Westminster Hall

Thursday 11th March 2021

(3 years, 3 months ago)

Westminster Hall
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.

Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.

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Thursday 11 March 2021
[Sir Graham Brady in the Chair]

Backbench Business

Thursday 11th March 2021

(3 years, 3 months ago)

Westminster Hall
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.

Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.

This information is provided by Parallel Parliament and does not comprise part of the offical record

Covid-19: Community Pharmacies

Thursday 11th March 2021

(3 years, 3 months ago)

Westminster Hall
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.

Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.

This information is provided by Parallel Parliament and does not comprise part of the offical record

Virtual participation in proceedings commenced (Order, 25 February).
[NB: [V] denotes a Member participating virtually.]
Graham Brady Portrait Sir Graham Brady (in the Chair)
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I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings for debates have been amended to allow technical arrangements to be made for the next debate. There will also be suspensions between each debate. I remind Members participating physically and virtually that they must arrive at the start of debates in Westminster Hall. Members are expected to remain for the entire debate. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically should clean their spaces before they use them and before they leave the room. Members attending physically who are in the later stages of the call list should use the seats in the Public Gallery and move on to the horseshoe when seats become available. Members may speak only from the horseshoe, because that is where the microphones are.

Once we move on to Back-Bench contributions, I intend to begin with a time limit of three and a half minutes. Hopefully we will not need to make it shorter during the course of the debate.

Jackie Doyle-Price Portrait Jackie Doyle-Price (Thurrock) (Con)
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I beg to move,

That this House has considered community pharmacies and the effect of the covid-19 outbreak.

It is good to have you in the Chair for this important debate, Sir Graham. It is an honour for me to chair the all-party parliamentary group on pharmacy, not least because so many colleagues are big fans of the pharmacy sector. I am pleased to be introducing this debate this afternoon and to see so much support from Members who recognise the huge contribution that our community pharmacists have made during the pandemic. They are the front door to the NHS, and their doors have never been closed throughout the last year. We are all very grateful to them.

That contribution has not been without consequences for pharmacists, both financially and in terms of their own personal wellbeing. This debate is a chance for me to make a plea that the Government and the NHS fully appreciate the contribution made by our community pharmacists and ensure that they are recompensed adequately for it. Pharmacists can play a much fuller contribution to primary care, as they have shown over the past year, and they should be supported to do so.

Let us look at some figures. According to the Pharmaceutical Services Negotiating Committee, community pharmacists dispense 1 billion prescription items every year. They deliver healthcare advice at a rate of 48 million consultations a year. To put that in context, that saves nearly half a million GP appointments and 57,000 A&E visits every single week. That, by any stretch, is a service that is offering good value for money, and it deserves better support from us.

Community pharmacies are part of the NHS family. We often talk about “our NHS,” but what do we actually mean by that? Quite often, people think of our hospitals, and the doctors and nurses who work in them. For me, the NHS is every single person who works in dispensing health services, be they a nurse or paramedic working in a hospital trust, or somebody working independently, either as a GP or a pharmacist. We must ensure that whoever they are and wherever they are employed, if they are delivering NHS services, the NHS should ensure that they are adequately recompensed for it.

I am pleased to see the Minister in her place. I am preaching to the converted, frankly, as she is a huge supporter of pharmacists. I know that the contribution made by the sector over the last year has not gone unnoticed by her. Those working in the sector have also felt well supported by the recognition they have received from the Secretary of State for Health and Social Care and the Prime Minister. It is a level of support they are not used to and they are grateful for it, but perhaps now is the time to look beyond words of thanks and see that reflected in deeds.

I am sad to say that while the sector is getting that support from Ministers, it does not always get it from the machinery of the NHS or from the Department of Health and Social Care. The truth is that there are some people in our health establishment who view pharmacists as nothing more but glorified retailers. They are not. They are medical professionals who go through a substantial amount of training, and they do not all work for Boots and Lloyds. Most of them work independently, in small shops on our high streets, in the heart of our communities, and for those, 90% of their income comes from the NHS.

I am sad to say that I attended a discussion in which a DHSC representative asked, “Why can’t pharmacists earn money from other sources?” My answer to that is, “Why should they?” They are providing medical services. We have a contract with society that the NHS will meet the cost of those services, and the pharmacy sector should not be expected to go scrabbling around for other business to subsidise work that is done for the NHS. That is not the deal, and I think we need to properly take that on. Their fundamental business is the dispensing of prescriptions, which is an integral part of delivering an NHS that works for all patients. The NHS therefore has a duty to ensure that it is supporting a functional community pharmacy sector. It is not the job of independent providers in our pharmacy sector to be subsidising their NHS work through what they can sell. That is fundamentally not the ethos of our national health service.

As such, I am very clear that we need to put our pharmacists on a more secure financial footing if we are to maximise the use of this sector in delivering good primary care services, and we need to look at how it is supported and how it sits with GP services in our primary care system. My challenge is for DHSC and the NHS to look properly at whether, and how, they can make sure that pharmacies get a fair deal. It is fair to say that our pharmacies are held in very high esteem by the patients who use them. That has been especially true during the pandemic, when patients often found that their pharmacy was the only ready source of advice.

Our 11,500 community pharmacies have been open every day for every single one of us, but that has not been without real costs, as I mentioned. Our pharmacists today are facing debts simply because they stayed open. They had to supply their own personal protective equipment. They had to invest in keeping their shops covid-secure. They had to deal with staff absence due to sickness or self-isolation, and they had to deal with the increased wholesale prices of medicines.

To be fair, like most of the NHS, community pharmacies did receive funding to ensure that they could remain operational, but that was only ever advanced as a loan that needs to be paid back. That is now threatening the operation of some of our pharmacy businesses—as many as one in five, as estimated by Ernst and Young. It simply cannot be right that, in stepping up to the challenge posed by the pandemic, some pharmacies have unwittingly crippled their businesses, as the additional costs are not being properly reimbursed.

The covid pandemic has highlighted that we are long overdue a conversation about the role of pharmacy and its place in the NHS, and the all-party group stands ready to play its part in having that debate. Central to this will be the following principles. First, pharmacies can play a fuller role in primary care. GPs will face additional pressures as we come out of the pandemic. Pharmacies can give that support, but they should be properly supported in doing so.

Secondly, we will be living with covid forever, and it looks as if regular vaccination will become as big a part of our lives as the flu vaccine. I really want to see pharmacists fully engaged in that. There has been disappointment with the number of pharmacists engaged so far, which I think is due to constraints on the supply of the vaccine, but I hope that will be properly addressed as we go forward.

Thirdly, we need a plan to deal with the £370 million loan to the sector. To be brutally frank, when we look at the sums given to other areas of the economy, and indeed to the NHS, our pharmacies can be forgiven for feeling a little hard done by. It will mean curtains for some businesses that acted in good faith after being promised that the NHS would receive all the money it needed to fight the pandemic. No pharmacist should be out of pocket for stepping up to this challenge, and we really do need to look very closely at this. Fourthly, we need to make this sector understand that it is valued, and we should encourage people to work in it.

To end, I can advise the House that the all-party parliamentary group on pharmacy held an inquiry in December in which we surveyed the opinions of pharmacists. We found an overstretched workforce responding heroically to the challenge of a pandemic, with an attitude of doing what needed to be done, and I salute them for that. The survey also told a story of businesses being saddled with debt for doing the right thing, and it found a workforce who felt undervalued and burnt out by the professional pressure they faced. Let us have a conversation about how we secure our finances for the future. Let us properly thank pharmacists for everything they have done to support us in the last year. If we do not, we will miss them when they are gone.

Peter Dowd Portrait Peter Dowd (Bootle) (Lab) [V]
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It is a pleasure to see you in the Chair, Sir Graham. I thank the hon. Member for Thurrock (Jackie Doyle-Price) for bringing this issue before us today. She is right to say that pharmacies need our support now. They have played a crucial role as an integral part of our health service, which is under stress and strain at the best of times, and that is all the more the case during the covid pandemic. Pharmacies continue to play an even more important role, if that is possible, during this crisis. They have been there to support our communities when people could not access GP services. We have heard so many times during the crisis that people did not seek advice from their GP, local walk-in centre or hospital because they did not want to put even more of a strain on those services. Of course, many of them got the help and support that they requested, and it was from pharmacies. On behalf of my constituency, I would like to thank all the pharmacies that have helped during this crisis.

As the hon. Lady says, all the warm words we express count for nothing if that is all we do. Words are meaningless without action to back them up. Pharmacists have had enough words to last them a lifetime, so I will cut to the chase. First, the Government should review the response from pharmacies during the pandemic and re-evaluate a clear vision of what we need from these undervalued and vital frontline healthcare workers. It is not good enough to take pharmacies for granted. If this pandemic has shown us anything, it is how hard-pressed yet responsive our pharmacies have been during the crisis.

Secondly, the NHS and the Government should enable pharmacists to do more, as the hon. Lady said, by giving additional resources for training and support for this vital sector. The Test and Trace system has been given £22 billion, with another £15 billion in the pipeline. That is almost £600 per person to run a system that, at best, has been mediocre in terms of its returns. Frankly, a fraction of that resource could be put back to pharmacies. That would have a higher rate of return, be more productive and have a better outcome for our constituents.

Thirdly, a reassessment of the value of pharmacies, especially by finance teams in the Department of Health and Social Care and the NHS, would be welcome. When was the last time any real assessment of the value of pharmacies was undertaken by the Department or NHS finance teams in a comprehensive fashion that has led to any real support for the sector?

Fourthly, the Government should write off the advance payments as an immediate way of providing relief. Additionally, they should re-evaluate the financial implications of asking pharmacies to pay back the £370 million advance. This is crucial, given that pressures are pushing many community pharmacies to the edge. Quite simply, payments have not been enough to cover the financial pressures brought on by covid-19.

Fifthly, and linked the points above, the sustainability of pharmacies is crucial. That is why the all-party parliamentary group on pharmacy is giving them its support.

I urge the Government, before it is too late, to consider that current funding levels may already be causing irreversible damage. It is time for us to give our local pharmacists—for example, Dr Lisa Manning, the CEO of my local pharmaceutical committee—and their colleagues a shot in the arm. It is time to support them, and the time is now.

Sitting suspended for a Division in the House.
On resuming—
Graham Brady Portrait Sir Graham Brady (in the Chair)
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The sitting is resumed. The debate may now continue until quarter past 3.

Simon Fell Portrait Simon Fell (Barrow and Furness) (Con) [V]
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It is an honour to serve under your chairmanship, Sir Graham. I thank my hon. Friend the Member for Thurrock (Jackie Doyle-Price) for securing this important debate.

The pandemic has shone a light on some of the more extreme challenges that we face as a society, but it has also highlighted the role of some of the institutions that support our communities—quietly, day in and day out. They are there for advice and support and offer a friendly and welcome face to those who are not reassured by going through online channels. Some people want a relationship but do not want to trouble their GP, and community pharmacies fill that role. These institutions have long been at the heart of all our constituencies, offering so much more than just prescriptions.

It would be remiss of me not to mention a few of the local pharmacies in my community and the incredible work that they have done and continue to do as part of the NHS family. Cohens, Coward’s and Murray’s, among others, are Furness institutions that have been remarkable in the support they have offered the community over the past year. Not only have pharmacies remained open over the past year; they are now supporting the vaccination programme.

A local pharmacist, Ben Merriman, was out vaccinating in Millom yesterday. I was told this morning of one pharmacist who was doing the same and, at the end of a very long day, found that their final patient was needle-phobic. It took an hour of gentle persuasion to get that final needle into the patient’s arm, which shows in one simple act the generosity and forbearance of the community pharmacist. This is a sector that we need to nurture and support, especially now.

Let us be honest: community pharmacies are struggling. While they have never been busier—significantly busy at the moment—90% of their business is pharmacy work and not retail, and that part of their business has dropped off. They have also seen a significant increase in their workload as the number of consultations they have taken on has increased since the start of the pandemic. Some of that is due to the approachability of community pharmacies, and some of it is due to word of mouth. If someone has had a good service, they are more than likely to tell their friends and family.

The Government’s support for this arm of the NHS is welcome, and the £370 million helped to deal with some of the immediate cash-flow issues at the start of the pandemic. I am sure my hon. Friend will continue to engage with the PSNC to ensure that this vital arm of the NHS has the support that it needs to stay afloat. Ultimately, if pharmacies close—that is what is happening now and it will continue at a faster rate if it is allowed to progress—the patients of Furness and those in constituencies around the country, along with the rest of the NHS, will suffer.

No one could have predicted the pandemic and the massive impact that it would have on the NHS, the Exchequer and the country as a whole, but pharmacies were already under massive financial strain before this. I have already lost one pharmacy in Barrow and several others have cut their hours because of financial cutbacks. It is worth looking at where the bulk of pharmacy closures have taken place in the past four years. The vast majority sit in the most deprived areas of our country, where we need to level up healthcare the most. Squaring that circle is the challenge that my hon. Friends in the Treasury face—one that they are no doubt alive to.

As my hon. Friend the Member for Thurrock said when she opened the debate, community pharmacies are the front door to the NHS. We need to make sure that that door stays firmly open.

Holly Lynch Portrait Holly Lynch (Halifax) (Lab) [V]
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It is a pleasure to serve under your chairmanship, Sir Graham. I feel there will be a great deal of consensus over the course of this debate.

I have shared my experiences of my first job working in my uncle’s community pharmacy on numerous occasions in Parliament. Indeed, I secured a Westminster Hall debate on the role of community pharmacies in October 2019. I spoke of how there was never a dull moment in a pharmacy. I recalled the time a frantic mother handed me dead headlice taped to a piece of cardboard, and someone asking me to run a pregnancy test on a bottle of cough medicine before discreetly letting me know it was actually a urine sample and the bottle was the most secure way that she could think of getting it to the shop.

The lighter moments aside, what has always stayed with me from my time working evenings and weekends in a local chemist shop was that so often, particularly for older people, someone’s relationship with the pharmacist was the longest standing and most trusted relationship they had with any clinical professional. When we think about the pandemic, we think what an invaluable community asset pharmacies are, and I take this opportunity to thank all those who have worked so hard to keep pharmacy doors open during the most difficult times of this crisis.

