Prescription Medicine Waste
The final item of business is a members’ business debate on motion S4M-00941, in the name of Margaret Mitchell, on prescription medicine waste. The debate will conclude without any question being put.
Motion moved,
That the Parliament notes with concern the amount of prescription medicine wastage in Scotland; commends the NHS Forth Valley eWard scheme, which allows hospitals and community pharmacies to share information electronically, thereby helping to improve patient safety and reduce medicine waste; notes the report published in 2010 by the University of York that shows that better medicines management around the time of hospital admission and discharge will result in more optimal use of medicines; believes that the role of pharmacists in helping people understand their medicines will be enhanced by the Chronic Medication Service; recognises that, in order to minimise medicine waste, the electronic recording and sharing of information between hospitals, GPs and pharmacies is essential, and considers that this issue is worthy of further debate.
17:05
According to the Royal Pharmaceutical Society, the cost of providing medicines is rising every year. Given that fact, and with the advent of free prescription charges, it is a matter of concern that, at a time when finances in the public sector are under pressure, there appears to have been no attempt to date to quantify the cost of wastage in Scotland.
My recent freedom of information request to Scottish national health service boards about prescription medicine wastage revealed that boards are largely unaware of how much that wastage costs, but NHS Lanarkshire estimated it to be a staggering £2 million each year and NHS Tayside subsequently estimated the cost to be £3.5 million a year. To put the figures in perspective, that is equivalent to the cost of 180 bypass operations and 137 community nurses respectively. In other words, there are substantial sums of money that could be used for the delivery of essential and front-line services and/or the provision of staff.
Prescription medicine wastage is clearly an issue that needs to be tackled. I am therefore pleased to see that, since I lodged the motion, the Scottish Government has announced that the role of pharmacists is to be reviewed. That is to be welcomed, as I believe that pharmacists are potentially key in our attempts to address the issue.
It is worth while to stress that some prescription wastage is unavoidable—for example, if a patient recovers before the prescribed course of medicine is completed, if a treatment is changed by a doctor because it is not working or has an adverse side effect, or if a patient builds up an immunity to the medicine prescribed to treat their condition.
The good news is that there are various ways that wastage can be reduced or even eliminated. For instance, NHS Lanarkshire and NHS Tayside have both taken steps to tackle wastage by raising awareness of repeat prescription usage through initiatives to encourage people to think about their repeat prescriptions, to stop ordering items on a just-in-case basis, and to make them aware of the costs, especially as most people do not realise that even if they return unused medicines to their pharmacy those medicines cannot be reused and are destroyed.
Other methods to reduce wastage include doing something as straightforward as ensuring that patients know how to take their medicines correctly and recognising that vulnerable groups may be unsure about how often to take their medicine or which medicine to take. If people are uncertain of their supply, they repeat order all of their prescription, which in turn leads to medicine going to waste or being stockpiled at home.
If pharmacists were given access to relevant parts of patients’ health records, they could dispense repeat prescriptions with more accuracy and at the same time help to manage patients’ care as they move between different parts of the NHS. Ultimately, there must be better communication between healthcare professionals, general practitioners, pharmacists and patients, thereby providing improved patient treatment and reducing waste.
It is evident that providing pharmacies with time-saving technology and enabling them to have access to accurate, up-to-date records will allow them to spend more time with patients, helping to address any problems with medication and ensuring that medicines are dispensed only in the quantities required and when they are needed.
To that end, the chronic medication service has not only the potential to improve significantly the care of those with long-term conditions but the ability, through its electronic sharing of information and the establishment of a relationship between the patient and a particular community pharmacist, to reduce prescription medicine wastage.
Furthermore, last year’s University of York “Evaluation of the Scale, Causes and Costs of Waste Medicines” concluded that
“enhancing hospital and primary care liaison in contexts such as improving the quality of care at around the time of hospital discharge”
was a positive opportunity for the reduction of medicines waste.
That is borne out by the experience in the new Forth Valley royal hospital, which has Scotland’s first fully robotic pharmacy, where NHS Forth Valley uses an innovative eWARD system. The system has substantially improved electronic communications between the hospital and the primary care sector and has resulted in a 20 per cent reduction in stockholding. The use of both electronic medicine records in the hospital and the innovative eWARD discharge system has already resulted in positive changes, not only in the ward but also at home.
