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  • Kieran Mullan – 2021 Speech on the Medical Cannabis Bill

    Kieran Mullan – 2021 Speech on the Medical Cannabis Bill

    The speech made by Kieran Mullan, the Conservative MP for Crewe and Nantwich, in the House of Commons on 10 December 2021.

    I welcome the opportunity to speak in this debate. I congratulate the hon. Member for Manchester, Withington (Jeff Smith) on introducing the Bill and highlighting the issue. I understand that he is trying to improve the situation for patients who are struggling, and I accept that he has the best intentions in that regard.

    At the outset, I think we have to unpick some of the debate so far. We are talking about two different things, potentially: unlicensed and licensed treatments. Some of the criticisms that have been raised about lack of evidence are very valid in relation to unlicensed treatments, but not so valid in relation to licensed treatments; that is an issue about how we spread best practice. What we are talking about today affects a lot of the NHS and a lot of treatments in many different ways: how we test and evaluate treatments, the accountability of our doctors and other healthcare professionals, and how we spread learning and best practice in the NHS.

    We have come an incredibly long way with testing and evaluating treatments in the NHS. I will try to give some of the history and the context of the challenge of knowing what good treatment is, because it is an enormous challenge. If people understood the history and how badly we have got it wrong on so many occasions, they might better understand why healthcare professionals can often be reluctant when it comes to unlicensed treatments.

    The starting point is the time when medicine was practised almost entirely without evidence. It was practised for a very long time without what we would now consider evidence. Clinical medicine has evolved organically over hundreds of years, if not thousands, from a starting point at which even the concept of evidence-based medicine was alien. In fact, there were occasions when individuals who sought to advance the cause of understanding the body and disease were castigated for challenging established understanding, even in relation to the most basic things.

    An old example that illustrates how fundamental the challenge of understanding good practice can be relates to handwashing. We all now take handwashing for granted as something that we should all do and that helps to keep us safe, particularly in relation to a pandemic, but that is largely down to the efforts of one man: Ignaz Semmelweis, a German-Hungarian physician and scientist born in Hungary in 1818. He died in an asylum in 1865 having suffered a nervous breakdown, ostracised by the medical establishment that rejected his theories, which we now know to be true.

    Semmelweis looked after women giving birth at a Viennese hospital. He worked in two different clinics; one had a maternal mortality rate of about 10% because of the infections that women would get after giving birth, while the other had a maternal mortality rate of about 4%. The difference was so stark that women begged to be admitted to the second clinic because it was common knowledge that they were much more likely to die in the first.

    Semmelweis noticed that difference and set out to understand it. He studied every detail of what was happening in each clinic, eliminating all possible differences, and discovered that the only major difference was the people working there. The first clinic taught medical students; the second did not. He combined that knowledge with the incidental finding that a friend of his who had pricked himself with a scalpel when performing an autopsy had become sick and died, in the same way as the ladies in the first clinic, of a general unwellness—germs were not even understood at that point.

    Semmelweis theorised that the connection must be something to do with contact with bodies among people at the clinic who were looking after the women giving birth. He instigated what we now take as common sense: handwashing with a chemical for anybody who had had any contact with those bodies and who went on to look after the women. When he instituted that policy, the maternal mortality rate in the clinic fell to exactly the same rate as the other’s.

    That theory is a landmark in our understanding of clinical medicine, but at the time it was considered extreme and Semmelweis was widely mocked. He was eventually dismissed from the hospital for political reasons, harassed by the local medical community and forced into an asylum; he ended up dying in terrible circumstances. That just goes to show how fundamental it is to doctors that we recognise that at various times medicine has got it very badly wrong in all directions. That guides a lot of what we do when we decide what treatments to give.

    Sometimes our beliefs about treatment are based on an incorrect understanding of the nature of disease, false assumptions about how the body works or misconceptions about cause and effect. If people get better after treatment, we very often assume that the treatment helped, when often it was just incidental. We now know about the placebo effect, an incredibly powerful effect that generates improvements in patients without the benefit of any evidence whatever. From 1898 to 1913, a heroin-laced aspirin was available for the treatment of sore throats, coughs and colds, with a particular focus on it as a treatment for children; it was only in 1924 that heroin was banned completely as a treatment.

    We still have a long way to go. Some research suggests that up to half the treatments we use even now lack what we might consider a full and reliable evidence base. Importantly for this debate, we can be badly wrong not just in identifying an effective treatment, but in understanding its side effects in the longer term. I have listened carefully to the descriptions of benefits for individual patients and I do not deny in any way, shape or form that they are benefiting, but when we aggregate that across the whole population, we can discover side effects, particularly in the long term, that we are simply not aware of when considering the benefit for an individual patient.

    There was some criticism of my hon. Friend the Member for South Ribble (Katherine Fletcher) for raising this example, but I had planned to raise it, too. People will have heard about the thalidomide scandal. That is important not as a comparison with a particular side effect, but in understanding how we get things wrong with medicine. Thalidomide was licensed in July 1956 for over-the-counter sale. No doctor’s prescription was even required in Germany. By the mid-1950s, 14 pharmaceutical companies were marketing thalidomide in 46 countries and, by 1958, that included the UK. A UK Government warning was not issued until May 1962 and, in the intervening period, the drug was responsible for a wide range of birth defects in children who would otherwise have been born healthy.

    Fen-Phen was a weight-loss drug used in the 1990s. It is estimated that as many as 6.5 million people took it. People taking it experienced heart disease, lung and pulmonary problems, and millions of pounds in compensation was paid out to people who took it after it was withdrawn.

    Vioxx was taken off the market in 2004 after having been available for five years. That is considered to be one of the largest drug recalls in history. Vioxx was given to more than 20 million people as a painkiller for arthritis, but was later found to be responsible for an increased risk of heart attack and stroke. The Lancet reported that as many as 140,000 people could have suffered from serious coronary heart disease from taking this drug in the US alone. One study that I reviewed in anticipation of this debate found that 462 medicinal products were withdrawn from the market between 1953 and 2013 alone. This provides an important context for our discussion in terms of medicinal safety.

    Modern clinical training teaches us how easily we can get our understanding wrong, how it can change and how difficult it can be to really understand the short and long-term benefits and harms of a medicinal treatment. We have a much more sceptical, vigilant workforce in healthcare as a result, and we must not be quick to rush to judgment when there is uncertainty about a particular treatment. We have come a long way with bodies such as the MHRA, NICE and others that attempt to support clinicians in making evidence-based decisions, because we realise that leaving it to the individual clinician is not necessarily helpful.

    Tonia Antoniazzi

    Do I understand the hon. Member well in thinking that he is saying that medical scientists do not know anything? We have allowed these children to have the medicinal cannabis. Is he saying that the scientists are wrong?

    Dr Mullan

    I encourage the hon. Lady to listen carefully to what I am saying. I said at the start of the debate that, absolutely, there are very good reasons for individual patients to receive this treatment. I have acknowledged that there are licensed treatments based on evidence, so I think she is kind of misrepresenting what I said. I said clearly that I am giving context to the—

    Madam Deputy Speaker (Dame Eleanor Laing)

    Order. I am sure that the hon. Member for Gower (Tonia Antoniazzi) was not misrepresenting what the hon. Member for Crewe and Nantwich (Dr Mullan) said. She is doing whatever he is suggesting that she is doing, but it will not be misrepresenting, because that would not be honourable.

    Dr Mullan

    Perhaps the hon. Lady is inadvertently giving an incorrect impression of what I said. I made it very clear that this is the context for how clinicians behave in our NHS.

    Mark Fletcher

    Far from doing what has just been accused of you, I felt as though you are giving a—[Interruption.] The hon. Gentleman is giving a cautionary tale and providing context for this debate, and that is very important for this discussion.

    Dr Mullan

    I thank my hon. Friend.

    Tonia Antoniazzi

    I thank the hon. Gentleman for his generosity in giving way again. This debate has been had in the House for many years. We have spoken about it a lot. I would like to extend an offer to him and other hon. Members to join the all-party group on access to medical cannabis under prescription and to educate themselves.

    Dr Mullan

    With the greatest possible respect, I do feel that I understand the challenges that the hon. Lady is talking about. I will go on to answer her question about the fact that we have talked about it for a long time, so how do we move it forward? As I will explain, unfortunately, that applies to a very wide range of treatments and clinical practices in the NHS and across the world. This is about the appropriateness of picking out one specific area of clinical practice and using primary legislation as a way to overcome one particular problem. That is my concern.

    Andy McDonald

    The hon. Gentleman is failing to grasp that we have done it. The change has been made. What I am hearing time and again from Government Members is them rewinding and revisiting the process. The medications we are talking about are authorised and have been prescribed. We do not need to go through this exercise again—we have done that, and we want to move on.

