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House of Commons Hansard

Commons Chamber

02 November 2016
Volume 616

    House of Commons

    Wednesday 2 November 2016

    The House met at half-past Eleven o’clock


    [Mr Speaker in the Chair]

    Oral Answers to Questions

    Cabinet Office and the Chancellor of the Duchy of Lancaster

    The Minister for the Cabinet Office was asked—

    Voter Registration: Young People

  • 1. What steps the Government are taking to increase the number of young people registered to vote. [906977]

  • The Government are building a democracy that works for everyone, including young people. Online registration has made it easier and faster to register to vote, and since its introduction a record 4.2 million applications to register have been made by people aged 16 to 24.

  • That was a very interesting answer. How can the Government be building a democracy when they have excluded nearly 2 million people who were allowed to vote in the referendum, and are going ahead with boundary reviews that will particularly affect young people in universities?

  • We are absolutely committed to taking account of the issues that matter to young people. As for the boundary changes, it is right for us to ensure that every seat is of equal value. It cannot be right for some constituencies to contain 95,000 people and others 38,000. We will ensure that every vote is equal, and that includes young people.

  • As my hon. Friend will know, next week the Youth Parliament will sit in this place. Does he agree that many 16, 17 and 18-year-olds are taking a growing interest in public affairs and what we do in the House—that is certainly what I find when I visit schools in my constituency—and that such initiatives will help youth registration?

  • It would be remiss of me not to note that the Youth Parliament will be sitting in this very Chamber on 11 November under your command, Mr Speaker. I am sure that we all look forward to hearing young people discuss the issues that matter to them. When it comes to “every vote matters”, we should bear in mind that young people are interested in issues such as mental health and a curriculum that works for everyone, and those are the issues that are being debated in the Chamber. We look forward to working with young people to ensure that their voice is heard.

  • I hope that the Youth Parliament will be sitting under my encouraging chairmanship rather than under my command, but I am extremely grateful to the Minister for the sentiment that he has expressed.

  • The Minister will be aware that 16-year-olds in Scotland are able to vote for Members of the Scottish Parliament and for councillors, and that the plans for devolution under the Wales Bill might mean that 16-year-olds are allowed to vote for Welsh Assembly Members and councillors. Will he now give proper consideration to a full and positive report about the need to ensure that 16-year-olds can vote for Members of the House of Commons so that there can be full democracy for people aged 16 and over?

  • We discussed this issue at the previous session of Cabinet Office questions. We will not be lowering the parliamentary voting age, because since the general election Parliament has debated the proposal a number of times and repeatedly voted against it. It is important to recognise that most democracies consider that 18 is the right age to enfranchise young people. A person must be at least 18 to serve on a jury for similar reasons.

  • My hon. Friend referred to the need to ensure that every vote is equal. In the light of the number of spoilt ballot papers in elections for police and crime commissioners, will he think again about reintroducing the first-past-the-post system for elections of that kind in England?

  • My hon. Friend is right that we need a clear and secure democracy if we are to continue to have confidence in our system. In the elections for police and crime commissioners, about 8 million people voted and there were more than 300,000 spoilt ballot papers. For the EU referendum, in which 35 million people voted, there were just 25,000 spoilt ballot papers. There is clearly an issue that the Government will want to look into.

  • Has it occurred to the Minister that if the Government were not so aggressively making it difficult for millions of people to be included in the register, and if the previous Prime Minister had not so arrogantly dismissed the case for enfranchising 16 and 17-year-olds, the referendum result would have been different, and he would still be Prime Minister?

  • It is important to recognise that in the referendum a record number of people voted on one side—17.4 million voted for the UK to leave the European Union—and that a record 46.5 million people were registered to vote, of whom 3 million registered using the individual electoral registration system online. That shows that people have full confidence in the future of our new system.

  • Does the Minister agree that more young people might register to vote if they thought that it would make a positive difference to their lives, and that decisions such as trebling tuition fees, abolishing the education maintenance allowance and restricting young people’s housing benefit only act as a disincentive for them to become involved in politics?

  • The hon. Lady is right, but there is a problem with young people’s registration: we allow 16-year-olds to register to vote, but only 37% of them choose to do so. As I said earlier, we need to take account of the issues that matter to young people. Such issues will be debated by the Youth Parliament next Friday, but none of those to which the hon. Lady refers are on the agenda.

  • Voting Rights: Overseas UK Citizens

  • 2. How he plans to give UK citizens living overseas the right to vote for life. [906978]

  • 10. What progress he has made on giving UK citizens living overseas the right to vote for life. [906986]

  • On 7 October the Government published a policy statement setting out our detailed proposals for votes for life, and explaining how we plan to meet our manifesto commitment to scrap the 15-year time limit for overseas voting. We intend the system to be in place before the next scheduled UK parliamentary general election.

  • I thank the Minister for that encouraging reply, but may I return to the subject of cutting the cost of politics? Can he tell us when the Government will be able to equalise the size of constituencies?

  • We are determined that by the time of the 2020 general election, the historic principle of equal seats will be in place. If we do not introduce that reform, we will be fighting our seats on the basis of data that go back to the year 2000, meaning that they are 20 years out of date. That is completely unacceptable, which is why we must press ahead with boundary reform.

  • Does my hon. Friend also agree that by including British citizens living abroad who have previously been resident to vote, as well as those who have previously been registered, the Government are enabling more people to participate in our politics and delivering a democracy that truly works for everyone?

  • I entirely agree with my hon. Friend. Our proposal to scrap the requirement that an overseas elector must have been previously registered to vote when they were resident in the UK will mean that even more Brits abroad can vote if they so choose.

  • How will the Minister ensure that UK citizens living overseas in the EU have not only the right to vote, but the right to remain in EU countries?

  • We will ensure that we have a democracy that works for everyone, which is why we are determined to ensure that Britons living abroad will, regardless of which country they live in, be able to participate in our democracy, especially those who have lived abroad for more than 15 years such as Harry Shindler, a Labour voter who lives in Italy and fought in world war two, but is unable to vote at the moment. It is right that we give these people who have served their country the right to vote.

  • Alongside extending suffrage for UK citizens living abroad, what consideration has the Cabinet Office given to extending suffrage in general elections to all EU and non-Commonwealth immigrants permanently living in Great Britain and Northern Ireland?

  • In terms of local government suffrage, EU citizens can already vote. For parliamentary suffrage, we are extending the franchise, as my hon. Friend the Member for Montgomeryshire (Glyn Davies) rightly says, to an extra 3.7 million Brits abroad. When it comes to the question of those living in this country, obviously that is subject to future negotiations.

  • At a time when the Government are failing in any serious way to address the democratic deficit in the UK, they are, as has been mentioned, pursuing plans to remove the 15-year time limit for overseas voters and to hand a vote for life to an estimated 1 million expats. Will the Minister explain how that might affect Electoral Commission guidelines on “permissible donors”, and will he assure the House that under no circumstances will the proposed changes allow unlimited political financial donations from non-UK taxpayers abroad to be funnelled into the coffers of any UK political party?