Finally, as I said, regulations mean that returned unused medicines cannot currently be reused and are destroyed. However, I understand that some European countries, including France, have waste medicine recycling schemes, whereby unused packs of medicines, with suitable expiry dates, are collected and later supplied to populations in need in countries around the world.
Given that counterfeit medicines are being distributed to so many third world countries, I request that the minister looks at the possibility of adopting a recycling scheme, similar to the French one, to help people in Africa and other parts of the world where medicines are desperately needed and could make a massive difference.
17:12
I think that Margaret Mitchell and I must have written our speeches together, because I will duplicate much of what she said.
There is no doubt that drug wastage is a major problem throughout the United Kingdom. A report that the York health economics consortium published in 2010 found that unused prescription medicines cost the United Kingdom more than £400 million per annum.
The Royal College of Nursing report published in 2011, entitled “Taking the Pulse of NHS Scotland”, identified that
“GP prescribing has been noted as a significant cost pressure by all NHS boards”.
It estimated that, in 2009,
“GP prescribing budgets were overspent by around £22 million.”
Researchers found that most medicine wastage is caused by a combination of patients not taking their drugs as prescribed, or by illness progression leading to changes in patient treatment regimes.
My recent visit to a pharmacy in my constituency confirmed those findings. Following discussions with the pharmacist, representatives of Community Pharmacy Scotland and, later, with a retired general practitioner, I was made aware of the issues that can cause prescription medicine wastage.
As Margaret Mitchell said, the reasons why patients stop taking their medications include: experiencing side effects and discarding their drugs; recovering before they have completed their course of medicine; issues with fitting medication into their daily routines; and medication becoming out-of-date. Other reasons for drug waste include: medicines from repeat prescriptions being stockpiled as a result of patients requesting everything instead of just the item that they need; wrong repeat medication being requested; and hospitals retaining medication on admission and not returning it to the patient on discharge.
There is no official mechanism for measuring medicine waste in primary or secondary care. However, the 2010 study found that in England it was estimated that £110 million of unused prescription medicines are returned to community pharmacies each year and that care homes annually dispose of medicines worth another £50 million. That represents half of the estimated total value of drug wastage in England of £300 million per annum.
A number of measures need to be put in place to tackle the problem effectively. More effective and co-ordinated partnership between GPs and pharmacists is needed, such as the sharing of online patient records. The chronic medication service is a move in that direction, but it is still in the early stages of development.
It would be simpler to share existing electronic patient records with community pharmacies so that all NHS professionals have access to the same level of information. Patient records are already shared with NHS 24 and hospital pharmacies, so why could they not be shared with community pharmacies?
We must encourage patients to discuss their repeat prescriptions with their pharmacist and their general practitioner so that any issues with their drugs can be highlighted. Giving patients the opportunity to discuss the use of their medicines will help them to take their medication properly, which, in turn, could reduce waste, as they would know what each item on the prescription was for and how to use their medicines appropriately. In addition, we must start thinking the unthinkable and allowing the recycling of unused, unexpired and unopened medicines that have been returned to community pharmacies.
Prescription charges have been touched on. I would like to quote what a retired GP said on the subject in a message to me:
“Prescription charges are illogical and do not stop waste ... If a prescription has been issued, a qualified doctor has come to the opinion that it is needed. If you think that prescription was unnecessary then it is the doctor you should get at, not the patient ... If someone does not get a script dispensed because they do not want or cannot afford to pay for it, their condition may well get worse, requiring even more expensive treatment. The lay person isn’t qualified to decide that not getting a prescription dispensed is in their best interests. The fact is that before we abolished charges, in poorer areas patients often asked pharmacists only to dispense some of the items. This is harmful to them and to others.”
Only through a more co-ordinated approach, better education on the use of drugs, and the recycling of unused medicines will we make major inroads into drug wastage in the NHS.
I should have said that speeches should be of four minutes.
17:17
I congratulate Margaret Mitchell on securing an important debate, and I commend the NHS Forth Valley eWARD scheme, to which she referred.
It is quite disappointing that the majority of NHS boards have not collected and held information on prescription medicine waste, or evaluated its cost to them. The findings of Margaret Mitchell’s freedom of information request offer the Scottish Parliament an opportunity to be innovative in implementing effective national policies for collecting information, minimising waste and improving medicine management.
