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House of Lords

Thursday, 19th November 1998.

The House met at three of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Blackburn.

Aspirin Products: Sale Limits

Lord Jacobs asked Her Majesty's Government:

    Whether they are satisfied with the operation of the new regulations which limit the sale of aspirin and other similar products to 32 tablets at one time without the express agreement of a pharmacist.

The Parliamentary Under-Secretary of State, Department for Health (Baroness Hayman): My Lords, the new regulations which took effect on 16th September this year restrict the sale of aspirin and paracetamol products to packs of 16 tablets or capsules for general sale and to packs of up to 32 where sale or supply is under the supervision of a pharmacist. When the pharmacist judges it appropriate, for patients with long-term or recurrent conditions up to 100 tablets can be provided. The operation of the new regulations will be monitored and kept under review.

Lord Jacobs: My Lords, I thank the Minister for her Answer, but is she aware that 1 million people or more a day are taking 75-milligram aspirins--that is, quarter-strength--to prevent heart disease and strokes? Will the Minister consider ending the regulations in respect of those tablets because the present situation causes people to visit the pharmacy 12 times a year? In addition, they are obliged to pay 50 per cent. more than before.

Finally, is the Minister also aware that it is possible to go into supermarkets and purchase 100 paracetamol or 100 aspirin tablets which are outside the regulations? Is she able to do something about that?

Baroness Hayman: My Lords, the noble Lord has asked a number of questions. The pack-size of aspirin and paracetamol products is limited. Those on sale in supermarkets have to be in packs of "only up to 16" and I know that some supermarkets are very careful about the number of packs that can be sold. That is in answer to the last point that the noble Lord raised.

On the noble Lord's first point about the public health benefits of low-dose aspirin, we certainly recognise those. We also recognise the difficulties caused for some patients by low-dose aspirin being limited in terms of numbers. However, I should point out that the limit is 100 when the pharmacist sees the patient as having a specific need.

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The issue about the 75-milligram aspirin is one that we take seriously. Obviously, we were addressing the higher-strength tablets and I shall ask the Medicines Control Agency to look at that specific area to see whether any change may be appropriate.

Lord Walton of Detchant: My Lords, although it is a minor inconvenience for those, like myself, who take aspirin each morning for the reasons that the noble Lord has mentioned, does not the Minister agree that in the case of paracetamol one of the principal reasons for reducing the pack size is that there has been an unfortunate tendency in recent years for people to buy large numbers of paracetamol tablets for suicide attempts? Does the Minister agree that that seems to override the restrictions, or to make valid the restrictions that have been imposed?

Baroness Hayman: My Lords, I am grateful to the noble Lord for those comments and questions. It is important not to lose sight of the reasons behind the decision and the regulations. Paracetamol can do very grave damage. We estimate that there are between 100 and 150 deaths a year from paracetamol poisoning through overdose. It is the commonest reason for liver transplants in this country. With young people in particular it is often the cause of an impulsive rather than a well-considered bid.

Lord Renton: My Lords, is the noble Baroness aware that far more people are advised to take an aspirin a day than to take any paracetamol? Is it not an unnecessary addition to the cost of the National Health Service that those people should have to see their doctor about once a month in order to renew their prescriptions?

Baroness Hayman: My Lords, I recognise that it is possible that there will be additional costs on the National Health Service and that there is some inconvenience to patients. However, as I pointed out, pharmacists are able to prescribe up to 100 paracetamol. We have to balance the issues very carefully. They include the question of the overwhelming National Health Service expenditure as well as the tragic personal and health consequences for many people through paracetamol overdose and, indeed, aspirin overdose. If aspirin were to become the drug of choice rather than paracetamol, overdoses would be even more difficult to treat.

Lord Stallard: My Lords, we accept the reasons that the Minister has given for the regulations, but is she aware of the ease with which anyone who wishes to take an overdose can obtain extra tablets by moving from one chemist to another? You can do that in any high street. You can get 100 tablets in four packets--or rather, 128 in four packets. Is there not an element of increased profit for retailers in the regulations?

Baroness Hayman: My Lords, I know that there have been concerns about price increases for such products which perhaps cannot be justified by the simple fact of different packaging being necessary for the

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smaller packs. I appreciate what my noble friend says about the ability to buy several packs. However, perhaps I may repeat that the evidence about suicide shows clearly that many attempts, particularly by young people, are impulsive attempts, using products in the medicine cupboard at home. One study in Oxford pointed out that 63 per cent. of those who used paracetamol did so because it was readily available and that 41 per cent. of the patients involved had considered overdosing seriously for less than one hour.

Lord Monson: My Lords, is the Minister aware that the new regulations raise the minimum retail price of a single tablet by between 67 and 105 per cent., which is equivalent to perhaps £5 per year for somebody who takes a tablet a day? As I have seen medical evidence which demonstrates that as few as 15 paracetamol tablets can kill, is not this an example of the nanny state run mad, and is it not almost as silly as the beef-on-the-bone ban?

Baroness Hayman: My Lords, I do not think that trying to prevent the deaths of between 100 and 150 people a year is the "nanny state run mad". It is responsible public health policy.

Pricing is an issue of concern. There are variations in the pricing and I would very much recommend people to shop around, because not all suppliers have increased the price of their tablets in the same way.

Lord Stewartby: My Lords, as one who takes a junior aspirin every morning in the hope of avoiding a heart attack as a result of the excitement of the proceedings in your Lordships' House, may I ask the Minister whether the Government have any figures for the number of people who set about trying to do themselves harm by taking junior aspirin?

Baroness Hayman: My Lords, I do not think that many people set about trying to do themselves harm by taking junior aspirin. I tried to give the House some figures about the number of people who succeed in doing themselves harm by taking overdoses of paracetamol and aspirin. I recognise the point that has been made about junior aspirin. This is a less simple concept than the noble Lord might think because applications to prevent heart attacks include higher strength aspirins as well as junior aspirins. As I said, this is an area in which there are legitimate concerns and I shall look into the matter.

Primary Care Group Boards: Pharmacists

3.14 p.m.

Lord Quirk asked Her Majesty's Government:

    Whether they are satisfied that primary care group boards are so structured as to make proper use of the skills and knowledge of pharmacists.

Baroness Hayman: My Lords, primary care groups will need to work with a wide range of professionals in

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order to take advantage of their skills and expertise for the benefit of patients. The membership and size of a PCG board has to be manageable and workable. We value highly the skills and knowledge of pharmacists. We made it clear in guidance issued in the summer that they are among the professional groups which PCGs will have the power to co-opt on to a board.

Lord Quirk: My Lords, I am grateful to the Minister for that Answer and I note carefully what she has said. Does she not agree that the 12,000 or so pharmacies up and down the country provide our most direct access to healthcare; that they are the first port of call in time of sickness, especially for the poorest in our society; and that in the process they reduce the pressure on GPs' surgeries? Is the Minister aware that graduates of the English schools of pharmacy--from the biggest in Bradford to the oldest in London--are very keen to show that their skills can contribute significantly both operationally and strategically to primary care groups, as they already do with the analogous structures in Wales and in Scotland?

Baroness Hayman: Yes, my Lords. I echo some of the noble Lord's remarks about the contribution that the skills of, particularly, community pharmacies can make to people's health and their importance in terms of providing a very local and accessible service. That is why we made it clear in our guidance in the summer that they should be involved as far as possible. That is because a great deal of the work of primary care groups will depend on good prescribing advice and support from professionals such as pharmacists.

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