Westminster Hall

Thursday 14th September 2023 Westminster Hall

Thursday 14 September 2023

[Martin Vickers in the Chair]

Backbench Business

Thursday 14th September 2023 Westminster Hall

Support for Kinship Carers

Thursday 14th September 2023 Westminster Hall

13:30

[Munira Wilson (Twickenham) (LD)]

I beg to move,

That this House has considered the matter of support for kinship carers.

It is a pleasure to serve under your chairmanship, Mr Vickers. I start by thanking the Backbench Business Committee for granting this important debate and by welcoming the many kinship carers who are here listening. The last two times that I led a debate on kinship care, the Children’s Minister resigned shortly after—literally within days—but in an exciting plot twist, this time the Children’s Minister got a promotion the week before, so perhaps things are looking up for the new Minister. I welcome him to his place.

On a serious note, I launched this campaign in Parliament in July last year and the hon. Member for Wantage (David Johnston) is the fourth Children’s Minister I have engaged with on this issue since then. I know that his brief covers so many important areas. I really hope, for the sake of our country’s children, that we will get some stability now and that we will be able to progress—on opposite sides of the Chamber, and also by working together on some of the critical issues facing children up and down the country. I know that the Minister has an extensive and long-standing interest in children’s policy, so I look forward to seeing him hit the ground running. We are all looking to him to ensure that the upcoming kinship care strategy will be delivered before the end of the year, as his Department has promised.

The last debate that I led on this issue was in this Chamber 11 months ago. I set out many of the themes and issues that are in my ten-minute rule Bill from July last year, so I want to focus on the upcoming strategy as well as revisiting some of the themes that we have talked about consistently.

I acknowledge some of the progress that has been made over the last year in getting the Government to acknowledge kinship. In their response to Josh MacAlister’s independent review of children’s social care—the Government document was called “Stable Homes, Built on Love”—we finally saw an acknowledgement by Government of kinship and kinship carers. In the document, there was recognition that

“kinship care has received little national policy attention”

and that

“too little support is given to extended family members who play a caring role for their young relatives.”

When the previous Children’s Minister made the statement in the House of Commons, I was really heartened by the number of Members on both sides of the House who spoke about kinship care. It was the first time that I had heard so much attention given to this important issue, which has too often been overlooked.

The MacAlister review was the crucial moment in putting kinship carers on the map, kick-starting what has happened. It recognised that, with the right help, housing a child in crisis with family or friends they know and love will often be the best outcome for them. We know that, every year, thousands of grandparents, aunts, uncles, siblings and family friends step up in this way, and they do so instinctively, out of love, despite the huge personal sacrifice involved. We know that children in kinship care have equal or better mental health, education and employment chances than looked-after children. With my Bill, I sought to press the Government to implement several of the MacAlister review’s recommendations.

I am delighted that, since then, kinship carers have shared their stories numerous times on breakfast TV and local radio. An ITV documentary highlighted their plight. My right hon. Friend the Member for Kingston and Surbiton (Ed Davey) shared, on Sky News, his moving story of growing up in kinship care, and I am really proud that in March this year, at the Liberal Democrat spring conference, Lib Dem members approved as party policy a lot of what was in my Bill about allowances, leave, pupil premium plus and having a statutory definition of kinship care.

Kinship care is on the Government’s lips and in the media spotlight in a way that it rarely has been. It has been a pleasure to work alongside these carers, the Family Rights Group, Kinship and other MPs in making the case that kinship care is worth investing in—saving the taxpayer in the long run. It would be remiss of me if I did not also acknowledge and thank, from the bottom of my heart, Andrew Burrell from my team, who is here today and has been the driving force in my office behind this work. He is leaving my office in a couple of weeks, and a lot of what I have done would not have been possible without his expertise and dedication, so I am very grateful to him.