The NHS Forth Valley eWARD scheme serves as a model for all health boards. Its capital costs have been recouped already, as a result of the destocking that it has allowed. The improvement in patient safety because of the data flow and tracking system, which means that pharmacists are not constantly interrupted by phone calls from the ward, has been an important element of the scheme. It has also allowed for the integration of medicines that are brought in by a patient, which can then be used or not used. If they are used, they are simply topped up so that, when the patient goes out, all their medicines are at the same level and there is not a discrepancy. That co-ordination with what happens in the community is the third element of an extremely important scheme, which I know that the Cabinet Secretary for Health, Wellbeing and Cities Strategy has seen. I expect that the minister has seen it, too, as it is in his constituency.
Community Pharmacy Scotland supports the innovative practice of transferring discharge information to pharmacists, to which Gordon MacDonald referred. That is important, because the sharing of electronic information fosters the practising of safe medicine. Community Pharmacy Scotland credits the reductions in waste that have been made to the sharing of information between hospitals and community pharmacies. Pharmacists will not supply medicines that have changed if they are made aware that a prescription was stopped or altered during a hospital admittance. There may be outstanding prescriptions that may be dispensed if the issue is not dealt with properly, so electronic sharing of information is critical.
Mention has been made of the University of York study, which quantified prescription medicine waste in England as amounting to about £300 million a year. Medicine waste Scotland estimates that, in Scotland, prescription medicine waste costs about £44 million each year. We can all suggest what that could be used for. I suggest that some of it could be used to provide some of the newer drugs that we need for patients, which are expensive. With cuts in Government spending and the provision of free prescriptions in Scotland, it has never been more crucial for the Scottish Government to recognise the cost of medicine waste and seek a solution. I hope that we will hear something from the minister on that.
The Welsh Government has recently implemented a discharge medicine review that is similar to the NHS Forth Valley eWARD scheme and has also implemented a policy that is designed to ensure that medicine information is transferred between the secondary and primary care services. The role of pharmacists and their access to patient records is pivotal in that regard. They should have access to electronic records, but at the moment they do not. However, I suggest that that happens only with the explicit permission of the patient.
Another possibility for Scotland is not the French scheme but the Inter Care scheme, which was referred to by Margaret Mitchell. Inter Care is a UK-registered charity that collects selected prescription medicines from registered GP practices and reallocates them to more than 100 health centres in six sub-Saharan African countries. I suggest that the Government considers the possibility of taking a much more active role in that regard. A pilot that has been run in a number of practices in Lothian—the minister might speak about it later—has demonstrated the capacity of the system to achieve savings at all levels.
In 1980, I began my life in committee work in the health service as the chairman of the pharmaceutical liaison committee in Forth Valley Health Board, collecting unused medicine. That amounted to tonnes, which were then incinerated. I welcome the motion and I acknowledge that we need to do more to solve this major problem.
17:21
My colleague, Margaret Mitchell, has brought an important issue to the Parliament this evening, and I join others in congratulating her on securing the debate.
At a time when public sector finance is under severe pressure, it is important that savings are made wherever possible in the NHS to allow optimum funding for front-line services, and it is encouraging that determined efforts are finally being made to reduce the annual waste of prescription medicines. It is self-evident that the money that is saved could be put to a variety of clinical uses, such as more drug courses for breast cancer or Alzheimer’s. However, the statistic that struck me most forcefully was that, if the £44 million that is currently wasted on prescription drugs was saved, nearly 11,900 patients could potentially be relieved of the severe pain that I endured earlier this year, prior to hip replacement surgery, and could return to a normal, productive lifestyle—I accept that that might be labouring a point, as I mentioned that earlier this afternoon.
As we have heard today, recent research has shown that, although not all prescribed medicine waste is avoidable, it can certainly be reduced, and often to the clinical benefit of patients.
When my husband was in general practice, he regularly found unused prescribed medicines in patients’ homes. That is not only wasteful but is also a potential hazard to any youngsters who come across them. They included antibiotics that were unused because patients felt better before their treatment was completed, pills not taken because of side effects and repeat prescriptions that had been ordered unnecessarily, resulting in stockpiles of them building up in medicine cupboards while the recipients were selective with regard to which pills they swallowed, resulting in less than optimal treatment of whatever long-term condition they were meant to treat.
