(11 years ago)
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Ben Gummer (Ipswich) (Con)
Dr McCrea, it is a pleasure to speak under your chairmanship in my first Adjournment debate. It is also a great pleasure to address the assembled hon. Members—this is a good turnout for a 9.30 am sitting on a Wednesday—and especially the Minister, not only because he is an excellent Health Minister, but because he is my constituency neighbour in Ipswich and will recognise the local issues that I shall mention.
This debate came out of a discussion that I first had with Miss Michelle Claridge, a pharmacist in my constituency; I admit that my knowledge of pharmacies and pharmaceutical services was close to zero before that. As with so many incidents in our lives as Members of Parliament, I learned something immediately from talking to a constituent who brought a new experience—a new query—to my attention. She explained something that I had not appreciated. Perhaps you know, Dr McCrea, because you are no doubt a far more experienced MP than I, that a pharmacy’s appearing on a street, especially a new one, is not the work of a simple entrepreneurial decision. It is a minor miracle, and I will explain why.
As the Minister knows, in the centre of Ipswich there is a new development on the waterfront, encompassing several thousand new apartments and a few houses. This new community is demanding new pharmacy services. Michelle Claridge, an entrepreneur, says, “I would like to set up a pharmacy in this area, to service the new community.” But it is not that simple. People cannot just get a retail unit for which they have planning permission and start a pharmacy; it does not work like that. The system is arranged by the Pharmaceutical Services Negotiating Committee. Hon. Members will understand that, from this moment, we will begin speaking as if we were in East Germany. It will be a time warp.
We start with the PSNC. People have to apply to be on the pharmaceutical list, which is now run by the NHS England area team—when Miss Claridge applied, it was run by the primary care trust—which manages it in consultation with the health and wellbeing board for the area and determines whether there is a need for a pharmacy in an area. It draws a circle around the existing pharmacies and says, “Is there a particular need, for this population in this area?”
When Miss Claridge started, the PSNC said that there was not a need because its map did not show the several thousand new apartments and houses on the waterfront area. Even a simple consultation with the Google maps travel distance calculator could have shown that most of its calculations about walking time were defective. The first problem is that the system starts with a group of no doubt well meaning and intelligent bureaucrats having to work out whether there is a need for a pharmacy in an area.
Once people decide that they want to set up a pharmacy, they have to apply to NHS England with 21 different forms, the shortest—section 21—being five sides long and the longest being 13 sides long. In total, they have to submit about 200 sides of application forms just to say, “I think there is a need in this area for this new pharmaceutical practice.”
After that, the application can either be accepted or rejected. If it is accepted, people can go ahead and if it is rejected they can appeal, via the local pharmaceutical committee, to which other local pharmacies can also make applications, perhaps saying, “This pharmacy is coming into my patch. It is far too close.” They can make whatever objection they feel is necessary.
The system is already completely regulated from the centre. It is a state-controlled system—contracted out to pharmacists, who are working in it—even at the geographical level, before we get on to buying and selling drugs. I do not intend to offer any radical solutions. I just want to open up the matter as a Member of Parliament. I want to explain my experiences in trying to deal with this system and talk about what I have found out, as a layman with none of the medical expertise of the Minister or hon. Members in this Chamber who are members of all-party groups. I want to explain what I saw as I examined this system.
I turned over a stone and found a lot of interesting bodies lying underneath. There are serious questions about the state’s ability to buy medicines. This is not a small bill. We spend £12 billion a year on drugs, via the NHS—a huge amount. The whole thing, from beginning to end, is run by a state bureaucracy, which, in its scale, complication and anticipation of market forces, would make the North Korean Government proud.
How do we comprehend this extraordinary system and what are the problems in it? First, I have been helped very much today by NHS Southwark clinical commissioning group—in London, I live in Southwark—which posted a useful piece of information through my door yesterday. It contains a nice map showing all the general practitioner practices and mentions lots of interesting things about what it wants to do, all of them worthy. In the middle, under a heading, “Our Vision”, it states:
“Our aim is simple—we want to work with the hospitals, community teams and GPs who provide care locally to make sure that the people of Southwark receive the best care possible and live longer, healthier, happy lives.
We will work to make sure that all Southwark residents receive high-quality, safe and accessible health services and that, over time, we narrow the gap in life expectancy between the richest and poorest people.”
All good stuff, but hon. Members will notice that one significant service provider is omitted: the pharmacist, which does not even bear a mention in this list of different health providers for NHS Southwark.
I understand that this is a common problem throughout the country. Indeed, only 10% of clinical commissioning groups have a contracting relationship for additional services with pharmacies. That is unusual in the European context. As is so often the case in health care provision, this country is somewhat behind our European neighbours.
Highly qualified people are centred where they can serve local populations, yet in so many cases they cannot offer the kind of medical services that they could offer if they were in France, Germany or the Netherlands, or some more enlightened parts of this country. Pharmacists could offer such services easily and relieve pressure on general practitioners and hospitals. The scale of what they could do is significant. Why can they not offer basic diabetic treatment or flu jabs? One could—I am sure not you, Dr McCrea—go to the pharmacist for emergency contraception, but not for various other treatments that they could offer, depending on the area.
Michelle Claridge has experienced this situation. She said, “I want to set up GP provision in this new community, linked to my pharmacy.” That is sensible, but—oh, no—people cannot just hire a locum in a pharmacy, providing a medical and pharmaceutical service to a new community, because there would be a series of new arrangements and contracts to go through with the NHS area team to allow that to be done. Therein lies another problem. The contracting relationship between the two is so complicated and separate that the area for innovation in what is not really a market at all is limited. That seems to me a great sadness and a missed opportunity, and I am sure the Minister will agree. So how do we loosen things up? I will address that in a second, because we first need to examine how pharmacists sell drugs and purchase them from the various wholesalers who sell the drugs on behalf of pharmaceutical companies.
There are essentially three categories of drugs. First, there are the so-called “special drugs”—not the special drugs that you might be aware of in Northern Ireland or in the rest of the country, Dr McCrea, but special drugs as defined by the NHS. Those drugs are outside the normal regulatory regime. They are called unregulated but, of course, this being the NHS, they are regulated.
Secondly, there are the regulated drugs—the vast majority. They are drugs that are within patent and a few other sectors. Finally, there are the category M drugs, which have come off patent. The NHS tries to derive benefits from their coming off patent by ensuring that there is not excessive profiteering in the sector. I hope I have explained that properly. No doubt I am making a series of solecisms, but I hope Members will excuse me.
David Simpson (Upper Bann) (DUP)
I congratulate the hon. Gentleman on obtaining this debate. He mentions special drugs, which are addressed in the research papers that we have received. I am sure he agrees that it is a scandal that the suppliers of those drugs issue invoices of, for example, £600, as it says here, when the actual cost of the drugs is £300. The NHS refunds the £600, and the pharmacy or the supplier pockets the other £300. Multiply that by the billions of pounds out there in the supply chain, and it is a scandal. Something must be done.
Ben Gummer
I could not agree more with the hon. Gentleman. I will address that point.
