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Medicine Reviews (Older People)

I fear that that is a problem. All too often, repeat prescriptions are ordered by care staff and inappropriate historic prescriptions continue without being properly checked and vetted. That is why the process really has to engage with the patient and, if necessary, carers and other family members who have authority to take informed decisions and give consent. The lack of a specific requirement for level 3-type reviews in the NSF and the quality and outcomes framework has reinforced the view in PCTs and among practitioners that patient-centred reviews are ““nice to have”” but not a ““must have””. Part 1 of the evaluation was conducted in January 2004 and published in March 2005, which really does prompt the question, why did it take so long to publish the findings? While I am asking about part 1 of the evaluation of ““Room for Review””, I hope that the Minister can clear up a mystery surrounding the publication of part 2, on the patient’s view. I was told in July that part 2 would be published over the summer. It was not, so I asked another question about when it would be published and I was told this time that due to ethics clearance requirements it would not be published until the end of 2006. Then I got the news, thanks to Mr. Speaker, that I had secured tonight’s debate, and the following day my office took a call from the Department, telling me that part 2 would be published on 5 December. So Christmas has come early, and that is good news. But what is going on? Certainly, part 2 paints a mixed picture of patient experience of medication reviews. Part 1 talks about face-to-face reviews being the gold standard, yet the evidence from part 2 suggests that there is quite a long way to go before the potential of that gold standard is realised. Many of the comments from patients suggest that they had been given the impression—I emphasise, given the impression, and that is how they saw it—that the purpose of the review was cost cutting. One woman is quoted in the evaluation as saying that the reason she was given for being called for a medication review was that the PCT wanted to change her tablets"““not for my benefit, but to bring me into line with the PCT.””" A man echoed that when he recounted a conversation that he had had with a doctor drawing the review. The doctor told him that"““capsules are dearer so they’ve got to give you the cheapest medication they’ve got.””" The concern that medication reviews are essentially about reducing NHS expenditure and saving money is a strong theme running through the second part of the evaluation from the patient’s perspective, and it clearly is a problem in terms of how we make these reviews something that people feel comfortable with and see the value of from their own point of view. Another concern that emerges concentrates on who conducts these reviews, and it touches on the intervention by the hon. Member for Kettering (Mr. Hollobone). When it came to GP-led reviews, while most people felt comfortable that their concerns were being addressed, points were made as to whether the GP had sufficient knowledge compared with colleagues in secondary care, which really did fuel a suspicion that the reviews were just being done to save money. Another set of concerns arose about pharmacists who were leading reviews. The main issue was about the fact that pharmacists did not have access to the medical records or knowledge of the individual medical situation, but above all there was a real concern, and a question mark, over whether the pharmacist could get medication changed; if they could not, delays were occurring while people waited for their practice to change their medicines. With the new pharmacist contract opening up the possibility of a greater role for pharmacists in medicine management, there is a need for clarity. As the medicines partnership points out in its report, the medicine reviews used by pharmacists are not the same as medication reviews. In the executive briefing published yesterday, the medicines partnership said:"““As with the NSF milestone, there was no published definition of what sort of medication review would qualify for QOF purposes. There is potential for overlap between the different medicines review services and some confusion as to which sorts of reviews ‘count’ towards which targets. This suggests a need to refocus attention from quantity to quality. PCTs need to consider how the various types of medicines review can help them deliver their objectives and priorities, making sure that reviews deliver maximum benefit to patients and that people with the greatest need and greatest potential to benefit have their medicines reviewed.""We consider that it is important for PCTs, GPs, nurses and pharmacists to have a clear picture of how the various forms of review fit together and how they can be used to meet local priorities and support care for people with long term conditions.””" To summarise in two words, confusion reigns. That confusion has caused a failure to join the dots between the rise in the prescribing of anti-psychotic drugs, the rise in adverse drug reaction to anti-psychotic drugs and the worrying 35 per cent. increase in the number of non-fatal ADRs among the over-75s and the alarming 83 per cent. increase in fatal ADRs among the over-75s. A recent report in the British Medical Journal found that significantly older people were admitted most because of ADRs. The cost to admissions authorities is huge, and the consequences for the individual go without saying. The study concluded that the NSF needs to be implemented. Yes, the NSF medicines standards should be implemented. That would be a step in the right direction. Medication reviews would help to safeguard the health and welfare of older people. To conclude, I have some questions. First, will the Minister confirm that the NSF standard for annual and six-monthly reviews is still the standard that the NHS should be measured against? Secondly, when will the NSF standard be achieved, and how will we know? Thirdly, does he agree that we need to look into the national minimum standards for medicines management in care homes for older people to ensure that medication reviews are triggered in accordance with the NSF standards and that the timing of medication is made clear to managers and staff? Fourthly, will he act now to clear up the confusion identified by the evaluation of the medicines partnership and ensure that clear guidance is issued to the NHS, so that everyone is clear what is expected? I agree with the medicines partnership that there is a need to focus on quality—that is absolutely right—but that is not sufficient if the NHS is to meet the needs of millions of older people in this country, whose quality of life is impaired because they are not getting the right medication, at the right time and in the right place. I hope that the Minister has something helpful and positive to say.