Valium prescriptions for vulnerable people in Cambridgeshire to be reviewed after investigation

A complaint that a healthcare charity commissioned by Cambridgeshire County Council prescribed sedative drugs to patients long-term against national guidance and its own prescribing policy has been upheld.

Change Grow Live (CGL) gave three patients long-term prescriptions for benzodiazepines, a class of drug that includes diazepam or Valium, without fully recording the reasons for doing so, the Local Government and Social Care Ombudsman (LGSCO) said in a report upholding the complaint.

The drugs, typically prescribed to treat conditions such as anxiety, are usually only prescribed short-term, particularly because they can become addictive. The NHS recommends Valium should not be used for longer than four weeks.

CGL “caused avoidable uncertainty about the management of clients prescribed long-term benzodiazepines” by failing to keep full and up-to-date records about their patients’ prescriptions, the LGSCO concluded after investigation, adding that both the charity and the council have accepted its findings.

CGL, whose services are commissioned by 50 other councils in England, has also said it will provide LGSCO with the results of a national clinical audit of benzodiazepine prescribing.

This will help “identify cases where injustice may already have been sustained” among the 343 other CGL patients on long-term benzodiazepine prescriptions, the ombudsman says.

CGL’s Cambridgeshire audit was carried out in September 2022 after the complaint was made to the ombudsman, which showed that three of the nine patients in the region with a long-term Valium prescription had no recorded rationale for this.

The charity also found during this audit that all three patients had benzodiazepine dependence syndrome and came to CGL for this reason - it was not CGL that had initially prescribed them.

One had recently completed a detox from alcohol and agreed to start a Valium reduction programme, it said, while another was reluctant to reduce Valium while also reducing methadone and would need mental health support before doing so. The third agreed to a reduction program after CGL’s audit.

The LGSCO found CGL’s actions were not in keeping with the Health and Social Care Act’s regulations around record-keeping or its own Management of Benzodiazepines Procedure, which includes regular audits to ensure everyone taking Valium long-term is on a reduction scheme and prioritising reducing the use of this over long-term methadone prescriptions.

But another review, undertaken by a specialist pharmacist and commissioned by the council, concluded that the drugs were prescribed in line with the NICE (National Institute for Health and Care Excellence) guidelines, and there were just improvements needed in record-keeping to show this.

This helped lead to the LGSCO’s conclusion there was “fault by CGL which acted for the council” as its lack of records resulted in “unavoidable uncertainty”.

Nigel Ellis, LGSCO’s chief executive, said: “Clinicians need to weigh up the benefits and risks for patients who are taking these medicines long term and should have a clear rationale for continuing to prescribe.

“I am pleased that patients in these vulnerable groups will now have their cases reviewed more regularly and comprehensively following my investigation. Both CGL and the council have cooperated fully with our investigation, and I welcome their ready acceptance of our recommendations.”

CGL is compiling a national clinical audit of benzodiazepine prescriptions.