Parliament’s first ever debate on economic contribution of medical cannabis
Hansard: https://hansard.parliament.uk/commons/2023-04-20/debates/6FE36998-D184-48A4-BA13-D600C2EC845E/MedicinalCannabisEconomicContribution
3.00pm
(Dumfriesshire, Clydesdale and Tweeddale) (Con)
I beg to move,
That this House has considered the economic contribution of medicinal cannabis.
It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the Backbench Business Committee for allocating this debate. This slot on a Thursday afternoon is a challenge for many Members to attend because they have constituency commitments on a Thursday afternoon, but I am confident that we will have a good-quality debate and, importantly, that the issues I want to raise will be put on the record.
I am conscious that a number of these issues relate to the Department for Business and Trade and that my hon. Friend the Minister will obviously respond in his capacity as a Minister in the Department of Health and Social Care. I hope that if any issues are not within my hon. Friend’s remit and he does not feel able to respond, he will undertake to take them forward with ministerial colleagues.
Many Members will have been introduced to the issue of medical cannabis by constituents getting in contact to tell them, as their MP, about the real difference that this form of cannabis has made or could make to their own or their families’ lives. Such testimonies, along with scientific study after scientific study, led to my right hon. Friend the Member for Bromsgrove (Sajid Javid), when he was Home Secretary, legalising medical cannabis in 2018, and thereby ending the potential criminalisation of those living with or just trying to manage multiple sclerosis, cancer or epilepsy. That was a significant step forward for patients.
Some 17,000 UK patients are estimated to have been prescribed Sativex, nabilone and Epidyolex in the UK last year. I am sure that many Members of Parliament could tell a story from their constituents about what a difference such prescriptions have made to the quality of users’ lives by easing agonising muscle stiffness, by reducing chemotherapy-induced sickness, or as a therapy for seizures, especially for children.
The 2018 legal changes were also a significant step for the medical cannabis industry in the UK. We should be clear that medical cannabis is just that. This is a legitimate industry, and an industry of the future. Its products do not come from humid, tinfoil-draped sheds or sunlamp-lit lofts; they come from laboratories and facilities that are as controlled an environment as those that synthesise a vaccine, for example. I know that to be the case, having seen at first hand such facilities being developed in my own constituency. The medical cannabis industry is one of legal and professional standards, rigorous regulators, approvals, licensing, inspections and almost endless specialist equipment—be it quantum sensors, microscopes or leaf barometers—not to mention stringent safety and security protocols.
Of note is not just the standards to which the cannabis is produced but the volumes produced. In the UK in 2021, some 59 hectares were harvested, producing 329 tonnes of cannabis for medical and scientific purposes. Of that, 213 tonnes were exported—more than half the reported world total. Beneath those impressive headline figures, though, is the impact that the industry can have on local economies and local communities. That is why I have been and remain very supportive of the development of a facility in my constituency by Hilltop Leaf.
Too often, investment in new industries is funnelled into enormous singular developments captured by large corporate interests, or it goes straight into cities. Rural and agricultural communities such as those I represent often get overlooked, with seemingly only wind farms and tourism receiving investment. The medical cannabis industry is an antidote to that.
In many ways, I feel the growing of medical herbs is a form of farm diversification—an evolution of horticulture that builds on local strengths and skills. I hope that the investment by Hilltop Leaf, with one of the largest greenhouses in the UK, will demonstrate that medical cannabis can have a transformational impact on local communities. It will bring a variety of good horticultural, administrative, managerial and logistical jobs that I hope will anchor young people, who often feel the gravitational pull of large cities for the want of opportunities in a rural area such as the one I represent, which has seen the demise of traditional industries such as textiles. It could also meet nearly 10% of the UK’s 2019 domestic need.
For all the successes of the UK cannabis sector to date, it could be so much more. Bureaucratic, legal, administrative, regulatory, medical, licensing and planning issues all inhibit the industry’s potential and hinder vital investment in rural Britain. Indeed, the over-onerous process for being licensed in the first instance has given me cause to worry about the development in my constituency stalling. I am afraid the UK’s approach to the industry is incoherent and insufficiently consistent.
Yes, medical cannabis can be prescribed, but only by specialists, and that is predominantly being done outside the NHS, particularly in Scotland. Although I said earlier that in 2021 some 17,000 people received legal prescriptions for medical cannabis, it is conservatively estimated that next year there will be approximately 337,000 potential patients. That could be many times larger should new conditions be covered. This state of legality but inaccessibility is grossly unfair, and is contrary to the principles of our health service that those who can pay can get private prescriptions—or source their requirements from drug dealers—while those who cannot pay go without. All the while, there are almost 24 million prescriptions for opioids in the UK. Those figures, in differential terms, are staggering.
The potential savings for the NHS in the prescribing of medical cannabis have been detailed, with one US study showing a potential provider saving of 29% because of reductions in opioid dosage. As I said, by confirming the efficiency of medical cannabis in helping with certain conditions while stopping it being readily available, we are pointing those who are desperate to illegal markets. Do we really think that patient safety is best served by criminal suppliers, who provide a product of poor quality that is likely to contain contaminants because of the fashion in which it was grown? I certainly do not. Do we need to see the benefits for British growers, supply chains, jobs and tax revenues bypassed and go instead to criminals and smugglers, both here and overseas?
Clearly not, especially when the medical cannabis sector has a potential value to the UK economy of more than £1 billion.
Our incoherence also extends to cannabidiol, or CBD. We allow its purchase—indeed, the UK’s CBD market is the second largest globally and was worth £300 million in 2019—but our hemp licensing measures mean that the flowers and leaves, where CBD is found, must be destroyed. As such, the CBD market fulfils its needs through overseas imports, and British supply chains do not benefit. Growers are necessarily forsaking the opportunity to yield a crop of £10,000 per acre, compared with £400 for wheat, because of this approach. Such yields would be a real boon for rural Britain.