Ministers are finally beginning to listen, and the attention given to kinship care in “Stable Homes, Built on Love” is hugely welcome. I am sad to say, however, that the document was policy-lite, with commitments to merely “explore the case” for greater financial support for kinship carers, and to pilot new “family first” decision making in just seven council areas. Other announcements were kicked down the road into the kinship care strategy promised by the end of the year, but, as the cost of living crisis bites, too many children in kinship care cannot afford to wait. There is a serious risk to children’s outcomes and the public finances if kinship care does not get the investment that it needs. The MacAlister review warned that, with no action, almost 20,000 more children will be in local authority care by 2032, costing the Treasury an extra £5 billion.

In recent months, Kinship has seen a significant increase in the complexity and severity of cases to its advice and support line. In its 2022 “The Cost of Loving” survey of more than 1,000 kinship carers, out of the three quarters who said that they were not getting the support they needed, one third said that they may not be able to continue caring for their children as a result.

The need for change is becoming increasingly urgent. We need the Government not just to acknowledge the love that kinship carers provide, but to value it, invest in it and step up for those who are struggling.

[Sir George Howarth (Knowsley) (Lab)]

I congratulate the hon. Member on securing the debate and the very eloquent way in which she is putting the case. Does she agree that if what she described were to happen to that one third, it would be a disaster not just for those families and the care system, but for the taxpayer, because it would require a very expensive solution to a problem that we could resolve by other means?

[Munira Wilson]

Absolutely, and I am grateful for that intervention, because the right hon. Member makes a case that I have made throughout, whenever I have talked about kinship carers: the Government cannot afford not to provide this support. The analysis shows that if we paid kinship carers a similar allowance to foster carers, for every child that we prevent from going into care, the Government would save £35,000 a year. It is a no-brainer because of both the short-term savings to the Treasury and the long-term savings, in terms of the more positive outcomes that we achieve for those children.

So what opportunity stands before us with the national kinship care strategy? It provides a key opportunity for the Government to deliver financial and educational support to children in kinship care that will be truly transformative. Kinship carers cannot wait for another spending review or a different colour of Government.

My Kinship Care Bill, introduced last year, had four main asks, and I hope that the strategy will make significant progress towards implementing each one. First, all kinship carers should have a weekly allowance at the same level as the national minimum fostering allowance. Many experience severe financial hardship. Kinship’s survey last year found that two in five kinship carers had avoided putting the heating on, one in five skipped meals and more than one in eight used food banks. A national, non-means-tested allowance would end the system of patchy, means-tested allowances that reflect a postcode lottery in the support that councils can afford to provide.

[Mr Robin Walker (Worcester) (Con)]

I apologise for missing the beginning of the hon. Lady’s speech, but I know that she has campaigned very effectively on this issue. Does she not agree, though, that the particular challenge with means testing in this space is that so many kinship carers are grandparents? They are retired and they have savings, but they need those savings for themselves and their retirement. It is vital that we have a system of support that recognises that particular challenge.

[Munira Wilson]

Absolutely, and that is why we need a consistent system applied across the board that is not dependent on the political persuasion of a local authority or what means it has to support kinship carers. I have come across many grandparents who are using up their life savings and people who might be about to retire and are having to quit the workforce sooner than they wanted. Kinship carers come in so many different shapes and sizes. That is why a proper means-tested allowance and national rules governing that is so important. The critical thing is that money should not be a barrier to a family or a friend taking in a child who is part of the wider family, because such barriers can lead to a child being forced into local authority care.

Secondly, kinship carers should be entitled to paid employment leave on a par with adoptive parents. Kinship’s “Forced Out” survey found that four in 10 kinship carers had to leave work permanently and a further 45% reduced their hours after becoming a kinship carer. Those carers are disproportionately women and are over-represented in healthcare, education and social care, which simply exacerbates our workforce crisis in public services.

Thirdly, the Bill proposes extending greater educational support to children in kinship care such as pupil premium plus, virtual school heads and a higher priority in school admissions.

Fourthly, there should be a definition of kinship care in statute that will help carers and councils to better understand who a kinship carer is and what support they are entitled to.