  • First, may I welcome the hon. Gentleman to his place? It is great to see him across the Dispatch Box.

    On the issue of overseas electors and ensuring those living abroad for more than 15 years have a vote for life, the principle is clear: we must ensure those who were born in this country, who have often paid tax in this country and have moved abroad are given a right to participate in our democracy. These include people such as Harry Shindler, a Labour voter who fought in world war two. We want to ensure that these people who have given something to our country are allowed to participate in our democracy.

  • House of Lords: Membership

  • 3. If he will bring forward proposals to limit the size of the membership of the House of Lords. [906979]

  • 5. If he will bring forward proposals to limit the size of the membership of the House of Lords. [906981]

  • The Government agree that the House of Lords cannot grow indefinitely. However, comprehensive reform is not a priority for this Parliament, given the growing number of pressing priorities elsewhere. Nevertheless, when there are measures that can command consensus, we would welcome working with peers to look at taking them forward.

  • A simpler answer would have been, “No, we will kick that into the long grass.”

    It is clear that the House of Lords needs radical reform. In fact, we should listen to the new Lord Speaker, who said only last week:

    “I don’t think we can justify a situation where you have over 800 peers at the same time as you’re bringing down the Commons to 600 MPs”.

    Does the Minister agree?

  • This was raised at an important debate on 26 October, when the House agreed with the Government that this is not a priority. The Government agree that House of Lords reform is not one of the priorities of the British people: a recent YouGov study showed that just 18% of the public think House of Lords reform is a priority. I am amazed that the Scottish National party has chosen this issue to campaign about. Why not campaign on education or on health—why not campaign on the issues that matter to the Scottish people?

  • What an outrage to democracy that answer from the Minister was. We have the ridiculous situation that there are more unelected Members of the House of Lords than MPs living in the highlands of Scotland, yet this Government want to cut democratic participation. We will be left with three Members of Parliament for half the landmass of Scotland and the highlands. That is not democratic accountability. Cut the Lords, not MPs.

  • It was difficult to detect a question there, but the intellectual dexterity of the Minister will enable him briefly to reply.

  • We have proposals on boundary changes in Scotland, and there is a consultation that I commend to all Members. Some seats in Scotland are twice the size of others, and that historical injustice must be rectified.

  • The Minister is absolutely right that reducing the size of the House of Lords is not a priority, but neither is reducing the size of the Commons. As we are abolishing goodness knows how many MEPs and taking on their workloads, should not the Government look again at their proposal and equalise seats, which is quite correct, but keep the same number of Members of Parliament?

  • The previous Parliament passed a law to ensure that we could reduce the number of seats from 650 to 600, but a delay occurred because Opposition Members decided to kick this can down the road. The reduction in the number of seats will save £66 million over the course of a Parliament. It is right that we should make savings and put our own House in order.

  • It is absolutely right that there should be equal votes and that we should cut the cost of politics in the House of Commons. It is absurd that there are no Scottish National party peers in the House of Lords while the party has 56 Members in this House, and that there are 100 Liberal Democrat peers but a pathetic rump of only eight Members here. Does the Minister agree that this shows the need to rebalance membership of the House of Lords?

  • My hon. Friend is absolutely right. The historic campaign for the equalisation of seats was initiated by the Chartists in their people’s manifesto back in 1838, and this Government are determined to deliver to ensure that this historic wrong is righted.

  • 13. There has been much speculation that a certain Nigel Farage will be joining the swarm of unelected bureaucrats in the House of Lords. Is Mr Farage to be rewarded with a peerage, or have the Government done enough damage already? [906989]

  • All appointments to the House of Lords are scrutinised by an independent Committee, and it is right that that process should be followed.

  • Does my hon. Friend recall the words of Sir Winston Churchill when he said that democracy was not a particularly good system but the best that we had? Does he agree that, until someone comes up with a better idea, the House of Lords is perhaps not that bad?

  • As I have said, House of Lords reform is not a priority in this Parliament; nor is it a priority for the general public. We want to establish a consensus with the House of Lords, and it must be for the House of Lords to come up with that consensus.

  • Could we not at least get rid of the by-elections for hereditary peers? Earlier this year, the House of Lords decided to remove the second Baron Bridges because he had not turned up for five whole years. There was then a by-election, in which the 15th Earl of Cork and Orrery defeated the 12th Lord Vaux of Harrowden and the eighth Viscount Hood. Under the alternative vote system, the Earl of Limerick was bottom of the list. Does not this bring the whole system into disrepute? Is this “Blackadder” or Gilbert and Sullivan?

  • When it comes to “Blackadder”, this was a Labour policy introduced by a Labour Government, so this is yet another U-turn from the Corbynistas.

  • Hon. Members


  • I think that—[Interruption.]

  • Order. I can scarcely hear the hon. Gentleman. He must be heard.

  • Thank you, Mr Speaker. I think that people watching this debate will be terrified by the complacency of this Government. Does the Minister not realise that the twin actions of increasing without limit the number of unelected Members of Parliament while reducing the number of elected lawmakers is seriously damaging this institution in the eyes of our own electorate and lowering the esteem in which we are held abroad?

  • The Government agree with the primacy of the House of Commons. The hon. Gentleman made those points in a debate on 26 October, and at that time the House agreed with the Government that this was not a priority and that our priority should be to equalise seats and to ensure that the historic principle of boundary reform occurs.

  • Departmental Efficiency Savings

  • 4. What steps he is taking to help Government Departments deliver efficiency savings. [906980]

  • The Government are striving towards their manifesto commitment to achieve £20 billion of annual efficiency savings by 2020. Cabinet Office functions are supporting Departments by providing expert support and advice in all areas, including commercial property, infrastructure, fraud and error, and debt. In addition, I will be leading a review with the Chief Secretary to the Treasury to see whether further savings are possible over that period.

  • I know the House will want to join me in congratulating the Minister on the recent arrival of his second child, a brother for Wilfred.

  • May I add my congratulations as well? I thank the Minister for his answer. How much did the Government deliver in efficiency savings over the last term and how much is to come?

  • I thank my hon. Friend and you, Mr Speaker.

    We saved £18.6 billion in the previous Parliament. We hope to do better than that over this Parliament. We have made a good start with more than £1.5 billion saved by transforming how Government works, but there is more to do. It is a hard task, but we will complete it.

  • May I first congratulate you, Mr Speaker, on your energy efficiency saving this morning on the bicycle in Portcullis House for the poppy appeal? Is it possible for hon. Members and the wider public to track savings in various Departments to see the practical benefits of those savings?

  • The hon. Gentleman makes a sensible suggestion. As we evolve the single departmental plans, I hope to be able make the savings in individual Departments far more transparent. He is right to touch on that subject; it is something that I want to do more with.

  • 15. Government efficiency savings can be achieved through greater use of new technology, such as GOV.UK Notify. Will the Minister encourage its greater use by Whitehall Departments? [906991]

  • GOV.UK Notify is another excellent Government Digital Service product. We are putting more money into the GDS, which we are using more across Government. I hope that that will be one of many applications brought forward as a result of its success.

