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Streptococcus A: Antibiotics

Volume 826: debated on Thursday 15 December 2022


Asked by

To ask His Majesty’s Government what steps they are taking to address reported shortages of supplies of antibiotics, given the increase in cases of Streptococcus A.

We are working at pace with manufacturers and wholesalers to expedite deliveries, bring forward stock and boost supply. UKHSA and the NHS are co-ordinating communication to healthcare professionals, including advice on using alternative effective medicines as necessary to ease pressure on supply. Early treatment is vital, so in addition to bolstering supply we are providing information to parents to understand the trigger points for urgent referrals.

I thank the noble Lord for his Answer, but despite Ministers saying that there is no problem—the Health Secretary has said that—worried parents across the country are going from pharmacy to pharmacy to seek the antibiotics their children need. Can the Minister update your Lordships’ House on the improvements in availability since the Health Secretary said, as in the statement repeated this morning, that he was

“working urgently with manufacturers and wholesalers to explore what can be done to expedite deliveries”?

Further, are there any plans within DHSC to update the concessionary price for amoxycillin and penicillin, so that pharmacies do not have to foot the bill for the rapid increase in costs they are experiencing?

I thank the noble Baroness for bringing this important matter to us all. Yes, they are working very strongly; I had a series of meetings yesterday on this very subject to go through all they are doing on the supply front. Importantly, as we speak, they are putting out advice to medics about suitable alternative antibiotics that can also be used in this case. I am satisfied that they are doing everything they can towards this. Clearly, where there are price problems such as those the noble Baroness mentions, we will also act in that area.

My Lords, the cost of producing strep A antibiotics has not changed but the selling price has rocketed in recent weeks from 80 pence to £19 per packet, mainly because of profiteering by companies. Will the Minister launch a publicly owned company to manufacture generic drugs, which would provide jobs and exports, secure long-term supplies, protect the NHS budget and end the profiteering by drug companies? Does he have any objections to that?

My general thinking—this is a personal view—is that the market is normally very well placed to supply these things. There was the excellent example of the vaccines, whereby it acted incredibly quickly and got Covid vaccines out as necessary. I think we are always better placed using the strength of the whole market and looking to international suppliers as well. They are always going to be able to provide the necessary medicine to a quicker timescale than our own company would.

My Lords, since the risk of invasive group A streptococcal infection is increased in the presence of other viral infections—any of them; it could even be chickenpox in children—what guidance are the Government giving to all schools on public health measures to decrease cross-infection between children and ensure parents are encouraged to keep those who might be unwell away from school, rather than sending them to school, as is the tendency, because of attendance registers?

The noble Baroness is correct; it is the coincidence of more than one condition, particularly respiratory conditions, which causes the more extreme cases. The advice is definitely to keep children away from school if there is any question on that at all, especially as we are about to enter a period of school holidays. It is very much the view of the experts that the school holidays should flatten the curve of infections. I should also say at this point that while we are all quite correctly concerned about this, and doing everything we can regarding supply, the current levels are still lower than those we saw in 2017-18, when March and April had the normal peaks of around 2,000 a week. We are currently at around 1,200 cases a week and, as I say, we expect that to flatten out a bit with the firebreak, so to speak, of the Christmas holidays.

My Lords, as someone on a six-day lockdown and on intermittent antibiotics to deal with a lung condition following surgery, can I suggest, on these shortages, that guidance on antibiotics such as amoxicillin should be updated to allow for greater flexibility of expiry dates? There is too much wastage, and with careful prescription advice and labelling, antibiotics can have a far longer shelf life before deteriorating. Rigid advice on packaging should be relaxed in favour of more flexible expiry dates, as current advice only serves the manufacturers, who sell more.

I thank the noble Lord and I agree. We are looking at every sensible measure we can to ensure we have the greatest flexibility of supply. Expiry dates are clearly one thing we can look at, and I will take that back to the department. I wish the noble Lord well and hope that he feels better soon.

My Lords, community pharmacies in Northern Ireland were warning back in October of serious problems with the supply and pricing of a range of drugs. While it is welcome that there now appear to be investigations into the wholesale supply chain for antibiotics, may I also urge the Minister to look at whether there were missed opportunities for earlier intervention?

Absolutely—clearly, we always need to learn in such circumstances, so we will be happy to do that.

My Lords, I remind the House of my interest with the Dispensing Doctors’ Association. Can my noble friend give reassurance that dispensing doctors, pharmacists and others will be reimbursed for the full cost of the increased price of antibiotics?

My understanding is that there are measures in place to ensure that the people supplying in those circumstances are not losing out because of profiteering. The most essential message today is that that supply is available to anyone who needs it, so I will take that back.

My Lords, is it the manufacturers in the pharmaceutical industry or the wholesalers—the middlemen—who are making the profits? What mechanisms are available to clamp down on them?

The key mechanisms always involve broadening the supply chain. I have given exactly that instruction to the department, which is very much taking it on board. It is looking at supply across a number of sources, not just from the UK but worldwide, as well as the substitution of antibiotics. Penicillin is currently the advised one, but a number of others are being advised right now which will also work well, so that there is as much choice as possible.

My Lords, my noble friend will be aware that, while some people are making profits, 16 children under the age of 15 have died as a result of strep A. Exactly what advice is being given to GPs so that parents have direct access to them very quickly? Of course, there is also a concern about antibacterial resistance as a result of overprescribing antibiotics.

I thank my noble friend and will take this opportunity to offer that public health advice. A rash, which is often the first sign of a bacterial infection in this case, or a child being floppy, drowsy or dehydrated are all key signs that they should urgently seek medical help. People can call 111 or 999 and be guided through the triaging process to make sure that they get help quickly. At the same time, medics have been told to lower the barrier for prescribing, so to speak, so that they can make sure that people get it early. Although every death is a tragedy, we are clearly now seeing some reduction in the death rate, which is welcome.

My Lords, while many pharmacies are being forced to sell the antibiotics they can get their hands on at a considerable loss, as wholesale prices soar, the Government have been saying that no company should be using this as an opportunity to exploit the NHS. Can the Minister assure the House that the Government have learned from previous mistakes with procurement and are taking measures to ensure that no company profits unduly from the increased demand for medication?

As I mentioned, no one wants to see profiteering in these sorts of situations. The absolute focus right now is on expanding supply, because that is clearly the first thing you need to do. But you then absolutely need to learn lessons and see that appropriate action is taken against companies doing that.