I am sure that my husband’s experience was not unique—Richard Simpson’s experience clearly agrees with it. If that experience is multiplied across households in Scotland and the many care homes in which patients are on multiple and often changing drugs for long-term conditions, it is not difficult to see where savings can be made.
It is therefore encouraging that health boards are at last seriously trying to take action in that regard. We have already heard about NHS Forth Valley’s effective eWARD scheme and the awareness-raising campaigns that are being undertaken by other health boards in Scotland.
In February this year, GPs and pharmacists in NHS Grampian joined with those in Orkney, Shetland and the Western Isles in a bid to educate patients about their treatment and to help them understand more about the medicines that they are taking and why they are taking them. The campaign was supported by television advertising and the colourful campaign materials were displayed in pharmacies and GP surgeries to raise awareness of medicine waste among patients and, importantly, carers, with more information to be found on a new national website. Patients were encouraged to have regular reviews of their prescribed medicines with their pharmacist or prescribing doctor, to iron out any issues that they might have with taking their medication.
A senior pharmacy representative said at the launch of the campaign:
“The least cost effective medicine is one that is sub-optimally or not used at all once supplied. It is estimated that up to half of all medicines are not taken as the prescriber intended”—
I am sure that members agree that that is a frightening statistic. She went on to say:
“Real value for money can only be achieved if the NHS supports patients to get more benefit from their medicines.”
I commend the recent and on-going campaigns by health boards and I encourage the minister to take up the Royal Pharmaceutical Society’s suggestion and organise a higher-profile national campaign, which involves community pharmacists alongside GPs and hospital practitioners. Community pharmacists undoubtedly have enormous untapped potential to help patients to understand and optimise their use of prescribed medication. Like Margaret Mitchell, I look forward to the outcome of the pharmacy review.
17:25
I congratulate Margaret Mitchell on securing the debate. She and Gordon MacDonald set out the extent of the problem and the challenge that we face if we are to reduce the cost of prescription medicine waste to the NHS in Scotland. Nanette Milne made a valuable speech from her professional perspective.
Richard Simpson talked about the approach that NHS Lothian, in my area, has taken. NHS Lothian estimates that, in 2008, the cost of prescription medicine waste was £3 million. That is the equivalent cost of 75 nurses, or 460 hip replacements, or 260 heart bypass operations. We are right to be concerned about the financial cost to the NHS of prescription medicine waste and the need to secure best value for the taxpayer, as the Royal Pharmaceutical Society and the Royal College of Nursing highlighted in advance of the debate. I note that the Royal Pharmaceutical Society said in its briefing:
“There is no conclusive evidence on whether the decision of the Scottish Government to set prescription charges to zero has had any impact on levels of medicines waste.”
In addressing the issue, we need to consider the factors that give rise to medicine waste. We also need to acknowledge that not all such waste is avoidable. Let us take the case of a patient who stops taking their medicine because their condition improves, or a patient who discontinues their medicine because of an adverse drug reaction, which in the UK is subject to the yellow-card reporting system, or indeed a patient who stops taking a particular medicine so that they can progress to a different and more effective treatment. In each case, we can see that what matters most is not the cost to the NHS but the safety and appropriateness of the patient’s care.
We must surely minimise waste where we can and I have no doubt that much more can be done in that regard. We must also provide the care and treatment that are most appropriate and effective for the patient. In their report, “Evaluation of the Scale, Causes and Costs of Waste Medicines”, researchers from the York Health Economics Consortium at the University of York and the University of London school of pharmacy said:
“in welfare terms significantly greater returns could be generated by better medicines use, as opposed to waste reduction per se. Improving adherence in medicine taking can improve health outcomes.”
If we consider the wider policy context in which this debate is being held, we can reflect that there have been significant and positive developments in Scotland since the publication of “The Right Medicine: A Strategy for Pharmaceutical Care in Scotland” in 2002. One successful initiative was the establishment of a national medicines utilisation unit, to provide the NHS in Scotland with valuable information on how medicines are used, for example through the development of a hospital medicines utilisation database, which identifies how medicines are used in hospitals and allows linkage between information sources. Perhaps we can explore the role that the medicines utilisation unit might have in addressing the important issue of waste.
There is also an enhanced role for pharmacists and nurses as supplementary and independent prescribers, who provide more timely access to appropriate treatment for patients. There is growing confidence on the part of community pharmacists throughout the country.
