PCF pro choice forumFor those with a specialist interest in abortion issues
Information Resource Library Opinion, Comment & Reviews Publications Psychological issues
pro choice forum   Search
Abortion and disability
Ante Natal diagnosis
Abortion law
Ireland and abortion
Reproductive technologies
Ethical issues
Contraception
What is PCF?  
Useful linksSubscribe  
Information Resource Library
Contraception
   
  Parliamentary Debate on Emergency Contraception
Emergency contraception in the House of Commons
Fifth Standing Committee on Delegated Legislation January 2001


The Prescription Only Medicines (Human Use) Amendment (No. 3) Order 2000

Dr Liam Fox MP: I beg to move that the Committee has considered the Prescription Only Medicines (Human Use) Amendment (No. 3) Order 2000 (S.I. 2000, No. 3231).

The most important aspect of the debate is the quality of care given to the patient. There has been criticism of the availability of emergency hormonal contraception, with some patients finding it difficult to gain access to their general practitioner in sufficient time for its use. We understand the problem and have suggested that EHC could be partially deregulated with practice nurses able to prescribe it. That would allow greater flexibility for patients, yet keep EHC in the context of the general practice setting. It would allow access to patients’ notes, enabling details of past medical history and any potential drug interactions to be assessed. It would give greater privacy for discussions about sexual contacts, sexually transmitted diseases, and so on, and allow detailed planning of future contraception.

The Government’s plans to move straight to an over-the-counter status will increase the risk of problems being missed. There is no question about the competence of pharmacists—indeed, the Conservative party believes that they should have wider prescribing powers—but we would dispute whether a pharmacy is the most appropriate setting for dispensing this type of contraception. Pharmacists must satisfy themselves on several matters. Has there been unprotected sex in the past 72 hours? Is the client present in the pharmacy? Is the client 16 or over? Is EHC needed? Could the client be pregnant already? Is the client taking other medication that might interact with levonorgestrel? Does the client have any medical condition that might affect absorption of levonorgestrel? Does the client have liver problems? Has the client previously had an allergic reaction to levonorgestrel? Many pharmacists themselves have complained that the further training recommended has not yet been undertaken and that a busy pharmacy is not an ideal location for highly sensitive questioning.

In addition, we have already had cases where EHC has been available over the counter in a way that would not have been intended under the Government’s proposals. An article from Saturday’s Daily Mail reads:

To test how the guidelines, which state that the pill—EHC—should only be sold to girls and women over 16 we sent 15-year-old Chloe Elliot, from north London, to a series of chemists. At Boots in Kensington High Street, West London, staff failed to ask her age and agreed to sell her the drug following a five-minute health consultation.

Calder chemists, in Notting Hill, failed to ask Chloe’s age and took just two minutes to hand over the prescription-only version after taking £20 from her.

The article goes on to quote Dr George Rae, chairman of the British Medical Association prescribing committee, about some earlier examples of this. He said:

‘The whole thing is turning into a hit of a hotchpotch and it needs looking at again. I do not think it is properly thought through.’

A health professional dealing with unprotected sex in a teenage girl should be aware of their age and it is hardly a step forward for prescribing to proceed without asking it. There is the question of the mental and physical well being of these girls who may, as we now see, be going from pharmacy to pharmacy, using the drug as contraception.

We must avoid the fragmentation of healthcare which could be dangerous.

Indeed, there have been numerous letters in the pharmaceutical press from pharmacists themselves. One pharmacist from Birmingham said:

‘The most serious concern I have with the announcement that Levonelle-2 was to be deregulated was that it was made to the public before the profession was made aware of it. Also, it gave the public the view that it would be available from all pharmacies, which I do not think will be the case if pharmacists object to selling the product on religious or moral grounds. Pharmacists have not been consulted about whether they would like to see this deregulation and it would have made a lot more sense to have a vote for it by those pharmacists who are going to be in the front line of the supply chain.’

