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Strep A Treatments: Supply

Volume 725: debated on Monday 19 December 2022

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the supply of strep A treatments.

I thank the hon. Lady for her question. I know families are concerned about the recent outbreak of strep A in children. Although the vast majority of strep A cases are mild and can easily be treated with antibiotics, a small number of children have gone on to develop serious infections.

The UK Health Security Agency has already declared a national enhanced incident to co-ordinate our public response. Increased demand has led to some temporary supply issues, but I reassure Members on both sides of the House that we have stock of antibiotics and have taken a number of steps to deal with some of the supply issues.

First, we have worked at pace to help to ensure that there are supplies of vital medicines to meet the increased demand. Earlier this month, we convened roundtables with manufacturers of the preferred treatment, penicillin V, and with major UK wholesalers. We continue to work with manufacturers and wholesalers to boost supply to meet demand. The key issue is getting stock to pharmacies across the country. We have brought forward stock to make sure it gets to where it is needed, and we are expediting deliveries. Deliveries to wholesalers and pharmacies continues to be made, with more expected in the coming days and weeks.

Secondly, we have issued eight serious shortage protocols to allow pharmacists to supply not only alternative forms of penicillin, but alternative antibiotics. This will make things easier for pharmacists, general practitioners and, of course, patients. We have also added a number of antibiotics to our list of medicines that cannot be exported or hoarded.

Finally, we have updated advice across the board. Further guidance was given to GPs and pharmacists on Friday as part of the new SSPs. My Department has provided advice to colleagues in primary and secondary care on the management of the current supply issues. We have also held a cross-party briefing for MPs, and a “Dear Colleague” letter will go out later today.

I know this is a worrying time for families across the country, but I reassure them and people across the healthcare sector that we are managing the higher-than-normal number of strep A cases this winter and we have a range of medicines available.

Across the country, parents are worried sick about the sharp rise in strep A infections. Tragically, strep A has caused the death of at least 19 children since September.

Last Thursday, just a few days after insisting there were no shortages, the Government finally admitted that there were indeed serious shortages of three penicillin medicines and issued serious shortage protocols to give pharmacists emergency powers to deal with supply issues. Why on earth did they take so long?

The Government will have seen the data on the number of prescriptions for strep A antibiotics, which started to rise more than a month ago. Health professionals, including Leyla Hannbeck, the chief executive of the Association of Independent Multiple Pharmacies, have been raising the alarm publicly for more than two weeks, and I called for a strep A summit to resolve the supply issues. Because the Government did not come clean sooner about the shortage of antibiotics, parents who are worried about their children have been left to travel to multiple pharmacies, GPs have had to find time to rewrite prescriptions and A&E departments have been overwhelmed by anxious parents and children who cannot access medical help when they need it.

Why have the Government taken so long to act? Did they not look at prescription data, or did they just ignore it? Why did the Secretary of State insist on television that there were no shortages, when GPs, pharmacists, directors of public health and parents all said that there were? After shortages of lateral flow tests, hormone replacement therapy and so on—you name it—why are we in this position again? The Government seem incapable of forward planning, and we are stuck in a shortage groundhog day. Can the Minister update us on the Competition and Markets Authority investigation into the sharp rise in the prices of antibiotics?

Finally, we are in the lead-up to Christmas. Pharmacists have told me that some key contacts in the manufacturing companies are already on leave for the Christmas holiday. Families are making difficult decisions about the safety of their children and extended family. What action will the Government take now to ensure that families across the country can access the antibiotics they might need over the entire Christmas period?

I reassure the hon. Lady that we have not waited to act. We have already issued serious shortage protocols, which are routine mechanisms when there is pressure on supplies. We have the stock of antibiotics in the country—as I outlined in my opening remarks, it is about supply issues. We are seeing five to six times the amount of antibiotics being prescribed at the moment. That is because the UK Health Security Agency has issued guidance to GPs, A&Es and healthcare professionals to lower the threshold of when they would normally give antibiotics. We are seeing significantly increased use of antibiotics. That is in addition to the prophylactic use of antibiotics by directors of public health, if they have had an outbreak locally. That is why we issued the initial SSPs already a couple of weeks ago so that pharmacists had flexibility in how they dispensed that medication. It is why on Friday we issued the new SSPs, which allow amoxicillin, clarithromycin, flucloxacillin, cefalexin, co-amoxiclav and erythromycin to be issued instead, if pharmacists do not have Penicillin V on their shelves. We are being as flexible as possible to give pharmacists that scope.

