An interesting post on Mark Easton’s BBC blog raises a number of questions about the state of the health service in both England and Wales. A freedom of information request by Mr. Easton has revealed an increase in prescribing pills like Prozac, despite national guidance advocating alternative treatments – up 3.15% in Wales and 3.64% in England during 2008.
He writes: ‘previously unpublished data, given to me by the Prescription Pricing Authority in England and the Prescribing Services Unit in Wales, focus on January this year. If one looks at the number of prescriptions for anti-depressants issued in that month per thousand patients, a startling story emerges.
The top seven are all Welsh Local Health Boards (LHBs) in a small area in the south of the country. Of the top thirty prescribers, 12 are in Wales and 10 are Primary Care Trusts (PCTs) in the north-east of England.
We even see a local health authority prescribing at a rate greater than one prescription for 10 patients. In Torfaen, the area around Pontypool in south Wales, GPs handed out 104 prescriptions per 1,000 patients during January. This appears to be an astonishing level of anti-depressant use. GPs we have contacted blame a shortage of counselling for the high prescribing levels.’
Mr. Easton makes it clear that the causes of these high level of prescriptions are complex: ‘Both south Wales and the north-east of England are areas with high levels of people not in work, but deprivation cannot explain what one sees as the other end of the table. Of the 30 PCTs which have the lowest levels of anti-depressant prescribing, all but two are in Greater London. And these areas include some of the most deprived in England.
The biggest year-on-year increases in prescribing are both in south Wales: Torfaen has seen a rise of over eight prescriptions per 1,000 patients in twelve months, consolidating its position at the top of the table.
Blaenau Gwent, Bridgend and Neath/Port Talbot have also seen very large rises. Six of the top 20 places ranked by the increase in prescribing anti-depressants are in Wales. Have free prescriptions made a difference? If so, why do figures for the Vale of Glamorgan and Wrexham show falls in anti-depressant use?
He concludes: I have no doubt that the threat and impact of recession is having a psychological effect upon many people in the UK – but anti-depressant prescribing has been rising for years and, in fact, the rate of increase is falling. Comparing Jan 2007 with Jan 2008, the increase in England was 8.3%, and it was 9% in Wales.
These figures deserve wider study so that we can fully understand what lies behind them but I have some preliminary thoughts. The Health Committee’s current review into Community Health Services has highlighted a number of trends that could have contributed to the use of prescription drugs by GPs rather than alternative approaches such as counselling.
The Association of Directors of Social Services Cymru for example drew attention to a number of weaknesses in services. In particular they said that treatment is too heavily skewed to a ‘medical model’ rather than a ‘recovery model’ and that there is a limited number of Approved Mental Health Practitioners and a decreasing number of specialist professionals in the Mental Health field. Given the limited options available to them it is little wonder that GPs prefer to prescribe anti-depressants rather than refer their patients to other professionals for more long term treatment.
I have also heard that in England £170 million was recently allocated for the training of psychological therapists. Counsellors in Wales have been told by the Welsh Government that they must achieve their targets by being ‘budget neutral’. Management are asking staff to be ‘creative’ in how they achieve their targets. Those retiring are not being replaced and as a result remaining staff are under pressure.
If we do not have investment in community mental health services then the trends evidenced by this freedom of information request will remain unchecked.
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