  • Given that the cost of special advisers has almost doubled in 10 years and that the Tory Government are spending more on special advisers than the new Labour Government, would not dealing with that be a simple cost-cutting measure?

  • On the contrary, we have kept the cost of special advisers under review and fairly flat. The list of responsibilities has been published recently and the hon. Gentleman will see that that cost is fairly constant.

  • Voting Fraud

  • 6. What steps he is taking to tackle voting fraud. [906982]

  • The Government are committed to tackling fraud in UK polls. We have already taken steps to improve the security of polls through the introduction of individual electoral registration. We are currently considering the findings and recommendations of the report of my right hon. Friend the Member for Brentwood and Ongar (Sir Eric Pickles) into electoral fraud. The Government will provide a full response in due course.

  • In a democracy, we want as many people to vote and register as possible. In some constituencies, however, there is still too much electoral register fraud. What more can the Minister and Government do about that?

  • For democracy to work for everyone, we need to ensure that it is clear and secure. The Government are determined to ensure that the electoral register is as complete and accurate as possible. We note that the Electoral Commission has also made recommendations about ID in polling stations. We will reflect on the report of my right hon. Friend the Member for Brentwood and Ongar and respond in due course.

  • Does the Minister believe that lessons can be learned from the additional measures to tackle voter fraud in Northern Ireland?

  • Obviously, the electoral system in Northern Ireland is separate and has seen advances when it comes to security around polling stations and the electoral process. The Government are interested in all such examples and will be happy to respond when we publish our findings following the report of my right hon. Friend the Member for Brentwood and Ongar.

  • Topical Questions

  • T1. If he will make a statement on his departmental responsibilities. [906992]

  • The Cabinet Office is responsible for delivering a democracy that works for everyone, supporting the design and delivery of Government policy, and driving efficiencies and reforms to make the Government work better.

  • Will my right hon. Friend join me in welcoming the work of the Minister for the constitution, my hon. Friend the Member for Kingswood (Chris Skidmore), with my constituent Mehala Osborne and the domestic violence charity Survive to reform anonymous registration to ensure that women silenced by the current registration process will no longer be denied the chance to express their democratic will?

  • I will indeed join with my hon. Friend. His commitment to the cause is well known, as is the commitment of my hon. Friend the Minister for the constitution, who has really taken this on as something that he wants to achieve in his post. For survivors of domestic abuse, voting is more than just a cross on a ballot paper; it is a renewed statement of the freedom that is rightfully theirs.

  • Let us take the Minister back to the boundary review, because interestingly the Government payroll is not being cut in this process. Ministers should therefore listen to the Members sitting behind them, such as the hon. Member for Shipley (Philip Davies), who has said:

    “We are talking about reducing the number of people we elect at the ballot box, whilst stuffing the House of Lords with yet more people”.

    If this is really not a partisan process, and given Brexit and the fact that we are removing 73 MEPs, is it not now time to have a fresh review, based on having 650 seats in this place?

  • I wonder whether the hon. Gentleman will start as he means to go on. I see that he has five Members on the Opposition Front-Bench, compared with our very modest two, which shows how we can cut the cost of politics just by being in power.

  • T3. After the referendum, the Public Administration and Constitutional Affairs Committee wrote to the Government suggesting that they should conduct a review of civil service capacity in view of the extra workload being piled on Whitehall. Can the Minister give any indication on whether such a review is being conducted? Would he consider conducting such a review? [906994]

  • The review is going on at the moment, and I am leading it. We have started by looking at senior civil service capacity, but it will go through the entire civil service. It is a very thorough process, and I am making sure that I am talking to all the Ministers leading Brexit-affected Departments to make sure that they are happy with the capacity of their offices.

  • T2. I do not disagree with the Minister on equalising constituencies, but if we want equal constituencies based on proper data, surely the 2 million newly registered voters should be taken into account in that equalisation. [906993]

  • The hon. Gentleman talks about data, so let us go back to the fact that if we delay boundary reform even further, we will be drawing up the seats on the basis of data, in England and Wales, from 2000—20 years ago. That is clearly unacceptable, which is why we must ensure that boundary reform takes place. [Interruption.]

  • Far too many noisy private conversations are taking place, which is very unfair to Members who want to ask questions and Ministers who want to answer them. Let us hear the voice of the Vale of Clwyd, Dr James Davies.

  • T4. One benefit of devolution was meant to be that it would allow the comparison of different policy approaches to the same problems. With that in mind, will the Minister consider legislating to ensure the provision of comparable data across the UK? [906995]

  • My hon. Friend makes a sensible point. We are learning a lot from the devolved Administrations, just as they are learning from us. His point is well made, which is why we signed a concordat on statistical evidence a few months ago, ensuring that we are sharing the same methods of evidence gathering across all the Administrations.

  • Instead of using the single example of an expat war veteran to justify extending the franchise to UK citizens abroad, should the Minister not concentrate on those who live here and pay their taxes—EU citizens—and those who will have to live with the consequences, the 16 and 17-year-olds?

  • Giving votes for life to those Britons who have lived abroad for more than 15 years was a manifesto commitment that will be delivered by this Government. We are determined to ensure that British people who live abroad are given the right to participate in our democracy, which is absolutely the right thing to do.

  • T5. I welcome the speech by the Minister for the Cabinet Office to the Reform think tank, in which he made the powerful case for public service reform, to make it more tailored to individual needs. May I urge him to be careful to ensure that, in delivering it, Whitehall does not end up exposing or misplacing personal data, as has happened in the past? [906996]

  • I will, and I thank my hon. Friend for his comments. It is of course important that we take people with us on this, but at its core we must remember that the state is there to serve people, not the other way round. That is why this Administration are putting themselves at the service of the British people, and I intend to ensure that public services reflect that fact.

  • T8. This Department has estimated that cutting the number of MPs to 600 will save £15 million a year. Library figures collated for me have shown that House of Lords allowances alone cost £20 million a year, so does the Minister not accept that the cuts and savings to be made should be applied to the unelected House, not the elected Chamber? [906999]

  • This Government are proud of the fact that the cost of the House of Lords has been reduced by 14% since 2010.

  • T6. It is good to see the Chancellor of the Duchy of Lancaster in his place. Will he perhaps set out what his priorities will be? [906997]

  • As Chancellor of the Duchy of Lancaster, I oversee the administration of the estates and the rents of the Duchy of Lancaster. I contribute to the Government’s policy and decision-making process by attending Cabinet and attending and chairing Cabinet Committees. This role is not without precedence under both Labour and Conservative Governments.

  • I am pleased that the Government plan to audit racial disparities in public service outcomes, but may I ask Ministers that, in doing so, they ensure that every Department and agency uses the 2011 census classifications, which distinguish Gypsies and Travellers?

  • That is a very helpful contribution from the hon. Lady, and I will indeed ensure that.

  • T9. The annual canvass is extremely expensive. What are the Government doing to reduce its cost? [907000]

  • It is absolutely right that we make the system as efficient as possible and less expensive. To address both those aims, we are undertaking three pilots this year to test new approaches to conducting a canvass. I am also pleased to announce today that there will be 18 more pilots in England and Wales in 2017.