We are monitoring this issue on a daily basis. May I reassure people that while these are higher than usual incidences for this time of year, overall for this season we are not yet at the 2017, 2018 levels, where we had a significantly higher number of deaths? Strep A occurs not just in—[Interruption.] Hon. Members do not want to listen. I think I have said enough.

I am pleased to hear that there are adequate supplies of penicillin and amoxicillin. My hon. Friend will be aware that some tetracyclines are less effective with certain ethnic groups. She is right in saying, is she not, that most strep A infections are not serious. Does she agree that we should be encouraging parents to give their children flu vaccinations? Usually, serious streptococcal infections occur when someone has been run down through a viral infection first.

My hon. Friend is right to advise people to take their flu vaccination. What I was trying to say, but the Opposition did not really want to hear, was that strep A occurs in all age groups. Actually, the highest number of deaths we see are in over-65s. It is important to get the message out that this issue does not just affect children. My hon. Friend is right. The flu vaccine is something that should always be recommended for winter. He is also right that the alternative antibiotics that I read out have been recommended by UKHSA, and we have taken its clinical advice.

May I wish you, Mr Speaker, and all staff of the House a merry Christmas? I also thank the hon. Member for St Albans (Daisy Cooper) for securing this urgent question. I put on record my deepest condolences to the families of the children who have tragically passed away with strep A. The news that cases are surging has been deeply worrying for parents of children showing symptoms, and it comes at a time when the NHS is facing unprecedented pressure.

We first heard about shortages of antibiotics to treat strep A almost two weeks ago, but when my right hon. Friend the Leader of the Opposition raised the issue with the Prime Minister, he said:

“There are no current shortages of drugs available”.—[Official Report, 7 December 2022; Vol. 724, c. 333.]

At the same time, parents were going from pharmacy to pharmacy to find the antibiotics their children had been prescribed, and they simply were not available. Why did the Prime Minister not know that there was a problem, when it was plain to see for parents of young people across the country? Had the Government been aware of the problem sooner, surely they could have acted to secure supplies earlier? The Minister said that there has been no shortage, just a supply chain issue. For a parent turning up to a pharmacy and finding that it does not have the antibiotics, it does not make much difference whether this is called a shortage or a supply chain issue, as the antibiotics are not there. The Government must get a grip on this situation and be honest with the public about the reality on the ground.

In addition to the export ban, will the Minister tell the House exactly what the Government are doing to shore up supply of drugs needed to treat strep A? During the past couple of weeks, as desperate parents have been looking for antibiotics, prices have disgracefully shot up. Will the Minister assure the House that the Government will come down like a ton of bricks on any company found to be exploiting this situation by jacking up prices for medication?

This is about access to not just medicine, but GPs and A&E. Parents concerned about symptoms are advised to seek prompt medical advice, yet about one in seven patients cannot get a GP appointment when they need one, a record 2 million patients are made to wait a month before they see a GP and A&E departments are overwhelmed. So will the Minister assure parents of children with symptoms of strep A that they will be able to see a GP when they need to? Finally, given that there are strikes planned in the NHS this week, may I ask the Minister whether the Secretary of State plans to update the House tomorrow and explain the Government’s disgraceful inaction on that issue too?