Members might ask what all that has to do with prescription medicine waste; I think that medicines utilisation, pharmacy prescribing and dispensing and community pharmacy all have a role to play if we are to address and tackle the issue better in future.
The Scottish Government said that work is being progressed through the national prescribing workstream of the NHS Scotland efficiency and productivity programme.
I hope that we can tackle waste by addressing the issues of the role of annual patient medication reviews and repeat prescribing; reducing the length of supply from 84 days to 56 days, and perhaps in time to 28 days, could make a difference. We also need to ensure that the effective therapeutic partnerships—GPs, pharmacists and others working together—can help to improve quality and reduce inefficiency in the system.
Mr Eadie, can you come to a conclusion?
It is apparent that more can be done to address prescription medicine waste. The key to doing that is to empower our healthcare professionals to undertake new ways of working and for them to redesign services. If we do that, we will not only reduce waste but enhance patient care.
17:30
I thank Margaret Mitchell for bringing the motion for debate. There is no doubt that this is an extremely important issue in terms of both reducing avoidable waste and saving the NHS money. Indeed, it could simply be described as a no-brainer to make progress on an issue that avoids unnecessary waste and saves money at the same time, especially money that can be used in the NHS at a time of such great need.
I read in advance of the debate that the Scottish Executive raised the very same issue in a strategy in 2002. The Scottish Government has now raised the issue in a strategy in 2011. That is recognition that medicines and money are still being wasted and welcome recognition that we need to do more to address that.
What are the solutions? The lack of progress could be down to the fact that, although it is a no-brainer to tackle the problem, only a combined and concerted effort will resolve it. Recent research means that we now have a better understanding of the causes of waste medicine, so we are best placed to act. General practitioners and pharmacies must combine forces to tackle the problem and they must be supported by backing from Government. I agree with Nanette Milne that community pharmacies have a vital role to play in reducing the amount of waste medicine.
We must also improve the quality of medicine management and make better use of medicine reviews, as well as make prescribers fully aware of the consequences of overprescribing. Responsibility lies with the patients receiving medicines, too. We must encourage a greater take-up of medicine use check-ups. Of course, that does not apply to all patients. For example, for care homes in particular, we must ensure that the necessary action is taken to reduce and avoid medicine waste.
Even with the best information technology, under present arrangements we cannot prevent the waste of all medicines, as we have heard. There are prescribed medicines that are never used. Even medicines in pristine, untouched packaging that, for whatever reason, have not been collected from pharmacies must be destroyed, as must pristine medicines that have never left professional care. We must explore alternatives to disposing of or incinerating that so-called waste medicine.
Currently, prescribed medicine can be used only by the person who is named on the medicine. As we have heard in the debate, there are many circumstances in which prescribed medicine can no longer be used by the named person but could be perfectly safe for another person to use. I ask the minister what action has been taken to consider how prescribed medicines in such circumstances could be recycled or reused rather than be incinerated and whether the current system could be changed so that, in a safe and regulated environment, the medicines could be used by another patient.
I agree whole-heartedly with colleagues that we should study practices around the globe where medicine waste has been reduced. I hope that the minister will be open to addressing this issue with the UK Government, where required. I also ask that he follow the example of Sweden, where clear labelling ensures that, to better ensure safe disposal, people are aware of the medicines that are most toxic to the environment.
17:34
I congratulate Margaret Mitchell on securing time for the debate, in which a number of very interesting points have been raised. Reducing prescription medicine waste across the NHS in Scotland is everyone’s business. From NHS clinicians and managers and the Scottish Government, to the behaviour of patients themselves, we should do everything we can to reduce unnecessary waste. It is important that we do not lose sight of the challenge of improving the quality of care as a whole within the resources that are available to us.
We should seek to reduce waste wherever possible as we strive to improve overall service quality through the ambitions that are set out in the healthcare quality strategy for Scotland, which are that care should be person-centred, safe and effective and should happen where the most appropriate treatment can take place and appropriate intervention and support services are provided.
A number of members, including Margaret Mitchell, referred to the research by the University of York and the University of London on evaluation of the scale and cause of waste of medicines in England. The Government has given that some consideration and members should be aware that the study did not find systemic problems with drug waste in the NHS or, in particular, in primary care. Although medicine waste deserves to be addressed, members will acknowledge that there are occasions on which it is unavoidable, although the study estimated that under 50 per cent of waste could be cost-effectively prevented in some fashion.