  • Latest assessments suggest that only 51% of 16 to 17-year-olds are registered to vote, compared with 85% of adults. In Neath, we have had successful voter registration awareness events to encourage under-18s to register. Will the Minister please explain the Government’s plans to promote young people’s registration?

  • As part of a democracy that works for everyone, we are determined that young people’s voices will be heard, which means going around the country, as I am doing in the coming weeks, to places such as Sheffield, Manchester and Liverpool to talk to young people about their priorities and how we can ensure that they are fully involved in the democratic process.

  • Prime Minister

    The Prime Minister was asked—


  • Q1. If she will list her official engagements for Wednesday 2 November. [906962]

  • This morning, I had meetings with ministerial colleagues and others. In addition to my duties in this House, I shall have further such meetings later today.

  • We have no clarity on access to the single market, huge disadvantages still in energy costs and foreign steel being used in our key defence projects. We know that the Prime Minister likes to try to channel the Iron Lady, but when will she show some mettle in standing up for British-made steel?

  • This Government have stood up for British-made steel, and we have taken a number of measures that have improved the situation for the steel industry. The hon. Gentleman says that there is no clarity in relation to Brexit. I am very clear that what we want to achieve is the best possible deal for businesses in the United Kingdom, so that they can trade with, and operate within, the single European market.

  • Q2. I applaud the Government’s continued commitment to infrastructure development, with 6,000 projects in the pipeline worth £480 billion. Will the Government quickly and speedily take forward the lower Thames crossing and extra investment in Kent roads, which will help to provide more homes, jobs and businesses, and help people in Kent, Medway and the Thames Gateway area? [906963]

  • I am grateful to my hon. Friend for his question and for recognising the contribution that the Government have made in increasing investment in infrastructure and the importance of that investment. We have consulted on proposals around a lower Thames crossing. There were more than 47,000 responses to that consultation. Those are now being considered, and my right hon. Friend the Secretary of State for Transport will respond to that consultation in due course.

  • May I take this opportunity to welcome Neasa Constance McGinn? I hope that the evidently effective crash course in midwifery undertaken by my hon. Friend the Member for St Helens North (Conor McGinn) is not a sign to the Government that we believe in downgrading midwifery training.

    Just a few months ago, on the steps of Downing Street, the Prime Minister promised to stand up for families who are “just managing” to get by. However, we now know that those were empty words, as this Government plan to cut work allowances for exactly those families who are just getting by. Is it not the case that her cuts to universal credit will leave millions worse off?

  • First, may I congratulate the right hon. Gentleman on the birth, I understand, of his granddaughter? [Interruption.] No? I am sorry. In that case, I am completely mystified. [Interruption.] In that case—[Interruption.] Wait for it. In that case, perhaps one should never trust a former Chief Whip. [Interruption.]

    On the point that the right hon. Gentleman raised in relation to universal credit, the introduction of universal credit was an important reform that was brought about in our welfare system. It is a simpler system, so people can see much more easily where they stand in relation to benefits. Crucially, the point about universal credit is making sure that work always pays. As people work more, they earn more. It is right that we do not want to see people just being written off to a life on benefits and that we are encouraging people to get into the workplace.

  • It is a bit unfair to blame a former Chief Whip for some little bit of confusion—very ungallant. Can we not just admire my hon. Friend the Member for St Helens North for his work? [Interruption.] It is extremely rude to point.

    The Prime Minister’s predecessor abandoned those same cuts to working people through the tax credit system. Now the right hon. Lady as Prime Minister is enacting them through universal credit. The Centre for Social Justice says that these cuts will leave 3 million families £1,000 per year worse off. Why is the Prime Minister slipping the same cuts in through the back door?

  • At least my former Chief Whip has a job. On the serious point that the right hon. Gentleman raises about universal credit, I repeat what I have just said. I think it is important that we look at why universal credit has been introduced. It was introduced because, under the benefits system under the Labour Government, we saw too many people finding that they were better off on benefits than they were in work. What is important is that we value work and we value getting people into work if they are able to work, but we want a system that is fair both to those who need the benefits and to those who pay for the benefits through their taxes. There are many families struggling to make ends meet who are paying for the benefits of others. I want a system that is fair to them as well.

  • This week, an Oxford University study found that there is a direct link between rising levels of benefit sanctions and rising demand for food banks. A million people accessed a food bank last year to receive a food parcel; only 40,000 did so in 2010. I welcome the Government’s promise to review the work capability assessment for disabled people, but will the Prime Minister further commit to reviewing the whole punitive sanctions regime?

  • It is absolutely right that in our welfare system, we have a system that makes sure that those people who receive benefits are those for whom it is right to receive benefits. That is why we have assessments in our welfare system. But it is also important in our welfare system that we ensure that those who are able to get into the workplace are making every effort to get into the workplace. That is why we have sanctions in our system. What the right hon. Gentleman wants is no assessments, no sanctions and unlimited welfare. That is not fair to those who are accessing the welfare system, and it is not fair to the taxpayers who pay for it.

  • According to a Sheffield Hallam University study, one in five claimants who have been sanctioned became homeless as a result. Many of those included families with children.

    Could I recommend the Prime Minister supports British cinema, and takes herself along to a cinema to see a Palme d’Or-winning film, “I, Daniel Blake”? While she is doing so, perhaps she could take the Work and Pensions Secretary with her, because he described the film as “monstrously unfair” and then went on to admit that he had never seen it, so he has obviously got a very fair sense of judgment on this. But I will tell the Prime Minister what is monstrously unfair: ex-servicemen like David Clapson dying without food in his home due to the Government’s sanctions regime. It is time that we ended this institutionalised barbarity against often very vulnerable people.

  • I have to say to the right hon. Gentleman that, of course, it is important that, in our welfare system, we ensure that those who need the support that the state is giving them through the benefits system are able to access that. But it is also important in our system that those who are paying for it feel that the system is fair to them as well. That is right; that is why we need to have work capability assessments—it is why we need to have sanctions in our system. Now, the right hon. Gentleman has a view that there should be no assessments, no sanctions and unlimited welfare. I have to say to him that the Labour party is drifting away from the views of Labour voters; it is the Conservative party that understands working-class people.

  • The housing benefit bill has gone up by more than £4 billion because of high levels of rent and the necessity of supporting people with that. Is that a sensible use of public money? I think not.

    In response to the March Budget, I asked the Chancellor to abandon the £30 cut for disabled people on employment and support allowance, who are unable to work, but who, with support, may be able to work in the future—they want to be able to get into work. What evidence does the Prime Minister have that imposing poverty on people with disabilities actually helps them into work?

  • I am pleased to say that what we have seen under this Government is nearly half a million more disabled people actually in the workplace. My right hon. Friend the Secretary of State for Work and Pensions has launched a Green Paper on work, which is starting to look at how we can continue to provide and increase support for those who are disabled who want to get into the workplace. But the right hon. Gentleman started his question by asking me about the increase in the money that is being spent on housing benefit. If he thinks that the amount of money being spent on housing benefit is so important, why did he oppose the changes we made to housing benefit to reduce the housing benefit bill?