Prior to the crisis, pharmacies had their budgets cut back in 2016, with a reduction from £2.8 billion in 2015-16 to £2.59 billion in 2017-18. That represented a 4% reduction in funding in 2016-17 and a further 3.4% reduction in 2017-18. When inflation is factored in, as well as all the services that pharmacies already offer free of charge—costs that they absorb—it dealt an almost fatal blow to pharmacies. The then Minister told the all-party parliamentary pharmacy group that he expected between 1,000 and 3,000 pharmacies to close as a result, because they would simply no longer be viable, with multiples and chains of pharmacies best placed to weather the cuts, and independent and more rural chemists left at a disadvantage.

That was in 2016 and it set the landscape going into the pandemic. When the pandemic started, these already underfunded pharmacies were called on to be a crucial element of the UK’s frontline response, dealing with a 20% rise in demand for medicines and a 35% increase in required prescriptions. They experienced a doubling in demand for home deliveries of medication and a tripling in calls from the public. According to the PSNC pharmacy advice audit, pharmacies have been providing healthcare advice to more than 600,000 people every week. We owe a great debt to these underfunded and overworked pharmacies and their teams, who went above and beyond to relieve pressures on our NHS.

I commend the work of the all-party parliamentary pharmacy group under the leadership of the hon. Member for Thurrock (Jackie Doyle-Price) for its detailed work on this issue. I ask the Government to reflect on the ask within its recent flash inquiry report. We need pharmacists—that has to be the bottom line—so why are we putting these perverse financial barriers in their way? They are providing a great deal of care, as well as social care, to those who most need it. We have to find ways of looking after them into the future.

Andrew Jones Portrait Andrew Jones (Harrogate and Knaresborough) (Con)
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It is always a pleasure to serve under your chairmanship, Sir Graham. I congratulate my hon. Friend the Member for Thurrock (Jackie Doyle-Price) on securing this debate.

We all know that the pandemic has put unprecedented pressure on our health services. That, for me, includes pharmacies. I consider pharmacies to be frontline medical services and a really important part of patient care. I emphasise that view, which is clearly shared among those of us in this debate, but I do not think it is a view universally held across the health sector.

Before going any further, I should declare an interest. Many years ago, I worked for Kingfisher and I had responsibility for pharmacy marketing and Superdrug, among other things. As a result, I spent considerable time with pharmacists and understood the value that people place on them. I saw at first hand the expertise and care, and have had much respect and affection for the sector ever since.

This debate is focused on the current crisis. The way that the whole sector has responded—the NHS, pharmacies, the pharmaceutical companies; everybody—has been truly impressive. They have showed agility, which is not always what we expect in large organisations. Their working together has perhaps also taken them to new places.

Pharmacies have remained open and accessible places of advice and reassurance, and, above all, sources of vital medicines. Keeping that flowing was critical. Pharmacies have adapted to new rules and used their positions of trust and authority to really help patients.

I saw a little bit of that doing some volunteering for the Harrogate Easier Living Project. It has not been the quietest time for MPs or I would have done a little more. I helped deliver prescriptions to those who were shielding and visited a number of pharmacies across the constituency as a result. I was impressed by the actions they had taken to keep people safe and to continue their vital work.

When the NHS was rightly dealing with the immediate urgency of this crisis, pharmacies took a pace forward and helped with health advice. They took the pressure off other parts of the system. That is my key point: pharmacists are key frontline health workers. They are owed a debt of thanks and I put my thanks on the record.

The pandemic has shown what pharmacies can do. There is the work of the pharmacy-led vaccination centres. In Knaresborough in my constituency, we have a vaccination centre run by the local company, Homecare Pharmacy Services, at the former Lidl store. It is going great guns. It has the capacity to do 1,000 vaccinations a day, and I have heard nothing but positive reports.

Looking ahead, I can see a role for pharmacies in helping with the likely winter covid booster jab, which is probably going to be part of all our futures, and a role in helping people who take several medicines as they manage what the NHS cheerfully calls “multiple comorbidities”, alongside their regular care and the community value that they bring, day in, day out.

My message is that pharmacies do a lot. They have shown us that, and that they could do more. They have the expertise and trust. They should be at the heart of how frontline health services are planned. A stable, secure pharmacy sector, planning and supported for the future, will be able to add a huge contribution to the health of our nation.

Taiwo Owatemi Portrait Taiwo Owatemi (Coventry North West) (Lab) [V]
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It is a pleasure to serve under your chairmanship, Sir Graham. I thank the hon. Member for Thurrock (Jackie Doyle-Price) for securing this crucial debate. As a qualified pharmacist, I know the important role that community pharmacists play at the heart of communities, going above and beyond for their patients on a daily basis. I thank those in my constituency such as Allesley pharmacy and Rotherham Road pharmacy for their ongoing hard work. Since the start of the pandemic, much of our high street has shut up shop, faced with the unique threats that covid presents. Community pharmacies, on the other hand, have opened their doors to all those who need them. They quickly adapted their services to be covid secure, and offered face-to-face advice and healthcare on a walk-in basis when communities needed it most. They have been a shining light in the dark times for our high street and taken the strain off other sections of our health system.

We should celebrate the innovation shown by community pharmacists. Pandemic delivery services ensured that patients shielding at home were able to access their prescriptions without putting themselves at risk, and pharmacists reviewed the medication for those discharged from hospital, helping patients manage their medicines properly, reducing confusion and improving patient safety. They have used their expertise to support the national covid-19 vaccination programme, making it easier for many to receive the vaccination at their own convenience, from a familiar trusted face.

However, these changes have come at a huge cost, both financially and emotionally. Pharmacies have been left to fund the increased staffing costs, PPE, cleaning and social distancing measures that came with the effects of covid. Coupled with a reduction in over-the-counter sales and services, many are now facing serious financial challenges. Yet pharmacies have received no targeted funding for their efforts. Instead, this Government have taken advantage of the good will. From the ongoing effects of the devastating cuts of 2016, to the unforeseen cuts of the last year, pharmacies have been left in the lurch, forced to fend for themselves.

The systemic underfunding has put community pharmacies in dire straits and many owners have been left having to use their own money to keep these vital parts of our community afloat. A third of pharmacies and businesses in England are now in deficit and many have closed for good. It is counterintuitive that pharmacies are being forced to close in the midst of the pandemic. If we do not act now to stop the loss of community pharmacies, our high streets will be hit hard and many of the most desperate and deprived will lose their main link to NHS services. Only by picking up the extra costs faced by pharmacists and writing off the £370 million in emergency loans—that most will struggle to ever repay—can the Government ever hope to fulfil their promise to do whatever it takes.

Looking ahead, we need to understand the value and work that our community pharmacists do every day. Not only do they provide a key link between individuals and a wider NHS but they are a vital part of our plan to address the health inequalities that many in my constituency and across the country, are seeing grow more and more. Our pharmacists have a fantastic set of skills, and a broad knowledge and expertise that can take some of the burden from the overstretched primary care network. I hope the Minister will listen to what has been said, because now we need active steps to give community pharmacists guaranteed support grants and to fully fund the enhanced community and public healthcare and covid-19 booster vaccinations. The Minister and his colleagues in the Treasury should remember that the success of pharmacies does not simply keep our communities healthy. They also inject life into our high street—which themselves have been ravaged by the pandemic. An investment in pharmacists is an investment in public health, local economies and preventing future pandemics having the startling impact that we have seen in the past year. This is an investment that will pay for itself many times over.

Chris Green Portrait Chris Green (Bolton West) (Con)
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It is a pleasure to follow the hon. Member for Coventry North West (Taiwo Owatemi), because she effectively puts over the concerns of many colleagues across the country. I congratulate my hon. Friend the Member for Thurrock (Jackie Doyle-Price) on securing this important debate and making a powerful speech championing the sector. My right hon. Friend the Minister, and the whole Health team, have done amazing work in general, but particularly over this recent period. For the wider agenda of the health service, pharmacies and high-street chemists are an important part of how we want the health system to evolve in the future. Making sure that this sector is secure, and can perform, in the long term ought to be a key part of her thinking about the way we support these places in the future. I did not appreciate just how many pharmacies there are right around the country. There are 11,500, with nearly 43,000 pharmacists and more than 19,000 technicians. As has rightly been highlighted, they are all medical professionals. There have been significant financial pressures, which, if not addressed, may challenge the ability of the Health team to develop and deliver effective health services in the future.

Through the pandemic era of the last year or so, access to GPs, hospital admissions and visits to accident and emergency have all been reduced. Those three sectors, and other aspects, too, are part of the loss from the mainstream NHS that local chemists on our high streets have taken up. We ought to credit them for that. It has put enormous stress and strain on those on the frontline in community chemists. They suffer all the pressure of additional hours, busier working lives, and concerns and fears about the risk of covid infection, as well as the pressure on chemists if someone is sent home for a period of time after a positive test. All those things add pressure. To some extent, for community chemists, as with GPs, there is vocational element, but there is also the aspect of the significant costs they have faced, which must be addressed.

Before the covid crisis began, there were significant concerns about the long-term financial viability of the sector, and I think those concerns have now been compounded. I express my appreciation of the chemists right across my constituency, especially those at Hootons pharmacy in Horwich, because of the work that they are doing on the vaccine roll-out, and for what they have done at the University of Bolton stadium to give so many people access to vaccinations. I support the recommendations of the APPG for pharmacies. Although we would normally want to reduce aches and pains and coughs and colds, will the Minister ensure that the Chancellor and the Prime Minister cough up the cash for community chemists?

Steve McCabe Portrait Steve McCabe (Birmingham, Selly Oak) (Lab) [V]
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It is a pleasure to see you in the Chair, Sir Graham. I congratulate the hon. Member for Thurrock (Jackie Doyle-Price) on securing the debate. As we have heard, most community pharmacies have remained open throughout the pandemic, and many have worked extra hours because they have often been the only available source of medical advice. The pandemic delivery service has ensured that those shielding have been able to receive their prescriptions. Last winter, community pharmacies administered 2.6 million flu jabs. I had mine at Kings pharmacy in Cotteridge, administered by pharmacist Ameet Pancholi.

Measures to take pharmacies covid-safe cost money. Pharmacies have had to install door entry systems and counter screens, and buy their own PPE. They have been involved in supporting people with mental health issues, and in fielding dental and optical inquiries, for which they do not get paid. Ameet Pancholi had to employ extra drivers to ensure the delivery of prescriptions to vulnerable patients.

As with much of the health service, the Government do not seem to recognise the real costs. Pressures date back to the 2016 Budget cuts, which resulted in many closures, often in the most deprived areas. If drug prices rise, pharmacies lose out because they are tied to a pre-set NHS drug tariff. A recent Ernst and Young report concluded that our pharmacy network is unsustainable within the current framework. It projected that 72% of pharmacies would be in deficit by 2024. As we have heard, pharmacies received money to meet extra pandemic costs, but they say that they have spent rather more, and it turns out that that money was loan that will now be clawed back. What happened to “whatever it takes” and “all help necessary”?

Only 55 days ago, I received an email from NHS England extolling the virtues of community pharmacies. It told me that 200 of them were due to start delivering the covid vaccine. It quoted the Secretary of State as saying:

“It is fantastic that high-street pharmacies will now begin”

administering the vaccine. He went on to say:

“Pharmacists have worked tirelessly throughout the pandemic, often acting as the first port of call…and often staying open when all around have closed.”

It also quotes the Vaccines Minister as saying:

“Pharmacies play a vital role in caring for the nation”.

If Ministers want to keep these fantastic pharmacies, which they think play such a vital role, there is only one solution: we need a review of funding and the drug tariff, and they should be fully compensated for the costs incurred during the pandemic. That means converting the £370 million covid funding to a grant.

Elliot Colburn Portrait Elliot Colburn (Carshalton and Wallington) (Con) [V]
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It is a pleasure to serve under your chairmanship, Sir Graham. I, too, congratulate my hon. Friend the Member for Thurrock (Jackie Doyle-Price) on securing this important debate, especially as pharmacists really have been the unsung heroes of this pandemic. Not only have their doors remained open to their customers for their regular services but they have also picked up huge demands for minor ailment consultations, medicine deliveries for people avoiding GPs and staying at home, and so on.

In Carshalton and Wallington, I pay particular tribute to my local community pharmacists for their extraordinary efforts over the past year, and for their strong lobbying on behalf of the sector, including Sanjay from Sutton pharmacy, Jaymil from Hackbridge and Anna pharmacies, and Alfie from MPS pharmacy. Of course, I know that the Minister will know Reena from S G Barai pharmacy. She does a lot of lobbying on behalf of the sector in the UK, and I am so proud that she operates a pharmacy in my constituency.

The increase in workload has taken its toll, as we have heard. Pharmacists tell us that they have worked late into the night and over the weekend without a break in order to keep up. That highlights a real problem: they have not been recompensed for much of the additional work that they have taken on. It has also demonstrated a great opportunity for the NHS—something that I know the Minister recognises but that I hope NHS England will also recognise and grasp with both hands.

Having worked in the NHS myself, I know first hand about the significant pressures on demand for GP appointments and A&E capacity, but we know that many people presenting at GPs and even at hospital could be seen by a pharmacist first. The talents and abilities of pharmacists were massively under-utilised before the pandemic began, and I argue that we need to unlock that capacity to ease pressures on the NHS and create a new culture of “pharmacy first” within the UK.

I will quickly make three points. First, I will outline what more pharmacists could do if we let them. I do not have time to go into any great detail, but they should be on the frontline of the prevention agenda, helping their customers with such things as obesity, smoking and drinking. They should also be providing a huge range of additional services. Any and all vaccinations could be done at a pharmacy, as could sexual health screenings and HIV testing, and they could have greater powers to prescribe, to name just a few.

Secondly, pharmacies should be better represented at strategic planning level, with representation in clinical commissioning groups and integrated care systems, for example, to ensure that they form part of the conversation about the delivery of health and care within our local communities.