    Dr Mullan

    I have explained that there are two challenges here. There are licensed, accepted treatments that are not being used, and there are very many examples across the NHS and healthcare globally of accepted, best practice, effective treatments that are not necessarily used as widely as they should be. We should not be picking out a particular treatment and using primary legislation as a mechanism to overcome that in one example; we should be working across the system and doing the hard work that has to be done to change clinical practices, as I will go on to explain.

    In terms of reopening the debate, as I have explained, there is still a debate to be had about unlicensed treatments where there is not an evidence base for their use. We are talking about two things today, and I wish hon. Members would be more careful in understanding the distinction between the two and not—[Interruption.] That is the argument I have made. I will carry on and make progress on the other issues I wish to discuss.

    Mark Fletcher

    I think there has been an accusation from the Opposition Benches that my hon. Friend does not seem to be educated in this particular area. Can he outline for the benefit of the House how much he understands medicine?

    Dr Mullan

    I thank my hon. Friend. When it comes to the issues I want to come on to talk about, it is not so much my practice as a doctor, but the fact that several years before becoming an MP I worked for the national clinical audit commission. The whole task of that organisation and very many other organisations in the NHS is to attempt to get clinical practice to change. There can be evidence and acceptance of what is best, and it does not happen, for very many reasons. That is the point I am trying to get across today.

    I understand the focus on this particular treatment and I do not in any way underestimate the impact on patients but, as a constituency MP, I have several other examples of other treatments and other things people want to have on the NHS that they are not able to access. We have to think about how we tackle that in the broader sense, and I do not believe that picking out a particular treatment and putting it into primary legislation is the way to do that.

    Ben Everitt

    In an effort to draw some unanimity across this House, we are all keen to move things forward. We do not want to wind the clock back; we want more treatments through the licensing process. Does my hon. Friend agree that what he is calling for is a cautious, evidence-based way of doing that? We are not winding the clock back—[Interruption.] The shadow Minister intervenes from a sedentary position, but it was she who pointed out that the legislation is already there and that this private Member’s Bill does not seek to frustrate that. I think we are all pushing in the same direction and I would like to draw us to push further.

    Dr Mullan

    The point to draw from my hon. Friend’s intervention is that I have been working in this field for some time and I cannot think of any other example where we have decided to set aside all the ordinary processes that have been developed over many years, with great thought and attention to ensuring they are equitable in terms of resources, the NHS’s time and NHS researchers’ time, and come up with a whole separate process for determining the evidence on a particular treatment. That has never happened before that I am aware of.

    I am happy to take an intervention from anyone on the Opposition side who can give me an example of when we have ever done that before, putting in place and encouraging the use of a particular treatment. I notice they do not—

    Jeff Smith rose—

    Dr Mullan

    Do, do intervene.

    Jeff Smith

    The hon. Gentleman is right, and I respect his view. He is very knowledgeable in these areas. The point, as I tried to outline earlier, is that there are very many experts who think the process we have at the moment is not appropriate for the cannabis plant and the full plant cannabis extract. All I am asking is for the wider evidence base to be looked at. That is also what the NHS asked for in 2019 and what Sir Michael Rawlins said we should be looking at. There are a lot of people who think that randomised controlled trials are not necessarily the right way forward in this particular instance. All I am asking is for the evidence to be looked at.

    Dr Mullan

    All I would say is that those discussions need to be had with NICE, the NIHR and the Department of Health and Social Care and many other people, but to use primary legislation is not the appropriate way to do it, I am afraid.

    Dr Allin-Khan

    Without doubt, no one in the House wants anyone to suffer unnecessarily. However, most of us understand, as I am sure the hon. Member does, that in this case a randomised control trial would be immoral. The recipients of these medications are in such dire need that to find a group of children in as dire need and deliberately withhold treatment from them would be immoral. I respect him for his clinical and professional practice and as a Member of Parliament, but what is his alternative? The Bill, which has already gone through several stages with cross-party agreement and understanding, seeks to take this forward in unusual circumstances, where an RCT would be immoral.

    Dr Mullan

    As you know, I respect your experience—

    Madam Deputy Speaker (Dame Eleanor Laing)

    No—hers.

    Dr Mullan

    I respect the experience that the hon. Member brings to her role. At no point have I said that the only way in which we can proceed is through RCTs. Earlier in the debate, when Opposition Members started talking in broad terms about observational studies and, to my mind, they were unfortunately disparaging RCTs, my comments were about being cautious. RCTs are incredibly important—they are fundamental to the vast majority of clinical medicine. I agree that other types of studies will be needed in some circumstances, but people need to make those arguments to the National Institute of Health Research. It is not for us as parliamentarians to override well-established processes designed to ensure that things are done in an appropriate, fair, thought-through and well-funded way.

    Andy McDonald

    The hon. Member is eloquent, but he is making a case for the commission. As the explanatory note says, the commission would be

    “required to consider the role of evidence other than from conventional controlled trials, including from observational studies and other countries in which cannabis-based medicines are more widely available.”

    So the net is wide. We are not pre-determining the evidence that would be considered. Opposition Members are saying that randomised control trials are not appropriate—we agreed on that; he has said that that is problematic—and there are other ways to look at this. We are not pre-determining it. We are saying that a commission of experts should do exactly that. Can he not see that he is speaking in favour of the Bill?

    Dr Mullan

    No. The point I am making is that nothing in the NIHR’s work says that it will only consider research and applications that are RCTs, and nothing prevents NICE from looking at any number of other methods of research. Opposition Members are saying that the Bill is the only way to get people to look at the evidence more broadly, but that is simply not true.

    Katherine Fletcher

    Briefly, I think I heard the hon. Member for Tooting (Dr Allin-Khan) talk about an RCT being immoral, implying that there is only one specific type of study design. She is talking about an RCT that would include forcing a placebo on children who are receiving medicine at the moment, but does my hon. Friend agree that RCTs can be designed in other ways and that we should not tar them all with one brush?

    Dr Mullan

    I agree. We have talked about observational studies and RCTs, and there are a number of different ways in which the evidence base can be developed.

    Dr Allin-Khan

    Having a number of research degrees, I am very aware that there are many different types of trials and that a randomised control trial is not the panacea in all cases. That exactly speaks to the importance of the Bill, which considers a number of other options. It talks about looking at evidence from a widely cast net—it is in agreement with the hon. Member. If he does not agree with the Bill’s suggestions, which he is speaking to, what is his alternative?

    Dr Mullan

    I will go on to talk about what I think you need to do—when I say “you”, of course, I mean the clinical community rather than the hon. Member—to advance these issues. I am afraid that very difficult work needs to be done across many parts of the clinical community, involving engagement with individual clinicians. The last thing we should be doing is creating a new mechanism for the appraisal of a clinical treatment in the NHS. I cannot support that when there are already well-established, well-developed mechanisms for the purpose which do not rely on any particular randomised control trial, for example. We know that, because several treatments have been approved, although it has been argued that cannabis-based treatments cannot be approved in the existing frameworks.

    Barbara Keeley

    Both the hon. Gentleman and one of his hon. Friends have questioned the use of primary legislation such as this wonderful Bill to advance this cause and remove these barriers. His hon. Friends have done the same on a number of occasions when private Members’ Bills have come before the House. What about the Autism Act 2009? What about the Down Syndrome Bill, which we discussed last week? When an issue—such as a medical condition—is not receiving the attention, or the appropriate treatment, that it should be receiving from the NHS, Members present Bills to deal with that. Such Bills are generally applauded here, but somehow this particular instance of using primary legislation to remove these barriers for this group of people—

    Dr Mullan indicated dissent.

    Barbara Keeley

    The hon. Gentleman sits there shaking his head, which he has been doing for about an hour, but it is not reasonable to pick this out as a separate issue.

    Dr Mullan

    There is a difference between presenting a Bill that seeks to establish frameworks and approaches that have had a wider application and seeking to use a Bill to advance a particular medical treatment. There is not another example of that in the House. The examples that the hon. Member has given did not seek to advance a particular medical treatment through primary legislation. I do not consider that acceptable.

    Tom Randall

    This is a point that I hope to address in my own speech, should I have time to make it this afternoon. I know that many Members wish to contribute.

    I spoke in the debate on the Down Syndrome Bill last week. Does my hon. Friend agree that the difference between that Bill—and the Autism Act—and this legislation is that whereas the Down Syndrome Bill was seeking to fill a gap, trying to bring different agencies together to create a common framework because there was obviously a deficiency and they were not working together, this Bill, as I understand it, seeks to duplicate the work of a body that already exists and is already functioning? In that sense, the two Bills are very different and cannot be compared.