The Government’s response so far on the first of the three core asks has been disappointing, and “Stable Homes, Built on Love” has provided little hope. The Government have simply said they will “explore the case” for a mandatory financial allowance for kinship carers who possess a legal order. I am intrigued to understand more from the Minister about what “explore the case” means. Perhaps he will shed some light on it today. Will we see a cost-benefit analysis and an impact assessment? Are civil servants working actively on the issue, or are we talking about a couple of emails and phone calls?

I am pleased that the Government have adopted wholesale the definition of kinship care that was proposed by the Family Rights Group and have put it out for consultation—it was the same definition that I used in my Bill. However, the definition will have clout only if it is put into legislation and has statutory rights or entitlements attached to it. Simply putting it into guidance will likely not resolve the poor recognition and understanding of the term.

We cannot have another strategy that ducks the big decisions and kicks them into the long grass. Even if the plan has no spending commitments, which would be an absolute disaster, there are some steps that the Government could take to significantly improve the lives of kinship carers.

On data, our ability to make the case for greater investment in kinship care is greatly hampered by confusion over how many children live in kinship care and where kinship carers work. The latest estimate that 152,000 children in England live in kinship care comes from a University of Bristol analysis of the 2011 census.

In April, I wrote to the UK Statistics Authority to ask whether the Office for National Statistics intended to publish figures from the 2021 census. It replied that the Department for Education formally requested data on kinship carers earlier that month and that it would provide an update on that later in the year. I understand that that data might be published later this month. Will the Minister confirm that? Will it include information on the demographic make-up of kinship carers and their labour market patterns?

Meanwhile, parliamentary questions that I tabled reveal that, although the Ministry of Justice publishes how many special guardianship orders and child arrangement orders are granted each year, it does not know how many children are currently subject to one. What more will the Minister do to ensure that his Department, the Ministry of Justice, and local authorities have accurate information on the number of children in kinship care?

On therapeutic care, I know how important the adoption support fund was to my constituent, Kim, who used it for her granddaughter’s attachment therapy. However, Kim was in the uncommon position that her granddaughter was previously looked after before she went into kinship care. That meant she was entitled to ASF and also to pupil premium plus. As I told the House during my debate in October, that creates a totally perverse incentive for families to allow children to go into care so that they can receive additional support. Will the Minister review the eligibility criteria for the schemes so that more children in kinship care can qualify? Could the name of the adoption support fund be changed to acknowledge that kinship carers can also apply?

On legal aid, the Department has committed to

“work across government to explore…options for an extension of legal aid with kinship carers with SGOs and CAOs.”

Again, I would be grateful if the Minister explained what “explore” means as we seek to plug the gaps in legal aid provisions, particularly when children’s services first reach out to prospective kinship carers.

The Government must remember that one in three kinship carer households is non-white. Ethnic minority children in kinship care are less likely to have a legal order. I recognise that a legal order may signify that the caring arrangement will be stable and permanent. However, if the Government restrict all their support to children in formal kinship arrangements, they risk widening ethnic disparities. Will the Minister confirm that the strategy will be accompanied by an equalities impact assessment, so that the risk can be mitigated?

This debate comes in the context of increasing anxiety about the financial stability of many local authorities across England. As we have seen in the press lately, some are in a catastrophic position with their finances. The strategy must not impose on local authorities various well-intentioned duties, pilots and instructions to change their culture without giving them the resources to implement them effectively.

I will end with a reminder of why we are all here and of the families whose lives we are trying to improve. Kim was one of the first kinship carers in my constituency to contact me. She is the special guardian of her granddaughter. She says of her experience:

“We are fortunate to have an understanding of the system now and can advocate for our granddaughter. However, the emotional, financial and physical price has taken its toll! Even 5 years into our Special Guardianship Order and with the help that we have been able to access, my granddaughter really struggles with any change…On a personal level, we have had to give up our roles as grandparents and become her parents. We have done so gladly but there are moments when we do grieve for those lost roles that we will never get back.”

April, which is not her real name, spoke to me about caring for her nephew after his mother passed away. She says:

“Little did I know that [by] giving my sister peace of mind as she faced leaving her small children, and [by] giving my nephew the security and care he desperately needed, I was unwittingly stepping into a ‘private arrangement’ with zero support.