If the UK’s regulatory, legal and medical frameworks were in line with those elsewhere, it is estimated that up to 100,000 jobs of the future could be created, and they would be good-quality jobs, as I have already set out. It is an opportunity that should be within our grasp, but unfortunately we currently do not seem able to take it forward. On 14 November last year, I was disappointed when a fellow Member asked the Business Department about its willingness to take forward the approach to the medical cannabis industry as part of its medical sciences strategy and commitment for the UK to be a world leader in such fields; unfortunately, the then Minister gave what I regarded as a lukewarm and non-committal answer.
As I am sure the Minister and all present will agree, nascent industries need nurturing, and the medical cannabis sector is no different. Much like the plants that the sector grows, the industry is seeking the conditions to grow. I hope the Government will be minded to support the sector and the economic benefits it could bring, particularly to rural Britain. This should not be considered an ask for wholesale legalisation, which is a completely different debate; it is an ask for consistency and coherence for the industry, and for access to medical cannabis for NHS patients.
We need the various strands in Government to be stitched together to provide support, rather than maintaining a strange patchwork of overlapping and clashing components. The UK Government and, where appropriate, the devolved Administrations should therefore accept the need to review the prescribing process, medical guidelines, acceptable tetrahydrocannabinol levels, and the overlapping legal and regulatory components. My specific ask of the UK Government is that they appoint a senior official to do so holistically, and that individual should be mandated to engage directly with the industry.
With coherent and consistent oversight, and by bringing the UK into line internationally, the medical cannabis sector could help to get rural Britain, and particularly constituencies such as mine, growing economically. In doing so, we could supply our domestic market with homegrown supplies and, even more importantly, relieve the pain and suffering of hundreds of thousands of our constituents, if they could access the prescriptions they need.
3.15pm
It is a pleasure to speak in this debate and to serve under your chairmanship, Mr Stringer. I thank the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) for leading the debate and for setting the scene so well and in such a balanced way. In his introduction, he said that we all have constituents who have benefited from medicinal cannabis. I have one such constituent, and I want to speak about that young girl and her family, because I have seen at first hand exactly what medicinal cannabis can do to improve health, to lift the fortunes of a family and to give them the encouragement that they need.
As the DUP spokesperson for health, these issues are very important to me. I have seen at first hand the impacts that medicinal cannabis can have on people who are ill. It is sad that it does not work for everyone, but it has certainly worked in cases that I am aware of. There are success stories, but also a large proportion of people for whom it does not work. However, for those who are fortunate enough to see results, it is a crucial treatment that can ultimately save lives. I am here today to celebrate that.
By their very nature, issues such as this can sometimes be contentious. The right hon. Gentleman set the scene well and got the balance right. I congratulate him on that because he presented the issue well. This subject sometimes sparks debate, but we would try anything if it gave someone a better chance at life.
There is never a debate on this topic in which I do not highlight the benefit of regulated medicinal cannabis prescription by talking about lovely Sophia Gibson. She is a young girl who, at about six or seven years old, was having epileptic fits every day of her life. In my office, I have a photograph of her from when she was smaller. She is the daughter of Danielle and Darren and has Dravet syndrome, which is incurable, and she will continue to have seizures until her wee body can no longer cope.
Medicinal cannabis is not the cure for Sophia—there is no cure—but that young girl’s quality of life has changed dramatically. I can remember when the epileptic fits were of such ferocity and in such numbers that it was impossible for that young girl to have a normal life, but today her life has changed. The prescription from the health board changed not only her life but the lives of her distraught parents. She was in hospital every month and was missing months of schooling at a time, but Sophia’s THC prescription has enabled her to attend school, because the intensity and number of her epileptic seizures has drastically reduced.
I recall the meeting that I had in this House with the then Minister, Mark Field, and Sophia’s mother, Danielle. I have said it before in this House and I will say it again: the Minister was such a help to Danielle, young Sophia and the whole family in moving forward. Ultimately, through Mark Field’s help, the assistance of the health board back home and the Department here, Sophia was able to receive medicinal cannabis and her life changed. That is what I see: I see a real difference in a young girl who was potentially looking at a life that was going to get worse and worse.
I have a wee nephew. I often say this, and I say it with regret because medicinal cannabis was neither available at that time nor did I have knowledge of it. My sister, Joy, has one child. He has epileptic fits. I often wonder whether, if he had had access to medicinal cannabis, it would have been possible to have changed his life. I am not saying that would have been the case, but now it is too late, because he has had so many years with the condition that it is impossible to put his life back.
Sophia still needs 24-hour care, but she can also live a life with her family. It did my heart glad to see her travel, as she did just last year with her family to Disneyland Paris. The family always bring their pictures in to encourage me; it is good to see her progress through the pictures. I saw a picture of Princess Belle dancing with Sophia. That would not have been possible without the blood, sweat and tears, the dedication and commitment, of her mum and dad, who did not cease until their daughter got the medication—they would do anything for their child, as parents do; and how right they are—or without the Health Minister at the time, Mark Field. Nor would it have been possible without the will of this House to take steps to provide for the safe classification of this drug for medicinal purposes.
While I celebrate Sophia’s victory, I also support my colleagues in trying to secure access for more children like her. That is why I am here today. When I saw the title of the debate, I automatically said to Naomi, my speechwriter, “I’ve got to be here for this debate—it’s important to me.” I have seen first hand the improvement to Sophia’s quality of life, and I want more people to be able to access this treatment for that purpose. I want to clarify: I am not looking for a free-for-all—and I do not think the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale is either, by the way. I want a process that allocates the drug in specific circumstances, as directed by the Health Department. I do not think we are currently there.