There are three separate groups that each present different and particular problems. The scandal to which the hon. Gentleman alludes, which was uncovered recently by an excellent piece of journalism in The Daily Telegraph, shows how the NHS, customers and taxpayers have been ripped off by the drug companies that are coming in and double invoicing—they are issuing credit notes to pharmacists but invoicing full amounts to the NHS. That situation is outrageous, but it is inevitable when the market is so complicated and lacking in transparency. That is the first of several problems with special drugs.
Category M drugs are incredibly complicated. In the parallel trading of pharmaceuticals across the European Union—just to take one issue—it was often beneficial to import drugs from Greece or southern Europe to the UK because of the price differences between the pound and the euro. The reverse is now true, which means that there is sometimes a shortage of supply in the United Kingdom.
The situation is addressed by a quota system imposed by the pharmaceutical companies, which inevitably causes difficulties for pharmacists because sometimes five people, rather than three, want a particular drug one week. At that point, the pharmacist rings up the wholesaler and says, “I need two more prescriptions.” The wholesaler will then say, “Actually, I don’t have them.” The pharmacist will then have to phone the supplier to ask for two prescriptions, and if the pharmacist cannot get the prescriptions from the supplier, they have to go into the secondary market to buy from another pharmacist who is keeping the prescriptions in stock. The other pharmacist, completely understandably, takes a margin on selling the drug to the pharmacist who requires the prescription.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
My hon. Friend might be aware that I am vice-chairman of the all-party group on pharmacy. The right hon. Member for Rother Valley (Mr Barron) and I considered the issue about 18 months ago, and we produced a report. Unfortunately, the Department of Health does not seem to have taken an awful lot of action and has rather pushed the report into the bottom drawer. Perhaps my hon. Friend might be willing to meet the chairman of the all-party group and me so that we can share our report.
Ben Gummer
My hon. Friend wrote and published his report before the Minister was appointed to his position, so I am sure my hon. Friend is calling on new ears and eyes that are able to consider the problem afresh.
Another problem is that pharmacists are completely at the mercy of the demographic that they happen to serve. The averaging of pricing operated by the PSNC means that if pharmacists happen to be selling a particular pharmaceutical in their area because of a high incidence of diabetes and are making a loss, and if they are not selling many drugs on which they might otherwise make a profit that allowed them to break even or make a small margin, they are immediately disadvantaged—just because of their geography.
If, however, a pharmacist happens to be in another location with a low incidence of diabetes but a high incidence of another condition that requires a high-margin drug, the pharmacist will do very well—not because of business acumen, not because they are running a particularly good service, not because they are friendly to customers, who want to come to see them, but just because of where they happen to be and the health indicators of their particular area. That cannot be right.
The third problem with the regulated market is that, because of the price changes of particular pharmaceuticals that happen every day and every week, it is impossible for businesses to plan, as they are uncertain of their future margins.
Those are all classic problems of trying to regulate a market. It would be good for the Opposition spokesman, the hon. Member for Copeland (Mr Reed), to take note of what happens when people try to regulate a market to the degree that his party—not him, I am sure; he is one of the more sensible members of his party—wishes to on energy prices. Such regulation results in inflated prices across the spectrum, as has happened in many instances in the drugs market in the United Kingdom. Good customer service is not incentivised, and good pharmacists are crying out to be rewarded for quality. Furthermore, innovation and supply are restricted.
I could go into those problems in far greater detail across the sector. The problems frustrate pharmacists and, no doubt, Ministers, who ultimately have to write the cheque on behalf of the taxpayer.
The third area I will address before I give others an opportunity to contribute is the essential problem at the heart of the debate. Of course it is understandable that we have ended up with a regulated system, because there is only one customer for most drugs. Indeed, if I understand things correctly, 80% of prescription drugs are bought by the NHS on behalf of people who are entitled to free prescriptions. Because of the way in which we have set up our health service in this country, it is impossible to extract the kind of value from the big pharmaceutical companies that other countries are able to extract, as there is only one purchaser. I do not know why in this country we have not got to a position of questioning the business motives and ethics of big pharmaceutical companies, as the United States has for many years.
I should qualify all that by saying that, of course, within the pharmaceutical sector there are the most fantastic companies that are innovating, contributing upwards of £12 billion a year to the UK economy and employing thousands of brilliant people across the country. We should be proud of those companies, but it is surprising that we have such an unquestioning attitude to those enormous interests, which have a relationship with the NHS and general practitioners that could be generously described as corporatist. That is unhealthy in driving innovation, in encouraging responsibility and, most importantly, in ensuring transparency. That is precisely why we get scandals such as the one raised by the hon. Member for Upper Bann (David Simpson). If there is an opaque market, frauds will be committed against the interests of the taxpayer.
I have, I hope, opened up the debate a little so that we can discuss some of the issues. I do not have any prescriptions for how we might deal with them, other than the general principle, which I hope the Opposition will agree with, that liberalisation is generally a good thing. If we deregulate this market—not the quality of the people dispensing pharmaceuticals, but the commercial side of the market—to allow pharmacists to offer more services more innovatively and more cheaply, and if we encourage competition in NHS purchasing and price-setting, we will do something on behalf of taxpayers and patients. I have put forward a group of questions to open up the debate, and I am grateful for the contributions that will follow mine.
Mr Kevin Barron (Rother Valley) (Lab)
I congratulate the hon. Member for Ipswich (Ben Gummer) on applying for and securing the debate at this opportune time. He will know that the change from primary care trusts to clinical commissioning groups means that there is indeed scrutiny in local communities of the worth of local pharmacists and of what they have been doing over many years.
I should put it on record that I chair the all-party group on pharmacy. The group receives financial support from the Company Chemists Association, the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and the Royal Pharmaceutical Society. The lobbyists Luther Pendragon provide the group with administrative assistance. I have no personal interest in the group, other than chairing it, but I thought I should put those details on record.
Community pharmacy sits at the heart of our communities, and pharmacists are trusted, professional and competent partners in supporting individual, family and community health. An estimated 1.6 million people visit a pharmacy each day, of whom 1.2 million do so for health reasons, making pharmacists the most accessible health care professionals.
I was not really surprised to hear the hon. Gentleman say that pharmacists were not mentioned in the information he got from Southwark. Pharmacists tend to be a little add-on, and we had an example last week, with the publication of the report on A and E, which said that pharmacists might be able to help with some of the issues it raised.
Like GPs, dentists and optometrists, community pharmacies are private organisations contracted to provide NHS services to the public on behalf of NHS England. However, that is not really understood by the public. A 2011 survey by Pharmacy Voice found that 88% of people regarded GP practices as public bodies, when the vast majority are, of course, private businesses. However, only 32% of people regarded pharmacies as public bodies, which is extraordinary, given their impact on our communities.
More than 90% of the average community pharmacist’s turnover comes from the NHS. That is a higher percentage than for GPs in some parts of the country, and even some NHS hospitals do not get that much of their income from the NHS. Pharmacies often provide advice to patients free of charge, with one in seven community pharmacy consultations not resulting in a sale.