We want to focus on the positives. It is a positive [that] we’ve got a new family member. But if we have to worry about financial things or [other] support…We don’t want to have to do that. I want to give him the very best childhood.”

Many of the kinship carers who are watching the debate from the Gallery will have similar testimonies. Indeed, last year I hosted an event in Parliament for kinship carers and heard many moving stories. I also met kinship carers in Sutton a few months ago. Although every story and every family is unique, the themes I have set out today, including the barriers and challenges kinship carers face in the system, are often a common thread. People are so exhausted from fighting against them.

I invite right hon. and hon. Members to come to tea in the café after the debate with me and the kinship carers here today to hear at first hand about their experiences. They and I now look to the Minister to make sure that the upcoming kinship care strategy will be truly transformational. By stepping up for kinship carers, we support every child to get the very best start in life, no matter what their background.

[Martin Vickers (in the Chair)]

Only one Back Bencher has applied to speak, so I invite others to bob if they wish to take part.

13:49

[Caroline Ansell (Eastbourne) (Con)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I congratulate the hon. Member for Twickenham (Munira Wilson) on securing the debate and bringing to the attention of the House all the costs of being a kinship carer, as well as illuminating the tremendous value they represent and the real difference they make to the children they bring into their immediate family and circle. I also congratulate her on her speech. I join her in paying tribute to the new Minister, who has a strong background that touches on all the issues we may consider today, most notably performance in school, outcomes and achievement. He will also be looking to ensure that the children in our care have every opportunity to thrive.

I pay tribute to the Government for bringing forward the kinship care strategy, with the tremendous potential therein to bring the sector into a much more sustainable and fair place. They have acknowledged that historically the sector has not had the focus and recognition it deserves, merits and needs, so I really welcome the sea change that we all hope to see. I praise East Sussex County Council for the work it does in this space—indeed, its support was recognised by the kinship carers I met most recently—and I pay tribute to the council’s team as they endeavour to meet the challenges and support kinship carers across East Sussex, and Eastbourne in particular.

The hon. Lady is right to recognise that across the House there is not just increasing recognition of this kinship care but an earnest desire to see change and reform. Ultimately, this place is all about creating the environment in which this youngish generation can rise up and take their place. We are all about the business of making the world a better place, and enabling children who, for all sorts of reasons, cannot and should not stay with their parents to move to the security, love and continuity offered often by their grandparents, but also by their wider family, is surely a really important policy objective for us to try to achieve. As she said, we must ensure that finances are never the barrier, because in my estimation, if a child can remain within the love of their family, it is the very best place for them, in many instances, to recover, and then thrive.

We know that, over and above almost every other circumstance or opportunity, the support of family is defining. We know that applies to every child from every background and every socio-economic setting. It is a defining factor in physical health, mental health, educational outcomes and life chances, so every effort should be made to try to secure the wider family stepping up to welcome in children who, for all sorts of reasons, cannot and should not stay with their parents.

In that light, the urgency that the hon. Lady described is the question of the day. We are agreed that family represents the best opportunity for children, and that kinship carers have been overlooked for too long. That urgency and pace is before us, so we await the strategy and for a number of recommendations to find form. The scale of the challenge is deep and wide, with 162,000 children cared for by their kin across England and Wales. To give a measure of the scale and scope of this sector in the shadows, that is more than double the number in foster care.

As we have heard, grandparents are of course the most common kinship carers, but grandparents increasingly have to work until later in life. The tension and the pressure of working is one very real barrier and obstacle to their being able to reach out and provide a full-time home to a child. There are perhaps more children in private arrangements that are not included in the official figures, and in such cases finance and support do not find their way to them. The census has really important information, which I hope will soon come to light, to help us to understand the scale and scope of the challenge before us.

On the financial issue, one of my constituents who attended the meeting that I arranged with kinship carers told me that she fears losing her job; she cannot get the parental leave she needs to care for her granddaughter, but without her job she cannot provide for the granddaughter she wants to offer a full-time home to. That is an excruciating tension. And another constituent described the mental anguish caused by years of court battles.

