Medicinal Cannabis

13:30:00

I beg to move, That this House has considered medicinal cannabis. I invite Members to consider the benefits of medicinal cannabis, and I will address the challenges facing patients across the country. It is a pleasure to serve under your chairship, Ms McVey; I always appreciate the opportunity to do so, and it is good to see you in your place. It is also a pleasure to see other hon. Members in the Chamber for the debate. I look forward very much to the contribution from the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), and particularly to hearing from the Minister. I know that this issue is not the Minister’s responsibility, but she always does her best to answer our queries. I spoke to her before the debate, and there are some things I want to ask her for, if that is all right. I have been interested in this issue for many years, and I thank the Backbench Business Committee for granting this debate. Many Members will have been introduced to the issue of medicinal cannabis by constituents who got in contact with them. In a way, it is a bit of a niche debate, and those Members who are here have specific asks. The right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) has been a stalwart on this issue over the years. I am pleased to see him here to provide support, and he will probably ask the more difficult questions, given his particular knowledge. Many Members will have been told by their constituents about the real difference medicinal cannabis has made, or could make, to their lives or those of their families. I asked a former Conservative Minister, Nick Hurd, for a meeting about a constituent some years ago, which he very kindly granted. I asked, “Would it be okay if I brought over the mother of Sophia, the young girl we are trying to help?” I knew that if I brought Danielle over —formidable lady that she is—she would be much more able to push the case, and of course she did. In all fairness to the Minister, he was impressed by her commitment on behalf of Sophia. In my office, I have a picture of that wee girl when she was a five or six-year-old. At that age, she was having multiple seizures, but through the Minister here and back home, she was allocated medicinal cannabis. Her seizures, which happened multiple times every day, have been reduced to either none in a day or just one. If that is not an evidential base to prove the case for medicinal cannabis, I would like to know what is. That campaign is one that I have been wholeheartedly behind. Sophia Gibson’s mum and dad told me about the needs of their beautiful daughter, and I was absolutely won over to the fight for medicinal cannabis for very defined purposes. I have fought hard for Sophia and those like her. Sophia’s mum and dad have sent me some information that is relevant to this issue, which I will quote for the record. Sophia was six when we first met, but she is now 13, and everyone involved in her care agrees that “this is the most stable she has ever been”— that is what her neurologist and paediatrician said at the last appointment Sophia had just before Christmas. Her school principal described the change Sophia has experienced since receiving this medicine, saying: “I remember the times poor Sophia had a seizure and we were waiting on ambulances”— that was when she was five or six, and I remember that. But her principal went on to say: “what a change it has been for her in school since the medicine.” Sophia’s mum says: “with less seizures Sophia’s skills are growing and even her speech therapist and physio have said she’s doing really well all thanks to wholeplant medicinal cannabis.” Now Sophia has reached her 13th birthday, and I put on my record my thanks to the former Minister for that. He got that medication prescribed for my constituent Sophia—Danielle and Darren’s young girl. The legislation on medicinal cannabis in 2018 was a significant step forward for patients, as it ended the potential criminalisation of those living with, or just trying to manage, chronic conditions, but access to medicinal cannabis remains limited. There is compelling evidence that it can improve the quality of life of individuals with chronic conditions, including neurological disorders such as Parkinson’s, attention deficit hyperactivity disorder, epilepsy and multiple sclerosis. However, since medicinal cannabis was made legal, only five patients have been prescribed it on the NHS. I was pleased that young Sophia was one of them, and although she is undoubtedly not a well child, her parents believe that medicinal cannabis has played a part in her still being with them to brighten their days with her smile and her infectious joy. I know young Sophia personally, and I can vouch for the difference I have seen between her at the age of five or six and the 13-year-old she is today. Her improvement has brought joy to her parents, and indeed to every one of us who knows her. Her epileptic fits are down to zero, or one and no more, so that treatment really is important. I also wish to bring the case of Ben to hon. Members’ attention. Joanne, his mum, is here on his behalf, and their MP, the hon. Member for South Ribble (Mr Foster), would have been here, but unfortunately he had other engagements. I spoke to the Minister beforehand, so she knows what I am going to ask. The hon. Gentleman is very supportive of Ben, Joanne and her husband, and is keen to help. Young Ben’s story is also incredible, and his mum can vouch for his problems. He was having up to 300 seizures per day. Can you imagine that? That wee boy was having seizures almost every other minute of the day. His parents are providing the medication themselves, but the NHS should be playing that role. It costs the family £2,000 a month, but they love their child and will do anything to help him. To get the correct medication, people have to go through trials, and Joanne told me that Ben had failed 14 medications. The NHS says that if someone fails seven medications, they go directly on to medicinal cannabis. For the life of me, I cannot understand why that has not happened for young Ben. I ask the Minister whether it would be possible for her to meet Joanne and her MP, so that Joanne can put forward her case and find out why medicinal cannabis has not been approved for that wee boy. Today, I saw a quick video of Ben when he was having all those problems and showing what he can do when he has access to medicinal cannabis. If ever we needed straightforward evidence that looks us straight in the eye, it is that. These exceptional circumstances require exceptional assistance. Ben has now had a 98% reduction in seizures, because his mum and dad are paying for the medicinal cannabis, even though they should qualify for it. There seem to be some problems, so I ask the Minister to please meet the parents and their MP, so that they can make that case. I want to put that on the record for Joanne. There is compelling evidence that medicinal cannabis can improve quality of life. The state of legality, but inaccessibility, is incredibly difficult for clinicians, who believe that their patients merit additional help. Subsequently, patients are not being given the proper care, because of challenges including a lack of awareness of the legislation and poor signposting of the treatments. It is incredibly hard to comprehend why we cannot get everyone on a pathway to better care. But when you meet the mums and dads and some of the children that I and other Members have met, you can understand the alternative and what it means. A recent survey of 250 practising doctors by Alternaleaf —some of its staff are here in the audience today as well—found overwhelming support for widening the accessibility of medicinal cannabis to treat chronic pain. It found that 84% of UK doctors—the figures are massive —said they would be open to prescribing medicinal cannabis to manage chronic pain if it were part of the NHS toolkit. I welcome the commitment from the Government and the Secretary of State, who told us in the main Chamber that £26 billion will be available for the NHS over the next few years. That is a good plan, and everybody, no matter their political persuasion, will welcome it, but we need to see some of that going towards this critical issue. Alternaleaf patients rated the effectiveness of medicinal cannabis to be 8.5 out of 10, versus only 4.5 out of 10 for traditional medication prescribed on the NHS. We are not being critical, but we are pointing to the facts —the evidence is there. If it is better to have medicinal cannabis, let us have it if the alternative is not as effective. Unlike many conventional painkillers, medicinal cannabis offers relief from symptoms without the high risk of dependency, overdose or debilitating side effects. Only 17% of Alternaleaf patients reported side effects from medicinal cannabis that affected their personal or work life, versus 88% for medication prescribed by the NHS. So there is a case to be made, and there are answers to be given. Although private specialist clinics and pharmacies such as Alternaleaf support thousands of patients across the UK, they often receive conflicting guidance from regulators on product labelling, which can impact the availability of medicines for the patients who may benefit the most. We are here to raise awareness of that and to put the case for all those patients who might benefit most. The UK has one of the strictest regulatory regimes in the world for the prescribing of medicinal cannabis, and I agree that that must be the case—that is not an issue. But if there is evidence that medicinal cannabis can do good, then let us act on it. The regime includes a prohibition against prescriptions being issued electronically to patients. However, we must allow doctors to access medicinal cannabis for their patients in the same way that we allow them to access opioids for them—under strict and certain circumstances. There are rules in place, and I understand that. I challenge the suggestion that electronic prescribing is always unsafe; it is not. Physical prescriptions