The hon. Gentleman said that we do not use pharmacies in the way people do abroad. Many years ago, when my children were quite young, and we were on holiday in places such as Spain or Portugal, the pharmacist was the first health professional people were asked to go to but, sadly, that is not the case in this country. The pharmacist was there with powers to help.
Community pharmacists are the face of the NHS in communities and on the high street, having more engagement with the public than other health care professionals. Some 99% of the population, including even those living in the most deprived areas, can get to a pharmacy by car within 20 minutes, and 96% can get to one by walking or by public transport. Pharmacists can reduce A and E waiting times by dealing with people with common conditions. The hon. Member for Plymouth—
Mr Barron
I am sure Hansard will put that right anyway—I could have said “somewhere in the south”. The hon. Gentleman mentioned the all-party group, and we had a session on pharmacies easing the burden of emergency care. We had several witnesses, one of whom—Paula Wilkinson—was the chief pharmacist at Mid Essex Clinical Commissioning Group. She showed us a publication that the CCG was sending round mid-Essex called “Why wait to see your doctor or nurse? See your pharmacist first!” It is part of the health care on the high street initiative that the CCG is running, and she focused the majority of her comments on that initiative, which she said nudged—that is very much Government-speak—people towards using the pharmacy first. Like another witness, she focused on the expanded role that pharmacies could play in serving patients with minor ailments.
Paula said—this is quite interesting, and I would be interested in the Minister’s comments—that for people on low incomes, prescriptions often provided a way of gaining free access to medicines that are otherwise available over the counter without a prescription. She said that meant that patients on low incomes were perversely incentivised to attend their GP or an A and E service to get prescriptions. She believed consideration should be given to providing some free medicines without prescription to those on low incomes. Clearly, if a patient has been on a medicine for a long time, that would not be that challenging, and a professional such as a pharmacist could extend the period without having to go through any rigmarole and clogging up the rest of the system.
The A and E report that came out last week showed that 40% of people who attend A and E have nothing whatever done to them, which is an extraordinary statistic. Indeed, 50% of people who are blue-lighted—an ambulance or paramedic goes out to them—are not admitted to hospital. We need to look at certain issues in primary care services and, to some extent, in the acute sector if we are to deal with such people.
Community pharmacy provides a common ailments service—we call it a minor ailments service in Rotherham —in 10% of England, and people are encouraged to go to the community pharmacy as part of that. A nationally commissioned service would reduce pressure on GP surgeries and, subsequently, on A and E. Recent reports suggest that 56 million to 57 million visits a year could be managed by pharmacists, freeing up GPs to manage more complex cases, and I agree.
Pharmacists support people with long-term conditions to manage their symptoms, improving access to care for people in the most deprived areas and increasing capacity to treat patients out of hours and in the community. The Minister will be well aware of this, but about 75% of NHS expenditure goes on people with long-term conditions. This winter, quite a lot of them are likely to end up going to A and E and clogging up the system because they have, for whatever reason—they may be forgetful as a result of other problems, such as dementia—not adhered to their drugs regime at home. Managing such people in the community using professionals such as GPs, nurses and pharmacists is a better way of caring for such people. We have few systems to deal with these things, although the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) will no doubt tell us what is going on in his constituency with healthy living pharmacies, so I will not go into that. These are, however, major issues, and the strengths of pharmacists should be used a bit more.
I mentioned the question of medicines adherence. Under the present general pharmacy contract, it is pharmacists’ duty—and they are paid for this—to take in unused medicines. It is extraordinary that every year medicines costing hundreds of millions of pounds are prescribed and then are unused, for whatever reason. It is a difficult situation. The 2010 report by the York health economics consortium and the school of pharmacy at the university of London suggested that up to £500 million could be generated in England in just five therapeutic areas—asthma, diabetes, raised blood pressure, vascular disease and the care of people with schizophrenia—if medicines were used optimally. Those are all long-term conditions on which taxpayers’ money is spent. The report rightly said that sub-optimal use of medicines and waste undermine the £12 billion investment in medicines by the NHS.
Pharmacists do quite a lot of work which, although it is contracted to the NHS, is not always laid out nationally or used by local health partnerships. The hon. Member for Ipswich pointed out that pharmacists were not included in the publication that he cited. A medicines use review is a review of a patient’s medicines—prescribed and non-prescribed—to promote adherence and to support the optimal use of medicines; 2.8 million MURs were provided by community pharmacies in England in 2012-13. Since 2011, pharmacies have offered a new medicine service to provide additional support to patients who are starting to take certain medicines for long-term conditions. An evaluation of the effectiveness of the NMS is due soon, and more than 640,000 people starting to take new medicines have benefited. That is adherence —making sure that people do as their prescription sets out.
The York and London review, which is entitled “Evaluation of the Scale, Causes and Costs of Waste Medicines”, goes into the question in great depth, and clearly the problem will never be eliminated altogether. Nevertheless it is clear that in this country people sit and write out prescriptions and people take them away and effectively put them on the shelf. The patient might use the medicine for a couple of days. Perhaps they do not like the side-effects, and indeed that is unavoidable on occasion. However, some medicines are stored in bathroom cabinets, and when they are emptied the medicines are taken back to the pharmacist or thrown away, which costs the nation hundreds of millions of pounds. We must question whether some of those medicines, given that they are not used, should be prescribed in the first place. However, that is a wider issue for health professionals, not me.
More than 57 million GP consultations a year involve minor ailments. If we rolled out the scheme that currently covers about 10% of England, we could greatly reduce pressure on those services, and GPs could get on with more important things. The patients could be moved to pharmacies, and more than £812 million of GP capacity could be freed for other things.
In 2009-10, 140,000 people chose their community pharmacy to set a quit date and 62,000 had successfully quit smoking by the fourth week, which was a 13% increase on the previous year. Pharmacists give support in a wide variety of public health roles, including flu vaccinations, international normalised ratio-testing clinics—monitoring and adjusting the dose of the blood-thinning medicine warfarin—and asthma clinics.
There has been much debate in Parliament about changes in the Health and Social Care Act 2012. The Minister was on the Committee that considered the measure. Two things were writ large in that Act. First, we have now put into statute the need to reduce health inequalities—but they are not reducing. Everyone is living longer, but in terms of social class things are still going downwards. Pharmacists could work on reducing health inequalities in areas where there is known deprivation. That should be a major aim. Secondly, the Minister will remember the emphasis on population health. In view of the statistics that I have read out, I think pharmacy has a major role to play in improving population health.
Public health problems were very bad 150 years ago, and they involved the environment—bad housing, bad sanitation and bad water. The public health issues that this century will suffer from will be to do with individual lifestyles. I read out some statistics about smoking cessation and pharmacies, and I believe that community pharmacists are the gatekeepers to the national health service. Far more people visit them than any other part of the NHS and they have a major role to play. The sooner we alter the current mode of contact and move away from the situation where pharmacists get the bulk of their money just churning out prescriptions to one where they cover wider issues within communities and look after the health of the population, the better we shall be.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
It is a pleasure to serve under your chairmanship this morning, Dr McCrea. I congratulate my hon. Friend the Member for Ipswich (Ben Gummer) on securing the debate. I have tried on one or two occasions to get a debate on pharmacy, and he has beaten me to it and introduced the debate very successfully. No doubt he has more pull with the Speaker’s Office than I do. I thank the Minister for attending, too.
