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Medicine Reviews (Older People)

I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing this debate. He has indeed taken a long interest in the subject. Medicines are by far the most common form of medical treatment in the UK. People with long-term conditions, many of whom are older, are reliant on those medicines to stay healthy. In fact, 80 per cent. of people over the age of 75 take at least one prescribed medicine and 36 per cent. of them—just over a third—take four or more medicines each day. With that level of medicine prescribing comes the challenge of ensuring that people with long-term conditions, including those who are older, get the maximum possible benefit from that medicine, and the hon. Gentleman made that argument rather eloquently. Half of all people—not just older people—on regular treatment do not take their medicines as intended for a number of reasons. Problems with medicines may be the cause of as many as 10 to 15 per cent. of hospital admissions. So people need simple information and advice if they are going to get the best benefit from their medicines. They need to know what their medicines are for, how they work and how they need to take them. However, people also have their own health beliefs, which can affect the way that they take their medicines. That is why, as the hon. Gentleman said, involving people in decisions about how medication is taken is an important way in which we can help to ensure that they take medicines effectively. That explains why medication review is important. It is good that the hon. Gentleman has secured such a debate on the Floor of the House because the matter sometimes does not get the airtime that it deserves. A medication review occurs when a health professional reviews a patient’s medicines. The health professional ensures that all medicines that would be of benefit are prescribed and that the various treatments work well together and do not cause problems. That might be done if a GP prescribes someone with repeat medicines, but there is also a place for more in-depth reviews in which a health professional sits down with a patient and discusses his or her medicines in detail. That might occur if someone is on an especially complex regime, or if a patient is experiencing problems. Such reviews are important, not least because they allow patients to ask questions about their medicines and to be more involved in any decisions that are taken. Given the importance of medicines to many people and the importance of medicine reviews, when we published the national service framework for older people in 2000, we produced a booklet that focused on the specific issue of medicines and older people. As the hon. Gentleman knows, that drew together the available evidence and made recommendations on how to improve older people’s medicine taking. Within that, we set a specific milestone on medication reviews. We recognised that the more medicines people take, the more likely they are to experience difficulties, so the scheme had two elements. First, by 2002, all people aged 75 and over were expected to have medicine reviews at least annually, and, secondly, those taking four or more medicines were to be reviewed at least every six months. Although it was largely for the NHS, working with other stakeholders locally, to implement the NSF on older people, we have nationally supported the improvement of medicine-taking in several ways. Before the publication of the NSF, medication reviews were not systematically undertaken or recorded. Let me outline several of the measures that we have taken to support the policy. We have supported several primary care trusts to identify what works best and to share that learning with others through the national medicines management collaborative. About half of PCTs have participated in that programme to implement local medicine management schemes so that people get more help in using their medicines from not only their GPs, but pharmacists and others. One of the measures used for assessing improvement was the proportion of people aged over 65 who were on four or more regular medicines and had received a documented medication review in the past 12 months. There was a significant increase in activity and, in some cases, the reported rate of reviews more than doubled. Another measure was the percentage of patients in care homes who had had a documented review of their medicines in the past year. I am aware that some people believe that people in care homes do not have their medicines reviewed regularly, or sufficiently regularly, but the data from the collaborative work showed that the situation was slightly different. The increase in activity for patients in care homes was similar to that for those living at home, although the two groups had slightly different starting positions. The extent of patient involvement in medication reviews was measured for PCTs in wave 4 of the programme. It increased from 22 per cent. to 62 per cent. in a single year. After drawing on this learning, guidance on medication reviews was widely disseminated through ““Room for Review: A guide to medication review””, which was published by medicines partnership in conjunction with the national medicines management collaborative in 2002. The document set out a framework on how medication reviews should work, together with supporting tools and advice for managers and health care professionals. Two years later, medicines partnership commissioned an evaluation of the impact of ““Room for Review””, first to determine the extent to which the guidance had been adopted by PCTs and, secondly, to assess the experience and opinions of a sample of patients who had had a medication review. As the hon. Gentleman knows, the original plan was to publish both parts of the evaluation together. However, there were unexpected delays in publishing the part involving patients because of the two practical issues—the need to obtain ethics committee approval and the need to identify a suitable sample of patients through GPs. Medicines partnership did not wish to withhold the findings, so it went ahead and disseminated the survey of PCTs in March 2005. Part two was published yesterday. I am glad that I have helped to ensure that Christmas has come early for the hon. Gentleman. From the survey of PCTs undertaken in 2004, we know that the majority of PCTs had a written strategy and that more than 60 per cent. of them had agreed local guidelines. About 45 per cent. of the PCTs that responded to that survey indicated that they were achieving or likely to achieve the older people’s NSF target. Just 30 per cent. of PCTs said they were unlikely to achieve the target. If the survey were carried out now the figures would be very different, and I shall come on to the results of the GP quality and outcomes framework data later. The relationship between the national service framework and the quality and outcomes framework is important. The NSF indicator is still very much in force, but the way in which it has been implemented through the QOF target has become slightly more flexible to make sure that there is local managerial flexibility for doctors who implement it.