There are so many companies that are investing in cannabis plant products for healthcare, because the benefits for those it works for are incredible. We know that the UK is the world’s biggest producer and exporter of legal cannabis for medical and scientific purposes. Globally, there is a rising trend in the legal production and use of cannabis for medicinal and scientific purposes. Jazz Pharmaceuticals has offices in Oxford, Cambridge and London, and manufactures the products Epidyolex and Sativex, and Target Healthcare makes certain bedrocan cannabis oils in the UK. In 2019, a major US cannabis company set up its European headquarters in—guess where?—Belfast. Colorado-based Mile High Labs, which is the largest extractor of cannabidiol isolate in the world, established its base on the Boucher Road in Belfast, so we have moved forward.
The benefit of medicinal cannabis to individuals and their families, as well as the economic benefit that is starting to arise from it, is reason enough to review the approach. That is what the right hon. Member is asking for, and I support his request. We are talking about allowing wider production and delivery within—ever mindful of what I said earlier—the strictest of frameworks. I will be clear again: I am not in favour of legalised cannabis in any other capacity than GP or consultant-led, and within the strictest medical protocols. But I believe that we can and should provide a safe and effective product to help those who need it for specific reasons within the pro forma.
I again thank the right hon. Member for introducing the debate. Sophia is my example of a young girl who has progressed to the point where she can attend school regularly. I met her at one of the fun days down on the West Winds estate in Newtownards last year. What a difference I can see in that wee girl. The wee girl in the photograph in my office was, at the time, having fits every half an hour or 45 minutes. Today, her and her parents’ lives have changed. In Sophia’s case, medical cannabis gave her a chance to live her best life with a debilitating condition. That is vitally important. I know each one of us in the Chamber wholeheartedly supports that. Can we make someone’s life better? I think we can. Sometimes when we do so, it is such a magnificent occurrence that it leaves a lasting effect on us.
3.24pm
(Kenilworth and Southam) (Con)
It is a pleasure to see you in the Chair, Mr Stringer. I congratulate my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on securing this debate and on the way he opened it. It is of course a pleasure to follow the hon. Member for Strangford (Jim Shannon). I agree entirely that if this were a debate about the wider use of cannabis, about encouraging its use or, worse yet, about its legalisation for recreational use, neither he nor I would be speaking in favour—we would be speaking strongly against. But that is not the debate we are having today. We are talking about the prescription of medical cannabis by doctors for use by patients such as Sophia, the hon. Gentleman’s constituent. I will come on to my own constituent whose involvement in this process leads me to be here.
It is worth recognising that the debate about whether we should prescribe medicinal cannabis medicines to patients who can benefit from them has been resolved. We have had that discussion and, as my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale mentioned, my right hon. Friend the Member for Bromsgrove (Sajid Javid) made that necessary change to the law in November 2018 so that such medicines can be prescribed within the law, and medicinal cannabis was rescheduled under the law to ensure that that was a legitimate process. That was, in my view, entirely the right change to make. I argued for it at the time, and I was involved in that process.
The credit must more substantially go to the family of my constituent Alfie Dingley. Alfie is a young boy whose circumstances are very similar to those of the constituent of the hon. Member for Strangford. He used to have a number of seizures a day of very great severity, and cannabis-based medicine has had a transformational effect on him. As a result, his family campaigned effectively and robustly for the change we have seen, and they deserve huge credit for it. I am delighted that they are here in the Public Gallery today. Alfie’s mother, Hannah Deacon, has been campaigning not just for Alfie’s benefit, but for the benefit of others who can also derive considerable beneficial change from these medicines.
We have already had a change to the law to allow medicinal cannabis to be prescribed and to deliver benefits to patients who can have it, but all of us who thought that that was a good change to make had rather expected that considerably more progress would have been made by now in ensuring that medicinal cannabis products are made available to patients who can benefit from them. It is a matter of profound sadness and regret, and it should be of concern, that only three NHS prescriptions have so far been made for these types of medicines. That cannot be right. I hope my hon. Friend the Minister will recognise that the logic of the legal change made in November 2018 was that we would make these medicines available to those who need them, and we are nowhere near that objective.
As I say, we have crossed the Rubicon. We have made the decision that medicinal cannabis should be made available to those who need it, and it seems to me that we need to follow through on the logic of that decision. The logic of that decision is not just that, in a medical context, we should make these medicines available to those who need them, but that we should also support their provision domestically. Therefore, the debate that we are having this afternoon, at the instigation of my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale, is about ensuring that the logic of our decisions is followed through, and that the UK economy can derive the necessary benefit from those sensible decisions.
We know that medicinal cannabis will be produced somewhere, and of course we must want it to be in order to have those products available for prescription within the NHS and the broader healthcare architecture. Why, then, would we not encourage the production of medicinal cannabis in this country, so that there can be a direct domestic financial benefit from it? It simply makes no sense to create a demand and then refuse to allow our domestic producers to meet it, and instead to import all the products.
Doing that is not just a wasted economic opportunity, but has a direct healthcare effect. That is why it is of benefit that my hon. Friend the Minister is answering this debate. If we were talking to a Minister from the Department for Environment, Food and Rural Affairs, we could talk about the benefits that these crops bring in an sense. If we were talking to a Business Minister, we could talk more about the direct financial benefits that have been mentioned. However, since a Health Minister is here, we can also talk about the direct benefits of a more secure supply chain to those receiving these medicines.
This is not just a theoretical concern. Alfie Dingley and his family had periods of intense worry during the Brexit process. They were concerned about the security of supply of what Alfie needed, which at that point was coming from the Netherlands. The potential disruption of that supply was evident. I put on record my thanks to the Minister’s predecessors, who were able to intervene and ensure some security of supply. However, that took up a good deal of ministerial time, because we were seeking to secure supply from overseas, when we could have so much more easily had that supply domestically. This is not just an economic argument, although I support the points made by my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale about the economic benefits. There is a direct healthcare benefit to ensuring that we have a domestic supply of these products.