In my constituency, there is a really strong support group led by Wendy Turner, who is here with us in the Public Gallery today, so in addition to recognising the hon. Member for Twickenham, the Minister, the Government and MPs from across the House, I most particularly recognise kinship carers themselves in this really important debate, because it is their stories, their testimonies, that will really and truly land the change that we all desire. I commend them for that.

[Mr Robin Walker]

I could not resist the opportunity to pay tribute to the local kinship care group in my Worcester constituency. Kinship Carers UK, which is led by Enza Smith, has campaigned hard on this issue and first drew my attention to some of the concerns. One of the issues that the group has raised is the status of kinship carers and recognition of that status, which I think is addressed in the Bill promoted by the hon. Member for Twickenham. There is a concern that when kinship carers take a child they look after for NHS care, they may not be able to take decisions in the way that a parent could. They can find it very difficult to work with the health service and other public services because of the distinction between parents and kinship carers. Is it not very important that we come up with a very clear definition of kinship carers and a clear way for them to identify themselves and their relationship to their charge, so that they can access all public services effectively?

[Caroline Ansell]

I thank my hon. Friend for his intervention; he makes an excellent point. Some means of recognition is needed, not only in healthcare but in all the different arms and institutions of public services, not least in schools, because recognition enables far swifter decision making, which is surely in the best interests of the child and those caring for them. There must be a way to achieve that recognition of status, and I look forward to the Minister telling us how such an innovation could help to rationalise the whole experience of kinship care, so that we can better address the challenges.

Interestingly, one of the members of the group of kinship carers that I met talked about guidance on how to navigate the quite complex bureaucratic situation in which they found themselves: they are responsible for a child, yet are not in a decision-making role. As an example, we spoke about a guide that had been established for the Homes for Ukraine scheme, interestingly enough, in which there was a step-by-step and issue-by-issue walkthrough to help people who were bringing Ukrainians into their home, showing them how they could navigate some of the complex systems that exist and where they could find support. The point was made to me that there is no handbook for kinship carers. There was simply a call, sometimes in the middle of the night, and then sometimes there was a social worker on the doorstep at any hour of the day, saying, “Over to you.”

Regarding some of the issues around passports and access to medical records, we can surely bring some sanity to bear on the bureaucracy, which just provides another layer of challenge and adds nothing to safeguarding or child protection. When we have put a child in the care of a family member, we should most certainly empower that family member to make decisions on behalf of the child. The point that my hon. Friend the Member for Worcester made in his intervention is very well made.

While their costs are no different and their challenges certainly of similar order, unlike foster carers the vast majority of kinship carers find themselves without a minimum financial allowance to assist with the covering of expenses. The current state of financial support for kinship carers is both insufficient and marked by significant variations, not always hinging on the specific needs of the kinship families, but rather being subject to legal and geographical disparities. If we bring a new understanding to bear, surely we can create something much fairer. The current system unintentionally—perversely even—encourages kinship carers to transition into foster carers, as this is often the sole path by which they can access reliable financial and other forms of support. That does not align with the best interests of the child. The repercussions, beyond the emotional and psychological, of this lack of financial support are profound and affect both families and the state. According to the 2022 annual survey report “The Cost of Loving”, six out of 10 kinship carers reported resorting to borrowing money, taking out short-term loans, or relying on credit cards for everyday expenses in the past year.

For every 1,000 children raised in kinship families rather than placed in local authority care, the state saves £40 million and enhances the lifetime earnings of the children by £20 million, so the statistics say. I know that there are very serious pressures on children’s social care, even in my own county. A mark of this is that, just this last financial year, for the first time the cost of children’s social services outweighed the cost of adult social care. This is a very significant development: not only has that cost now overtaken that of adult social care, but its trajectory is set to escalate exponentially. We know through our work on the Education Committee that the care sector is under massive pressure, to the point where providers in the marketplace are able to charge what they will, leaving county councils competing for places. Kinship care is, in part, an answer to that very real, sustained pressure on services. Surely it merits significant investment.