Another pharmacist wrote from Cheshire to say:

‘I can foresee a situation where, because of their lifestyle, the same women will return time after time. I have witnessed this with ‘patients’ on National Health Service prescriptions for EHC. So we have a potential medical time bomb waiting to explode as steroids are sold without control to girls and women of all ages. How, as a busy community pharmacist, can I check their medical history or age? What is there to prevent an over-16 purchasing the drug for an under-age girl? The Society’s guidelines on supply of EHC would be hilarious if they were not intended as serious proposals!’

Dr Jenny Tonge MP: As a fellow trained medical practitioner, will the hon. Gentleman explain how a dose of levonorgestrel will lead to a potential time bomb of steroids? I am confused, so will the hon. Gentleman provide some scientific background.

Dr Fox: If the hon. Lady would let me finish, I am quoting from a letter written by a pharmacist in Cheshire. He continues:

We are supposed to obtain information and render advice and counselling in more than 20 areas in a totally private section of the pharmacy to ensure complete confidentiality for clients who may be under-age girls with parents who are regular customers of the pharmacy.

I am not aware of studies on the extensive and repeated use of EHC on girls under 16. If the hon. Lady is aware of such studies, perhaps she will tell me. It is important to assess the long-term effects of regular and repeated use of this new product among young girls. I suspect that we do not yet have that information.

Another issue is whether the Government’s wider policy is sending out the right messages. The new product is not as effective as other methods of contraception. On average, it has an 85 per cent. success rate. I am worried about inadvertently sending out the message that there is less need to use barrier methods of contraception—a serious public health concern in an age of sexually transmitted diseases.

Conservative proposals for retaining EHC as a prescriptions only medicine, but with availability through the practice nurse as well as the doctor, provide the best way forward. Our policy maintains safeguards and provides enhanced access to patients. Making it an entirely over-the-counter medicine would provide too few safeguards and be inappropriate in such a sensitive and complex clinical domain.

The Minister for Public Health (Yvette Cooper): I am disappointed that the Opposition decided to pray against the order and make it a political issue. Levonelle is a licensed medicine that is assessed by the Medicines Control Agency and the Committee on Safety of Medicines as safe and effective for the purpose of emergency contraception.

When the company Medimpex UK applied to change its legal classification to pharmacy status, all the standard procedures were followed and there was widespread consultation. The medical, safety and public health arguments all support the change and the arguments in favour of the order are strong. The arguments of the hon. Member for Woodspring (Dr Fox) are not based on an accurate assessment of the facts.

Let us start with the facts. We amended the Prescription Only Medicines (Human Use) Order 1997 to allow 0.75mg of levonorgestrel for emergency contraception to be sold in pharmacies without a prescription to women aged 16 years and over. For pharmacists knowingly to supply the product to women under 16 is an offence the Medicines Act 1968.

Levonorgestrel, a medicine used for emergency contraception, has been assessed by the Medicines Control Agency and the Committee on Safety of Medicines as both effective and safe. It works prior to implantation and prevents pregnancy. The accepted legal and medical view is that emergency contraception is not a method of abortion. It is more effective the sooner it is taken, reaching 95 per cent. effectiveness if it is taken within the first 24 hours after unprotected sex.

Under United Kingdom and European Community law, the sale and supply of all medicines, including emergency contraception, is regulated to protect public health and medicines are legally classified as prescription-only if the medicine needs to be supplied under the supervision of a doctor to ensure that it is used safely. It can be sold in pharmacies only if the legal criteria for listing medicines for prescription-only no longer applies.

Mr Desmond Swayne: The hon. Lady may recall the then headmaster of Westminster school, Dr John Ray, describing sexual intercourse while wearing a condom as similar to the experience of eating a Mars bar with the wrapper on. Does not it occur to the hon. Lady that there will now be a means of avoiding such barrier methods? If the product is sold over the counter what safeguards will there be to enable any restraint on young girls habitually having recourse to morning-after contraception, and what will be the long-term consequences?

Yvette Cooper MP: The hon. Gentleman was not listening to what I said earlier. This is an application for the product to be given to women over the age of 16. It is an offence under the Medicines Act 1968 for pharmacists knowingly to supply the product to women under 16. The chance of the measure having the effect of increasing the amount that young women use emergency contraception is highly unlikely. I shall deal with the safety issues, and matters of age, later.