Finally and most importantly, as has been well covered and eloquently set out by colleagues, pharmacies have to be adequately funded for the work that they do. Time prevents me again from going into any great detail, but I echo calls from colleagues to look at the recommendations of the APPG, at turning loans into grants, at the Ernst and Young report, and at formally making pharmacies part of our frontline NHS and using existing primary care resources where necessary to ensure that that can happen.

I will finish by thanking yet again the pharmacies in my constituency and across the country for their extraordinary efforts. I know how valued they are by my constituents, so I hope that we can secure them greater responsibilities and appropriate funding to create that “pharmacy first” culture in the UK.

Jim Shannon Portrait Jim Shannon (Strangford) (DUP)
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It is a pleasure to serve under your chairmanship, Sir Graham. I thank the hon. Member for Thurrock (Jackie Doyle-Price) for setting the scene, as she always does on such issues. I am very pleased to speak on this matter, because it is essential for me. I have often referred to pharmacies in my constituency, and I have often sent questions to the Minister here, and to the Minister whose responsibility they are back home as well.

Those pharmacies have reported much of the concern that has already been outlined by others, and they are in need of Government support. I have a good working relationship with pharmacies in my area and I visit them fairly regularly, but they are under additional pressure because of the recent strains relating to the Northern Ireland protocol. I know that the Minister is not responsible for the Northern Ireland protocol, but this debate is about pharmacies and the Northern Ireland protocol becomes part of that, as it always does with everything, for us in Northern Ireland anyway.

I was in contact with one of my local pharmacies, who spoke with other members of Community Pharmacy Northern Ireland and outlined the following:

“Community Pharmacy NI has been in on-going local and national discussions in respect of matters relating to the supply of medicines to Northern Ireland, and has highlighted the continuing concerns in respect of continuity of supply from a Northern Ireland perspective in 2021/22 and beyond. There is a 12-month derogation in place and Mr Gove has requested that this be extended to 2023.”

That is good news because it helps us in the short term, but we need a long-term solution as well. It goes on:

“there is work being undertaken at policy and operational levels to resolve anticipated supply issues before they impact on contractors and patients here.”

So, we are seeing some conciliation and help for us in Northern Ireland, and we appreciate that.

Community Pharmacy NI continues:

“However, additional regulatory requirements post 2021 may put a significant burden on manufacturers for a small NI market”—

it might be small, but it is crucial for us in Northern Ireland and for our constituents—

“and the fear is that this may force them to withdraw altogether from supplying here and that there may be significant disruption to the supply chain which will result in shortages.

There are also looming implementation dates for full compliance with HMRC and EHC requirements, which may impact on medicines movement. The potential shortage issue could be managed to a large degree by ensuring that the licensing status quo is retained as far as possible to allow the unfettered use of GB packs in Northern Ireland.

Community pharmacies in Northern Ireland provided a vital role in supporting patients, the health service and by maintaining medicines supply to patients during COVID.”

We have all said that.

“As we go forward now in 2021 can Government provide details/give assurances that work is ongoing to identify and quantify any possible medicines shortages and to put in place sufficient measures and contingencies to deal with any anticipated issues in respect of medicines supplies to Northern Ireland?”

Can the Minister respond to that today? If not, can she respond to it further down the line?

Local pharmacies are a focal point of villages and communities across my constituency. Throughout the pandemic, the community pharmacies have battled through as a lifeline for people. In the same way that we owe a debt to the NHS, I believe we also owe a debt to local pharmacies, who did their utmost to keep it together and keep going. There must be a better use of them to relieve the pressure on the NHS. I believe that pharmacies are at the frontline to do that. They could be addressing issues to do with diabetes, minor ailments or small medication problems.

I end by putting on record my sincere thanks to all the pharmacists, technicians and staff who kept making the packs, were available for assistance, and kept their doors open and medication flowing. We could not have done it without them, and now is the time to do right by them.

John Howell Portrait John Howell (Henley) (Con) [V]
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It is a great pleasure to serve under your chairmanship, Sir Graham. I thank my hon. Friend the Member for Thurrock (Jackie Doyle-Price) for securing the debate and for speaking so eloquently. It is a pleasure to follow the hon. Member for Strangford (Jim Shannon); it is usually the other way around. He usually follows me, so it is a pleasure to do it this way around.

My first point is about the question of inoculation. A number of hon. Members have said that their pharmacies are already providing the covid inoculation. They are not doing so in my area. I raised that with the Minister for Covid Vaccine Deployment. He, like me, said that he wanted to be able to wander down to his local pharmacy to obtain his vaccine. His view was that it was not available because of the lumpiness of the supply of vaccine and that we would see more pharmacies coming online to take that on. Can the Minister comment on how we are getting on with that? How far have pharmacies been brought into the continuation of the programme?

I had my flu injection at my local pharmacy. It worked efficiently and discreetly, and I was pleased to be able to have it there. Looking forward, pharmacies have a great role in the ongoing provision of booster vaccinations for covid. However, we have a problem at the moment with the net closure of something like 400 pharmacies. We have a problem of funding there. Concern has already been raised during the debate about the emergency loans that were provided and being able to convert those into some form of grant, or simply to write them off altogether. Any policy needs to reflect the fact that pharmacies have had to provide covid-secure screening facilities on their premises, and that they have not been reimbursed for having to provide their own PPE.

For the future, there is a lot that can be built on the relationship between pharmacies and GPs. For example, I see a role for pharmacies in being able to detect undiagnosed high blood pressure in a number of people. When my hon. Friend the Member for Winchester (Steve Brine) was a Minister, he always said that I used these debates as an excuse to reveal my ailments. I am not doing that this time, but I am saying that this is a very good opportunity to be able to provide public health guidance for communities at a local level.

Steve Brine Portrait Steve Brine (Winchester) (Con) [V]
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I am delighted that the Henley reveal is not on show today. It is always good to discuss community pharmacy in the House. In doing so, I declare my entry in the Register of Members’ Financial Interests and of course my experience as a former pharmacy Minister.

The Medicines and Medical Devices Act 2021 has received Royal Assent, which is a good thing, as it is an important piece of legislation. I remember its conception. The Minister is right to say, as she has done previously, that it has the patient at its heart, but the Bill, and certainly the discussion around it, has also advanced the idea of making what would be a pretty fundamental change to community pharmacies through a shift to what we call the hub and spoke model, which I want to touch on. The Minister is very familiar with the arguments. For those who are not, we are talking about a totally new way of working, whereby independent pharmacists have a hub pharmacy that dispenses medicines on a large scale for regular spoke pharmacies, which then supply them to the patient.

A consultation as far back as 2016 flew this flag, and it was confirmed in the long-term plan of January 2018. Fast-forward to life in the pandemic, and it is true that the combination of rising prescription volumes and reduced patient access to primary care services has put great pressure on community pharmacies to keep up the face-to-face contact that their customers want and need. Boy, have they done that. I am so glad that Ministers have consistently recognised the work of community pharmacists throughout, and I join colleagues in paying tribute to mine. They are a workforce who just get on with it.

Adding the rising volumes and access to primary care services to the Government’s requirement for greater value from pharmacy, it is clear why many people believe that a hub and spoke dispensing model is the way forward. On the flipside of the debate, many are understandably worried that centralised dispensing could drive down costs in pharmacy. Unless the pharmacy on the high street then acts as the spoke part by handling the prescription to the patient, we just end up with a bigger distance-selling pharmacy market and a lack of patient contact, which then puts opportunities for wider primary care contact out of reach. Put simply, the unintended consequence could be a total stitch-up that leaves community pharmacy not so much as “always the bridesmaid, never the bride”—as I have often heard—but more like “jilted at the altar,” and I do not want to see that happen. The truth is that, as with everything else, and especially the growth of distance-selling pharmacies, it is somewhere in between.

We can debate the pros and cons all we like, and I am really pleased that the Minister has committed to a full public consultation on hub and spoke, to ensure that we get the right model going forward, but let us be clear that it is already happening, with the technology embedded in the multiples and the large chains long ago. Can she give an indication of when she thinks it is likely that her Department will bring forward concrete proposals to consult on hub and spoke?

In closing, I return to an old theme of mine in respect of community pharmacy: whatever the future architecture of the NHS—obviously, the White Paper is being discussed—it must take its rightful place as part of pre-primary care, as I call it. That is why I have always been so positive about the potential that primary care networks have for this sector. PCNs are a great chance for community pharmacy, and the new integrated care systems set out in the White Paper are the chance to bake in primary care, in its widest sense, within the NHS family. Hub and spoke is a positive opportunity moment for community pharmacy post covid, but only if the income and the process of dispensing are replaced in a way that allows the sector finally to realise its potential as part of primary care.

Bob Seely Portrait Bob Seely (Isle of Wight) (Con) [V]
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It is a pleasure to see you in the Chair, Sir Graham, and also to follow a very knowledgeable former Public Health Minister, my hon. Friend the Member for Winchester (Steve Brine). I am grateful to my hon. Friend the Member for Thurrock (Jackie Doyle-Price) for securing this debate and for the lot of good work that she has been doing on the all-party parliamentary group on pharmacy.

I will be brief, as we are all saying pretty much the same thing. I hope that at the end of the debate the Minister will suggest some concrete measures that can make a difference, and specifically answers the questions that I will put. I have also written today to the Secretary of State and the Chancellor about support for pharmacies, and I am grateful for the conversation that I had with the Minister the day before yesterday about them.

First, we are attending this debate because we know what an important service pharmacies perform for communities, which they are embedded in. Pharmacies, especially independent pharmacies, are a friendly, valued and, above all, trusted voice. For the NHS and the nation, they take pressure off accident and emergency departments, GPs’ surgeries and other parts of the health service. At a modest cost, they deliver very significant benefits, and they are a critical part of primary care that pays significant dividends, as well as alleviating pressure elsewhere.

I have six independent pharmacies in my constituency and they are all highly valued: Yarmouth; Freshwater; Seaview; Ryde; and Regent, which has branches in both East Cowes and Shanklin. I talk to all the pharmacists regularly. Despite pharmacies’ significant role during covid, by remaining open they have incurred nationally costs of £370 million in staffing and other costs. I am delighted that the Prime Minister said in a recent press conference that that money was going to be reimbursed, but following the Budget we have not yet seen that money and I am none the wiser as to whether we will see it. Can the Minister therefore reassure us that the support promised will actually be seen through, and that that £370 million will reach pharmacists?

Secondly, hon. Members have already referred to the Ernst and Young report. Three quarters of independent pharmacies are under pressure and may be forced to close within the next 12 months, and between two thirds and three quarters of community pharmacies will potentially be in financial deficit by 2024, according to that report. I asked a written question about the report but was told that, as it was not in the public domain, the Government would not comment on it. That is not true; it is in the public domain and I would like the Government to comment on it. If the Government agree with what the report says, the Minister needs to act.

Thirdly, we know that independent pharmacies do not gain the discounts given to big multiples, which are often part of a single wholesale and retail chain. Why can the Minister not ensure that the independent pharmacies are paid the same and are allowed to make the same profit margins on prescriptions and other services?

Summing up, I know that the Minister has good plans for pharmacies, because she has talked them through with me in the past, and I am grateful to her for sparing that time. However, pharmacies need to be open and functioning if they are to take advantage of the plans that we have for them. There must be a financial model that allows pharmacies, especially independent pharmacies, to make a reasonable living for the exceptionally valuable work that they do nationally and in their communities. I look forward to hearing some solutions to these problems from the Minister.

David Amess Portrait Sir David Amess (Southend West) (Con) [V]
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I congratulate my hon. Friend the Member for Thurrock (Jackie Doyle-Price) on securing this debate and on being determined that it would not be a hot air debate but one in which we actually work together to find some solutions.

Although many GPs’ surgeries closed their doors at the start of the pandemic, pharmacies have stayed open and even increased their hours of operation in order to meet the extra demand for their services. They have been a lifeline for the elderly and vulnerable, delivering medicines to those shielding or self-isolating. Many pharmacies in Southend have also supported care homes, sourcing medication where there were shortages of end-of-life medicines. When needed, they have also assisted with the reuse of medicines in care homes under national protocols.

Working with local general practitioners, chemists are now processing the majority of prescriptions electronically, reducing the number of face-to-face visits that are required. The discharge medicines service has just rolled out to Southend pharmacies, so that they are able to see all the medicines that a patient has been given upon being discharged from hospital, which improves safety and reduces potential errors. Many pharmacies have also joined the vaccination programme. Their experience in handling large numbers of patients effectively has been vital in delivering the first jab to the elderly and clinically vulnerable.

Having visited a number of pharmacies in my constituency before the coronavirus outbreak, I am aware of the pride that they feel in serving their community and of their ambitions for the future. Frenchs Chemist in Leigh-on-Sea suggested running a phlebotomy clinic three days a week and installing a treatment room with ultrasound scanning facilities, so that many routine scans can be carried out without the need for a hospital visit. Derix Healthcare Pharmacy, also in Leigh-on-Sea, is keen to take on more work, such as producing blister packs on behalf of the hospital, which is a very time-consuming task, and has offered to perform medicine use reviews and other services currently carried out in hospitals, freeing up staff time on wards and in out-patient departments.

As chairman of the all-party parliamentary group on liver health, I have worked closely with our brilliant secretariat, the Hepatitis C Trust, to promote the delivery of testing and treatment for hepatitis C in community settings. A report published by the APPG in 2018 showed that, in order to eliminate the disease, levels of testing and diagnosis needs to be much higher. Offering testing and treatment in community pharmacies presents an important opportunity to access at-risk groups who are already attending for other services. Hepatitis C is a major cause of liver cirrhosis and cancer, and in order to eliminate it as a public health concern by 2030, those who cannot be reached by traditional healthcare settings must be offered more help locally.

