Simon Burns (The Minister of State, Department of Health; Chelmsford, Conservative)
The right hon. Gentleman anticipates my remarks on the NICE guidelines, and I hope that once he has heard them the situation will be clearer.
The 2008 NICE clinical guidelines on the treatment of ADHD are clear that medication is an appropriate treatment for severe ADHD, but that it should be initiated only by a specialist and should form part of a holistic care package that may include talking therapies. The guidelines do not recommend drug treatment for pre-school children, and health care professionals are expected to take the guidelines fully into account when exercising their clinical judgment. They do, however, have the right to prescribe the drugs if they feel it is clinically justified and in keeping with specialist consensus, given the individual circumstances of the child and in consultation with the parent or guardian. Such prescribing can include so-called off licence prescriptions, which means a prescription of medication outside its licensed age indications.
The right hon. Gentleman has asked the Department of Health to conduct a review of the prescription of drugs for the treatment of ADHD, working with families, teachers, medical and mental health professionals. It is, however, for NICE, as an independent organisation, and not for the Department of Health, to review the evidence and to provide national clinical guidance. Between
In June 2007, the UK led a European review of the risks and benefits of Ritalin and sought advice from independent scientific advisory groups on the available evidence. As a result of that review, the prescribing guidance for patients has been updated to ensure that it contains clear, comprehensive information about the effects of Ritalin and the importance of monitoring children and adolescents throughout their treatment. The safety of Ritalin remains under close review. In addition, the findings of research continue to inform the field and a number of bodies may commission such research, including the National Institute for Health Research. The Government are committed to improving mental health outcomes and have laid down important principles for the future in the strategy, “No health without mental health”, published earlier this year.
The emotional well-being and mental health of children and young people are vital to them as individuals, to their families and to wider society. A principle of the Government's mental health outcomes strategy is the importance of prevention and early evidence-based intervention. Half of those with lifelong mental health problems first experience symptoms before the age of 14, and three quarters of them before their mid-20s. Indeed, today, the Minister with responsibility for social care, my hon. Friend the Member for Sutton and Cheam, has announced £32 million of funding to improve access to psychological therapies for children and young people over the next four years.
Psychological therapies can in some cases form part of the holistic package of care that NICE recommended for children and young people with ADHD. It is important that a range of clinicians—paediatricians and GPs as well as child and adolescent mental health service professionals—are well informed on the diagnosis and treatment of mental health problems in children and young people. I am pleased to tell the right hon. Gentleman
that the chief medical officer and the NHS medical director plan to write to clinicians to remind them of the full range of NICE guidelines on conditions—including ADHD—that affect children's mental health. They will highlight the opportunities to support rigorous use of evidence-based treatment through the improving access to psychological therapies programme. High-quality, evidence-based treatment is central to our programme to transform mental health services for children.
The right hon. Gentleman referred to DSM-V. This point goes much wider than ADHD alone and touches on the appropriateness of diagnostic categories that are the subject of international professional consensus through the American Psychiatric Association and through the World Health Organisation. The Association of Educational Psychologists and other concerned professional organisations might wish to make their representations on this issue through the American Psychiatric Association and the World Health Organisation.
The right hon. Gentleman asked what the Government’s response would be, but it is not the responsibility of the Department of Health to respond. The professional bodies respond and reach a broad, scientific consensus on the way forward.
I fully appreciate the concerns of those worried by the increasing number of prescriptions for Ritalin and similar drugs. We are investigating whether further helpful information can be derived from prescribing research databases. It is of course for NICE, not the Department, to review the broader evidence and to consider the case for updating the existing clinical guidelines. That is what it has been doing and we await its conclusion. Furthermore, the NICE clinical guidelines on ADHD state that drug treatment for children and young people with ADHD
“should always form part of a comprehensive treatment plan that includes psychological, behavioural and educational advice and interventions.”
The NICE guidelines do not replace the clinical judgment needed to treat individual cases, but health care professionals are expected to consider fully the guidelines alongside professional consensus when exercising their clinical judgment.
Sitting adjourned without Question put (