The standard procedure was followed after Medimpex UK applied for the product to have pharmacy status. First, the Medicines Control Agency assessed the safety of the medicine in the light of the legal criteria for prescription-only status. Then it was referred to the Committee on Safety of Medicines for advice. That committee recommended that the Prescription Only Medicines (Human Use) Order should be amended to allow the non-prescription supply of the product. The matter then went to public and professional consultation; 138 organisations were consulted and the Medicines Control Agency posted a consultation letter on its website. All the main medical and pharmaceutical bodies that responded were in favour of pharmacy supply. The matter was referred to the Medicines Commission, which advised that it was appropriate to reclassify the product for emergency contraception for women aged 16 years and above from prescription only medicines status to pharmacy status.

The Committee on Safety of Medicines and the Medicines Commission carefully considered all the available evidence on safety and effectiveness. They advised that Levonelle can be safely supplied under the supervision of a pharmacist for emergency contraception.

There has been considerable experience of world-wide use. In the UK the active ingredient has been available in other contraceptive and hormone replacement therapy products for 30 years, though only more recently as an emergency contraceptive. However, it has already been used for emergency contraception in other parts of the world since the 1980s. In France, it has been available from pharmacists since 1999.

The side effects of the medicine are usually mild and short-lived. The committees therefore considered that the medicine had an acceptable safety profile for supply under the professional supervision of a qualified pharmacist and that women would be able to use the product correctly.

In support of that change, the Royal Pharmaceutical Society set professional standards and developed comprehensive guidance for pharmacists on the retail supply of emergency contraception. That guidance is detailed and clear. Although pharmacists are already familiar with the product, through prescription supply, additional training is being provided. A distance learning programme is being sent to pharmacists ahead of the product launch and workshops are available. Although pharmacists are expected to deal with requests personally, pharmacy staff will also receive training to ensure that they respond appropriately.

Dr Fox MP: Why did not the Government wait until the training was completed before the product was made available?

Yvette Cooper MP: It is a matter for the Royal Pharmaceutical Society to put the professional training in place and to set standards. It is primarily for the Royal Pharmaceutical Society to ensure that the Medicines Act 1968 is enforced and that the product is supplied appropriately. Pharmacists are well qualified health professionals who have long experience of handling a range of medicines and medical conditions.

The hon. Gentleman spoke earlier about pharmacists objecting to the measure, and I have to tell him that, according to the Royal Pharmaceutical Society, the majority of members in a couple of surveys of 1,500 community pharmacists in 1999 showed that 75 per cent. wanted to supply EHC as a pharmacy medicine. It is important that the Royal Pharmaceutical Society ensures that training is in place and that the guidance is followed. The hon. Gentleman discredits the huge number of pharmacists who do a fantastic job and are quite capable of handling the product effectively, and working appropriately and with discretion with women who need and want the product.

Mr David Drew MP: My hon. Friend makes a strong case for what pharmacists want. I should like to know what information, advice and education they may offer to women who go to them for the service, especially those who go regularly. For example, will pharmacists be able to refer a woman to a general practitioner if they feel that she needs further medical advice?

Yvette Cooper MP: Yes. The guidance is clear. Pharmacists should, whenever possible, take reasonable measures to inform patients of regular methods of contraception, disease prevention and sources of help. That includes ensuring that women who go to a pharmacy for emergency contraception are aware of other sources of advice on regular contraception, such as their local family planning clinic or their local GP. Emergency contraception is not an alternative to regular contraception— women use it when regular contraception breaks down—nor is it a protection against sexually transmitted infection. That is why the Government’s work on health education and sexual health, including the teenage pregnancy campaign, ensures the distribution of essential information on sexually transmitted infections.

Dr Fox MP: It is clear from what the Minister said that EHC is not intended to replace regular contraception, but does she understand the anxiety of many people that it will be used in that way if it is as easy to obtain as it would appear from some of the cases quoted?

Yvette Cooper MP: I am aware of that anxiety, but emergency contraception is already available through family planning clinics, general practitioners and other sources. Someone who is determined to use emergency contraception can obtain it. Anyone who wants to obtain emergency contraception from a pharmacy will have to pay for the product and the pharmacists will have to use their professional judgment and follow the guidance.