  • As the Prime Minister well knows, my concern, and that of my party, is about the incredible amount of money being paid into the private rented sector in excessive rents, and that could be brought under control and handled much better.

    Many people in this House will have been deeply moved by the article by my hon. Friend the Member for Swansea East (Carolyn Harris) about the tragic death of her son and having to take out a bank loan to cover the funeral costs. The Prime Minister may be aware that the Sunday Mirror, with the support of the Labour party, is calling for an end to council charges for the cost to parents of laying a child to rest. It would cost £10 million a year—a very small proportion of total Government expenditure—to ensure that every council could ensure that those going through the horror of laying a child to rest did not have a bill imposed on them by the local authority to put that child to rest. I hope the Prime Minister will be able to consider this and act accordingly.

  • I recognise the issue that the right hon. Gentleman has raised. There are, of course, facilities available through the social fund funeral expenses payment scheme for payments to be made available to people who qualify and meet the eligibility conditions. Of course it is difficult for anybody when they have to go through the tragedy of losing a child and then face consequences of the sort that the right hon. Gentleman mentions. We are making sure, of course, in relation to local authorities, that they now have the extra revenues available to them through business rates and other local revenues. It is up to councils to consider what they wish to do on this, but I say to the right hon. Gentleman that there are facilities available through those social fund funeral expenses to deal with the issue that he raises.

  • Q3. Northamptonshire has for a long time had a growing population without the right level of funding for our public services. Can my right hon. Friend assure me that the current reviews of the funding formulas for schools, policing and health will properly reflect the population growths in Northampton and the rest of the county so that our services get the funding they need? [906964]

  • We have protected the schools budget in relation to funding paid per pupil, and we are protecting the police budget. But of course, as we look at the various ways—the various funding formulas—through which we are funding public services in my hon. Friend’s constituency and in the county of Northamptonshire, we will be looking at the very issue of what is right in terms of the needs of the local area and the numbers of people there.

  • It is with sadness that we learned of the death of a serviceman in a live firing exercise at the range in Tain. No doubt the Prime Minister and right hon. and hon. Members across this House will extend their condolences to the family, friends and colleagues of the serviceman who has died so tragically.

    The Prime Minister says that she wants to tackle international and domestic tax avoidance and serious criminality. SNP Members support this. If she were told that specific UK financial vehicles were being used for tax avoidance and other serious criminality, what would she do about it?

  • First, I am sure that, as the right hon. Gentleman says, the whole House would wish to pass on our condolences to the friends and family of the serviceman who has died at the Tain range.

    The right hon. Gentleman mentions tax avoidance. Yes indeed, we have done a significant amount in relation to tax avoidance. He asks what anybody should do if they have evidence of people actually avoiding tax. I suggest that he speaks to HMRC.

  • Scottish limited partnerships were established by this House in 1907, and they are being aggressively marketed internationally, especially in eastern Europe. The International Monetary Fund has warned of the risk posed by SLPs in the fight against global money laundering and against organised crime. It is now a matter of public record that SLPs have acted as

    “fronts for websites peddling child abuse images, and…have been part of major corruption cases”

    in Ukraine, Uzbekistan, Latvia and Moldova, including in the arms industry. Given the seriousness of this issue and the Prime Minister’s commitment to deal with criminality, but the lack of progress on SLPs, will she agree to meet me to discuss a joint way forward?

  • The right hon. Gentleman raises issues around criminality and investigations into criminal activity that is taking place, and talks about the issue of websites peddling child abuse and child sexual exploitation. It is precisely in order to increase our ability to deal with this criminal activity that we created the National Crime Agency and have been ensuring that we are working with the City on other issues such as money laundering. We are looking at the whole question of how we can ensure that we are taking effective action on criminal activity. I am pleased to say to the right hon. Gentleman—[Interruption.] He keeps asking me to meet him. As he knows, I do meet him on occasion—I am always happy to do so—but if he wants to talk to me about dealing with criminal activity, then I will be able to tell him about the work that has been done over the past six years under this Government in terms of the National Crime Agency, working with the City on money laundering, and enhancing our ability to deal with exactly the sort of criminal activity he is talking about.

  • Q5. Does the Prime Minister agree that it is disappointing that we did not hear from the Leader of the Opposition any welcome for the huge boost to manufacturing and employment that has come from Nissan’s decision to produce two new models at its factory? Does she agree that that decision demonstrates great confidence in the UK, with benefits throughout the supply chain, which includes companies such as Automotive Insulations in my constituency? [906966]

  • My hon. Friend is right in two senses. First, it is extremely disappointing that the Leader of the Opposition has not welcomed this, unlike his colleague, the hon. Member for Washington and Sunderland West (Mrs Hodgson), who has welcomed the fact that these jobs have been saved in her constituency and in the supply chain around the country—that supply chain is every bit as important. I know that Automotive Insulations in my hon. Friend’s constituency is receiving money as part of a project funded through the Advanced Propulsion Centre, and I wish it all the very best for the future.

  • Q4. What assurances can the Prime Minister give to the agri-food sector right across the United Kingdom that it will be given the important status required in Brexit negotiations? [906965]

  • I can absolutely assure the hon. Gentleman that we are determined to get the best possible deal for the British people on exiting the European Union. We are looking at the various sectors and we are very conscious of the importance of the food and agricultural sector across the United Kingdom, particularly in Northern Ireland. We will do everything we can, including listening to representations made by the Northern Ireland Executive, to ensure that we get the best deal possible for our agri-food sector.

  • Q8. Last week’s announcement on the report on accelerated access to medicines will have a positive impact on the lives of children and adults with a rare genetic or undiagnosed condition. For decades, patients have struggled to get access to medicines in a timely fashion, and the work of my hon. Friend the Member for Mid Norfolk (George Freeman) made massive progress. Will the Prime Minister confirm that if the programme is successful with the first five to 10 drugs in the first year, it will be extended to further drugs in following years? [906969]

  • My hon. Friend is right to welcome the accelerated access review and to pay tribute to my hon. Friend the Member for Mid Norfolk (George Freeman), who has done so much to place life sciences in the UK on the agenda and to ensure that the UK develops as the best possible place to develop new drugs, which is exactly what we want to see. The Department of Health will look at the review’s recommendations and respond to them shortly. This is an important development in our ability to accelerate access to drugs, which is to the benefit of patients.

  • Q6. In recent weeks, three Government Ministers have expressed three different views on what will happen, while industry cries out for clarity. I am talking not of Brexit, surprisingly, but of the oil and gas industry. Will the autumn statement provide additional support for the industry, or is the Prime Minister happy to sit back and see thousands more jobs lost? [906967]

  • We understand the challenges faced by the UK oil and gas industry and we take them very seriously. That is why we established the Oil and Gas Authority and why we have taken action, with the £2.3 billion package of measures in the last two Budgets, to make sure that the North sea continues to attract investment, and to safeguard the future of that vital national asset. We have taken a range of measures. We understand the concerns about the oil and gas industry, which is why the Government have already taken action.