are understandably at risk of being lost, damaged or destroyed, whereas electronic records can permit greater real-time oversight and control of prescribing practices, both by private clinics and by regulatory bodies such as the Care Quality Commission. The reason I believe that that could be done electronically is that controlled drugs such as morphine are routinely prescribed electronically on the NHS. If we can do it for morphine, we can do it for medicinal cannabis. That is my point. And it can work as well, which is more important. However, there must be strict measures in place to ensure that electronic prescription can never be a route to simply legalising cannabis in general. I am not pro drugs in any way, but I see the goodness and benefits of medicinal cannabis. That is why we are here: to prove that case and to put forward the evidential base. Although the benefit of medicinal cannabis to individuals and their families, as well as the economic benefit that is starting to arise, is reason enough to review the current approach and address the challenges, this is absolutely not a call to legalise cannabis wholesale, in the same way that we could never consider wholesale opioid legalisation. Medicinal cannabis has offered a lifeline to another of constituents, Richard Barber. He spent years struggling with chronic conditions. Initially, an injury led to a misdiagnosed shoulder condition, which resulted in prescribed painkillers that not only proved ineffective, but caused distressing side effects, such as night terrors. Those things cannot be ignored either. After extensive research, Richard discussed medicinal cannabis with his GP. After trying three different pain medications without success, his GP suggested exploring medicinal cannabis as an alternative treatment approach. Richard was prescribed medicinal cannabis through Alternaleaf and the results have been transformative for his condition. He has regained the ability to do the little things that people take for granted, such as going to the shops and walking his dogs, which he was unable to do in the past due to mobility issues, pain and seizures. Richard’s story highlights some of the challenges that patients across the UK are facing. When Richard was first prescribed medicinal cannabis, he got in touch with his local police force—that is the right thing to do—to ensure that it was aware of the legality, yet the officers had never been informed about legal medicinal cannabis prescriptions. In fact, one in five police officers does not know that medicinal cannabis is legal and 89% of police officers say that they would benefit from more training on medicinal cannabis. That is not the Minister’s responsibility, but there is a role for another Government Department to look at that. That lack of awareness can manifest in patients being challenged in public when using legal products to manage their conditions, causing unnecessary distress to those in receipt of medicinal cannabis for a medical reason. Patients are also finding that their landlords are unaware that medicinal cannabis is legal, when the Equality Act 2010 mandates that landlords, housing associations and property managers make reasonable adjustments to accommodate tenants’ medical needs, including the use of prescribed medicinal cannabis where appropriate. There are lots of issues, including the need for better awareness among the police and more accessibility for all our constituents across this great United Kingdom of Great Britain and Northern Ireland. This debate is not new. The End Our Pain campaign has presented ways forward, and I ask the Minister once again to consider its trials; I am ever mindful that she will be conveying what we are asking for to another Minister. In 2019, the Health and Social Care Committee recommended initiating observational trials for patients already using cannabis-based medicines who cannot enter the randomised controlled trials. That recommendation initially had support from the Government, but that was retracted during the covid-19 pandemic. In 2023, the Home Affairs Committee reaffirmed the need for increased access to these vital treatments. We all understand that there were pressures from all sides during covid-19, but that unfortunate suspension of support threw the trials back a few years. If the Home Affairs Committee reaffirmed that need for increased access in 2023, however, we need to make sure that that happens, and fully. There is a notable precedent from 2013, when the Government granted a licence to GW Pharmaceuticals to supply Epidyolex to a child given only six months to live. These are true stories; I am not making any of them up. That decision not only saved that child’s life, but provided valuable evidence to the National Institute for Health and Care Excellence, highlighting the need for similar decisive action today. The treatments make lives better—they save lives—contribute to easing the pain and suffering of children and adults and give peace of mind to families. End Our Pain proposes two observational trials. The operative word is trial—if they are not suitable, they can and should be shut down. Observational trial 1 would support individuals who are already prescribed medicinal cannabis and cannot undergo a dangerous washout period to enter a traditional RCT trial. Those patients could be funded to provide crucial data on the long-term use of their current and previous cannabis oil medicines. That was the original plan. Observational trial 2 would focus on children in desperate need—just like Sophia, Darren and Danielle’s wee girl, and Ben, the son of Joanne, who is in the Public Gallery. Many families are resorting to the black market due to insufficient private paediatric prescribers and wish to find a regulated, safer option for their children while maintaining their anonymity. EOP has engaged with Melissa Sturgess, the CEO of Ananda Developments, which is willing to supply trial medicines early to those in urgent need—patients who may not survive the wait for trial recruitment to begin in 12 months. I have heard stories of people who are waiting for medicinal cannabis and whose health has been quite severely affected. Perhaps I view things too simply, but if I see a way of doing things, I think that we should just do those things and make a difference. There are patients who may not survive for the trial recruitment to begin in 12 months, for instance. Where will they be in 12 months? Where will their health be in 12 months? It will be worse, so we should be doing something right now. EOP also believes that the data from current full extract prescriptions can be a significant aid in developing future treatments and improving long-term outcomes. It is estimated that the observational trial for those who are currently prescribed cannabis-based medicines but who cannot participate in other trials would cost approximately £2.7 million annually. That figure is based on an estimate of 150 children and young adults participating, with an average cost of £1,500 per patient per month. Given the good that that treatment could do and the difference it could make to people’s lives, that is a small price to pay for improved health for all those children and adults who could have a better life as a result. It is imperative that the commitments to families are honoured, as the consequences of inaction could be devastating for those children. Many of their parents can no longer afford the cost of medication. I have given Members an idea about Joanne, who is here in the Public Gallery on behalf of her boy Ben, and what it costs her to provide the medication each month to ensure that Ben’s life-threatening seizures can be managed. It is really important that we get this matter right. This debate will help to highlight the real impact that medicinal cannabis can have not only on patients and their families but on economic growth and how we can better spend the £26 billion that the Government have allocated for the NHS. It will also highlight how we can ensure that medicinal cannabis can make a difference for young people in my constituency and in Scotland, Wales and England. The Minister is a compassionate and understanding lady and, by her very nature, she wants to make lives better—that is what we are all here for. We beseech our Government and our Minister to make decisions that we can all support. The hon. Member for Mid Dunbartonshire (Susan Murray), the Liberal Democrat spokesperson, told me before the debate that she will also talk about some personal experiences. We express such experiences on behalf of our constituents and others who, when we meet them, make us suddenly realise, “Yes, there is a simple way forward. There is a way that we can do it.” We are also asking for consistency; it should not just be about the postcode that people live in. There has been an allocation of medicinal cannabis, and my constituent is one of those who benefited from that; I believe that others who could benefit should also be allowed to. We need consistency and coherence for the industry and to enable wider access to medicinal cannabis for those who could benefit in certain medically defined circumstances. We need the signposting of treatments, and we need to break down the persistent stigma and discrimination that patients face—perhaps from police, and from employers and landlords. I have taken up enough time, and I am keen to hear the helpful contributions from other hon. Members who are here to back my plea on behalf of my constituents and others. Collectively, the parties can come together and act. We look beseechingly to the Minister and the Government to ensure that the offer of medicinal cannabis can be available for every child and adult in the United Kingdom of Great Britain and Northern Ireland who can benefit from it. If we have a goal and a way of achieving it, the Government might consider that it is cheaper to have medicinal cannabis available on prescription under very strict conditions to make sure that people’s lives are better. If we do that, we will have done a lot.