I support the arguments made by my right hon. Friend and the hon. Member for Strangford. It is sensible to follow through on the logic of the decisions that we have—in my view, rightly—already made. We must therefore support domestic supply and address the bureaucratic obstacles in the way of securing that supply, which my right hon. Friend rightly described. I hope the Minister will reassure us that he and colleagues in other Departments will be able to work together to achieve that security of supply and those financial and economic benefits. Most importantly, patients who benefit from these medicines should not just receive them by prescription, but bereassured that their future and their supply is secure because we have developed a sustainable domestic industry in the production of medicinal cannabis.
3.32pm
I congratulate the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on bringing forward this debate. I put on record that I am a trustee of the charity Intractable Epilepsy, whose aim is to raise money to fund the purchase of medical cannabis for children with intractable epilepsy. Details are contained in the Register of Members’ Financial Interests.
It is appropriate that this debate is being held on 20 April. I wish a happy 4/20 to everyone—some people know what I am talking about. In March 2019, the then Health Secretary, the right hon. Member for West Suffolk (Matt Hancock), reassured parents of children living with life-threatening epilepsy when he said that medical cannabis would be made available on the NHS. Of course, that never happened. Instead, he threw the problem over the wall and left the health professionals to deal with it, and they have not.
I think I have raised the issue of the provision of medical cannabis 36 times in this place. Every time, the UK Government have ignored my plea and reverted to their default position of “cannabis is bad”. Their lack of knowledge is evident in the way that they confuse synthetics such as Spice and Mamba with marijuana. That is the background against which parents and guardians have constantly lobbied the UK Government to provide medical cannabis on the NHS. I have tried to support them as best I can.
Clearly, we were wrong in our approach, and I apologise to those children and their parents for my shortcomings. I appealed to the moral or ethical need. I appealed to the compassion that this Government repeatedly tell us they have. I have found today that what I should have done is make the economic argument instead, as the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale has done. The UK Government have ignored the parents struggling to raise the thousands of pounds required just to keep their kids alive, but once we start highlighting the potential for making money, their ears prick up. I am not criticising the right hon. Member; if that is what it takes to get the Government to engage, then so be it, because engage they must. People are suffering needlessly.
I went to great lengths in my Budget speech to highlight the benefits to the UK Government of supporting the hemp industry. Much of the argument about medical cannabis is the same, because it is the same plant that we are trying to grow. The UK Government’s insistence that cannabis is a class B drug under the Misuse of Drugs Act 1971 and in schedule 1 to the Misuse of Drugs Regulations 2001, and that all varieties are treated the same, means that we fail to understand that cannabis is a very complex plant with over 483 compounds. Because of the UK Government’s bias and ignorance, they have turned their back on the plant’s potential and known benefits.
In fact, the hemp plant has over 50,000 uses, and medical cannabis is only one. Finding markets for hemp would not be a problem. I allow myself the indulgence of reminding us all of some of those uses. It is estimated that a medium-sized economically viable establishment
would employ 120 people. When hemp was widely grown back in the 16th century, in the enlightened days of King Henry VIII, it was used to manufacture rope and canvas for the King’s Navy, but we now know that we can make clothing, shoes, biodegradable plastic, insulation panels, food, paper, biofuels and medicine. Those products will sell and be profitable, and the Government could reap the benefits.
But the benefits do not end there. Hemp absorbs 22 tonnes per hectare of atmospheric carbon during its four-month growing cycle. Hemp produces four times the biomass of the same sized area of forest, which makes it a far more sustainable source of material. Hemp does not need pesticides, insecticides or fertiliser to grow in the UK. Hemp has natural anti-microbial properties, so it passively cleans the air in buildings. Hemp has a high capacity for moisture absorption, which allows for controlled atmospheres in buildings. Hemp construction materials act as a long-term carbon sink. One £60 million investment would create a facility that is capable of growing 32,000 acres per year. That would sequester over 207,000 tonnes of CO2 per annum. That is the CO2 photosynthesised by the hemp in its four-month growth and does not include the carbon sequestered into the soil or the net effect of replacing high embodied carbon products from international supply chains and their emissions.
As a wee bonus, hemp regenerates the soil that it grows in, so it would work well in crop rotation. It increases winter wheat and spring barley yields by 16% to 18% when they follow hemp in rotation. It cleans groundwater, by which I mean that it has a deep root mass that absorbs residual pesticides and insecticides from the soil, which prevents run-off into streams and rivers, and therefore avoids costly remediation by the water companies to achieve UK drinking water standards. The barrier to this industry raising the funding it requires is licensing. This is the licensing problem that, as far as I am aware, Hilltop Leaf, the company mentioned by the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale, is currently banging its head against. Hilltop Leaf wants to grow and expand. It has built the facility, but it cannot get a licence from the UK Government to allow it to expand.
The problem with licensing is the categorisation of cannabis. To make the cannabis industry a success, the Government have only to open their mind to the reality of what it is and distribute the appropriate licences to the appropriate growers. That will be possible only if cannabis is re-categorised. I welcome everything and anything that encourages the provision of medical cannabis, but the UK’s Government’s knowledge has to increase if they are truly to capitalise on the hemp plant and provide the good outcomes that are available. I would prefer the UK Government to come to the table driven by a desire to provide medicine for people suffering from a range of conditions—and we will need a supply chain from private companies to do that—but if they are drawn closer by the lure of tax revenue, so be it. But we cannot wait any longer. The patients who require medical cannabis to help them towards better lives have waited far too long for this Government to recognise their needs and act accordingly.
Finally, the argument that we need more research is no longer viable. The argument that cannabis is bad and that we cannot countenance its use is misplaced. Rather than standing on the sidelines shuffling their feet, it is
now time for the UK Government to be proactive in funding and promoting the growth of the feedstock, the academic research and the production of the medicines, in providing and promoting the necessary training for GPs to allow them to prescribe, and in ensuring that the legal framework exists to allow those in the medical profession to carry out their duties, while protecting them and their patients, which by my reckoning would mean the involvement of the Department for Environment, Food and Rural Affairs, the Department for Business, the Home Office, the Department of Health and Social Care and—as there is no show without Punch—the Treasury. Minister, it is time to go to work.