Of course, all this comes at a price, and many pharmacies are struggling to continue the level of service they currently offer. Coping with the pressure of additional demand during the covid-19 crisis has meant many extra costs in staffing and PPE and an increased cost of medicines. The advance payments made during the pandemic, which allowed them to cope with additional demand on their services, were welcome but will have to be paid back—a total of £370 million—putting pressure on pharmacies to cut services and opening hours. This is a real opportunity for our wonderful pharmacies to deliver even more services than they have been given the power to do at the moment.

Graham Brady Portrait Sir Graham Brady (in the Chair)
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I thank everybody for keeping to time so well, making sure that we have sufficient time left for each of the Front-Bench spokespeople to have up to 10 minutes to wind up, and for the hon. Member for Thurrock (Jackie Doyle-Price) to have at least a couple of minutes at the end to sum up.

Martyn Day Portrait Martyn Day (Linlithgow and East Falkirk) (SNP) [V]
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It is a pleasure to take part in the debate, which I am grateful to the hon. Member for Thurrock (Jackie Doyle-Price) for securing. I think we all agree with the hon. Lady that the sector is valued. There can be no doubt that, throughout these islands, pharmacies play a vital role in our communities, and they have gone above and beyond that during the covid crisis.

Health is a devolved matter, of course, and in Scotland we do things a little differently, which means I often feel like a foreign observer during debates about pharmacies and healthcare in England. We have heard from a number of speakers about the different practices that affect their parts of England, and I hope that my observations from Scotland may also be of interest to Members. I have commented in a few debates that there are often lessons that we can learn from one another, and good practices that can be shared. This issue provides an excellent case in point.

Community pharmacies were developed in Scotland 15 years ago and are there for minor ailments, chronic medication and public health services. These services involve pharmacists more in the community in the provision of direct patient-centred care. It may be worth pointing out that prescriptions are free in Scotland, and that fact enabled the development of the minor ailment service across Scotland, which in turn has evolved into our Pharmacy First service, launched last July. Originally planned to start in April 2020, it was delayed to allow pharmacy teams to focus on managing the covid-19 pandemic. It is backed by £7.5 million of investment in 2021-22, rising to £10 million by 2022-23.

The Pharmacy First approach removes huge pressure from GPs and A&E services and allows the public to access treatments more easily across some 1,200 pharmacies located throughout Scotland, and with the greater flexibility of longer opening hours. Community pharmacists can only give out certain medicines and products, but the benefits of this are massive because it can cut the workload of GPs and other NHS staff across the country. Pharmacists are located throughout communities in Scotland, from rural areas to the deprived inner cities, providing pharmaceutical care on behalf of NHS Scotland.

The Scottish Government’s policy remains that, wherever possible, people across Scotland should have local access to NHS pharmaceutical care. From 1 October, Scottish pharmacies now receive £1,250 a month as part of this scheme, and in Scotland, if a person is registered with a GP practice and has a minor illness, a pharmacy is the first place they should go for advice. They do not usually need an appointment, and they can go to any pharmacy. The pharmacist can give advice for a minor illness, and medicine if they think the person needs it. Pharmacists, like GPs, can only provide certain medicines and products on the NHS. Health boards in Scotland have been able to enter into local arrangements with pharmacy contractors for the delivery of the covid-19 vaccination, following an agreement between the Scottish Government and Community Pharmacy Scotland.

The covid pandemic has flagged up examples of both good and bad behaviour from our fellow citizens. We have heard tremendous examples today of how pharmacists have adapted to the challenges over the past year, providing vital lifelines in so many of our communities. The work and efforts from our pharmacists have been a great example for us all. The growth in abuse faced by pharmacy staff, on the other hand, is of particular concern. That pharmacy staff are needing to wear body cameras to protect themselves speaks volumes about the world we now live in, and my praise goes to the Pharmacists’ Defence Association for its work in combating threatening and abusive behaviour. We must all support, and give leadership to, a zero-tolerance approach.

In conclusion, we have seen societal change from before the pandemic to where we are now, and indicators of what may emerge in the future, with more people than before now treating their minor ailments at home with the support of pharmacies. We should encourage this transition to continue, in order to alleviate the strain that minor ailments place on the NHS, such as in A&E. Scotland’s Pharmacy First programme is an example of how this is possible.

Alex Norris Portrait Alex Norris (Nottingham North) (Lab/Co-op)
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It is an honour to serve under your chairship, Sir Graham. I thank the hon. Member for Thurrock (Jackie Doyle-Price) for securing this important debate through the Backbench Business Committee, as well as for her leadership of the all-party parliamentary group on pharmacy. We are very lucky to have her commitment and her expertise in this area, and we can tell by how subscribed the debate has been and the high quality of it just how important community pharmacy is to Members of Parliament of all political persuasions. This is a very well-timed opportunity to talk about this important subject. As a Nottingham Member of Parliament, I know that Boots has been putting us on the map for 170 years now, so I am always very enthusiastic to talk about pharmacy.

The hon. Member for Thurrock made a number of important points, a couple of which I double-underlined. First, that sheer volume of work is indicative of the capacity, ability and creativity of our pharmacies, but also just how popular they are with our constituents. Secondly, she made a particularly important point about cross-funding, which is what pharmacy is built on at the moment. We have to get to a place where pharmacy, and the provision of what are, however we think about them, NHS services, is not cross-subsidised from selling Dairy Milks as well. That is the situation at the moment, and we need to do better.

The contributions from colleagues were really great, and it was really interesting to hear just how much commonality there is. I will start with my hon. Friend the Member for Coventry North West (Taiwo Owatemi), because of her special expertise in the NHS as an oncologist pharmacist. The points she made about how pharmacies stayed open and the financial pressures that they face today were shared by my hon. Friends the Members for Bootle (Peter Dowd), for Halifax (Holly Lynch) and for Birmingham, Selly Oak (Steve McCabe), but they were also echoed across parties, in the contributions of the hon. Members for Bolton West (Chris Green), for Harrogate and Knaresborough (Andrew Jones), for Isle of Wight (Bob Seely) and for Southend West (Sir David Amess), as well as by the hon. Member for Barrow and Furness (Simon Fell), who left us with the sobering reality that his community has lost a pharmacy during this crisis. That is a big gap in the high street.

The hon. Members for Henley (John Howell) and for Carshalton and Wallington (Elliot Colburn) made very good points about vaccinations, which I will draw on shortly. The hon. Member for Strangford (Jim Shannon), as ever, brought his insight from Northern Ireland, which I thought was interesting. In particular, his points about medicine supply remind us that, without the right supply, we can have all the best services in the world but we will be unable to meet need. Finally, I was delighted that the hon. Member for Winchester (Steve Brine), the former Minister, raised the issue of hub and spoke. This is going to be such a seismic change to pharmacy that is going to affect all of our high streets, and I will make a couple of points about that in my conclusion in a moment.

Throughout this pandemic, we have had many heroes working on the frontline—doctors, nurses, dentists and other healthcare staff, as well as others in other professions, such as teachers, retail workers and many more. They have all adapted to fight the impact of the pandemic on the frontlines. They have had to adapt the way in which they operate, as has everybody in some way, whether it is working from home, working with social distancing measures or being on furlough. We ourselves are meeting in an extraordinary Chamber today, and we are very lucky to have the staff to deliver this for us.

However, one profession that has carried on very much as normal on the frontlines is community pharmacy. My local chemist in Bulwell has been open for me to pop in to pick up essentials, to get face-to-face advice and healthcare, and to pick up prescriptions. Now he is starting up as a vaccine centre—Raza, we are very lucky to have you. That has been the case all over the country, and although the hon. Member for Thurrock and I have obviously had similar briefings on this, I will reiterate the numbers, because they are really something. As well as dispensing the annual 1 billion prescription items, pharmacies have delivered healthcare advice at a rate of more than 48 million consultations a year. More than 600,000 people have sought advice from English pharmacies on medical symptoms each week, with a further 185,000 regularly needing help with an existing medical condition.

Pharmacies are acting as a buffer for the NHS, sharing the load when it has been most desperately needed. Thanks to community pharmacies, half a million GP appointments and 57,000 A&E walk-in centre appointments every week have been avoided. This has been a massive help for local communities and kept our NHS going. We should feel very fortunate to have these services available to us throughout the pandemic, but we must therefore show our gratitude in a meaningful way.

On 8 March last year, the Chancellor said that the NHS would have whatever it needs. Well, like the hon. Member for Harrogate and Knaresborough (Andrew Jones), I count community pharmacy very much as NHS—absolutely—and they should be covered by this too. That extra work and the extra costs of providing a safe environment have cost them money, and we have an obligation to meet those costs. That is not just my view, but the view of the Prime Minister on 10 February at the Downing Street press conference. He promised reimbursement as soon as possible, but pharmacies are still waiting. Those must not be empty words, to go along with empty claps for carers who have done so much for us but whose justice is a real-terms pay cut. We cannot see that happen again.

In a written answer to my hon. Friend the Member for Luton North (Sarah Owen) published on Tuesday, the Minister said that negotiations about this issue are ongoing. I hope the Minister can update us on progress and give us some good news. I am very mindful that, whatever we think about the recovery in dentistry, it was not satisfactory that negotiations between NHS England and the dentistry negotiating bodies collapsed before Christmas, meaning that the new arrangements were imposed on dentists. That has left a lot of ill feeling and anxiety. We should not repeat the same in pharmacy.

In that reply, the Minister also discussed advance payments as part of Government support for pharmacy, but we know now that the Government want those emergency cash-flow loans to be paid back. We should not be selling this as money given to the sector, when it is indeed a loan. That repayment of £370 million—an average of £32,000 per community pharmacy—is a real burden. I would be keen to know from the Minister what assessment she has made of the impact, because this could well harm patient care. It is impossible not to see, certainly because of the elegance of the figures, that that is exactly 1% of what we will spend on Test and Trace. Given what the Public Accounts Committee said about the effectiveness there, community pharmacies, which are getting a 100th of the funding, have probably had 100 times the impact.

This has been an ongoing situation in recent years. Pharmacy finances were marginal prior to this pandemic. A study by the National Pharmacy Association last year found that 28% to 38% were in financial deficit already, that this number would more than double without funding changes and that we have lost 400 pharmacies since 2016—disproportionally in the poorest communities, as the hon. Member for Barrow and Furness said. That has a significant impact on communities: patients travelling further, people waiting longer for appointments with overstretched GPs, and people suffering in pain with their minor illnesses and ailments or overloading our A&E departments. Communities lose the benefits of prevention, tackling health inequalities, early identification of disease, tackling obesity and other health conditions, and, of course, the vital administration of vaccinations.

Now is a good time to talk about the covid vaccine supply. With vaccine supply doubling this week, and with community pharmacy being so keen to do more, could the Minister tell us how we might get up from the few hundreds to perhaps the majority of the 11,500 pharmacies in England being part of the programme?

I want to finish by talking about hub and spoke dispensing. I am not against it, or particularly in favour of it. It still seems a bit like a solution in search of a problem to solve. I have met with pharmacy big and small—pharmacy representative bodies, independents and massive multiples—and everyone is always pretty nonplussed by it. It is never in the top few things that they want to talk about. That gives me some cause for concern. There will be thorny issues around the regulatory framework relating to the Medicines and Healthcare Products Regulatory Agency and the General Pharmaceutical Council over issues such as refrigeration and those differences that will need to be ironed out. Similarly, there are issues about finances and where risk and reward relating to the dispensing margin will lie in the system.

Despite the ambivalence on hub and spoke generally, there is a lot of interest in how it is going to proceed. I echo much of what the hon. Member for Winchester said. I hope the Minister will say today when we can expect the consultation on hub and spoke and critically— I have been asked this question multiple times—whether the Government see it happening before the NHS Bill, at the same time as the NHS Bill or after the NHS Bill. I understand that information sometimes cannot be shared, but knowing that would be of great importance to organisations that are planning their responses to both things and that want to know what their priority should be.

The Minister has made welcome commitments about consultation, but what is coming back to me from the sector is a desire for a really deep, proper technical consultation about this. I hope she can commit to that, because this is one of those strange circumstances where some people are already doing these things: we can build on their expertise and understand what hub and spoke does and does not do.

Pharmacy is a critical part of our health service. It has delivered for us in the most testing of times. We do not want to repeat the mistake that was made with dentists. We do not want broken commitments such as those that have been made to NHS staff. Pharmacy deserves better than that. I hope that today we can hear good news from the Minister about negotiations and get a sense of where we are going in the future.

Jo Churchill Portrait The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
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It is a pleasure to serve under your chairmanship, Sir Graham. I am incredibly grateful to my hon. Friend the Member for Thurrock (Jackie Doyle-Price), not only for securing the debate today, but for her work as chair of the all-party parliamentary group on pharmacy, and across the health space more generally.

All those who have participated today have shown how important pharmacy is to every one of us. The voices of my hon. Friends the Members for Barrow and Furness (Simon Fell), for Harrogate and Knaresborough (Andrew Jones), for Bolton West (Chris Green), for Carshalton and Wallington (Elliot Colburn), for Henley (John Howell), for Winchester (Steve Brine), for Isle of Wight (Bob Seely) and for Southend West (Sir David Amess) joined those of the hon. Members for Strangford (Jim Shannon), for Birmingham, Selly Oak (Steve McCabe), for Coventry North West (Taiwo Owatemi), for Halifax (Holly Lynch) and for Bootle (Peter Dowd). Everyone recognised how important community pharmacy is in their community, and I want to join in the thanks given to that community today and say how much I value what it does on the frontline. As my hon. Friend the Member for Harrogate and Knaresborough said, pharmacy workers are key, skilled frontline workers and deliver over and above, every day, to our communities. I repeat the thanks of the Prime Minister and the Secretary of State for Health and Social Care, and add my gratitude.

The fact that pharmacy workers are a key part of our NHS family, as my hon. Friend the Member for Thurrock said, and have risen unfailingly to the many, varied and enormous challenges of the pandemic should not go unnoticed. There are 11,210 pharmacies sitting at the heart of our communities. They are easily accessible: 80% of them are within 20 minutes for someone walking there. They are highly rated, as many hon. Members have said, and highly trusted. Throughout the pandemic they have stayed open and served their communities. They have provided vital pharmaceutical services. Medicines are not something that people can choose to have or not have.