I got involved in the pharmacy story when in the 1990s resale price maintenance on non-prescription medicines became a big issue. The chief executive of Asda—I do not think that he was a Member at the time—was very keen to get rid of RPM on non-prescription medicines because he felt the market should be much more open. Quite a debate has taken place over the years on how to liberalise the pharmacy market in a big way.
At that time, community pharmacists were concerned about whether their trade would be reduced and the effect on their livelihoods. We must recognise that community pharmacies play a significant role in the high street economy. People are regularly drawn into town and city centres to spend money and visit the community pharmacy at the same time. I have followed developments with interest. I congratulate and support pharmacists, who do an incredible job. As the right hon. Member for Rother Valley (Mr Barron) pointed out, they are the first point of contact for people who need help.
I understand the concern of my hon. Friend the Member for Ipswich about the lack of liberalisation in the market and the need for transparency. I am always one for a lot of transparency—more sunlight normally produces it. During the 1980s and 1990s, the Conservative Government made sure that town centre retail developments and new supermarkets were assessed, to find out the implications for other supermarkets and food retailers. Regulation of town centres has been going on for a while. That was also to do with the sequential test.
Steve Baker (Wycombe) (Con)
My hon. Friend reminds me that we often complain that our town centres are in decline; he may have given us the reason.
Oliver Colvile
I agree that supermarkets have had an impact, but my point is about trying to protect small businesses in town and city centres.
Steve Baker
That is not quite what I meant. I pointed out that our town centres have been regulated for a long time, and that they are now in decline. Perhaps we should liberalise more consistently, and should have done so for a long time.
Oliver Colvile
The bigger issue, frankly, is car parking in town centres. Outside town centres people do not pay charges for car parking, but they do in town centres: so where do they go? In my constituency, I suspect that they end up at the Marsh Mills Sainsbury’s or elsewhere.
Two other big issues affect the pharmacy profession, one of which is the criminalisation of dispensing errors. If pharmacists make a mistake, they can be prosecuted and potentially sent to prison, whereas GPs, for whom I have a great deal of time, do not suffer the same prospect. The Department of Health is looking at that, and I hope that it will come to a conclusion on how we can equalise the situation and ensure a more level playing field.
The other issue is the sharing of data between pharmacists and GPs. I raised the matter during a recent statement from the Secretary of State for Health on the whole business of how pharmacists could play a part in helping to relieve accident and emergency units. The Government are keen to ensure that more and better data sharing takes place. I have a slight concern in that my understanding is that the process would be run by the Department of Health, but I recently read in an article that the Department was suggesting that the responsibility would lie much more with the local commissioning boards. If the Minister can respond to that confusion, that will be helpful.
We need to ensure that pharmacies play a much better role. They need to be the first point of call for people seeking help from professionals, as that would help to relieve GPs. During the summer recess, I visited the Keyham healthy living pharmacy, which is a brilliant organisation in a deprived community. Life expectancy differs by 11 years between the suburbs of Plymouth and Devonport, which is where the Keyham pharmacy is located. The pharmacy offers not only flu vaccinations, but also smoking cessation services and other such things. It is a service that certainly needs to be available.
Finally, there is concern about how we can improve how people feel about pharmacies to ensure that they are used in a much better way. If pharmacies were used to deliver flu vaccinations, that would take some pressure off our accident and emergency units over the winter. We have discussed an important issue this morning, and I am delighted that you, Dr McCrea, have been in the Chair to ensure that we get some positive comments.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Member for Ipswich (Ben Gummer) on bringing this matter for our consideration today. Although I agree with him on many things, his football team, Ipswich Town, is playing my team, Leicester City, on Saturday, so our opinions will differ on that.
Jim Shannon
Well, I hope we won’t.
To return to the matter in hand, having run my own business, I can well understand the pressures on businesses—the need to make profit and to pay the bills at home. I can also understand the principle behind paying for what you get and that a good service needs to be paid for. At the same time, however, from what I have read in the media and the considerable background information to the debate today, the scandal of double-invoicing and cashback to the detriment of the NHS cannot ever be accepted.
I take my hat off to the whistleblowers who have highlighted the practice, which it is claimed has robbed the NHS of up to £120 million. The headlines are clear: “Pricing scandal sees NHS pay £89 for cod-liver oil capsules”; “Firms boast of profits on drugs that cost ‘pennies’”; “‘There’s a lot of flexibility over prices’”; “Pharmacies and suppliers accused of price rigging”, and last, but not least, “The NHS, the drug firms and the price racket”. All those headlines are cause for concern.
I have asked several questions of the Secretary of State regarding the provision of new cancer drugs, Alzheimer’s drugs or any number of other new drugs that are not accessible on the NHS. How do I tell my young constituent suffering from cancer that there is no funding for a drug that has been proven in other countries to help when she is reading about double-invoicing? Is the cost of her life so little for the House that we can allow the practice to continue? I have asked those questions of myself and my constituents ask me them, too.
I was angered when I read about £10,000 monthly kickbacks and other horror stories. It is clear that any agreement needs to stop that from being able to happen. I have the greatest respect for the Minister and I am sure he will hit on such issues in his response. If we need new legislation that enables the NHS to go deeper than merely checking invoices, so be it. It concerns me greatly to think of the number of families who could have received life-changing help this year with the money—our money, our constituents’ money—that has been lost to those who are working the system. That has to stop.
Many heads should hang in shame over how bills have been creatively put together by providers, but I cannot simply allow the Government not to understand that they need to do more.
Mr Gregory Campbell (East Londonderry) (DUP)
Does my hon. Friend agree that one of the most significant recent statements in the press was when a senior executive of one of the large companies said that it would be more than happy to agree to a 70% discount if that is what it took to get the contract? That is a damning indictment of the original price.
Jim Shannon
I thank my hon. Friend for that helpful contribution. The contributions from him, my hon. Friend the Member for Upper Bann (David Simpson) and others may focus the Minister’s attention.
On the availability of medicines, I have read that the National Institute for Health and Care Excellence has approved fewer than one in three medicines since 2005. A recent letter from nine major pharmaceutical companies to The Daily Telegraph started with something that I agree with. I am sure that any Member and, more importantly, any doctor or care worker in the NHS, will also agree with it:
“Medicines should not just be seen as a cost.”
They should first and foremost be about healing and curing illnesses. The letter continues:
“They are an investment and an essential part of improving patient outcomes. Yet…the proportion of medicines refused by NICE is only increasing.”
That is a concern for me, too. Jonathan Emms, UK managing director at Pfizer, has said:
“Right now NICE is saying ‘no’ too often. It is blocking many innovative new medicines from reaching the UK patients who need them most, medicines that are often readily available in Europe.”
Will the Minister say what contact he has had with NICE about not making available in the UK drugs that are available in other parts of Europe?
