I inform the House that I have selected the amendment tabled in the name of the Prime Minister.
I beg to move,
That this House notes that community pharmacies are valued assets that offer face-to-face healthcare advice which relieves pressure on other NHS services; calls on the Government to rethink its changes to community pharmacy funding; and further calls on the Government to ensure that community pharmacies are protected from service reduction and closure and that local provision of community pharmacy services is protected.
This is an issue that affects many of our constituents, and it has aroused considerable opposition from so many of them that 2.2 million people have signed a petition. Community pharmacists, I am sure, have lobbied Members of all parties about these cuts and have explained why they should be opposed. Indeed, Members of all parties have raised their concerns and their opposition to these cuts.
I pay particular tribute to my hon. Friend the Member for Barnsley East (Michael Dugher), who has campaigned tirelessly on this issue, and to my right hon. Friend the Member for Rother Valley (Kevin Barron). Government Members have also raised their opposition in Westminster Hall debates, Adjournment debates and parliamentary questions. Their opposition to the cuts is entirely understandable.
When the Government announced, in December last year, that they were going to pursue the cuts, they talked of cutting the budget for community pharmacy services by £170 million, with further cuts to follow. Opposition to the cuts was clear, and indeed was heightened when the previous Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), who I see in his place and for whom I have tremendous respect, suggested that the cuts could lead to the closure of up to 3,000 community pharmacies.
We have had a lot of correspondence from local pharmacists and their customers worried about essential parts of the local community such as businesses, but is it not also the case that, with massive cuts in acute services and with primary care under pressure, those pharmacies provide an essential and cost-effective part of the local health service, which we simply cannot do without?
My hon. Friend has anticipated my argument—I could probably sit down now that he has put it so eloquently, but I shall plough on while I have the indulgence of the House.
I was saying that the right hon. Member for North East Bedfordshire had said that the cuts might lead to some 3,000 community pharmacies closing. Then, of course, the right hon. Gentleman left his post in the Department of Health, which we are all very sad about. Now we have a new Minister, and we are delighted to welcome the hon. Member for Warrington South (David Mowat) to his place—not least because in one of his first interventions when he was allowed out, he visited the Royal Pharmaceutical Society’s annual conference in September and said he was delaying the cuts. He said:
“I think it is right that we spend the time, particularly me as an incoming minister, to make sure that we are making the correct decision”.
He continued by saying that
“what we do is going to be right for you, is going to be right for the NHS and right for the public more generally.”
Well, if the Minister had left it there—with that U-turn—he would have won the praise of Labour Members.
Unfortunately, we then had a U-turn on the U-turn from the Minister. When the Minister came before the House last month we found out that, far from having listened, taken account of various consultations and decided to do what was best for the NHS, he intended to impose a 12% cut on current levels to pharmacy budgets for the remainder of this financial year—giving pharmacists just six weeks’ notice—and a 7% cut the year after that.
Because she represents my mother’s home town, I will give way first to my hon. Friend the Member for Stretford and Urmston.
It is a privilege to represent my hon. Friend’s mother, and he, of course, knows my constituency well. The constituency has high levels of deprivation, and our primary care services face incredible pressure owing to unsuitable practice premises and the difficulty of recruiting GPs. Does my hon. Friend agree that with only seven weeks’ notice, it is impossible for GPs, other primary care providers and pharmacists to accommodate and make provision for these cuts in a way that will allow them to continue to support deprived communities in my constituency and, indeed, the constituencies of all Members?
My hon. Friend is absolutely right. That is why the cuts have aroused so much opposition from not just Labour but Conservative Members.
My hon. Friend is making an excellent speech. Over the past few years, a significant amount of work has been put into the Think Pharmacy First campaign, whose aim is to take pressure off GPs, ambulances and A & E services, but is “Think Pharmacy First for cuts and closures” really what the Government have in mind?
My hon. Friend has made a powerful point, which completely blows apart many of the arguments that the Government have advanced in recent years.
Given the clustering of pharmacies, does the hon. Gentleman believe that no better way of funding the service can be envisaged?
The cuts are not aimed at clusters. They are completely arbitrary, and they will result in the closure of many pharmacies in some of the most deprived parts of the country.
I want to make a bit of progress, because I know that many other Members wish to speak.
The cuts will mean that patients, many of them elderly and unable to travel long distances, will be forced to go elsewhere for essential medical advice and support. What we need from the Minister now are the details of how many pharmacies will close. The previous Minister, the right hon. Member for North East Bedfordshire, told us that up to 3,000 community pharmacies—a quarter of all pharmacies—could close.
It may be helpful if I make a brief intervention at this stage. I gave an estimate which was based on what we thought was a possible worst-case scenario. The Department never had any plans to close pharmacies. It was the best estimate that I had at the time, but it was not a definitive figure.
The right hon. Gentleman is an extremely experienced former Health Minister, possibly the most extreme—[Laughter.] He is definitely not an extremist, but he is possibly the most experienced Conservative former Health Minister apart from, perhaps, the right hon. and learned Member for Rushcliffe (Mr Clarke). It is very noble of him to try to get the Minister off the hook, but the fact remains that he was the one who said that 3,000 pharmacies would close, and we will continue to remind Ministers of that.
I will give way to the former Chief Whip, but then I will make some progress.
Doncaster pharmacists have told me that at least 20 pharmacies in the town will close as a result of the cuts. That is their estimate, on the ground. They have also told me that the Government should sit down with pharmacists and engage in meaningful discussions about pharmacy delivery. For example, setting up a minor ailments service and cutting the drugs budget could possibly save the NHS £5 million in Doncaster and £650 million overall.
My right hon. Friend is absolutely correct. She was not only an exceptional Chief Whip but an exceptional pharmacies Minister in the last Labour Government, and she knows how foolhardy it would be to make cuts in the pharmacy sector.
Will the hon. Gentleman give way?
I should like to make a bit of progress, if I may. As I said earlier, I am extremely conscious that other Members wish to speak.
As we have heard, the former Health Minister said that 3,000 community pharmacies could close. When pressed about the figures last month, the current Minister said
“no community will be left without a pharmacy.”—[Official Report, 17 October 2016; Vol. 615.]
I hope he will confirm that he still stands by that statement. He also claimed:
“Nobody is talking about thousands of pharmacies closing”. —[Official Report, 17 October 2016; Vol. 615, c. 602-3.]
He obviously did not receive the memo from the right hon. Member for North East Bedfordshire. But what did he say when he was pressed by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) about the number of closures? What soothing, reassuring words did he offer to all our constituents? He said, “I do not know.”
I am sorry that the Minister has not got a clue, but I hope that when he winds up the debate he will be able to tell us how many pharmacies will close as a result of these cuts. If he is not prepared to tell us that, will he tell us how many services will be cut?
I will give way to the vice-chair of the all-party parliamentary group on pharmacy, but then I must make progress.
Is the hon. Gentleman aware that the number of pharmacies has increased by 18% over the past 10 years?
I know that the hon. Gentleman works tirelessly as a champion for pharmacies, but he knows that these proposals will mean cuts in many services.
Many pharmacies in Halewood deliver medication, up to 8.30 pm, to elderly and vulnerable people who cannot get out of the house, and to care homes. What does my hon. Friend think will happen if those pharmacies have to close?
I do not need to say what I think; I need to say what the sector thinks, and the sector has made it clear today that it will have to cut services such as the delivery of medicines to some of the most elderly and vulnerable members of society.
I will give way to my right hon. Friend the Member for Exeter, but then I really must make some progress.
Although the Government say that they want to devote a greater proportion of overall health spending to primary care, our Health Committee’s report on primary care, published in the summer, showed that a smaller proportion was being devoted to the primary care sector, which, of course, includes pharmacies. Is that not the ultimate false economy? If we do not invest more in primary care, all the pressure goes into the acute sector.
My right hon. Friend is another experienced former Health Minister, and he is right. As we learned this week, the Health Committee has completely blown apart the Government’s figures on the financing of the NHS.
Will the hon. Gentleman give way?
If I may, I shall make some progress. I promise to give way to the hon. Gentleman in a few moments, but I know that others wish to speak.
The Government will say that they are mitigating the cuts by introducing a pharmacy access scheme, but the scheme takes no account of the needs of the most deprived communities. The four constituencies that top the health deprivation and disability indices are Liverpool Walton, Blackpool South, Manchester Central and Blackley and Broughton. Not one pharmacy in those constituencies is eligible for the pharmacy access scheme. The least deprived constituencies are Chesham and Amersham and Wokingham. In Chesham and Amersham, 28% of pharmacies are eligible for this mitigating scheme, while in Wokingham 35% are eligible. [Interruption.] The Minister says that it is a disgrace, but those are the figures. Only this Department, which spins figures all the time and which has been discredited for the way in which it uses them, can call a pharmacy cuts package an “access scheme”.
Today, in an article in The Times, the Minister himself focuses on cities such as Leicester and Birmingham. He claims that if you walk
“along roads in Leicester you will see 12 pharmacies within ten minutes of each other”.
As the Member of Parliament for Leicester South, I walk along roads in Leicester every day. I do not know whether the Minister has actually walked along any of those roads; he has never told me that he has. Let me therefore extend an invitation to him to come to Leicester, where he will see numerous community pharmacists in areas with a high proportion of black and ethnic minority communities providing specialist services for families who have relied on them for 20 or 30 years, often dealing with elderly people and speaking to them in Gujarati, Urdu and Punjabi. Many of those people will have to go to GPs’ surgeries and A & E departments if the pharmacies are closed. The Government’s assessment takes no account of the disproportionate effect that the cuts will have on black and ethnic minority communities in cities such as Leicester and Birmingham.
I will give way to the hon. Member for Newark.
Will the hon. Gentleman at least acknowledge that we all support community pharmacies? The town I live in has 3,500 residents and there are four pharmacies within a quarter of a mile. Will he at least acknowledge that a model that gives a block grant of £25,000 to each of those pharmacies purely for establishing themselves regardless of demand obviously needs review?
If the hon. Gentleman wants to tell his constituents he is in favour of closing pharmacies, good luck to him.
Of course it is not just pharmacy closures that we will see. The National Pharmacy Association has reported today that that 81% of community pharmacies will have to restrict services that help elderly people and 86% will have to restrict free services such as delivering medicine to housebound patients. Does that not confirm that the elderly and the most vulnerable will be hit the hardest by the cuts to community pharmacies, and the Government are entirely to blame?
I give way to the hon. Gentleman, who has been very patient.
Surely the hon. Gentleman accepts that we have to get the most efficiencies we possibly can from the system? His party colleague the right hon. Member for Doncaster Central (Dame Rosie Winterton) made a serious point about engaging with pharmacies to see how we can do it better. Does he agree—I would be interested to know why this is not in his motion—that category M clawbacks, which are levied exclusively on small independent pharmacies, might be extended to vertically integrated wholesalers as a way of making sure the system is more efficient than at present?
The hon. Gentleman talks of efficiencies; he will presumably have seen the research that says if people cannot get to a pharmacy one in four will go to a GP. We will see greater demand on GP surgeries and A&E departments. That is not efficient. It is a false economy, which is why the Pharmaceutical Services Negotiating Committee has said the proposals are
“founded on ignorance of the value of pharmacies to local communities, to the NHS, and to social care, and will do great damage to all three. We cannot accept them.”
It is why the chief executive of Pharmacy Voice described the decision as
“incoherent, self-defeating and wholly unacceptable”,
and it is why charities such as Age UK have said the plans are
“out of step with messages encouraging people to make more use of their community pharmacists, to relieve pressure on overstretched A&E departments and GP surgeries.”
Age UK has hit the nail on the head: these cuts to community pharmacies completely contradict everything we have been told by Ministers over recent years and will lead to increased pressures and increased demands on GP surgeries and A&E departments.
My hon. Friend has made some crucial points about how the funding has been allocated across our country. There are 129 community pharmacies across the whole of Liverpool, yet just two of them will be eligible for this payment. Does my hon. Friend agree that that is absolutely outrageous and will impact on the entire population of Liverpool?
My hon. Friend is right, and even after this scheme is in place pharmacists who are eligible for the mitigating funds are still saying that they will have to close despite them.
We believe in the importance of community pharmacies, because
“pharmacies have a big role to play in this, as one in 11 or 12 A and E appointments could be dealt with at a pharmacy”—[Official Report, 25 February 2014; Vol. 576, c. 162.]—
“Pharmacies have an important role to play, because they could save a significant number of A and E and GP visits.”—[Official Report, 23 October 2014; Vol. 586, c. 1049.]
Those are not my words: they are the words of the Health Secretary, said from that Dispatch Box over the last two years.
If the message the Health Secretary has been giving at that Dispatch Box is that community pharmacies are a way of relieving pressure on A&Es and GP surgeries, why is he now coming to the House to support cutting community pharmacies? It is a complete false economy. I will give way if he wants to explain that. He does not, probably because he knows it is a completely false economy.
Arundhati Patel runs the Jamaica Road pharmacy in my constituency and an alcohol cessation service is one of the services it provides to the local community. He pointed out there were 1,400 hospital stays in Southwark due to alcohol harm. On the point about efficiencies and avoiding visits to hospital that Members have talked about, is this not another example of what my right hon. Friend the Member for Exeter (Mr Bradshaw) called a false economy?
My hon. Friend is right, and Government Ministers, including the Health Secretary even on Monday, justify these as part of a package of efficiencies. Indeed when I raised this a few months ago with the previous Minister, the right hon. Member for North East Bedfordshire, he told me in correspondence that these cuts were necessary as part of delivering the £22 billion-worth of efficiency savings. So this is more proof that when they talk of efficiency savings, they are actually talking of cuts to frontline services.
I am sorry, but I need to make progress.
The NHS is going through the worst financial crisis in its 68-year history. Even the previous Health Secretary, who is now in the other place, said he did not expect another five years of such tight budgets for the NHS.
The black hole in hospital finances last year was £2.45 billion. Under Labour, we spent the European average on health as a proportion of GDP; we are now spending less than Greece. We are seeing a huge financial squeeze on the NHS and the cuts are part of that squeeze agenda.
We want the Government to think again on the cuts, because they will lead to more pressures on GP surgeries and A&E departments. There is a consensus not just among the Labour party, but among our constituents, the sector, clinicians and indeed Conservative Members against the cuts. It is Ministers who stand outside that consensus. The hon. Member for Stevenage (Stephen McPartland) has said:
“It does not make sense that we are encouraging pharmacies to take on a bigger role in the NHS, while potentially reducing the number of them.”
The right hon. Member for Broxtowe (Anna Soubry) has said:
“I do not think this 4% cut is a wise move.”—[Official Report, 20 October 2016; Vol. 615, c. 974.]
The hon. Member for Colne Valley (Jason McCartney) said
“when our A&Es are under so much pressure, we need community pharmacies”.—[Official Report, 17 October 2016; Vol. 615, c. 598.]
I agree and our message to Conservative Members who want to stand up for their constituents and who have been lobbied by pharmacists is, “Join us in the Division Lobbies and get Ministers to think again on these damaging cuts.” I commend the motion to the House.
I beg to move an amendment, to leave out from “NHS services” to the end of the Question and add:
“welcomes the Government’s proposals to further integrate community pharmacy into the NHS, including through the Pharmacy Integration Fund, and make better use of pharmacists’ clinical expertise, including investing £112 million to deliver a further 1,500 pharmacists in general practice by 2020; supports the need to reform the funding system to ensure better value for the taxpayer; and welcomes the establishment of a Pharmacy Access Scheme which will ensure all patients in all parts of the country continue to enjoy good access to a local community pharmacy.”.
I welcome the opportunity to set out again the Government’s approach to pharmacy in general and community pharmacy in particular over the next few years. I will also address some of the points that we just heard, which were, frankly, alarmist scare-mongering.