I am immensely proud to stand here as the Minister for pharmacy, and I thank everyone involved in community pharmacy for their hard work, whether they talk to patients every day or are involved in the vaccine roll-out or the broader team. From the times I have spoken to them, I know that they are tired. They have worked unbelievably hard for the past year. I do not think that, when this started, anyone anticipated that it would go on week after week. They have been working evenings and weekends, and I would like to thank them for it.

Hon. Members might recall that we agreed a five-year deal back in July 2019, before the pandemic. It commits almost £13 billion to community pharmacy—just under £2.6 billion a year—and was the joint vision of Government, NHS England and the pharmaceutical negotiating committee, the PSNC, for how community pharmacy will support the delivery of the NHS long-term plan, and patients.

As we have heard from many, particularly my hon. Friend the Member for Southend West, there is so much more that pharmacies are saying they want to do for our communities. Having spoken to many pharmacists and their teams, I know that using their full skillset is something they would welcome. It is what they want to do and what they want to see happen.

Over the period of the five-year deal, community pharmacy will be more integrated into the NHS and will deliver more clinical services, taking pressure off other areas in the NHS, as the first port of call for minor illnesses. That recognises, importantly, the skill base in the sector. To that end, more than 2,800 pharmacists each year go into training at the current time; there are more than 10,000 in training at the moment. We are making sure that, as the current cohort come out, they are equipped to be part of that future high-skilled workforce, enhancing their skills for consultation and so on.

Jim Shannon Portrait Jim Shannon
- Hansard - - - Excerpts

One of the advantages that I am sure the Minister is coming to is that GP surgeries and A&Es will potentially have fewer people to see if the pharmacies take over that role.

Jo Churchill Portrait Jo Churchill
- Hansard - - - Excerpts

I thank the hon. Gentleman for that point.

We are already making good progress on the journey. The community pharmacist consultation service went live in November 2019, enabling NHS 111 to refer patients into community pharmacies for minor illnesses or the urgent supply of prescribed meds. We have had more than 750,000 referrals so far.

In November 2020, we expanded that service to GP surgeries, so GPs can now formally refer patients to community pharmacies for consultation. In February, we introduced the discharge medicines service, enabling hospitals to refer discharged patients into a community pharmacist for support with their medicines. There will be more services introduced over the financial year.

Those services are to do what pharmacists and their teams do best, and that is to help patients. My hon. Friend the Member for Southend West spoke about hepatitis C. I assure him that, as of last year, we gave access to hepatitis C testing to those pharmacies that chose to take up that option.

I agree with my hon. Friend the Member for Winchester that there is great potential in hub and spoke dispensing. I also agree with the hon. Member for Nottingham North (Alex Norris) that there is already experience to learn from in the sector.

As set out in the community pharmacy contractual framework five-year deal, we want to make dispensing more efficient and, by doing that, free up pharmacist time to provide more clinical services—they are highly skilled, and we know they want to do that. The Medicine and Medical Devices Act 2021 paves the way for us now to progress legislative change to enable the better use of skills in pharmacies, something that several Members this afternoon have alluded to. There is a large amount of will to make sure that the whole team can use their skills appropriately and perhaps free up the pharmacist a little more for him or her to concentrate on other areas.

We have already started informal engagement with stakeholders—that started this week—which will be followed by a formal consultation. I am afraid I cannot give hon. Members an exact date, but I will commit that I want that to be as soon as possible—I want us to get on with this. I thank my hon. Friend the Member for Winchester, who knows the sector extremely well, for his comments about the opportunities that lie therein. I am sure that many hon. Members will want to work to develop that.

New services will develop and expand the role of community pharmacy across three key areas. Several hon. Members alluded to the fact that pharmacies would be expert in helping with prevention, urgent care and medicine safety and optimisation. Those are all areas in which growth is envisaged in the short, medium and longer terms.

That brings us to the pressure. I am well aware of the pressures community pharmacies are under. Not only has the last year brought quite unprecedented circumstances, but it has not allowed some things to go on that we thought would be embedded by this point. Throughout the last year, we have had conversations with community pharmacy and stakeholders, and have tried to respond as best we can by putting in place a package of measures and support for the sector.

Most community pharmacies have been able to access some general covid-19 business support, including various rates reliefs and some retail, leisure and hospitality grants, and we estimate that there has been access to about £82 million in grants. There has been extra funding for bank holiday openings, when—particularly looking back to last Easter, for example—the sector has responded phenomenally by remaining open and giving patients access across long holiday periods; for a medicines delivery service for shielded patients, which has been mentioned and has been hugely appreciated; and for a contribution to ensure that social distancing measures can be in place in every pharmacy.

We are still talking, however. We have provided personal protective equipment free of charge via the PPE portal, and have reimbursed community pharmacies for PPE purchased. We have also provided non-monetary support, such as the removal of some administrative tasks, flexibility around some of the opening hours, support through the pharmacy quality scheme for the sector’s response to covid-19, and the delay to the start of new services, all of which have been requested.

Between April and July 2020, an advance payment of £370 million was made to support community pharmacies with cash-flow pressures, which were extremely acute. Those were caused by several issues, including a sharp increase in prescription items in the March-April period, higher drug prices, delayed payments from the pharmacy quality scheme, and extra covid-related costs. Acting swiftly and providing those advance payments helped to alleviate immediate cash-flow concerns, but since then pharmacies have been paid for the increased items that they have dispensed, reimbursement prices were increased to reflect higher drug prices, and payments have been made under the pharmacy quality scheme.

We are still in discussions with the PSNC about the reimbursement of covid-19 costs incurred by community pharmacy, and I can reassure the House that the Government will take a pragmatic approach. I expect to deduct any agreed funding from the £370 million advance payments, and to discuss timescales around the advance separately with the PSNC, being very mindful of the pressures. We need to assure ourselves that community pharmacies are financially stable. Without that stability, they cannot deliver those services.

I am aware of the concerns that current funding is not enough, and I need to work with the sector to look at things in much more detail, because pharmaceutical services are complex, and there is a range of different providers. The hon. Member for Nottingham North mentioned that he has a Boots in his constituency, but that is a very different operation from many of the individual pharmacists, such as Tim, who has a pharmacy on the harbour in the constituency of the hon. Member for Isle of Wight.

Whether they are independent, small-chain or large-chain pharmacies, no two pharmacies are the same. The solution has to be one that we can tailor. A balanced and considered approach must be taken to maintain the variety and vibrancy that we all recognise as absolutely key in the pharmacy network. People and patients absolutely value the diversity that best suits them and their own needs. We need a sustainable funding model that works for all types.

I have heard the concerns about pharmacy closures, and I can assure Members we monitor the issue very closely indeed. Our data shows that, despite the number of pharmacies reducing since 2016, there are still more than there were 10 years ago. We have seen more closures in deprived areas, as many Members have said. However, importantly, there were more in deprived areas, so making sure that there are still more pharmacies in deprived areas is extremely important.

Proportionally, the closures reflect the spread of pharmacies across England, with closures tending to be where they are clustered. The most recent data shows that three quarters of the closures were part of large chains, and that aligns with consolidation announcements made before the pandemic. It is important that we protect access to pharmaceutical services. The pharmacy access scheme protects access in areas where there are fewer pharmacies and higher health needs so that no area is left without access to a local NHS pharmacy.

It is important to recognise that covid-19 is also an opportunity, which many Members have alluded to. The pandemic has shown across healthcare the value of our highly skilled community pharmacy teams, and how they can contribute and receive more funding. Commissioning community pharmacies to operate the medicines delivery service has been vital to ensure that vulnerable constituents have received their medicine. Community pharmacies have delivered the biggest flu vaccination programme ever, vaccinating more people than ever before.

There are currently around 200 pharmacy-led covid-19 vaccination sites, with a target to double that number by the end of this month, and there have been 60 more this week alone—on many of the questions around vaccines, I will defer to the Minister for Covid Vaccine Deployment. I expect more to follow, and NHS England is looking to designate more pharmacy-led sites, including sites that can deal with up to 400 vaccinations a week in areas where there were not sites that could deal with large quantities of vaccine, which initially put some sites off.

We are considering the important role of community pharmacy and how that can play out in future as we learn to live with covid-19 and having vaccinations. In addition, community pharmacies are taking part in pilots of antigen testing at lateral flow test collection sites. If those are successful, community pharmacies will be able to provide a valuable service to their local area and will be paid to do it.

The community pharmacy continues to be part of local PCNs, and I know it stands ready to take its full part in primary care as we learn to live with the disease. Those examples show how community pharmacy is helping the broader healthcare family fight covid-19. The Government are keen to make better use of the clinical skills, while giving pharmacies opportunities to generate more income above the £2.5 billion per year that the five-year deal went to—and there are opportunities.

Finally, I once again thank my hon. Friend the Member for Thurrock for this important debate. The past year has tested all pharmacies, and the following months will continue to be challenging. I am personally committed to doing everything I can to support all community pharmacies in what I view as their essential role as part of the NHS family, which, again, many have spoken of. This is a responsibility on all of us. Pharmacies bring incredible value to local communities and their patients. We are beginning to see the light at the end of a troubling tunnel, and we would not have made it this far without the contribution from community pharmacy. I look forward to having the conversation to ensure that we get a sustainable funding model not only with colleagues but, mainly, with the sector.

Jackie Doyle-Price Portrait Jackie Doyle-Price
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No one watching this debate could be left without the impression that our pharmacists are regarded with huge respect and affection, not just by Members of Parliament but by our constituents. We heard the Chancellor say that the NHS will get everything it needs to fight the pandemic, but it is fair to say that some of us feel that pharmacists have perhaps not been treated as fairly as they should be. I recognise that that is fully connected with the future sustainability of pharmacy, and I look forward to having this debate again in due course.

Question put and agreed to.


That this House has considered community pharmacies and the effect of the covid-19 outbreak.

Graham Brady Portrait Sir Graham Brady (in the Chair)
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In order to allow the safe exit of hon. Members participating in this item of business and the safe arrival of those participating in the next, we will suspend until half-past 3.

Sitting suspended.

Patients with Heart Failure

Thursday 11th March 2021

(3 years, 3 months ago)

Westminster Hall
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[David Mundell in the Chair]
David Mundell Portrait David Mundell (in the Chair)
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I remind hon. Members that there have been changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will also be suspensions between each debate.

I remind Members participating physically and virtually that they must arrive for the start of debates in Westminster Hall. Members are expected to remain for the entire debate. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically should clean their spaces before they use them and as they leave the room.

Jim Shannon Portrait Jim Shannon (Strangford) (DUP)
- Hansard - - - Excerpts

I beg to move,

That this House has considered quality of life for patients with heart failure.

It is an absolute pleasure to serve under your chairmanship, Mr Mundell, and I look forward to this debate. Believe it or not, I applied for it this time last year. It has taken that long for the opportunity to come round. It does not matter that it did not happen in March or April last year; I am pleased that it is happening now. That is the important thing.

I am very pleased to see Members virtually and in person. I look forward to the contribution from the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders). It is a pleasure to see the Minister. I have already enjoyed her company for an hour and a half, and now I will enjoy it for another period of time. We will see how we get on.

I am delighted to have been granted this important debate and I am particularly pleased to see Members from across the House present to take part in it. Heart failure is a progressive, long-term condition affecting nearly 1 million people across the United Kingdom of Great Britain and Northern Ireland; nearly 20,000 people have been diagnosed with it in Northern Ireland alone. I am my party’s health spokesperson, so I am pleased to present the case, and as we are on the UK mainland, I ask the Minister to respond.

I am pleased to see the hon. Member for Birmingham, Selly Oak (Steve McCabe). He and I had an opportunity to observe an operation at St Thomas’ Hospital. I was telling the shadow Minister about it. I will not go into the details, but the hon. Member for Birmingham, Selly Oak will remember it well. The operation was on someone who was having a stent put it. I thought we were going to have a wee chat, and was not fully aware that we were going to see it. When I got there, I suddenly found out. We were in the blue surgical gowns, had the body armour on and were present as the gentleman had his operation. The hon. Gentleman was more prepared than I was; he survived it, and I just about survived it. So, we have seen that in person, and I am sure the hon. Gentleman will make a valuable contribution later in the debate.

Around 98% of people in this country who have heart failure live with at least one other long-term health condition, and many have complex care needs. Living with heart failure means that the heart cannot pump blood around the body as effectively as it should, and it usually occurs as a result of a heart attack, high blood pressure or congenital heart disease, though there are other causes. As people get older, their bodies get weaker. I hope you are an exception, Mr Mundell. I myself am on a list of tablets, and during the last debate, about pharmacies, I knew my tablets were in my pocket, and I was thinking about them when the Minister was speaking, so I know what it is like to live with a disease. In my case, it is high blood pressure and diabetes, not heart disease.

At present, it is not possible to cure heart failure, as there is no way to repair damaged heart muscle, so people with that condition can live their lives dealing with severe fatigue and shortness of breath, among other symptoms. A young lady called Tara Loughlin from Ballyclare was diagnosed with heart failure at the age of just 41, as the result of a rare heart muscle disorder. Tara had symptoms such as breathlessness and extreme fatigue for years. She visited her doctor multiple times with those symptoms. Only when she felt very unwell one day and was referred for an echocardiogram, which is an ultrasound scan of the heart, did she receive the diagnosis of heart failure.

Unfortunately, a significant delay between identifying symptoms and a diagnosis of heart failure is common for many people with the condition. I will speak about that more as we go forward. Life changed forever for Tara, who is a keen runner and loves nothing more than walking her dogs or working up a sweat in Zumba classes. People might think that Tara looks well from the outside, but in fact she battles extreme fatigue and wakes up exhausted and breathless. She gets severe fluid build-up in her hands and legs, to the point where she cannot wear jeans. Tara says this gets her down. Before, she loved clothes and going out, but she is now forced to wear looser clothing and stay home. She said she has still not come to terms with her diagnosis, and the same is applicable to many other patients across the United Kingdom.