    Dr Mullan

    I entirely agree. For example, if this legislation were seeking to reform or amend the general approach that we take to the appraisal of healthcare technology treatments in the NHS, I might have more sympathy with it, but it is not seeking to do that. Its promoter has picked out a particular line of medical treatment and sought to use primary legislation to drive it forward, and for the reasons I gave earlier relating to the history of deciding what treatments doctors should or should not be using, that is something about which I am extremely uncomfortable, although I am very sympathetic to the individual cases that Members have been raising.

    James Daly

    In November 2019, NICE conducted a review of the international evidence available in respect of this important issue. The report that followed was essentially inconclusive, but it did consult widely and obtained a wide range of information on some of the issues that Members have rightly identified. If the commissioning proposal in the Bill went ahead, how would the relationship with NICE and its statutory responsibilities work in this situation?

    Dr Mullan

    As my hon. Friend says, this is creating complexities and competing relationships that need to be given considerably more thought, rather than our aiming to promote a particular treatment.

    We have talked about the risks. I now want to describe some of the many ways in which healthcare practitioners are held to account for their decisions. This is particularly important in relation to the unlicensed use of a medicine. First there is the sense of personal, moral or social responsibility that we would hope anyone involved in healthcare feels. Even if we do not necessarily take the Hippocratic oath any more, we are signed up on the basis of the fundamental principle, “First, do no harm”. Understanding that can be complicated, as I have tried to explain in relation to side-effects, for example.

    Secondly, we are accountable to our employer. For example, a person working in a hospital is not free to practise as they wish. Their employer will have reasonable expectations that they ensure that their practice is safe, evidence based and works in the best interests of their patients. Increasingly, employers will place a big emphasis on following best practice guidelines from royal colleges, the National Institute for Health and Care Excellence and others that restrict their practice in some regard.

    Andy McDonald

    There is nothing in this Bill that will substitute our view and our professional assessment for that home medical practitioner. I want to congratulate the Members on the Conservative Benches: the clock is running down to 2.30 and they have successfully talked out this Bill. May I just ask anybody on those Benches to volunteer some explanation that I can take back to my constituents who wanted to see us make progress today, and we have not. By the way, can they also think of something that I may be able to say to my wife?

    Dr Mullan

    I think the hon. Member will understand that legislative progress is not an exercise purely in discussion. We should not be putting forward legislation if Members on one side of the House do not feel that that legislation should be passing into law. I am very happy to say that, for the reasons that I have outlined and will continue to outline, I do not feel that this legislation is appropriate, and I do that and will still sleep soundly tonight. It does not mean that I do not understand the deep concern, the hurt, and the anguish that individual parents are feeling. As I have said, I have worked in this field for a long time. There are very many people who suffer hurt and anguish in relation to treatments. I can talk about my own personal experience. My mother was diagnosed and treated for cancer. There was a period of a couple of years where I had seen a treatment that I wanted her to be on because I felt that it would be effective. There was some evidence to suggest that it was effective. We had to wait a couple of years for the further studies to come out, recommending that particular treatment. I have a young boy in my constituency, or a neighbouring constituency, whose family has raised an enormous amount of money to go to another part of the world to try a treatment that we do not consider to be sufficiently evidence-based—

    Andy McDonald

    That is not this—

    Dr Mullan

    The Member shouts from a sedentary position, but I am afraid that we are talking about a relevant issue. Labour Members want unlicensed treatments to be brought forward. There is a mixture of unlicensed treatments and licensed treatments.

    Hon. Members

    Absolutely wrong.

    Dr Mullan

    Members say that they do not want to achieve that, so why are they bringing forward this legislation? If they do not think that it will make a difference to the use of a treatment, why are they bringing this Bill before the House? They must think that it will have an impact.

    Jeff Smith

    I think the hon. Gentleman might have inadvertently misrepresented things. I have not proposed the Bill to try to have unlicensed medicines—as I think he said—put forward. What I am trying to do is to introduce a Bill that will enable clinicians to look at a wider evidence base in order to get those medicines licensed. That is what I am trying to do. I want to listen to the hon. Gentleman because he is very knowledgeable and I respect what he is saying. I think he is making an important speech. It is disappointing, however, that Members have spoken for so long that the Minister will not be able to speak. That is a bit of a poor show from the Government.

    Dr Mullan

    As I said, my view is that there is nothing at the moment in any of the legislation or roles of the bodies that we already have in place that restrict them from looking at any particular type of evidence. That is simply not true. They are allowed to look at whatever evidence they choose to look at. It is whether that evidence is there, is available to them and is sufficient.

    Tom Randall

    I know that there has been a lot of talk in this debate about a campaign that has been going on for four years. My hon. Friend speaks with his medical experience, and many of us on these Benches do not. Does he agree that there has been a churn in the representation of this House over the past four years and there are new MPs who are coming to this debate afresh? This debate has been very useful in illuminating and educating those Members who are newer to the debate and that has been a very productive exercise. Does he further agree that, in spite of the understandable emotions that exist within this debate, the primary duty of Members of this House is to pass good legislation?

    Dr Mullan

    I completely agree. I would just add that processes are in place because we are at the greatest risk of making mistakes when we are faced with people in very desperate circumstances. The risk is greatest when a parent is extremely concerned for the welfare of their child, or when someone has a terminal illness. Those are the types of scenarios where people are most at risk of having the wrong treatment. I gave the example, which is incredibly important to remember in the wider discussion, of the MMR cases. Parents were advocating very, very strongly that that treatment had caused damage and distress to their children. Doctors were involved in amplifying and giving credibility to that circumstance. As a result, fewer people took their vaccines. I say this with all compassion to individual parents, but we have to retain a degree of objectivity, and I am afraid that parental passion is not a substitute for the systems we put in place.

    Lia Nici

    We all know there are a huge amount of emotions around this argument. All of us, I think, across the House would like to see the situation move forward. The issue is that the proposed legislation will not move things forward. In fact, it has the potential to slow the whole process down. If I understand it correctly, a private Member’s Bill cannot bring forward any money resolutions. What we need here is money, and for CCG and NHS processes to be working properly. We do not need primary legislation to do exactly what hon. Members across the House want. We just need to get on with it via the NHS and CCGs.

    Dr Mullan

    My hon. Friend is correct to say that in other circumstances funding and pots of money are sometimes set aside to deliver improvement in a particular area. However, as she says, the Bill is incapable of bringing forward funding in that regard.

    Tonia Antoniazzi

    I thank the hon. Gentleman for giving way. The hon. Member for Great Grimsby (Lia Nici) makes a valid point. We have asked for a pot of money. We went to the Department of Health and Social Care. The hon. Member for Bury St Edmunds (Jo Churchill) was on the verge of organising it and getting it sorted so that we could have that pot of money. The Bill was the next option, because that option was no longer available when she was replaced as Minister. What next? There are 20 families, and hundreds more, who need something to happen. Inertia is not what we want. We have to move on. What is being done by the Government?

    Dr Mullan

    I am not familiar with the discussions the hon. Member may or may not have had—I am sure the hon. Member did have them—with the Government in relation to pots of money. Again, I will gently say that there are enormous pressures on NHS budgets. That is why we have NICE, for example, to take out some of the emotion and personal feelings people have in relation to clinical care, and to try to look objectively at what secures value for money. I am not aware of what work the Department may have done on whether this represented an equitable use of resources for this particular area of clinical care. I will be happy to write to the Minister and make inquiries, as I am sure Opposition Members and the all-party group have done.

    Andy McDonald

    On cost-efficiency, does the hon. Member not agree that, considering the cost of emergency admissions to hospital and the use of intensive care and expensive medicines that do not work as effectively, this system would be a much better use of national health resources and would actually be a financial economic benefit to our nation, not a detriment?

    Dr Mullan

    I agree. I am sure that that is part of the reason why some treatments secured a licence and NICE approval. Again, we must not give the impression to people listening to the debate that the NHS’s systems are not engaging with this issue. I am sure that some treatments were approved. I am sure—or would hope, if the evidence is there—that future treatments might also secure approval as we go forward, particularly if the evidence is there to demonstrate that they are of use. I just reiterate that the things that Members on the Opposition Benches have been asking for have been happening. It may be at a rate that frustrates them, but I share that frustration, as do many others, and it goes across lots of different clinical treatments. I have direct experience of it, and it is not just an issue for the NHS; it is a global issue for modern healthcare systems when a vast amount of money is going into medical research with new treatments all the time. Governments need systems to decide which treatments they approve and so that they can look at the evidence properly. That is why we have the MHRA, NICE, the royal college guidelines and NHS best practice guidelines. All those things are in place.

