David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con) I beg
to move, That this House has considered the economic contribution
of medicinal cannabis. It is a pleasure to serve under your
chairmanship, Mr Stringer. I thank the Backbench Business Committee
for allocating this debate. This slot on a Thursday afternoon is a
challenge for many Members to attend because they have constituency
commitments on a Thursday afternoon, but I am confident that we
will have a...Request free trial
(Dumfriesshire, Clydesdale
and Tweeddale) (Con)
I beg to move,
That this House has considered the economic contribution of
medicinal cannabis.
It is a pleasure to serve under your chairmanship, Mr Stringer. I
thank the Backbench Business Committee for allocating this
debate. This slot on a Thursday afternoon is a challenge for many
Members to attend because they have constituency commitments on a
Thursday afternoon, but I am confident that we will have a
good-quality debate and, importantly, that the issues I want to
raise will be put on the record.
I am conscious that a number of these issues relate to the
Department for Business and Trade and that my hon. Friend the
Minister will obviously respond in his capacity as a Minister in
the Department of Health and Social Care. I hope that if any
issues are not within my hon. Friend’s remit and he does not feel
able to respond, he will undertake to take them forward with
ministerial colleagues.
Many Members will have been introduced to the issue of medical
cannabis by constituents getting in contact to tell them, as
their MP, about the real difference that this form of cannabis
has made or could make to their own or their families’ lives.
Such testimonies, along with scientific study after scientific
study, led to my right hon. Friend the Member for Bromsgrove
(), when he was Home Secretary,
legalising medical cannabis in 2018, and thereby ending the
potential criminalisation of those living with or just trying to
manage multiple sclerosis, cancer or epilepsy. That was a
significant step forward for patients.
Some 17,000 UK patients are estimated to have been prescribed
Sativex, nabilone and Epidyolex in the UK last year. I am sure
that many Members of Parliament could tell a story from their
constituents about what a difference such prescriptions have made
to the quality of users’ lives by easing agonising muscle
stiffness, by reducing chemotherapy-induced sickness, or as a
therapy for seizures, especially for children.
The 2018 legal changes were also a significant step for the
medical cannabis industry in the UK. We should be clear that
medical cannabis is just that. This is a legitimate industry, and
an industry of the future. Its products do not come from humid,
tinfoil-draped sheds or sunlamp-lit lofts; they come from
laboratories and facilities that are as controlled an environment
as those that synthesise a vaccine, for example. I know that to
be the case, having seen at first hand such facilities being
developed in my own constituency. The medical cannabis industry
is one of legal and professional standards, rigorous regulators,
approvals, licensing, inspections and almost endless specialist
equipment—be it quantum sensors, microscopes or leaf
barometers—not to mention stringent safety and security
protocols.
Of note is not just the standards to which the cannabis is
produced but the volumes produced. In the UK in 2021, some 59
hectares were harvested, producing 329 tonnes of cannabis for
medical and scientific purposes. Of that, 213 tonnes were
exported—more than half the reported world total. Beneath those
impressive headline figures, though, is the impact that the
industry can have on local economies and local communities. That
is why I have been and remain very supportive of the development
of a facility in my constituency by Hilltop Leaf.
Too often, investment in new industries is funnelled into
enormous singular developments captured by large corporate
interests, or it goes straight into cities. Rural and
agricultural communities such as those I represent often get
overlooked, with seemingly only wind farms and tourism receiving
investment. The medical cannabis industry is an antidote to
that.
In many ways, I feel the growing of medical herbs is a form of
farm diversification—an evolution of horticulture that builds on
local strengths and skills. I hope that the investment by Hilltop
Leaf, with one of the largest greenhouses in the UK, will
demonstrate that medical cannabis can have a transformational
impact on local communities. It will bring a variety of good
horticultural, administrative, managerial and logistical jobs
that I hope will anchor young people, who often feel the
gravitational pull of large cities for the want of opportunities
in a rural area such as the one I represent, which has seen the
demise of traditional industries such as textiles. It could also
meet nearly 10% of the UK’s 2019 domestic need.
For all the successes of the UK cannabis sector to date, it could
be so much more. Bureaucratic, legal, administrative, regulatory,
medical, licensing and planning issues all inhibit the industry’s
potential and hinder vital investment in rural Britain. Indeed,
the over-onerous process for being licensed in the first instance
has given me cause to worry about the development in my
constituency stalling. I am afraid the UK’s approach to the
industry is incoherent and insufficiently consistent.
Yes, medical cannabis can be prescribed, but only by specialists,
and that is predominantly being done outside the NHS,
particularly in Scotland. Although I said earlier that in 2021
some 17,000 people received legal prescriptions for medical
cannabis, it is conservatively estimated that next year there
will be approximately 337,000 potential patients. That could be
many times larger should new conditions be covered. This state of
legality but inaccessibility is grossly unfair, and is contrary
to the principles of our health service that those who can pay
can get private prescriptions—or source their requirements from
drug dealers—while those who cannot pay go without. All the
while, there are almost 24 million prescriptions for opioids in
the UK. Those figures, in differential terms, are staggering.
The potential savings for the NHS in the prescribing of medical
cannabis have been detailed, with one US study showing a
potential provider saving of 29% because of reductions in opioid
dosage. As I said, by confirming the efficiency of medical
cannabis in helping with certain conditions while stopping it
being readily available, we are pointing those who are desperate
to illegal markets. Do we really think that patient safety is
best served by criminal suppliers, who provide a product of poor
quality that is likely to contain contaminants because of the
fashion in which it was grown? I certainly do not. Do we need to
see the benefits for British growers, supply chains, jobs and tax
revenues bypassed and go instead to criminals and smugglers, both
here and overseas? Clearly not, especially when the medical
cannabis sector has a potential value to the UK economy of more
than £1 billion.
Our incoherence also extends to cannabidiol, or CBD. We allow its
purchase—indeed, the UK’s CBD market is the second largest
globally and was worth £300 million in 2019—but our hemp
licensing measures mean that the flowers and leaves, where CBD is
found, must be destroyed. As such, the CBD market fulfils its
needs through overseas imports, and British supply chains do not
benefit. Growers are necessarily forsaking the opportunity to
yield a crop of £10,000 per acre, compared with £400 for wheat,
because of this approach. Such yields would be a real boon for
rural Britain.