The important issue is that emergency contraception is more effective the earlier it is given. Waiting to see a doctor can cause delay and reduce the chance of it working; providing direct sale through pharmacies will be an important additional route, especially at times when traditional services may not be available. Huge numbers of women know the frustration of trying to track down the morning-after pill at the weekend after regular contraception has let them down. If they fail to obtain emergency contraception and a pregnancy becomes established, the risk to their health is far greater if they go ahead with the pregnancy or seek a termination.

According to the Conservative Christian Fellowship, the hon. Member for Woodspring asked his party to pray that there would be a huge restriction on our abortion law, if not abolition. What does he want women to do? If he is so against abortion, why is he also so determined to make it more difficult for women to have access to the emergency contraception that could prevent those abortions? He wants to block access to abortion, but he also wants to block access to emergency contraception, which could avoid the need for abortions. What is he saying to women? Is it Conservative policy that every woman whose regular contraception fails should be forced to have a baby? He has made it clear to the Committee that his party’s policy is to make it harder for women to get emergency contraception. Will he confirm that his party’s view is that women should not have access to abortion either?

Dr Fox MP: I am sorry that the Minister has decided to go down that track in what had been quite a rational debate. I want to make it perfectly clear that the Conservative party’s view on abortion is that it is an issue for individuals. It is subject to a free vote in Parliament, and the party will continue to decide on that basis. Abortion is not a party issue. I am sorry that the Minister has introduced that note into what had been a serious debate in which we were considering serious matters.

Yvette Cooper MP: The Committee will be grateful that the hon. Gentleman has clarified the interpretation of his words in this morning’s newspapers.

It is clear that both pharmacists and women want access to emergency contraception through pharmacists. A recent Mintel survey shows that nearly two thirds of adults believe that pharmacists should be allowed to prescribe emergency hormonal contraception without the need for a GP’s prescription. Last year, 800,000 prescriptions for emergency contraception were issued.

Research shows that studies in which women had increased access to emergency contraception, perhaps through advance prescription, have not suggested that they change their sexual behaviour or their use of other contraceptive methods in any way. The only difference is that women have earlier access to emergency contraception. As I have said, it is not an alternative to regular contraception.

The Royal Pharmaceutical Society’s guidelines will make clear the way in which pharmacists can provide the support and advice that women want and need when they go to them, rather than to family planning clinics, to get emergency contraception.

On under-16s, I am aware of the report in the Daily Mail to which the hon. Gentleman referred. The Royal Pharmaceutical Society has said that it will investigate the cases in that report to ensure that the proper guidelines and the Medicines Act 1968 are being followed. It is not part of the licence that emergency contraception should be supplied to people under the age of 16 through pharmacies. The initiative is not part of the Government’s teenage pregnancy strategy; it is about increasing access and helping to reduce the number of unwanted pregnancies among over-16s.

The Government’s teenage pregnancy policy is far broader and is about improving relationship and sex education and about improving information for teenagers about how easy it is to get pregnant, but how hard it is to be a teenage parent. The measure is not a substitute for the provision of free emergency contraception on the NHS through family planning clinics and GPs in the usual way, because the product will not be affordable for many women, even in an emergency.

The product has been through a standard and extremely sensible process. It has been assessed as safe and effective by all the extremely experienced and reputable bodies that regularly consider all such medicines and applications. They have looked at the product in great detail. The Royal Pharmaceutical Society has also worked in great detail to support these sensible changes that women want. It is right to make those changes.

Dr Jenny Tonge MP: Before I join in the debate proper, I shall say a little about my background, because it is very relevant. Before I became a Member of Parliament, I was for more than 25 years in general practice and then I specialised entirely in community family planning and community gynaecology. In that capacity, and as a member of the faculty of family planning for the Royal College of Obstetricians and Gynaecologists, I organised and implemented training courses for GPs and hospital registrars to obtain their family planning training and qualifications, so I have some experience in the field. During those 25 years, I saw many hundreds and thousands of patients of all ages. Included in my experience was five years as the medical adviser and practising doctor at what was then the London youth advisory centre, where I saw many people, from as young as nine years old to those in their mid-twenties. I do not want to appear egocentric, I simply think that it is relevant that the Committee should know that what I say today is based on personal experience and the experience of my colleagues, not just on scientific knowledge.