The proposals I announced two weeks ago are directed at four main areas: first, the need to better integrate pharmacy with GPs, primary care and the NHS more widely; secondly, the need for the existing community pharmacy network to move from a dispensing-based model to a value-added services-based model; thirdly, the need to continue to work with NHS England to ensure value for every penny we spend on the NHS; and fourthly, the need to ensure that, as we undertake these reforms, everybody in the country continues to have ready access to a community pharmacy.
First, on integration with the NHS, especially in general practice, over the weekend Simon Stevens, the NHS England chief executive, again reiterated the importance of that and why he supports this process. We know we need to expand the number of GPs, and by 2020 we will have a further 5,000 doctors working in this area, but as well as recruiting and retaining more doctors, we need to provide them with further support. The “General Practice Forward View”, published by NHS England, has set out fully costed plans to recruit a further 1,500 clinical pharmacists into GP practices by 2020. By then there will be one pharmacist working within a GP practice for every 30,000 of population. Most of these will be prescribing pharmacists, and all will have a role in performing medicine reviews and leveraging GP time. This is a major investment and it is already happening.
The point I wanted to make when trying to intervene on the hon. Member for Leicester South (Jonathan Ashworth) was that I recently went to a pharmacy in my town of Bexhill, and it is making deliveries to every single customer who asks for a delivery, not just the vulnerable and the elderly. It does so because if it did not Lloyds would put it out of business. Does the Minister agree that that shows that there are efficiencies to be made, and the fact that those efficiencies are recycled in the health service has got to be good for all our constituents?
It does show that. This is a competitive business. My hon. Friend mentions Lloyds; it is one of the two big players in this industry, in which two players own 30% of all pharmacies.
The Minister talks about moving away from a dispensing model to a value-added model. I shall say something about healthy living if I get the opportunity to speak in the debate, but in relation to that shift, what is his view on warehouse pharmacies?
Our view on the structure of the industry is that it is up to individual companies within the sector to organise themselves and to provide their services as efficiently as possible. It is true that 70% of all pharmacies are either chains, multiples or public companies, and I will address that point later.
I want to make some progress.
Secondly, we want to see an enhanced role for the community pharmacy network in providing value-added services. This is an aspiration that we share with the network and its representatives. To that end, NHS England has commissioned Richard Murray of the King’s Fund to produce an evidence-based report to determine which types of primary care services are best done by pharmacists over the next two or three years. The report, which will be published later this year, will inform NHS England’s decisions on how to use the integration fund of £42 million that I announced two weeks ago. There are many candidate areas, including long-term conditions, minor ailments, better care home support and more medicine reviews, as well as the work that pharmacists do in public health.
Many of the pharmacies in my constituency already provide such services, but they are now threatened by the Government’s proposals. Does the Minister not realise that, according to research carried out by Pharmacy Voice, in a constituency such as mine, which is No. 20 on the list of deprived areas, four in five people who cannot see a pharmacist will end up going to their GP? Does he not agree that that will achieve exactly the opposite of what he wants?
The impact review, which was published at the same time as my statement two weeks ago, estimated that the amount of extra time that people would have to spend going to a pharmacy would be a matter of seconds, even if we had, say, 100 closures. The impact review sets that out in some detail. Did someone sitting behind me wish to intervene?
Perhaps the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) could detach himself from his device for a matter of seconds. It is very good of him to drop in on us and to take a continuing interest in our proceedings. They certainly interested him greatly a few seconds ago.
Thank you, Mr Speaker. I was just trying to find something that was going to inform my intervention. Is my hon. Friend the Minister aware that in Devon, about £5.5 million is wasted on unused medicines? We need to do something about that.
I do realise that, and I mentioned the fact that the King’s Fund is looking into medicine reviews.
As I have said before in the Chamber, the model that is adopted for pharmacies in Scotland has a lot to commend it, even though we might not adopt it in its entirety. I hope that we will get a chance to discuss that later.
Before I give way, I should like to quote the chief pharmacist himself. Dr Keith Ridge has confirmed that the review
“will support community pharmacy to develop new clinical pharmacy services, working practices and online support to meet the public’s expectations for a modern NHS.”
Two weeks ago, I announced two initiatives that will proceed in advance of the King’s Fund report. From 1 December, phone calls made to NHS 111 for urgent repeat prescriptions will be directed not to an out-of-hours GP service as at present but to a community pharmacy. This will amount to some 200,000 calls a year, resulting in further revenue streams, for the consultations and for supplying the medicine. NHS England has also committed to encouraging national coverage of a locally commissioned NHS minor ailments service. Some areas, including West Yorkshire, already do this, and we will roll it out to the whole country by April 2018. Both those initiatives will relieve pressure on surgeries and emergency care centres. Both will result in additional incremental revenue for pharmacies, but they are very much only the start.
Does the Minister accept the view expressed in the impact assessment that independent pharmacies, which are often micro-businesses, and small chains of up to 20 pharmacies will be at a higher risk of closure than the larger chains?
In terms of these proposals, we have to be blind to the ownership of pharmacies. The fact is that the average pharmacy sells for something like £750,000. I do not accept that the proposals will cause closures in those segments, if that was the thrust of the right hon. Gentleman’s question.
I want to continue.
The third area I wish to address is value for money, and I make no apology for doing this. According to recent OECD analysis, the UK now spends above the OECD average on healthcare, but however much money we spend, every penny needs to be spent as efficiently as possible. If that does not happen, waiting lists can become too long, treatments can be denied to patients and drugs might not be available. We also know that efficiency savings are required of every part of the NHS, and community pharmacy must play a role in contributing to the £22 billion of savings that we need to find. I do not apologise for that.
I certainly support the amendment on the Order Paper today, but does the Minister agree that, in relation to efficiencies, the issue of category M clawback is an important one? I tried to extract an answer to that question from the hon. Member for Leicester South (Jonathan Ashworth) earlier. Also, I ask the Minister to think again about the ownership-blind point that he just made. There is not an equal playing field at the moment, and there is a real risk that small independent pharmacies will continue to be done in.
I do accept that point. We are working on the category M clawback, and I hope to be able to make some progress on that matter soon.
If anybody can square this circle, it is the Minister, given his extensive experience in this area. I genuinely believe that we have to sort out this issue. I am not happy to subsidise large private companies through the system—some of the chains have already been mentioned—so it is right to look at where the clusters occur. The Minister is well aware of the Kennet pharmacy in my constituency, and we all have really value-added pharmacies that are doing very valuable work. How can we help him, over the review period, to identify and support the services that those pharmacies provide? They must not be allowed to close as a result of this policy.
I agree with my hon. Friend. I have set out the work that we are doing, and the fact that we are providing more money for services, over and above all the money involved in the cuts and efficiency savings that we have had to make, will help that process.
Further to that point, the Minister knows that our pharmacists are a highly skilled and professional resource that has long been underused in the NHS. He has mentioned the ongoing Murray review, and a sustainability and transformation plan process is also going on around the country. My concern is that the closures will come about in a random way, rather than through a planned process based on identifying skills in particular areas. Will he consider delaying them until we have all the reports in place and we can consider the matter on an area-by-area basis?
The access scheme is the device that will ensure that pharmacies are not closed in a random way. I want to address the point about closures head on. It is my belief that there will be a minimal number of closures. The impact analysis talks about 100 and it models 100. The average pharmacy has a margin of 15%, and the amount of efficiency savings that we are asking pharmacies to make over two years is 7%. In addition, the average pharmacy is trading for £750,000 when it closes or merges, even after we announced these efficiency savings a year ago. That value is being retained.
The previous Minister put a figure on this. Will the hon. Gentleman tell us what he means by a “minimal” number of closures? What is the number?
These are private businesses, each with a different business model and a different amount of income from the NHS, from other retail activities and from services. Each is financed in a different way. Indeed, 30% of them are owned by two public companies, and 70% of them are multiples.
Can reassurance be given that local pharmacies are the frontline of primary care? Will the Minister extend the work and responsibility of those local pharmacies, particularly in deprived areas, and reassure us that that is the focus of this debate?
I spoke to 500 pharmacists this morning and gave them that precise reassurance. The changes that we are making to transform the sector into a service-based, not dispensing-based, economy will do just that. That is where pharmacies need to go and it is where they want to go. Frankly, it has taken too long.
I need to make some progress. I will give way in a moment.
At present, the average pharmacy receives NHS income of £220,000 a year, which is based on throughput of £1 million from the NHS. That translates into a value of the order of £750,000 for each pharmacy. When pharmacies merge or are sold, that is what they are traded for and the changes will not make a significant difference.
Returning to an earlier point, 40% of all pharmacies are located within a 10-minute walk of at least two others. Instances exist of a dozen or more pharmacies located within half a mile of each other. As I noted earlier, each one will most likely be receiving £25,000 a year just for being there.
Has the Minister been to Leicester?
I was brought up on the outskirts of Leicester, so I am delighted to tell the hon. Gentleman that I have indeed been there. Giving all these clusters £25,000 of national health service money is not the best way to spend precious resources.
In addition, the extra services that pharmacies will choose to provide, such as winter flu jabs and public health services, are commissioned separately and will be unaffected by the reset. For example, 600,000 flu jabs have been given in community pharmacies this year—more than all of last winter.
I need to make progress.
Order. I think it is fair to say that the Minister is being what I would call—if it does not sound a contradiction in terms—courteously harangued to give way, but it is perfectly evident to me that he is not giving way at the moment. Members will therefore have to exercise their judgment as to the frequency with which they make further attempts.
I will continue to make some progress and then give way towards the end of my remarks.
I do not want to downplay the impact of the change on the private businesses that own and operate the network. The pharmacy sector is a mixed economy with 70% of the market made up of multiples and chains and 30% owned by independents. It is hard to accurately predict the impact of the changes on those individual business models. What I can say, however, is that the savings we are making will be entirely recycled back into the NHS. Every penny of the efficiency savings that we are asking of community pharmacies will be spent on better patient care, better drugs and better GP access.
I am grateful to the Minister for giving way. I totally understand the importance of trying to get as much bang for your buck from pharmacy services, but does this not actually amount to a significant cut in spending on preventive services? That seems completely counter to the Government’s aim.
When one takes into account the £112 million that we are spending on getting more pharmacists into GP practices, the right hon. Gentleman’s point is incorrect.
Will the Minister give way?
I will give way to the hon. Lady in a moment.
Finally, I want to talk about the work that we are doing to ensure that everyone in the country has access to a community pharmacy. We have developed a scheme with two components. First, all pharmacies that are more than 1 mile from another pharmacy will be eligible for additional funding, which will almost entirely mitigate the impact of the changes. That component is specifically designed to protect areas where current provision is quite spread out. In total, it will apply to around 1,400 locations—roughly half urban and half rural. Pharmacies that are in the highest 25% by prescription volume, and therefore most profitable, will not be eligible for the scheme. Secondly, there is a near-miss scheme under which pharmacies that are located up to 0.8 miles from each other and in the 20% most deprived areas in the country can apply to be reviewed by NHS England as a special case. The final safeguard is that NHS England has a continuing duty to ensure the adequate provision of services. Its role is to commission a new pharmacy in any area where it believes access is inadequate. That duty will continue.
I thank the Minister for very kindly giving way. Will he correct the record on something? Pharmacies are not all private enterprises. Many co-operatives across our country provide community pharmacies, often in rural and isolated areas. For the purposes of this debate, will he clarify his understanding of the distinction between a community pharmacy and a GP pharmacy? That has not been clear in his remarks so far.
The distinction is that a community pharmacy is part of a privately owned business that dispenses and is paid in that way. The ones that we are hiring into GP practices will leverage GP time and do medicine reviews, and I expect them to enable the pharmacy network in an area to work more cohesively. It is a welcome and, frankly, overdue step forward.
I need to continue.
Taken as a whole, I am confident that the three measures I have talked about for protecting access will ensure that everyone has access to a community pharmacy in much the same way as they do at present. The future for pharmacy is bright. The change we are implementing of a 7.4% efficiency requirement over two years is proportionate and will continue to orientate the profession towards services and—for the first time—quality and away from a remuneration model based on dispensing.
I will finish by again quoting the chief pharmacist, who said:
“The public can be reassured that while efficiencies are being asked of community pharmacy just as they are of other parts of the NHS, there is still sufficient funding to ensure there are accessible and convenient local NHS pharmacy services across England. The NHS is committed to a positive future for pharmacists and community pharmacy.”
Every penny that we save as a result of the efficiency reviews will be spent within the NHS on better care, better drugs and on quicker treatment. I urge Members to support the amendment later today.
The Minister kindly referred to the system in Scotland, which has been running for 10 years since we passed the Smoking, Health and Social Care (Scotland) Act 2005. It took time to introduce the new system, but now all pharmacies in Scotland are community pharmacies, meaning that they all provide services. They do not get a big payment merely for existing—they receive a quite tiny £1,730—but they do get payments based on needs that reflect a population’s age, vulnerability and deprivation, so those things are taken into account in their global funding. That funding is due to go up 1.2% in Scotland while there is talk of a reduction of 4% here.
The services provided have been referred to as the minor ailment scheme. Many pharmacies in England make provision under that scheme, but it is not a national system. In Scotland, the scheme is national and such services must be provided. One issue is that the pharmacies have to invest. They have to build a consulting room and change their building so that people can be seen privately when their minor ailment is diagnosed. They work to protocol for a whole list of ailments that they can diagnose and have the ability to treat. The ailments are minor things that many people would experience, and the approach avoids their having to go to a GP.
The hon. Lady makes an incredibly important point. People who go into a community pharmacy today will see a special treatment room where they can get phlebotomy, advice on blood pressure and all sorts of other things. Is it not perverse, cruel and utterly irrational to say to a group of professionals, who have done all this work to change the way they deliver their services, “Now we are finished with you. Out you go. You’ve done your bit. We are going to put you out and close down your pharmacy”?
I agree with the Government about looking for more services, but this is not the way to work with the profession, given that they want those in it to do more work and to work differently. Sadly, during my time in the House, we have repeatedly seen the Government not sitting down with a profession and saying, “Why not look for where savings can be made?”, but simply making a cut.
I was going to intervene on the Minister to follow up the point made by the Chair of the Health Committee. We are looking at bottom-up planning in England for the first time for a number of years with the sustainability and transformation plan process, so this is completely the wrong time to be making these irrational and random cuts.
We recently debated STPs and the potential they provide. The danger is that at the moment we are seeing finance-centred care, instead of patient-centred care. Going back to place-based planning, which is what we have kept in Scotland, where we still have health boards, means that we can look at integrating services, and pharmacies definitely need to be part of that. They have the potential to be a significant front-line player.
I am interested in the experience in Scotland, although we do not have the same system in England. What does the hon. Lady think about moving pharmacists into GP surgeries? I think that it is a mistake. I would much prefer the approach that is being taken in Scotland, where pharmacies are expanding by having consulting rooms of their own.
Scotland actually has both. We do have pharmacists who are in a consulting room within a practice, and our Government have put £85 million into taking on an additional 140 pharmacists who work in primary care with GPs. We are not, as has been done in the past, saying, “Everyone on drug A must change to drug B because it is cheaper,” without giving any thought to how that affects the patient. We are consulting patients, who are often on 10 or 15 medications, all of which interact and have different side effects, and then rationalising that and giving the patient advice. We are therefore providing a clinical service rather than just a changeover service.