  • Q11. Rochester airport and Medway city industrial estate in my constituency are home to a growing number of successful science and tech SMEs that are doing wonders for innovation and our economy. Ahead of my right hon. Friend’s trade mission to India, I congratulate her on her decision to take with her a cohort of SMEs to help to increase trading relationships with emerging economies. Will her delegation continue to ensure that all parts our economy are able to seize the opportunities that present themselves as we leave the EU? [906972]

  • My hon. Friend is absolutely right about the importance of small and medium-sized businesses, particularly in the technology industry. That is why I am pleased that I will take leading small and medium-sized businesses from the life sciences and technology sectors with me on my forthcoming trip to India. It is important to enable them to forge trading links with India, and I assure my hon. Friend that, as we look at the arrangements for leaving the European Union, we will take the interests of all sectors into account.

  • Q7. Tata Speciality is a big employer in my constituency and its workforce are worried by the long period of uncertainty enacted by Tata Steel. Will the Prime Minister use her trade visit to India to secure from the company the future of steel production in Britain, and to convey the importance of Tata acting as a responsible owner and, in the case of Tata Speciality, seller of its UK steel assets? [906968]

  • I can assure the hon. Lady that we recognise both the importance of steel and the importance of Tata in the United Kingdom. That is why, as a Government, we have had discussions with Tata on the future of steel here in the United Kingdom, and we will continue to do so.

  • Q12. As I am sure the Prime Minister is aware, my constituency apparently contains more cows than any other. That means world-class cheese, from Godminster and Barber’s to Montgomery’s Cheddar, Wkye Farms and many more. Can my right hon. Friend assure the west country’s farmers that in negotiating the best deal for Britain in the coming weeks and months, the interests of our agricultural industry and farming community will be foremost in her mind? Will she pop down to Somerset soon for a chunk of Cheddar and perhaps a drop of cider? [906973]

  • West country cheese! I think we are clear.

  • My hon. Friend’s invitation for some west country cheese and cider is difficult to refuse, so I look forward at some stage to coming down to Somerset and being able to sample those products. He is absolutely right, as others in this Chamber have been, about the importance of our agricultural sector to economies across the UK. Particular parts of the UK rely heavily on the agricultural sector, and we will be taking their needs and considerations into account as we negotiate and deliver the best possible deal for this country in leaving the EU.

  • Q9. This morning the High Court ruled that the Government have comprehensively failed to tackle air pollution properly. Which does the Prime Minister feel is worse: the Government losing in the High Court for the second time, or the 40,000 early deaths that result from air pollution every year in the UK? [906970]

  • I have been asked about air quality in this Chamber previously at Prime Minister’s questions, and I have always made it clear that we recognise that there is more for the Government to do. We have been doing a lot in this area. We have been putting extra money into actions that will relieve the issues around air quality, but we recognise that the Department for Environment, Food and Rural Affairs now has to look at the judgment that has been made by the courts, and we have to look again at the proposals that we will bring forward. Nobody in this House doubts the importance of the issue of air quality. We have taken action, but there is more to do and we will do it.

  • The Prime Minister will remember visiting the Witney constituency recently. I am pleased to report that Chipping Norton has been shortlisted for the Great British High Street awards. Will she join me in congratulating the small businesses of Chipping Norton, and can she tell me what support Government offer to the small businesses in our market towns?

  • May I take this opportunity, which is my first opportunity, to welcome my hon. Friend to this Chamber? I congratulate him on his excellent result in the by-election.

    My hon. Friend’s question brings back many happy memories for me, because when I was a child Chipping Norton was our local town. I used to go there and spend my pocket money assiduously in the shops, so I have done my bit for his high street in Chipping Norton. We are very clear, as a Government, that the action we have taken on issues such as business rates is there to help to support small businesses.

  • We are always grateful for a bit of extra information, and we have now had it.

  • Q10. This Government’s record on immigration detention is disgraceful, with the UK being the only country in the EU that has no time limit on detention. Amid concern over plans to replace Dungavel with a short-term detention facility near Glasgow airport, the people of Renfrewshire want no part in these inhumane and ineffective practices. Will she use the closure of Dungavel as an opportunity to rethink detention policy and end this stain on our human rights record? [906971]

  • The hon. Gentleman will know that a lot of work has been done by the Government on the whole question of immigration detention, and a number of changes have been made. An independent review took place about a year ago on the whole question of detention of people in the immigration estate. It is important to realise that where people are due to be removed from this country and there is the prospect that they could be lost to the system if they are not detained, there are circumstances in which it is right to detain them in the immigration estate. We need to make sure we have got that estate right, and that is why a lot of work has been done on this. The fundamental point is that I suspect he does not think we should detain anybody in relation to immigration enforcement, but we believe there are those who are rightly detained before we remove them from this country.

  • When people make fun of Christianity in this country, it rightly turns the other cheek. When a young gymnast, Louis Smith, makes fun of another religion widely practised in this country, he is hounded on Twitter and by the media and suspended by his association. For goodness’ sake, this man received death threats, and we have all looked the other way. My question to the Prime Minister is this: what is going on in this country, because I no longer understand the rules?

  • I understand the level of concern that my hon. Friend has raised in relation to this matter. There is a balance that we need to find. We value freedom of expression and freedom of speech in this country—that is absolutely essential in underpinning our democracy—but we also value tolerance of others and tolerance in relation to religions. This is one of the issues we have looked at in the counter-extremism strategy that the Government have produced. Yes, it is right that people can have that freedom of expression, but that right has a responsibility too, which is the responsibility to recognise the importance of tolerance of others.

  • Q13. Today’s Daily Record leads on DWP issues. Is the Prime Minister aware that a telephone call to the Department for Work and Pensions by a severely disabled person or their carer can cost up to 45p a minute, which, with an average length of a call of 13 minutes, is a considerable sum from their social security entitlement? Should a disabled citizen pay this price, or does the Prime Minister agree with me that we should end this telephone tax on the most vulnerable in our society? [906974]

  • The hon. Gentleman raises an issue that has been raised on a number of occasions in this House. That is why the Government are implementing new guidelines in relation to the operation of these telephone lines. The number of lines that are costing people in the way to which he refers is being reduced, so the Government have recognised the issue and are taking action.

  • The past 18 months have been hell for commuters in my constituency of Lewes using the Southern rail network. Last night, a journey that should have taken just over an hour took over four hours. May I beg the Prime Minister to intervene on the Southern rail network? While we have a country that works for everyone, in Sussex we have a railway that works for no one.

  • I feel for my hon. Friend in relation to the journey she had to go through last night and the extended time that it took. My right hon. Friend the Secretary of State for Transport has been taking action in working with Southern rail and Network Rail in relation to the improvements that are necessary. We have stepped in to invest £20 million specifically to tackle the breakdown on the Southern rail network, which is proving so difficult for passengers. I recognise the degree of concern about this. My right hon. Friend the Secretary of State for Transport is on the case, and is working to ensure those improvements.