3.40pm
It is a pleasure to serve under your chairmanship, Mr Stringer, and to be present for this debate. I take what the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) said about it being in a late slot on a Thursday, but it is an important debate, and I am pleased that we have had time for contributions.
The right hon. Gentleman clearly outlined the case for a legitimate industry of the future. He asked the Government for consistency and coherence in their approach to the industry. I wish him luck on getting Government coherence on policy for many nascent industries, but the point was well made about good standards of production and the importance of jobs, particularly in rural economies such as the one he represents.
Many people present—and, on other occasions, many who could not be here this afternoon—have spoken movingly about constituents, as the hon. Member for Strangford (Jim Shannon) did. He spoke about the difference that earlier movement would have made to his nephew.
We welcome the constituents of the right hon. and learned Member for Kenilworth and Southam (Sir Jeremy Wright), who were present to hear the debate, as they have been on many similar occasions over the past few years. He made the sensible point that the 2018 decision logically necessitated action from the Government, and said that the insecure supply chain is worrying for so many families across the country. Having an industry in this country would alleviate that worry.
Finally, we heard from the hon. Member for Inverclyde (Ronnie Cowan), who has raised the issue 36 times. I work well with him on Committees, and he is a persistent campaigner on this and many other subjects, so I suspect he will be here for a 37th and a 38th time as well. He has done a huge amount of work in the area. He took us on a trip into history, and spoke about the importance of many such plants to the wider economy, and on the need for the Government to have more knowledge when it comes to the logic of their decision making on supporting the industry.
This debate is about the economy, and points have been made well. As we have a Health Minister present, however, it is worth recapping why we have not made greater progress since 2018, in particular for those campaigners who worked so hard. Despite that 2018 decision, the trials and clinical research that would help the wider industry have moved at a glacial pace, so across the NHS, since 2018 only five people have been prescribed medical cannabis. That is ridiculously slow, and so many people have to go private.
Five years later, it is totally unacceptable that so little progress has been made. It would be helpful if the Minister could set out what steps he is taking to empower and accelerate research in this space. I hope he will not dodge the question by saying that the issue is simply one for clinicians. The Government have a responsibility—the Minister is nodding, and we await his reply with interest, but there seems to be a lack of urgency on the issue, which is concerning. People are suffering right now. We have heard again this afternoon about children who are fitting, sometimes 100 times or more. Accessing care is, in some cases, pushing families to the brink of destitution. We should do everything we can to support those people.
If research is needed before clinicians feel comfortable prescribing, then it is incumbent on the Government to support clinicians. We need more streamlined clinical trials and better engagement with clinicians. We do not want to be back here in another two years, having a rerun of this debate. In 2020-21, the then Minister said:
“It will take time to generate further evidence and see the results of clinical trials. The Health Secretary and I are committed to doing everything in our power to accelerate this work.”—[Official Report, 4 November 2021; Vol. 702, c. 1120.]
If the Minister could update us on where this work has got to, and whether the Government are any closer to finding a solution, that would be welcomed by people tuning in today, and to the families present.
Finally, I would be grateful if the Minister set out what action he has taken to support people in the system right now—those living in extreme pain who are paying thousands of pounds to access treatment. There is consensus on this issue, as we have heard. The debate has been had and a decision has been made, but we can and should do better. In that spirit of consensus, we would all like to see some progress from the Minister.
3.45pm
The Minister for Health and Secondary Care
It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on securing this important debate, which would be considerably better attended if it was held on any other day, because I know from my inbox and from speaking to Members from across the House that there is considerable interest in this issue.
Although this is the first debate on this important topic that I have responded to as a Health Minister, I know that the House has debated medicinal cannabis at great length in the past, in good, constructive debates. I appreciate the depth of passion that hon. and right hon. Members from across the House have on this issue. I recently met members of the all-party parliamentary group for access to medical cannabis under prescription and, as mentioned by my hon. Friend the Member for Strangford (Jim Shannon), I visited one of Jazz Pharmaceuticals’s sites to learn more about the industry, the applications of its products—the medicines—and the challenges that it faces. I also learned about the huge opportunities for not just UK life sciences and UK plc, but, importantly, our NHS and patients.
I note that the interest from my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale is largely a constituency one; he talked about Hilltop
Leaf. He has long championed investment in Scotland, particularly in rural and remote areas, where it has sometimes been a challenge in the past to attract certain high-skilled jobs. This issue is an example of that—and here, the investment would be accompanied by research capability. My right hon. Friend has eloquently and articulately made his case. I am very much alive to the fact that this is a complex issue, and complex issues rarely have simple solutions. I will try to respond to as many of the points that he and other hon. Members have made in the available time, which is reasonably substantial—in a Westminster Hall debate, it is rare to have more than seven or eight minutes in which to respond.
As my right hon. Friend pointed out, this issue crosses multiple Departments—the Department for Science, Innovation and Technology, the Department of Health and Social Care, the Department for Business and Trade and, vitally, the Home Office, which has been alluded to, and NHS England. There was mention of the calls to grow the UK CBD industry, and hemp farmers’ harvests. I am straying somewhat out of my health remit for a moment to polish off some of these points, in so far as I have the bandwidth to do so. I understand that the Home Office has no plans to permit cannabis cultivation without a licence—my right hon. Friend pointed to the licensing programme and the challenges thereto—or to remove the distinction between the industrial hemp regime and the standard cannabis cultivation regime. I cannot say anything more specific on that. As I hope my right hon. Friend will agree, it is well outside my area of knowledge and expertise, and my brief. However, I do understand, having done some rudimentary research and obviously from my conversations with Jazz Pharmaceuticals, that this relates to plants being grown outside versus inside, and the use of leaves and flowers specifically.
