Strep A Treatments: Supply

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the supply of strep A treatments.

I thank the hon. Lady for her question. I know families are concerned about the recent outbreak of strep A in children. Although the vast majority of strep A cases are mild and can easily be treated with antibiotics, a small number of children have gone on to develop serious infections.

The UK Health Security Agency has already declared a national enhanced incident to co-ordinate our public response. Increased demand has led to some temporary supply issues, but I reassure Members on both sides of the House that we have stock of antibiotics and have taken a number of steps to deal with some of the supply issues.

First, we have worked at pace to help to ensure that there are supplies of vital medicines to meet the increased demand. Earlier this month, we convened roundtables with manufacturers of the preferred treatment, penicillin V, and with major UK wholesalers. We continue to work with manufacturers and wholesalers to boost supply to meet demand. The key issue is getting stock to pharmacies across the country. We have brought forward stock to make sure it gets to where it is needed, and we are expediting deliveries. Deliveries to wholesalers and pharmacies continues to be made, with more expected in the coming days and weeks.

Secondly, we have issued eight serious shortage protocols to allow pharmacists to supply not only alternative forms of penicillin, but alternative antibiotics. This will make things easier for pharmacists, general practitioners and, of course, patients. We have also added a number of antibiotics to our list of medicines that cannot be exported or hoarded.

Finally, we have updated advice across the board. Further guidance was given to GPs and pharmacists on Friday as part of the new SSPs. My Department has provided advice to colleagues in primary and secondary care on the management of the current supply issues. We have also held a cross-party briefing for MPs, and a “Dear Colleague” letter will go out later today.

Across the country, parents are worried sick about the sharp rise in strep A infections. Tragically, strep A has caused the death of at least 19 children since September.

Last Thursday, just a few days after insisting there were no shortages, the Government finally admitted that there were indeed serious shortages of three penicillin medicines and issued serious shortage protocols to give pharmacists emergency powers to deal with supply issues. Why on earth did they take so long?

The Government will have seen the data on the number of prescriptions for strep A antibiotics, which started to rise more than a month ago. Health professionals, including Leyla Hannbeck, the chief executive of the Association of Independent Multiple Pharmacies, have been raising the alarm publicly for more than two weeks, and I called for a strep A summit to resolve the supply issues. Because the Government did not come clean sooner about the shortage of antibiotics, parents who are worried about their children have been left to travel to multiple pharmacies, GPs have had to find time to rewrite prescriptions and A&E departments have been overwhelmed by anxious parents and children who cannot access medical help when they need it.

Why have the Government taken so long to act? Did they not look at prescription data, or did they just ignore it? Why did the Secretary of State insist on television that there were no shortages, when GPs, pharmacists, directors of public health and parents all said that there were? After shortages of lateral flow tests, hormone replacement therapy and so on—you name it—why are we in this position again? The Government seem incapable of forward planning, and we are stuck in a shortage groundhog day. Can the Minister update us on the Competition and Markets Authority investigation into the sharp rise in the prices of antibiotics?

Finally, we are in the lead-up to Christmas. Pharmacists have told me that some key contacts in the manufacturing companies are already on leave for the Christmas holiday. Families are making difficult decisions about the safety of their children and extended family. What action will the Government take now to ensure that families across the country can access the antibiotics they might need over the entire Christmas period?

I reassure the hon. Lady that we have not waited to act. We have already issued serious shortage protocols, which are routine mechanisms when there is pressure on supplies. We have the stock of antibiotics in the country—as I outlined in my opening remarks, it is about supply issues. We are seeing five to six times the amount of antibiotics being prescribed at the moment. That is because the UK Health Security Agency has issued guidance to GPs, A&Es and healthcare professionals to lower the threshold of when they would normally give antibiotics. We are seeing significantly increased use of antibiotics. That is in addition to the prophylactic use of antibiotics by directors of public health, if they have had an outbreak locally. That is why we issued the initial SSPs already a couple of weeks ago so that pharmacists had flexibility in how they dispensed that medication. It is why on Friday we issued the new SSPs, which allow amoxicillin, clarithromycin, flucloxacillin, cefalexin, co-amoxiclav and erythromycin to be issued instead, if pharmacists do not have Penicillin V on their shelves. We are being as flexible as possible to give pharmacists that scope.

We are monitoring this issue on a daily basis. May I reassure people that while these are higher than usual incidences for this time of year, overall for this season we are not yet at the 2017, 2018 levels, where we had a significantly higher number of deaths? Strep A occurs not just in—[Interruption.] Hon. Members do not want to listen. I think I have said enough.

I am pleased to hear that there are adequate supplies of penicillin and amoxicillin. My hon. Friend will be aware that some tetracyclines are less effective with certain ethnic groups. She is right in saying, is she not, that most strep A infections are not serious. Does she agree that we should be encouraging parents to give their children flu vaccinations? Usually, serious streptococcal infections occur when someone has been run down through a viral infection first.

My hon. Friend is right to advise people to take their flu vaccination. What I was trying to say, but the Opposition did not really want to hear, was that strep A occurs in all age groups. Actually, the highest number of deaths we see are in over-65s. It is important to get the message out that this issue does not just affect children. My hon. Friend is right. The flu vaccine is something that should always be recommended for winter. He is also right that the alternative antibiotics that I read out have been recommended by UKHSA, and we have taken its clinical advice.

We now come to the shadow Secretary of State.

May I wish you, Mr Speaker, and all staff of the House a merry Christmas? I also thank the hon. Member for St Albans (Daisy Cooper) for securing this urgent question. I put on record my deepest condolences to the families of the children who have tragically passed away with strep A. The news that cases are surging has been deeply worrying for parents of children showing symptoms, and it comes at a time when the NHS is facing unprecedented pressure.

