Asked by
To ask His Majesty’s Government what steps they are taking to
ensure the provision of essential services provided by
pharmacies, particularly the assembly of blister medicine packs,
to support the safe administration of medicines at home by
patients, care workers and unpaid carers.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
Pharmacies in England do an incredible job, dispensing over 1
billion medicines every year and supporting patients with their
medication. Where appropriate, that includes blister packs or
other medicine adherence aids. To support patients with taking
their medication, we have introduced structured medication
reviews in general practice and extra support in community
pharmacy. On 9 May, we announced an additional investment of up
to £645 million in community pharmacies over this and next
year.
(Lab)
My Lords, given the urgent need to get thousands of people out of
hospital and provide care and support in the community and in
their homes, it is surprising that the Government do not
recognise the importance of having a national or local data
overview of the scale of funding for this essential core service
for home care, which is being withdrawn from hundreds of chemists
across the country. Hard-pressed domiciliary care workers,
providing daily care to thousands of people in their homes,
depend on blister packs to administer medicine safely. They will
not have the time to sort out multiple medicines each day for
their clients, or to risk responsibility for possible mistakes
and overdosing. Are the Government saying that, in the future, it
is okay for the complex task of sorting out daily medicine doses
to be yet another burden placed on unpaid carers, on top of
everything else that they have to do? How will people living on
their own be able to cope and stay safe?
(Con)
NICE and the Royal Pharmaceutical Society are clear that they do
not recommend widespread adoption but prefer a case-by-case
basis. There are many examples of where blister packs are not
appropriate: some pills cannot be stored next to each other, some
pills need to be stored in their original packaging and some
blister packs cannot have more than four pills. So it is clear
that you need a case-by-case review to make sure of what is right
for the patient.
(Con)
My Lords, the Government have the excellent Pharmacy First
initiative. Can my noble friend the Minister say what the
Government are doing to support community pharmacists with
technology, and to advise those with chronic diseases, such as
diabetes and heart disease, what their roles and responsibilities
could be in relation to the technology that may be available to
them?
(Con)
I thank my noble friend. She is right to stress the importance of
how we support Pharmacy First as a way of delivering primary
services and supporting pharmacies in and of themselves.
Technology will play a key part in that, both in terms of
navigating the patient, when appropriate, to use the pharmacy and
by allowing them to book pharmacy appointments.
(CB)
My Lords, an estimated £300 million-worth of prescribed NHS
medicines are wasted every year. Over half of those come from
medicines either disposed of in care homes or returned to
pharmacies. Do the Government have plans to ensure that, where
terminally ill patients are being cared for at home, “just in
case” medication, which is personalised, is available so that if
a crisis arises out of hours it can be dealt with rapidly and
appropriately, and so that some of that wastage could be
decreased?
(Con)
Absolutely. That is one of the major reasons why blister packs
are not always the right solution, because there are many cases
of wastage in exactly the way that the noble Baroness has
mentioned. Wastage is one of the many reasons why both NICE and
the Royal Pharmaceutical Society have come out against the
blanket use of blister packs.
(Lab)
My noble friend on the Front Bench is absolutely right. As
somebody who is currently taking hourly medication, I can tell
the Minister that it is extremely difficult to keep that up. Does
he not recognise that we need to have set blood levels for many
drugs, and that it is really important that those are not delayed
if we are to have proper pharmaceutical action in the blood
stream?
(Con)
Yes. There are occasions when it is absolutely appropriate that
medicines are packaged in that way; I am sure we all have plenty
examples of friends and relatives for whom that is very useful.
The whole point is that the blanket application of blister packs
is not the right approach.
(LD)
My Lords, the Government’s welcome plans for pharmacists to play
a broader role in primary healthcare depend on there being
pharmacies present in every area of the country, yet we have seen
hundreds of community pharmacies close over recent years. If this
trend is not reversed and there are even fewer community
pharmacies in a year’s time, would it be reasonable for us to see
this as a failure of government policies?
