What is the point of Thérèse Coffey, MP for the safe Tory seat of Suffolk Coastal?
Since her friend and political ally, Liz Truss, entered Downing Street in September, Coffey has been both Deputy Prime Minister and Secretary of State for Health and Social Care. And on the one occasion since then when a ‘Deputy PM’ would surely have been invaluable – the Urgent Question on the Budget U-turns on 17 October – Coffey was conspicuous by her absence from the despatch box: it was Penny Mordaunt who went in to bat for the Prime Minister.
Our Health Secretary shocked the health world
Her first few weeks as Health Secretary, too, have been mired in controversy. Her now notorious statement about antibiotics appeared in the Times on Saturday 15 October. It came in two parts. Firstly, she suggested that pharmacists should be allowed to prescribe antibiotics. Secondly, she confessed in a meeting with civil servants that she had given her own ‘excess’ antibiotics to a sick friend. By both her words and her example, she had promoted the indiscriminate, unnecessary or inappropriate use of antibiotics: an important driver of antibiotic resistance. A series of medical experts condemned her actions: one calling it “monumental stupidity” from our Secretary of State for Health.
How antibiotics work
This is the process through which micro-organisms evolve so that they are no longer harmed by chemicals in their environment. When bacteria come into contact with an antibiotic (or any harmful substance) one of two things happens: either they die or become harmless, or they survive the attack, become resistant and out-compete more sensitive strains. These resistant ‘superbugs’, such as methicillin-resistant Staphylococcus aureus (MRSA), are already responsible for about a million deaths a year, worldwide: it is suggested that, if we ignore the problem, this may rise to about 10 million – a higher toll than cancer – by 2050.
The risks of antibiotic resistance
As David Cameron, who became Prime Minister at the 2010 election when Coffey entered Parliament, explains:
“If we fail to act [to prevent antibiotic resistance], we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine”
It is hard to believe now, but under Cameron’s Coalition government the UK was a global leader in combating this threat. In 2014, the then-PM commissioned the distinguished economist Jim O’Neill, now a crossbench peer, to produce a review setting out the extent of the problem and proposing solutions.
The final O’Neill report, published in May 2016, was comprehensive, authoritative and timely. It set out two parallel requirements: to use current antibiotics smartly and sparingly and so delay the inevitable onset of resistance, and to invest in the development of new ones. Seven interventions were suggested to address the first of these:
- A global awareness campaign, focusing on reducing the demand for antibiotics and encouraging patients to complete courses
- Improving sanitation to reduce the spread of infection
- Reducing antibiotic use in agriculture
- Improving global surveillance of antibiotic use and resistance
- Promoting rapid diagnostic tests to ensure that the correct antibiotics are used
- Promoting the use of vaccines and other alternatives to antibiotics
- Improving the number, pay and recognition of professionals working in infectious disease
So, how do our Health Secretary’s comments stand up to what is considered ‘best practice’ in combating antibiotic resistance?
- Pharmacist prescribing
Coffey deserves some credit for the broad thinking behind this suggestion. It is perfectly sensible to suggest that skilled pharmacists can take some tasks away from beleaguered GPs. It is also possible that, one day, surveillance and diagnostics might become precise enough for some antibiotic prescribing to be taken out of the hands of qualified medics, but we are not there yet. Coffey seems to be suggesting, foolishly, that pharmacists should be able to dispense antibiotics from symptom descriptions alone. This does occur in some countries, particularly low- and middle-income ones, and there it is associated with high resistance levels.
- Sharing antibiotics
This is far more cut and dried; sharing antibiotics is dangerous and, under an Act of Parliament passed by Cameron’s government in 2012, illegal. Without diagnostics – which Coffey would not have been able to use – she couldn’t possibly tell whether her ‘sick friend’s’ infection was the same as her own: taking the wrong antibiotic cannot cure an infection and is very likely to promote resistance.
In summary, in the words of one Cambridge-based GP, “… incorrect and haphazard administration [of antibiotics] without the authority of an appropriately trained medical professional increases the risk of antibiotic resistance”. Any MP who aspires to the position of Health Secretary should be well aware of this: it seems that the libertarian Coffey was not.
A silver lining after all?
But there may be one thing to be said for the controversy. In the few days since she first raised the topic, public awareness of the resistance issue has gone through the roof. It would be splendidly ironic if her foolish words were to lead to an increase in exactly those behaviours recommended in O’Neill’s report.
So – maybe that’s the point of Thérèse Coffey.