  • Barbara Keeley – 2021 Speech on the Medical Cannabis Bill

    Barbara Keeley – 2021 Speech on the Medical Cannabis Bill

    The speech made by Barbara Keeley, the Labour MP for Worsley and Eccles South, in the House of Commons on 10 December 2021.

    I thank my hon. Friend the Member for Manchester, Withington (Jeff Smith) for introducing this important Bill that could improve the lives of so many people. As we have heard, it could particularly help families with children affected by serve treatment-resistant epilepsy, for whom cannabis-based products may be the only treatment that works. I pay tribute to my hon. Friend the Member for Middlesbrough (Andy McDonald) for his powerful appeal on behalf of the Bill.

    My constituent Zoe Kirkman contacted me several years ago when she was seeking treatment for her son Riley, who experienced severe seizures up to 30 times a day that were very distressing for both him and the rest of his family. Ms Kirkman told me she was worried that he could die at any moment as a result of a seizure. These are the fears of parents and that is what drives them.

    Riley’s condition has led to his missing a lot of education and being out of school a lot. As she could not access cannabis-based treatment for Riley on the NHS, Zoe Kirkman was forced to purchase THC and CBD products privately. As we have heard, many families are in a similar position, left with no choice but to pay hundreds of pounds a month—in some cases thousands—for private prescriptions. THC products work better for Riley, but Zoe Kirkman told me that there was little support alongside the prescriptions when they were purchased privately. The fact that parents are pushed into private prescriptions with little support must have some weight with us.

    Thankfully, the cannabis-based treatments that his mother bought have reduced Riley’s seizures significantly and allowed him to stop taking a lot of his medications. However, he is still out of school because his school cannot include the cannabis-based treatment in his rescue package, as it is not prescribed on the NHS. For the same reason, Riley cannot access respite care, which would help him, at St Francis children’s hospice. Will the Minister say why schools and respite-care facilities such as hospices cannot be allowed to administer the oils that make such a difference to children such as Riley? Zoe Kirkman tells me that if Riley has a seizure because of a gap in the treatment, it can take weeks for his condition to settle down again.

    In July 2018, I wrote to the then Home Secretary to raise Riley’s case. I received a belated response from a Home Office Minister in January 2019—more than six months after my initial letter—saying that following the changes to the law in November 2018, he hoped Riley would be receiving the treatment he needed. Of course, he is not receiving that treatment. The campaign group End Our Pain estimated that, a full three years on from the rescheduling of cannabis-based products to schedule 2 to the Misuse of Drugs Regulations 2001, just three children living with severe epilepsy have received an NHS prescription. As we know, two of them were at the centre of the 2018 campaigns. We have heard that a number of times in this debate and it is right that we focus on the fact that there have been just three prescriptions, and ask why.

    When the Health Committee ran its inquiry on medical cannabis in March 2019, it heard from Peter Carroll, the campaign director at End Our Pain—we heard about him in earlier speeches—who said:

    “What has happened is that hopes have been correctly raised, because this offers a lot of hope and benefit to a lot of people, but we have now moved across to implementation and the honest reality is that it is a disaster…The families…should be getting prescriptions…and watching their children…hopefully…improving day after day.”

    After the Government raised hopes with the change in the law, it is a great pity that they have not increased access to medical cannabis for those who need it in line with the findings of the review that they commissioned in 2018. I hope that the Minister will explain why.

    While I accept that we still need more research and studies into the effectiveness of cannabis-based products for treatment-resistant epilepsy in children, the Bill would offer important measures to increase the number of doctors who could prescribe such products and widen access to them through its proposed commission.

    I asked Zoe Kirkman what she hoped for. She told me it was a purer form of the medication, because the products available to purchase contain a lot of synthetic ingredients and she worries that they could have long-term side effects for Riley. I hope that, through the Bill, Zoe Kirkman and Riley, and many families like them, will finally be able to access the treatment they need through the national health service.

    The Bill contains a proportionate set of measures, with a commission to propose an assessment framework for cannabis-based medicines and their suitability for prescription and to make recommendations of measures to overcome the barriers that we have heard about in CCGs and other NHS structures to accessing cannabis from the NHS for medical reasons.

    We have had a lengthy debate about different forms of trials. The commission could consider evidence from observational studies and from other countries as well as conventional control trials. My hon. Friend the Member for Manchester, Withington made an important point about evidence that could be weighed from EU countries—it is time that we started to think about that. It could also consider the important register of GPs who may prescribe cannabis-based medicines and permit them to do so. That would help to avoid the side effects of the cannabis-based products that Zoe Kirkman is currently forced to buy as the only option available. Most importantly, Riley would be able to attend school and have respite care when he needs it.

    Let us end the years of pain. As my hon. Friend said at the end of his excellent speech, if not this Bill, what else?

  • Elliot Colburn – 2021 Speech on the Medical Cannabis Bill

    Elliot Colburn – 2021 Speech on the Medical Cannabis Bill

    The speech made by Elliot Colburn, the Conservative MP for Carshalton and Wallington, in the House of Commons on 10 December 2021.

    I join others in congratulating the hon. Member for Manchester, Withington (Jeff Smith) on securing time for us to debate the Bill today. He is clearly very passionate and knowledgeable about this issue, and I learnt a huge amount from his opening speech, for which I am extremely grateful. I also pay tribute to the hon. Member for Middlesbrough (Andy McDonald) for his moving testimony. It is characteristic of sitting Fridays that we tend to work more collegiately across the House. My hon. Friend the Member for North Devon (Selaine Saxby) said that it is not a question of whether we do but of how we do, and I entirely agree with her.

    I am really here today at the behest of a constituent who asked me to come to the House and share his experiences, but before I delve into those, it may be helpful for me to give some of my own perspective. Before coming to this place, I too was employed in the NHS, although not as a frontline practitioner; I was not a doctor or a nurse. I worked for the sustainability and transformation partnership, the footprint of the new integrated care systems in south-west London. Along with commissioners across six south-west London boroughs, I looked at all the services that those boroughs provided, and this was a topic that arose during that time. It was obvious to me, when I spoke to colleagues, that there was almost a nervousness, almost a—confusion, I suppose, is the word I am looking for; it is a bit hard to describe—about commissioning medicines of this type.

    I thought it might be helpful for the Front-Bench team to hear a bit about the experience of frontline commissioning, but, as I said earlier, I am really here at the behest of one of my constituents to share his story. I hope the House will indulge me if I go into a bit of detail, because I did find this very profound, and I hope that other Members will agree with me. My constituent sent me an email, in which he wrote:

    “I would like to explain to you a little of my life which unfortunately has been plagued with intractable chronic migraines and the fallout from such.

    Although suffering all my life with Migraine attacks, 5 years ago I was diagnosed with severe chronic migraine which after a long wait I was prescribed 9 different medications to try and bring the migraines under control, none of which worked only causing nasty side effects.

    Having…sickness constantly with added migraine pain—1 was left diagnosed with intractable chronic migraine with attacks 6 days out of 7, putting me out of work and putting me in a state of deep depression.

    I was fortunate to meet a Dr. who was testing the benefits of Cannabis in neurological cases and after a discussion I decided to follow her strict advice and started self-medicating Cannabis which unfortunately meant sourcing off the black market, something that I’m not in any way proud of but the impact of using cannabis for my ailment was profound.

    Within three days of my first use, my migraine frequency dropped significantly as did…the usual nausea which accompanies my attacks. Within a week, I felt for the first time somewhat normal, depression had lifted, I was able to start work again almost immediately (I was open and honest with my employer who welcomed me back into the workplace and to this day has been extremely supportive).

    Summarising my experience, I went from someone who saw no hope in any way with modern medicine to someone who almost overnight got their life back.

    I have one son—aged 12 who has got his father back, and my wife although extremely anti-drugs (a doctor who works in the dental profession) has seen the relief I experience, especially after seeing me for many years hiding in a dark room, in pain, hiding from the world most days to someone who now is relishing in family life.”

    My constituent went on to say:

    “The stigma of the word Cannabis is something that I have had to deal with”.

    This, he said, included

    “seeking out black market providers which in its self I would not want anyone to go through”,

    and I think all Members would agree with that.

    Lia Nici

    On that point, which I was going to raise later, quite often the issue is semantics. There is a fear about the word “cannabis”, be it medical or not, and we need to get over that. One of my concerns about the Bill is the use of the broad term “cannabis”. I think that my hon. Friend’s constituent has been fighting with that issue.

    Elliot Colburn

    My hon. Friend has taken the words right out of my mouth. When talking to Carshalton and Wallington residents, I have found that there is a sense of stigma, and a stereotype, associated with the word “cannabis”.