I remind Members that they need to bob if they wish to be called. I also remind Members that, if they wish to speak, they need to be here for both the opening and closing speeches.

13:54:00

It is a great pleasure to serve under your chairmanship, Ms McVey. I commend the hon. Member for Strangford (Jim Shannon) for bringing forward this debate on an important issue. On the number of Members present, the Thursday afternoon slot in Westminster Hall is challenging because Members often have to return to their constituencies. For people outside who have an interest in this matter, it is very important to convey that there are a large number of Members on both sides of the House who are focused and interested in this subject. I am a member of the all-party parliamentary group for medical cannabis on or under prescription, which is chaired by the hon. Member for Gower (Tonia Antoniazzi). I contributed—as did the hon. Member for Strangford and the Minister as the then Opposition spokesperson—to the last debate that took place on this in Westminster Hall. The hon. Member for Strangford, as is often the case, delivered a tour de force on the issues and concerns, with the appropriate level of compassion and empathy for those who are caught up in this issue and affected by it. I do not want to overly dwell on the issues that he set out, because he did that very well. Medical cannabis is demonstrably a cost-effective way to treat an array of conditions, including childhood epilepsy, to ease the impact of chemotherapy, or to alleviate the stiffness and spasms of multiple sclerosis. There is a strong body of evidence that it could be used for even more conditions, and the hon. Gentleman highlighted the continuing and ongoing need for trials.