Our community pharmacy system has been running for 10 years, so it is quite mature. Patients register with a pharmacist in the same way as they register with a GP. The aim is for all people to be registered with whomever they consider their local pharmacist to be, as that means that they can access minor ailment treatment. It also means that people who are on chronic medication have a chronic medication service, with their prescription sent electronically to the pharmacy, which then keeps track of when it is due and therefore ensures that patients do not run out of medication. The pharmacies also provide an acute medication service for people who have not signed up to the other service but suddenly find they have no tablets, as they had not thought to re-order them with their GP. If they are regulars at the pharmacy, a single round of drugs can be prescribed for them there so that they do not have a gap in their treatment. The important thing is that our vision is to have all our pharmacists as prescribers by 2023, and to have our public registered with pharmacists by 2020.
The hon. Lady makes two important points: this move is cuts-led, rather than well planned; and just as communities rely on their doctor, they rely on the facilities at their pharmacy. That is particularly true of elderly people and those with disabilities, who may have to travel miles, depending on where the pharmacy is.
It is crucial that the service covers all areas, including those that are deprived and those that do not have good public transport. Distance is not everything; this is also about how people travel that distance. In many places, the distance involved might not be that great, but there simply may not be a bus going in the required direction.
I wanted to make this point to the Minister: the closure of community pharmacies will clearly lead to a poorer service, a loss of patient choice and poorer health outcomes for those in more deprived parts of the country. Is this not just another example of Government short-term cuts that will cost us more in the long term?
If this is introduced badly, the cost will be greater in the long term. When the Minister talks about a more service-based approach, I think that he aspires to something more like the Scottish model, which I would commend. I just feel that this is being done “backside forward”.
I need to make a bit of progress.
We need to design the services with the people who work in them. Some 18% of Scotland’s population—nearly 1 million people—are registered with and do access the minor ailment service, which takes pressure off accident and emergency, because there is availability out of hours, and GPs. The fourth service that we have is the public health service, with 70% of all smoking cessation work in primary care being carried out in our community pharmacies. These four services together—minor ailments, chronic medication, acute medication and public health—represent a huge breadth of service for a community. It is important that pharmacies in England that are currently just retail and dispensing pharmacies are encouraged to go in that direction, because it brings benefit for the NHS.
My biggest concern is the random nature of how this process might develop. If the Government simply cut and let the dice fall where they will, the problem is that they will not end up with an integrated service. Scotland still has health boards, so if a community pharmacy is to open there, an application needs to be made to the health board. When the project started, the boards decided which places got to become community pharmacies, and they decide whether there is a need to open a new community pharmacy. The biggest mistake in this scheme is its randomness.
One issue raised by the hon. Member for South West Wiltshire (Dr Murrison) was the profits made when drugs are sold on. The Government could look at the vertically integrated wholesalers—the big chains. In the mid-2000s, they were not considered. The Government do not know how much profit they make or where that profit is made, and the system is totally unregulated. These chains control about 40% of the pharmacy market. One of the biggest chains, Walgreens Boots Alliance, has declared profits of almost £1 billion, yet it has somehow been able to reduce its tax bill by more than £1 billion in this country. We are talking about people who are make almost half their profit from taxpayers yet do not pay their full share of tax. I absolutely agree that under this proposal the big chains will survive and the small, independent, very community-based pharmacies will be lost.
The Minister accused those who highlight concerns of “scaremongering”. Atul, who runs St George’s pharmacy at the Elephant and Castle in my constituency, says:
“We may survive the first set of”—
“cuts by compromising on our services. But the second set of cuts next April will most definitely place us at a real risk of closure.”
Does the hon. Lady agree with Atul that it is right for us to highlight our concerns, especially in constituencies such as mine, where we face losing 18 community pharmacies?
Losing that many pharmacies in any area would be a disaster. This is a bit like groundhog day, because this is our third discussion on this topic in as many weeks. The Minister said that there absolutely would be protection, but the pharmacy access scheme still largely comes down to the amount of dispensing that is done and the distances. It does not take account of which pharmacies are providing a good service, which ones are set up to provide a good service and how to encourage others to develop. This is what is completely wrong in the Government’s approach. They are just slicing money off and leaving individual businesses to decide whether they think they will be profitable. The danger would be that we get a whole lot of pharmacies deciding to sell out and walk, instead of someone saying for a particular area, “Eighteen is too many”—especially if they are all around one town square—“so which ones are best able to develop a service? Let them bid for it and let them be inspected, and let’s see how they take it forward.”
The Government could make a lot of savings by addressing the wholesalers. In Scotland, we have margin sharing, which means that a price control group looks at the profit that is made at various stages, and some of it has to be shared back. We do have people who are trading on the open market and moving drugs around, especially in the big chains. As we heard earlier, we would get a better result by sitting down with the profession and designing a service. STPs could provide the model within which to look at how many community pharmacies there should be and where they should be, and then it would be a case of working backwards.
The danger of the Government’s approach is that it is the wrong way round. Just calling something an “efficiency cut” does not make it efficient, and the danger is that we just slash something and it falls over. The pharmacy access scheme is not enough of a protection or of an intervention. There needs to be planning. I commend the idea of a proper services-based pharmacy system, but the aspiration should be not just that a few pharmacies choose to do it and others do not. It should be that a patient who walks into a community pharmacy will know what services they can get, and we should aim to have that right across the country.
Order. Before I call the next speaker, let me say that there will be a limit of five minutes on Back-Bench speeches. There are 25 people who are trying to take part in this debate, so it may be necessary to drop down that time a bit further later on, but let us start with five minutes.
It is a shame that the Front-Bench speakers took so long because many colleagues want to contribute to the debate.
I agree with the Minister’s thrust of ensuring that we get the greatest efficiency for the taxpayer and the best possible health service for our constituents. We cannot afford to waste money in any way, shape or form, but if we can find ways to redirect money into NHS front-line services, I agree that we should do so. As the Minister said, the NHS chief pharmacist has been very clear throughout the consultation that the current way in which community pharmacy is paid and organised needs to be reformed, so it is right that we should look at it.
The NHS is labouring under huge financial pressures, so we should look at any areas in which inefficiencies or duplications lead to precious resources being distributed inefficiently. The public want the money that could be saved through this measure to be reinvested in front-line NHS services. I am glad that the Minister has taken the opportunity to reassure us about that.
My own West Hertfordshire Hospitals NHS Trust struggles under a massive deficit that has been growing year on year. Its latest financial report revealed that it had a revenue deficit of £41.2 million by 2015-16. We cannot fail to tackle the huge financial pressures on the NHS, but just throwing money at the problem will never be enough if we do not seek to tackle the system at the same time. Surely the Opposition cannot be asserting that these matters should never be looked into. Their manifesto pledged £6 billion less than this Government have committed, so I am really intrigued to know how on earth they would keep this system in its entirety and, at the same time, put more money into NHS services, which is what I would like to happen.
I, like many, want the biggest bang for the taxpayer’s buck. I want the Health Minister to succeed in his aim of delivering the very best pharmacy service, with facilities that help to keep patients out of A&E and doctors’ surgeries and, at the same time, promote good health within communities. I agree that it is important to integrate community pharmacies into the NHS urgent care system and GP services.
I welcomed the Government’s announcement in October that the pharmacy integration fund will provide up to £42 million
“to improve on how pharmacists, their teams and community pharmacy operates within the NHS as a whole.”
If we are looking at an establishment payment of £25,000 to pharmacies, we must ensure that we get the right result. When it comes to the closure of small pharmacies, we must protect residents who live in more rural or sparsely populated areas, as well as those who do not have access to cars. The Minister has said that the existing funding system does not do enough to promote efficiency and quality, or to promote integration with the rest of the NHS. He has also said that in most cases the NHS is giving each of these pharmacies a guaranteed fixed payment of £25,000 per year regardless of their size, quality or local demand, and that in total the average pharmacy receives nearly £1 million for the NHS goods and services that it provides, of which around £220,000 is direct income.
Our pharmacy provision varies greatly across the country. The Quadrant pharmacy in St Albans, which I am due to visit on Friday, is situated in a small parade of shops and provides a valued local service. Other pharmacies are located as concessions in huge supermarkets such as Sainsbury’s in London Colney, which have the added attraction of longer opening hours, a large car park, being surrounded by other out-of-town superstores, and a huge footfall of shoppers who can get their prescriptions along with the dog food and Sunday roast. As many concessions are operated by the bigger chains, such as LloydsPharmacy, we must ensure that they do not extinguish the light of the smaller pharmacy that also operates in London Colney, just around the corner from the doctor’s surgery. It is important that we get this right.
I accept that there is an inefficient allocation of NHS funds when Government figures show that 40% of pharmacies are now in clusters of three or more. That means that two fifths are within 10 minutes’ walk of two or more other pharmacies, and I know that that is the case in certain areas of my own constituency. In the St Albans high street shopping area, there are five dispensing pharmacies within a half-mile area. Some are just over the road from each other, some have only yards between them, and some are also operating fairly near to that tightly packed city zone. That cannot be a good idea. St Albans is certainly very well served by pharmacies—not surprisingly St Albans is also the home of the National Pharmacy Association.
It is important that we look at the proposal on offer, but we must get this right. I hope that quality can be provided, that nobody is left behind when pharmacy services are streamlined, and that everyone has access to good services.
I should say that I am chair of the all-party pharmacy group. I am sure that many of my colleagues will today talk about the savings and services that community pharmacies provide to the national health service. Although that is an important point, it is also essential that we highlight the good that they provide to patients. They do so much more than just deliver prescriptions to people. Let me just highlight the scale of their operations. Some 11,800 community pharmacies dispensed more than 1 billion prescription items in 2015.
Community pharmacists are well prepared to adapt to many different problems with which they are presented. They help people to give up smoking, alter their diets, become healthier and manage their cholesterol. Effectively, they are on the frontline as far as the health of the public is concerned.
My right hon. Friend makes an extremely important point. Pharmacies are right at the heart of their communities. As has already been mentioned today, access to those services is vital. In some areas—such as our two constituencies—bus services are being cut and people are finding it increasingly difficult to access services. It is nonsense for the Minister to say that it is a matter of seconds between pharmacies. Will my right hon. Friend comment on how important access to pharmacies is to our communities?
It is very important, and the mechanism that has been put in place will not solve everything. We may get Boots in Gatwick airport supporting it, but there is the potential that others may drop off the line because they are just outside the geographical area. We need to look at that.
Let me turn to population health. This cannot be done by central distribution centres or a pharmacy based miles away, as they have no link with the locality. I am pleased that the idea of major companies getting involved in prescribing has been dropped. Pharmacists know their customers well and are familiar with their medications and, consequently, the customers feel confident in asking them for their advice.
The Government’s figures show that the £170 million cut could force up to 3,000 community pharmacies—one in four across the country—to close their doors to the public, so people would have to travel a lot further to their pharmacist and not have the local connection that I mentioned previously. Community pharmacy is the gateway to health for some 1.6 million patients each day. If anything, that is something we need to get a grip on.
A core component of current pharmacy services supports the public to stay well, live healthier lives and self-care. Pharmacists play a central role in the management of long-term conditions. They carry out medicines use reviews, for example. We must remember that more than 70% of expenditure on our national health service at both primary and acute level is spent on people with long-term conditions. There could not be a better gateway for those people to get the assistance they need to manage those conditions than through local pharmacies.
My right hon. Friend is right. Community pharmacies are at the heart of the gateway. Does he agree that there is a danger that the proposed cuts might end up costing more money than they save?
That is a danger. We do not know what is going to happen.
Community pharmacies attract patients who will not access health care anywhere else. People greatly value the fact that they do not need an appointment at a pharmacy. The long opening hours, too, are appealing. People from deprived populations who may not access conventional NHS services do access community pharmacies, which helps to improve the health of the local population and to reduce health inequalities.
I know that there is some weighting of the figures in relation to the assessment scheme. We need to see how that will work. I hope that we will take it into account that where there are higher levels of deprivation, large numbers of pharmacies might not be inconsistent with need.
I was contacted by a pharmacist in my constituency to highlight two examples from the past week that showed the vital role of a local community pharmacy. In the first example, a 34-year-old lady with epilepsy had run out of her essential medication, owing to a visit lasting longer than she had anticipated. She went along to the local walk-in centre but was denied a supply because of the lack of prescription evidence. As we all know, records are not as joined-up as they should be. The lady then visited her local pharmacy, which, thanks to local record access, was able to determine that her request was genuine and gave her a short-term supply. A lengthy and stressful visit to A&E was therefore avoided and the risk of potentially harmful seizures was averted as well.
In the second example, the pharmacist described spending 45 minutes with the parents of a one-year-old late on Wednesday evening, helping to administer soluble prednisolone for severe croup. The fact that the pharmacist was able to spend that time with the family got the job done, and again an A&E visit was avoided.
The difficulty in collecting such examples is that so many pharmacists see this simply as what they do, rather than as great examples of care for patients. They do not moan about it, worry about whether they get paid to do it or pass the buck; they just deal with the situation and improve patient care for the individual in front of them.
As well as providing extra services, community pharmacies are taking on more of the clinical roles that have traditionally been undertaken by doctors, such as the management of asthma and diabetes and blood pressure testing. That should be welcomed, as it reduces the pressure on GPs. It is usually so much easier for people to visit their local pharmacy for these services than to wait at their GP’s surgery. Because of the greater amount of time that they can spend with each patient, community pharmacists can respond to patients’ symptoms and advise on medicines that have been prescribed or are for sale in pharmacies.
The public support for local pharmacies and the services that they provide is huge. I was one of a number of Members from both sides of the House who presented a petition to No.10 a few weeks ago that now has some 2.2 million signatures. It is the biggest health petition that we have ever had here in the UK.
I shall finish with a quote from a pharmacist in Rotherham, who said, “I do what I do to make a positive difference to patients’ health and wellbeing every single day. How many things would I be able to pick up post-cuts? Probably not as many, as we will have to cut back on staff and I won’t have as much patient-facing time.” The all-party group will be looking at the proposals. I do not say that we should move away from a dispensing model, but we need reassurance that any move will not affect our community pharmacies and patients’ needs.
It is a pleasure to follow the right hon. Member for Rother Valley (Kevin Barron), who runs the all-party parliamentary group extremely well. I agree with much of what he says about the value of community pharmacy.
I start my brief remarks by thanking the people I was involved with in pharmacy for their immense courtesy at all times, even though we were talking about some very difficult things. Those people included my local pharmacists, Arif and Raj in Wootton; Graham Phillips of Harpenden, who spent a large amount of time showing me his shops and is still very engaged with me; those on Bedford local pharmaceutical committee, who invited me at a most difficult time to launch their healthy living pharmacies in the area; and of course my team in the Department of Health.
Instead of repeating the Minister’s statement and his commitment to pharmacy, I shall say a little about why we are where we are and what I found when I was dealing with pharmacy, and look ahead to the future. This is the sort of debate where the previous Minister finds that, owing to pressing parliamentary business, he is not able to attend and he is somewhere else because all this is now nothing to do with him, guv. I thought that would be most unfair and I wanted to be here to support my hon. Friend and to give a little background.
The process started with the settlement made in 2015 between the Department of Health and the Treasury. In that settlement, extra money was released for the NHS, particularly in my portfolio—adult social care, mental health and primary care—but as was mentioned by the hon. Member for Leicester South (Jonathan Ashworth) in speaking for the Opposition, efficiency cuts were required throughout the NHS, as advocated by Simon Stevens. Part of that involved £170 million off the £2.8 billion for pharmacy. I thought that this was appropriate and that, once it was announced, we could work through it.
I regret the 3,000 figure that I gave to the right hon. Member for Rother Valley at a meeting with the APPG. It was a worst-case estimate, taking no account of what changes pharmacies might make to accommodate any reductions in finance, and therefore it was absolutely top-end. The reason that I gave it in conversation with colleagues—it was open and public and I have no objection to the figure being used—was to indicate that I was aware of the difficulty and that we wanted to work very hard to mitigate it, which we then started to do. But the 3,000 figure took on a life of its own. With hindsight, it might have been wiser if I had stuck to exactly what the Minister says, which is that we do not know because the Government do not have a plan to close pharmacies. They are not in a position to do that and we do not know what will happen.