We first heard about shortages of antibiotics to treat strep A almost two weeks ago, but when my right hon. Friend the Leader of the Opposition raised the issue with the Prime Minister, he said:

“There are no current shortages of drugs available”.—[Official Report, 7 December 2022; Vol. 724, c. 333.]

At the same time, parents were going from pharmacy to pharmacy to find the antibiotics their children had been prescribed, and they simply were not available. Why did the Prime Minister not know that there was a problem, when it was plain to see for parents of young people across the country? Had the Government been aware of the problem sooner, surely they could have acted to secure supplies earlier? The Minister said that there has been no shortage, just a supply chain issue. For a parent turning up to a pharmacy and finding that it does not have the antibiotics, it does not make much difference whether this is called a shortage or a supply chain issue, as the antibiotics are not there. The Government must get a grip on this situation and be honest with the public about the reality on the ground.

In addition to the export ban, will the Minister tell the House exactly what the Government are doing to shore up supply of drugs needed to treat strep A? During the past couple of weeks, as desperate parents have been looking for antibiotics, prices have disgracefully shot up. Will the Minister assure the House that the Government will come down like a ton of bricks on any company found to be exploiting this situation by jacking up prices for medication?

Let me reassure Members that, as I said in my opening remarks, there is no shortage of antibiotics to deal with strep A. There have been pressures on supplies; there have been five to six times the amount of prescriptions that are normally issued at this time of year. Let me give the House an idea of the sorts of figures we are talking about. This season, we have seen 74 deaths across all age groups in England, with 16 of them, unfortunately, having been deaths of children under 18—the vast majority have been among the over-65s. In the 2017-18 peak, we had 355 deaths of all ages, with 27 of those being deaths of children under 18. That just gives us an idea of the scale of the difference compared with the peak of 2017-18. We have put significant measures in place to expedite that supply. Manufacturers are ramping up production lines. Deliveries to pharmacies have been happening every day, but often when the supplies arrive there they go very quickly. That is why we have issued the SSPs already, so that pharmacies can allow the different medication to be dispensed, and the alternative antibiotics are there as well. May I also put on record my thanks to GPs and A&E staff, who have seen record numbers of people, particularly children, with concerns about strep A? We did lower the threshold to prescribe antibiotics and they have gone above and beyond in seeing as many children as they can, as quickly as possible.

Group A streptococcus has been associated as a trigger for PANDAS—paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections—a distressing autoimmune neuropsychiatric disorder in children. I welcome the planned PANDAS surveillance study, which will, no doubt, help assess the impact of this outbreak on children, but will the Minister meet me and other members of the all-party group that deals with this to discuss how we can develop and move towards a treatment pathway for PANDAS in the UK?

I thank my hon. Friend for raising this important point. UKHSA is looking at the data on this outbreak and previous ones. I am happy to meet him to discuss that, particularly if he has details of treatment options he feels are not being pursued at the moment.

Does the Minister accept that no production lines in UK pharmaceutical suppliers are operating, because we have contracted out all our supplies to China and India, which manufacture all the drugs? Both countries have not signed up to the pharmaceutical inspection and co-operation scheme, which ensures homogenisation of good manufacturing practices. The UK manufacturers have to apply that whereas the overseas manufacturers do not. Therefore, we have over 10 manufacturers of pharmaceuticals who are not able to produce the right antibiotics because of the unfair discrimination against them by the Government. Will she ensure that this is put right before Christmas so that our local, British pharmaceutical manufacturers can produce the right antibiotics to give to all our children who need them so desperately?

Perhaps if the hon. Gentleman had not been heckling me throughout my opening remarks, he would have heard that we are working with manufacturers and wholesalers across the country. Manufacturers are opening up new production lines and those supplies will be hitting pharmacy shelves very soon.

I recently visited Broomfield Hospital and was concerned to hear that the paediatric A&E was seeing three times as many children as was normal for this time of year. Given that strep A is often a complication of flu, which can be harmful to children, and given that the vaccine take-up, especially of two and three-year-olds, is so low, will my hon. Friend join me in urging all parents, especially those of two and three-year-olds, to go out and get that protection against both flu and strep A by getting their child the flu vaccine?

My right hon. Friend is right to encourage parents to take their children for the flu vaccine. She is also right to highlight the level of demand in her local A&E. Parents are doing the right thing. If they are concerned about their children, they should get them seen as early as possible. For those in doubt about the symptoms: they are flu-like symptoms of sore throat, headache, fever, muscle aches and also a rash that can feel like sandpaper. If parents are concerned, they should seek medical advice.

It is currently suggested that parents contact 111 or book a GP appointment if they are concerned about strep A. Yet 111 workers are already stretched and millions of parents are struggling to get GP appointments, but with strep A there is no time to be wasted. What are the Government doing to ensure that diagnosis and treatment are expedited, because no more families should be facing the prospect of mourning this Christmas?

The hon. Lady is right to raise that matter. Every day, we monitor the number of appointments with GPs, A&E visits, pharmacy visits and the impact that those are having on our stock levels of antibiotics, and the number of incidents of positive cases. Scarlet fever is a notifiable disease, so we are able to track this fairly easily, but she is right on this. GPs and A&E doctors are going above and beyond to see as many as possible of the people coming forward with concerns.

It is good to hear that there is no shortage of antibiotics, and I know that many parents in my constituency will be reassured by that. None the less, from speaking to constituents, I do know that they have had to travel further than normal to get the antibiotics that have been prescribed by a GP. What steps are the Government taking to make sure that antibiotics are delivered to a range of places, particularly those areas where there is a larger outbreak, because that is where they will be needed the most?