The right hon. Gentleman touches on something that piqued my interest in this subject 20 years ago, when my constituent the late Biz Ivol, who was a sufferer from multiple sclerosis, told me that the only relief she got from multiple sclerosis was by her own—shall we say—non-prescribed use of cannabis. She described multiple sclerosis to me as being not just stiffness and spasms, but like somebody was pulling barbed wire down inside her spine. When somebody is feeling that sort of pain and discomfort, surely it is incumbent on us all to find a way, through medicine, to give them some relief if we possibly can.

The right hon. Gentleman makes a very good point. Indeed, over time, I think all of us who have taken an interest in this issue have heard from multiple sclerosis sufferers about the pain and difficulties that they have encountered. It is incumbent on us, those in Government and those in the medical world to do what we can to make sure that that is no longer the case. I want to focus my remarks on the economic case for medical cannabis. I will talk about the contribution that a different and more progressive approach could make to the economies of rural constituencies such as mine—those were some of the points that I touched on in the previous debate—because, at its core, the nascent medical cannabis sector is horticultural in character and is situated in rural and agricultural communities such as the one I represent. In my constituency, I see Hilltop Leaf develop growing and processing facilities that are pristine and equipped with high-tech quantum sensors, microscopes or leaf barometers. It is a stark contrast to the damp tinfoil-wrapped rooms of illegal production, referred to earlier. It is certainly a marked contrast to the circumstances in which some people feel forced to acquire cannabis and the dangers and difficulties that they place themselves in through doing that. As the hon. Member for Strangford said, they do that because they love the person who is suffering. They do not want to see them suffer, and they are willing to take risks and do things that they would not otherwise consider. In that context, it is all the more important that we see the industry—a modern, progressive industry—as a step forward. I enormously support the investment in my constituency. I particularly hope that good horticultural, administrative, managerial and logistics jobs, which will anchor the young people in the constituency, will flow from it; young people all too often feel the need to leave such communities for the want of opportunities. The facilities at Hilltop should also be able to provide some 10% of the UK’s medical cannabis needs. I have hopes that Hilltop can go further still, because the medical cannabis sector could potentially bring more than £1 billion to the UK economy. I do not wish to divert into the Chancellor’s remarks about economic growth, Dame Esther, because we have heard a lot about that in the Chamber. But this industry is there and ready to grow—ready to create wealth and jobs, particularly in some of the most difficult rural environments in the UK. It has been estimated that tens of thousands of good quality jobs could be created if the UK’s regulatory, legal and medical frameworks were in line with norms elsewhere. Sadly, byzantine rules on prescribing and overlapping and onerous regulations are holding the sector back. Medical cannabis was legalised in 2018 by my former colleague Sajid Javid, then the Home Secretary, but it remains unduly difficult to prescribe on the NHS across every part of the United Kingdom. Those in need—we should be clear that this is a matter of need—turn to private medical services, with the huge costs that they bring; the hon. Member for Strangford also highlighted that. They turn to criminals as well. It is absurd to make something of medicinal benefit legal, but for it to be put out of the reach of so many people who need it. The situation has a knock-on effect on the sector. In recent years, we exported 213 tonnes of medical and scientific cannabis of the 329 tonnes produced in the UK. The sector could meet domestic patients’ needs and international demands, but incoherence in regulation and approach is hindering that. That also extends to cannabidiol or CBD, which has many benefits too. It is readily available to purchase on the high street, so much so that the CBD market in the UK is the second largest globally. However, hemp licensing laws mean that the flowers and leaves where CBD is found must be destroyed. Overseas imports then fulfil the needs of the domestic CBD market, and British supply chains do not benefit. Because of that approach, growers have to forsake the opportunity of a crop yielding £10,000 per acre, compared to £400 for wheat. At a time when rural Britain is struggling, such yields would be a real boon and bring income into the pockets of farmers. Patients, producers, taxpayers and even the police, as the hon. Member for Strangford mentioned, could all benefit from unblocking the bottlenecks in prescription and production. As I have said on many occasions, for that to happen the various strands of Government need to be stitched together. Instead of keeping the strange patchwork of overlapping and clashing components, there needs to be a clear policy of supporting the prescription of medical cannabis, and the necessary regulation and official approach that would allow that to happen. The UK Government and, where appropriate, the devolved Administrations should review the prescription process, medical guidelines, acceptable technical levels and the overlapping regulatory and legal regimes. We have debated and discussed this issue many times. I hope that we will see some progress and that we do not have to repeatedly debate an issue to which we should have a common-sense approach. It benefits patients and our economy. It has an adverse effect on criminals. Why would we not do it?

14:06:00

It is a pleasure to see you in the Chair, Ms McVey. Do not worry, I have not defected. I just sat here, rather than where Conservatives would normally sit, because I did not want to interrupt the flow of the hon. Member for Strangford (Jim Shannon) while he was making his speech. I am grateful to him for securing this debate. I am here because of one of my constituents, Matt Hughes, and particularly on behalf of his son, Charlie, who has severe treatment-resistant epilepsy. Mr Hughes has been to see me on a number of occasions. I am in the thick of a correspondence battle with the Department —the latest was in December last year—trying to deal with some of the problems that have arisen out of the 2018 NICE guideline change, which was brought in by Sajid Javid. Somebody looking at the NICE guidelines would think, “Problem solved—wonderful! We can get access to these very important treatments for severely epileptic children.” But we are here today because that access is simply not available in practice. It is no good for us, as policymakers, to think that we have done the job because the policy has changed: if it is not working in practice, there was no point in changing the guidance. There are a huge number of problems. There are licensing issues, to which I will return in more detail. There was the very unhelpful advice given by the British Paediatric Neurology Association in 2021, which seems to directly contravene the advice of NICE from 2018. There are many examples in which general practitioners have thought, after clinical assessment, that this kind of treatment, particularly second-generation drugs, should be supplied and yet local hospital advice was against it. Finally, there is the failure of the funding pathway. We have already heard about individual funding requests, but one problem is that the general application for many children to benefit from this kind of drug means that it fails the exceptionality test, so requests for individual funding are being refused on the grounds that the impact of the drug on the particular patient is insufficiently exceptional.