Before I came to this place, my career was in education, so I know the impact that family support can have on children and young people. It was too often the very parents I needed to speak to who did not come to parents evenings. Children who have been taken from mum or dad and out of the family setting for very good reasons have experienced trauma. The fact that that is not more recognised in school is, to my mind, a burning injustice. They experience challenges with their focus and stamina, and their ability to concentrate is affected because they come from a place of trauma. It is really that clear. They need additional support as urgently as possible, because with every year of lost learning, it is exponentially harder to recover and recapture that learning.

The effects of those early years can last a lifetime if we do not rush in with more support. Schools are the strongest partners for kinship carers when it comes to rescuing these children. I am hoping the Minister, perhaps today, but ultimately as we approach the strategy, will have some encouraging words around what new provision and recognition we might see in schools, because they are important partners too.

In addition to the financial support I have spoken of—the pupil premium plus—I long to see employment leave to facilitate kinship care, particularly at the start of the placement, legal aid to take the sting out of court battles, and recognition of the work of local authorities and a just settlement, so that they can more ably meet the needs of families in their areas. I look forward to seeing progress, recognition and investment for all of those things.

14:06

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Vickers, and to follow the hon. Member for Eastbourne (Caroline Ansell), who made some important points that I wholeheartedly support. I am also grateful to the hon. Member for Twickenham (Munira Wilson) for securing the debate and all the cross-party work that she does on the issue. She works incredibly hard in this area. I thank the Backbench Business Committee for granting the time.

It would be remiss of me not to welcome the new Children’s Minister to his post. I hope that he enjoys his time in the Department for Education, dealing with some important issues. Today it is kinship care, but there is also the wider issue of how we improve children’s services across England, because in too many parts of our country, children’s services are not just underperforming but letting children down. I hope that the Government take a close look at those local authorities that could and should be doing better for our children and young people.

I wanted to speak in this debate because not only am I the chair of the all-party parliamentary group on kinship care, but, as many Members know, my wife Allison and I are kinship carers to our grandson Lyle. We never planned on becoming kinship carers, but life can be unpredictable. Sadly, Lyle’s mum and dad were unable to care for him, and social services knocked on our door. We did not think twice—of course we would take him in; of course we would care for him. It was, and it is, one of the best decisions that I—that both of us—have ever made, probably apart from getting married, as otherwise the rest would not have happened.

We love Lyle to pieces. He is a little ball of energy and joy. He is four now, and has just started primary school. He is kind, caring, incredibly funny and just the right level of mischievous. That is why being a kinship carer is such a strange conundrum: on the one hand, you are given this gift, whom you love more than anything in the world. Every Thursday evening I race home from this place back to Manchester, because spending time with Lyle is the thing above all else that I look forward to.

[Caroline Ansell]

I thank the hon. Gentleman for giving way, because in my contribution I focused on the issues, challenges, setbacks and disasters, but I should also say that all the kinship carers I met spoke about love. That is how the conversations started: they spoke about their motivation to reach out and to protect the child, and how they would do anything and everything in their power to look after them.

[Andrew Gwynne]

The hon. Lady is absolutely right. I can speak from experience. Mondays and Fridays have now got even better for me because I get to take Lyle to the local primary school. He is loving his time there, especially now he has worked out that he gets fed—last week was the first week he was there all the time, and it came as a revelation to him that they fed him at lunchtime.

On the other hand, as we have heard in the previous two contributions, kinship care is also exceptionally hard. Kinship carers are essentially picked up and dropped into a legal and emotional labyrinth, with precious little support from anyone. Like many carers, Allison and I had to go through the family courts to obtain a special guardianship order, which gives us parental responsibilities so that we can make active decisions about Lyle’s upbringing and about precisely the things the hon. Member for Eastbourne mentioned—healthcare, school and passports. We have parental rights and can make those decisions for Lyle. We had to undergo hours and hours of assessment—really intrusive police assessment of not just me and Allison, but my children and my friends. It is a gruelling system that demands an extraordinary amount from all those involved.