Let me reassure Members that, as I said in my opening remarks, there is no shortage of antibiotics to deal with strep A. There have been pressures on supplies; there have been five to six times the amount of prescriptions that are normally issued at this time of year. Let me give the House an idea of the sorts of figures we are talking about. This season, we have seen 74 deaths across all age groups in England, with 16 of them, unfortunately, having been deaths of children under 18—the vast majority have been among the over-65s. In the 2017-18 peak, we had 355 deaths of all ages, with 27 of those being deaths of children under 18. That just gives us an idea of the scale of the difference compared with the peak of 2017-18. We have put significant measures in place to expedite that supply. Manufacturers are ramping up production lines. Deliveries to pharmacies have been happening every day, but often when the supplies arrive there they go very quickly. That is why we have issued the SSPs already, so that pharmacies can allow the different medication to be dispensed, and the alternative antibiotics are there as well. May I also put on record my thanks to GPs and A&E staff, who have seen record numbers of people, particularly children, with concerns about strep A? We did lower the threshold to prescribe antibiotics and they have gone above and beyond in seeing as many children as they can, as quickly as possible.

Group A streptococcus has been associated as a trigger for PANDAS—paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections—a distressing autoimmune neuropsychiatric disorder in children. I welcome the planned PANDAS surveillance study, which will, no doubt, help assess the impact of this outbreak on children, but will the Minister meet me and other members of the all-party group that deals with this to discuss how we can develop and move towards a treatment pathway for PANDAS in the UK?

I thank my hon. Friend for raising this important point. UKHSA is looking at the data on this outbreak and previous ones. I am happy to meet him to discuss that, particularly if he has details of treatment options he feels are not being pursued at the moment.

Does the Minister accept that no production lines in UK pharmaceutical suppliers are operating, because we have contracted out all our supplies to China and India, which manufacture all the drugs? Both countries have not signed up to the pharmaceutical inspection and co-operation scheme, which ensures homogenisation of good manufacturing practices. The UK manufacturers have to apply that whereas the overseas manufacturers do not. Therefore, we have over 10 manufacturers of pharmaceuticals who are not able to produce the right antibiotics because of the unfair discrimination against them by the Government. Will she ensure that this is put right before Christmas so that our local, British pharmaceutical manufacturers can produce the right antibiotics to give to all our children who need them so desperately?

Perhaps if the hon. Gentleman had not been heckling me throughout my opening remarks, he would have heard that we are working with manufacturers and wholesalers across the country. Manufacturers are opening up new production lines and those supplies will be hitting pharmacy shelves very soon.

I recently visited Broomfield Hospital and was concerned to hear that the paediatric A&E was seeing three times as many children as was normal for this time of year. Given that strep A is often a complication of flu, which can be harmful to children, and given that the vaccine take-up, especially of two and three-year-olds, is so low, will my hon. Friend join me in urging all parents, especially those of two and three-year-olds, to go out and get that protection against both flu and strep A by getting their child the flu vaccine?

My right hon. Friend is right to encourage parents to take their children for the flu vaccine. She is also right to highlight the level of demand in her local A&E. Parents are doing the right thing. If they are concerned about their children, they should get them seen as early as possible. For those in doubt about the symptoms: they are flu-like symptoms of sore throat, headache, fever, muscle aches and also a rash that can feel like sandpaper. If parents are concerned, they should seek medical advice.

It is currently suggested that parents contact 111 or book a GP appointment if they are concerned about strep A. Yet 111 workers are already stretched and millions of parents are struggling to get GP appointments, but with strep A there is no time to be wasted. What are the Government doing to ensure that diagnosis and treatment are expedited, because no more families should be facing the prospect of mourning this Christmas?

The hon. Lady is right to raise that matter. Every day, we monitor the number of appointments with GPs, A&E visits, pharmacy visits and the impact that those are having on our stock levels of antibiotics, and the number of incidents of positive cases. Scarlet fever is a notifiable disease, so we are able to track this fairly easily, but she is right on this. GPs and A&E doctors are going above and beyond to see as many as possible of the people coming forward with concerns.

It is good to hear that there is no shortage of antibiotics, and I know that many parents in my constituency will be reassured by that. None the less, from speaking to constituents, I do know that they have had to travel further than normal to get the antibiotics that have been prescribed by a GP. What steps are the Government taking to make sure that antibiotics are delivered to a range of places, particularly those areas where there is a larger outbreak, because that is where they will be needed the most?