I thank the hon. Gentleman for coming along. I mentioned Joanne’s son Ben, who has failed 14 medications—the NHS says seven, so it is clear that there are failures in the system. We would think that the NHS should automatically respond, but it has not. That underlines the issue that the hon. Gentleman is raising.

That is the purpose of this debate: to encourage the Minister to get the NHS to change practice in this area. She could usefully start with the difficulty in licensing because second-generation medication is personalised. It does not have one or two active ingredients, but up to 20—that is probably not the right terminology but I hope we all understand—and the amounts of each of those active ingredients are personalised, in a patient-centric way. Yet we persist in applying a randomised controlled trial approach simply not appropriate for personalised medication. As a result, there is a failure to adopt licensing for medication that, anecdotally, is hugely effective, and has been hugely effective in supporting my constituent Charlie. It is not beyond the wit of man to design an appropriate licensing system for this kind of medication because it has been done effectively elsewhere. We could look at the examples of Australia, Canada, the Netherlands, Spain, Portugal, Italy and even some states in the United States of America. If they can do it, why can’t we? I would be grateful if the Minister addressed that question specifically. Why do we persist with randomised control trials when we know that that acts against the adoption of this kind of modern medicine? Why does the Minister think that the licensing approach in all those first-world countries is in some way dangerous or inadequate? Rather than repeating current policy, what change are the Government proposing to make to provide access through licensing for multiple active ingredient patient-centric dosing? What change are they proposing in relation to individual funding requests? Are they prepared to fix the problem of exceptionality, given that these drugs are routinely refused because they help too many children? This is a huge issue. An estimated 35,000 children are affected. I hope the Minister will not dole out sympathy alone in her response, but set out the active change that the Government intend to make.

14:11:00

It is a pleasure to serve under your chairmanship, Ms McVey. It is undeniable that the United Kingdom’s relationship with cannabis remains fundamentally flawed. For too long, our prohibitionist stance has shaped public perception, linking cannabis with criminality instead of recognising its significant therapeutic value. Sometimes those who do recognise its therapeutic value are pushed into criminality. In reality, for many people across the UK, access to cannabis-based medicines can represent the difference between enduring chronic pain or multiple fits and leading a fulfilling life. That discrepancy is central to this debate. Although, in principle, current regulations permit cannabis prescriptions for severe epilepsy, chemotherapy-induced nausea, muscle stiffness or spasms related to multiple sclerosis, genuine accessibility remains elusive. As the hon. Member for Strangford (Jim Shannon) has already mentioned, between 2018 and 2022 fewer than five NHS prescriptions for unlicensed medical cannabis, with the resulting funding issues, were issued, while private providers supplied nearly 90,000. The stark contrast highlights the vast gulf between existing policy intentions and the lived experiences of patients seeking relief. Not only is this situation profoundly unjust for individuals who rely on cannabis to manage debilitating symptoms and have found no alternative, but it also entrenches an inherently two-tier healthcare system. Those with the financial means to travel for specialised appointments and cover private clinical expenses can access treatments that are virtually unobtainable for those who depend entirely on the NHS. While opinions on medical cannabis differ, I am sure we all agree that no one in Britain should be forced to pay exorbitant fees simply to secure a legally sanctioned and potentially life-changing medication. The situation is further compounded by the fact that our outdated perspective on cannabis continues to hold back domestic medical innovation and economic growth. At a time when the Government project a modern vision for the nation, Britain lags behind international counterparts who have embraced a more progressive approach to cannabis-based treatments. By clinging to outdated stigmas, we not only fail our patients but also forgo opportunities to develop a robust medical cannabis sector, stifling both financial potential and essential healthcare advantages. In the light of those realities, we must adopt a more compassionate and patient-centred strategy that does not penalise individuals for their economic circumstances. It is with this in mind that we must launch an investigation into the feasibility of GP prescribing of cannabis-based products, so that crucial treatments reach those who need them quickly. Such measures would reduce reliance on expensive private options, remove inequality and the push towards criminality, and alleviate unnecessary suffering of thousands of people nationwide. Given the clear shortcomings of the current system, my colleagues in the Liberal Democrats and I urge the Government to reform policy in practice around medicinal cannabis across the UK. By doing so, we can ensure that patients receive the care they deserve while fostering a modern healthcare environment that truly reflects Britain’s commitment to innovation, compassion and equity.