If the Minister is struggling to understand, I am more than happy to give him a copy of the report by the all-party parliamentary group on industrial hemp and CBD products called “A Plan for a Legal and Regulated UK Hemp and Cannabis Sector”.
I thank the hon. Member for that; I will gladly take a copy on the way out. I hope he will excuse the fact that I am not an expert in this field, but I will happily take that report as my weekend reading and read up on the subject. I certainly agree to take this up with my counterpart in the Home Office, as my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale requested, and I am sure he will, too. I will especially take away my right hon. Friend’s important points on licensing, and on how the Government can support companies that want to invest in the UK, or that are here and want to diversify their agricultural business, and want to get the licences required to grow these products.
All of us understand that the Minister does not speak for each of the Government Departments responsible for this area, and I know he will take away from this debate that nobody is arguing that there should not be licensing of this process. There are obvious concerns that need to be met by regulatory intervention. The concern is the fragmentation of the regulatory landscape that applies to those seeking to grow these products. I am sure that the Minister can assist us by helping to better co-ordinate the way in which regulation is applied, as we are not seeking a removal of licensing.
I thank my right hon. and learned Friend for his intervention. I think we are probably in violent agreement on this point. I cannot specifically speak to regulation or licensing from a Home Office perspective. We are talking about a controlled drug; that may come as a disappointment to the hon. Member for Inverclyde, but it is—and is likely to remain, I hasten to add—a controlled drug. I will turn later to regulation from the perspective of the Department of Health and Social Care, but it is really important that there be consistency and coherence, and that we treat these products as we would any other medicinal product. However, my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale makes his point well, and I will raise it with Home Office colleagues.
More broadly on growing a UK CBD industry, I am of course aware of the growing consumer CBD wellness market. One only has to walk down any high street to see CBD products advertised in windows, and indeed in major supermarkets. DEFRA, which I did not mention, and the Food Standards Agency are taking action to regulate this side of the market. Importantly, that will protect consumers by ensuring that only safe, high-quality products are placed on the market. That is vital. Consumers will also be protected against misleading health claims. I was recently told about CBD products that come in aluminium cans, but in fact the CBD remains on the aluminium and is not contained in the product. That is just one example. This is a very complex area that I do not want to delve too much into, as it is very much a DEFRA and Food Standards Agency lead.
The Food Standards Agency is working closely with the Home Office on how CBD products are regulated, considering their composition and the possible presence of a controlled substance. This is very much a live issue, and I am told that the Home Office has sought the advice of the Advisory Council on the Misuse of Drugs. I understand that the Government intend to respond to the ACMD recommendations on this matter shortly.
My right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale and my right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright) both raised a point about regulatory barriers. Not that this reminder is needed, but it is perhaps helpful if I remind the House that cannabis- based medicines are controlled drugs and are therefore regulated by the Home Office, which is responsible for all controlled drug regulation legislation. Then there is the controlled drugs licensing regime, which supports cultivation, research and, where the issue crosses over into the health sphere, clinical trials in the UK. This licensing regime enables the possession, supply, production and import and export of those controlled drugs to support industry, pharmaceutical research and healthcare. However, more and more these products are being grown in the UK, including Jazz Pharmaceuticals, for use in research.
This time, when the ACMD makes recommendations to the Government, will the Government acknowledge and accept them? They have knocked back its recommendations a couple of times in the past, most recently over nitrous oxide.
The hon. Member tempts me—it is always tempting—to respond on behalf of another Government Department and Minister. I mentioned that because it is my understanding that the Government intend to respond to the report and the recommendations. I am not the responsible Minister, so it would not be appropriate to comment, but I will gladly point the hon. Member in the direction of the Home Office Minister who will have responsibility for responding, and will ensure that he has the opportunity to have a conversation with them.
The point I was making is that the overall legislative framework on illicit drugs seeks to control harmful substances while enabling appropriate access to those drugs for legitimate medicinal research and, in exceptional cases, for industrial purposes. The example I touched on is Jazz Pharmaceuticals, which—I do not believe this is a secret—is providing a product for clinical trials here in the United Kingdom. That is something that I think we all welcome. I know that the legislation has recently been reviewed by the independent ACMD, which concluded that no legislative amendments are currently required, as there is not yet sufficient evidence that the law needs amending.
Turning to a key point of the debate—cannabis for medicinal use, which falls firmly within my sphere of influence—I am hugely moved by so many of the cases that I have heard about, and I will come back to the specific cases that right hon. and hon. Members have raised today. These are really difficult, because my overriding priority as a Health Minister must always be to ensure that patients have access to medicines that are proven to be safe and effective. That is the biggest challenge, and it is why I am committed—the hon. Member for Bristol South (Karin Smyth) rightly challenged me on this—to galvanising research in this area; that is key to unlocking so much of this debate.
The prospect of a future in which more licensed— I put the emphasis on “licensed”—cannabis-based products that are proven to be safe and effective can be prescribed on our NHS to help relieve suffering is genuinely exciting. That is where I desperately want us to get to as quickly as possible, but herein lies the problem. There are clinical concerns, which, having spoken to clinicians, I share, about the limited evidence on the safety and efficacy of unlicensed cannabis-based products. Only in a few cases have enough clinical trials been done to prove scientifically that the drug is safe and effective. However—I want to labour this point—progress is being made.
Let me turn to the cases of Sophia and Alfie, which were raised by the hon. Member for Strangford and my right hon. and learned Friend the Member for Kenilworth and Southam. I have two young children and am deeply moved by these stories. The debate around medicinal cannabis often centres on children with difficult-to-treat epilepsy, for whom I think the law was changed under my right hon. Friend the Member for Bromsgrove (Sajid Javid), when prescribing was made legal in November 2018. Of course, as right hon. and hon. Members have pointed out, that was to enable those children to access a product that their families believed would ease the symptoms of their desperately difficult-to-treat conditions, if a prescriber deemed it clinically appropriate.