If the UK’s regulatory, legal and medical frameworks were in line
with those elsewhere, it is estimated that up to 100,000 jobs of
the future could be created, and they would be good-quality jobs,
as I have already set out. It is an opportunity that should be
within our grasp, but unfortunately we currently do not seem able
to take it forward. On 14 November last year, I was disappointed
when a fellow Member asked the Business Department about its
willingness to take forward the approach to the medical cannabis
industry as part of its medical sciences strategy and commitment
for the UK to be a world leader in such fields; unfortunately,
the then Minister gave what I regarded as a lukewarm and
non-committal answer.
As I am sure the Minister and all present will agree, nascent
industries need nurturing, and the medical cannabis sector is no
different. Much like the plants that the sector grows, the
industry is seeking the conditions to grow. I hope the Government
will be minded to support the sector and the economic benefits it
could bring, particularly to rural Britain. This should not be
considered an ask for wholesale legalisation, which is a
completely different debate; it is an ask for consistency and
coherence for the industry, and for access to medical cannabis
for NHS patients.
We need the various strands in Government to be stitched together
to provide support, rather than maintaining a strange patchwork
of overlapping and clashing components. The UK Government and,
where appropriate, the devolved Administrations should therefore
accept the need to review the prescribing process, medical
guidelines, acceptable tetrahydrocannabinol levels, and the
overlapping legal and regulatory components. My specific ask of
the UK Government is that they appoint a senior official to do so
holistically, and that individual should be mandated to engage
directly with the industry.
With coherent and consistent oversight, and by bringing the UK
into line internationally, the medical cannabis sector could help
to get rural Britain, and particularly constituencies such as
mine, growing economically. In doing so, we could supply our
domestic market with homegrown supplies and, even more
importantly, relieve the pain and suffering of hundreds of
thousands of our constituents, if they could access the
prescriptions they need.
15:15:00
(Strangford) (DUP)
It is a pleasure to speak in this debate and to serve under your
chairmanship, Mr Stringer. I thank the right hon. Member for
Dumfriesshire, Clydesdale and Tweeddale () for leading the debate and
for setting the scene so well and in such a balanced way. In his
introduction, he said that we all have constituents who have
benefited from medicinal cannabis. I have one such constituent,
and I want to speak about that young girl and her family, because
I have seen at first hand exactly what medicinal cannabis can do
to improve health, to lift the fortunes of a family and to give
them the encouragement that they need.
As the DUP spokesperson for health, these issues are very
important to me. I have seen at first hand the impacts that
medicinal cannabis can have on people who are ill. It is sad that
it does not work for everyone, but it has certainly worked in
cases that I am aware of. There are success stories, but also a
large proportion of people for whom it does not work. However,
for those who are fortunate enough to see results, it is a
crucial treatment that can ultimately save lives. I am here today
to celebrate that.
By their very nature, issues such as this can sometimes be
contentious. The right hon. Gentleman set the scene well and got
the balance right. I congratulate him on that because he
presented the issue well. This subject sometimes sparks debate,
but we would try anything if it gave someone a better chance at
life.
There is never a debate on this topic in which I do not highlight
the benefit of regulated medicinal cannabis prescription by
talking about lovely Sophia Gibson. She is a young girl who, at
about six or seven years old, was having epileptic fits every day
of her life. In my office, I have a photograph of her from when
she was smaller. She is the daughter of Danielle and Darren and
has Dravet syndrome, which is incurable, and she will continue to
have seizures until her wee body can no longer cope.
Medicinal cannabis is not the cure for Sophia—there is no
cure—but that young girl’s quality of life has changed
dramatically. I can remember when the epileptic fits were of such
ferocity and in such numbers that it was impossible for that
young girl to have a normal life, but today her life has changed.
The prescription from the health board changed not only her life
but the lives of her distraught parents. She was in hospital
every month and was missing months of schooling at a time, but
Sophia’s THC prescription has enabled her to attend school,
because the intensity and number of her epileptic seizures has
drastically reduced.
I recall the meeting that I had in this House with the then
Minister, , and Sophia’s mother, Danielle.
I have said it before in this House and I will say it again: the
Minister was such a help to Danielle, young Sophia and the whole
family in moving forward. Ultimately, through Mark Field’s help,
the assistance of the health board back home and the Department
here, Sophia was able to receive medicinal cannabis and her life
changed. That is what I see: I see a real difference in a young
girl who was potentially looking at a life that was going to get
worse and worse.
I have a wee nephew. I often say this, and I say it with regret
because medicinal cannabis was neither available at that time nor
did I have knowledge of it. My sister, Joy, has one child. He has
epileptic fits. I often wonder whether, if he had had access to
medicinal cannabis, it would have been possible to have changed
his life. I am not saying that would have been the case, but now
it is too late, because he has had so many years with the
condition that it is impossible to put his life back.
Sophia still needs 24-hour care, but she can also live a life
with her family. It did my heart glad to see her travel, as she
did just last year with her family to Disneyland Paris. The
family always bring their pictures in to encourage me; it is good
to see her progress through the pictures. I saw a picture of
Princess Belle dancing with Sophia. That would not have been
possible without the blood, sweat and tears, the dedication and
commitment, of her mum and dad, who did not cease until their
daughter got the medication—they would do anything for their
child, as parents do; and how right they are—or without the
Health Minister at the time, . Nor would it have been possible
without the will of this House to take steps to provide for the
safe classification of this drug for medicinal purposes.
While I celebrate Sophia’s victory, I also support my colleagues
in trying to secure access for more children like her. That is
why I am here today. When I saw the title of the debate, I
automatically said to Naomi, my speechwriter, “I’ve got to be
here for this debate—it’s important to me.” I have seen first
hand the improvement to Sophia’s quality of life, and I want more
people to be able to access this treatment for that purpose. I
want to clarify: I am not looking for a free-for-all—and I do not
think the right hon. Member for Dumfriesshire, Clydesdale and
Tweeddale is either, by the way. I want a process that allocates
the drug in specific circumstances, as directed by the Health
Department. I do not think we are currently there.