    Christian Wakeford

    Earlier this week, we started talking again about drugs from a public health perspective. We need to tackle the stigma of not only drugs, but alcohol addiction. No one chooses addiction. There are many things that we can do, including removing the exclusion of addiction from the Equality Act 2010, and properly funding addiction and rehabilitation services, but, again, this comes down to the financing.

    Elliot Colburn

    My hon. Friend is absolutely right.

    Ben Everitt (Milton Keynes North) (Con)

    My hon. Friend is being very generous with his time. A point that occurred to me earlier is that one of the problems that we have when we debate this issue in Parliament and elsewhere is the conflation of national drugs policy and policy relating specifically to medicinal drugs—in this case, specifically medicinal cannabis. In many ways, it is deeply unhelpful when those two matters are conflated, because people come at them with strong opinions. However, the case study that my hon. Friend is outlining today shows the relationship between the two, and I am grateful to him for bringing that to the attention of the House. May I make a plea to everybody here—I hope that he agrees—not to fall into the trap of conflating the two issues, because although they are very important and we should have a discussion about both, they are vastly different?

    Elliot Colburn

    I totally agree. Indeed, I had no intention of opening the can of worms around recreational use, decriminalisation, legalisation, or whatever term we might want to use. I hope that my hon. Friend can rest easy in the knowledge that I will not go there, as they say.

    My constituent said that he would not want to put anyone else through having to seek out black market providers, and that somewhere in the back of his mind was always the worry of being prosecuted, but to him the benefit outweighed the risk tenfold.

    Lia Nici

    The case that my hon. Friend is outlining highlights real concerns about the side effects of smoking recreational drugs, including potential mouth cancer, potential throat cancer and potential psychosis, as well as the unpleasant social activities. I have had constituents who have had to live next door to people who take recreational cannabis, and it really is not a pleasant situation to be in—and then we get into the issue of potential secondary smoking and all those kinds of things. That is why constituents such as my hon. Friend’s should not have to go through that route.

    Elliot Colburn

    I totally agree. It might be of some use to the House if I read a little more of my constituent’s reflections, as he went on to say:

    “Then came along the introduction of Drug Science and their Project Twenty 21, this gave me the ability to seek professional help, to be able to get a prescription to legal Cannabis flower to which I vape as a preventative and when needed as a pain killer. I still get migraines but luckily now I have a medicinal way to cope and quell most of the side effects, literally giving me my life back.

    Although this does sound like a fairy tale, with a happy ending, there is a darker side to this.

    Currently the expense and experience of being with a private clinic and private dispensary/pharmacy is quite strained, adding anxiety and stress into the situation. We rely on the ability of both the clinic’s and Dispensary’s to keep us in prescription which does not happen and is quite literally floored. Medication is imported into the UK, its very often caught up in customs and the added issues with Covid has broken supply chains.

    Dispensary’s are often out of product and the clinics are not kept abreast of this so many re-writes of prescriptions have to happen and thus costing time to get the needed medication and cost for re-writes. This all breaks down to us the patients being without medication, sometimes up to a month, putting us back at square one (prescriptions have to be written monthly).

    On top of the supply and demand issues, quality is also something that has been with issue, many reporting to Yellow Card unusable medication due to sub-standard product and often mould that cannot be used – with no way of a refund or quick turnaround of a re-stock.

    Without a shadow of a doubt this would never happen under the NHS but as we have no other choice in the matter its either suffering under private clinics or unfortunately breaking the law and turning back to the black market.

    There are many thousands like me in this position, I’m but a single drop in a large ocean of people with similar experiences, I would like to draw your attention to this so you may air this as unfortunately the situation is not getting better. I understand that the primary concern is for children with epilepsy though there is a much larger footprint of people benefiting from medical cannabis and this should whole heartedly be pulled into the NHS to better control and support patients.

    I would be grateful if you could keep this all”—

    he refers to all of us in this place—

    “in the back of your mind so you have some real world information from one of your local constituents of the big picture surrounding medical cannabis, it’s time for this to be pushed forward as it was supposed to have been back in 2019…

    Luckily medical cannabis has given me my life back, I hope others can benefit in the future but it needs to be under the protective umbrella of the NHS.”

    I thank that constituent for sharing what was obviously a harrowing story, and for permitting me to raise it on the Floor of the House this afternoon. I am sure colleagues will agree that that was incredibly brave, so I am very grateful to that person for allowing me to do so.

    We have heard many constituents’ stories during the debate, although we have explored just two elements of them—childhood epilepsy and the migraines that my constituent has suffered. I would like quickly to bring in one more, which is the exploratory research being conducted on the use of CBD for fibromyalgia and other treatment-resistant neuropathic pain.

    I know the suffering that those conditions can cause, especially when there is so little known or understood about them; I have many family members who have been diagnosed with fibromyalgia or similar conditions. Again, I have seen the benefits that CBD can bring, but I agree with colleagues about the need for robust research. I do not think it is a question of whether we will get there, but a question of how. I hope that the Minister has been able to take on board the experience—

    James Daly

    Does my hon. Friend agree that the law is very clear that medical professionals can prescribe non-licensed cannabis products, but the question is why clinical commissioning groups are not funding that? That is what we have to address, to force them to fund it.

    Elliot Colburn

    I totally agree with my hon. Friend. I have experience of working in what we might call a super CCG, which is now an integrated care system, looking at commissioning at a strategic level across six London boroughs, which is by no means a small footprint—we commissioned services for more than 1 million people when I was there, including for four of London’s biggest hospitals. I agree with the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), that practitioners were screaming from the rooftops that they wanted to be able to give such prescriptions and, indeed, felt confident about that. I will not say that they all were—a lot of the colleagues I used to work with in the NHS were not—but a significant amount were confident. From a commissioning perspective, when we were sat in our offices in Wimbledon, talking about commissioning services and looking at the health of the six south-west London boroughs we were tasked with dealing with, there was a clear sense of nervousness and even confusion among commissioners. That obviously needs to change and there needs to be some way to support commissioners to make the positive decisions to deliver the funding. I hope that when the Minister responds we will hear a little bit about what the Government can do about that.

    In bringing my remarks to a close, I emphasise that the constituent experiences we have heard about in this debate, including from the constituent who was kind enough to allow me to read out their story, have been profound. That should be in the back of all our minds when we discuss this issue, because there are real-life implications that we do not always see when we pore over the details of text. I look forward to hearing from the Minister what we can do to unlock some of the issues we have explored in this debate.

  • Rosena Allin-Khan – 2021 Speech on the Medical Cannabis Bill

    Rosena Allin-Khan – 2021 Speech on the Medical Cannabis Bill

    The speech made by Rosena Allin-Khan, the Labour MP for Tooting, in the House of Commons on 10 December 2021.

    I must begin by paying tribute to my hon. Friend the Member for Manchester, Withington (Jeff Smith), a fantastic campaigner who is working across party lines and with affected families up and down the country to make a real difference, both for those who are unable to obtain the treatment they need and for those who are left paying huge sums of money for private prescriptions. I also pay tribute to my dear and hon. Friend the Member for Middlesbrough (Andy McDonald), whose bravery in speaking today adds powerful testimony to this debate. I know 100% that his story echoes those of the people we are fighting for in this debate.

    The objectives of this Bill, for me, are clear and simple, but I fear, listening to some of the contributions today, it has been misunderstood. It would be a huge step forward for patients who need access to medical cannabis, and it creates a register of general practitioners trained in medical cannabis who are allowed to prescribe it, in addition to the specialist doctors who are already able to do so. Inclusion on the register is on an opt-in basis for GPs. The Bill importantly creates a commission to propose a framework for the assessment of cannabis-based medicines and their suitability for prescription in England, to sit alongside existing Medicines and Healthcare Products Regulatory Agency processes for conventional pharmaceutical drugs.

    I think it is very clear that what the Bill is asking for is a step forward with an end in sight for the pain, anguish and heartache, not to mention bankruptcy, experienced by many families. No one is saying that there should not be a robust examination of all evidence, but we are saying that there are current mechanisms in place to protect people on the medication and that, while we wait for some extremely timely processes, there are families who cannot wait and who are very clearly benefiting from the medication. It is very important that we recognise that.

    The commission is also tasked with recommending any other measures to overcome barriers to access on the NHS, which has been mentioned. Those changes would be welcome, as they would certainly help to reduce many of the barriers patients currently face when attempting to access medicinal cannabis. Progress in making cannabis-based medical products available to those who need them has been extremely slow. As we have heard today, there are people who have transitioned from childhood to adulthood while waiting for further progress on something that is important. The impact of continued seizures means that there is developmental delay for young people—the children we are talking about—and their ability to achieve their full potential in life. We cannot ignore that.