14:16:00

I am grateful for the honour of responding for His Majesty’s Opposition in this debate, Ms McVey. I thank the hon. Member for Strangford (Jim Shannon) for his tireless dedication to health issues—not just this one, but many others. In my short career on the Front Bench, I think this is already the fourth time in the space of six weeks that I have responded to a debate that he has secured; I congratulate him on his success in doing so. He never ceases to amaze me, because not only does he represent his own constituents—he has told us so passionately about Danielle, Sophia and their story—but he even represents others’ constituents as well, bringing forward and championing their issues. His ability to step forward and raise those issues is a true testament to the parliamentarian he is, and he has my full admiration and respect for doing so. Today we have heard some moving stories about the difficulties faced by patients who are suffering, and about the plethora of conditions that could benefit from having these medications. I thank Medcan Family Foundation and the Medical Cannabis Clinicians Society for their advocacy on the issue, and for repeatedly bringing that information to the fore so that this country can debate such an important topic. The debate has focused on the challenges that many children and adults face with accessing medical cannabis, but we appear to be in a new phase when it comes to managing the fact that such prescribing is becoming more prevalent. It is worth recognising, as we have done, that there was no legal route for such treatment only seven years ago. It was Sir Sajid Javid, who, as the Home Secretary, listened to the families and commissioned a review into that area to allow the creation of legal routes for accessing those medications. That decision has led to significantly more people being able to access licensed cannabis-based medicines. Between January 2018 and September 2024, written answers show that 24,395 NHS prescriptions for licensed cannabis-based medications such as nabilone, Sativex and—even as a doctor, I am struggling to say it—Epidyolex were dispensed across the community in England. However, it must be recognised that that is dwarfed by the number of private prescriptions currently being issued. Where there have been challenges with access to licensed medications, as with Sativex, the last Government worked with the NHS to take steps to increase uptake of prescribing. On 6 September 2021, the NHS wrote to local trusts and integrated care boards reminding them about NICE’s guidance relating to that medication, and their responsibilities to prescribe in line with NICE recommendations. My understanding is that the letter contributed to an increase of prescriptions of Sativex. However, challenges remain with access to unlicensed cannabis-based medications. We have heard that those medicines must be accessed through individual funding requests, but clinicians are wary of prescribing them, because of concerns about both the evidence base and the legal responsibilities involved. I can attest to the fact that, as a doctor who prescribes unlicensed medications, one looks for guidance on the best way to do so safely. The law was changed in part to encourage more research and clinical trials so that robust evidence can be collected, potentially leading to marketing authorisation and licensing. In the meantime, it is notable that NICE guidance does not prohibit healthcare professionals from considering unlicensed medications. In 2021, NICE stated: “The fact that NICE made no such population-wide recommendation should not however be interpreted by healthcare professionals as meaning that they are prevented from considering the use of unlicensed cannabis-based medicinal products where that is clinically appropriate in an individual case. Patients in this population can be prescribed cannabis-based medicinal products if a tertiary paediatric epilepsy specialist considers that that would be appropriate on a balance of benefit and risk, and in consultation with the patient, and their families and carers or guardian.” However, a recent report by Medcan Family Foundation has highlighted that more restricted prescribing in some areas may be leading to serious or unintended consequences. It is concerning to see, when reviewing their research, that three online forums identified 382 families in the UK who are giving their child illegal cannabis products specifically to manage epilepsy. Given the nature of that research, it could be argued that the figure may be significantly higher nationwide. Is that just the tip of the iceberg? It is worth reflecting on some of the debates that have taken place in this House that have been mentioned previously. I think it was Mark Twain who said, “The past doesn’t repeat itself, but it does rhyme,” which I feel is apt in this case. To that end, it is always wise to try and learn from previous experiences. After all, advice from the wise is like the torch in the dark; it does not walk the path for us but it does light the path. So I looked at Hansard for the last debate and noted a particularly strong contribution from the then shadow Health Minister, the hon. Member for Bristol South (Karin Smyth), who is now the Minister with the power at her disposal. I think it is fair to ask her the questions she posed to the then Minister: “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.’ 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.” —[Official Report, 20 April 2023; Vol. 731, c. 223WH.] The Minister is clearly a strong advocate, and she is now in a position of power. She has been in post for over half a year, so what steps has she taken to empower and accelerate research in that area? What action has she taken to streamline clinical trials? Since taking office, what steps has she taken to empower clinicians to prescribe and to feel more comfortable? Since being in post, what action have her Government taken to support people in the system now? It seems to me that the debate has moved on, but it is still rhyming. We are two years on and progress has been made. More than 24,000 prescriptions clearly represent an improvement. As has been said today, however, there is more to do, and we have new problems. The right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) talked about the legal farming industry, the Hilltop Leaf situation and trying to create a virgin industry. My hon. Friend the Member for Broadland and Fakenham (Jerome Mayhew) talked about the clinical pathways and how they need to be specifically looked at. The hon. Member for Strangford highlighted policing, given that there is a growth in use. I will not tempt the Minister to stray into the Home Office brief, but I want to ask what conversations she is having with her Home Office counterparts about legal medical cannabis. I hope the Government will continue to progress in this space as the issue evolves. They will have the Opposition’s support as they continue to research, educate and raise awareness. I hope the Minister will agree to meet Medcan and the Medical Cannabis Clinicians Society, if she has not done so already. Given the concerns that have been raised today, perhaps as a first step she will write to trusts and ICBs again to highlight the guidance on prescribing these medications. After all, we all want the safest, most effective medications to treat patients as soon as they are needed, and they should be uniformly accessible. I believe that noble aim is distinctly achievable, and I hope the Minister does too.