There are so many companies that are investing in cannabis plant
products for healthcare, because the benefits for those it works
for are incredible. We know that the UK is the world’s biggest
producer and exporter of legal cannabis for medical and
scientific purposes. Globally, there is a rising trend in the
legal production and use of cannabis for medicinal and scientific
purposes. Jazz Pharmaceuticals has offices in Oxford, Cambridge
and London, and manufactures the products Epidyolex and Sativex,
and Target Healthcare makes certain bedrocan cannabis oils in the
UK. In 2019, a major US cannabis company set up its European
headquarters in—guess where?—Belfast. Colorado-based Mile High
Labs, which is the largest extractor of cannabidiol isolate in
the world, established its base on the Boucher Road in Belfast,
so we have moved forward.
The benefit of medicinal cannabis to individuals and their
families, as well as the economic benefit that is starting to
arise from it, is reason enough to review the approach. That is
what the right hon. Member is asking for, and I support his
request. We are talking about allowing wider production and
delivery within—ever mindful of what I said earlier—the strictest
of frameworks. I will be clear again: I am not in favour of
legalised cannabis in any other capacity than GP or
consultant-led, and within the strictest medical protocols. But I
believe that we can and should provide a safe and effective
product to help those who need it for specific reasons within the
pro forma.
I again thank the right hon. Member for introducing the debate.
Sophia is my example of a young girl who has progressed to the
point where she can attend school regularly. I met her at one of
the fun days down on the West Winds estate in Newtownards last
year. What a difference I can see in that wee girl. The wee girl
in the photograph in my office was, at the time, having fits
every half an hour or 45 minutes. Today, her and her parents’
lives have changed. In Sophia’s case, medical cannabis gave her a
chance to live her best life with a debilitating condition. That
is vitally important. I know each one of us in the Chamber
wholeheartedly supports that. Can we make someone’s life better?
I think we can. Sometimes when we do so, it is such a magnificent
occurrence that it leaves a lasting effect on us.
15:24:00
Sir (Kenilworth and Southam)
(Con)
It is a pleasure to see you in the Chair, Mr Stringer. I
congratulate my right hon. Friend the Member for Dumfriesshire,
Clydesdale and Tweeddale () on securing this debate and
on the way he opened it. It is of course a pleasure to follow the
hon. Member for Strangford (). I agree entirely that if this were a debate about
the wider use of cannabis, about encouraging its use or, worse
yet, about its legalisation for recreational use, neither he nor
I would be speaking in favour—we would be speaking strongly
against. But that is not the debate we are having today. We are
talking about the prescription of medical cannabis by doctors for
use by patients such as Sophia, the hon. Gentleman’s constituent.
I will come on to my own constituent whose involvement in this
process leads me to be here.
It is worth recognising that the debate about whether we should
prescribe medicinal cannabis medicines to patients who can
benefit from them has been resolved. We have had that discussion
and, as my right hon. Friend the Member for Dumfriesshire,
Clydesdale and Tweeddale mentioned, my right hon. Friend the
Member for Bromsgrove () made that necessary change to
the law in November 2018 so that such medicines can be prescribed
within the law, and medicinal cannabis was rescheduled under the
law to ensure that that was a legitimate process. That was, in my
view, entirely the right change to make. I argued for it at the
time, and I was involved in that process.
The credit must more substantially go to the family of my
constituent Alfie Dingley. Alfie is a young boy whose
circumstances are very similar to those of the constituent of the
hon. Member for Strangford. He used to have a number of seizures
a day of very great severity, and cannabis-based medicine has had
a transformational effect on him. As a result, his family
campaigned effectively and robustly for the change we have seen,
and they deserve huge credit for it. I am delighted that they are
here in the Public Gallery today. Alfie’s mother, Hannah Deacon,
has been campaigning not just for Alfie’s benefit, but for the
benefit of others who can also derive considerable beneficial
change from these medicines.
We have already had a change to the law to allow medicinal
cannabis to be prescribed and to deliver benefits to patients who
can have it, but all of us who thought that that was a good
change to make had rather expected that considerably more
progress would have been made by now in ensuring that medicinal
cannabis products are made available to patients who can benefit
from them. It is a matter of profound sadness and regret, and it
should be of concern, that only three NHS prescriptions have so
far been made for these types of medicines. That cannot be right.
I hope my hon. Friend the Minister will recognise that the logic
of the legal change made in November 2018 was that we would make
these medicines available to those who need them, and we are
nowhere near that objective.
As I say, we have crossed the Rubicon. We have made the decision
that medicinal cannabis should be made available to those who
need it, and it seems to me that we need to follow through on the
logic of that decision. The logic of that decision is not just
that, in a medical context, we should make these medicines
available to those who need them, but that we should also support
their provision domestically. Therefore, the debate that we are
having this afternoon, at the instigation of my right hon. Friend
the Member for Dumfriesshire, Clydesdale and Tweeddale, is about
ensuring that the logic of our decisions is followed through, and
that the UK economy can derive the necessary benefit from those
sensible decisions.
We know that medicinal cannabis will be produced somewhere, and
of course we must want it to be in order to have those products
available for prescription within the NHS and the broader
healthcare architecture. Why, then, would we not encourage the
production of medicinal cannabis in this country, so that there
can be a direct domestic financial benefit from it? It simply
makes no sense to create a demand and then refuse to allow our
domestic producers to meet it, and instead to import all the
products.
Doing that is not just a wasted economic opportunity, but has a
direct healthcare effect. That is why it is of benefit that my
hon. Friend the Minister is answering this debate. If we were
talking to a Minister from the Department for Environment, Food
and Rural Affairs, we could talk about the benefits that these
crops bring in an sense. If we were talking to a Business
Minister, we could talk more about the direct financial benefits
that have been mentioned. However, since a Health Minister is
here, we can also talk about the direct benefits of a more secure
supply chain to those receiving these medicines.
This is not just a theoretical concern. Alfie Dingley and his
family had periods of intense worry during the Brexit process.
They were concerned about the security of supply of what Alfie
needed, which at that point was coming from the Netherlands. The
potential disruption of that supply was evident. I put on record
my thanks to the Minister’s predecessors, who were able to
intervene and ensure some security of supply. However, that took
up a good deal of ministerial time, because we were seeking to
secure supply from overseas, when we could have so much more
easily had that supply domestically. This is not just an economic
argument, although I support the points made by my right hon.
Friend the Member for Dumfriesshire, Clydesdale and Tweeddale
about the economic benefits. There is a direct healthcare benefit
to ensuring that we have a domestic supply of these products.
I support the arguments made by my right hon. Friend and the hon.
