dormand, J. D. | Irving, Rt Hon S. (Dartford) | Rodgers, George (Chorley) |
| Douglas-Mann, Bruce | Jackson, Miss Margaret (Lincoln) | Rooker, J. W. |
| Dunn, James A. | Jenkins, Hugh (Putney) | Ross, Rt Hon W. (Kilmarnock) |
| Dunnett, Jack | Johnson, James (Hull West) | Sandelson, Neville |
| Edwards, Robert (Wolv SE) | Jones, Dan (Burnley) | Sedgemore, Brian |
| Ellis, John (Brigg & Scun) | Lamond, James | Selby, Harry |
| Evans, Fred (Caerphilly) | Latham, Arthur (Paddington) | Silverman, Julius |
| Evans, loan (Aberdare) | Lipton, Marcus | Skinner, Dennis |
| Fitt, Gerard (Belfast W) | Loyden, Eddie | Smith, John (N Lanarkshire) |
| Flannery, Martin | Macfarquhar, Roderick | Snape, Peter |
| Fletcher, Ted (Darlington) | Mackenzie, Gregor | Spearing, Nigel |
| Forrester, John | McMillan, Tom (Glasgow C) | Stallard, A. W. |
| Freeson, Reginald | Marks, Kenneth | Stoddart, David |
| Garrett, W. E. (Wallsend) | Mellish, Rt Hon Robert | Stott, Roger |
| George, Bruce | Mikardo, Ian | Thomas, Dafydd (Merioneth) |
| Golding, John | Molloy, William | Thomas, Mike (Newcastle E) |
| Graham, Ted | Moonman, Eric | Thomas, Ron (Bristol NW) |
| Grant, George (Morpeth) | Murray, Rt Hon Ronald King | Torney, Tom |
| Grant, John (Islington C) | Noble, Mike | Walker, Terry (Kingswood) |
| Grocott, Bruce | O'Halloran, Michael | White, Frank R. (Bury) |
| Hamilton, James (Bothwell) | Orbach, Maurice | Wise, Mrs Audrey |
| Harper, Joseph | Orme, Rt Hon Stanley | Young, David (Bolton E) |
| Harrison, Walter (Wakefield) | Ovenden, John | |
| Hayman, Mrs Helene | Pardoe, John | TELLERS FOR THE AYES: |
| Heffer, Eric S. | Parker, John | Mr. Christopher Price and |
| Hooson, Emyln | Pavitt, Laurie | Mr. Michael Ward. |
| Horam, John | ||
| NOES | ||
| Atkins, Rt Hon H. (Spelthorne) | Gray, Hamish | Prior. Rt Hon James |
| Baker, Kenneth | Hall, Sir John | Renton, Rt Hon Sir D. (Hunts) |
| Bell, Ronald | Hamilton, Michael (Salisbury) | Ridley, Hon Nicholas |
| Benyon, W. | Hannam, John | Rif kind, Malcolm |
| Berry, Hon Anthony | Harvle Anderson, Rt Hon Miss | Roberts, Michael (Cardiff NW) |
| Biggs-Davison, John | Hicks, Robert | Ross, Stephen (Isle of Wight) |
| Boscawen, Hon Robert | Hordern, Peter | Sainsbury, Tim |
| Bottomley, Peter | Howe, Rt Hon Sir Geoffrey | Scott-Hopkins, James |
| Boyson, Dr Rhodes (Brent) | Howell, David (Guildford) | Skeet, T. H. H. |
| Brotherton, Michael | Hurd, Douglas | Spicer, Jim (W Dorset) |
| Brown, Sir Edward (Bath) | Hutchison, Michael Clark | Sproat, lain |
| Buchanan-Smith, Alick | Jenkin, Rt Hon P. (Wanst'd & W'df'd) | Stanley, John |
| Budgen, Nick | Jones. Arthur (Daventry) | Steen, Anthony (Wavertree) |
| Butler, Adam (Bosworth) | Kellett-Bowman, Mrs Elaine | Stewart, Ian (Hitchin) |
| Clerk, Alan (Plymouth, Sutton) | Langford-Holt, Sir John | Stradling Thomas, J. |
| Clegg, Walter | Lawrence, Ivan | Tapsell, Peter |
| Cooke, Robert (Bristol W) | Le Marchant, Spencer | Tebbit, Norman |
| Cope, John | Lester, Jim (Beeston) | Thatcher, Rt Hon Margaret |
| Corrie, John | McAdden, Sir Stephen | Thompson, George |
| Crawford, Douglas | McCusker, H. | Townsend, Cyril D. |
| Crouch, David | Macfarlane, Neil | Vaughan, Dr Gerard |
| Davies, Pt Hon J. (Knutslord) | Macmillan, Rt Hon M. (Farnham) | Wakeham, John |
| Douglas-Hamilton, Lord James | Marten, Neil | Walker, Rt Hon P. (Worcester) |
| Drayson, Burnaby | Mather, Carol | Walker-Smith, Rt Hon Sir Derek |
| Dunlop, John | Maxwell-Hyslop, Robin | Walters, Dennis |
| Durant, Tony | Mayhew, Patrick | Watt, Hamish |
| Dykes, Hugh | Miller, Hal (Bromsgrove) | Weatherill, Bernard |
| Ewing, Mrs Winifred (Moray) | Mills, Peter | Whitelaw, Rt Hon William |
| Fairgrieve, Russell | Moate, Roger | Wiggin, Jerry |
| Fletcher, Alex (Edinburgh N) | Mudd, David | Wilson, Gordon (Dundee E) |
| Fletcher-Cooke, Charles | Neave, Airey | Winterton, Nicholas |
| Fry, Peter | Neubert, Michael | Wood, Rt Hon Richard |
| Gilmour, Rt Hon Ian (Chesham) | Onslow, Cranley | |
| Glyn, Dr Alan | Page, Rt Hon R. Graham (Crosby) | TELLERS FOR THE NOES: |
| Goodhart, Philip | Penhaligon, David | Mrs. Jill Knight and |
| Gow, Ian (Eastbourne) | Peyton, Rt Hon John | Sir George Young. |
§ Question accordingly agreed to.
§ Bill ordered to be brought in by Mr. Mike Thomas, Mr. Laurie Pavitt, Mr. John Horam, Mr. John Cartwright, Mr. Roger Stott, Mr. Bruce Douglas-Mann, Mr. W. E. Garrett and Mr. Brian Gould.