Sadly, around half of people diagnosed with heart failure in the UK will die within five years of the diagnosis, but that can be improved; we can do better. With early diagnosis and access to the right treatment, care and support, people can manage their symptoms. Perhaps the Minister will tell us something about that in her response—I look forward to hearing what those things might be. They can have a better quality of life and live longer, which has to be good news.

That, however, has not been a reality for many people with heart failure, which is why the debate is being held —to look at those people who might not be getting what they need. At the end of my speech, the Minister will have heard the four questions that we are asking, and I hope she will be able to respond. We might ask a few more on the way; we do not want to let her off with just four, if we can help it.

As we all know, health services across the country are under unprecedented pressure, and I express my deep gratitude to all frontline staff who work tirelessly to provide care to people who urgently need it. It is vital that we do not lose sight of people with heart failure who may not be able to access the care and support they need at this time, and who may become more unwell as a result. The same is true of other things—for example, cancer has been a big issue, and the Minister understands that disease better than most—but I seek clarifications and reassurance on heart failure.

In 2016, the all-party parliamentary group on heart disease made 10 recommendations to improve heart failure care in England. Its inquiry highlighted issues and opportunities across the patient pathway, including the need to raise awareness of heart failure among generalist medical professionals, so that they understand it. I know that they are experts, but they deal with lots of problems. It would also be good to improve the information given to patients at the point of diagnosis, and to ensure that all patients can access the specialist care needed from a multidisciplinary team. They should also be able to access rehabilitation services and timely palliative care.

Unfortunately, insight gathered by the British Heart Foundation and others suggests that progress has been slow in realising the recommendations. Perhaps the Minister will reassure us about the 10 recommendations made by the APPG in 2016. Services are still not always joined up or consistently addressing the needs of people with heart failure across the patient pathway. That variation starts at diagnosis.

We always say that diagnosis is so important—it is critical—but many people are still diagnosed late and in inappropriate settings. Research shows that although 40% of heart failure patients display symptoms that should trigger an assessment in primary care, as many as 80% of heart failure cases in England are diagnosed in hospital. That can lead to worse outcomes and higher mortality rates. Why has that happened? That is one of the questions that we want to ask.

Staffing shortages and variable access to echocardio- graphy—a key tool for diagnosing heart failure—in primary care and the community are just some of the reasons for late diagnosis. Again, we seek from the Minister some assurance that such issues are being addressed. N-terminal pro B-type natriuretic peptide testing—a blood test that helps in the diagnosis of heart failure—is another key tool, but it is still not routinely available or appropriately used in primary or secondary care settings across the country.

Heart failure can also be challenging to diagnose. What is happening on that? Are we are seeing an improvement? I look forward to the Minister’s response. I know her well, and I am quite convinced that we will get the answers we seek, which will help to alleviate some of our fears and concerns. Symptoms are variable and can be confused with those of other conditions, meaning that it is easy for those without specialist expertise to miss the signs of heart failure. I sometimes wonder how that can happen, but it can, because of the system that we have. Better training of generalist healthcare professionals and improved access to key diagnostics will be critical to improving outcomes, while early intervention allows people with heart failure to live with a better quality of life for longer. I gave an example of that earlier. Their quality of life can be better, and they can live longer as well.

There is also significant regional variation in the quality of care patients receive following admission to hospital; the percentage of patients seen by a specialist is reported to be 100% in some hospitals in England and Wales but less than 40% in others. Why the variation? Specialist input during admission is key, because it increases the likelihood that patients receive the drugs and referral to ongoing support that they need. It is important to note that the audit does not include data from hospitals in Northern Ireland, as this is obviously a devolved matter, although the National Institute for Cardiovascular Outcomes Research seeks the participation of our hospitals back home for future reports. I intend to follow up on that, and I will replicate every question I ask the Minister here to the Minister who has responsibility for this in Northern Ireland.

Regardless of where a person is diagnosed, National Institute for Health and Care Excellence guidance recommends that heart failure be managed by a multidisciplinary team with relevant expertise to optimise medications, provide the necessary information about heart failure and its treatment, and refer patients to other services, such as rehabilitation and palliative care, as needed. Again, it would be helpful to know from the Minister exactly where the multidisciplinary team plays its role.

Hospital data shows that, in 2018-19, only 41% of patients discharged from hospitals in England and Wales were recorded as having relevant follow-up with a member of the multidisciplinary team within two weeks of discharge. That figure concerns me. We need reassurance that that shortfall is being addressed, and that, in the long term, a much larger number of patients will have that treatment and this problem will no longer occur. Access to multidisciplinary team-led care is vital for improving outcomes for people with heart failure. As well as treating the acute episodes that bring someone with heart failure into hospital, it is really important that healthcare services treat each person as someone living with a long-term condition, giving them the tools to self-manage and access routine care in community settings.

Only 13% of patients admitted to hospital were referred to cardiac rehabilitation services at the point of discharge. Many of these services have been severely depleted by the pandemic. I understand the pressures that the Minister and the Government are under, and I know how hard they work to try to address these issues, but that really is a small number, so we need reassurance on that. I found evidence that some people are even disappearing, and others are moving online. Perhaps the follow-up is just not done in the way that it should be.

Rehabilitation services offer a range of support for patients, including exercise to improve cardiac function, advice on living healthier, and psychological and peer support. How important is peer support? It should be there, if at all possible. It is the family around the patient who give them the help that they need. Many people with heart failure who have been referred to rehabilitation services describe them as having a major positive impact on their wellbeing. Many rely on these services to help them exercise safely and to provide the emotional, psychological and physical support needed.

Very few people with heart failure are referred to palliative or hospice support, or are referred late. This is partly due to the disease trajectory of heart failure. Many patients can experience several acute episodes, after which they recover, making it hard to know when they are truly at the end of their life. This means that end of life care decisions may be made late for many heart failure patients, which limits the time for advanced care planning, and increases the chance that professionals without the necessary palliative care skills will deliver inappropriate care at the end of patients’ lives. I find that disturbing—we all do—but it tells us that we have to look at this issue. This reduces the chances of patients having their wishes around their end of life treatment being met.

Although these statistics are not published by nation, it is concerning to see that referrals to cardiac rehabilitation services are low, and that conversations about end of life care are not starting as early as possible during a patient’s heart failure journey. This disrupts their chances of receiving the care they need and of their wishes being met at this critical time. To avoid this, we must stop treating each healthcare touchpoint in isolation. By focusing on the person and taking a full pathway approach, we can avoid disjointed care and better address all care needs, including psychological support and end of life care. Clear leadership across the whole pathway is vital.

Strong leadership in heart failure services has led to significant improvements in care in Scotland. I often look to the Scottish health system with a purpose, because it is always good to share. They have some advantages and have taken good steps—I welcome that. The Scottish Heart Failure Hub is working to raise the profile of heart failure among decision makers and spread best advice across the nation. This has allowed it to respond quickly to the impact of coronavirus. Health services across Northern Ireland, England and Wales must follow suit, identify strong leaders of heart failure services, and give the resources needed to drive change across the pathway, both nationally and regionally.

Despite improvements in heart failure therapies over the past two decades, the risk of premature mortality remains high among heart failure patients. There are inequalities linked to characteristics including age, ethnicity and gender, and details such as geographical location and socioeconomic status. The variability in mortality can be linked to how quickly someone is diagnosed with heart failure and the severity of their condition at diagnosis, the number of times that they are readmitted to hospital, and whether they receive support following discharge.

Socioeconomically deprived groups have consistently worse outcomes than the most affluent. They face a 20% higher risk of hospitalisation, even after adjustment for other factors. This inequality has persisted for several decades. Again, I ask the Minister, what has been done to address this continual problem? Access to important services, such as rehabilitation and other relevant recovery and support services in primary care and the community, can also vary as a result of demographic factors, geographical location and socioeconomic status. It is vital that comprehensive demographic data be collected, so that we can better understand the inequalities in access to care and healthcare outcomes. This will help those with worse outcomes to receive better care. Government, and the Minister in particular, must act to ensure that no one is receiving substandard care just because of their age, ethnicity, or gender, where they live, or their economic status.

It is likely that the coronavirus pandemic has exacerbated all the issues that I have talked about—we all know that. Little did we know this time last year, when we were coming into the covid-19 episode, that we would still be in it a year later. I certainly did not. We all thought that the summertime would be better, but that was not the case. The Government’s strategy and response, here and in the devolved Administrations, together with the vaccine roll-out, has enabled us to look forward with positivity. I give the Government credit for this: there is no doubt in my mind that the Government pushed that and made it happen. From the regional point of view, we in Northern Ireland thank them. Over 600,000 of our people from Northern Ireland have had their covid-19 jab. On Monday coming, at 20 minutes to 5 in the afternoon in the Ulster Hospital, I will have my covid-19 jab. I will go and get the other one about eight weeks later.

While the NHS has rightly prioritised providing urgent and emergency care, the redeployment of clinical staff, combined with the need to maintain social distancing, has resulted in a significant amount of routine care and treatment being postponed. I understand that, but the question is: how do we address the problems that are being caused even now?

The postponed care and treatment include routine appointments that allow for review, opportunities for medication optimisation and access to treatments to prevent the exacerbation of conditions. These are the interventions that enable people with heart failure to maintain a good quality of life, and without them we risk patients becoming more unwell, adding to urgent and emergency care needs, and to a rapidly growing backlog of people for health services to deal with as we come out of the pandemic. That is being seen not just with delays to treatment, but with delays to diagnosis. Again, the issues are very clear.

Although we do not have figures for Northern Ireland, figures from NHS England show that completion of echocardiograms—as I mentioned before, these are scans that can detect heart failure, so it is very important for people to have them—fell by around two thirds, or 67%, in April and May 2020, compared with February 2020. While I understand that there was some improvement throughout the rest of 2020, for which I give credit, can the Minister say whether we have caught up yet and matched the figure from before the pandemic?

The use of echocardiograms has struggled to return to pre-pandemic activity levels, meaning that waiting lists have remained long—perhaps even longer than they should have been. As a result, thousands of heart failure diagnoses are likely to be delayed or even missed, with potential implications for people’s long-term health and quality of life.

The fall in the number of people presenting to hospital with heart failure has also been dramatic, dropping by 41% in England as we entered the second wave of the pandemic. I believe that there is limited information about how these missing patients may or may not have accessed care and support during this period. It seems that many people with heart failure have fallen through the cracks since the pandemic began, adding to the picture of disrupted and fragmented care. Again, I seek an answer to this question: has the Minister any figures or statistics that can identify these missing patients?

While some parts of the country lost heart failure services altogether during the first wave, due to redeployment of heart failure specialist teams to the initial covid-19 response, other parts maintained a skeleton service. The impact on services, combined with the continuing reduction in capacity to deliver face-to-face care, has meant that many people with heart failure have struggled to access the support that they need.

Organisations such as the British Heart Foundation—I work quite closely with it; indeed, I think it works quite closely with everyone—have stepped in to provide information, for example through the BHF’s heart failure online hub and heart helpline. It is vital that people can access the health and care services they need to live well during, and indeed beyond, the pandemic.

The BHF has highlighted in its report, “Heart failure: a blueprint for change”, that one of the main problems is that there is a lack of co-ordinated data outside hospital settings, and particularly in primary and community settings. This has meant that a significant proportion of the heart failure community has been largely invisible to the system during the pandemic, and opportunities to drive real system change have been lost. Again, the information and statistics that the BHF has been able to gather show that many people with heart problems went missing during the pandemic.

The covid-19 pandemic has clearly exposed the huge inequalities in care that people have been experiencing for years. I believe that now is the time for stakeholders across the health service and the Government, and parliamentarians, to come together and seize the opportunity to build back better. I want to ensure that each and every one of the 860 people diagnosed with heart failure in Strangford in the last year, and the thousands more across the United Kingdom of Great Britain and Northern Ireland who have received a similar diagnosis, has the opportunity to live a better quality of life, and that we all have an opportunity to create better outcomes for everyone living with this condition.

I have four asks—indeed, I made a few asks throughout my speech and I know that the Minister has been writing them down. However, there are four key asks that I hope the Minister will respond to at the end of the debate. I will conclude with them.

First, system leaders must take a full pathway approach to improving services. By focusing on the person and taking a full pathway approach, we can avoid disjointed care and provide better support for patients, including addressing their psychological and emotional needs, from diagnosis to end of life.

Secondly, we must stop just treating the acute episodes that bring someone with heart failure into hospital, and instead treat each person as someone living with a long-term condition, providing them with the tools to manage their condition and access routine care in community settings.

Thirdly, leadership across the pathway will be vital. Recruiting heart failure champions at regional and national levels—it is really important that we do this—will help to strengthen leadership and accountability for services, and lead to significant improvements in care.

Fourthly, collecting more reliable, comprehensive and timely data across the whole pathway could break down the barriers to improving heart failure services and drive real system change. I do not know how many debates the Minister and I have been at, but the issue of data comes up continuously. That data will prove where we need to focus the attention, and I think that is what we are likely to do.

In conclusion, for too long people with heart failure have not been given the chance to live well with their condition, and the pandemic has disrupted opportunities to make that a reality for more people. I believe we owe it to those people to finally address this issue and give everyone the opportunity to live well for longer. I thank those who are going to speak for their participation, and look forward very much to the Minister’s response.

Steve McCabe Portrait Steve McCabe (Birmingham, Selly Oak) (Lab) [V]
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It is a pleasure to see you in the Chair, Mr Mundell.

As chair of the newly formed all-party parliamentary group on heart valve disease, I congratulate the hon. Member for Strangford (Jim Shannon), a co-founder of that new all-party group, on securing the debate. The aim of the all-party group is to increase awareness of heart valve disease in the United Kingdom, and help ensure that patients receive timely diagnoses and the optimal management and treatment of their condition.

Heart valve disease affects approximately 1.5 million people in the UK. As we have heard, patients can experience fatigue, shortness of breath and chest tightness and/or pain. The most common form of heart valve disease is aortic stenosis, which affects about one in eight people over the age of 75. Unfortunately, awareness and knowledge of the condition in the general population is alarmingly low: in a recent survey, only 3.8% of people really knew what aortic stenosis was. People with heart valve disease have poor survival rates without prompt treatment, and longer waiting times inevitably lead to worse outcomes. However, as we have heard, heart valve disease is a very treatable condition, particularly if patients are diagnosed early.