Member for Strangford. It is sensible to follow through on the
logic of the decisions that we have—in my view, rightly—already
made. We must therefore support domestic supply and address the
bureaucratic obstacles in the way of securing that supply, which
my right hon. Friend rightly described. I hope the Minister will
reassure us that he and colleagues in other Departments will be
able to work together to achieve that security of supply and
those financial and economic benefits. Most importantly, patients
who benefit from these medicines should not just receive them by
prescription, but be reassured that their future and their supply
is secure because we have developed a sustainable domestic
industry in the production of medicinal cannabis.
15:32:00
(Inverclyde) (SNP)
I congratulate the right hon. Member for Dumfriesshire,
Clydesdale and Tweeddale () on bringing forward this
debate. I put on record that I am a trustee of the charity
Intractable Epilepsy, whose aim is to raise money to fund the
purchase of medical cannabis for children with intractable
epilepsy. Details are contained in the Register of Members’
Financial Interests.
It is appropriate that this debate is being held on 20 April. I
wish a happy 4/20 to everyone—some people know what I am talking
about. In March 2019, the then Health Secretary, the right hon.
Member for West Suffolk (), reassured parents of
children living with life-threatening epilepsy when he said that
medical cannabis would be made available on the NHS. Of course,
that never happened. Instead, he threw the problem over the wall
and left the health professionals to deal with it, and they have
not.
I think I have raised the issue of the provision of medical
cannabis 36 times in this place. Every time, the UK Government
have ignored my plea and reverted to their default position of
“cannabis is bad”. Their lack of knowledge is evident in the way
that they confuse synthetics such as Spice and Mamba with
marijuana. That is the background against which parents and
guardians have constantly lobbied the UK Government to provide
medical cannabis on the NHS. I have tried to support them as best
I can.
Clearly, we were wrong in our approach, and I apologise to those
children and their parents for my shortcomings. I appealed to the
moral or ethical need. I appealed to the compassion that this
Government repeatedly tell us they have. I have found today that
what I should have done is make the economic argument instead, as
the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale
has done. The UK Government have ignored the parents struggling
to raise the thousands of pounds required just to keep their kids
alive, but once we start highlighting the potential for making
money, their ears prick up. I am not criticising the right hon.
Member; if that is what it takes to get the Government to engage,
then so be it, because engage they must. People are suffering
needlessly.
I went to great lengths in my Budget speech to highlight the
benefits to the UK Government of supporting the hemp industry.
Much of the argument about medical cannabis is the same, because
it is the same plant that we are trying to grow. The UK
Government’s insistence that cannabis is a class B drug under the
Misuse of Drugs Act 1971 and in schedule 1 to the Misuse of Drugs
Regulations 2001, and that all varieties are treated the same,
means that we fail to understand that cannabis is a very complex
plant with over 483 compounds. Because of the UK Government’s
bias and ignorance, they have turned their back on the plant’s
potential and known benefits.
In fact, the hemp plant has over 50,000 uses, and medical
cannabis is only one. Finding markets for hemp would not be a
problem. I allow myself the indulgence of reminding us all of
some of those uses. It is estimated that a medium-sized
economically viable establishment would employ 120 people. When
hemp was widely grown back in the 16th century, in the
enlightened days of King Henry VIII, it was used to manufacture
rope and canvas for the King’s Navy, but we now know that we can
make clothing, shoes, biodegradable plastic, insulation panels,
food, paper, biofuels and medicine. Those products will sell and
be profitable, and the Government could reap the benefits.
But the benefits do not end there. Hemp absorbs 22 tonnes per
hectare of atmospheric carbon during its four-month growing
cycle. Hemp produces four times the biomass of the same sized
area of forest, which makes it a far more sustainable source of
material. Hemp does not need pesticides, insecticides or
fertiliser to grow in the UK. Hemp has natural anti-microbial
properties, so it passively cleans the air in buildings. Hemp has
a high capacity for moisture absorption, which allows for
controlled atmospheres in buildings. Hemp construction materials
act as a long-term carbon sink. One £60 million investment would
create a facility that is capable of growing 32,000 acres per
year. That would sequester over 207,000 tonnes of CO2 per annum.
That is the CO2 photosynthesised by the hemp in its four-month
growth and does not include the carbon sequestered into the soil
or the net effect of replacing high embodied carbon products from
international supply chains and their emissions.
As a wee bonus, hemp regenerates the soil that it grows in, so it
would work well in crop rotation. It increases winter wheat and
spring barley yields by 16% to 18% when they follow hemp in
rotation. It cleans groundwater, by which I mean that it has a
deep root mass that absorbs residual pesticides and insecticides
from the soil, which prevents run-off into streams and rivers,
and therefore avoids costly remediation by the water companies to
achieve UK drinking water standards. The barrier to this industry
raising the funding it requires is licensing. This is the
licensing problem that, as far as I am aware, Hilltop Leaf, the
company mentioned by the right hon. Member for Dumfriesshire,
Clydesdale and Tweeddale, is currently banging its head against.
Hilltop Leaf wants to grow and expand. It has built the facility,
but it cannot get a licence from the UK Government to allow it to
expand.
The problem with licensing is the categorisation of cannabis. To
make the cannabis industry a success, the Government have only to
open their mind to the reality of what it is and distribute the
appropriate licences to the appropriate growers. That will be
possible only if cannabis is re-categorised. I welcome everything
and anything that encourages the provision of medical cannabis,
but the UK’s Government’s knowledge has to increase if they are
truly to capitalise on the hemp plant and provide the good
outcomes that are available. I would prefer the UK Government to
come to the table driven by a desire to provide medicine for
people suffering from a range of conditions—and we will need a
supply chain from private companies to do that—but if they are
drawn closer by the lure of tax revenue, so be it. But we cannot
wait any longer. The patients who require medical cannabis to
help them towards better lives have waited far too long for this
Government to recognise their needs and act accordingly.
Finally, the argument that we need more research is no longer
viable. The argument that cannabis is bad and that we cannot
countenance its use is misplaced. Rather than standing on the
sidelines shuffling their feet, it is now time for the UK
Government to be proactive in funding and promoting the growth of
the feedstock, the academic research and the production of the
medicines, in providing and promoting the necessary training for
GPs to allow them to prescribe, and in ensuring that the legal
framework exists to allow those in the medical profession to
carry out their duties, while protecting them and their patients,
which by my reckoning would mean the involvement of the
Department for Environment, Food and Rural Affairs, the
Department for Business, the Home Office, the Department of
Health and Social Care and—as there is no show without Punch—the
Treasury. Minister, it is time to go to work.