  • Q14. Has the Prime Minister spotted the ludicrous refusal by FIFA, the footballing federation, to let our players wear poppies at the forthcoming Scotland-England game? Will she tell the respective associations that, in this country, we decide when to wear poppies and that we will be wearing them at Wembley? [906975]

  • I think the stance that has been taken by FIFA is utterly outrageous. Our football players want to recognise and respect those who have given their lives for our safety and security. I think it is absolutely right that they should be able to do so. This is for our football associations, but I think a clear message is going from this House that we want our players to be able to wear poppies. I have to say to FIFA that before they start telling us what to do they jolly well ought to sort their own house out.

  • May I congratulate my right hon. Friend on her recent announcement of a taskforce to stamp out the vile business of modern slavery? Will she join me in congratulating my constituent Mike Emberson and the Medaille Trust on their 10 years of work with the victims and the 70 places they now provide across their homes for these most unfortunate women?

  • I am very pleased to endorse my hon. Friend’s comments. I have met representatives of the Medaille Trust and talked to some of the victims they have helped. It is absolutely right that we continue the momentum in our fight against modern slavery. This country is leading the world and we should continue the fight because, sadly, too much slavery is still taking place on the streets and in the towns and villages of this country. That is why the taskforce I have set up will continue that momentum. We will be relentless in our pursuit of eradicating modern slavery.

  • Q15. In July, the armed forces charity SSAFA published an in-depth survey of nearly 1,000 working-age veterans. Some 85% of them thought the UK did not give them enough support and only 16% thought the armed forces covenant was being implemented effectively. What is the Prime Minister doing personally to change that? [906976]

  • We absolutely recognise the debt we owe to our veterans. That is why, through the armed forces covenant and throughout the work the Ministry of Defence is doing, we increasingly recognise the support that is necessary for veterans. The hon. Gentleman talks about what we can do. One thing we can do is to help people who come out of the armed forces to find their way into the world of work. That is why it is important both that we have a system that helps them to find the support that is necessary to get into the world of work and that we have an economy that is providing the jobs that people need.

  • This week is Offshore Wind Week. The development of the offshore wind sector is vital to my Cleethorpes constituency. Will my right hon. Friend assure the industry and my constituents that the Government will continue to work with the industry to develop future jobs for young people, with a particular emphasis on training?

  • I am happy to reassure my hon. Friend that the Government will continue to work with the industry. It has been an important development for the United Kingdom and makes up an important part of the energy we generate from renewables. As he says, it does provide jobs and we need to ensure that we look at the training that will enable people to take up those jobs. That is why skills form part of the work we are doing on our future industrial strategy.

  • Does the Prime Minister agree that it is highly irresponsible and, indeed, dangerous for people to talk up the prospect of increased violence in Northern Ireland as a result of our leaving the EU, and that people should use the agreed institutions that were set up under the various agreements, not stand outside them or create new ones? Does she also agree that Brexit will not result in any change, alteration or impeding of the way in which the regions, countries and people within the UK connect with one another?

  • I am very happy to give the right hon. Gentleman that assurance in relation to movement around the United Kingdom. No change will take place. We will ensure that Brexit is a good deal for the whole of the United Kingdom. Those who wish to encourage violence off the back of that should, frankly, be ashamed of themselves. It is essential that we all work together to make a success of this and get the best possible opportunities for people across the whole of the United Kingdom.

  • Will the Prime Minister join me in praising Henley-on-Thames for receiving its first tranche of community infrastructure levy money at the higher rate because it has a neighbourhood plan? Will she join me in praising neighbourhood planning generally as the best means of giving communities a say over the planning system?

  • I am very happy to congratulate my neighbouring MP and Henley-on-Thames on that achievement. My hon. Friend is absolutely right that neighbourhood plans are a crucial part of the planning system. That is how local people can have a real say over what is happening in their local area.

  • May I add my congratulations to my hon. Friend the Member for St Helens North (Conor McGinn)? Moving swiftly from midwives to doctors, is the Prime Minister aware that doctors in Doncaster face a crisis in primary care, because as GPs retire, it is proving almost impossible to get new ones to take over their practices? Because of restrictions in the Health and Social Care Act 2012, NHS bodies cannot take the necessary action, for example putting in salaried GPs. Will she do something about this matter quickly? Otherwise, many of my constituents will be left without a doctor.

  • After my unfortunate mistake earlier about the right hon. Member for Islington North (Jeremy Corbyn), I failed to add my congratulations to the hon. Member for St Helens North (Conor McGinn), so am happy now to do so.

    It is important to have GPs coming through, so that we can replace those who are retiring. Over the past six years we have seen thousands more GPs in our NHS. That is why the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), and my right hon. Friend the Secretary of State for Health are ensuring that we have a programme to bring more doctors into training, so that places such as the right hon. Lady’s constituency, and those of other Members across the House, have GPs in the numbers needed.

  • Point of Order

  • On a point of order, Mr Speaker. Can you do anything about the fact that the Home Office is not observing named days? On 17 October, the Home Secretary made a statement on the independent inquiry into child sexual abuse, in the course of which she said that she had passed on a request that Dame Lowell Goddard should appear before the Home Affairs Committee—as you know, Dame Lowell Goddard had resigned as the inquiry’s chair. I put down a named day written question to the Home Secretary asking if she would put the relevant correspondence with Dame Lowell Goddard in the Library. There was an interim reply saying that the Home Office was unable to answer the question on that particular day. A few days later I therefore put down another question, due for answer yesterday, asking when the Home Secretary would make a substantive reply to the first question. There has been no reply at all.

    The Home Office, as I understand the position, seems to be in such a state of crisis about written questions that it is not able to answer them—unless it does not want to provide an answer in the first place. This seems quite simple to me: the Home Secretary could say that she had placed the correspondence in the Library or else say what she meant when she said what she had passed on the information. It is hardly a complex question, so why do I have to raise a point of order with you, Mr Speaker?

  • It is a very curious state of affairs to which the hon. Gentleman alludes. If he has a wider concern about overall response rates to questions it is of course open to him to write to the hon. Member for Broxbourne (Mr Walker), the Chair of the Procedure Committee, which keeps an eye on these matters. In relation to this particular question, the situation seems rather curious. However, experience tells me that when a Member raises his or her disquiet about a lengthy delay in securing a reply to a parliamentary question, that reply is, thereafter, ordinarily forthcoming very quickly. If the hon. Gentleman is in any doubt on that matter, he can always have a word with his right hon. Friend the Member for Manchester, Gorton (Sir Gerald Kaufman), who has found it expedient to complain from time to time and has then secured very quick replies. The Leader of the House will have the hon. Gentleman’s interests at heart and I think a solution will be found, possibly within hours.

  • Further to that point of order, Mr Speaker. I will persist if that does not happen.

  • If I may very politely say so, that observation was superfluous, in the sense that I do not think that any Member of the House would have expected anything less of the hon. Gentleman. He is nothing if not persistent and tenacious to a fault.