    Labour welcomed the fact that the Government accepted the therapeutic use of cannabis in 2018, but it still remains too difficult for suffering patients to obtain the treatment that they need. Despite that change in the law over three years ago, the vast majority of people who would benefit from cannabis-based medical products are still unable to access them through the health service. The campaign group End our Pain believes that only three prescriptions have been granted through the NHS. That is surely nowhere near the levels that this House, patients and the wider medical community would have anticipated.

    Andy McDonald

    My hon. Friend is making a wonderful summary and presentation. Is she as frustrated as I am by some of the contributions that have been made today, which seem to suggest that we need to start again when having this debate? We have been through this process. The law has been changed to allow the prescription of these products, yet all we have are three. Is it not really frightening that we are now challenging the original decision to change the law? That is what has happened today.

    Dr Allin-Khan

    Absolutely. I thank my hon. Friend for his contribution. To take any further step backwards from the progress we have made in a cross-party collegiate manner would be a travesty. We would be letting down families across the country.

    Lia Nici (Great Grimsby) (Con)

    The way the discussion is going at the moment is that we are talking about going backwards. The reason my hon. Friends are having those discussions is that the law has already changed, and I do not believe we need to legislate. We need to say, “We need to get these medicines that are approved already on the NHS.”

    Dr Allin-Khan

    I thank the hon. Member for that contribution. That is exactly right. The Bill seeks to move that forward, not frustrate the process. I welcome any intervention that underscores that.

    Lia Nici

    When we talk to members of the public and our constituents about the debates we have, we explain that we learn a lot by having this exchange of views. It is wonderful. Every school and business should have such debates in this collegiate way. It is not that we are against the Bill, but that we believe the law is already in place. We just need action on NHS funding and to get more of these approved, tested medicines on the lists.

    Dr Allin-Khan

    In three years, we have had three prescriptions on the NHS. In three years, we have seen people in fear of not having roofs over their heads because they cannot afford to give life-changing medication to their children.

    James Daly

    Will the hon. Member give way?

    Dr Allin-Khan

    I will make a bit more progress and then I would be absolutely delighted to give way.

    The situation that we face, whereby only three prescriptions in three years have been allowed, pushes more and more patients into the hands of private providers, who, as we have heard, are charging extortionate amounts of money each month for treatment. For the vast majority of people, that is simply out of reach.

    Let me add something that I was not originally going to say: I, too, am a science geek. I have a biochemistry degree and I worked in medical research before even going to medical school. I understand the importance of robust, evidence-based medicine, but I can also tell hon. Members that people searching in a very desperate way for things that will improve the quality of their life, or even keep their children alive, might also go to places where absolutely no thought is given to the purity of a drug. They may seek alternatives that are increasingly more dangerous for their children. It is important to recognise that.

    Christian Wakeford (Bury South) (Con)

    As another science geek with a chemistry degree, in which I specialised in drug design and synthesis, I completely agree with the hon. Member’s point. That is part of the concern. It is about having not just the product right now, but the right product, and about making sure that we have efficacy and safety. I completely appreciate all these points. That is why I do not necessarily agree with the perspective on the commission, but I have a lot of sympathy for clauses 1 and 2, which will go some way to help. However, the main stumbling block is the financing. We have already legalised the product. Every time it falls down, is it because it has not been licensed? Maybe, but finance seems to be the stumbling block at every single level.

    Dr Allin-Khan

    I do not need to tell the hon. Member, who has mentioned his CV—as many of us scientists have today—the cost of not investing in these young people. Think of every time a young person who would benefit from this drug goes into intensive care with seizures, every time they have alternative, expensive sedatives keeping them alive on a ventilator or the fact that they do not fulfil their potential, cannot go on and work and cannot give back to the economy. It is a false economy not to invest in this.

    Colum Eastwood (Foyle) (SDLP)

    Does the hon. Lady agree that it would be much better if we had less sympathy from Government Members and we got them to stop talking the Bill out and come with us to vote it through?

    Dr Allin-Khan

    I could not agree more; my hon. Friend puts the point across perfectly. If anyone is planning on talking the Bill out today, please will they ask themselves who benefits from that and whether they would feel proud of frustrating a process for many children and families that would mean that they did not have to go through, frankly, the hell that we have heard described?

    James Daly

    The hon. Lady is being extremely generous with her time; she will please forgive me for intervening, but I want to call on her expertise. The specific intent of Parliament was to allow medical professionals to prescribe non-licensed cannabis-based products. It cannot be any clearer than that; that is where the law is now. I agree with the point that was made—the fact that there have been only three prescriptions is ridiculous. However, perhaps she can address this question: the medical professionals who are considering such matters can see the evidence that we have talked about—it has been incredibly well articulated by all hon. Members—so why are they not referring those matters on and saying, “This patient needs this treatment”?

    The other question that I want to ask—very inarticulately—is about the two-stage process of the clinical referral and then the money within the CCG. Is the problem that it is getting through the first bit—the clinical referral—but the money in the CCG is stopping it? I wonder if she could address those points in her remarks.

    Dr Allin-Khan

    My understanding and my belief, unless someone has an alternative proposal, is that clinicians are often screaming from the rooftops in the knowledge that their patients need this medicine. We are where we are, however, with only three prescriptions having been granted in three years. This Bill seeks to improve that and move us forward.

    Families being forced to pay for treatment from private providers creates an unjust two-tier health system. A founding principle of our health service is that we do not believe that people’s access to treatment and services should be based on their ability to pay—it is as simple as that. The barriers in accessing medicinal cannabis are causing exactly that situation. We would not tolerate that for any other medication, so we should not tolerate it here. The Government must speed up and improve the availability of medical cannabis on the NHS and guarantee that patients across the country can access those products where appropriate.

    We have all heard the testimonies of children who receive no respite from their seizures and of patients whose chronic pain has become a constant of their lives. Working in hospitals, I regularly meet those people and their families, who beg me and other doctors to help their loved ones. Witnessing their suffering never gets any less upsetting, especially when we know that there are options to alleviate it. Unrelenting pain can be so devastating for all involved. It is imperative that we listen to those who would benefit from access to cannabis-based products and allow them to guide our future thinking.

    We have a voice in this place. I commend hon. Members from both sides of the House for using their voice today to speak up for those families who cannot be here to make the case themselves. Hon. Members have been begging, but we should not have to beg to do the right thing for the people who we serve.

    Tonia Antoniazzi

    Some of the voices that we have heard in the House today have talked about an unlicensed drug. The children who we have been talking about have been taking unlicensed drugs. I went to The Hague with two different families—two mothers—to pick up a prescription there before they could get it here. We walked into a pharmacy and picked it up, just as I would pick up my inhaler from Boots. There should be no fear. This is an over-the-counter drug in places such as the Netherlands, not an awful unlicensed drug that it is impossible to get. Does my hon. Friend agree that we need to break down that barrier and move on?

    Dr Allin-Khan

    As usual, I could not agree more with my hon. Friend, who makes a passionate and fair point.

    The Bill serves as an opportunity to move forward in a way that even the sceptics could support. I say again that anyone who is planning to talk out the Bill should take a long hard look at themselves in the mirror and ask themselves what they are doing. They need to walk a mile in the shoes of the families who are worrying about whether their child will be alive the next day.

    Last month, we had two debates on the issue in a matter of days. I would like to think that that demonstrates the collective will in the House to make progress, but that will and the warm words it brings are not enough for the thousands of people who should have benefited from those prescriptions in 2018 and since. We now need further action, and I wholeheartedly believe that the Bill would go some way towards achieving that. I trust that the Government believe that too.

  • Selaine Saxby – 2021 Speech on the Medical Cannabis Bill

    Selaine Saxby – 2021 Speech on the Medical Cannabis Bill

    The speech made by Selaine Saxby, the Conservative MP for North Devon, in the House of Commons on 10 December 2021.

    On sitting Fridays, I often find that we have much in common with Opposition Members and that, when we work together, such as through all-party parliamentary groups—the hon. Member for Gower (Tonia Antoniazzi) referenced such work—we are divided only by how, rather than whether, we will get there. I recognise what an emotive topic this is and send my deepest sympathies to the hon. Member for Middlesbrough (Andy McDonald), who shared his story. I am grateful not to have such a case in my inbox, because this is an incredibly emotional issue.

    When we hear about individual cases of children and families with drug-resistant epilepsy who have found relief from whole-plant extract medical cannabis, all we want to do as human beings is help. Most of us came here to make people’s lives better, and we all want to expedite such things as far as is possible. I am a mathematician by training—I will not draw on medical GCSEs and A-levels—and, as I do not have such a case and therefore an emotional tie, I would like to use logic and talk through what the Government have done to make progress in the area before looking at the specifics of the Bill and how we have, hopefully, started to make some progress.