(Con)
No. What I want to be tested on is how many people are using
their pharmacies for primary appointments—that is the real
measure. I think we will see a marked change, and we will see it
as a real convenience. The fact that this will drive more
footfall to pharmacies will mean that more pharmacies will
probably gain extra business and stay open. We have 24,000 more
pharmacy workers than in 2010—there has been an increase in that
number since then.
(Con)
My Lords, on the subject of support services, is my noble friend
the Minister aware of, and does he deprecate, the widespread
practice of catheterising very elderly people who are only
temporarily immobile or infirm? In the long term, that reduces
their independence and adds to the cumulative costs to the state
of their care, particularly to primary care, the NHS and local
authorities.
(Con)
Yes.
(Lab)
My Lords, the Minister referred to the Royal Pharmaceutical
Society guidelines, but those were issued in 2013—some 10 years
ago. If it was so important, why has it taken Boots and Lloyds
Pharmacy so long to phase them out? Surely, the Minister
recognises, as his noble friend said, that there must be
automated ways of delivering blister packs safely, thereby
helping very vulnerable people to take the right medicine?
(Con)
As noble Lords are aware, I hold the technology brief, so, if
there are automated ways, I am absolutely all for them. As I
learned while researching this Question, this is a complicated
area, given the number of permutations of pills that can be there
in each circumstance. I have not seen those solutions, but I will
look into them.
(CB)
My Lords, medicines reconciliation —the right drug to the right
dose at the right time—is an important part of managing diseases,
particularly for patients who are on multiple medications.
Blister packs were seen as one of the solutions to reduce risks,
as 10% to 15% of older people on multiple medications end up in
acute medical wards. If blister packs are not the solution, what
solution does the Minister propose to reduce issues with
medicines reconciliation?
(Con)
I am sorry: I will try to be clear to make sure that I am fully
understood. There are many, many people for whom a blister pack
is absolutely the right solution. Basically, what has been put in
place here is a structured medicine review, so that, in each
case, it will be the responsibility of the pharmacist to make
sure that they have the right solution for the patient. What I am
saying equally is that blister packs are not a blanket solution,
and it needs to be done on a case-by-case basis.
of Hudnall (Lab)
My Lords, I cannot claim any expertise in this matter; I have
just been listening to the conversation that has been going on.
My noble friend’s original Question referred to the burden on
carers. I have not heard the Minister say much about that,
particularly when the negotiation over what is the right way of
dispensing certain kinds of medicine presumably has to go on
between a patient, a pharmacist and, presumably, a doctor
somewhere in it, or somebody representing the patient who would,
in many cases, be the carer. In what way are carers being helped
to engage in that negotiation, with all the knowledge and
expertise that they bring about what actually works in the
circumstances?
(Con)
The noble Baroness is absolutely correct. It is the patient, or
often their proxy or carer, who absolutely should be considered
in this. It is the responsibility of the pharmacist to make sure
that they are taking that into account. Again, I say very clearly
to patients or pharmacists: if patients do not believe that they
are getting the right packaging, and they believe that they need
blister packs, they should absolutely be speaking to the
pharmacist and the pharmacist should be providing that
solution.
(LD)
My Lords, the Minister said that there were an extra 24,000
pharmacists. He will be aware that community pharmacists have
complained that primary care networks are poaching them because
they can afford to pay them more and community pharmacy is £1
billion short for providing existing services. What are the
Government doing to plug that £1 billion gap in order to ensure
that there are enough community pharmacists?
(Con)
As I say, I do not recognise those numbers. I do recognise that
we are putting £645 million more into this space to fund this,
and also that this will drive more people into pharmacies, who
will not only go there for an appointment, but, no doubt because
they are already there, they will generate other business off the
back of it. I think and hope that this will actually reinvigorate
the local pharmacy sector to the good of local communities and
local people.