I know acutely, because I have spoken to campaigners and members of the all-party parliamentary group, that there is disappointment that the law change did not relate to routinely being able to get these products, funded, on the NHS; that is rightly governed by a range of processes and procedures, to ensure the equitable distribution of funding. The NHS prioritises medicines that have proven their safety, quality, efficacy and cost effectiveness. Coming back to the heart of the issue—the hon. Member for Bristol South is right to push me on this—that is why research is absolutely essential, and I will talk about that a bit more in a moment. The Government have done all we can to remove legislative barriers, but it is now largely up to the cannabis industry to prove that its products are safe and effective for children.
What you are saying is that if I can afford to pay for a private prescription, I can access medicine that you are saying is not proven to be effective, because you are not going to allow its use on the NHS; it has to pass other tests. What about bedrocan? That is manufactured in the United Kingdom, so we do not have to import cannabis from the Netherlands anymore. Hilltop Leaf wants to grow and help to produce the product. The supply chain is already there for us, but you will not allow it to be prescribed. You will not train GPs, and you will not give them the legal framework to work in so that they can actually prescribe that for children on the NHS, but if I can afford to buy it privately, I can buy it privately.
The hon. Gentleman raises a fair point, but he raises it as if this is something new or novel; it is not. All medicines in this country are either unlicensed or licensed. For use and prescription in the NHS, they need to be licensed. That means that they have gone through both the Medicines and Healthcare products Regulatory Agency process and the National Institute for Health and Care Excellence process, which proves that they are safe, effective and—through the NICE element—cost effective. That is the difference here.
The “cost effective” factor relates to NICE. That is the reason I talk about why it is important that the cannabis industry steps up and proves that its products are safe and effective. I did not talk about cost effective; I am talking about safe and effective, because that element is through the MHRA. Let us not forget that many of these cannabis-based companies are multinational; they are not telling me that they cannot afford to go through the same process that any other pharmaceutical company can go through and has done to get their products prescribed through the NHS. Part of it is research and part of it is those companies stepping up and proving that their products are safe and effective for these children, more generally, through the MHRA process.
I am curious. What we have done is—
Order. Can the hon. Gentleman return to parliamentary language in this intervention? I am not participating in this debate at all. The hon. Gentleman referred to “you” in his last intervention, so I would be grateful if he could return to normal language.
The Minister is saying that he is allowing a licence for a product to be manufactured in the United Kingdom, in East Kilbride, so that is okay. We are allowing it to be manufactured here in the United Kingdom—that is all right. We are saying that people cannot get it on the NHS, but it is okay for other people to have it. Surely it has passed all the tests that we need it to.
I do not want to labour the point, but the point is that it has not passed those tests. It is either a licensed product or an unlicensed product. To be licensed, a product must go through the MHRA process. That is something that these products have not done to date. Yes, they can be manufactured here and prescribed privately, at the risk of the doctor—the private general practitioner—but for a product to be prescribed on the NHS, it needs MHRA and NICE approval.
There are some exceptions to that, because the law was changed in 2018, as my right hon. and learned Friend the Member for Kenilworth and Southam referred to, for a specialist doctor or for some very specific conditions. He asked why there have been only three prescriptions. I did not know that that was the exact figure, but I will check; regardless, it sounds very low. I suspect that the reason is that the decisions are taken at the doctor’s own risk, and among general practitioners there is reticence to prescribe an unlicensed product that has not gone through the MHRA and NICE process.
The Minister is probably right, but I am sure that when he looks at this again he will also want to look at the NICE guidelines that apply, which are extremely restrictive. The risk to an individual doctor from making a decision to prescribe will be perceived to be much higher if the NICE guidelines appear to deter such a prescription. The Minister is right that there are many elements to this, but one of them is how much we encourage doctors to believe that this is the right thing to do. I go back to the point that I was making: there is some logical dissonance here. We have said already that it is right to reschedule these products as far as the Home Office is concerned. We are starting to see prescriptions in the NHS, but not in the numbers that will benefit the maximum number of patients.
Order. We have not been short of time this afternoon, and every hon. Member has had the opportunity to speak. Interventions should be brief and to the point.
Thank you, Mr Stringer. My right hon. and learned Friend makes a good point. When we meet the members of the APPG, it is very hard not to be moved and to want to do all in our power to bring about the change that people want to see. I have considered the calls to change NICE guidelines, which have recently reviewed the basis of these products, but I am afraid the guidelines are unlikely to change until the evidence base develops, and that will happen through clinical trials and evidence. That is why I say all roads lead back to building an evidence base and a clinical trials base. That is the crux of this debate.
In January, the National Institute for Health and Care Research issued guidance recommending that the NHS prescribe cannabidiol to patients with a rare, seizure-causing genetic disorder, which is, I think, the fifth condition for which a cannabis-based treatment has been approved by regulators and offered to NHS patients in England. I understand that the treatment is also available and approved in Scotland and Northern Ireland. The NHS now funds thousands of these medicines each year.
I mentioned Jazz Pharmaceuticals earlier. I am not sponsored by it; it just happens to be the manufacturer and provider that I visited. It is a good example of the trailblazers in this space that not only create, but undertake the research, manufacturing and—the key part—licensing of cannabis-based medicines. It has shown what can be done. The key is very much in the research.
My right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale mentioned consistency and coherence in policy, which is why it is key that we treat cannabis-based products as we would any other medicinal product that we wanted to prescribe on our NHS. There is an economic case as well, although that is not what drives the Government. My whole focus in this is what is right for our NHS and patients. I am aware that there is huge hope and patient demand for access to medicinal cannabis, and that it is claimed that it can help with an array of medical conditions from chronic pain to anxiety; I believe there is also research under way at the moment on how cannabis-based products might be able to help with psychosis. I very much hope that those trials are successful. That is the right approach.