Much is said about the safety of this particular product. The hon. Member for Woodspring, referred to it as being a new product. It may be a new product in this dosage, for this purpose, to a GP, but levonorgestrel has been on the market for at least 20 years. Over the years, it has been used as a progesterone-only contraceptive pill by many hundreds of thousands of women. It is interesting to note that if a toddler accidentally took mum’s month’s supply of levonorgestrel, no action would be needed. A girl baby might have a tiny amount of vaginal bleeding, but she would then be all right, because levonorgestrel is not toxic. That is the degree of safety of the substance; it is far safer than aspirin. We need to bear that in mind when we read hysterical comments about how dangerous it is to give a drug to a patient without their seeing a doctor first. People in Britain can now obtain up to 32 aspirin—fortunately no more than that at a time—and while that amount of aspirin could kill a number of babies, a similar amount of levonorgestrel would have no effect at all.

What would happen if young people were too disorganised and shy, as many of them are, to go along to the GP or family planning clinic where they might meet mum’s friend in the waiting room—young people are shy about going for help on sexual matters and birth control—and so just kept nipping into different pharmacies week after week? First, young people would run out of cash; their big sister, older friend or boyfriend, would become tired of forking out for them to buy the product over the counter. I do think that £20 is a large amount, but I am all in favour of them paying something. Most young people today can afford cigarettes and mobile phones, so if they are in a hole they can certainly afford a dose of the morning-after pill. A charge will in itself militate against them using it too frequently. If they have an unlimited supply of cash, or an endless supply of boyfriends to give them £20 every week they need it, their periods will go haywire and they will have breakthrough bleeding. A young girl ready to take off on holiday to the Costa Brava will rush to her GP, furious because her period has started. I assure hon. Members that, after more than 25 years of practice, I know that nothing engages the mind of a young woman more than unexpected vaginal bleeding. Girls get very fed up; they hate it; it cramps their style. We know that periods cramp young women’s style because that is how sanitary protection is advertised. It is important to realise that that in itself will stop them using EHC too frequently. Young women will soon decide to take the pharmacist’s advice and go to a proper clinic, or to their GP for some proper form of contraception on a long-term basis.

I have discovered during years of experience that a doctor cannot be too questioning or judgmental with desperately worried teenagers when they first come to the surgery. They may have had sex for the first time, or even the fifth, and fear they may be pregnant. If the doctor is judgmental, he will never see them again. However, if he can help them quickly, especially in the way a local pharmacist can as an anonymous person who is unlike their general practitioner, they can be pointed in the right direction and told that the morning-after pill may stop them getting pregnant, but that condoms are the only things that will stop them getting infections. That way, they are much more likely to come back on a regular basis. I could cite numerous cases of young people with whom I have had precisely that experience. It is good to make it easy for young people, because that is the way to get them into proper care.

Let us not also forget that the measure is designed for older women. The Minister will correct me, as that is not my brief, but I think the highest abortion rates in this country are among women in their 20s. Women often become rather cavalier. At first, they are careful. They have responsible parents and, if they are lucky enough, they have had all their sex education and they know what to do, but when they reach their mid-20s they assume that, because they have not become pregnant so far, precautions are not necessary. They may go away and forget their pills, or fall sick. I could cite numerous examples of why people accidentally fail to use proper contraception. They do not want to have to go the doctor and tell him that they have made a mistake, and they do not want to have to wait 72 hours for an appointment. They want to be able to go into the pharmacy for some pills to deal with the problem. It would be sensible for an older woman to keep a supply of the product in the bathroom cupboard alongside the paracetamol and her regular form of birth control, providing a ready means of preventing pregnancy if necessary. It is important to remember older women and the freedom that they should have in deciding what to do with their lives.

I know that my hon. Friend the Member for Romsey (Sandra Gidley) would like to speak for the pharmacist, so I conclude by saying that, for the past 15 years, either as a doctor working in the field or since entering Parliament, I have sought to have this measure enacted. It represents a huge leap forward. It is a way of getting people introducing people to good sex education and good family planning advice. It is a gateway to the services. It gives older women the freedom to control their own lives. For them to have to control their lives, and their sexual lives in particular, via the family doctor, is something of an insult.