My hon. Friend makes a valid point. While we do not have a shortage, there are, as I have clearly outlined, supply issues. When deliveries are made to pharmacies, those pharmacies very quickly run out because of the sheer scale of demand. I say to parents that the new SSPs issued on Friday will allow pharmacists to replace the prescription antibiotic with a number of antibiotics. If they go in with a prescription for penicillin B and are given amoxicillin, clarithromycin, flucloxacillin, cephalexin, co-amoxiclav or erythromycin, for example, that is because they are recommended as alternative antibiotics that can adequately treat strep A.

I am sorry, Mr Speaker, but you caught me unawares there. I was expecting to go up and down automatically until the very end.

I thank the Minister for her answers, but this is not only about strep A. Will she confirm that discussions have taken place with Army medics, so that they can step into the breach as GPs are under pressure? One parent in my constituency simply refused to leave the GP’s office until he was seen, and quite rightly so, as his daughter had scarlet fever and needed an immediate antibiotic injection. I do not blame the GPs, because it is clear that they need more support. Can this be made available? The Army medics are perhaps the solution.

I am sorry to hear about the problems that the hon. Gentleman’s constituent has had in accessing help. We do recognise that there are serious pressures. Winter is a busy time for GPs in the best of years, but this year, with strep A, UKHSA and officials are encouraging parents to come forward, and parents are doing exactly the right thing. We are working with GPs, and NHS England is reaching out to primary care colleagues to see what additional support is needed to meet that demand.

I think the Minister’s definition of a “shortage” is different from that of parents. One parent in my constituency got in touch with me last week. She was a local mum of a 13-month-old boy who has been diagnosed with strep A. After a frantic search for antibiotics—during which the doctors changed the prescription—she managed, in her desperation, to get a third of the necessary prescription. Since then she has been trying pharmacies repeatedly to get the remainder. Today, she runs out, and she still does not have the drugs that she needs. What is the Minister’s message for that mum trying to keep that little boy safe?

We recognise that there are supply issues with pharmacies. That is why pharmacists have had the flexibility since before last week to adjust doses and preparations. Since Friday they have also been able to issue alternative antibiotics. I would say to the hon. Lady’s constituent to go back to her pharmacist, who will be able to give her an alternative supply.[Official Report, 20 December 2022, Vol. 725, c. 3MC.]

Parents right across my constituency have been raising concerns with me about the rise in strep A cases. I spoke to a reception class teacher last week who told me that more than half the reception class were off with a variety of winter diseases, including strep A. Parents tell me that when they see the symptoms, they struggle to get a GP appointment because of the logjam in the primary care system. What steps is the Minister taking to make more GP appointments available so that parents are not left waiting?

Where there has been an outbreak in a local area, many directors of public health are starting children in classes or in schools with known cases on prophylactic antibiotics, preventing strep A in the first place. If the hon. Lady has a case in her constituency, I urge her to talk to her director of public health; it is a clinical decision, but they may be able to start pupils in those classes on prophylactic doses.

On Friday, with my local pharmaceutical committee, I visited Whitworth Pharmacy in Elswick in my constituency and saw the fantastic work it does to support health in the community. I also saw the empty shelves where the antibiotics that would normally be used to treat strep A should be. The Minister does not seem to realise that a supply issue means a shortage on the shelves. I learned too that pharmacies are being asked to pay up to £19 for a box of antibiotics that would normally cost £2, and there is no commitment from the Government to reimburse that amount. What immediate assurances can she give that local pharmacies will not be priced out of supporting their communities?

Let me be absolutely clear that no supplier should be using this as an opportunity to exploit the NHS. The Competition and Markets Authority is looking at any complaints about price increases and we are working with the Pharmaceutical Services Negotiating Committee at pace to review the concessionary price arrangements and see how they can be improved.

If parents right across the country are reporting to their MPs that they are having to go from pharmacy to pharmacy to get the right antibiotics, there is a shortage. If pharmacies are reporting that they are running out of supplies as soon as they come in because they already have high demand, there is a shortage. It was not until last Thursday that the serious shortage protocols were introduced. I raised this issue with the Government on 6 December at health questions, and I was told that there was no shortage. As well as repeating her answer that there is no shortage, can the Minister give us an assurance that the antibiotics are available in liquid form, which is suitable for children?

