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Mental Health Bill [HL]

This has been an interesting short debate. I do not disagree with the noble Lords and the noble Earl, who commented on the impact of what can be very powerful drugs and on the dangers of overmedication. However, this is ultimately a matter of clinical practice. There would be real difficulties with putting into legislation what the noble Earl seeks to do. I accept, however, that there are issues regarding clinical practice and the code that need to be addressed. In medicines management in general, in mental health trusts, there are a number of challenges that fall to be met. I will come back to discuss a Healthcare Commission report on that, published last Friday. The amendment aims to put restrictions on prescribing medications at doses above the limits supposedly set out in the British National Formulary. It is worth pointing out that the BNF does not set, or even purport to set, any such limits. To quote from the BNF itself: "““The doses stated in the BNF are intended for general guidance and represent, unless otherwise stated, the usual range of doses that are generally regarded as being suitable for adults””." The BNF further states: "““The BNF is designed as a digest for rapid reference and may not include all the information necessary for prescribing and dispensing””." It goes on to say: "““The BNF should be interpreted in the light of professional knowledge and supplemented as necessary by specialised publications and by reference to the product literature. In areas requiring specialist expertise, it is expected that the BNF will be supplemented by specialist knowledge””." The BNF does not provide guidance on calculating high doses when combinations of similar drugs are used, referred to as polypharmacy. The noble Earl, Lord Howe, referred to the Royal College of Psychiatrists council report Consensus Statement on High-Dose Antipsychotic Medications. The statement acknowledges two different mechanisms for determining a high dose when using a combination of different antipsychotics. One method involves converting each drug into chlorpromazine equivalents, while the other method adds together the percentage of the BNF limit for each of the drugs used. The statement uses the latter method in its guidance, which addresses best practice, to limit the need for high doses, and best practice in the use of high doses and polypharmacy. We believe that, in the end, these matters are best left to clinical judgment, in the light of the various guidelines given. That is the best approach. Noble Lords will see that there are, and would be, severe practical difficulties in using the BNF provisions in statute in the way described, for the reasons that I have given. I accept that there is a challenge here to do all we can to ensure that clinicians prescribe doses in the most appropriate way possible. We believe that the code of practice, and all that is associated with it, is the best approach to this matter. I would also like to take this opportunity to comment on the Healthcare Commission report, published last Friday, Talking about Medicines: the Management of Medicines in Trusts Providing Mental Health Services. I commend that report to your Lordships. It highlights the importance of safe, effective and efficient medicine management as central to the delivery of high quality patient care. I assure the noble Earl, Lord Howe, that the department, the trust and the commissioners will want to review the recommendations in that report. That is one way that we can look to dealing with some of the issues that the noble Earl raised tonight.