15:40:00
(Bristol South) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer,
and to be present for this debate. I take what the right hon.
Member for Dumfriesshire, Clydesdale and Tweeddale () said about it being in a
late slot on a Thursday, but it is an important debate, and I am
pleased that we have had time for contributions.
The right hon. Gentleman clearly outlined the case for a
legitimate industry of the future. He asked the Government for
consistency and coherence in their approach to the industry. I
wish him luck on getting Government coherence on policy for many
nascent industries, but the point was well made about good
standards of production and the importance of jobs, particularly
in rural economies such as the one he represents.
Many people present—and, on other occasions, many who could not
be here this afternoon—have spoken movingly about constituents,
as the hon. Member for Strangford () did. He spoke about the difference that earlier
movement would have made to his nephew.
We welcome the constituents of the right hon. and learned Member
for Kenilworth and Southam (Sir ), who were present to hear
the debate, as they have been on many similar occasions over the
past few years. He made the sensible point that the 2018 decision
logically necessitated action from the Government, and said that
the insecure supply chain is worrying for so many families across
the country. Having an industry in this country would alleviate
that worry.
Finally, we heard from the hon. Member for Inverclyde (), who has raised the issue 36
times. I work well with him on Committees, and he is a persistent
campaigner on this and many other subjects, so I suspect he will
be here for a 37th and a 38th time as well. He has done a huge
amount of work in the area. He took us on a trip into history,
and spoke about the importance of many such plants to the wider
economy, and on the need for the Government to have more
knowledge when it comes to the logic of their decision making on
supporting the industry.
This debate is about the economy, and points have been made well.
As we have a Health Minister present, however, it is worth
recapping why we have not made greater progress since 2018, in
particular for those campaigners who worked so hard. Despite that
2018 decision, the trials and clinical research that would help
the wider industry have moved at a glacial pace, so across the
NHS, since 2018 only five people have been prescribed medical
cannabis. That is ridiculously slow, and so many people have to
go private.
Five years later, it is totally unacceptable that so little
progress has been made. It would be helpful if the Minister could
set out what steps he is taking to empower and accelerate
research in this space. I hope he will not dodge the question by
saying that the issue is simply one for clinicians. The
Government have a responsibility—the Minister is nodding, and we
await his reply with interest, but there seems to be a lack of
urgency on the issue, which is concerning. People are suffering
right now. We have heard again this afternoon about children who
are fitting, sometimes 100 times or more. Accessing care is, in
some cases, pushing families to the brink of destitution. We
should do everything we can to support those people.
If research is needed before clinicians feel comfortable
prescribing, then it is incumbent on the Government to support
clinicians. We need more streamlined clinical trials and better
engagement with clinicians. We do not want to be back here in
another two years, having a rerun of this debate. In 2020-21, the
then Minister said:
“It will take time to generate further evidence and see the
results of clinical trials. The Health Secretary and I are
committed to doing everything in our power to accelerate this
work.”—[Official Report, 4 November 2021; Vol. 702, c. 1120.]
If the Minister could update us on where this work has got to,
and whether the Government are any closer to finding a solution,
that would be welcomed by people tuning in today, and to the
families present.
Finally, I would be grateful if the Minister set out what action
he has taken to support people in the system right now—those
living in extreme pain who are paying thousands of pounds to
access treatment. There is consensus on this issue, as we have
heard. The debate has been had and a decision has been made, but
we can and should do better. In that spirit of consensus, we
would all like to see some progress from the Minister.
15:45:00
The Minister for Health and Secondary Care ()
It is a pleasure to serve under your chairmanship, Mr Stringer. I
congratulate my right hon. Friend the Member for Dumfriesshire,
Clydesdale and Tweeddale () on securing this important
debate, which would be considerably better attended if it was
held on any other day, because I know from my inbox and from
speaking to Members from across the House that there is
considerable interest in this issue.
Although this is the first debate on this important topic that I
have responded to as a Health Minister, I know that the House has
debated medicinal cannabis at great length in the past, in good,
constructive debates. I appreciate the depth of passion that hon.
and right hon. Members from across the House have on this issue.
I recently met members of the all-party parliamentary group for
access to medical cannabis under prescription and, as mentioned
by my hon. Friend the Member for Strangford (), I visited one of Jazz Pharmaceuticals’s sites to
learn more about the industry, the applications of its
products—the medicines—and the challenges that it faces. I also
learned about the huge opportunities for not just UK life
sciences and UK plc, but, importantly, our NHS and patients.
I note that the interest from my right hon. Friend the Member for
Dumfriesshire, Clydesdale and Tweeddale is largely a constituency
one; he talked about Hilltop Leaf. He has long championed
investment in Scotland, particularly in rural and remote areas,
where it has sometimes been a challenge in the past to attract
certain high-skilled jobs. This issue is an example of that—and
here, the investment would be accompanied by research capability.
My right hon. Friend has eloquently and articulately made his
case. I am very much alive to the fact that this is a complex
issue, and complex issues rarely have simple solutions. I will
try to respond to as many of the points that he and other hon.
Members have made in the available time, which is reasonably
substantial—in a Westminster Hall debate, it is rare to have more
than seven or eight minutes in which to respond.
As my right hon. Friend pointed out, this issue crosses multiple
Departments—the Department for Science, Innovation and
Technology, the Department of Health and Social Care, the
Department for Business and Trade and, vitally, the Home Office,
which has been alluded to, and NHS England. There was mention of
the calls to grow the UK CBD industry, and hemp farmers’
harvests. I am straying somewhat out of my health remit for a
moment to polish off some of these points, in so far as I have
the bandwidth to do so. I understand that the Home Office has no
plans to permit cannabis cultivation without a licence—my right
hon. Friend pointed to the licensing programme and the challenges
thereto—or to remove the distinction between the industrial hemp
regime and the standard cannabis cultivation regime. I cannot say
anything more specific on that. As I hope my right hon. Friend
will agree, it is well outside my area of knowledge and
expertise, and my brief. However, I do understand, having done
some rudimentary research and obviously from my conversations
with Jazz Pharmaceuticals, that this relates to plants being
grown outside versus inside, and the use of leaves and flowers
specifically.