Although it is hoped that the agreed deal will save the NHS £1 billion over two years, it is essential that that saving goes into making more drugs available for the healing of those who need them and not simply the healing of the deficit. Will the Minister assure me and the House that the savings made will go into the provision in the UK of drugs that have been widely tested and that are widely available in Europe?
Oliver Colvile
Does the hon. Gentleman recognise that drugs and medicines can be dangerous if they get into the wrong hands? Pharmacies also have to face people using the internet to acquire drugs, which is an option that does not carry the same regulation that we expect in the domestic market.
Jim Shannon
I thank the hon. Gentleman for that contribution. It is something that many of us have highlighted and I know that the Minister has spoken about it in the past. The availability of drugs on the internet is an anomaly in the system, and perhaps the Minister can give us an indication of how best to deal with it.
Back in April, we were told that the number of cancer drugs on the approved list was to be halved. Will the Minister commit to ensuring that the savings will be used to increase the amount of drugs that might save lives and give a better quality of life?
I read the story of a mother with terminal cancer, who was forced to fund herself a drug that she believed would give her extra time with her young children, after being refused by a special Government fund. I find such stories incredible, hearing about the real heartache and issues that impact on family lives, and yet we—as collective representatives—are unable to help and assist as we should. In America, Obama is trying to bring in a health care system similar to ours. It is referred to as Obamacare—people say that it will make or break him, and it probably will. We, however, seem to be turning ourselves into an American system, whereby we have to fundraise to get treatment. That is certainly not what my constituents or I pay our taxes for, and I am sure that others agree with me.
I want to make a quick comment about Northern Ireland, where our Health Minister abolished prescription charges. That was done on the understanding that cheap generic drugs were not prescribed. Health is a devolved matter in Northern Ireland, and our Minister made a decision, which I support entirely. Will this Minister—I ask this with respect—liaise with the Northern Ireland Minister, Edwin Poots, to ascertain how the scheme is working and how we have been able to stick within our budget in Northern Ireland on prescription drugs?
The right hon. Member for Rother Valley (Mr Barron) made a valuable contribution today. One of the things that he referred to was the drugs that people have and do not use; they sit until they go out of date and are then dumped. In Northern Ireland, the Minister, the GP surgeries and so on have taken steps to ensure that the prescription of drugs is better controlled. Sometimes, people might run out of drugs, rather than having extra in the cupboard, but such steps help and take away wastage in the system. The right hon. Gentleman made that clear in his contribution.
Over the years in Northern Ireland, through the Minister and in co-operation with the pharmacies, we have also tried to reduce the number of people attending accident and emergency. If people have a minor ailment, they should go to their pharmacist or chemist; he or she will be able to give some direction on what needs to be done. There are ways and means of good practice, to which I have referred on many occasions. I say what we do in Northern Ireland with humility, but we actually do some things very well. If such things are done well, they can be a marker for elsewhere.
Time is flying past, but changes clearly need to be made soon. Yes, pharmaceutical companies and pharmacies need to make a profit, but that must be done in the right way; we need legislation in place to ensure that that is done in such a way. Yes, NICE must protect people from drugs that promise all, but deliver nothing, and yet that cannot be used to count pennies and to justify saying no to drugs that will make a difference.
Finally, yes, Government must make savings, but those cannot be taken from the most vulnerable by denying them treatment; any savings should be used for new drugs, to give people a better chance of life, for the sake of our constituents in the whole of the United Kingdom of Great Britain and Northern Ireland. We are not talking simply about numbers on a hospital list—the changes need to be made, and made soon.
Steve Baker (Wycombe) (Con)
I congratulate my hon. Friend the Member for Ipswich (Ben Gummer) on provoking a stimulating debate, and one in which I have learned a great deal. In particular, he emphasised the local impact that pharmacies can have, while the right hon. Member for Rother Valley (Mr Barron) clearly explained some of the opportunities that can be seized through pharmacies.
In Lane End in my constituency, a pharmacy opened alongside a dispensing GP practice, but if I remember the circumstances correctly, the practice was forbidden from serving local people; we had an absurd situation in which the purpose of the regulation made my constituents’ lives less convenient and less easy, in the interests of somehow distributing profit fairly. The debate has brought in some of the wider aspects for society and some of the things that a heavily regulatory state has messed up.
The purpose of prices, profit and loss in a market society is to guide individuals and voluntary associations into best serving society. If pharmacists wish to open a pharmacy, they should simply be able to do so, if they can find a place to do it, can do so within the law and are selling lawful products. They should be able to get on with it and serve whomever comes through the door. Instead, we have the situation described by my hon. Friend—people have to fill in a 200-page application form and might subsequently find themselves subject to particular restrictions on whom they may or may not supply.
One of the issues with a market system is that business men are profit-maximising, which is both a problem and a benefit. The problem is that business men do not like competition much, because that is what drives down prices and therefore profit. That is the crux of the matter. The purpose of the Government is not to entrench in law and regulation the tendency of business men to seek rent—excess income through capturing the state—but that is just what is happening when competition is inhibited by restrictions placed on a dispensing practice simply because a neighbour has opened a pharmacy. Certainly, on the siting of pharmacies, the Minister should seek to abolish rules and controls wherever he can, because they are getting in the way.
Ben Gummer
In my address, I omitted to mention the whole range of practice payments paid to pharmacists simply for, in effect, being open. The problem is that the opening of a new pharmacy creates a liability for the NHS to pay those practice payments, no matter who does or does not go through its doors. That shows the rather extraordinary situation that we have ended up with in respect of how pharmacies are remunerated.
Steve Baker
My hon. Friend is absolutely right and I am extremely grateful to him for bringing that up. We pretend that we live in a capitalist society—I have said this in the House before—but if our system is capitalism, I am not a capitalist. We have an absurd hybrid system, in which the state constantly intervenes in order to give people rents. It is peculiar that we call it a free market society.
The purpose of our all being here, of course, is to improve our constituents’ lives. When I say such things, my intention is to ensure that my constituents—all our constituents—have better access to pharmacies. In the House, we have a real consensus about an increase in the services offered by pharmacists being of benefit to all our constituents. What I want is for the Government to get out of the way, not to use taxpayers’ money to provide the payments that my hon. Friend mentioned and to allow pharmacists to get on and best serve the public in a way that is in the public’s best interests—a way that can be discovered only through experimentation and entrepreneurship.
On pricing, I want to make the point that in this country we are not good at haggling. We should haggle over prices and drive them down. The hon. Member for Strangford (Jim Shannon) talked about the scandal of some simple and inexpensive medicines that ought to cost pennies, but cost very much more. What I see at work there could be something that I witnessed when I was a contractor working with Government: Departments are not good at driving down prices. They tend to accept the price that they are given—“Oh, that must be the market price.” No—they should set the market price by demanding that they are charged less and, if suppliers do not provide the goods at a lower price, they should go elsewhere.
That brings me to generics and parallel imports, a subject touched on earlier. We ought to be making sure that the big pharmaceutical firms do not hold the NHS over a barrel. I have heard some of their arguments, and of course producing a new drug is an expensive business, but we should not be held over a barrel. In a market society, people should be held to account to drive down costs and drive up quality.