    In November 2018, cannabis-based products for medicinal use, known as CBPMs, were rescheduled under the Misuse of Drugs Regulations 2001 from schedule 1 to schedule 2, as detailed in the excellent opening speech by the hon. Member for Manchester, Withington (Jeff Smith). I thank him for bringing the matter to the House to enable us to speak on it again. The change followed advice in July 2018 from the UK Government’s chief medical adviser and the Advisory Council on the Misuse of Drugs, both of whom said that the rescheduling of such products would facilitate the development of clinical evidence.

    I have not been in this place that long but, for most of my two years here, we have been in a global pandemic. Again, my heart goes out to the families tied up in this, but the pandemic has slowed down medical trials and treatments for a huge number of people. My hon. Friend the Member for Crewe and Nantwich (Dr Mullan) referenced the need for research in the area. In the last 12 months, 18 trials of cannabis-based products for medicinal use have come forward, and six are now complete. Things are therefore moving, although perhaps not at the pace that we would like.

    Since the change in the 2001 regulations, doctors on the General Medical Council’s specialist register have been able to prescribe an unlicensed CBPM if clinically appropriate for their patients. As we have heard, the law allows GPs to prescribe these products under the direction of a specialist as part of a shared care arrangement. Currently, all the CBPMs prescribed by specialist doctors are, as we have discussed, unlicensed medicines, which unlike licensed medicines have not undergone rigorous tests for quality, safety and efficacy. As has been said so passionately, such unlicensed medicines are treatments of last resort, and patients at that stage in their treatment pathway will be under the care of a doctor with specialist knowledge in their field and all the treatment options to take responsibility for such prescribing.

    As we know, access to medical cannabis has been debated at length in both Houses. However, while it is understandable that these campaigns continue for greater access to unlicensed cannabis-based products for medicinal use funded by the NHS, as detailed so beautifully by my hon. Friend the Member for Dover (Mrs Elphicke), these products have not had their safety, quality or efficacy assessed or assured by the Medicines and Healthcare products Regulatory Agency or their clinical and cost-effectiveness assessed by the National Institute for Health and Care Excellence, otherwise known as NICE, which is the basis for NHS routine funding.

    It is critical to progressing public funding decisions that manufacturers of those products invest in those clinical trials and prove that the products are safe and effective so that more of our constituents are able to access them. The National Institute for Health Research remains open to receiving good-quality proposals for research in this area. The latest clinical guidelines from NICE demonstrate a clear need for more evidence on the clinical and cost-effectiveness of the unlicensed medicines.

    Sally-Ann Hart (Hastings and Rye) (Con)

    On the NICE guidelines and the clinical evidence, does my hon. Friend agree that all medication, whether cannabis-based, heroin-based or cocaine-based medication, must have rigorous testing through clinical trials so that we understand the possible side-effects and everyone—GPs, all doctors and patients—has full knowledge in making the ultimate decision on whether a drug should be prescribed?

    Selaine Saxby

    I agree with my hon. Friend: it is vital that we fully understand the side-effects of these drugs that we know, when used in the wrong way, have clinical downsides.

    The Government continue to support the establishment of clinical trials with NHS England and the National Institute for Health Research, but they have been clear that the law enables lawful access where deemed clinically appropriate. The most significant barrier to access on the NHS is the lack of evidence on the quality, safety, and clinical and cost-effectiveness of these products. That sounds uncaring, but I want to revisit the black-and-whiteness behind the terrible emotion tied up with these individual cases.

    I understand that the Royal College of General Practitioners is supportive of the Government’s position that, until the evidence base has developed further, GPs should not be asked to initiate prescribing these products independently of a specialist. I suspect that trust in doctors in this particular area is well placed, which in my mind makes clauses 1 and 2 hard to support.

    There is indeed clear merit in understanding, then overcoming any barriers to accessing unlicensed cannabis-based medicines on the NHS. That is why in March 2019 the then Health Secretary commissioned NHS England and NHS Improvement to review NHS systems and processes and identify and recommend any actions necessary to addressing barriers to clinically appropriate prescribing of unlicensed cannabis-based medicines on the NHS.

    The findings of that review were reported in August 2019 and the majority of recommendations have now been implemented. Since this work has been undertaken recently and the recommendations acted on, I find it hard to support clause 3 of the Bill, as so much has already been achieved by non-legislative means. I very much hope that trials will progress to enable more families to access this treatment, and I take this opportunity to thank the hon. Member for Manchester, Withington for introducing his Bill.

  • Andrew Adonis – 2021 Comments on Funding for TFL

    Andrew Adonis – 2021 Comments on Funding for TFL

    The comments made by Andrew Adonis on Twitter on 11 December 2021.

    London makes huge net contribution to national taxation, billions in excess of the current TfL deficit. So it’s absurd to call it “unfair” to taxpayers to maintain TfL through the pandemic. TfL is economically & socially vital not just for the capital but for the country at large.

  • Sadiq Khan – 2021 Comments on ULEZ Expansion

    Sadiq Khan – 2021 Comments on ULEZ Expansion

    The comments made by Sadiq Khan, the Mayor of London, on 10 December 2021.

    This shows how bold action reaps rewards on air quality and climate change. Just one month after expanding the world’s first Ultra Low Emission Zone, we have seen a significant reduction in the number of older, more polluting vehicles driving in our capital. This is vitally important because toxic air is an invisible killer, responsible for one of the biggest public health crises of our generation.

    In central London, the ULEZ has already helped cut toxic roadside nitrogen dioxide pollution by nearly half. But pollution isn’t just a central London problem. Everyone should have the right to breathe clean air, which is why expanding the ULEZ was a crucial step. The high compliance rate means that millions of Londoners are already benefiting from cleaner air.

  • Charles Walker – 2021 Speech on Specialist Care for Young People

    Charles Walker – 2021 Speech on Specialist Care for Young People

    The speech made by Charles Walker, the Conservative MP for Broxbourne, in the House of Commons on 10 December 2021.

    Sadly, some children and young people are not able to live safely with their families. The significant majority of these children have experienced trauma at a point during their developmental years, resulting in a range of behaviours, many of which cause distress to them or others. Those behaviours include self-harm and an increased vulnerability to criminal exploitation.

    If a young person is unable to live safely at home, he or she may come into the care of the local authority or require hospital care. There is currently an insufficient supply of specialist care to meet the needs of such young people. As a result of the challenges posed by covid-19, health and social care professionals describe an unprecedented level of complexity and acuity of need, making an already difficult situation worse.

    When a young person comes into care they will require either a children’s home, with staff skilled and experienced in meeting complex needs, or in some instances a court-directed placement into a secure unit, to keep them safe. Over the past 18 months, Hertfordshire children’s service has made three applications to the national secure bed bank. Despite repeated referrals, a secure placement was achieved for only one child. The most recent referral was made approximately six weeks ago, and on that occasion the local authority was advised that there were 50 referrals for only four available beds. That means that a secure bed was not available for 46 young people who had been assessed as requiring such accommodation to keep them safe. In each of those cases, the relevant authorities, including Hertfordshire, were required to make their own arrangements while the secure referral remained active.

    Increasingly, local authorities turn to the courts for a deprivation of liberty order in the absence of more appropriate secure placements. Such orders are sought as a last resort, even though when granted they can place local authorities in the invidious position of having knowingly to place children in environments that are not best suited or equipped to meet their complex needs. Similarly, young people who require psychiatric hospital care find such care unavailable because of a shortage of appropriate hospital beds. In Hertfordshire, a number of young people have been assessed as detainable under the Mental Health Act 1983 and are waiting for appropriate hospital beds. The number waiting for a placement often rests at around 10 children, which means that in each of their cases their needs are not being met.

    Despite people’s best efforts, the whole system is creaking because it is unable to cope with the demand. Problems with recruitment and the increasing complexity of some children’s needs mean that Ofsted and the Care Quality Commission too often find themselves in the position of having to close providers down, or reduce their bed capacity. It is important to note that there is a difference between physical beds and usable beds. Many beds are not in service because, in meeting the increasingly complex needs of children in care, there is not the staff capacity safely to service all the available beds in a home.

    Not only is the current situation having a detrimental impact on young people, but its impact on the public purse is significant. Delivering bespoke care to a young person, often through a commissioned provider, is very expensive, particularly because these young people, due to the risks they present, will require high staffing levels. Placements are expensive: they can cost from £4,500 a week to upwards of £30,000 a week. Often, a child who has difficulty accessing support further down the needs scale quickly ends up requiring a far most costly set of interventions and specialist care.