There are those who are worried about the abortion angle, as I certainly am. I deplore the abortion rate and the number of teenage pregnancies. However, we must keep on reminding ourselves that the morning-after pill acts before implantation of the fertilised egg, or stops the egg being fertilised in the first place. Therefore, legally, whatever the tabloid newspapers say, it does not result in an abortion. Those who have strongly held religious views will maintain that the soul enters the potential human being when sperm meets egg. However, I commend to hon. Members an excellent speech made by the Bishop of Oxford, Richard Harries, in the other place on Monday, who points out that for the Church to say when the soul reaches the egg is very arbitrary, and was done for all sorts of reasons. There is no absolute truth here. In any case, many people in Britain do not believe that, or are not Christians, or are coming from a different direction altogether. Therefore, it must be emphasised that the morning-after pill is not an abortion pill, but a liberation for older women, providing access to proper services and education for many teenagers in this country, and I commend it.

Mr Peter Luff MP: I have some moral concerns about this issue, but it should not be decided on the basis of those concerns as I have no right to impose them on this decision. It is right that we should look at the practicalities, as this debate has done very well.

The Minister set out very well the science that led to the conclusion that she and the Government reached. I learnt as Chairman of the Select Committee on Agriculture, Fisheries and Food not always to trust scientists; they have their own agendas. But, more importantly, politicians must reach judgments on the basis of that science and not just allow those scientific conclusions to dictate their own conclusions.

I was struck by the research undertaken by one of my local newspapers about the attitudes of young people in Worcestershire. The concerns expressed by those young people encapsulate the points made by my hon. Friend the Member for Woodspring. A group of 16 and 17-year-old pupils was asked about the availability of emergency contraception in schools, not about availability over the counter. The concerns that they expressed were those that my hon. Friend described. The article states:

The group interviewed were immediately concerned that their peers would stop using barrier methods of contraception, which stop sexually transmitted diseases.

That is a major concern. I respect what the Government are trying to do on teenage pregnancy and education on such issues, but, in theory, those schoolchildren are right that the increased availability of emergency contraception will undermine that work.

This is a classic vox pop survey. Barji Kumar says that having the pill so readily available would encourage youngsters to have unprotected sex. He added:

You are supposed to take precautions beforehand and if people can just take this pill the morning after, I don’t think they will bother.

We must keep that concern at the front of our minds. It is interesting that those children were concerned about their parents not being informed. Not all 16-year-olds are fully mature, and there is an argument for parents being informed of what happens to their children up to the age of at least 18, but that is another debate. [Interruption.] I am sorry that the hon. Member for Richmond Park (Dr Tonge) finds that funny, but I think there is an argument. Parents are legally responsible for their children until they are 18, but not for their medical history at that age. There is a debate to be had on that.

Dr Tonge MP: Does the hon. Gentleman agree that, whether a young person is mature, depends entirely on the young person?

Mr Luff MP: I have a great deal of sympathy for that. Having a teenage daughter myself, I know exactly what the hon. Lady means.

The group interviewed was concerned—it is important that the Government reassure us on this point—that the easy availability of contraception, without access to medical history, would be a problem. It said:

If there was a family medical history of blood clots and the child didn’t know, they would be put at risk by taking the pill.

That concern may be addressable, it may not be a fair concern, but it is one that this group of young people has. The group also said that it feared that the pill would be misused and that much better information should be available through chemists. I have a high respect for pharmacists, one is about to speak, my mother was one and her father was one. However, there is a problem about making information on sensitive and personal matters available to a young person over a pharmacy counter. It would be much better done in the privacy of a practice nurse’s room or a GP’s surgery.

Finally, the group was concerned about the number of times that the morning-after pill would be available. The hon. Member for Richmond Park made a powerful case about the cost and some of the practical implications of excessive use of the pill, but we should be concerned about using this particular method of contraception too often. I understand that it is intended for older women, but the practical reality is that it will reach younger women. As my hon. Friend the Member for Woodspring said, older women will buy for it for younger women, and younger women will trick pharmacists into selling it to them. We have to accept that the morning-after pill will, in practice, be used by 14 and 15-year-old women, not just 16-year-old women, and we must bear that in mind.