Johnson & Johnson, based in my constituency, has a wonderful credo, which was written when the basis of a free society was under threat in an earlier time. That credo sets out the principles on which the industry should be founded, and one such should be: no legal privileges, wherever possible.
Oliver Colvile
During the all-party group inquiry, we looked at that issue. One suggestion for easy identification of who was exporting and importing pharmaceutical products in this country was to look at VAT returns—when I ran a small business and was VAT registered, I had to fill in a piece of paper that recorded what level of EU trade I had ended up doing. I approached the Treasury on the matter, but it was not willing to participate and help, but that seems to me to be a way in which we could identify who the offenders are. We had some difficulty in identifying the offenders.
Steve Baker
My hon. Friend has identified what might be a missed opportunity because an enormous effort is going into preventing that fraud. With the opportunities that electronic communication offers today, it should be possible to use some of that information in other contexts. With that in mind, I will turn to the internet.
Clearly, everyone wants to ensure that prescribing takes place properly, but when people have been prescribed medicines it should be possible for them to buy over the internet in appropriate circumstances. I am particularly aware that homeopaths have had great difficulty with the internet because of the need for people to present physically to buy a medicine.
We cannot have it both ways on homeopathy—either the medicines are relatively harmless and can be treated with scorn by the medical profession, in which case they should be freely available on the internet, or they are dangerous and should be tightly regulated. Homeopaths’ experience suggests that people can take responsibility for themselves and buy products on the internet.
Ben Gummer
My hon. Friend touches on an interesting issue. Given the fact that the Government are going to great lengths to try to get GPs to do more consultations on the internet and Skype—great news for many of my constituents, especially those in busy jobs with difficult hours—it seems obvious to extend such innovation to the dispensing of pharmaceuticals.
Steve Baker
My hon. Friend is right. In the 21st century, we should be waking up to the opportunities to use technology to drive down costs and drive up service. People are so busy today, so why can they not have consultations in their offices with Skype, and why can pharmacists not prescribe to offices with Skype? The solution to these problems is for the Government to abolish whatever rules and controls they can and wherever they can, and to liberalise when abolition is not possible.
Mr Barron
The majority of patented goods that the national health service buys are a recognition not just of cost, but of the pharmaceutical industry’s worth to the British economy—including exports, manufacturing base and so on. We export around £7 billion of pharmaceutical goods a year. Might a free market endanger that?
Steve Baker
We may be in danger of straying into philosophically deep water about what free markets do and do not do. Clearly, because of the moral imperatives of health care, we cannot have an unimpeded market. We have made political decisions to ensure that no one goes without health care. That has consequences, and we should accept them.
The way to deploy scarce resources in the service of the public is to allow the price system, as well as profit and loss, to run as freely as possible. When we talk about something’s worth, price is too often ascribed to things that are not subject to market transactions. Only through exchange can it be established how people value things. I do not want to go on for too long, so I will leave that to another debate, perhaps the one on the Budget.
I want to encourage the Government to liberalise and to look more closely at what can be done to enable pharmacists to set up wherever they need to in order to serve the public best.
Mr Jamie Reed (Copeland) (Lab)
I thank the hon. Member for Ipswich (Ben Gummer) for bringing this debate to the whole of Parliament today—we often forget that Westminster Hall is Parliament. Issues of the utmost importance have been raised regarding pharmacies and the pharmaceutical industry, and shocking allegations have been made. The House of Commons has a duty to learn the facts and to act accordingly, whether by expanding the role of the pharmaceutical industry and pharmacies or by remedying any wrongdoing in existing price structures.
The hon. Gentleman is right to extol the virtues of community pharmacies for many reasons and I will touch on them in due course. He is right to open up an extremely broad debate, and we have touched on its potential breadth. We need to explore the scandal of what The Daily Telegraph called the drug price racket. I can understand a patient missing an appointment which regrettably wastes the time of clinicians and costs the NHS money. I can understand the worried well occupying GPs’ time when they have no real need to do so. I can understand patients not taking a full course of antibiotics or keeping the medicine cabinet at home filled with prescribed drugs for which they have no real need. All those behaviours cost the NHS money, but individuals will not be aware of the costs they are incurring for the NHS, nor do they intend to divert scarce resources. There is no deliberate disregard for the NHS, for other patients, or for the taxpayer in these instances, but clearly more work needs to be done to reduce these costs.
Let us consider one of the central allegations before us today—the drug price racket. Some private interests—pharmaceutical companies and pharmacies—are knowingly and deliberately committing fraud. We live in a world that is very different from the pre-crisis world that existed before the global economic crash. We live in an era that is set to be defined by austerity, and public finances are still in a parlous state. In society at large, not just in Parliament and across the political spectrum, but at the school gate, in the high street, and in the boardroom, it is understood that public money is valuable and scarce, and that it should be spent wisely and prudently.
Drug price fraud is happening in our most valued public service at a time of economic crisis, and it has occurred by design and not accident. Those responsible are not simply undertaking a grotesque financial deceit of patients and taxpayers, but are probably depriving the NHS of resources that could and should be used for patient care. To take the point to its logical conclusion, these parties have fraudulently diverted from the NHS resources that could have saved lives.
A few years ago, the Prime Minister referred to lobbying as
“the next big scandal waiting to happen”.
We now know that he was wrong. Shamefully, in recent months and again today, we may have unearthed the next big scandal that the Prime Minister warned of. My hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), the shadow Attorney-General, wrote to the Serious Fraud Office about the drug price racket in July:
“You will be aware that the Telegraph has brought to light extremely serious allegations that pharmaceutical companies in collusion with chemists have been rigging the market in prescription drugs that are generally not covered by NHS price regulations…If the allegations are substantiated it will mean that the NHS has been systematically overcharged hundreds of millions of pounds. This would represent a colossal fraud on the taxpayer. An offence of that magnitude would surely warrant the attention of the Serious Fraud Office and not just an internal inquiry of the counter-fraud department of the NHS. I would be grateful if you could let me know what steps, if any, the SFO intends to take on what appears to be prima facie evidence of conspiracy to defraud.”
David Green, CB QC, of the Serious Fraud Office responded on July 19 and concluded:
“The SFO are working closely with NHS Protect and the allegations that have been made are the subject of careful consideration. If, having considered the available information, evidence of fraud is identified, further consideration will be given as to which agency is the most appropriate to investigate these matters.”
My hon. Friend has received no other communications from the Serious Fraud Office in the intervening period, and I have today written to Mr Green asking what progress the SFO has made with its considerations. I have also written to the Chairs of the Select Committee on Health and of the Public Accounts Committee to alert them to these issues with a view to their undertaking their own inquiries.
The Daily Telegraph should be congratulated on its investigative journalism. There is absolute consent on that. It has provided a great service to the public and the NHS. We should be cognisant of the awful parallel that it rightly exposed: the parliamentary expenses scandal. That was another truly remarkable service entirely within the public interest. It is an apt comparison. The abuse of public money represented by the parliamentary expenses scandal resulted in the jailing of Members of Parliament and of peers. Shocking as that was to the public and seismic as it was to the political establishment, the fraud and false accounting pales into insignificance in monetary terms compared with the sheer scale of the embezzlement that is now being alleged in the drug price racket.