    It is of course important to intervene early to work with young people in the community to prevent family breakdown and the escalation of needs, but the current placement situation must be addressed, so in this debate I wish to ask regulators to work with the care sector to reopen closed beds through the development of a specialist taskforce that supports providers—be they mental health providers, social care providers or specialist schools—that struggle to deliver good-quality care. Alongside such efforts, we should make a national intervention to reassure providers that their Ofsted rating will not be negatively impacted if they admit children with the most challenging of needs. Too often, specialist care providers will refuse these children because they are concerned that if a child absconds or creates a high level of service demand, that will negatively affect their Ofsted rating.

    We also need a national campaign both to challenge the stereotypes about children in care and to recruit residential childcare officers. Such schemes are already in place for fostering and adoption, and we have Teach First and Think Ahead. A similar programme now needs to be introduced to attract people into child social care and, in particular, the care of children with high levels of need.

    Backing up this recruitment drive, we need a programme of support to design children’s homes that can accommodate children with the most complex needs but, as I have already said, without extra specialist staff the Government programme to match fund local authorities to develop new children’s homes will face significant challenges. New homes require skilled staff if they are to be viable. Also, in wanting to build new specialist homes, we need to appeal to the better part of people’s human nature, as too many of these specialist homes, when they come up for planning approval, are opposed by local communities.

    When it comes to registering specialist residential care homes and facilities, we need to find a way of expediting the Ofsted registration process, which can take upwards of three months. In an emergency, a local authority will sometimes use one of its bedroomed properties as a care setting for a vulnerable child or adolescent, with a rota of specialist social care staff in attendance. Without Ofsted registration, such facilities will be operating outside the regulatory framework.

    Darren Henry (Broxtowe) (Con)

    I hear my hon. Friend’s point about care in the community, which is essential and something we need to focus on. Children and young people with complex needs too often end up in hospital, which is not the right place for them, as they end up being affected by people in hospital with other issues. Care in the community is essential. How can we give local authorities the onus and the investment to make this happen?

    Sir Charles Walker

    I thank my hon. Friend for his intervention, and I will come on to that. We need to have the right setting delivering the right care—the care that the child needs. The child needs to be at the centre of that care.

    How does a care emergency arise? That question is often put to me. Beyond the national shortage of beds, a provider can notify a local authority, with only a few hours’ notice, that it will be terminating a young person’s placement in its facility. They can say, “In just a few hours, you will have this child back. This child is now your problem again.” This practice needs to be eliminated, but eliminating it will only alleviate the need for the provision of emergency accommodation and care; it will not end it. That will be done only through the provision of more beds, in both the social care sector and the psychiatric care sector. In the psychiatric care sector, it is not just the overall quantum of beds that counts; it is also the type of bed. These will cover general adolescent units, eating disorders, low-secure units and psychiatric intensive care units.

    Almost all the concerns I have highlighted and will highlight this afternoon were identified in Sir Martin Narey’s independent review of residential care and in the Government’s response of 2016. We need to implement the findings of this report and tie them into a review of the Care Standards Act 2000 and the children’s homes regulations.

    If anyone watching or listening to this debate wants to learn more about what is happening in this sector, I refer them to an excellent report by the BBC correspondent Sanchia Berg that can be found on the BBC website, dated 12 November, “The court orders depriving vulnerable children of their ‘liberty’”. The report contains harrowing accounts of what is happening, and they are framed throughout by the concerns of the High Court judge Sir Alistair MacDonald, who is deeply concerned about what he is witnessing in the courts and family courts.

    Let me return to Sir Martin Narey’s independent review. Beyond its implementation, we need better joined-up care between the NHS and local authorities. The continuing healthcare framework has much to recommend it in relation to children and adolescents, but it is still heavily slanted towards their physical health. A robust commitment to parity of esteem would see the framework cover clinically diagnosed mental illness, as well as the challenges caused by trauma, attachment difficulties and, increasingly, autism. Let me say, as an aside, that all Department of Health legislation should make it perfectly clear that health means mental health and physical health; we cannot have one without the other.

    Why is mental health so important? There are still far too many lengthy debates between local authorities and the NHS as to whether a child is suffering from a mental illness or a behavioural difficulty. To many, this seems like dancing on the head of a pin, as the debate does not change the fact that at the heart of the discussion is a child in crisis, as referred to by my hon. Friend the Member for Broxtowe (Darren Henry). A good solution has to be more joint commissioning between health, education and care providers, thereby removing barriers to joint funding. An example of best practice can be found in my own county of Hertfordshire, where we are opening up a three-bed unit that will be jointly staffed by social care professionals and mental health professionals. Perhaps this initiative could pave the way for a national programme of hybrid mental health children’s homes, with a hybrid model of worker.

    I must conclude by returning to staffing and recruitment. There really is a need for an enhanced programme of training for residential workers that recognises the unique challenges of the role and the high level of skill required to deliver an effective service. Residential work currently requires a lesser qualification than social work, yet those working in residential settings have significantly more direct contact with the most vulnerable children with the most complex needs. Better training would lead to better pay and an enhanced profile, thereby making the role a career of choice and one which is attractive to graduates.

    I have made these recommendations and observations today on behalf of the excellent Hertfordshire County Council, which does a fabulous job across my county, and, of course, on behalf of the children for which it cares. Both Hertfordshire County Council and I want to support the Government’s programme to develop more beds in the secure estate, but we want an estate that is compassionate and able to provide the high levels of care and support that I know, the Minister knows and Madam Deputy Speaker knows, it wants to provide.

  • Liz Truss – 2021 Comments on Hosting G7

    Liz Truss – 2021 Comments on Hosting G7

    The comments made by Liz Truss, the Foreign Secretary, on 11 December 2021.

    This weekend the world’s most influential democracies will take a stand against aggressors who seek to undermine liberty and send a clear message that we are a united front.

    I want G7 countries to deepen ties in areas like trade, investment, technology and security so we can defend and advance freedom and democracy across the world. I will be pushing that point over the next few days.

  • Christopher Pincher – 2021 Statement on the Delivery Supply Chain

    Christopher Pincher – 2021 Statement on the Delivery Supply Chain

    The statement made by Christopher Pincher, the Minister for Housing, in the House of Commons on 10 December 2021.

    I wish to update the House on the measures the Government are taking to facilitate flexibility within the delivery supply chain and mitigate challenges faced by construction sites.

    Due to the covid pandemic, the logistics sector is facing an exceptional challenge resulting from the acute shortage of HGV drivers across the distribution network. This has resulted in missed deliveries which have the potential to lead to significant shortages and hinder economic growth.

    Through a previous written ministerial statement made by the former Secretary of State, dated 15 July 2021, the Government responded to these pressures proactively by ensuring the industry had the tools available to adapt effectively and minimise any disruption to the public. The statement made it clear that local planning authorities should take a positive approach to their engagement with food retailers and distributors, as well as the freight industry, to ensure planning controls are not a barrier to deliveries of food, sanitary and other essential goods.

    I am now expanding the scope of these measures. The purpose of this written ministerial statement, which comes into effect immediately, is to make it clear that local planning authorities should take a positive approach to their engagement with all supply chain stakeholders to ensure planning controls are not a barrier to the supply of all goods and services.

    Many commercial activities in England are subject to controls which restrict the time and number of deliveries from lorries and other delivery vehicles, particularly during evenings and at night. These restrictions may be imposed by planning conditions, which are necessary to make the development acceptable to local residents who might otherwise suffer from traffic, noise and other local amenity issues. However, this needs to be balanced with the public interest, for all residents, to have access to shops which are well stocked.

    The National Planning Policy Framework already emphasises that planning enforcement is a discretionary activity, and local planning authorities should act proportionately in responding to suspected breaches of planning control.

    Local planning authorities should not seek to undertake planning enforcement action which would result in unnecessarily restricting deliveries, having regard to their legal obligations.

    Construction output has also been inconsistent in recent months and not returned to pre-February 2020 levels. Construction sites in England may also be subject to controls which restrict the hours within which they can operate. Wherever possible, local planning authorities should respond positively to requests for flexibility for operation of construction sites to support the sector’s recovery.

    The Government recognise that it may be necessary for action to be taken in relation to the impacts on neighbours of sustained disturbance due to deliveries and construction outside of conditioned hours, particularly where this affects sleep. In this case a local planning authority should consider any efforts made to manage and mitigate such disturbance, taking into account the degree and longevity of amenity impacts.

    This statement will replace all the previous statements on these matters.

    This written ministerial statement only covers England and will expire on 30 September 2022, giving direction to the industry and local planning authorities over the next 10 months. We will keep the need for this statement under review.