I do not believe for an instant that the outcome will be as dramatic as Opposition Members have suggested, because businesses do adapt. One of the things that I found when I arrived, as several Members have said, is that 18% growth had taken place in 10 years. Pharmacies are a business and pharmacists will make adaptations to their business to cope, so we will have to wait and see what happens. I would not use the 3,000 figure again.
As Health Minister, the right hon. Gentleman said that 3,000 of the 12,000 pharmacies could close. That has come from pharmacies, not from politicians, so does he not accept that that is the real situation, as he said himself?
No. I said it, so I know why I said it. I said it because it was an estimate, and it took no account of any business change that people might make. It was a top-end estimate and I said it to indicate that I was aware that there might be closures and that we accordingly wanted to mitigate the effects. With hindsight, I would not have given that figure, because everyone has said that the Minister said that so many pharmacies would close. No, I did not. That figure does not represent the pharmacies that will close. They might have done if we had not had mitigating measures and if businesses had not made changes themselves. I wanted to put that on the record.
Let me say what I found when I took on the role. There was a discussion in pharmacy about its future. There were plenty of voices in pharmacy which said that the funding model that values volume and establishment but not necessarily quality of service was not the right way for pharmacy to go. The pharmacy profession wanted to see some changes. I thought that was relevant. There were differing voices in pharmacy. The Pharmaceutical Services Negotiating Committee represents some, but there are other voices.
The integration fund we suggested as a way to look at how pharmacy was changing to come into GPs’ surgeries was warmly welcomed. There were innovations all over the country in pharmacy in general. There was a growing move towards healthy living pharmacies providing more services. All this was going on at the same time as we were talking about what changes we needed to make to provide the extra funds for the NHS.
So where are we going to go in the future? I think that we will get through this process. I remember saying to stakeholders in December 2015, “The future of pharmacy will not be decided by this letter. The future of pharmacy in 2020, 2025 and 2030 is still to be decided. It won’t all rest on this; it will rest on changes and progress to be made.”
First, the PSNC consultation process needs to be changed; I am not sure whether it works well when other voices are excluded, and that should be looked at. Secondly, the differing voices in pharmacy should find a way to get together and present a view beyond what is happening on the high street to show where pharmacy is going.
Thirdly, the integration of the NHS could be done better. Why are there not pharmacists on every single clinical commissioning group? There should be more commissioning of services; the hon. Member for Central Ayrshire (Dr Whitford) was absolutely right that we need to do more, but the NHS needs to do more, with better commissioning and pharmacists being involved.
Fourthly, there needs to be a thorough review of what pharmacy can do and provide in the future, and that should be a springboard. Sometimes innovation comes out of pressure, not out of great resources, which we would love to see in a perfect world. Finally, we should ensure there is long-term support for a locally based network—there are models that would remove more from the locally based network that we should all resist—and such an approach would be the start of a good future for pharmacy.
It is a pleasure to follow the right hon. Member for North East Bedfordshire (Alistair Burt), who tried to be extremely helpful to the current Minister—most ex-Ministers have ex-Ministeritis and tend to be extremely unhelpful to current Ministers, but not so the right hon. Gentleman. However, he did use that figure of 3,000 pharmacies—one in four—facing closure. He has attempted to qualify it now, and his defence seems to be that he made the estimate without properly thinking it through. To that extent, there is remarkable continuity with his successor, who makes a number of assertions without remotely thinking them through. However, if we are now told that we have to disregard what the previous Minister said, why on earth we should believe what the incumbent says? Who is to say that, in a year’s time, after some reshuffle, the Minister’s successor will not come to the House and tell us at the Dispatch Box, “You don’t want to pay any attention to what the fellow before me said. He never knew what he was talking about.”?
The Government’s impact assessment is worth closer examination, because it states:
“the potential impacts…are assessed on the basis that there is a scenario where no pharmacy closes”—
not one. That scenario is not shared by anyone else. Even the Minister, when asked how many would close, told the House, “I do not know.” The impact assessment goes on to concede:
“There is no reliable way of estimating the number of pharmacies that may close as a result of this policy.”
The Department literally has no idea. According to the impact assessment, the Department is officially clueless as to the impact on pharmacies.
Does my hon. Friend agree that an impact assessment of the knock-on effects for the NHS more broadly would have been useful? One in four patients will probably seek with a GP an appointment they would have sought with a pharmacist. We have heard nothing from the Government about what the knock-on effect would be or what investigation they have done into that.
My hon. Friend makes an excellent point. It would have been helpful to have had an impact assessment as the basis for debate, rather than having something that was published on the day of the announcement.
My hon. Friend alludes to the fact that the impact assessment on community pharmacy says that cuts to community pharmacies will increase patient health benefits
“by reallocating savings from community pharmacy funding to other uses”—
a point the Minister made—
“ensuring that patient health is unaffected”.
Yet, polling commissioned by Pharmacy Voice shows that one in four patients would make an appointment at a GP if their local chemist was closed—a figure rising to four in five in more deprived communities such as my own in Barnsley.
There is no consideration whatever in the Government’s assessment of the potential downstream costs to other parts of the NHS budget, such as the pressure on GPs and A&E. The Department’s impact assessment does say that these cuts are
“expected to lead to reductions in the employment of pharmacists, pharmacy technicians and other pharmacy staff”,
so the Government are clear at least that local pharmacists—the people many of our constituents rely on—will go because of these cuts.
The impact assessment predicts that there will be a “corresponding increase” in other NHS employee numbers, so there will be “no net effect” on the NHS. That is completely without foundation. Are the Government really trying to tell us today that, for all their talk about the importance of community pharmacies and all the evidence about the pressures that will result on GPs and A&Es, which are already overstretched, the work of pharmacists in our local communities will, and should be, taken up by a corresponding increase in other NHS staff?
The impact assessment says:
“the modelling does not take any account of potential reduction in opening hours which may also affect access.”
You bet! New research published today and carried out by the National Pharmacy Association shows that, when faced with the Government’s budgetary cuts, 86% of community pharmacies are likely to limit or remove the home delivery of medicines to housebound patients; 77% of chemists say they will probably become more retail focused to deal with funding shortages—exactly the opposite of what the Minister hopes to achieve; and 54%—more than half—are likely to reduce their opening hours, which will limit patient access and put more strain on our already overstretched GP surgeries and A&E departments.
To sum up, the Government’s own impact assessment, which is well worth a read, if only for comedy value, reads as though it was written in haste on the back of a cigarette packet. The Government—rather like the Minister—are making up the policy as they go along. What Ministers are actually asking us to do today is to make a leap of faith: to turn a blind eye to all the evidence; to disregard all the warnings; to ignore the unanswered questions, the contradictory statements and the glaring omissions in the Government’s own case; to brush away expert opinion; and to dismiss the concerns of the public. Based on the Department’s own impact assessment, how can any right hon. or hon. Member possibly support the Government in the Lobby today?
As we have already heard in the debate, many of us have seen the considerable value that local community pharmacies provide in our constituencies. I have seen that myself with the Manor pharmacy in Elstree, which is run by Graham Philips, to whom my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) paid tribute. I would urge the Minister to meet him; he really is a pool of expertise on this issue. The same is true of those at the Crown pharmacy at Borehamwood and Shenley.
What we see time and time again in these places is that the commitment to the customers goes way beyond what we would see from a normal retailer. There is a genuine understanding of the needs, health and wellbeing of the people who use such pharmacies. The services range from dementia-friendly services, picking up the early stages of the disease; healthy living advice, including assistance with drugs and weight management; and smoking cessation services.
Would my hon. Friend add to his list Nick Kaye in my constituency? He is carrying out some excellent work to collaborate with local GPs and to find innovative ways to deal with patients. Does my hon. Friend agree that pharmacies are particularly important in tourist areas, as the frontline that can deal with tourists who have health problems, and take pressure off the other health services?
My hon. Friend is absolutely right that pharmacies play a crucial role in relieving the frontline of NHS services. However, that does not mean that reforms are not necessary. Of course we need to incentivise the kind of advantageous behaviour we have talked about; but we also need to recognise some of the problems with the provision of pharmaceutical services.
We know the basic problem; it has been referred to by other Members. The pharmacy budget has increased by 40% over the last decade. Even taking into account all the changes that the Government are proposing, funding for community pharmacies will still be 30% higher than when this Government first came to office in 2010. Equally, we have the problem of excessive clustering—a situation where there are many pharmacies within a short distance of one another.
Those who argue that there is no need for reform really need to explain where the money will come from. If we are not recycling these services to the frontline, we need to look for other savings, or we need to look at lower levels of service in the frontline of the NHS, whether that is services for diabetes or for cancer. There is no magic money tree. We have to take these difficult decisions in order to provide for the frontline, so I completely agree with the overall thrust of Government policy.
We can take an intelligent approach towards this issue. As we have heard, there is a big difference between various types of pharmacies. At one end of the scale, there are the very large pharmacies that are often in large retail outlets such as supermarkets and sit at the very back of the store. They are there, in essence, to encourage customers to go through the rest of the store to purchase other goods. They could easily take a larger cut than is being proposed, because they are just operating as loss leaders for those stores to get customers in the door in the first place.
My hon. Friend is making an excellent point. I was slightly disappointed that the shadow Minister did not really understand the principle of vertically integrated pharmacies. Some big national companies are making a lot of money out of pharmacy at the moment.
I thank my hon. Friend for that intervention. Equally, many such pharmacies do not provide any of the wider community health benefits. In essence, they are just dispensing services.
Is it not estimated, however, that those will be the ones that survive, purely because they are big, while the small, high-service pharmacies in communities are more vulnerable?
That is precisely the point that I am coming to. As we proceed with these reforms, hon. Members need to recognise that we will need further savings in this area. I am not attacking large retailers because of their size; it is because of the lack of such wider provisions. We need to look at ways of securing further savings from them which we can plough back into the community pharmacies that are providing the services on which all our constituents rely. I completely accept that pharmacies that are purely dispensing services are very inefficient as such. They are highly labour-intensive; it is just a very expensive way of delivering drugs. We need to identify ways in which we can bifurcate the two different types of providers.
I pay tribute to what the Minister has announced so far. He clearly demonstrates an understanding of the situation, as we have seen in relation to the protection of key local pharmacies through the community access scheme. For example, in my constituency, the services in places such as Elstree and Shenley, where we have small, rural communities, often with an elderly population, will be protected. Equally, the quality payment scheme recognises some of these wider community benefits.
However, I urge the Minister to do more in that area. Let me make two brief suggestions. First, we need more detailed recording of the sorts of services that are provided by pharmacies which take pressure off the NHS. As I understand it, there is no systematic way in which these additional benefits are recorded, and we are all working on the basis of estimates. We could have a system whereby the community pharmacies systematically recorded the benefit that they provided, and then they could be better rewarded for those benefits. At the same time, there would be a means by which we could penalise, or find further cuts from, the pharmacies that did not provide those additional services.
Secondly, the hon. Member for Central Ayrshire (Dr Whitford) rightly commented on the common ailments scheme that operates in Scotland. The Minister indicated that the Government are moving down that route. I urge the Government to go further on this. There is absolutely no reason why patients suffering from things such as common cold and flu symptoms or head lice could not be referred directly from their GPs to pharmacies, thereby saving money for GPs and providing additional income for those pharmacies.
I support the overall direction of reform, but as the Government proceed with these reforms, they could do with engaging more in looking at ways of supporting what is best in community pharmacies while providing further savings from the services that do not provide them.
I rise to speak in support of the Opposition motion. I put on record my thanks for the extremely hard work that has been done on this campaign by a number of my hon. Friends, particularly my hon. Friend the Member for Barnsley East (Michael Dugher).
Community pharmacies play a really crucial role in my constituency and, indeed, right across the country. We know from the many statistics, and the surveys and inquiries that have been done, that they are trusted. When I speak and listen to my constituents, it is clear that they trust the community pharmacies that they engage with, and also develop very close relationships with the people who work in them. I see that for myself when I go to collect my prescriptions locally. They are enormously busy places. I note that the hon. Member for Hertsmere (Oliver Dowden) said that they just deliver drugs, but they do so much more than that within our communities.
That was not my point; I was saying that many large-scale dispensaries, particularly in supermarkets, do little more than deliver drugs, but we need to focus on the community pharmacies that provide the wider services.
The hon. Gentleman has just spoken in support of the Opposition motion.
When we had an urgent question on this subject, I listened closely to the Minister, who talked particularly about how far he expected people to travel and said that lots of community pharmacies were not very busy. Over recent weeks, I have made a point of looking through the windows of my local community pharmacies to see whether any of them are in fact empty, and it is fair to say that none of them are at any point. The statistics show how busy our local community pharmacies actually are. The figures speak for themselves. The average community pharmacy sees, on average, 137 people every single day. They dispense 87,000 prescription items over the course of a year. They support, on average, 250 people with diabetes, 389 people with asthma, 463 unpaid carers, 805 older people, 1,317 with a mental health condition, and 1,416 people discharged from hospital. The last figure is particularly important. I will not presuppose what the Health Committee report that comes out tomorrow might say about pressures on our winter A&E services, but it is fair to say that many people are expecting, following a summer crisis in the A&Es in our hospitals, that our local hospital services will be under enormous amounts of pressure. Our community pharmacies already do a really important job in supporting our constituents who have been discharged from hospital.
I have had the opportunity to listen to members of my local pharmaceutical committee. When I asked them what the local stats and figures were so that I was equipped for this debate, I was very struck by what they said. Hon. Members have already mentioned to the Minister—it is regrettable that he is no longer in his place—the pharmacy assessment scheme and how it has been put together. It is enormously regrettable, to put it politely, that it does not take account of deprivation. That means that the pharmacies in the most deprived areas of our country, where patients have greater health needs, are not entitled to claim the payment. I made this point earlier, and I make it again: in Liverpool, we have some of the highest levels of deprivation; Kensington ward is in the top 20 in the country. No pharmacies in my constituency are eligible for the pharmacy assessment scheme payment, and just two across the whole of Liverpool are eligible—one in Croxteth and one in Netherley. That means that all the other 129 community pharmacies across Liverpool, and six distance-selling pharmacies, face the full funding cut. That puts at risk the very vital service that they offer to my constituents and people across Liverpool.
The funding cut in this financial year has already had an impact on our local pharmacies. Some have already curtailed their free, but unfunded, delivery service to patients. My hon. Friend the Member for Barnsley East highlighted the hours in which those services are often provided. They are a lifeline for house-bound and vulnerable patients across our country.
Other pharmacies are already in the process of making staff redundant, so they will have to survive on fewer staff. Pharmacists in some of our community pharmacies will, therefore, inevitably be tied more to the dispensing bench rather than undertaking the enhanced clinical role that NHS England, the Department of Health and Ministers expect them to deliver under the five year forward view.
The point about deprivation is so important. As my hon. Friend the Member for Leicester South (Jonathan Ashworth) said in his important opening remarks, it is outrageous that the pharmacy assessment scheme will further widen health inequalities in our country. We will have a specific debate about that issue next Tuesday, so I ask the Minister to reflect on it. In 2016, we have a responsibility to close the gap, not promote schemes that will widen it. I note in particular that the scheme makes no provision for patients and communities with protected characteristics under the Equality Act 2010.
I know that many other hon. Members wish to speak, so I will make a very brief point in the 13 seconds that I have left. Some Members, including the Minister, keep calling community pharmacies “private enterprises,” but there are many co-operatives that provide these services, often in rural and isolated areas across the country.