14:25:00

It is a pleasure to serve under your chairship, Ms McVey. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this debate. As he said, there are many hon. Members from both sides of the House representing constituents affected by the issue across the United Kingdom who would have liked to be here today. Obviously, health is a devolved matter. The hon. Gentleman spoke movingly about his constituents, and other colleagues talked about theirs. I agree with him. My words have been repeated back to me, so I do not need to say them again. This is an important issue for everyone in the Chamber and those who are listening in, as we all want to support people who are in very difficult circumstances. The hon. Gentleman raised some key issues, which I will address. He said that landlords and the police are unaware of the legality surrounding prescribed medicinal cannabis. I encourage him to take that up with the Deputy Prime Minister and the Home Secretary. I understand that the Home Office has notified all police forces about the change to the law, and guidance has been issued to summarise what that means. The hon. Gentleman mentioned electronic prescribing, which has been in operation for schedule 2 and 3 controlled drugs in NHS primary care settings since 2019. I am afraid there are no current plans to extend that to private clinics at this time. The hon. Gentleman also spoke about an observational study with a small patient cohort. I am afraid that it would not produce results as robust as a randomised control trial, which is the gold standard for clinical trials, nor would it add to the current evidence base. It would not provide results suitable to inform routine clinical or NHS commissioning decisions, because there would be no way to compare the findings with what would have happened in the absence of the intervention. I will come on to clinical trials in more detail, but let us be clear about the problem we face, the challenge faced by all of us involved in this debate and the challenge faced by children, many of whom have been mentioned today. Of course, we listen to Members of this House, and to patients, parents and families, who say that these medicines are safe and should be available. We must ensure the safety and effectiveness of all medicines. The benefits should outweigh any potential harm and, as the hon. Gentleman outlined, clinicians must have that assurance and clarity, too. There are currently only two cannabis-based medicines in the world with marketing authorisations or licence. They are—I hope I do not stumble over them too—Sativex, for the treatment of muscle spasms in multiple sclerosis, and Epidyolex, for treatment related to two rare forms of epilepsy and tuberous sclerosis complex. Those medicines show that it is possible to develop cannabis-based treatments that have been assessed for safety, quality and efficacy. The evidence generated on their clinical effectiveness and cost-effectiveness can enable the National Institute for Care and Health Excellence to recommend them for use in the NHS. The medicines we are talking about today are unlicensed, which means that they have not been assessed by the Medicines and Healthcare products Regulatory Agency. Indeed, they have not been assessed or granted market authorisations by any medicines regulator anywhere in the world. However, as has been noted, in 2018 the then Home Secretary, Sajid Javid, enabled the prescription of unlicensed cannabis-based products for medicinal use. That provided a lawful route to these medicines for prescriptions for individual patients who were not benefiting from standard treatments and were not part of clinical trials, while limiting the ability to prescribe to specialist doctors. That came on the heels of the review by Professor Dame Sally Davies, then the chief medical officer, which found enough evidence of benefit to recommend that cannabis-based medicine should be moved out of schedule 1 to the Misuse of Drugs Regulations 2001. For epilepsy, that evidence was mainly in relation to cannabidiol, also known as CBD, rather than products containing the psychoactive compound tetrahydrocannabinol, or THC. The review did not provide evidence to support routine prescribing or funding of those medicines on the NHS, which the previous Government should have made clear at the time. Before we see routine prescribing of these unlicensed medicines, the NHS must have greater assurance on their clinical effectiveness and cost-effectiveness at a population level. I am not a clinician—we are all here as politicians—and it is right that prescribing any medicine or treatment is a clinical decision, whether it is done on the NHS or privately. It is not for us to influence those decisions, so I cannot comment on individual cases. We want to see more medicines approved by the MHRA and available on the NHS. We inherited a broken system, and it will take time to fix that failure, but the Chancellor has made an in-year investment in the NHS to fill the black hole that we inherited and prevent our having to cut back on services. That means that, more than ever, the NHS must account for every penny that it spends and make difficult decisions on what treatments are made available. The NHS must get the best possible value for its investment in medicines and consider the cost-effectiveness of treatments to ensure that resources are used efficiently. For that to be fair, medicines or treatments initiated privately would not routinely be prescribed by the NHS unless the requested treatment was already approved under existing policies, which unlicensed medicinal cannabis is not, or when there are individual, exceptional circumstances. That remains the case even if privately funded treatment has been shown to have clinical benefit for an individual patient. This is the current NHS policy for all treatment initiated and prescribed privately, and it is not specific to medicinal cannabis.

I thank the Minister for her comprehensive response. A constituent of her colleague, the hon. Member for South Ribble (Mr Foster), is in the Gallery today. Her young boy, Ben, is receiving Bedrolite and Bedica, which are both proven to assist him in having a 98% reduction in fits. The same thing happens to my young constituent, wee Sophia, and to many others as well, including Charlie, the constituent of the hon. Member for Broadland and Fakenham (Jerome Mayhew). If there is a proven evidential base, which there quite clearly is, should it not be part of the evidential base for NICE to ensure that all these medications are taken on board?