As Margaret Mitchell rightly pointed out, there is more to be gained from helping people to take their medicines more effectively, even though that might increase the overall volume of drugs that are paid for. The most expensive drug, as Nanette Milne said, is the one that is prescribed but not taken. That is why we need to ensure that there is more education to support patients in taking their medication.
In Scotland, more patients are registering with the chronic medication service, which is delivered through our community pharmacists and is designed to support people with long-term conditions and, in particular, to provide support in and advice on taking medication. It formalises the contribution of community pharmacists to improving the quality, safety and effectiveness of pharmaceutical care to patients with long-term conditions. Some 81,000 patients across Scotland are now registered with the chronic medication service, which offers each patient a comprehensive assessment of their pharmaceutical care needs in order to identify any problems that they might be experiencing with their medicines. The pharmacist and the patient agree the actions that are required to address the problems and they are recorded in an individual pharmacy care record that is regularly monitored and reviewed by the pharmacist.
Later this year, we will further enhance that service in two additional areas. The first aim is to address early engagement with patients on newly prescribed medicines in order to increase patients’ compliance and to reduce waste. The other aim is to support patients who are on specific forms of medication, when greater support might be appropriate. That is all helping to pave the way to ensuring that pharmacists take a much more proactive role in working with patients and general practitioners in order to optimise the benefit to patients of their medication.
That is also helping the Scottish Government to achieve its manifesto commitment
“to further enhance the role of pharmacists ... and encourage even closer joint working between GPs, pharmacists and other community services”
by capitalising on the investments that can be made through the chronic medication service. I am disappointed to have to inform Margaret Mitchell that the review is the result of our manifesto commitment to continue to improve community pharmacy, rather than the result of the motion that she has put before the Scottish Parliament.
In addition, the research by the University of York and the University of London identified that systems that support closer professional management of medicine supply at the point of dispensing, such as the development of the pharmacy-managed repeat-dispensing process, might have a significant future role to play in reducing waste. We are piloting several prescribing and dispensing programmes within the chronic medication service with a view to rolling them out in 2012-13. That will allow community pharmacists to check that each medicine is required at each dispensing interval, thereby reducing the unnecessary waste that occurs through repeat prescriptions being taken when they are not required, as members have mentioned.
We have already seen some promising results from the pilots, and we will continue to monitor them. The research has identified that further enhanced hospital and primary care liaison could, by improving the quality of care around the time of hospital discharge, help to reduce waste.
Margaret Mitchell highlighted the benefits of electronic recording and sharing of information among hospitals, GPs and pharmacists. In particular, she mentioned the initiative that is taking place in the new Forth Valley royal hospital in my constituency. That system allows accurate recording of the medicines-reconciliation process and patients’ drugs history, prescribing by electronic transmission to pharmacies, and information sharing between acute care and community pharmacists. The pharmacy department at Forth Valley royal hospital is working on a Scottish Government sponsored project to assess the benefits of sending electronic discharge information, including any associated pharmaceutical care plan, to the patient’s community pharmacy when the patient is discharged from hospital. It is expected that the results of that project will be made available to the Government by the end of this year. We will then take an informed view of its benefits in terms of improving information sharing between hospitals and community pharmacists, and we will consider the potential benefits for patients.
In addition, our e-health team has recently undertaken a pilot to allow hospital pharmacists and other hospital clinicians to access the emergency care summary to assist medicines-reconciliation activities. The pilot was considered to be successful, so following the current consultation we intend to roll it out across all health boards.
The Scottish Government recognises the public concern that the NHS should not waste in any way the important money that it has, and that it should ensure that money is directed towards patient care wherever possible.
I would be grateful if the minister could come to a conclusion.
I am just about to draw my remarks to a conclusion.
Waste by its nature cannot always be easily measured. Most health boards offer a service through community pharmacists whereby medicines can be returned for disposal. I hear what members have said about considering alternative measures for disposal, and I am happy to go away and consider whether we can put in place further measures.
A number of members have raised concerns around waste of medicines. It is important that we put in place mechanisms that are effective in reducing such waste where it is reasonably possible. I hope that some of the measures that I have outlined this evening will reassure members that the Government is taking the issue seriously, and that we will consider further how we can make better use of medicines that are returned by patients.
Meeting closed at 17:42.