If the Minister is struggling to understand, I am more than happy
to give him a copy of the report by the all-party parliamentary
group on industrial hemp and CBD products called “A Plan for a
Legal and Regulated UK Hemp and Cannabis Sector”.
I thank the hon. Member for that; I will gladly take a copy on
the way out. I hope he will excuse the fact that I am not an
expert in this field, but I will happily take that report as my
weekend reading and read up on the subject. I certainly agree to
take this up with my counterpart in the Home Office, as my right
hon. Friend the Member for Dumfriesshire, Clydesdale and
Tweeddale requested, and I am sure he will, too. I will
especially take away my right hon. Friend’s important points on
licensing, and on how the Government can support companies that
want to invest in the UK, or that are here and want to diversify
their agricultural business, and want to get the licences
required to grow these products.
Sir
All of us understand that the Minister does not speak for each of
the Government Departments responsible for this area, and I know
he will take away from this debate that nobody is arguing that
there should not be licensing of this process. There are obvious
concerns that need to be met by regulatory intervention. The
concern is the fragmentation of the regulatory landscape that
applies to those seeking to grow these products. I am sure that
the Minister can assist us by helping to better co-ordinate the
way in which regulation is applied, as we are not seeking a
removal of licensing.
I thank my right hon. and learned Friend for his intervention. I
think we are probably in violent agreement on this point. I
cannot specifically speak to regulation or licensing from a Home
Office perspective. We are talking about a controlled drug; that
may come as a disappointment to the hon. Member for Inverclyde,
but it is—and is likely to remain, I hasten to add—a controlled
drug. I will turn later to regulation from the perspective of the
Department of Health and Social Care, but it is really important
that there be consistency and coherence, and that we treat these
products as we would any other medicinal product. However, my
right hon. Friend the Member for Dumfriesshire, Clydesdale and
Tweeddale makes his point well, and I will raise it with Home
Office colleagues.
More broadly on growing a UK CBD industry, I am of course aware
of the growing consumer CBD wellness market. One only has to walk
down any high street to see CBD products advertised in windows,
and indeed in major supermarkets. DEFRA, which I did not mention,
and the Food Standards Agency are taking action to regulate this
side of the market. Importantly, that will protect consumers by
ensuring that only safe, high-quality products are placed on the
market. That is vital. Consumers will also be protected against
misleading health claims. I was recently told about CBD products
that come in aluminium cans, but in fact the CBD remains on the
aluminium and is not contained in the product. That is just one
example. This is a very complex area that I do not want to delve
too much into, as it is very much a DEFRA and Food Standards
Agency lead.
The Food Standards Agency is working closely with the Home Office
on how CBD products are regulated, considering their composition
and the possible presence of a controlled substance. This is very
much a live issue, and I am told that the Home Office has sought
the advice of the Advisory Council on the Misuse of Drugs. I
understand that the Government intend to respond to the ACMD
recommendations on this matter shortly.
My right hon. Friend the Member for Dumfriesshire, Clydesdale and
Tweeddale and my right hon. and learned Friend the Member for
Kenilworth and Southam (Sir ) both raised a point about
regulatory barriers. Not that this reminder is needed, but it is
perhaps helpful if I remind the House that cannabis- based
medicines are controlled drugs and are therefore regulated by the
Home Office, which is responsible for all controlled drug
regulation legislation. Then there is the controlled drugs
licensing regime, which supports cultivation, research and, where
the issue crosses over into the health sphere, clinical trials in
the UK. This licensing regime enables the possession, supply,
production and import and export of those controlled drugs to
support industry, pharmaceutical research and healthcare.
However, more and more these products are being grown in the UK,
including Jazz Pharmaceuticals, for use in research.
This time, when the ACMD makes recommendations to the Government,
will the Government acknowledge and accept them? They have
knocked back its recommendations a couple of times in the past,
most recently over nitrous oxide.
The hon. Member tempts me—it is always tempting—to respond on
behalf of another Government Department and Minister. I mentioned
that because it is my understanding that the Government intend to
respond to the report and the recommendations. I am not the
responsible Minister, so it would not be appropriate to comment,
but I will gladly point the hon. Member in the direction of the
Home Office Minister who will have responsibility for responding,
and will ensure that he has the opportunity to have a
conversation with them.
The point I was making is that the overall legislative framework
on illicit drugs seeks to control harmful substances while
enabling appropriate access to those drugs for legitimate
medicinal research and, in exceptional cases, for industrial
purposes. The example I touched on is Jazz Pharmaceuticals,
which—I do not believe this is a secret—is providing a product
for clinical trials here in the United Kingdom. That is something
that I think we all welcome. I know that the legislation has
recently been reviewed by the independent ACMD, which concluded
that no legislative amendments are currently required, as there
is not yet sufficient evidence that the law needs amending.
Turning to a key point of the debate—cannabis for medicinal use,
which falls firmly within my sphere of influence—I am hugely
moved by so many of the cases that I have heard about, and I will
come back to the specific cases that right hon. and hon. Members
have raised today. These are really difficult, because my
overriding priority as a Health Minister must always be to ensure
that patients have access to medicines that are proven to be safe
and effective. That is the biggest challenge, and it is why I am
committed—the hon. Member for Bristol South () rightly challenged me on
this—to galvanising research in this area; that is key to
unlocking so much of this debate.
The prospect of a future in which more licensed— I put the
emphasis on “licensed”—cannabis-based products that are proven to
be safe and effective can be prescribed on our NHS to help
relieve suffering is genuinely exciting. That is where I
desperately want us to get to as quickly as possible, but herein
lies the problem. There are clinical concerns, which, having
spoken to clinicians, I share, about the limited evidence on the
safety and efficacy of unlicensed cannabis-based products. Only
in a few cases have enough clinical trials been done to prove
scientifically that the drug is safe and effective. However—I
want to labour this point—progress is being made.
Let me turn to the cases of Sophia and Alfie, which were raised
by the hon. Member for Strangford and my right hon. and learned
Friend the Member for Kenilworth and Southam. I have two young
children and am deeply moved by these stories. The debate around
medicinal cannabis often centres on children with
difficult-to-treat epilepsy, for whom I think the law was changed
under my right hon. Friend the Member for Bromsgrove (), when prescribing was made
legal in November 2018. Of course, as right hon. and hon. Members
have pointed out, that was to enable those children to access a
product that their families believed would ease the symptoms of
their desperately difficult-to-treat conditions, if a prescriber
deemed it clinically appropriate.