To date, much of the evidence suggesting cannabis could be an effective medical treatment is anecdotal or observational. As I mentioned earlier, only for a handful of conditions have enough clinical trials been done to prove scientifically that the drug is safe and effective. However, I am acutely aware that there are thousands of patients who now pay to access those unlicensed products on private prescriptions. Having spoken with campaigners and members of the APPG, I also know that some patients believe that funding cannabis on the NHS will reduce overall healthcare costs by alleviating symptoms and reducing the extent of hospital visits and other treatments. I understand and hear that case, but—I apologise for labouring the point; I have to keep coming back to it—before any new medicine can be proven to be cost effective, it must be proven to be safe and clinically effective. That is why research is so essential.
The Labour Front-Bench spokesperson, the hon. Member for Bristol South, asked what steps we are taking. That is a challenging question, because it is a pioneering area of research. Following collaborative work with clinicians and patient representatives, the NIHR and NHS England have confirmed support for two clinical trials into early onset and genetic generalised epilepsy. If you will permit me, Mr Stringer, I would love to use this debate to highlight a tender opportunity that will be launched by University College London in the next few weeks. UCL is seeking a supplier to assist in a world-first randomised control trial comparing cannabis-based medicines containing CBD and THC in the treatment of drug-resistant epilepsies in adults and children. I hope that that tender process is successful and that UCL finds a commercial partner to supply products for the trials so that they can commence as soon as possible.
I have three kids and two grandkids. If one of them was suffering from intractable epilepsy and I had them on bedrocan, and they were either seizure-free or had the condition under control, I would not want to hand them over to a random control test where they might be fed a placebo and therefore incur more damage. Would the Minister?
That is a difficult question to answer. We need people to take part in clinical trials, which are the answer to so many of the challenges that we face in the health sphere. That is how we build the evidence base. I do not know what the study will involve in terms of the detail and the potential for a placebo, but I will put the hon. Gentleman in touch with UCL and those who are looking to run the trial so that they can give him a measure of comfort and reassurance. On his point more generally, the biggest risk is that the industry does not engage with the tender process. Notwithstanding the hon. Gentleman’s point, I hope that all right hon. and hon. Members here today will help me by amplifying my call for the cannabis industry to come forward and engage with this pioneering and world-first research. I have also committed to a roundtable with the all-party parliamentary group, and I invite all right hon. and hon. Members in the Chamber today to attend that, too, because it is very important that we hear all of the issues.
Once again, I thank my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale for securing this really important debate. I look forward to engaging with him and Members from all parties. To the point made by the hon. Member for Bristol South, I am absolutely committed to better determine why the cannabis industry is not, in the way that so many other pharmaceutical companies do, investing in the routine research required to prove that its products are safe and effective. I will of course explore how best to engage with industry on the issue. Until then, I implore companies to explore supplying their products to the UCL clinical trials. As I have said, they will be a world first and will give us the evidence that we need to determine whether the products should be funded in the NHS. I wish them every success. I genuinely hope that they provide that evidence base.
On the matters concerning the cultivation and licensing of cannabis and cannabis-based products, I will, as I promised my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale, raise that with my counterpart, the Minister for Crime, Policing and Fire, who I know will champion this cause, too. I thank all right hon. and hon. Members for their contributions to this afternoon’s debate.
4.12pm
I feel that we have had a very useful debate. Like you, Mr Stringer, I chair these sittings and it is extremely good to get half an hour from a Minister rather than five minutes. Although it was not necessarily comfortable for him, we were able to cover a lot of ground. Whether deliberately or otherwise, he came back to one of the issues that I raised, which was the need for co-ordination in Government on this issue. The hon. Member for Inverclyde (Ronnie Cowan) read out the list of Government Departments with an interest in this matter, and I am sure there are others that were missed, such as the Cabinet Office and the former bailiwick of my right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright), the Law Officers. There is a need for co-ordination. I do not think the Minister was saying this, but we cannot push back to the industry and say, “Well, actually, it’s your job to co-ordinate all these different bits in Government.” The industry needs to have a clear “in” or conduit to Government to discuss and engage on these issues.
I fully understand, having been a Minister myself, that it is not possible to commit the Home Office—of all Departments, it is certainly not possible to commit the Home Office. We know how government operates, but we need to have a co-ordinated approach with which the industry can engage. Of course the Minister is right that this should not be economically driven in terms of the clinical decisions, but we have already made the decision, as my right hon. and learned Friend said. We are not debating whether this should be done; that decision has been made, and now we want to do it on a basis that benefits not only the patients, but the economy of the United Kingdom.
It is always poignant to hear individual examples. In any debate in which he participates, the hon. Member for Strangford (Jim Shannon) is particularly good at bringing the discussion down to the personal level of individual examples, and I thank him for doing that today, as I do my right hon. and learned Friend the Member for Kenilworth and Southam. I have had the pleasure of meeting Alfie’s mother in my constituency. She is a very powerful advocate, but I do not believe, or
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think that anybody who has taken part in this debate believes, that the pain and suffering of anybody should be the requirement for us to do the right thing.
I was remiss in my opening remarks in not referencing the APPG, because I have engaged with it and particularly the hon. Members for Gower (Tonia Antoniazzi) and for Edinburgh West (Christine Jardine), who are also strong advocates on these matters.
Although I did not agree with everything that the hon. Member for Inverclyde said, which is often the case, what I did admire particularly was his passion for this subject, which came across clearly. It is shared by many hon. Members across the House.
I welcome the opportunity that we have had to air the issues, and the Minister’s full and well intentioned response, but we need to see action. I reiterate that the principal ask is for co-ordination within Government to take this forward. We are not requiring those in the industry and those lobbying for patient interests to manage the process across a wide range of Departments. That is one doable ask that could flow from today’s debate, and I hope that it will.
Question put and agreed to.
Resolved,
That this House has considered the economic contribution of medicinal cannabis.