There are also wider family implications. Children are raised in kinship care for a variety of complex reasons, including parental mental health problems, substance misuse or illness. A kinship carer often has to manage a sensitive family situation while fiercely protecting the health and wellbeing of the child they are caring for. They are given absolutely no formal emotional support. It is only thanks to organisations such as Kinship and the Family Rights Group that Allison and I have been able to speak with other kinship carers, build support networks and access advice. It is amazing, because you find that you are not alone and that virtually every other person in the system has, to a lesser or greater extent, gone through the things you are going through, which you think are incredibly traumatic and a massive upheaval.

Then there are the financial implications. Allison and I have spent thousands of pounds in legal fees since we became kinship carers, and we continue to do so. There is always the threat of being taken back to court umpteen times. That puts a carer under such stress, trauma and emotional and financial pressure while they are trying to care for and protect their loved one. Allison and I are lucky because we are in a financial position to be able to pay these fees, but over the years I have found myself asking pretty basic questions: What if we did not have that money? What if I lost my job? What if I did not have a platform? What then?

The answers to those questions are as depressing as they are concerning. Last year, the APPG on kinship care found that 38% of kinship carers surveyed had received no legal advice about their rights and options in relation to their kinship child. Where carers had received legal advice, just 16% had received part or full payment through legal aid. Of the kinship carers who ended up in court, almost a third had to represent themselves. Some 53% of carers have made personal contributions of above £1,000, with 9% accruing costs of £10,000 or more. To be frank, the system treats kinship carers as an afterthought. They are a convenient solution in a time of crisis, and then they are left to drift in a buckling system that does not seem to recognise their existence, let alone the love they have for the children they care for.

Studies consistently show that kinship care, where possible, is in the best interests of the child. It certainly is for Lyle, and it is for hundreds of thousands of children across the country. Research from the parliamentary taskforce on kinship care shows that behavioural, educational and emotional outcomes for children in kinship care are, on the whole, better than for children living with unrelated foster carers. Kinship care allows children to develop a strong sense of their own identity and a feeling of belonging that comes from the stability of living within their wider network of family and friends. Kinship care placements are 2.6 times more likely to be permanent than unrelated foster care arrangements. It is essential that we embrace the opportunities that kinship care offers and that we make it easier for families who want to be kinship carers to do so.

It is estimated that around 100,000 children will be in care by 2032, and we must prioritise things such as kinship care if we want to avoid that reality. However, without even a legal, inclusive definition of kinship care in legislation, there is a long way to go. I am glad the Government have committed to publishing a national kinship care strategy by the end of the year. I sincerely hope Ministers will listen to the voices of kinship carers and organisations such as the Family Rights Group and Kinship and develop a system that gives kinship carers not only the support they need but the recognition they deserve.

I get uncharacteristically nervous when this subject is debated in Parliament. It sometimes feels a bit too exposing and personal to speak publicly about it. The reality is that there are hundreds of thousands of kinship carers in the same position as Allison and me. We owe it to them to get this right. Above all, we owe it to the children being cared for—children such as Lyle, who deserve all the love, care and stability the world can give. Kinship care makes that possible, so let’s make it happen.

14:17

[Richard Thomson (Gordon) (SNP)]

It is a pleasure to serve under your chairship, Mr Vickers. I congratulate the hon. Member for Twickenham (Munira Wilson) on securing the debate, and I welcome everyone with an interest in kinship care who has made the journey to Westminster to hear it. Anybody who has done so or who is watching cannot fail to be moved by the powerful speeches that have been made by all the Members who have contributed substantively or made interventions to share their perspective.

I dare say I could fill a speech 10 times over with stories of the love, care and benefit that kinship carers bring to relationships. The only time I have had to consider this issue in my own context was in a discussion with my then partner about who, in an ideal world, we would like to look after our children if we ever found ourselves, for whatever reason, unable to do so. That was a challenging enough discussion, so I cannot adequately express my gratitude and admiration for those who step up when they are called on to do so, as we have just heard.