Order. I am afraid that the limit has to be dropped to four minutes.
Like many Members, I have been fortunate over the years to see the brilliant services provided by local pharmacies in my constituency, including in the communities of Haxby and Wigginton, Fulford and Poppleton, to name but a few. I have also witnessed the very important role that pharmacies play in delivering care in the community. We must ensure that they are properly incorporated into the delivery of primary care.
I have the utmost respect for the new Minister and I wish him well in his new role, but I fear that he has been given a hospital pass. Having said that, I understand why he wants to make reforms. I agree that we need to improve the service offered to patients, allocate resources more efficiently and ensure better integration with the wider NHS. I welcome the recently announced pharmacy integration fund, which aims to link pharmacies to primary care.
If we are truly seeking to integrate services better, however, and to reduce reliance on funding to pharmacies for simply existing and to promote high-quality care, we must further expand the role of pharmacies and the treatments that they can administer. That would help shrug off the lingering perception that pharmacies are simply drug dispensers. For example, could things such as the winter flu jab be overseen exclusively by pharmacies?
I also support the growing calls for a truly national minor ailments scheme that directs patients to pharmacies and away from GP practices where appropriate. I welcome the Minister’s announcement that NHS England hopes to have such a scheme in place by April 2018. I hope that it will be a transformative moment for community pharmacies and primary care more widely, and I look forward to scrutinising it.
I am also pleased that, through the introduction of a pharmacy access scheme, the Minister is seeking to address some of the concerns about rural communities losing their pharmacies. He has said that 40% of pharmacies are in clusters of three or more, and I agree that we should introduce a better funding system to disincentivise that practice.
That brings me to the one-mile rule. Although I understand completely the principle behind it, I remain concerned about whether it will truly ensure that
“a baseline level of patient access to NHS community pharmacy services is protected.”
In the short time that I have left, I will cite an example in my constituency. Fulford pharmacy, which is a small, independent business and is not part of a large chain, sits only 80 metres away from the one-mile rule and is, therefore, ineligible for the pharmacy access scheme. It is not in one of the 20% most deprived areas, either. As a result, I fear that the 3,000 residents of Fulford could lose access to that fantastic service, given that the next nearest pharmacy is some distance away in Fishergate. May I encourage the Minister to consider introducing flexibility or a case-by-case assessment to ensure that pharmacies that serve specific communities do not fall by the wayside?
I will reinforce that point in the last few seconds that I have left. I am told that two branches of Boots pharmacy in terminals 3 and 5 of Heathrow airport will receive pharmacy access scheme payments, as they are more than a mile apart, despite clearly not serving any specific community.
This debate could not come at a more important time for my constituents, because a potential 25% of the 42 community pharmacies in my constituency face closure due to the funding deal that this short-sighted Government imposed last week.
Pharmacies in Bradford West play a vital role in the total holistic healthcare services on offer to my constituents. My constituency is the fourth most deprived in the country, and we have one of the most diverse communities. Constituents face genuine day-to-day struggles to access the services and advice that they require. The 2014 patient survey report showed that more than a quarter of them could not access a GP appointment when they needed it.
We acknowledge the essential and diverse service that our community pharmacies perform and, in an attempt to maximise their impact, Bradford trialled the minor ailments scheme, which the Minister has referred to, in 2014. I spoke to Mr Ajmal Amin of my local pharmacy, Sahara, only this morning, and he explained that, in addition to the more than 100 people a week who walk through his door, an average 50 a week do so as part of the minor ailments scheme. Even if one in four people end up going to a GP appointment, that means 90,000 extra GP appointments a year in my constituency alone, at a cost of more than £4 million.
Bradford has a higher incidence of cancer, diabetes, stroke and coronary heart disease, and that is because poverty, deprivation and ill health go hand in hand—there is a clear correlation between them.
I will give a recent personal example. Over the past few months, my mother has suffered three transient ischaemic attacks. One of them was a potential stroke and she has already had cancer. Only last week, she was admitted to Luton hospital with an acute kidney infection. On Monday morning, it took 42 attempts for me to get through to my GP practice to make an appointment, but by the time I got through at 23 minutes past 8, all the appointments had gone. That experience is not unique to me; it is happening across the country. If we close community pharmacies, GPs will come under extra pressure. I have not seen a Government plan to give my constituency—which is one of five in Bradford—£4 million for another 90,000 appointments a year.
The reality is that the proposals will disproportionately affect those who need healthcare the most. Yes, we have lots of pharmacies, but the Government’s proposals do not take into account diverse communities with complex health needs.
It is interesting to hear what is happening in my hon. Friend’s constituency. Five of the 23 pharmacies in my constituency of Wirral West are at risk of closure because of the Government cuts. Given the huge pressures that NHS services are under, does my hon. Friend share my concerns that the cuts will further inhibit the options of elderly and infirm people in particular in accessing the services that they need?
I agree with my hon. Friend. My constituents have so many complex health needs. I am a former NHS commissioner, and I commissioned services in accordance with public health priorities in Bradford. Obesity, cancer and diabetes are long-term chronic conditions and they impact on those communities with the most deprivation. It is not just one whammy: we have deprivation, lack of jobs and so on. We need to look holistically at people. Taking away pharmacies from our communities is not the way to provide healthcare services. We cannot and must not look at pharmacies as stand-alone items. They are part of a holistic care package across the board, and they complement the NHS and GPs.
Let me be clear: the fact that I could not get through to my GP surgery until my 42nd attempt is not a reflection on my GP practice, Kensington Street health centre, which is one of the best I have ever experienced. The staff are amazing. They are working to try to fit a square peg into a round hole because of the extent of the cuts that they have already experienced. This is not about GP practices not delivering what they can; it is simply that they do not have the resources. We do not have enough GPs as it is, and taking away pharmacies will not help.
I urge the Government to revisit this proposal, which has not been clearly thought through and does not take into account constituencies such as mine. I urge the Government to abolish it and bring something else to the table, because it is clearly not going to work.
We are all aware of the letter received by pharmacists on 17 December last year, in which the Department of Health discussed the potential for far greater use of community pharmacies and pharmacists. The letter referred to community pharmacists’ role in preventive care, in support for healthy living, in support for self-care for minor ailments and long-term conditions, in medication reviews in care homes and as part of a more integrated local care model. The letter also informed us of plans to reduce funding by £170 million.
I was fortunate enough to be the first MP to raise the matter in a Westminster Hall debate at the beginning of this year. I raised the concerns of community pharmacists about their funding as the plan progressed, as it was intended to do by October 2016. That all came about because the issue was raised in a constituency surgery that I held in St Ives at the start of January. Since then, the general public have been very engaged in this, and they are concerned about the future of their pharmacies. I joined others in this House to present a petition with 2 million signatures to No. 10 in the summer.
I represent a Cornish seat where every effort is being made to integrate health and social care, and community pharmacists see themselves as essential players in a new, modern national health service that is equipped to meet the demands placed on it by today’s society. Community pharmacy is valued and depended on, and it can embrace new clinical responsibilities and meet the demands of an ageing population, but the sector is looking to Government for some reassurance about its future, particularly regarding funding for community pharmacy.
In my constituency, I have several independent community pharmacists. That is because my patch is large and includes areas of social deprivation, which has an inherent impact on health. A car journey from the north to the south of my constituency takes an hour, and a journey from the most westerly point to the most southerly point takes an hour and nine minutes. In a rural area such as mine, community pharmacists provide invaluable access to the NHS and invaluable support to vulnerable people. I am reassured by the fact that the Government have indicated that some protection will be given to rural pharmacies and those in deprived rural areas. That is welcome indeed.
However, funding of community pharmacy remains a concern, and the community pharmacy sector has called for the Department of Health to use funds cut from the community pharmacy budget to fund a minor ailments service from 2017. The service would allow eligible people with a list of common health complaints to visit their pharmacy for advice and, where appropriate, medicines at no cost. That could create significant savings for the NHS by ensuring that patients with minor conditions use pharmacies, thereby preventing unnecessary GP appointments and A&E attendances.
I am well aware of the need to secure better value for money in areas of the NHS. In Cornwall and the Isles of Scilly we are actively involved in drawing up our STP, as directed by NHS England. The NHS has outlined this approach to ensure that health and care services are built around the needs of local populations. I believe that that provides the best opportunity to integrate health and social care in a meaningful way, reduce the pressure on acute services and avoid unnecessary hospital admissions. I also believe that the community pharmacy is central to achieving that objective.
I am aware of the time, so I will just ask a few questions of the Minister. Can the Minister give more details about what support will be given to rural independent community pharmacies and those in deprived areas, many of which operate in Cornwall? Will the Minister comment on the community pharmacy forward view, and the Department’s response to the vision set out by community pharmacy—
Here we are again, debating more slash-and-burn cuts to vital public services. Generations and decades of investment are being eroded in just a few short years. What will be left?
I think we all accept that if we can make savings in the public sector, we should do so, because we should use the money to the best possible effect. But it is short-sighted to take money away from community services when the accepted logic is that those services save money in the long run. It beggars belief that we are debating this again.
In my constituency, local pharmacies and GPs are working collaboratively to build an integrated health centre in Haydock. Does my hon. Friend agree that although the Government say they want to encourage such working, their actions, as usual, do not match their words, because they are cutting the funding that would make that long-term, sustainable investment worthwhile?
I share that view entirely. My preferred option would be to devolve that power with fair funding to local areas, so that they can decide. The Government have proved time and again that they do not understand or value the public services that our communities rely on.
Let me tell Members what it is like in Oldham. We have 57 community pharmacies, nine of which have 100-hour contracts and four of which offer delivery services. That is about 25 pharmacies per 100,000 residents. Ask the public how they perceive those pharmacies, and 93% say that those pharmacies are doing a good job, while 88% of people in Oldham use those pharmacies. They are respected, and they are used by the community. When asked, the main reason people gave for using those pharmacies was their proximity and location. People could get to those pharmacies to access the services that they needed.
The truth is that we do not need fewer pharmacies; we need more, because demand is going up. I am not the only one who says so. The local health and wellbeing board says so in a 90-page review of pharmaceutical support in Oldham. It says that we have enough pharmacies to meet current demand, but that demand is going up because people are living longer, because the population is increasing and because new homes are—as the Government want—being built in the area to support new families. That requires the infrastructure to be in place.
Many wards in the borough do not have pharmacies that are open at weekends, so it is not as though we have a gold-plated service. We are just about getting by. It is not as though pharmacists are twiddling their thumbs behind the counter waiting for somebody to walk through the door. The average number of prescriptions dispensed by those outlets is 7,000 a month. We really need to think about what we are doing, whether the money is in the best possible place and whether we are valuing the real saving that can be derived further down the line.
I am not the only one who says that pharmacies can help us to achieve savings. PwC, which is hardly a standard bearer for public services, has said that pharmacies in the community save £3 billion a year. Why? Because people do not have to go to the GP or present to A&E, and because prevention is far better than cure. That is exactly what community pharmacists are there to do.
I really worry about what we are going to do to the industry and to the profession—that community service—which people aspire to be part of. I can tell Members what community pharmacists are saying, because I have a letter from a local pharmacist who lives in the Werneth area of my constituency. Mr Khan studied hard through school, sixth-form college and university to set up his own pharmacy. He works very long hours; although he is funded to work 40 hours a week, he actually works 50 hours a week—10 hours a week free of charge to the NHS—because he believes in a community service. He provides a delivery service, which is not paid for by the NHS, where he takes prescriptions out to the public. For a lot of the people he meets, he might be the only person they see during the week. According to the estimates in the report that I referred to, 15,000 more people in my borough will be living alone by 2017. Loneliness and isolation are real issues, and such community infrastructure is an important way of combating them.
I want to read out an important quote from the pharmacist I have mentioned. He said:
“Many of us, however, feel betrayed, angry and confused right now because the government who promised to make Pharmacy at the heart of the NHS; has ripped the very heart out of Pharmacy.”
It is not me or the Labour party saying that, but a pharmacist. They have studied hard and worked hard to set up their own business, and they work hard every day for their community, but they are being let down by this callous Government.
I declare an interest, as my wife works as a community pharmacist just outside my constituency. It is probably fair to say that from my discussions with her and with my local pharmacists, I know the valuable work they do and the pressures on them, as well as the changes that they would like so that they can give a better service.
The Public Accounts Committee has had nine or 10 inquiries in the past year or so looking at the pressure on NHS finances and the various deficits in the system. It is therefore quite hard to stand up and say that the Government are completely wrong to try to find some efficiency savings from the pharmacy budget, or that we should just ignore the £3 billion or so paid to pharmacies each year without trying to find some savings. If we are going to hit the efficiency target across the NHS of £22 billion during this Parliament, while having all the services we want, we will have to accept such savings in every area, although it is not going to be easy wherever they fall. I can therefore see the logic of why the Government need to look at the pharmacy budget.
I also accept the logic that although the system we have ended up with, in which we give each pharmacy a fixed establishment payment, may well have been suitable when we had a very controlled regime, under which a licence had to be got to open a new pharmacy, it probably did not fit well with the old 100-hour regime, under which there was a vast expansion in the number of pharmacies across the country. It is right to look at that system. It may also be right to look at the 100-hour pharmacies to see exactly what the rules for them should be.
I welcome the pharmacy access scheme, which is a very welcome improvement on what was originally suggested for this round of cuts. Two pharmacies in my constituency will benefit from it. I met both pharmacists when the cuts were first announced. Those pharmacies provide the only health provision in the villages they serve, so it is vital for them to be saved.
Does the hon. Gentleman agree that it is a false economy to cut services, given that the knock-on effects on GP services and the NHS will cost more, and that it will do nothing to alleviate the problem of health inequalities in this country?
It would clearly be a false economy if it resulted in losing pharmacies in areas where we need them. Equally, we would have to say to GPs, “I’m sorry. We can’t take the money off the pharmacies. We are taking it off you instead.” That would make it harder for them to deliver the services that they want to deliver. I do not think there are any easy answers. The system is under so much financial pressure that we must find savings wherever we can.
I have a few areas on which I want the Minister to comment when he winds up. The first is the hub-and-spoke model. Such a model would have been a complete disaster for community pharmacies. If the system is to work, we need pharmacists who know and are trusted by their patients so that they can deliver to patients the extra services that they need. If we moved to a hub-and-spoke model, in which the pharmacy knows almost nothing about the patients—the drugs are just prepared in a factory somewhere and then turn up for the patient—we would not have the community advantages from the pharmacy network that we all want. I hope that that idea, which may have been raised by some management consultants, can safely be binned—where most such ideas are probably worth sending.
The second area is the provision of services by pharmacists. I know that my local pharmacies are very keen to deliver more value-added services. They see that as right for the NHS and in the best interests of their patients. As I found out five years ago, when we went through the clinical commissioning group reform, they are not quite so sure that local GPs are keen on commissioning new services from pharmacies, rather than carrying out those services and taking the revenue themselves. We know that there is pressure in the GP sector, so we can see the point of that.
We need to have a vision throughout the country about what core services should be commissioned from pharmacies. I think the word the Government use about the minor ailments scheme, which I generally support, is that we should “encourage” all CCGs to commission such a scheme. I hope we can do something a little stronger than encourage, and that we can have a broader list of services for CCGs to commission from pharmacies. I have seen great work done on that in my constituency. Permission has been given for syringe driver services to be carried out by some pharmacies, rather than hospitals, so that they can be got to the patients needing them much more quickly and cheaply. Some pharmacies do warfarin testing, because it is much more convenient for patients to go to their local pharmacy than to have to trek to the nearest hospital or to their GP. Those services are very patchy and do not even cover a whole constituency, so I hope we will draw up a core list of services that can be done better by pharmacies and which will be used.
