The Government has made ‘limited progress’ in achieving its vision of containing antimicrobial resistance (AMR), the National Audit Office (NAO) has warned.
The public spending watchdog investigated how the Government is addressing AMR in light of it being a ‘serous public health threat’, after the Covid-19 pandemic showed that the UK was ‘not as resilient’ to such threats ‘as it expected to be’.
In its newly published report, the watchdog said that the Government is taking the problem ‘seriously’, with AMR identified as one of 26 chronic national risks, but that it remains ‘a long way away’ from meeting targets set in 2019 as part of the National Action Plan (NAP19-24), which included:
- Reduce antimicrobial use in humans by 15% by 2024
- Reduce the number of specific drug-resistant infections in people by 10% by 2025
- Halve healthcare associated Gram-negative blood stream infections
- Reduce antibiotic use in food-producing animals by 25% between 2016 and 2020 and define new objectives by 2021 for 2025
- Be able to report on the percentage of prescriptions supported by a diagnostic test or decision support tool by 2024.
The Government spent around £567m directly on AMR programmes between 2020/21 and 2023/24, while much more public money was spent on ‘relevant activities’ like purchasing antibiotics and cleaning hospitals, the report said.
Despite this, only one of the five domestic targets set in 2019 was met: reducing the use of antibiotics in food producing animals.
Drug-resistant infections in humans were found to have increased by 13% since the 2018 baseline, despite the target to reduce them by 10%.
The report also found that:
- There has been no sustained reduction in the amount of AMR-related human infections that the Government tracks
- Human usage of antibiotics has reduced in England, but by less than targeted
- The target for reducing antimicrobial use in food-producing animals in the UK was met one year late
- The new AMR national action plan, covering 2024-2029, had more ‘achievable’ targets than its predecessor, but in some cases it was ‘unclear’ whether meeting them would reduce the burden of AMR in the UK.
The NAO report found that human usage of antibiotics fell significantly in 2020 and 2021 before rising, so that the level in 2023 was only slightly lower than in 2018.
The Government attributed this to a post-pandemic increase in circulating infections, which increased demand for antibiotics, but the report noted that a ‘shift from face-to-face to online GP appointments’ may also have contributed, with ‘some research’ suggesting GPs may be ‘more likely to prescribe antimicrobials during virtual interactions’.
It is also of concern, and indicative of rising resistance, that prescriptions for the most important antibiotics, those designated ‘watch’ and ‘reserve’, where usage is recommended to be limited, has been increasing since 2020, the report added.
The fifth target was to create a way to count the proportion of prescriptions supported by diagnostic
tests, which was not achieved due to continuing unaddressed data limitations. NHS England reported to the NAO that this included ongoing use of paper prescriptions, diagnostic tests not being digitally recorded, pathology systems not being linked to electronic prescribing systems and the lack of a standardised national digital pathology system in hospitals.
The NAO report reiterated the NAP19–24 concern around the challenging nature of achieving such change, which it said explains the limited progress.
‘The UK’s fight against AMR is further complicated by the fact that its population is ageing and spending more years in ill health, both currently correlated with increased antimicrobial use,’ it said.
‘Sharp reductions in the sales of antimicrobials for animal use show that major changes can be achieved.
‘But the UK remains a long way from the 20-year vision the Government expressed in 2019: to control, contain and mitigate AMR through a lower burden of infection, the optimal use of antimicrobials and new treatments so that everyday illnesses can continue to be cured.’
Commenting on the report’s findings, head of the NAO Gareth Davies said: ‘Antimicrobial resistance presents a major public health threat and addressing it is a multifaceted challenge.
‘Government is responding but, so far, the results have been limited and the country needs to become more resilient to this long-term risk.
‘Government needs to consider whether its existing commitments and other efforts across the public sector will be enough to achieve its 20-year vision to contain and control AMR.’
Public accounts committee chair Sir Geoffrey Clifton-Brown MP said: ‘The world needs to take the problem of antimicrobial resistance seriously, and the UK Government must lead by example.
‘While the UK has been bold in its ambitions to try to address this issue, progress so far has been limited and public awareness is low.
‘In the shadow of Covid-19, this silent pandemic deserves equal attention to safeguard public health and the NHS.
‘Unless measurable change to reduce the spread of antimicrobial resistance is achieved, there remains a grave threat to human life and society as we know it.’
UK public health officials recently updated the list of first-option antibiotics, as part of efforts to tackle antimicrobial resistance.
Last year, research aimed at quantifying excess antibiotic use in an acute UK hospital found that nearly a quarter of antibiotic days of therapy were unnecessary.
A version of this article was originally published by our sister publication Pulse.