Just to confirm, the five SSPs issued on Friday were in addition to the three issued previously. If colleagues are having problems with the pharmacies in their constituencies not getting stock, I must say that I held a cross-party meeting with MPs on this very issue not so long ago and a handful of colleagues attended. My door is open and, if people are having problems in their constituencies, I ask them to please come and see me, because we have mechanisms in place to deal with that—but I need colleagues to let me know when we hold cross-party meetings.

Last week Hannah, a young mum from the Runcorn part of my constituency, visited nine different pharmacies looking for the appropriate medication for her four-year-old little boy. It was not available, because there is a shortage. It is time to be clear and transparent about that. The Minister should not be in denial about the reality; she should give those parents and their children reassurance by getting a grip of the situation.

I can give parents struggling to get those antibiotics the reassurance that pharmacies are now able to dispense alternative antibiotics. I have read them out, but I can do so again: amoxicillin, clarithromycin, flucloxacillin, cefalexin, co-amoxiclav and erythromycin. We have taken action to make sure that those antibiotics are available to parents.

There appears to be some confusion about the difference between an insufficiency of stocks and supply difficulties. Just for absolute clarity, given that the Minister has reported to the House today that demand has gone up five or six times, are there currently sufficient or insufficient stocks in the country to meet that increased demand?

The deputy chair of the British Medical Association’s general practitioners committee told the Health Committee two weeks ago about the challenges faced by GPs in accessing appropriate pharmaceuticals. What are NHS planners doing to ensure that logistics are getting stocks to the appropriate place in a timely way? With strep A, we just cannot wait.

Absolutely. That is why wholesalers have expedited deliveries and increased the number of deliveries that are going to pharmacies. We are working with NHS England, with UKHSA and with pharmaceutical bodies to make sure that those supplies are getting to them. But we recognise that even with the expedited and extra deliveries there is still demand on supplies, which is why the SSPs have been issued—so that pharmacists can dispense not just alternative preparations of what has been prescribed, but alternative substitutes.

Parents in Barnsley are really worried. The Minister has said more than once that there is no shortage, but I say gently to her that that is not the experience of many of my constituents. They do not need her to refer to that simply as a supply issue; they want to hear what the Government are doing to tackle the shortage and to ensure that there are no regional disparities in access to medicine.

I do not want to repeat myself, but we have been clear. We have been working with manufacturers and wholesalers to up production and expedite deliveries to pharmacies, but we recognised fairly early on that that was not going to be enough to meet demand. That is why we already had SSPs in place, so that pharmacists had some flexibility. But we recognised that that was not enough, so on Thursday and Friday we issued five new SSPs so that pharmacists had the flexibility to dispense alternative antibiotics that are as good at dealing with strep A as penicillin V. We will go further. We have more manufacturing plans to increase supply, and we also have alternative provision coming onstream in the next few days, about which I can update the House as well, so we are not just resting on our laurels. We will do whatever it takes to get those antibiotics to those who need them.

The Minister said that there are supply issues but no shortage. I am trying to be helpful here, so may I make a suggestion to improve domestic supply? I recently visited Bristol Laboratories in Peterlee in my constituency—I pay tribute to its management and workforce for their hard work—which has the facilities and the flexible capacity to supply generic medicines to the NHS at relatively short notice. It would seem advantageous to meet Bristol Laboratories and similar manufacturers. UK domestic production capacity for such medications is vital, as was demonstrated during covid. If we do not protect our sovereign manufacturing capability, we risk the UK being at the back of the queue if and when the next global supply shortage or demand surge hits.

If the hon. Gentleman forwards to me the details, I will happily look at that. I would just point out that, as of 12 December, a number of European countries, including Ireland, France, the Netherlands and Sweden have indicated an increase this winter, particularly since September. Antibiotics and amoxicillin are both reported to be in short supply in those countries. This issue is not related solely to the United Kingdom.