I repeat that this is not just a get-rich-quick caper, but the knowing and deliberate abuse of public money that should have been used to save lives. That is the scale of the allegations. We need the pharmaceutical industry, and we need pharmacies and pharmacists. We need the pharmaceutical industry to help to deliver our national life sciences strategy. We need it to help to underpin academia so that we can continue to break new ground in medicine research and to develop new treatments, new drugs and new medicines. We need to recognise and reward the public good that that represents.
We need to expand the role of community pharmacies if we are better to deliver a more integrated, efficient and effective health care system. We need to make better use of the 1.6 million interactions that will take place today between the population in England alone and pharmacies. The average person visits the pharmacist 14 times a year—more than once a month—and we need to capture better and utilise those interactions for improved individual and public health. Of that, there is absolutely no doubt.
However, for us to do any of that, we need to be able to trust the motives and actions of all the groups involved. Let me say to the pharmacists and pharmaceutical companies that are doing no wrong—clearly, that is the overwhelming majority—that I regret the distress that this issue will inevitably cause them, but it is essential for all of us involved with the sector to leave no stone unturned in establishing the facts, if we are to be able to maintain the faith and trust of the public. I know that the Minister, for whom I have genuine respect, will be as appalled by the revelations as anybody else, and I hope that he will be able to answer the questions that I put to him today. If not, I would appreciate a written reply.
The Daily Telegraph describes the Government announcement of drug-pricing caps in 2011 as “a ‘hallelujah’ moment” that has led to significant fraud. Does the Minister consider that that is the case, and will he investigate why it is that those disposed to committing fraud are using the announcement as the basis on which they are able to defraud the NHS? On 20 July, the Secretary of State for Health told The Daily Telegraph that he had ordered an investigation into the allegations. Will the Minister tell us where those investigations are up to? What has been investigated? What is the scope of the investigation? When will the investigation be completed? The Minister will note that Serco has been made to repay £24 million to the Treasury for financial wrongdoing in the course of delivering public services. Will the Minister support repayments to the NHS if price fraud allegations are proven?
Finally, we all want to develop the role of community pharmacies. We all want to help our pharmaceutical industry to thrive and innovate, and we all have a duty to spend public money effectively, properly and honestly. I look forward to the Minister’s reply.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
We have had a wide-ranging debate today on issues such as the deregulation and regulation of pharmacies, the local provision of pharmaceutical services and the extension of the role of pharmacists and what they do in our communities. Importantly, we have also discussed pricing and behaviour that, if not fraudulent, is certainly very irregular on behalf of some pharmacists and drugs companies. I hope that I will have time to deal with all those issues, but I will write in more detail to any Member here today who feels that more points need to be answered.
Before I go any further, may I say that it is a pleasure, as always, to serve under your chairmanship, Dr McCrea? We took part in many sittings together when the Health and Social Care Act 2012 was considered in Committee, and it is always a pleasure to serve under your chairmanship. I congratulate my hon. Friend the Member for Ipswich (Ben Gummer), my constituency neighbour, on securing today’s debate. It is important to recognise that our NHS is not only about doctors and nurses, but about midwives, physiotherapists, occupational therapists, heath care assistants and all the other people who contribute to the health of the nation every day, including pharmacists, who play an increasingly important role in delivering high-quality local health care and who are embracing the enhanced role that they have been offered under the 2012 Act. It is right that we put on record our thanks for the work that pharmacists do every day.
The right hon. Member for Rother Valley (Mr Barron), in an excellent, considered speech, made some very good points. In particular, he said that community pharmacists are the face of our NHS in many communities. He is absolutely right in saying that because, particularly in more deprived areas of the country, pharmacists are often the first point of call for advice—whether on simple details about medications or for important primary health care advice. Pharmacists perform that role every day. We should be grateful to them for what they do, and I put on record my thanks for that work.
It is important to put on record that pharmacies are in robust health. Although we debate deregulation and difficulties, we know that there are more NHS community pharmacies than ever before—more than 11,400 in England—and they are offering health care, treatment and healthy lifestyle advice and support throughout the country. They dispensed more than 900 million prescription items last year, which is up 53% from 10 years ago, and about 2 million prescriptions are handed out every day by pharmacists. Therefore, we have an industry, as part of our NHS and in its commercial activities and other work, that is in robust health and is performing a valuable service for our NHS.
Of course, we could get into the issues that the right hon. Gentleman rightly raised on the appropriateness of prescribing medication. The chief medical officer talked in some detail in a report about the need for GPs to look sometimes at the appropriateness of the antibiotics that they prescribe and about how we need to look at antimicrobial resistance in this country. The right hon. Gentleman made his points very well, but I hope that he will forgive the fact that I shall not address them directly in today’s remarks. However, he was right to make them and the chief medical officer certainly agrees with him, as do I.
I shall deal with other points that have been made, but initially, I would like to address the important points made by my hon. Friend the Member for Ipswich. We rightly value the innovation and the opportunities that pharmacists have to innovate and support their local communities in different ways. Because they are centred in the community, only pharmacists are able to use such methods. I had the pleasure of attending the annual pharmacy awards and looking at some of those ways. I saw pharmacies, embedded in local communities, making a real difference in providing health and lifestyle advice and improving the quality of care available to local patients.
At the same time, although we want to encourage and support innovation—the pharmaceutical price regulation scheme, or the PPRS, was recently renegotiated and enhanced to give pharmacists the opportunity to innovate exactly as I have described—we also need to recognise that we have a publicly funded national health service, which is a point that has been made across the Chamber today, and we are very proud of it. It is free at the point of need, and it is important to ensure that the money that is given to the health service, whether to pharmacies or to other parts of the NHS, is properly spent, and there is also a role in ensuring that services are provided in a safe and effective way. I shall come on to some of those points later.
My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) has been a consistently strong advocate for the role of pharmacists, and he made his points very well today. The hon. Member for Strangford (Jim Shannon) also made a useful and powerful contribution, which was picked up by the hon. Member for Copeland (Mr Reed) a few moments ago, about the importance of ensuring that there is no fraud in the system and that pharmacists always behave appropriately. I am sure that the majority of the time pharmacists behave appropriately and make a very valuable contribution. When there may be fraudulent behaviour, it is right to pick up on that and investigate it. I will come back to that in a moment, because we all want to see high value for money from our NHS and to make sure that the money is spent on patients and not wasted. I think that that is something that we all agree with and believe in across the House.
I turn to the important issue of pricing. The vast majority of drugs that are prescribed are either covered by the PPRS or are generics, where competition helps to keep the price down. We recently introduced a price for common specialists, but a small number of prescriptions, as has been mentioned in the debate, fall outside the pricing mechanisms that are in place. We are working with the Pharmaceutical Services Negotiating Committee to find a better mechanism to encourage pharmacists to seek lower prices.