The balance was about right. The pragmatic decision to allow practice nurses to prescribe the morning-after pill would be a sensible next step. But the work done by The Droitwich Spa Advertiser and others convinces me that this measure is just one step too far.

Sandra Gidley MP: Members of Parliament may not be aware that, in the past few years, a steady stream of medicinal products that started off as prescription only products have been deregulated, in just the way that we are discussing, and they are now fully available through pharmacists. Many of those products carry with them protocols to which pharmacists must adhere, but it is by no means uncommon for a pharmacist to have to refer the patient to the GP. Patients do not always like that; they think that, because a medicine is available from a pharmacy, they should automatically be able to buy it. However, all good pharmacists will adhere to the protocols and refer back to the GP when necessary.

As we have heard, the product has been discussed by the Committee on Safety of Medicines and the proposal has been out to public consultation, at which stage any pharmacist with an interest could have had an input into the process; finally the Medicines Commission has approved the deregulation of the product. Given that the Conservatives’ mantra is that we should trust the teachers to teach, I fail to understand why they do not trust the health professionals to examine the health aspects of deregulating Levonelle.

Dr Fox MP: I am grateful to the hon. Lady for giving me the chance to point out a fact of which she may not be aware. It is Conservative party policy to deregulate a wider range of medicines than are currently deregulated; we are very much in favour of that. The question is whether regulations are being followed in the particular cases mentioned. She will be aware of the cases that the Royal Pharmaceutical Society is to investigate. In her opinion, exactly what level of investigation and supervision of pharmacists should there be when this sort of product is put on the market?

Sandra Gidley MP: I did not quite understand the question. Pharmacists are professionals and they will follow the protocols. We always have people investigating to make sure that procedures are followed properly and that there is no problem. The Royal Pharmaceutical Society has inspectors who investigate what is going on in pharmacies. I believe that we are a strongly regulated profession. Despite the fact that I heard earlier that there was no intention to cast aspersions on pharmacists, I feel demeaned by the comments of the shadow Secretary of State for Health. The strict protocols that are in place will be followed, which will ensure that important information is not missed.

It has been said that pharmacies are not always especially private. Well, women do have a right to choose: if they do not think they have enough privacy at a pharmacy, they will not go to one. The truth is that many pharmacies have quiet areas and some have private consulting rooms at the side of the dispensary—I had one in the last pharmacy in which I worked. It is easy to take someone into a quiet confidential area and have a fairly in-depth discussion. I will not go into it here, but the Committee would be quite surprised to hear what some people are ready to admit to a pharmacist. I cannot condone any pharmacist not following the guidelines. I trust the Royal Pharmaceutical Society to investigate any case in which there is evidence that the guidelines have not been followed.

It has been said that usage will increase, but I fear that those who say that have not done their research correctly. In 1998, Glasier and Baird showed that there was no increase in the frequency of use of emergency contraception, even if kept at home; and that women were not likely to stop using long-term methods of contraception either. That research appeared in the New England Journal of Medicine. More recently, in 2000, in the British Journal of Family Planning published a called ‘Repeated use of hormonal emergency contraception by younger women in the UK’, the conclusion of which specifically addresses that point, saying:

The results of our study disprove the notion of widespread repeated use of emergency contraception and hopefully will reassure GPs and others that provision of an emergency contraception service does not result in failure to initiate regular contraception or abandonment of regular contraception.

The writers support widespread access to emergency contraception as an integral component of a comprehensive family planning service.

The distinguishing feature of the product that we are debating is that some people object to its use on moral grounds, but we should not take such considerations into account. The moral argument is for another time and place. The product is available as contraception and it does not make any difference whether doctors are supplying it, nurses are supplying it or pharmacists are supplying it. The outcry is just a mischievous move to create media interest at a time when we should be allowing the health professionals to get on with the job.

