All Party Parliamentary Group for Mental Health

Notes of meeting: May 2003

All Party Parliamentary Group on Mental Health &

All Party Parliamentary Group on the Pharmaceutical Industry

Joint Meeting on Access to Medicines

20th May 2003

Panel:

Dr Adrianne Reveley-South London and Maudsley NHS Trust)

Paul Farmer-Dir. Public Affairs “Rethink”

Rt Hon Kevin Barron MP(Lab, Rother Valley)-Chair of APPG on the Pharmaceutical Industry

Dr Lynne Jones MP (Lab, Birmingham Selly Oak)-Co Chair of APPG on Mental Health

Rt. Hon Virginia Bottomley MP (Con, South West Surrey)-Co Chair of APPG on Mental Health and Vice Chair of APPG on Pharmaceutical Industry

Summary

The meeting focused on the implementation of NICE guidance on severe mental health conditions, such as schizophrenia, and wider mental health issues. It was well attended by MPs, Peers, pharmaceutical industry representatives, patient groups and members of non-governmental groups.

Kevin Barron MP, Chair of the Pharmaceutical Industry APPG, opened the meeting and introduced the two speakers addressing the meeting.

Dr Adrianne Reveley of South London & Maudsley NHS Trust stated that:

· Mental Health is a huge problem, 1% of the population has schizophrenia, 1% manic depression, 15% depression.

· New medicines on the market have less debilitating side-effects than the older ones for schizophrenia.

· Drug treatments for schizophrenia do work and are vital.

· The older treatments can have a major impact on people’s lives. A diagnosis of schizophrenia usually means a reduction in life span of around 10 years, some of this is accounted for by the older drug treatments.

· NICE guidance on schizophrenia was issued a year ago and most NHS Trusts have now received this.

· One of the key pillars of the new guidance is that of choice involving the clinician and patient in deciding a course and treatment of anti-psychotic drugs. But there have been problems with implementation of this and other NICE recommendations. Many consultant psychiatrists claim that they do not have the time – barely 15 minutes per patient in order to effectively carry this out.

· Solutions to implementation problems could be:

- Key performance indicators linked to NICE

- Flexibility of approaches e.g. the use of nurse led teams, which relieve pressure on consultant’s and doctor’s time.

- Greater involvement of pharmacists e.g. alerting continual use of old drugs

· There is a “lethargy” among many consultants and trust towards the new NICE guidance – opinion formers and decision makers must show they are committed to the issue.

Paul Farmer, Director of Public Affairs “Rethink” stated that

· There have been several new initiatives from Government:

- Early intervention – There is an average of 18 months after the onset of severe mental illness and detection and diagnosis

- NICE

- Assertive outreach of Mental Health services

- The draft Mental Health Bill

- Carers strategy

· Before the NICE guidance:

- 45% said they hadn’t received any written information about possible side effects

- 62% said that had not been offered a choice of medicines

· 80% of PCTs have implemented NICE guidance. Of the 20% that haven’t:

- 78% are under severe financial pressures and cannot implement guidance.

· Despite NICE there is still a massive disparity of postcode prescribing in drug and care provision for mental illness.

Dr Lynne Jones MP (Lab, Birmingham, Selly Oak) commented and asked:

· We need to create a climate where the old practices and attitudes towards mental health are unacceptable.

· Is there a shortage of finance and a short fall?

· Could Vagal Nerve Stimulation be a future treatment?

Dr Reveley replied:

· Vagal Nerve Stimulation is not a standard treatment and needs to be assessed by NICE.

Paul Farmer replied:

· There is a concern that extra money form the DoH is not making its way to where it is intended.

· Financial settlements may not have been calculated properly – e.g. local drug budgets.

· There is a reallocation of funds into what are seen as bigger priorities such as Cardiovascular Disease or Cancer.

· Many still see the treatment of mental health as only a priority where “dangerous” people are concerned, rather than there being a long term strategy for all.

Dr Ian Gibson MP (Lab, Norwich North) asked

· IS NICE affecting the development of new drugs and research?

Dr Reveley replied:

· The guidance has only been issued for a short time and is not due for review until 2005. There doesn’t seem to be a difference in the pharmaceutical industry’s approach. Most involved in mental health know that we do not have the cure and that there needs to be significant investment into research.

Paul Farmer said:

· The proportion of the DoH R&D budget spent on mental health is in inverse proportion to the problem, compared to other disease areas, and has not shifted.

David Taylor MP (Lab, North West Leicestershire) asked:

· Have numbers affected by mental health increased?

· Are fewer doctors specialising in psychiatry?

Paul Farmer replied:

· The numbers affected have not increased but there is a lot of debate over “Multiple Diagnosis” where patients are diagnosed with different conditions over a period of time.

Dr Reveley replied:

· We have found that the more you offer to a population in terms of mental health services, the more problems you uncover, this doesn’t mean they were not there before, just not uncovered. This raises issues of catch-up.

· There are currently more psychiatric consultant vacancies than ever, it is unclear why this is the case.

Rt Hon Virginia Bottomley MP (Con, South West Surrey) asked:

· Some people seem to find if very difficult to get a second opinion – is this the case?

· How do we explain that as soon as NICE sanctioned Statins [for reducing cholesterol and treating cardiovascular disease] they were made available, but this does not seem to be the case for Atypicals?

· Are specialist teams being developed?

Paul Farmer replied:

· The CHI inspection process doesn’t seem to be effective.

· We need more resources for specialist nurses – these are an effective way forward (e.g. the LloydsTSB foundation has made a significant contribution).

Dr Reveley said:

· There is a nurse-training programme. Nurses are cheaper and offer more effective care than doctors.

· The numbers of second opinions have risen sharply – especially after NICE publication.

Sue Doughty MP (Lib Dem, Guildford) and Des Turner MP (Brighton Kemptown) asked:

· Is there any hope of treating people who are classified as having “Personality Disorders”?

Paul Farmer replied:

· There is the perception that people with “Personality Disorders” are untreatable. This is not the case. These groups of people have been demonised as a danger to society. A pilot is being pioneered to study this.

Dr Reveley said:

· People classified as having “Personality Disorders” are in danger of being jettisoned as untreatable by mental health teams, and not being offered effective services.

Andrew Curl, Deputy Director General of the ABPI said:

· There is no evidence that the pharmaceutical industry is reducing research due to NICE – medicines are produced on a global basis. There is a major problem with “NICE blight” where medicines that are approved for sale and licensed are not being used until they have had a NICE assessment which is slowing down the whole process.

Dr Roger Freeman, Royal College of Psychiatrists said:

· There are too many vacancies. The DoH are developing a process to look into shortages, but the problem is that it will take years to train people.

· The DoH does seem to be putting more money in but it doesn’t seem to be getting to the frontline – PCTs are using the money in other areas.

Kevin Barron MP closed the meeting stating that people should take their problems with mental health services to their local MPs who can take on problems and act as facilitators.