I will quickly touch on the third area, which is the variety of opening hours. Quite rightly, we are to start directing patients from the 111 service to their pharmacy rather than to out-of-hours doctors as the first port of call for emergency repeat prescriptions. However, there is an interesting mix in that some pharmacies open for 100 hours a week—perhaps opening at 6 am and closing at midnight—and other pharmacies open from 9 o’clock to 5 o’clock from Monday to Friday and may open for a couple of hours on Saturday morning. How will we commission all pharmacies to carry out such a service if some do not open out of hours? On the flipside, we still require many of them to open for 100 hours a week, even though it is not economic for them to do so during many of those hours. There is therefore scope for a review of the hours during which we expect pharmacies to open.
Madam Deputy Speaker, if you were to walk along a busy shopping street in Bedminster in my Bristol South constituency today, you would pass seven pharmacies within a mile or so. However, if you were to walk through the Knowle West estate or Hartcliffe, which are two of the most deprived wards in the country, you would see many fewer pharmacies.
I have spent time in pharmacies in Filwood Broadway and Bedminster, and like most hon. Members, I have been contacted by pharmacists and constituents who are worried about the plans. The greatest fear in my constituency, which has a relatively high density of pharmacies, is its severe problem with GP recruitment and with the sustainability of primary care. We stand to lose disproportionately from those twin concerns. As hon. Members have said, we all know the valuable role that pharmacies play in our communities. This is not just about the damage to healthcare as a result of some of the cuts, but about the impact on our wider economy in some of our most deprived areas.
Madam Deputy Speaker, if you were to wander around my constituency in two years’ time, how many pharmacies—and, crucially, which ones—would still exist? As hon. Members are aware, the NHS-wide process of sustainability and transformation planning is currently being undertaken with the aim, finally, of taking a strategic overview of the whole system. This is the first bottom-up, system-wide planning that has taken place since the disastrous Health and Social Care Act 2012. We are bringing back planning to the system, which is long overdue. This is also about saving a lot of money.
In that context, the delayed Government funding announcements on pharmacies, followed by rushed ones, are the opposite of the STP process. It shows an absence of planning, and a failure to include the vital role that the community pharmacy can play. Where is the sense, when communities need stability, in forcing through a cut of this magnitude at this time? The Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), said that earlier.
In my area, the local pharmacy committee is represented on the STP board. All the local players are working hard, collaboratively, in the best interests of patients, to find a solution to our local healthcare needs. However, as has been said by the chair of the LPC, Lisa Fisher, who runs a pharmacy at Whitchurch in my constituency, this measure is a “devastating blow”. It runs totally counter to the process that Ministers want to succeed.
The Bristol CCG reported earlier this year on the root cause of the waste of medicines, and made recommendations to address the problems in the system. The figures are eye-watering. It estimates that medicine waste amounts to £5.7 million a year in Bristol, and that we can save £2.8 million a year. It made 15 recommendations for such work, but none covers having fewer pharmacies in our community.
The Minister may stand in front of pharmacies and lament the way in which the market has produced clusters in some areas, but will a large supermarket chain housing a pharmacy decide the floor space is better utilised for a café, and will the pharmacy that does the most deliveries in areas of greatest health need and that offers the most self-care advice close? How does he know? He does not. Crucially, how will my constituents know, and how can they influence the service provided to them?
In Ministers’ minds, is any consideration being given to starting from community need, not from market forces at such a time? If they were putting forward a new model that was genuinely built on pharmacies being at the forefront of Government thinking in addressing the challenges of our healthcare system, that would be good, but they are not doing so. This is not a modernisation package, but a fig leaf. It is a missed opportunity, and that is a great shame at this time.
During the past year, I have visited a number of local, independently run community pharmacies across Sutton. They add much to our local healthcare provision, and they have the potential to add so much more, as we have heard. We therefore need to tread carefully when looking at changes to funding and configuration. When I spent time in those pharmacies, I saw a steady stream of customers. The pharmacist knew most of them by name, as well as their background and wider circumstances. Such a special relationship takes time to build, but it can be so valuable in assessing health needs and pre-empting any problems. We need to look at how we can develop community pharmacies further as a neighbourhood health and wellbeing hub, so that they become the go-to destination for support and advice and act as a gateway for other healthcare services.
As a number of hon. Members have done, I have been to A&E and seen people who have not had an accident or do not appear to be an emergency, so it is right to look at how we push people towards GP services. However, there seems to be less discussion in public about encouraging people to look to their pharmacist, rather than to their GP, for healthy lifestyle advice, minor ailments care and routine support. The all-party parliamentary group on pharmacy heard some great evidence from the LloydsPharmacy group about its diabetes foot service and inhaler check service, which enable people to get the most out of their treatment and can make their medication far more effective. Those kinds of extra services make community pharmacies incredibly valuable.
Does my hon. Friend recognise that we need to make greater use of things such as opticians as well?
My hon. Friend makes a very good point.
Independent pharmacies in Sutton conduct medicine reviews, which we have heard about, and often deliver to their patients’ homes. They therefore see people in their own environment, rather than in a GP surgery. They get to see what is left in the bathroom cabinet, forgotten about or set aside. Ignoring or forgetting to take prescribed medicines causes such a lot of waste. There is an estimated £300 million a year that could go to other front-line services. By seeing the patient in their own environment, the pharmacist can make an assessment based on the patient’s everyday life, rather than just a snapshot, which might be affected by things such as white coat syndrome.
Consultation room services, such as sexual health, smoking cessation and minor ailment services, have to be a good thing for the NHS and should be encouraged. From what I have seen in pharmacies, there is still too much of a disconnect in the exchange of patient information between GPs and pharmacists. If advice and treatment are to work, they must be done in full knowledge of the patient’s background and medical history.
I understand the concerns that have driven the review and the changes that we are debating. The current funding system encourages pharmacy companies to open numerous low prescription volume sites, especially with the guaranteed fixed payment of £25,000 a year, regardless of size, quality or local demand. Some 40% of pharmacies are in clusters of two or more, with 20% being within 10 minutes’ walk of at least two others. That is reflected in Sutton. There are three in Worcester Park, four in north Cheam and six in and around Sutton High Street.
My concern is that any closures that result from these changes are more likely to come from the independent portion—those pharmacists who go beyond the corporate approach, often offering services at no cost or at a loss, because it is the right thing to do; those who prioritise the service that patients need, rather than shareholder value. Responding to customers on a personal basis allows independent pharmacists to consider savings such as generic substitution. We talk about a seven-day NHS, but pharmacists need to be set free to offer a high street NHS.
The Government’s changes recognise much of what pharmacists’ bodies have been raising. The changes seek to move pharmacists away from being reliant primarily on dispensing income, which is more vulnerable in the long term, towards services. Repeat prescriptions and those who come in via the 111 service will be directed to pharmacies, rather than out-of-hours GPs. For the first time, pharmacies will be paid for the quality of the services they provide, not just the volume. There is much to be welcomed, but I urge the Minister to keep the impact of the changes on independent pharmacies, which are often family run, under constant review.
My hon. Friend is speaking very well for the independent pharmacy sector. It is those pharmacies that we should be protecting the most, because they are the first triage that saves the NHS money down the line. They can save a lot of money for the general NHS drugs bill by knowing their patients well, knowing the GPs and suggesting something cheaper. I am not convinced that the Government have looked into that aspect closely enough.
I thank my hon. Friend for his comments. I have spoken about generic substitution and some of the things LloydsPharmacy and family-run services are doing in the consultation room. Those things are to be welcomed, encouraged and boosted.
I urge the Minister, in the coming months and years, to keep the impact of the changes on independent, often family-run pharmacists under constant review, because I and many others in this place certainly will.
I support the Opposition motion and pay tribute to the great campaigning leadership shown by my hon. Friend the Member for Barnsley East (Michael Dugher) and the shadow Health Secretary in bringing this matter to public attention and opposing the £170 million of cuts, the 12% reduction in funding and the further 7% reduction next year, and the threat to shorten the working hours in pharmacies and to strip out jobs in local pharmacies, which will have an impact, particularly in high-poverty communities. We are having this debate on the day that the Resolution Foundation reports that tax cuts since 2010 have taken £32 billion out of the Exchequer, so this debate is about political choice. It is about where we put public funds and whether we support the impact on high-poverty communities that the Opposition believe these cuts to pharmacies will engender.
I will focus briefly on the situation in Stoke-on-Trent. My constituency has a very good Miltons chemist in Stoke and the Norfolk Street pharmacy in Hanley, which is a former pub that was converted into an excellent community pharmacy. Those pharmacies are very concerned about the impact of the proposed cuts. Earlier this week in the Chamber, the Secretary of State for Health acknowledged the stress on healthcare in Stoke-on-Trent. He is coming to the city to see the Royal Stoke hospital because the closure of Stafford hospital and the community hospitals at Longton, Cheadle and Bradwell, and the pressure on our GPs, are putting immense pressure on it.
Part of the answer has to be ensuring that we have primary preventive care, of which pharmacies are an essential component. Everything we have heard in this Chamber is about the enormous contribution they make and should make to healthcare provision, yet the trajectory of Government policy is to undermine that provision. We know that if people do not have access to pharmacies, they try to get appointments at the GP. We know that in disadvantaged communities, more and more people would seek to do that.
We have addressed the issue of clustering, with too many pharmacies being clustered together. However, we know from the Durham University report that this is a particular issue in high-poverty communities. As the shadow Health Secretary put it, pharmacies have a particular value in local communities in terms of the language skills they offer black and minority ethnic communities, their opening hours and the trust and confidence engendered by the professionals running these operations. To strip that out will, as my hon. Friend the Member for Oldham West and Royton (Jim McMahon) said, wreak enormous costs down the line through the impact on healthcare.
I urge the Minister, who is financially astute, to understand that it will be a gross disservice if those who are hardest hit by these reforms are the family-run community pharmacies, while highly indebted, highly leveraged multinational pharmacies, whose taxes are not always located in the UK, somehow do not take the hit. Family pharmacies that contribute to the UK through their taxes and their community role should not be the victims of this change.
I agree with reform to the NHS. I do not have some Ken Loach fetishisation of the past. I believe in modernisation and reform. There was much that I agreed with in what the right hon. Member for North East Bedfordshire (Alistair Burt) said about reforms in pharmacies. However, we must ensure that this modernisation is built around progressive reform, particularly for low-income communities such as Stoke-on-Trent, and is not simply based on cost and political choice, which the Resolution Foundation has highlighted today.
I will not go through the many arguments made by hon. Members, but the reason I do not support the Opposition motion is that I do not agree with their argument about funding. The current funding system for pharmacies in this country is not working. Pharmacies have grown organically in a haphazard way, not necessarily meeting the needs of patients or the changing demands of healthcare.
I find it extraordinary that Opposition Members are satisfied that big national companies such as Sainsbury’s, Boots and Asda, many of which make profits of £1 billion a year, are being funded with NHS money, which goes to each and every one of their branches. That is completely unacceptable. [Interruption.] I will not give way because there is not enough time. I agree with the hon. Member for Central Ayrshire (Dr Whitford) that the money that is saved through these changes must go to community pharmacies and away from big business.
I have severe concerns about the proposals on the table, however, and I have met the Minister to raise them. The first is my fear that the role of the pharmacist is not properly understood. As a practising nurse, I see at first hand every day the role that pharmacists play in safeguarding patients. Doctors often make out prescriptions that are wrong or do not take into account current medications a patient is on. That is where the pharmacist comes in. Thinking that pharmacists simply stand at a counter, pick a box off a shelf and put a sticker on it is misguided; they do a huge amount more.
Another concern is the proposal or recommendation that we move towards either GP dispensing or GP practices housing pharmacists. I know from talking to my GP practices that they are bursting at the seams. It is not as simple as installing a pharmacist at a practice; pharmacists need storage space for their medication, temperature-controlled rooms and space to make up that medication. I know that my GP practices do not have that space right now. I also have concerns about GPs’ taking on dispensing; as I have said, pharmacists have a crucial role in safeguarding patients. Who will pick up those mistakes, or look at patient medication or drug interaction if no pharmacist is there?
My biggest concern—again, this point was made by the hon. Member for Central Ayrshire—is that this is a huge missed opportunity. We are doing things the wrong way round. We should be looking at the system and at patients’ needs. We should follow the excellent model currently running in Scotland and learn from it, rather than thinking, “We need to save money. How can we best do that?”
As many Members have mentioned, there is some obvious stuff that pharmacists are doing now.
Will the hon. Lady give way?
I will not—as I have said, time is short.
Right now, pharmacists are running clinics for asthma, blood pressure and thyroid issues. But we are not seeing what pharmacists could do. They are highly experienced and highly qualified. They should have registers of patients and be referring people to clinicians and hospitals themselves. They should be a second point of primary medical care. I cannot support the Opposition, because they are wrong that this is only about saving money. It is much bigger than that, and should be an opportunity to improve primary care overall.
My central argument is that this is a cut to preventive healthcare and as such is completely irrational, makes no sense and will be a false economy. It will end up with fewer people accessing pharmacies than at the moment, resulting in more pressure on GPs and A&E departments.
I have made the point to the Government before that, by all means, they should do more to get more bang for their buck, to ensure that money is working effectively and that people get good preventive care in their communities, but they should not cut the budget for preventive care. In response to my earlier intervention, the Minister said that the cut was compensated for by the extra investment in GP practices, but that is misleading because the total investment in GP practices for pharmacies will be £112 million between now and 2020, yet in one year, by 2017-18, this budget will be down by £208 million. It is a massive cut to preventive care. It makes no sense at all and is the precise opposite of what the Government claim they seek to do on shifting resources within the NHS.
When I surveyed pharmacists in my community, they told me, among other things, that in what is probably England’s most rural county, more than 80% of pharmacies do not qualify for the rural pharmacy access scheme, and for those that do, that money will be blown away by the larger cuts. Given that staff are already being laid off, does my right hon. Friend agree that one of the greatest areas of damage will be to small, rural pharmacies in areas such as ours?
I thank my hon. Friend for making that point; it was the second one that I was going to make. As the hon. Member for Central Ayrshire (Dr Whitford) made clear earlier, the impact will be arbitrary, and disadvantaged communities and rural areas will feel it most. Only four of the 15 pharmacists in my community will benefit from the pharmacy access scheme; all the others will not, yet they are needed by their local community.
There were some outrageous comments earlier suggesting that some of those smaller pharmacies are simply there for dispensing, when they have trained pharmacists helping people. As well as the important village and rural pharmacies—I have village pharmacies in Pool and Bramhope that do excellent work—communities in suburbs rely on smaller pharmacies; those communities will lose that service.
Absolutely. It is the arbitrary impact of the cut that concerns me so much.
The other aspect of that arbitrariness is—again, a point made by the hon. Member for Central Ayrshire—that the big boys will be fine. They will survive. Surely, the Government should be addressing the excess profits of those organisations, rather than putting in danger—as their own impact assessment says—the small independent pharmacies and small chains. It is completely irrational and makes no sense.
The final issue I want to raise is that, instead of going about cutting preventive care, protecting the big boys and putting small pharmacies at risk, the Government ought to be undertaking a major programme to increase what pharmacies do. We heard earlier about what is happening in Scotland; that is the approach that should be taken. There should be more work on smoking cessation, on sexual health, on substance misuse and on screening and immunisation, and more should be done to promote independent living, encourage healthy lifestyles and support people in their self-care.
The Government’s approach makes no sense. The bottom line is that, as the Government scrape around trying to find enough resources to prop up the NHS, which, as we know, is expecting to receive a reducing percentage of our national income between now and 2020, they are making stupid decisions such as cutting spending on health education, on public health and on community pharmacies. The Government are in a complete mess. We need extra resources for the NHS and a new long-term settlement. The sooner the Government recognise that, the better.