Where there may be cases of fraud, it is right that we investigate them, and they are investigated. NHS Protect exists to safeguard—to protect—against fraud in the NHS. That has been a consistent policy; it was followed by the previous Government, and it has been followed by the current Government. The reason why we need services such as NHS Protect is to ensure that if there is fraudulent practice—in this case, potentially in the behaviour of a small number of pharmacists in dealing with small, unique areas of pricing—it is investigated properly. I will ensure that either I or Earl Howe, who is the Minister responsible, writes to the hon. Member for Copeland to inform him of where we have got to with the investigation.
The other point, which was made by the hon. Member for Strangford and is very important, is that we want to ensure that money goes on patients. There is increasing demand for drugs. It is very good that the NHS is continually innovating and developing more treatments, better surgical techniques and improved drugs and mechanisms. Of course, when drugs are used in the NHS, they need to be evidence-based, but I hope that he will agree that it is good that we have set up the cancer drugs fund, which has helped to increase the speed at which people with cancer receive drugs. More than 30,000 people have benefited from the cancer drugs fund and received cancer drugs. We should all be pleased about that and proud of it.
Jim Shannon
I thank the Minister for that positive response. I outlined in my contribution a couple of examples of people who did not access the cancer drugs fund, but in my mind clearly should have qualified. Is he prepared to look at that issue to satisfy those people who need drugs urgently because of the time they have left on this earth?
Dr Poulter
On how drugs are accessed, one of the problems—this was why the cancer drugs fund was set up—was that some people, as the hon. Gentleman rightly outlined, had been receiving drugs in other countries for many years, but we in this country were a little slower to respond to some of those innovations. But of course we need to ensure that, whatever fund we set up for providing medications, those medications are shown to be effective and there is an evidence base for them. However we do things, there will always be new treatments on the horizon that we would like to get through to people more quickly, and we need to ensure that those treatments are always evidence-based. I think that we can be pleased that the cancer drugs fund has made a significant difference by providing treatments in a more effective and much quicker manner, but if the hon. Gentleman would like to discus the matter further, I would be very happy to see him and talk it through in more detail.
I think that it would be useful for me, picking up on the points raised early in the debate, to outline the processes involved in opening a pharmacy. Anyone can open a pharmacy anywhere, subject to the premises being registered with the General Pharmaceutical Council, when the owner’s service model includes the sale or supply of pharmacy medicines or prescription-only medicines against prescriptions from that pharmacy. However, there are extra criteria for providing NHS pharmaceutical services. Anyone wanting to provide NHS pharmaceutical services is required to apply to the NHS to be included on a pharmaceutical list.
Before September 2012, there were control of entry requirements. The NHS (Pharmaceutical Services) Regulations 2005 determined whether a pharmaceutical contractor could provide NHS pharmaceutical services. In England, no new contractor could be entered on to a PCT pharmaceutical list unless it was “necessary or expedient” to secure the adequate provision of pharmaceutical services locally. That was the control of entry test. If a new service provider was judged neither necessary nor expedient, the NHS, or the PCT in question, had to refuse the application. There were rights of appeal to the family health services appeal unit, which is run by the NHS Litigation Authority. That was available if there was a concern.
Part of the reason for the strict criteria relates to the pricing mechanism and how pharmacists are paid, which I will come to later. Obviously, the local health economy is an issue, and pharmacists are not paid just for the number of prescriptions that they provide; they are also given a baseline fee. When we have a publicly funded health service and we need to ensure that need and demand are aligned, it is important that we look at this in the round. I sympathise very strongly with the points about the need to de-bureaucratise the NHS where possible—those were good points well made—but we also have to recognise that this is not just about arbitrary mapping; it is about aligning need and demand for a service within the pricing framework in place. That is not just about the number of prescriptions that are provided; it is a much more complex mechanism. I will come to those points later.
Mr Jamie Reed
I am grateful to the Minister for giving way; he is being typically generous. On pharmacy numbers, does he think that we have too few or too many, or is the number about right?
Dr Poulter
The hon. Gentleman will be aware that under the previous Government, the Office of Fair Trading did a review and recommended total deregulation of the pharmacy industry. That was in 2003. The previous Government put in place a strong package of reforms to recognise that we need some degree of what my hon. Friend the Member for Ipswich would call market forces but I would probably refer to more as patient choice. We need to support patient choice as much as we can, but within the context in which we have a publicly funded service that needs to be regulated. It is a health care service; it is treating and looking after patients. We need not only to secure good value for the taxpayer, as part of how we fund that service, but to ensure that there is independent regulation and some regulation by Government as well. That is about ensuring that we have the highest-quality services available.
Given that I am running short of time, I will write to my hon. Friend or I would be happy to meet him—whichever he prefers—to talk through the specifics of the context of mapping out a local needs assessment, which is now carried out by health and wellbeing boards. That is a pharmaceutical needs assessment. I am happy to talk through with him in detail how that interrelates with the pricing mechanism and how we need to ensure that the two are kept in balance in the context of the conversation that the hon. Member for Copeland and I have just had.
It is worth highlighting the fact that pharmacists and pharmacies play an increasingly important role in our NHS. Many pharmacies now provide additional services. They are contracted to do so outside those pricing frameworks. That is done locally by clinical commissioning groups. Health and wellbeing boards or local authorities can also contract pharmacists to provide services. As my hon. Friend will be aware, responsibility for public health—40% of that budget—has now passed to local authorities. Given that public health responsibility, there is a strong role for local authorities in commissioning local health care services if they feel that that would be in the interests of the local population.
Under the Health and Social Care Act 2012, other providers of health care services, outside the traditional framework of GP and community services and secondary care, were given more of an opportunity to put themselves forward and offer to provide valuable services. This is a real opportunity for pharmacists to bring forward to CCGs what they do and to make the case that they can provide many services in a way that will be focused on primary prevention and that will save the local health economy money but also deliver better care. The track record of pharmacies and pharmacists is very good in delivering community care—whether looking after people with diabetes or providing simple services for other patient groups. Under the 2012 Act, there is now a much greater opportunity for pharmacists to come forward and put in offers, within an integrated health service, and make the case about how they can provide services. They may be able to do that in a much better way, as they are often embedded in their communities, than some of the traditional mechanisms in the NHS.
I hope that my hon. Friend will be reassured by the fact that the legislation that we have put in place as a Government has given pharmacists a much greater opportunity to contribute to their local health economy, not just in economic terms and in terms of the economic benefits that that will bring for pharmacists, but by delivering the very good care that we know they can deliver.
We have had a wide-ranging debate. I think that we can be sure that there is in place a robust pricing mechanism, which on the whole works very well and secures good value for the taxpayer and for local patients, but there are issues about certain items that pharmacists can prescribe, and we do need to look into them. There is a role for NHS Protect in doing that. We value the innovation that pharmacists provide locally in delivering better—higher-quality—patient-centred care, and the 2012 Act has put us in a better place to support local pharmacists in delivering the kind of patient care that we all want to see in our local communities.
Dr William McCrea (in the Chair)
I thank Members for the courteous manner in which they conducted the debate.