  • British Victims of Terrorism (Asset-Freezing and Compensation)

    Motion for leave to bring in a Bill (Standing Order No. 23)

  • I beg to move,

    That leave be given to bring in a Bill to make provision about the freezing and seizing of assets belonging to states or organisations who sponsor or perpetrate acts of terrorism for the purposes of enabling compensation to be paid to the British victims of such terrorism; to provide a definition of British victims for the purpose of eligibility for such compensation; and for connected purposes.

    Today, I lay before the House a Bill that will give hope to all British citizens who have suffered at the hands of terrorism—hope that one day soon their own United Kingdom Government might be obliged to act decisively against the perpetrators and backers of these horrific crimes, and deliver justice to all those whose lives have been so cruelly cut short, or have suffered injury or loss. My Bill would give Her Majesty’s Government direct power to freeze or seize assets of any state or organisation that sponsors or perpetrates such acts. IRA terrorism, supported by Colonel Gaddafi’s regime, is the most significant example in recent times of when British citizens have been failed by their own Government in seeking justice for crimes committed against them, but in today’s world there are new threats and new generations of terrorists who seek to harm British people. My Bill will mandate Governments to seek compensation for all British victims of terrorism, providing them with the powers they need to do so.

    As chairman of the parliamentary support group for victims of Libyan-sponsored IRA terrorism, I am proud to have championed, along with my colleagues, the cause to obtain compensation for the victims of these dreadful crimes, and to follow on the good work of the former Member for Thurrock, Andrew Mackinlay, to whom I pay heartfelt tribute for his steadfast support for the campaign for justice for the victims of terrorism perpetrated by the IRA.

    Many of us have friends, family or constituents who have suffered at the hands of politically motivated terrorism. Last year marked a quarter of a century since the assassination of my friend and former Member for Eastbourne, Ian Gow, whose murder at the hands of the IRA in July 1990 had a profound effect on me and on so many others who knew Ian as a soldier, lawyer, parliamentarian, friend, and staunch defender of Queen and country. In this Chamber, we commemorate with personal shields our own fallen colleagues who were victims of terrorism: Ian Gow, Airey Neave, Robert Bradford and Sir Anthony Berry, who was killed in the Grand hotel, Brighton in 1984. All were victims of IRA-INLA terrorism.

    Terrorism in the ’70s, ’80s and ’90s had a profound effect on so many of my generation, who remember growing up with the threat of bombs in London, Belfast and towns and cities across the United Kingdom. Indeed, 9 February 1996 will always be etched on my mind. I visited the Britannia hotel in Docklands to discuss plans for an international dinner I had organised, to be held on 1 October that year, in honour of Lady Thatcher. I travelled back via South Quay station and arrived home in Romford only to watch the “ITN News” with horror, as I learnt about the devastating bomb explosion that had occurred soon after I had boarded the docklands light railway. That bombing, as well as so many other acts of terrorism by the IRA, was carried out using explosives supplied by the Libyan regime, yet so many years later victims have not received the compensation they rightly deserve. Some of the victims and their families who suffered that trauma are now elderly or have passed away.

    Zaoui Berezag was a victim of the Canary Wharf bombing, and was left severely mentally and physically impaired; he was cared for by his devoted wife Gemma until she sadly died last year. They never received one penny in compensation. Victims of the Harrods bombing of 17 December 1983, such as the family of WPC Jane Arbuthnot and Police Inspector Stephen Dodd, did not receive compensation, while the family of an American who was killed precisely in the same place at the same time did receive compensation. That is because, unlike the UK Government, the United States Government, under President George W Bush, fought and won the argument with the Gaddafi regime for American victims.

    How can it be justified that some victims should receive compensation while others do not? Surely it should be settled when the victims or their families are still alive. It is truly terrible that British victims have been treated so differently than Americans. Their Government stood by their victims; our Government did not.

    Each time the issue of compensation for these deserving victims is raised, we have until now received the same empty response from Governments of all persuasions. Each time, we hear weak excuses for not pursuing a way of bringing this matter to a satisfactory conclusion for the British victims of terrorism. Each time, the long-hurting victims of the IRA-Gaddafi’s regime listen in, only to be let down and left to wait indefinitely.

    These wicked acts took place a long time ago and many of the victims fear that, unless action is taken soon, they will not be around to see this matter concluded and will never receive the justice and compensation they deserve. Time is running out, so today I bring this Bill to the Floor of the House with the aim of giving Her Majesty’s Government the power to act and resolve this issue by making provision for the freezing and seizing of assets belonging to any state or organisation that sponsors or perpetrates acts of terrorism against a British citizen. I include in that category citizens of Ireland, as well as any citizens of our Crown dependencies or overseas territories that might have been affected.

    When sanctions against Libya are eventually lifted, it is vital that we do not miss the opportunity finally to bring this matter to a close and come to an agreement with any future Government in Tripoli. The British victims of Libyan-sponsored IRA terrorism must never be forgotten, and we must not discard the one bargaining tool we have—of frozen assets—to ensure that justice is served.

    Over many decades, Governments have both missed and avoided opportunities to bring justice to the victims. This cannot be allowed to happen one moment longer. It would be intolerable if when the assets are unfrozen, the UK is unable to ensure that talks are opened and had no power to act. Just as the Libyan people were victims of Gaddafi, the British victims of Gaddafi-sponsored IRA terrorism are too, and it is the duty of Her Majesty’s Government to fight to bring justice.

    This Bill proposes a thorough basis for legislation to allow Her Majesty’s Government to ensure that eventually, however many years it takes, the UK victims of the IRA-Gaddafi regime will eventually receive compensation and justice. I say to the House that we need a law that ensures that any future victims of terrorism will not have to suffer the same trauma. That is why my Bill is important, not just for the victims of IRA terrorism, but for those British citizens who may, God forbid, become victims of terrorism in years hence. So it is for the defence, the well-being and the protection of all of Her Majesty’s subjects that I commend this Bill to the House.

    Question put and agreed to.


    That Andrew Rosindell, James Cartlidge, Mr Nigel Dodds, Kate Hoey, Sir Gerald Howarth, Daniel Kawczynski, Danny Kinahan, Mr Khalid Mahmood, Dr Paul Monaghan, Ian Paisley, Gavin Robinson and Henry Smith present the Bill.

    Andrew Rosindell accordingly presented the Bill.

    Bill read the First time; to be read a Second time on Friday 24 February 2017, and to be printed (Bill 88).

  • Opposition Day

    [11th Allotted Day]

    Community Pharmacies

  • 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.

  • Several hon. Members rose—

  • 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 learnt 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.

  • Several hon. Members rose—

  • 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.

  • Several hon. Members rose—

  • 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.

  • Several hon. Members rose—

  • 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 amount 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.

  • Several hon. Members rose—

  • 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.

  • Several hon. Members rose—

  • 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.

  • Several hon. Members rose—

  • 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 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 on when it is due and therefore ensures that patients do not run out of medication. The pharmacies also provides 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.

  • Several hon. Members rose—

  • 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 problem 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 on which we need to get a grip.

    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 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 the debate 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 also 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 communities 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.

  • Several hon. Members rose—

  • 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 proven 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 they 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 differentiate 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.

  • Several hon. Members rose—

  • 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 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 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