As many hon. Members have already described, our community pharmacies play a vital role in all our communities. When my mum was seriously ill and housebound, her local pharmacist and all his staff were amazing. Nothing was too much trouble, whether it was changing her medicines at the last minute and delivering them to her home, or offering to deliver things like toothpaste and loo rolls at the same time. That is what community pharmacists are all about—being at the centre of the community, wherever they are.
Being part of the local community is even more important in rural areas, especially for the elderly who are often housebound, or have limited access to cars and so rely on public transport. That is why I welcome the pharmacy access scheme that the Minister has put in place. It should safeguard those pharmacies that are more than a mile apart and, more importantly, protect their patients. The Minister has gone further by adding in areas with high health needs. That must be welcomed, but I would like more specific information to help to reassure pharmacies in my constituency.
We all know that pharmacists can and want to do more. It is imperative that every community pharmacy across the country plays its part in providing first-class healthcare outside the hospital setting. Pharmacists are highly trained professionals with a wealth of knowledge that must be used to its fullest. As we hear time and again, our GPs are under a great deal of pressure. Our pharmacists are a group of professionals who can and do shoulder some of that workload. To name just a few of the services they can provide, they can give flu jabs, test cholesterol, monitor warfarin and check blood pressure. There is no reason why they cannot carry out other simple tests, such as point of care C-reactive protein tests to distinguish between viral and bacterial infections, and so play their role in combating antimicrobial resistance.
I have a request for the Minister. He should be more ambitious with the timescale for roll-out of the minor ailments service. We have already heard from the hon. Member for Central Ayrshire (Dr Whitford) about just how successful that service is in Scotland. We must combat any barriers that the CCGs put forward, as my hon. Friend the Member for Amber Valley (Nigel Mills) suggested.
The 18% increase in the number of pharmacies over the past 10 years has in many instances led to clusters of three or more pharmacies within just one location. Each gets a guaranteed payment of £25,000 every year regardless of the quality of service they offer, the number of prescriptions they process or whether increased capacity in the area was needed when they actually opened. I am sure many of my constituents will think that is wrong and wonder whether it is the right way to spend taxpayers’ money.
Does the hon. Lady recognise that pharmacies were allowed to open simply because they were willing to be open for 100 hours? The growth was random, and my concern is that this cut is random. Planning is the issue.
I completely agree that growth has not been controlled. We need to go back a number of years to learn from what happened and ensure it does not happen again. We also need to ensure that we put the right reforms in place now.
It is important that the £25,000, just for opening the doors, is not offered to other retail stores on the high street. It is vital we get the best possible deal for the taxpayer and the patient. The patient must be at the heart of everything. We must also remember that every pound saved by these changes will be invested back into the NHS. We need to get the important message out that, whether it is for cancer treatment or other life-saving treatment, every penny counts.
If the proposed reforms reward quality, pay pharmacists for their value added services and fully embed community pharmacists into the urgent care pathway, they will be welcome. However, we need to ensure they do what they are intended to do, and that we do not, as the hon. Member for Central Ayrshire said, end up with what we have now.
I give advance notice that, after the next speech, we will have to drop the time limit for speeches to three minutes. Even then, things will be quite tight if Members use all their intervention time.
In my constituency, there are 22 pharmacies. Some 60% are not eligible for the pharmacy access scheme, which, I understand, is based on distance between pharmacies and does not take into consideration deprivation and other health issues. It is predicted that of the 22, six will close. In the Durham, Darlington and Tees area, there are 271 pharmacies, issuing 2.5 million prescriptions a month and covering a population of 1.2 million. The Government want to take £170 million out of community pharmacies, which is equivalent to £14,500 a pharmacy. That is a total of a third of a million pounds out of community pharmacies in my constituency or £4 million across the Durham, Darlington and Tees area.
A new pharmacy integration fund has also been announced. This was originally allocated £300 million over five years. I now believe that the figure will be £42 million over two years. The Government have admitted that these proposals in total will lead to the closure of 3,000 community pharmacies. Pharmacy closures will only place further strain on those pharmacies that remain open. More people will use GP surgeries and A&E departments when they need not do so. Pharmacies could be forced to scale back services, while being under increased pressure.
The proposal to encourage people to contact the 111 service for emergency referrals on repeat prescriptions, which will then be referred to a chemist, was described by one pharmacy in Trimdon in my constituency as “ludicrous” because
“It will place an extra burden on the 111 service, and ignores the fact most people who require an emergency supply of their regular medication will go to their local pharmacy who have their records, and who will bend over backwards to help. In the case of people from out of the area needing an emergency supply of regular medication in Trimdon this only happens around three or four times a year. Ultimately, the 111 service is designed to help people who do not know what is wrong with them, not to assist those who know exactly what is wrong with them and are already being treated for it.”
The Government’s impact assessment states:
“there is no reliable way of estimating the number of pharmacies that may close as a result of this policy”.
However, the figure of 3,000 has been mentioned and the question then arises: is that figure a minimum? Pharmacies offer important services to their local communities, the elderly, the disabled and those with long-term illness, and offer vital support to overstretched GPs and hospitals. I looked at the statistics: there are 11,700 community pharmacies and 1.6 million people visit a pharmacy every day. Some 79% of people have visited a pharmacy at least once in the last 12 months, with 75% of adults visiting the same pharmacy, and 2.7 million items are dispensed every day.
Pharmacies are increasingly seen as a referral mechanism to GPs for patients with possible early symptoms of cancer. Two in five of the pharmacies in my constituency may be protected—I say “may be”—but three out of the five will not be. They face an unsettled and uncertain future in an area with some of the worst health, deprivation and disability statistics in the country. More importantly, the tens of thousands of my constituents who use pharmacies will be affected the most. They will feel that uncertainty the most and will feel unsettled the most. With all that in mind, only this Government would introduce a strategy to close the pharmacies on which so many of my constituents rely.
The first time I became involved in this area of policy was in the 1990s. I was working commercially for pharmacies on the Community Pharmacy Action Group resale price maintenance campaign. One of my very great friends who was very much involved in that campaign, Sharon Buckle, is on the English Pharmacy Board and has been incredibly helpful in providing me with advice. I am vice-chair of the all-party pharmacy group and the Government’s pharmacy champion, which is a great honour and privilege.
My concern is that we seem to be discussing buildings and pharmacies, rather than talking about how we can protect pharmacists. I understand that the Department of Health and Keith Ridge, the chief pharmaceutical officer, are very keen to ensure the pharmacists, the people who serve and have the expertise, are looked after, rather than the buildings. That is very important. We need to ensure there is significantly better integration between the NHS and pharmacies, including on summary care records, when the Government will deliver on decriminalisation for dispensing errors and so on.
Finally, if the likes of Boots will be expected to release their leases, could they kindly have a condition that those leases cannot be re-let to other pharmacies? What we do not need is to end up replacing one form of pharmacy with another. If that is not possible, it is very important that those leases are given to independent community pharmacies rather than the big boys.
I represent a constituency with real deprivation. There is an 11-year gap in life expectancy between one part of my constituency and another. I therefore know at first hand what the issues are. We need to ensure that pharmacies work more closely together, so they can work together on delivering medicines.
As many colleagues have pointed out, not just today, but in previous Westminster Hall and other debates, cuts of £170 million to pharmacy funding will decimate NHS primary care. It could force up to 3,000 pharmacies to close their doors to the public. In Lancashire alone, 387 pharmacies are at risk. I am deeply concerned about that. It will put an intolerable amount of pressure on front-line NHS services. When we look at the evidence, we find that 25% of the 2 million people who normally seek advice from their community pharmacy would visit their GP instead if they could not get it from their pharmacy. Other NHS services, which are already facing sustained attack from the Health Secretary, will become even more stretched.
I am particularly concerned about the impact on innovative and pioneering models of primary care that are provided through pharmacies. My local pharmacy in Baxenden, for example, is a healthy living pharmacy, ensuring that its provision is localised and preventive. I believe that all pharmacies should look to achieve such added value. This tiered commissioning framework, of which healthy living pharmacies are part, has been praised by the Pharmaceutical Services Negotiating Committee for its successes in reducing smoking, alcoholism and obesity. The majority of users do not have to go elsewhere for their health advice; they can use their local pharmacy instead of their local GP. Indeed, 70% of people who visit pharmacies do not regularly access other healthcare services. The healthy living pharmacy framework should be rolled out across Lancashire and should be part of the primary care review.
Does my hon. Friend agree that the pharmacy access scheme is more about the Tories buying off their Back Benchers than delivering the services that he mentions?
My hon. Friend makes a powerful point, which was also made by our Front-Bench spokesperson, who rightly observed that most of the cuts will fall in deprived areas, while the exemptions will be mostly in wealthy areas. The Government must address why they favour those who have the fewest health issues and are almost punishing those who face the greatest health challenges. The cuts will do precisely the opposite of what the Minister claims. The value-added local pharmacies in those areas will be undermined completely by the cuts. As a result, community centre provision in some of the most deprived areas might well be eroded, reduced or lost altogether. The personal relationship between patient and pharmacist will be lost, which brings me to my final point.
If these cuts go ahead, what will be the future of primary care? My right hon. Friend the Member for Rother Valley (Kevin Barron) has stated on several occasions that an Amazon model of delivery could take the place of community-centred pharmacies. Remote warehouses with box shifters driven by profit are proliferating. They are unable to provide a localised service and are unwilling to carry out primary care. They could be a dangerous replacement for community pharmacies, and that is on top of the cuts that the Government are making. This is a double whammy. Instead of promoting a primary care model that includes pharmacies at the centre, we are undermining it with these cuts.
Pharmacies in my constituency have expressed concern about this trend. They inform me that some of the warehouse pharmacies have already used patients’ personal data for marketing purposes. I have seen evidence from a company called Pharmacy4U—a mail order company—of feigned official NHS letters targeting repeat prescription users, many of whom were vulnerable. In reality, these letters were switch approval forms. This is a worrying sign of things to come if the cuts go ahead. I urge the Government to think again.
Last year, when the Government put out to consultation the proposed cuts to pharmacies, I went out to speak to many of the small pharmacists in my constituency—in Kearsley, Over Hulton, Little Lever, Farnworth, Deane and Daubhill. What they all said—most are individually owned pharmacies—is that they do a number of things for which they are not paid. Completing all the pill boxes for the elderly and long-term unwell people is one example. We know that there are increasing numbers of old people, so there are a tremendous number of boxes to prepare every day and every week, yet they get paid nothing for doing that. People come to them to ask about various ailments and health issues, and the pharmacists often recommend non-prescription medications, thus saving enormous amounts of GPs’ time and, of course, helping to prevent people from going to A&E. On the one hand, we might save a few hundred million pounds from the proposals, but on the other, expenses for GPs, A&E and hospitals will go up, so it is a completely false economy.
Such pharmacies also deliver the medication to many long-term unwell and elderly people. I am told by my pharmacists that they are often the only people whom such people ever see and talk to. Often people talk to their pharmacist about other health issues, and other minor ailments are dealt with. Pharmacists will contact the GPs or alert somebody in their surgeries to what is happening. The pharmacists are providing all these services, but they will not be able to do any of it if they face cuts, because they will not have the necessary financial resources.
Pharmacies provide a lot of advice, as I mentioned. The only people who will benefit from these cuts will be the big companies such as Boots and others, because they can buy their medication at wholesale prices. The NHS may pay them £20 per medication, but they have probably been able to buy that medication for £5, thus benefiting by £15. A small pharmacy will probably pay £20 and be paid £20, so it will make hardly any profits. As a result, most of the small pharmacies that are responsive to local needs will be forced to stop operating, and customers will have to travel further to find alternatives. It is possible that the only remaining pharmacies will be those owned by Boots and other big companies. I ask the Government to think again about their policy, because it will not save money, and it will do a disservice to people.
I thank the pharmacists in my constituency for all their work. Let me make a personal declaration. My mother, who is 84, lives near one of the nicest pharmacists in the area, who regularly provides the many different types of medication that she takes and who looks after her. He is not an exception, however; many other pharmacists do the same for people.
Let me begin by thanking Greg Burke of County Durham & Darlington local pharmaceutical committee for his valiant efforts in bringing the issue of cuts in community pharmacies to my attention. I also thank him for arranging my visit to Bowburn pharmacy, where I met Phyllis Whitburn, Nigel Nimmo, Len Britten and Hieu Truong Van. The visit reinforced my view that community pharmacies are vital to our communities, and especially to those in the ex-mining villages in my constituency, where they often provide a lifeline. The Minister has said that many pharmacies are within a 10-minute walk of two or more others, but that is simply not the case in many parts of my constituency.
I had hoped that all the lobbying that took place earlier this year, led by my hon. Friend the Member for Barnsley East (Michael Dugher), would remind the Government of the excellent services that community pharmacies offer and how much money they ultimately save the NHS, and that that might persuade them to abandon the cuts agenda. It was therefore with great sadness that I listened to the Minister’s statement on 20 October, in which he outlined the cuts. No rationale for them was presented, and it seems odd that the Government have instigated them without waiting for the outcome of either the King’s Fund review or the Royal Pharmaceutical Society’s review of community pharmacy services.
Let me also draw the Minister’s attention to the large body of research on community pharmacies that has been carried out by Durham University. It has established that they are very well placed to address health inequalities, that they are most prevalent and most used in the most disadvantaged areas, and, indeed, that 100% of people in most deprived areas could have access to one. It is very odd that the Government are cutting services that benefit those areas. The same point has also been made by the Local Government Association, the Pharmacists’ Defence Association and others. According to the LGA, the closure of community pharmacies could leave many isolated and vulnerable residents struggling to gain access to pharmacies, particularly in deprived and rural areas. The LGA has also drawn attention to the knock-on effect on local government services, which are suffering cuts as well.
The Minister ought to take up some of the points made in the PDA briefing that was sent to all of us before the debate. The Government should be thinking about regulating the wholesale margins, reviewing the margins of some of the larger companies, and reviewing the way in which community pharmacies and the pharmaceutical wholesale industry are organised. They should not be making these cuts in community pharmacy services.
We in Scotland recognise just how important community pharmacies are. They are part of the fabric of our local communities, providing crucial access to the NHS and support for some of our most vulnerable people. In fact, the community pharmacy model that has been adopted in Scotland has been recognised by the Health Minister as one to aspire to, which makes the mess that the UK Government have made of community pharmacies all the more difficult to understand.
Community pharmacies in Scotland not only have a vital role in dispensing medicines, but provide other important services. Simply popping in to have their blood pressure checked can give people an early warning of other possible health concerns. The SNP in Scotland has a coherent vision for the pharmaceutical sector, and we want pharmacists to play a crucial role in the wider health team. Ensuring that pharmacists, including those who work in community pharmacies—as well as Community Pharmacy Scotland—are consulted is a key priority for the Scottish Government.
Unlike the UK Government, we would be looking to ensure that any decisions that would have a major impact on the industry were for the benefit of the industry as well as the patients. By contrast, the UK Government appear determined to alienate as many medical professionals as possible. Much of the Government’s argument for these cuts appears to be based on their objection to “clusters” of community pharmacies. Rather than take a planned approach to the spread of services and the levels of provision needed in specific areas, their solution seems to be to slash the funding and see who stays afloat.
When vital services are provided on a commercial model, it is disadvantaged communities that suffer the most. To take such an attitude to an entire industry at the same time as trying to get it on board with providing more of the services that free up time in GP surgeries and A&E departments suggests that an extremely short-term view is being taken to the provision of care. It also suggests a complete disregard to savings in the NHS in the long term.