The all-party group receives secretariat support from Heart Valve Voice, with which I have worked closely on several projects. Most recently, I have been working with Wil Woan, its chief executive, on the “100,000 Conversations” initiative, a campaign focused on improving awareness by encouraging people to discuss their condition with friends and relatives, particularly the symptoms, as well as access to diagnosis and treatment. I should perhaps confess that I had open heart surgery for a repair to my mitral valve back in 2012, and so feel very familiar with many of the issues people raise. I recently had the opportunity to hold one of these conversations with the shadow Health Secretary, my right hon. Friend the Member for Leicester South (Jonathan Ashworth), and I know Heart Valve Voice would be delighted if I could persuade the Minister to also take part in one.

We are also working on a campaign called “Just Treat Us”, which concentrates on encouraging patients to see their doctor if they are experiencing symptoms such as breathlessness, dizziness or fatigue, as well as encouraging care centres to treat patients, especially as the country starts to move out of lockdown. A simple stethoscope test is often all that is needed to identify a heart valve problem. Delaying treatment leads to worse outcomes, but with timely treatment, people can go back to a good—or even a better—quality of life.

As we have heard from the hon. Member for Strangford, covid-19 has had a significant impact on the investigation and care of people with heart valve disease, as with many other conditions. It has been reported that 100,000 fewer heart operations were carried out in 2020 compared with 2019. It has also been reported that 45,000 cardiac procedures have been cancelled.

When I had my mitral valve repaired, I was in an operating theatre for over seven hours. I was in intensive care for three days and spent another two weeks in hospital, and it took me approximately six months to fully recover. Transcatheter aortic valve implantation—TAVI— has been introduced as an alternative therapy to replace damaged aortic valves in patients who are considered high risk for traditional open-heart surgery. The procedure is less invasive, and patients can be discharged from hospital in a short period, allowing them to return to normal life while also saving hospital resources. As the hon. Member for Strangford said, he and I once witnessed a transcatheter procedure carried out on an 85-year-old gentleman at St Thomas’s. He had a local anaesthetic and was largely alert during the procedure. He was able to return home and was working on his allotment within three weeks of the procedure.

The “Valve for Life” initiative, run by the European Association of Percutaneous Cardiovascular Interventions, aims to promote transcatheter valve interventions, which could be crucial in rapidly reducing the waiting list that has been built up during the covid-19 crisis. It has four main goals: to raise awareness of valvular heart disease; to facilitate access to new therapies, such as TAVI; to increase educational standards; and to reduce obstacles to therapy and discrimination in access to care. The overall objectives of “Valve for Life” are to address inequalities in patient access and the disparities between countries in Europe, as well as to inform Government officials, healthcare administrators and healthcare providers about the clinical and economic value of transcatheter heart valve therapies in the management of valvular heart disease.

The UK has the second lowest rate of TAVI procedures per million people in Europe. Even within the UK, there is a large geographical disparity regarding access to treatment, as I think we heard earlier. We are very lucky in this country to have Dr Daniel Blackman, one of our leading interventional cardiologists, spearheading the campaign to raise the volume of transcatheter procedures. As we learn the lessons from the pandemic, I hope this is one area where we might be willing to entertain new thinking.

Heart valve disease is extremely common among older people and will obviously continue to place huge demands on our health service, but with early diagnosis and increased use of TAVI procedures, it need not be a killer. Indeed, it need not impair the quality of life. I hope that in the months and years ahead we can work to increase the use of new treatments and interventions, so that those suffering with heart disease can, in large part, look forward to a long and productive life following timely treatment and prompt rehabilitation support. Once again, I thank the hon. Member for Strangford for securing the debate and for making such an informed contribution.

Patricia Gibson Portrait Patricia Gibson (North Ayrshire and Arran) (SNP) [V]
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I echo the comments just made. I am very grateful to the hon. Member for Strangford (Jim Shannon) for securing this debate and for the comprehensive exposition with which he started it.

A debate on heart health matters to many of our constituents who live with heart conditions. My father died in 1969, when I was 15 months old, of a heart attack in Hamilton where he had been working, collapsing and dying at Hamilton Cross, leaving my mother widowed with eight children. I looked on helplessly as my stepfather collapsed and died in the hallway of our home with a heart attack in 1985, when I was 17 years old. That is something I will never forget.

Sadly, too many of those who have lived with someone with compromised heart health could recount similar experiences. Sadly, in my family the deaths were caused by lifestyle factors, but it is important to remember that the most important factor in such disease and premature deaths is poverty. Ultimately, it is poverty that kills, whatever may be written on the death certificate. We really need to be mindful of that.

About 1 million people across the UK and 48,000 people in Scotland have been diagnosed with heart failure. There are around 200,000 diagnoses of heart failure every year in the UK, with some evidence to suggest that the burden of this terrible condition is increasing and is now similar to the four most common causes of cancer combined, in terms of the scale of the challenge. The British Heart Foundation estimates that around 230,000 people in Scotland have been diagnosed with coronary heart disease, more than 700,000 with hypertension and around 48,000 with heart failure. Heart and circulatory diseases are killing three in every 10 people in Scotland.

Some 98% of those in the UK diagnosed with heart failure live with at least one other long-term condition, such as diabetes or chronic obstructive pulmonary disease. As we have heard this afternoon, the signs of heart failure are there if you know how to recognise them: breathlessness, frequent and excessive tiredness, swollen ankles or legs, perhaps a persistent cough, a fast heart rate and dizziness. If anyone has these symptoms, it is very important that they go to their GP.

It is often the case that the underlying causes of heart failure are heavily influenced by lifestyle factors, which can cause heart disease and high blood pressure, although we have to be aware of genetic inheritance and the fact that some people are born, unfortunately, with congenital heart difficulties. While treatment is available, there is no real cure, but the important thing for us all to do is to do the best we can to live as healthy a lifestyle as possible. However, as we have heard, the scale of this illness is significant and demands our attention.

Those living with heart failure can find their lives limited in ways that detrimentally impact their quality of life. They may experience various physical and emotional symptoms, such as dyspnoea, fatigue, oedema, sleeping difficulties, depression and chest pain. These symptoms limit the daily physical and social activities of those living with heart failure and result in a poor quality of life. That, in turn, often corresponds with high hospitalisation and mortality rates.

I am pleased that the Scottish Government are taking action to tackle heart health problems and will publish an updated heart disease improvement plan later this spring, which will make sure that there is equitable access to diagnostic tests, treatment and care for people with heart disease in a timely manner. This must remain a national priority. In addition, £1 million has been invested in the heart disease improvement plan, supporting important work such as that led by the Heart Failure Hub and the cardiac rehabilitation champion. The recent publication of the British Heart Foundation Scotland strategy document has been welcomed by the Scottish Government, who are keen to work with the British Heart Foundation.

As we begin to hope that we can emerge from this health pandemic, we cannot forget the stark health inequalities that were exposed and exacerbated by covid-19. The disproportionate harm caused by covid-19 to a number of groups in our communities, including those with cardiovascular disease, has highlighted new vulnerabilities and underscored existing health inequalities. That is why the Scottish Government in their recent Budget delivered an increase of more than £800 million on health spending, bringing overall health funding to a total of £16 billion, with an additional investment of more than £1 billion to address pressures related to covid-19. A significant proportion of those resources will be spent on caring for those with heart disease. I urge the UK Government to match Scottish Government spending per capita on health and social care.

I shall end where I began, by saying that the answer to many of our health problems, and even our social problems, is to do all we can to build a more equitable society. If we can do that, fewer adults will develop heart failure and other serious life-limiting conditions. There will be fewer folk whose health prevents them from being economically active. We will have children who can reach their full potential if the chains of poverty and poor health outcomes can be broken. Health outcomes are driven by poverty and our health is the key to the kinds of lives that each of us can live, the kinds of opportunities that we can create for ourselves, and the kinds of paths that we can follow. As with so many things, we could make much greater inroads into this and other health inequalities if we were to tackle at source, with more vigour and determination, inequality born of poverty. As we begin to emerge from the pandemic, I hope that the Minister will reflect on the fact that there is no better time than right now to look afresh at how our society works, to make it better for everyone.

Justin Madders Portrait Justin Madders (Ellesmere Port and Neston) (Lab)
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It is a pleasure to see you in the Chair this afternoon, Mr Mundell. I want to add my congratulations to those offered to the hon. Member for Strangford (Jim Shannon), on securing the debate and on his persistence in getting it almost a year after he first requested it. It is important to discuss the quality of life for patients with heart failure. I thank the hon. Gentleman for his excellent introduction, and for raising many issues, many of which are similar to those that I want to talk about. I add my thanks to those he expressed to people working in the NHS, for the wonderful care that they provide.

I also thank my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) for his contribution and congratulate him on the formation of the new all-party parliamentary group on heart valve disease. He spoke about the initiative for 100,000 conversations, which sounds like an excellent way of drawing attention to the issue. Indeed, he brought his own experiences to the fore, which can only help in drawing more attention to the matter.

It is important to discuss heart failure. It is a progressive, potentially life-limiting condition, and there are a number of potential causes; coronary heart disease, high blood pressure and diabetes can all contribute. It can manifest in a number of different ways, including, as we heard, shortness of breath, fatigue and sometimes swelling of the lower limbs. It can occur at any age and the example that the hon. Member for Strangford gave from his constituency was of someone at the lower end of the age bracket. However, heart failure is of course more common in older groups.

As we have heard, there are currently an estimated 920,000 people living with heart failure in the UK, with around 200,000 new diagnoses every year. That is a significant number of people, by any calculation. Nearly all of those people—98%—will also have at least one other long-term health condition. Sadly, about half of all people diagnosed with heart failure die within five years of their diagnosis. Heart failure is a common cause of unplanned hospital admissions, with more than 110,000 of those each year. The rate of such admissions increased by nearly a third in the past five years, and now nearly one in 17 hospital visits in England can include a heart failure diagnosis as either a cause or a contributing factor.

That of course means that the issue puts a considerable burden on the NHS. The Lancet reports that

“the burden of heart failure in the UK…is now similar to the four most common causes of cancer combined.”

It accounts for 2% of the total NHS budget, and around 70% of those costs are due to hospitalisation. I should add the caveat that that clearly does not include covid, which we hope will not be something we must deal with on an annual basis at the level we have had to for the past 12 months.

The British Heart Foundation says that, despite improvements in heart failure therapies over the last two decades, the risk of mortality for patients with heart failure remains high, with the inequalities that we have heard about linked to age, ethnicity, gender, socio-economic status and geographical location. Those inequalities can affect the entire patient pathway, from how quickly someone is diagnosed, which of course, as we have discussed, has an impact on the severity of their condition, to the number of times they are readmitted to hospital and whether they receive the correct support in the community following their discharge from hospital.

For example, while the National Institute for Health and Care Excellence reports the average age of diagnosis as 77, according to the British Heart Foundation it falls to the age of 69 for people from black and minority ethnic groups, and to the low 60s for people from the most economically and socially deprived backgrounds. In 2021, that is simply unacceptable.

Looking more closely at diagnosis, as with many serious health conditions, early diagnosis can of course save lives, yet sadly it is still too often the case that patients are diagnosed late. In a hospital setting, that means they are more likely to have advanced disease, and therefore face poorer outcomes. Research from Imperial College shows that eight in 10 diagnoses of heart failure in England are actually made in hospital—for example, when a patient is admitted with a life-threatening episode of breathlessness—despite four in 10 people presenting with potential symptoms, such as fluid retention or breathlessness, to their own GP. That could have triggered an early assessment or diagnosis in a different care setting.

NICE guidelines for diagnosis and management have been in place for over a decade now, but the British Heart Foundation reports that they have not been universally implemented, meaning that heart failure services remain variable across the country. When there are national guidelines in place, it really should not be something that we have to address, and we need to do better.

Moving on to admission, we know that specialist input during admission is vital to ensuring that patients receive the care that they need. It leads to fewer deaths in hospital and fewer deaths after discharge. Heart failure cannot be cured, but there are treatments that can keep symptoms under control, such as healthy lifestyle changes, medication or devices implanted in a person’s chest. Those treatments not only prolong life, as we have heard, but can improve quality of life, relieving symptoms and improving overall enjoyment and participation in life. Some of the most common symptoms of heart failure—breathlessness, fatigue and fluid retention—really matter on a day-to-day basis for people’s quality of life.

Some treatments can limit physical function, leading to withdrawal from activities and social contact. They can cause psychological problems. Being aware of our own mortality obviously can have an impact, leading to sleep disturbance, depression and anxiety. Many things flow from such a diagnosis that cannot be underestimated. It is therefore vital that we look at all of the pathway in terms of a patient’s journey, so that they receive the best possible specialist care and treatment throughout, to ensure that their quality of life can get better following a diagnosis.

We know from the heart failure audit carried out by the National Institute for Cardiovascular Outcomes Research in 2018-19 that the percentage of patients seen by a specialist ranges from as little as 40% in some hospitals to 100% in others. That can continue following discharge, when many patients are unable to access or are not offered the care and support, such as rehabilitation and relevant recovery and support services in primary care in the community, that they need in order to continue to live well.

Again, unfortunately that is particularly true for those in socially and economically deprived groups, who have consistently worse outcomes than those in more affluent groups and are 20% more likely to be hospitalised. According to a population-based study by The Lancet, that has not changed in decades. We should be ashamed that we are still talking about it today.

This is before we even start to consider the impact that covid has had on such vital services, which, as we would expect, has been significant. NHS England data shows that during the first wave of the pandemic the number of echocardiograms fell by around two thirds in April and May of last year, compared with February 2020, and it has since struggled to return to pre-pandemic levels. During the second wave, the number of people presenting to hospital with heart failure also fell dramatically—by some 41% from the beginning of October to mid-November.