Yvette Cooper MP: I welcome the points made by the hon. Member for Richmond Park about the safety of the product, the importance of improving access, especially for older women, and the product’s potential to reduce the number of abortions. I also welcome the points made by the hon. Member for Romsey about the ability of pharmacists, as trained health professionals, to do the job.

The hon. Member for Mid-Worcestershire (Mr Luff) raised a number of concerns, the first of which relates to access for under-16s and 16 to 18-year-olds without parental consent. Access to contraception and emergency contraception is governed by a legal framework that has been in place for the past 15 years; that framework, rightly, remains completely unchanged and by the order or by the introduction of the product, which applies to over-16s.

The hon. Gentleman also mentioned privacy and the importance of having a private area in which to discuss these matters. I refer his attention to the remark made by the hon. Member for Romsey that the customer will choose where to go and decide what level of privacy is required. I doubt that many pharmacists would be embarrassed discussing these issues in the middle of the pharmacy. The most recent survey of community pharmacies shows that 90 per cent. of pharmacies have an area in which advice can be given out of earshot of other customers, so we should not underestimate existing provision.

Mr Luff MP: Did the Minister say 90 per cent?

Yvette Cooper MP: The information that I have been given comes from a survey carried out by the Royal Pharmaceutical Society of Great Britain which found that more than 90 per cent.of the community pharmacies surveyed had an area where advice could be given out of earshot of other customers.

The application from the company to change the legal status of this product has gone through all the proper procedures; it has been assessed by all the proper bodies, as safe and effective. It is a very sensible public health measure that improves women’s access to a product that they want and need from time to time and that they should be able to get. The order will make it easier for them to do so, should they choose to buy the product through the pharmacies. Ultimately, it is their choice, but it will provide a way to reduce the number of unwanted pregnancies.

It is important that the Royal Pharmaceutical Society’s guidance is properly followed and it will be the society’s responsibility to ensure that the measure is implemented effectively. We should accept the order and accept that it is sensible in terms of public health and sensible for women right across this country as well.

Dr Fox MP: We have had a useful debate. I reiterate that the debate is not about whether EHC should be available, nor about its moral legitimacy. Those are not considerations to be taken into account in this order. We are debating the practicality of it being available over the counter, in the way proposed by the Government.

I have great respect for the hon. Member for Richmond Park and for her experience of these issues. She will, of course, recognise that there is a legitimate counter view to her own, but I in no way doubt her sincerity and the value of her experience in bringing her argument to the Committee.

I must tell the hon. Member for Romsey that we are not casting doubt in any way, shape or form about the ability of pharmacists to perform their trained duty. There is a question about the training they receive, and we have already had examples of where they have not carried out in practice what they should have, and that, of course, needs investigation. I must take complete exception to the idea that this is a frivolous debate. I would say most soberly to the hon. Lady, that it is the role of the House of Commons to debate issues where there are controversial elements. As Members of Parliament, it is our job to ensure that those views are heard inside the House, on behalf of those who have concerns outside and cannot express them themselves. Perhaps, when she has been in the House a little longer, she will give more weight to that.

My hon. Friend the Member for Mid-Worcestershire’s point about whether the Government are inadvertently giving the wrong message about the need for barrier contraception and the risk of transmission of sexually transmitted disease needs to be considered. If the Government proceed with this order, I hope that they find ways to strengthen the message in any advice that is given in guidelines to pharmacists, to ensure that greater emphasis is placed on that.

It would be a great pity if the order, which the Government want to see in place, were to have the opposite result to that which they seek in terms of public health policy and sexual health. I ask the Minister to bear that in mind in future guidelines.

Question put:—

The Committee divided: Ayes 9, Noes 3.

AYES
Benn, Mr Hilary
Cooper, Yvette
Drew, Mr David
Eagle, Maria
Fisher, Mr Mark
Gidley, Sandra
Henderson, Mr Doug
Jamieson, Mr David
Tonge, Dr Jenny

NOES
Fox, Dr Liam
Luff, Mr Peter
Swayne, Mr Desmond

More >>

 
Return to top


">
 
Send
Contact us
Information Resource LibraryOpinion, Comment & ReviewsEvents DiaryPsychological Issues
Home © PCF copyright