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Pharmacies: Medicines at Home

Volume 830: debated on Wednesday 17 May 2023


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.

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.

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a national or local data overview of the scale of funding for this essential core service for home care, which is being withdrawn from hundreds of chemists across the country.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?

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.

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?

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.

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?

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.

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?

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.

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?

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.

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.

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?

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.

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?

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.

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?

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.

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?

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.