We should be worried about that, because we know that late diagnosis has long-term implications for health and quality of life, but also because we do not know whether these missing patients have accessed care and support during this period or whether they have simply fallen through the cracks. Then there are the indirect effects on patients who are already in the system who face reduced access or delays because their care has struggled to meet what we would normally expect in a non-pandemic situation.

We know the reasons for that: staff had been redeployed; there is a need to maintain social distancing in clinical settings; there have been changes to the way services operate; and a significant amount of routine care and treatment for heart failure patients has been postponed, including routine appointments just to review their condition and their treatment or medication to ensure that they are able to live well. The backlog has come about for a number of reasons. We know that services across the board were already severely strained before covid-19 hit us. The shutdown of non-covid services, combined with drastic changes in patient behaviour, means the NHS is now facing a large backlog of non-covid-19 cases.

We also know that stricter infection control measures mean that, as we hopefully move out of the pandemic, there will still be a reduction in the number of patients able to go through hospital. That backlog could actually take longer to work through than we would otherwise expect it to. All this matters because we know that diagnosing people with heart failure earlier and getting them into the specialist care as soon as possible not only cuts emergency admissions, but relieves overall pressure on the NHS. It also improves the quality of those individuals’ lives, giving them the opportunity to live well for longer.

We are thankfully past the peak of the virus, we hope, although we know the pressure that the NHS is still under. We know the number of patients in England waiting over a year for routine hospital care is now 130 times higher than before the pandemic, and there are now 4.5 million people waiting for NHS treatment. This could take years to address, and of course, as we have discussed many times in the past few weeks, our healthcare workers are exhausted. They are struggling with the long-term consequences of giving care during the pandemic, with one in four doctors having sought mental health support during the pandemic. The staff survey that was released today gave some alarming statistics about how our NHS workforce are feeling at the moment.

It is vital that we come up with a realistic plan to tackle the backlog in non-covid care, which is something we have called for. I hope the Minister can set out how the NHS, and heart failure services in particular, will be able to recover from the pandemic, now that hospitalisations for covid are beginning to decrease. We know that the long-term plan already identifies cardiovascular disease as a clinical priority and commits to supporting people with heart failure better through improved rapid access to heart failure nurses, so that more patients with heart failure who are not on a cardiology ward will receive specialist care and advice. It is welcome that the Minister has confirmed that these are priorities from the number of written questions we have seen her answer recently.

We know that there are shortages across the NHS workforce. The 2018 audit of heart failure nurses showed that the biggest concern was the significant case load that they are having to manage, with demand on services increasing without further resources being provided. Can I ask the Minister to set out in her response what steps she will take to increase the number of heart failure nurses to meet this commitment? Could she also update us on the number of heart failure patients who actually have access to a specialist heart failure nurse?

The Minister will be aware that a report from the Public Accounts Committee in September was highly critical of the Government’s approach, finding that a long-term plan was not supported by a detailed workforce plan to ensure the numbers and types of nurses that are needed across the board. It also found that the removal of the NHS bursary in 2017 failed to see the increase in student numbers that we would have liked to see and that the Government had said would occur.

We are also still waiting for publication of the substantive long-term workforce plan, which we all want to see deliver a lasting solution to recruitment and retention in the workforce, ensuring that there are enough skilled staff to provide the care that we all want to see. Again, I would be grateful if the Minister updated us on when we might see that plan. The long-term plan also commits to greater access to echocardiography in primary care to improve early detection. Will the Minister update us on what steps have been taken to improve that access?

I will say a few words on data, which the hon. Member for Strangford mentioned. The only nationally available mandated dataset for heart failure is the heart failure audit, which collects data about hospital admissions, symptoms, demographics, access to diagnostics, specialist input, types of treatment, and mortality. Unfortunately, that data is not linked to primary community data, and local systems struggle to get their own data back out of the audit to inform their local decision making. We need a comprehensive dataset that is accessible and useable for clinicians in a timely manner. It should include the comprehensive demographic data that we need to understand inequalities in access to care and in outcomes, as well as an expanded range of data to include primary community care, allowing clinicians and system leaders to get hold of the analysis that I think we all want to have. Will the Minister tell us a little more about what is happening on the adequacy of data collection, and whether there are any plans to expand the collection of data across primary community care settings?

As we know, many medical research charities have made dramatic cuts to their research budgets because of fundraising shortfalls in the last year. The Minister will be aware that the medical research charities reacted with some disappointment to the comprehensive spending review, which committed to £14.6 billion in research funding, but failed to ring-fence any of that for medical research charities and did not provide any long-term assurances of funding for the sector. The British Heart Foundation, whose research all Members appreciate and rely on, has had to reduce its spending by half in the last year. Are there plans to support those medical research charities in meeting the shortfall that they will have to find after the last 12 months?

Jo Churchill Portrait The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
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It is a pleasure to serve under your chairmanship, Mr Mundell. I thank the hon. Member for Strangford (Jim Shannon) for securing the debate, and for his tenacity in waiting a year before we could be here to discuss what is an incredibly important subject. He is right: it is vital that we keep this serious disease on the agenda.

I was interested in the comments from the hon. Member for Birmingham, Selly Oak (Steve McCabe), who was also in the Chamber with us for the last debate, about his own experience in 2012. I am glad to see that he is a living testament to how well people can recover from heart incidents with the right treatment and in the way they live their lives.

Although in recent years we have made enormous progress in understanding more about heart disease, I acknowledge that it remains high on the list of biggest killers in England, and there is still a lot of work to do. I would like the hon. Member for Strangford to extend my good wishes to his constituent Tara, about whom he spoke. Key to improving the quality of life that we want to see for everybody is ensuring that those who are diagnosed younger and who probably do not have the co-morbidities that we have spoken about in others have access to those good services.

We must, in particular, ensure that we intervene earlier, that we have the right care, and that we have the right rehabilitation services and support. I hope to explain what we are doing, and I am more than happy to have further conversations with the hon. Members for Strangford and for Birmingham, Selly Oak in their capacity as chairs of the APPG, and knowing their keen interest in health matters in particular.

I want to extend my thanks to all those on the frontline who have worked so hard, particularly in the area of cardiac services. They did recover, but they have dropped again during this second wave, so we know there is work to do. Heart failure is a key priority for NHS England and Improvement. One ambition in the NHS long-term plan is to raise awareness of the symptoms of heart failure and to ensure early and rapid access to diagnostic tests and treatments. The British Heart Foundation report found that people are still concerned and worried about coming forward, so if anyone is worried about any symptoms, I very much urge them to come forward. The NHS is open and is here to help.

NHSE has a programme of work to support the ambition, overseen by clinical professionals from across the country. It remained a priority during the covid-19 pandemic. We know that cardiac rehabilitation saves lives. It improves the quality of life and reduces, as several Members have said, the hospital admissions that occur when people do not access services. In scaling up and improving the promotion and awareness of cardiac rehabilitation, we aim to improve quality of life and to reduce hospital admissions.

In the long-term plan we set out steps to ensure that by 2028 the proportion of patients accessing cardiac rehabilitation would be among the best in Europe, with 85% of those eligible accessing care. It is a long way from where we are now and will need a lot of hard work in the intervening years. We estimate, however, that this will prevent up to 23,000 premature deaths and 50,000 acute admissions over a 10-year period. NHS England and NHS Improvement is developing cardiac networks that will support the regional delivery of the long-term plan ambitions and address the regional variations in health inequalities that the hon. Member for Strangford alluded to throughout his speech.

The long-term plan also commits to improving rapid access to heart failure nurses so that more patients with heart failure who are not on a cardiology ward can receive specialist care and advice. Better personalised planning for patients will reduce nights spent in hospital and also reduce drugs spend. NHSE is accelerating some of the positive lessons learnt from the pandemic, such as the enhanced use of digital technology for cardiac rehabilitation and the greater application of remote consultations, enabling us to bring forward the delivery of some of the ambitions for patients with heart disease.

NHSE is working with Health Education England to develop a new e-learning for health course, which aims to support healthcare professionals in learning more about heart failure and heart valve disease so that they can better recognise the symptoms of heart failure and diagnose, manage and support patients further. We anticipate this will be made available on digital platforms in late summer this year, so they are working at pace.

We are also establishing community diagnostic hubs to more rapidly diagnose heart failure patients, which will include echocardiograms, blood tests and NT-proBNP testing, making sure that that NT-proBNP testing is available to all general practices.

Hon. Members will be aware that high blood pressure can often be a component factor of heart failure. To increase support for people at greater risk, NHSE plans to increase the number of people who have access to remote blood pressure monitoring and management. The NHS at home programme remains committed to addressing health inequalities, and we have introduced targeted blood pressure monitoring systems for patients who are clinically extremely vulnerable and have high blood pressure, including individuals from black, Asian or ethnic minority backgrounds in areas of high deprivation. We are making sure that we target communities who are worst affected because, as we know, the statistics are often worse in areas that are socially and economically deprived and where health inequalities are greater.

We are also targeting those aged over 65 because age is a large component here. This intervention will allow people to monitor their blood pressure from their home, which is something that we know they prefer, and to avoid trips to their general practice by communicating results to their primary care clinician via a digital platform or, for those who may not have access, a phone call to the practice. From April 2021, a further 198,000 blood pressure monitors will be available for primary care.

The NHS at Home scheme is a self-management scheme to enable patients with heart failure and heart valve disease to look after themselves in their own home. However, they will work with a specialist clinician, and patients will be supported to understand their medications, how to reduce their salt intake, and how to monitor and record their daily weight and blood pressure, as we know that fluid retention is associated with the disease. They will also be helped to recognise—this is really important—symptoms if their condition is deteriorating, so that they seek help in a timely manner. We know that many people wait too long before they reach out for help and services.

Where patients have suffered heart failure, doctors, nurses, the valuable pharmacists who we spent the previous debate talking about, and allied health professionals can provide support to patients in the multidisciplinary teams that the hon. Member for Strangford spoke about. It is anticipated that this will lead to a reduction in hospital admissions and increased quality of life, which is a key component, with better patient and carer knowledge about how to manage their condition. It will also improve primary, community and specialist team communication.

From 1 July 2019, all patients in England have been covered by a primary care network, and the development of the primary care network directed enhanced service for cardiovascular disease prevention and diagnosis is ongoing, with the phased implementation of new PCN services expected in 2021-22. This emphasises the importance of early diagnosis in the management of patients with heart failure and heart valve disease in primary care, in line with the published NICE guidance.

The quality outcomes framework—QOF—is an annual reward and incentive programme for general practice surgeries in England. Although the specific requirements were stepped down in 2021 to release general practice capacity in order to support the pandemic response, I am pleased that the QOF will be returning later in 2021. This will include the updates that were previously agreed to support moves towards earlier diagnosis and management. GP surgeries are asked to capture data in order to evidence that they have fulfilled the QOF requirements, which encourage the earlier confirmation of heart failure diagnosis and improve pharmacological management.

As several Members have said, data is absolutely key in this space for making sure that we know where patients are and that they are being managed. I am pleased to say that this update also means that patients with heart failure can have an annual review in order to enable better management of their care, which goes to the point about making sure there is sufficient contact. NHS England has had sight of the British Heart Foundation report and thanks it for sharing it, and I have been assured that the national medical director has written back on the matters that were included.

I hope that I have demonstrated that the Government, the long-term plan and the workforce have a key ambition to improve the lives and health outcomes of people living with heart failure in this country. Everybody has to play a part, including the individual. As the hon. Member for North Ayrshire and Arran (Patricia Gibson) said, lifestyle plays an important part, so making changes that can help prevent heart failure—healthier eating, reducing salt intake and exercising more—is particularly important. As several hon. Members have said, it is often a disease with comorbidities, and many of those changes will help health overall.

We can all agree that this agenda really matters. Once again, I thank the hon. Member for Strangford for highlighting this important issue. If we continue to make an impact on the lives of people with heart failure, there will be significant benefits for the NHS and, mostly, enormous benefits for those who are affected. To conclude, I say to people that, if they have any of the signs—breathlessness and so on—or any worries at all, they should come forward to seek help.

Jim Shannon Portrait Jim Shannon
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First, I very much thank the hon. Members for North Ayrshire and Arran (Patricia Gibson) and for Birmingham, Selly Oak (Steve McCabe). The hon. Gentleman in particular referred to the APPG which was started up four or five weeks ago. We look forward to working with many others, and we will probably hold an inquiry about providing a better quality of life.

I am quite friendly with the hon. Lady, but I did not know that her father and stepfather both died from heart failure, which is a very personal thing. She also mentioned poverty and socioeconomic status—to which the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders) and I referred, and the Minister responded—and how that can impact on way of life, affecting us all. She also referred to tackling at source inequality and poverty. We all heard the Minister respond and how she understands that.

I thank the shadow Minister very much for his contribution. He, too, referred to the social and economic backgrounds in which people are severely impacted; to the pandemic’s impact on heart failure; and to late diagnosis, which we all realise is an issue.

In particular, I thank the Minister very much. I always do, but I mean it, because that was a very comprehensive response. We are all heartened by that. You would not have given me the time, Mr Mundell, to go through all the things on which the Minister responded, but what she said was marvellous—quickly, the cardiac rehabilitation input, the community diagnostic hubs, the NT-proBNP community specialists, the primary care network NICE guidelines and the GP surgeries gathering the data. As the Minister, the shadow Minister and we all said, data is very important—with the data, we can focus the strategy on where we want to be.

There are life changes to make and so a role for us all to play, including me. I am a diabetic today, because of my lifestyle. I did not know what I was doing—or I did not know until too late—and it was all that Chinese food, plus two bottles of Coca-Cola. I would not recommend it. My sugar levels were extremely high. Add a bit of stress to that, and all of a sudden, someone becomes a diabetic. I am guilty of that, but I am saying that we all therefore have a role to play.

I thank everyone for their contribution, you for your patience, Mr Mundell, and the Minister in particular for a comprehensive and helpful response. We appreciate it.

Question put and agreed to.


That this House has considered quality of life for patients with heart failure.

Sitting adjourned.