I know acutely, because I have spoken to campaigners and members
of the all-party parliamentary group, that there is
disappointment that the law change did not relate to routinely
being able to get these products, funded, on the NHS; that is
rightly governed by a range of processes and procedures, to
ensure the equitable distribution of funding. The NHS prioritises
medicines that have proven their safety, quality, efficacy and
cost effectiveness. Coming back to the heart of the issue—the
hon. Member for Bristol South is right to push me on this—that is
why research is absolutely essential, and I will talk about that
a bit more in a moment. The Government have done all we can to
remove legislative barriers, but it is now largely up to the
cannabis industry to prove that its products are safe and
effective for children.
What you are saying is that if I can afford to pay for a private
prescription, I can access medicine that you are saying is not
proven to be effective, because you are not going to allow its
use on the NHS; it has to pass other tests. What about bedrocan?
That is manufactured in the United Kingdom, so we do not have to
import cannabis from the Netherlands anymore. Hilltop Leaf wants
to grow and help to produce the product. The supply chain is
already there for us, but you will not allow it to be prescribed.
You will not train GPs, and you will not give them the legal
framework to work in so that they can actually prescribe that for
children on the NHS, but if I can afford to buy it privately, I
can buy it privately.
The hon. Gentleman raises a fair point, but he raises it as if
this is something new or novel; it is not. All medicines in this
country are either unlicensed or licensed. For use and
prescription in the NHS, they need to be licensed. That means
that they have gone through both the Medicines and Healthcare
products Regulatory Agency process and the National Institute for
Health and Care Excellence process, which proves that they are
safe, effective and—through the NICE element—cost effective. That
is the difference here.
The “cost effective” factor relates to NICE. That is the reason I
talk about why it is important that the cannabis industry steps
up and proves that its products are safe and effective. I did not
talk about cost effective; I am talking about safe and effective,
because that element is through the MHRA. Let us not forget that
many of these cannabis-based companies are multinational; they
are not telling me that they cannot afford to go through the same
process that any other pharmaceutical company can go through and
has done to get their products prescribed through the NHS. Part
of it is research and part of it is those companies stepping up
and proving that their products are safe and effective for these
children, more generally, through the MHRA process.
I am curious. What we have done is—
(in the Chair)
Order. Can the hon. Gentleman return to parliamentary language in
this intervention? I am not participating in this debate at all.
The hon. Gentleman referred to “you” in his last intervention, so
I would be grateful if he could return to normal language.
The Minister is saying that he is allowing a licence for a
product to be manufactured in the United Kingdom, in East
Kilbride, so that is okay. We are allowing it to be manufactured
here in the United Kingdom—that is all right. We are saying that
people cannot get it on the NHS, but it is okay for other people
to have it. Surely it has passed all the tests that we need it
to.
I do not want to labour the point, but the point is that it has
not passed those tests. It is either a licensed product or an
unlicensed product. To be licensed, a product must go through the
MHRA process. That is something that these products have not done
to date. Yes, they can be manufactured here and prescribed
privately, at the risk of the doctor—the private general
practitioner—but for a product to be prescribed on the NHS, it
needs MHRA and NICE approval.
There are some exceptions to that, because the law was changed in
2018, as my right hon. and learned Friend the Member for
Kenilworth and Southam referred to, for a specialist doctor or
for some very specific conditions. He asked why there have been
only three prescriptions. I did not know that that was the exact
figure, but I will check; regardless, it sounds very low. I
suspect that the reason is that the decisions are taken at the
doctor’s own risk, and among general practitioners there is
reticence to prescribe an unlicensed product that has not gone
through the MHRA and NICE process.
Sir
The Minister is probably right, but I am sure that when he looks
at this again he will also want to look at the NICE guidelines
that apply, which are extremely restrictive. The risk to an
individual doctor from making a decision to prescribe will be
perceived to be much higher if the NICE guidelines appear to
deter such a prescription. The Minister is right that there are
many elements to this, but one of them is how much we encourage
doctors to believe that this is the right thing to do. I go back
to the point that I was making: there is some logical dissonance
here. We have said already that it is right to reschedule these
products as far as the Home Office is concerned. We are starting
to see prescriptions in the NHS, but not in the numbers that will
benefit the maximum number of patients.
(in the Chair)
Order. We have not been short of time this afternoon, and every
hon. Member has had the opportunity to speak. Interventions
should be brief and to the point.
Thank you, Mr Stringer. My right hon. and learned Friend makes a
good point. When we meet the members of the APPG, it is very hard
not to be moved and to want to do all in our power to bring about
the change that people want to see. I have considered the calls
to change NICE guidelines, which have recently reviewed the basis
of these products, but I am afraid the guidelines are unlikely to
change until the evidence base develops, and that will happen
through clinical trials and evidence. That is why I say all roads
lead back to building an evidence base and a clinical trials
base. That is the crux of this debate.
In January, the National Institute for Health and Care Research
issued guidance recommending that the NHS prescribe cannabidiol
to patients with a rare, seizure-causing genetic disorder, which
is, I think, the fifth condition for which a cannabis-based
treatment has been approved by regulators and offered to NHS
patients in England. I understand that the treatment is also
available and approved in Scotland and Northern Ireland. The NHS
now funds thousands of these medicines each year.
I mentioned Jazz Pharmaceuticals earlier. I am not sponsored by
it; it just happens to be the manufacturer and provider that I
visited. It is a good example of the trailblazers in this space
that not only create, but undertake the research, manufacturing
and—the key part—licensing of cannabis-based medicines. It has
shown what can be done. The key is very much in the research.
My right hon. Friend the Member for Dumfriesshire, Clydesdale and
Tweeddale mentioned consistency and coherence in policy, which is
why it is key that we treat cannabis-based products as we would
any other medicinal product that we wanted to prescribe on our
NHS. There is an economic case as well, although that is not what
drives the Government. My whole focus in this is what is right
for our NHS and patients. I am aware that there is huge hope and
patient demand for access to medicinal cannabis, and that it is
claimed that it can help with an array of medical conditions from
chronic pain to anxiety; I believe there is also research under
way at the moment on how cannabis-based products might be able to
help with psychosis. I very much hope that those trials are
successful. That is the right approach.