It would seem from the rhetoric used by the Government on this issue that they know community pharmacies are part of the solution to England’s creaking health service, but they just cannot stop themselves treating them like they are part of the problem.
This issue is about a very important cog in the grand scheme of our health service. Some might look at pharmacies as small businesses who get most of their custom from the NHS, but that is not the case. The reason why they are funded is that they are vital organs in the body of the NHS. Local community pharmacies take some of the pressure from GP surgeries. Some 14.2 million people had to wait over a week to see their GP in 2015; without the minor injuries service, how many more people would be waiting that long? How much of the doctor’s time would be taken up with issues that could be handled by a pharmacist?
There are 549 registered pharmacies in Northern Ireland and 2,300 pharmacists. They dispense both medication and advice, and that advice is important. The widespread locations of community pharmacies across Northern Ireland, where people live, shop and work, means that they are readily accessible to the public. Each year community pharmacies in Northern Ireland safely dispense approximately 40 million prescription items, including through the repeat dispensing service. They provide advice to help us look after and care for ourselves and help patients take their medicines more effectively by improving patient knowledge and adherence and use of their medicines. This service has initially been commissioned for patients living with asthma, chronic obstructive pulmonary disease, and diabetes, and it is hoped that it will be extended to other long-term conditions in the future. So the role of pharmacies can be even greater than it is at present.
The minor ailments service supports the use of the community pharmacy as the first point of call for health advice. Pharmacists can use their professional skills to provide advice and if necessary recommend appropriate treatment or refer to another healthcare professional. Other services include the smoking cessation service, which supports nearly 70% of quit attempts every year.
For constituencies such as Strangford which contain rural areas where GP surgeries are few and far between, the provision of a pharmacy is essential. If every mother with a young child takes an appointment with the doctor because the child has a cold and they are rightly worried, our surgeries, which prioritise child appointments, would never have time to check the lady with a small lump under her arm or the man who has had a problem with toileting needs, both of whom are too embarrassed to push for an appointment when everyone is too busy.
These cuts are too harsh. We need community pharmacists to play their vital role in order to allow GPs to focus on what they need to do. I say yes, make savings; yes, trim the fat if there is any; but do not ask for cuts that can only be achieved by cutting vital services. I support the Labour motion.
It is my pleasure to respond to this interesting debate. I was not feeling very well today so on my way here I called at my community pharmacy, and I am feeling much better now. This is a very important subject. I wish first to pay tribute to my hon. Friend the Member for Barnsley East (Michael Dugher) for his sterling work in standing up for community pharmacy, and to the chair of the all-party parliamentary group on pharmacy, my right hon. Friend the Member for Rother Valley (Kevin Barron), for ensuring that the contribution of pharmacy is always recognised.
I have to say that this subject is very dear to my heart. I worked with my husband, who is a pharmacist in community pharmacy, for 24 years. I must make it clear that I no longer own a community pharmacy, but I do have a clear understanding of the contribution that community pharmacies make to patients, communities and the wider NHS. Many members have spoken powerfully today about the pharmacies in their constituencies and how much they mean to the people they serve. We have heard from my hon. Friends the Members for Hyndburn (Graham Jones), for Bolton South East (Yasmin Qureshi), for Bristol South (Karin Smyth), for Stoke-on-Trent Central (Tristram Hunt), for Oldham West and Royton (Jim McMahon), for St Helens North (Conor McGinn), for Wirral West (Margaret Greenwood), for Sedgefield (Phil Wilson), for Bradford West (Naz Shah) and for City of Durham (Dr Blackman-Woods).
Make no mistake, community pharmacy is for many the gateway to the NHS, providing far more than prescriptions and paracetamol. As my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) pointed out, it is a lifeline for many people. The Minister spoke last week about the need to move to a focus on quality and not just on the volume of scripts dispensed. He also spoke of the desirability of community pharmacies becoming an integrated part of the primary care team. I say to him that that has been happening for years. The fact that he does not know this is in itself proof that he needs to take his plans back to the drawing board.
The typical community pharmacy, whether it serves a rural or an urban population, provides a wide range of services to support the sick, the elderly and the disabled, together with a host of initiatives to promote health and wellbeing in the community. Community pharmacies have close working relationships with other members of the primary care teams, including GPs. Of all those health professionals, the community pharmacist, who employs a no-appointment-necessary approach, is the most accessible and often provides the only continuity of care in a health service that is struggling to recruit and retain staff.
On the subject of NHS staff, the promise of more than 1,000 additional pharmacists in GPs’ surgeries is a red herring. It is a separate issue and will do nothing to mitigate the loss of local community pharmacies. The Minister spoke last week of the need for pharmacists to move to a more clinical approach to healthcare. Again I say to him that that has been happening for years. All community pharmacies have consulting areas where patients can speak privately. They also provide a perfect space for the provision of a variety of important services. There is an ever-expanding list of services, which a number of Members have described in their speeches. My hon. Friend the Member for Garston and Halewood (Maria Eagle) mentioned the fact that pharmacists often go above and beyond the call of duty, sometimes delivering prescriptions at 8.30 in the evening. I well recognise that situation. The list is limited only by the Government’s unwillingness to engage and the clinical commissioning groups’ lack of funding to commission services.
Let me make it clear that community pharmacies, far from being a costly drain on NHS resources, actually save the NHS money through a variety of schemes, some of which have been mentioned today. The minor ailments service is already available in some areas, and I welcome the Minister’s suggestion that it will have a full roll-out. Medication use reviews carried out in the pharmacy often identify medicines that are routinely ordered but are no longer taken, and wasteful stockpiling of such items can therefore be avoided. In addition to the specific services, every prescription item dispensed presents the opportunity for a productive health intervention. Given that the average community pharmacy dispenses thousands of prescriptions each month, the potential impact is enormous and the professional advice of the pharmacist is undoubtedly invaluable in the promotion of health and wellbeing. The right hon. Member for North Norfolk (Norman Lamb) rightly identified the prevention work that pharmacists do, and mentioned the fact that the promotion of health and wellbeing can reduce demand on the NHS overall.
Despite statements to the contrary, community pharmacies have been making substantial efficiency savings in recent years. The vice-chair of the all-party group, the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile), mentioned a 40% increase in funding over the past 10 years, but he omitted to mention that prescription numbers have increased by 50% during the same period and that pharmacy funding has been static for the past two years.
Under the Government’s current plans, pharmacies would have to implement a year’s worth of cuts in four months with only six weeks’ notice. As someone with considerable experience of community pharmacy, I know that the plans will force the closure of many pharmacies and a service reduction in others. I do not know how many will close and neither does the Minister. The right hon. Member for North East Bedfordshire (Alistair Burt) suggested that the number could be as high as 3,000, and I can assure the Minister it will not be the large pharmacy chains that close but the small independents, the owners of many of which have put their heart and soul into providing an excellent service to the community.
Those that do not close will reduce services. An NPA survey of 250 pharmacies found that 76% are likely to reduce services from April 2017 if the cuts go ahead. The assessment of the financial impact of the closures is flawed and provides no evidence to support the Department of Health’s claim that access to services will not be compromised. It is clear that community pharmacies satisfy an ever-growing demand for services. When they close, that demand will not just disappear. Where will all the patients go? Some will pack out their GP surgery and others will head straight to A&E. The NHS is already in the throes of a staffing and funding crisis. Forcing community pharmacies to cut back services and close down is short-sighted in the extreme and could be catastrophic in the long term.
The Minister has frowned on the growth of pharmacy clusters, but he really needs to understand that clusters have grown, often in the most deprived areas, in response to considerable demand. My hon. Friend the Member for Bradford West outlined examples of such areas of deprivation. Is the Minister really suggesting that forcing the closure of such pharmacies is the most effective way to reduce demand for healthcare in deprived communities? The Minister has got this wrong. The proposals on the table are short-sighted and will do more harm than good. They will have a negative impact on patient care and will force extra demand on already stretched GP surgeries and hospitals. The proposals will not save money. They will not reduce the number of patients with long-term conditions or the number of medicines they require.
It is right to review the situation. I agree with the Government Members who said that it is right to examine the funding issues, but instead of forcing through damaging changes to a service that the Government clearly do not understand, I ask the Minister to listen to pharmacists and sit down with them to discuss how pharmacies can help to ease the burden on the wider NHS in a planned and cost-effective way. I ask the Minister to listen to his Conservative colleagues who spoke against these simplistic cuts, which have not been properly planned. I ask him to recognise that the access scheme will do little to protect the long-term future of urban or rural community pharmacies.
The Government have shown time and again an unwillingness to listen to professionals. I urge the Minister to listen to community pharmacists, to the pleas of Members and to people across the country, and to rethink the funding cut. I ask him to sit down with pharmacists and their representatives and work with them to develop and extend services that will take the burden off GPs and off the NHS. I ask that he do so now before he makes a decision that will devastate a whole sector and bring even more pressure to bear on our overstretched health service. I ask Members to support the motion.
It is a pleasure to follow the hon. Member for Burnley (Julie Cooper). I was interested to learn of her personal experience in the sector. She gave a well-informed speech that was in stark contrast to that of her boss, the hon. Member for Leicester South (Jonathan Ashworth). She was generous to contributions from Opposition Members, but it is only fair to say that Members on both sides of the House expressed considerable support for the work done by community pharmacies up and down the country. There is unanimity in the House on the importance of not only pharmacies’ current work, but their increasing role in supporting the NHS and providing services in future.
I am grateful for the contributions made today by 24 hon. Members, in addition to the Front-Bench speakers. I wish to start my remarks by referring to the impact that these proposals will actually have on the typical pharmacy, because I am sorry to say that there has been considerable confusion, mostly among Opposition Members, about what the proposals deliver. The average pharmacy will see a reduction in taxpayer subsidy of £16,000 a year. The largest element of that is a reduction in the establishment payment, which is a fixed payment of between £23,000 and £25,000 that most pharmacies receive just for being there. It will be reduced by 20% from 1 December, which equates to a reduction of just over £400 per month, or £100 a week. From April, it will decrease by a further £400 per month, to £200 a week. Those are not huge reductions for private businesses. This element is a 40% reduction in the only fixed taxpayer subsidy that I am aware of that is paid to private businesses up and down retail high streets in England.
Meanwhile, pharmacies will still receive £1.13 for every prescription item they dispense, with the average pharmacy dispensing 87,000 items a year, as was said by the hon. Member for Liverpool, Wavertree (Luciana Berger), who is, sadly, not in her place.
I am here.
Oh, she is—I apologise. We are also introducing a new quality payment scheme worth up to £6,400 a year, so that the amount of NHS funding community pharmacies will be receiving will remain very significant.
In addition to payments from the NHS, pharmacies can earn extra income from a range of sources other than dispensing fees. About half the clinical commissioning groups in England already commission minor ailment services from pharmacies. These services include: flu vaccinations, which are topical today; stop-smoking schemes, which were topical last month, in Stoptober; and emergency hormonal contraception. All of those provide an additional source of income for community pharmacies. I believe the right hon. Member for North Norfolk (Norman Lamb) referred to healthy living pharmacies, and they will now qualify for this new quality payment, whereas they have not in the past—I hope he will welcome that. The Local Government Association’s briefing ahead of this debate echoed that fact, saying that
“there are significant opportunities for councils to commission public health services from community pharmacies as a key element of their health improvement strategies.”
In addition to those two alternative sources from NHS and non-NHS public bodies, in many cases pharmacies get a whole section of private sector income from non-publicly funded elements. That has not been referred to at all, but it is a significant element in the profitability of many pharmacies.
The Government’s vision in these reforms is to bring pharmacy into the heart of the NHS. The Opposition spokesman, the hon. Member for Leicester South, gave what appears, from his early outings at the Dispatch Box, to be becoming a trademark speech in his new role, seeking to scare the public about the proposals without demonstrating a genuine understanding of how community pharmacies are funded or owned, or of what is proposed by the measures. Since 2005-06, there has been an 18% increase in the number of pharmacies, so that today some 1,800 more operate in England than did so 10 years ago. Next year, pharmacies in England will receive £2.6 billion in funding from the NHS. NHS England supports the developments that we are proposing. The suggestion is that we will decimate NHS services because we will push a large number of people out of community pharmacies to their GP, but that is not the belief of NHS England. This is not about pharmacy closures—the point made by almost every Opposition Member who spoke—but about securing better value from the funding that we provide, modernising the way in which we do it so that pharmacies are not the only sector in the country that receives direct taxpayer subsidy for opening premises on the high street, and encouraging them, through increasing payments in the future, to provide more services to help patients in every community.
Community pharmacies are already much more than the place to which we go to get our medicines. They are an essential front-line service, providing care direct to patients and increasingly advising on a wide range of public health issues, for which, as I have indicated, they are paid separately from their dispensing fees. In doing so, they can relieve, and are relieving, pressures on other parts of the NHS.
Our package of reforms are about advancing that agenda, by rewarding quality for the first time, and moving to an enhanced role for the community pharmacy network in providing value-added services, as well as dispensing prescriptions. Yes, it does include making efficiencies in the way that these pharmacies are funded—I am talking about a reduction of £200 a week from next April—but those savings can be made within community pharmacies without compromising the quality of services or the public’s access to them. A key element of our proposals is that we will protect those pharmacies on which communities depend the most through the pharmacy access scheme, which has been supported by many hon. Members. A review of eligibility will assess the impact on those pharmacies in 20% of the most deprived areas, close to the one-mile test. That review opened yesterday and lasts for six weeks.
The hon. Member for Sedgefield (Phil Wilson) referred to the pharmacy access scheme. He admitted that, by his calculation, 40% of the pharmacies in his constituency will benefit from the scheme. I can update him on that. Nine out of the 20 pharmacies—or 45%—in his constituency will benefit. Indeed, his constituency will be one of the biggest beneficiaries of this scheme.
In summary, the reforms are what the NHS needs and what patients and taxpayers expect. I am confident that we will see a community pharmacy sector that is more efficient and better integrated with the rest of the healthcare system and delivering better services for patients as a result. I urge colleagues to support the amendment to this motion.
Question put (Standing Order No. 31(2)), That the original words stand part of the Question.
2 November 2016
The House divided:
Question accordingly negatived.View Details
Question put forthwith (Standing Order No. 31(2)), That the proposed words be there added.
Question agreed to.
Main Question, as amended, put and agreed to.
That this House notes that community pharmacies are valued assets that offer face-to-face healthcare advice which relieves pressure on other NHS services; welcomes the Government’s proposals to further integrate community pharmacy into the NHS, including through the Pharmacy Integration Fund, and make better use of pharmacists’ clinical expertise, including investing £112 million to deliver a further 1,500 pharmacists in general practice by 2020; supports the need to reform the funding system to ensure better value for the taxpayer; and welcomes the establishment of a Pharmacy Access Scheme which will ensure all patients in all parts of the country continue to enjoy good access to a local community pharmacy.
On a point of order, Madam Deputy Speaker. Has the Secretary of State for Environment, Food and Rural Affairs given notice of whether she intends to make a statement to this House in the light of today’s High Court judgment, which found against the Government for the second time on the matter of being in breach of air quality standards and putting in place an inadequate air quality plan? I am sure that you will appreciate the level of interest in the outcome of those proceedings, given that between 40,000 and 50,000 people in our country die prematurely each year as a direct consequence of the Government’s failure to reach those air quality standards.
I understand the hon. Lady’s concern about the matter and thank her for raising it, but she and her colleagues will understand that it is not a matter for the Chair. If she wishes a Minister to come to the House, the correct procedure is to submit a request for an urgent question. I am sure that if the hon. Lady believes that she has sufficient grounds for asking for an urgent question, she will submit a request and Mr Speaker will give it due consideration.