I will come on to the research. As we have heard, and as I recognise, fewer than five patients have accessed these medicines on the NHS, so access is truly exceptional. The testimony of the children and families accessing these treatments privately—often at great personal cost, as we have heard this afternoon—is truly heartbreaking. I am sure we can all agree that all Government spending on health must be evidence-based, and colleagues are seeking to ensure that that is the case. If we are to see more cannabis-based medicines routinely available on the NHS, we need more research. The National Institute for Health and Care Research, also known as the NIHR, and the MHRA are there to support manufacturers and researchers to develop new medicines and design quality studies. I strongly encourage the manufacturers of those products to invest in research to prove that they are safe and effective and meet the rigorous standards that we rightly expect for all medicines. They should engage with the NIHR and the MHRA on clinical research and medicines licensing processes. That is key in providing doctors with the confidence to prescribe cannabis-based products in the same way that they use any other licensed medicines recommended for use on the NHS, but we are not waiting for industry to respond to patient voices. The NIHR and NHS England have recently confirmed more than £8.5 million in funding for clinical trials to investigate whether cannabis-based medicines are effective in the treatment of drug-related epilepsies. As I said when we were in opposition, and as has been highlighted today, action in this space is vital. Epilepsy is a terrible disease, and it can be life-limiting in the most serious cases. We also know that although epilepsy is a fairly common neurological condition, affecting 1% to 2% of the population, about 30% of cases will sadly have seizures that are resistant to current treatments, so it is absolutely right that the NIHR and NHS England are pioneering truly world-first trials that will investigate the safety and effectiveness of CBD and THC in adults and children with treatment-resistant epilepsy. The trials will be co-led by experts from University College London and Great Ormond Street hospital and will look to recruit around 480 patients from across the UK. The study details are published on the NIHR website, and I understand that it will publish further details soon. Further funding has also been awarded to the University of Edinburgh to investigate the efficacy of CBD in patients with neuropathic pain due to chemotherapy. Those are two examples of the type of research that we desperately need in this area of medicine, and a further 28 studies looking at cannabis-based medicines have been approved by the MHRA since 2018. It is an emotive and complex debate, but the clinical trials give me encouragement that there is a way forward. If the evidence supports it, we will see more cannabis-based medicines approved by the regulators and recommended by NICE. That is the only way we will see the evidence base improved and give clinicians the confidence to prescribe. To conclude, the hon. Member for Strangford has brought this debate forward with his customary good faith and compassion.

Will the hon. Lady give way?

I will take another intervention.

I am sorry. I am not intervening just for the heck of it; I just want a wee bit of clarification. I welcome the fact that the Minister is referring to the trials, and how long they are. I ask the Minister, very quickly: how long will it be before they are complete? Also, I asked the Minister beforehand if she would agree to a meeting with the hon. Member for South Ribble and his constituent just to clarify the matter and take forward the case for a wee bairn. Those are my two asks.

I cannot answer the question about trials and research directly because, obviously, trials are run by the specialists at NIHR, in the usual way, and I am sure that the request for meeting has been heard. It would probably not be with me, but I am sure the officials have heard it and that the hon. Gentleman will have a response. I thank the Opposition spokesperson for reading out my contribution and highlighting how proactive we are being, only seven months since forming the new Government. I am proud that the trials that we are looking to do are world firsts. No other country in the world is taking the same action to prove that the medicines are safe and effective. I know it will not come as much consolation to those families who are at the end of their tether with talk of processes, debates and regulations. I also know it may not feel like it, based on some of the things I have said today, but I think there is a way forward. There may be some light at the end of the tunnel, and this Government will do what we can to support NHS England and the NIHR to get the trials done.

14:37:00

I thank all hon. Members who contributed. The debate has been very helpful—indeed, more helpful than most. The Minister is right that it is unfortunate that a number of hon. Members who wished to be here just could not attend, including the hon. Member for South Ribble (Mr Foster), as an example. I thank, first of all, the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell). I thank him for all his knowledge on the subject. It is always a pleasure to come and hear him make a contribution based on his knowledge and expertise. He also referred to the framework that is in place; he says it is “absurd”. That was the word that he used for the way that we do not have a system that seems to embrace the benefits of medicinal cannabis. He referred to the economic case, which is part of the issue. It cannot be ignored, because it is really important. The right hon. Gentleman has the knowledge to bring something forward that can work and I thank him for his contribution. The right hon. Member for Orkney and Shetland (Mr Carmichael), in his intervention, referred to people resorting, as they do sometimes, to finding the capacity to source medicinal cannabis when the system does not work for them. The hon. Member for Broadland and Fakenham (Jerome Mayhew) also referred to his constituent and his constituent’s son, Charlie. Nothing ever tells a story better than an example, and his wee Charlie and my wee Sophia—if I may refer to a constituent of mine like that —do very clearly illustrate the case. He also referred to the trial, which is perhaps not working. I think the Minister, in a way, tried to answer that question, to be fair, but our impatience is one of the issues. The hon. Member also raised exceptionality issues, and he referred to clinical pathways. A process that responds quickly is important. The hon. Member for Mid Dunbartonshire (Susan Murray) brought forward her personal knowledge on the subject and it was helpful to have that contribution. As she said, no one in the UK should have to pay large fees when there is a product available to help that is evidentially proven. It is essential that we provide care and advantages for a better life, and that is what we are all trying to achieve. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), always brings his personal knowledge from his previous occupation—I do not say that to give him a big head. He referred to the NICE process. There is a way forward but, as he said, we need to empower and accelerate that process. The fact is that the 24,000 prescriptions in the UK are only part of the process, and there is much more to address. I thank the Minister very much. Her final words were that there is light at the end of the tunnel. We have always got to be optimistic for our constituents and I think the Minister wants that to happen as well—I do not think it, I know that she wants that to happen. She also said she wants to support those who need help and the timescale for treatment is part of that. A message from the Gallery tells me that Bedrocan asked about trials and was told that a company had been found. I know that the Minister is not able to respond now, but perhaps she or her officials will come back to me and confirm where that is in the process. Our whole objective in being here is to represent our constituents—to do our job the best we can on their behalf and to give them hope and solutions. Whether it is economic life or the personal or emotional help that people need, the debate has been used to raise awareness, which we all wish to do. On behalf of my constituents and other constituents across this whole United Kingdom of Great Britain and Northern Ireland, who we love and represent each day we are here, we ask that the Government move with urgency to provide the medicinal cannabis that we need. Question put and agreed to. Resolved, That this House has considered medicinal cannabis.

14:41:00