To date, much of the evidence suggesting cannabis could be an
effective medical treatment is anecdotal or observational. As I
mentioned earlier, only for a handful of conditions have enough
clinical trials been done to prove scientifically that the drug
is safe and effective. However, I am acutely aware that there are
thousands of patients who now pay to access those unlicensed
products on private prescriptions. Having spoken with campaigners
and members of the APPG, I also know that some patients believe
that funding cannabis on the NHS will reduce overall healthcare
costs by alleviating symptoms and reducing the extent of hospital
visits and other treatments. I understand and hear that case,
but—I apologise for labouring the point; I have to keep coming
back to it—before any new medicine can be proven to be cost
effective, it must be proven to be safe and clinically effective.
That is why research is so essential.
The Labour Front-Bench spokesperson, the hon. Member for Bristol
South, asked what steps we are taking. That is a challenging
question, because it is a pioneering area of research. Following
collaborative work with clinicians and patient representatives,
the NIHR and NHS England have confirmed support for two clinical
trials into early onset and genetic generalised epilepsy. If you
will permit me, Mr Stringer, I would love to use this debate to
highlight a tender opportunity that will be launched by
University College London in the next few weeks. UCL is seeking a
supplier to assist in a world-first randomised control trial
comparing cannabis-based medicines containing CBD and THC in the
treatment of drug-resistant epilepsies in adults and children. I
hope that that tender process is successful and that UCL finds a
commercial partner to supply products for the trials so that they
can commence as soon as possible.
I have three kids and two grandkids. If one of them was suffering
from intractable epilepsy and I had them on bedrocan, and they
were either seizure-free or had the condition under control, I
would not want to hand them over to a random control test where
they might be fed a placebo and therefore incur more damage.
Would the Minister?
That is a difficult question to answer. We need people to take
part in clinical trials, which are the answer to so many of the
challenges that we face in the health sphere. That is how we
build the evidence base. I do not know what the study will
involve in terms of the detail and the potential for a placebo,
but I will put the hon. Gentleman in touch with UCL and those who
are looking to run the trial so that they can give him a measure
of comfort and reassurance. On his point more generally, the
biggest risk is that the industry does not engage with the tender
process. Notwithstanding the hon. Gentleman’s point, I hope that
all right hon. and hon. Members here today will help me by
amplifying my call for the cannabis industry to come forward and
engage with this pioneering and world-first research. I have also
committed to a roundtable with the all-party parliamentary group,
and I invite all right hon. and hon. Members in the Chamber today
to attend that, too, because it is very important that we hear
all of the issues.
Once again, I thank my right hon. Friend the Member for
Dumfriesshire, Clydesdale and Tweeddale for securing this really
important debate. I look forward to engaging with him and Members
from all parties. To the point made by the hon. Member for
Bristol South, I am absolutely committed to better determine why
the cannabis industry is not, in the way that so many other
pharmaceutical companies do, investing in the routine research
required to prove that its products are safe and effective. I
will of course explore how best to engage with industry on the
issue. Until then, I implore companies to explore supplying their
products to the UCL clinical trials. As I have said, they will be
a world first and will give us the evidence that we need to
determine whether the products should be funded in the NHS. I
wish them every success. I genuinely hope that they provide that
evidence base.
On the matters concerning the cultivation and licensing of
cannabis and cannabis-based products, I will, as I promised my
right hon. Friend the Member for Dumfriesshire, Clydesdale and
Tweeddale, raise that with my counterpart, the Minister for
Crime, Policing and Fire, who I know will champion this cause,
too. I thank all right hon. and hon. Members for their
contributions to this afternoon’s debate.
16:12:00
I feel that we have had a very useful debate. Like you, Mr
Stringer, I chair these sittings and it is extremely good to get
half an hour from a Minister rather than five minutes. Although
it was not necessarily comfortable for him, we were able to cover
a lot of ground. Whether deliberately or otherwise, he came back
to one of the issues that I raised, which was the need for
co-ordination in Government on this issue. The hon. Member for
Inverclyde () read out the list of
Government Departments with an interest in this matter, and I am
sure there are others that were missed, such as the Cabinet
Office and the former bailiwick of my right hon. and learned
Friend the Member for Kenilworth and Southam (Sir ), the Law Officers. There is
a need for co-ordination. I do not think the Minister was saying
this, but we cannot push back to the industry and say, “Well,
actually, it’s your job to co-ordinate all these different bits
in Government.” The industry needs to have a clear “in” or
conduit to Government to discuss and engage on these issues.
I fully understand, having been a Minister myself, that it is not
possible to commit the Home Office—of all Departments, it is
certainly not possible to commit the Home Office. We know how
government operates, but we need to have a co-ordinated approach
with which the industry can engage. Of course the Minister is
right that this should not be economically driven in terms of the
clinical decisions, but we have already made the decision, as my
right hon. and learned Friend said. We are not debating whether
this should be done; that decision has been made, and now we want
to do it on a basis that benefits not only the patients, but the
economy of the United Kingdom.
It is always poignant to hear individual examples. In any debate
in which he participates, the hon. Member for Strangford () is particularly good at bringing the discussion down
to the personal level of individual examples, and I thank him for
doing that today, as I do my right hon. and learned Friend the
Member for Kenilworth and Southam. I have had the pleasure of
meeting Alfie’s mother in my constituency. She is a very powerful
advocate, but I do not believe, or think that anybody who
has taken part in this debate believes, that the pain and
suffering of anybody should be the requirement for us to do the
right thing.
I was remiss in my opening remarks in not referencing the APPG,
because I have engaged with it and particularly the hon. Members
for Gower () and for Edinburgh West
(), who are also strong
advocates on these matters.
Although I did not agree with everything that the hon. Member for
Inverclyde said, which is often the case, what I did admire
particularly was his passion for this subject, which came across
clearly. It is shared by many hon. Members across the House.
I welcome the opportunity that we have had to air the issues, and
the Minister’s full and well intentioned response, but we need to
see action. I reiterate that the principal ask is for
co-ordination within Government to take this forward. We are not
requiring those in the industry and those lobbying for patient
interests to manage the process across a wide range of
Departments. That is one doable ask that could flow from today’s
debate, and I hope that it will.
Question put and agreed to.
Resolved,
That this House has considered the economic contribution of
medicinal cannabis.
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