The UK Government are set to publish their strategy for kinship carers later in the year. The Scottish Government have published a number of strategies, which they are in the process of implementing. This is not a matter of geography, because the best place for a child to be brought up is not about geography. The best place for a child to live when they need to leave their birth parents is, wherever possible, in that wider family setting, if it is safe and in the child’s best interests to do so. Kinship care helps a child retain that sense of identity, family, heritage and background and can help them—in ways that other settings, with the best will in the world, simply cannot—to feel safe, protected and valued.

We have already heard about some of the challenges that kinship carers face—the number of legal processes as well as the financial expenses associated with taking on these important responsibilities—and often they did not plan to spend their future years fulfilling those responsibilities. All too often, despite the best efforts of Governments and agencies, the available support is not—and can never be—commensurate with the responsibilities that kinship carers are asked to fulfil.

The hon. Member for Worcester (Mr Walker) gave an honourable mention to an organisation in his constituency. My good and hon. Friend the Member for Airdrie and Shotts (Ms Qaisar) specifically asked me to mention Airdrie Kinship Carers, and the vital network it provides across north Lanarkshire to support kinship carers. It is important that Governments do all they can to ensure not only that individual kinship carers and wider family units are supported, but that the support networks out there are well funded and can operate within a framework of best practice.

Back in 2020, the Scottish Government committed to something that has been called “The Promise”. That was the report of the independent care review, which had the aim of ensuring that Scotland could be one of the best places in the world for care-experienced children and young people to grow up. That is an extremely high ambition, but it starts from a place of knowing that improvement was needed. In the seven preceding years, there had been six reviews of how Scotland cared for children, yet the recommendations—even though they were based on a range of evidence, knowledge and understanding—did not lead to the kind of wholesale change that was necessary.

In publishing “The Promise”, Fiona Duncan—the chair of the independent care review—spoke to the chairs of those previous reviews to take on their perspective on what had stalled things. The answers that came back are probably depressingly familiar: a lack of buy-in for change; insufficient resources invested in enabling the necessary change; in some cases, restrictive rules preventing change; people simply not knowing how to make the change; and much more.

That care review had to be different, and it started with an unwavering commitment to making sure that the care experience community would be at the very heart of its considerations, to ensure as full and proper an understanding as possible of not only how the care system operates, but how it feels to those in it and what children and their families truly need to flourish. On concluding its deliberations, the care review had listened to over 5,500 experiences. Over half of the voices were those of children and young people with experience of the care system. The review took into account the experiences of adults who had lived in care and lots of different types of families. The remaining voices came from the paid and unpaid workforce, whose stories guided the review and whose experiences shaped all its conclusions. As the UK Government set off down their own path of considering similar issues, I commend the work encapsulated by that document, and the resulting action plan, which might inform their work in taking forward the areas for which they are responsible.

As the chair, Fiona Duncan, said:

“It is clear that Scotland must not aim to fix a broken system but set a higher collective ambition that enables loving, supportive and nurturing relationships as a basis on which to thrive.”

Last year, the implementation plan was published. The Scottish Government’s approach reflected “The Fundamentals” set out in “The Promise”, which were:

“To do what matters to children and families

To listen and embed what we have heard from children and families

To tackle poverty and the forces that push families into it

To respect children’s rights

To improve our language”

when we are talking about the care settings.

Some key policy commitments have come out of this plan, including to invest £500 million in preventive spend over the course of the parliamentary Session through the whole family wellbeing fund. That is designed to deliver transformational change and service redesign in the totality of family support, with the aim of reducing the crisis intervention that needs to take place and contributing to the improvement of lives across a wide range of areas, including, but not limited to, child and adolescent mental health, child poverty, alcohol and drug use, and educational attainment.

There are also measures to support local areas to implement the national guidance on child protection, with £10 million invested per annum through the care experience grant—a new £200 annual grant for young people aged 16 to 25 who have care experience. The grant is intended to provide additional financial security for those young people and to help reduce some of the barriers they face in their transition to adulthood and more independent living.

As much as we would like to, it is not always possible for SNP spokespersons to stand up and say how much better we think we are doing, because we know that that is sometimes simply not the case. One area where we have been playing catch-up is in having a standard national allowance. Prior to its introduction, Scotland was the only part of the UK with no national minimum allowance for care support grants for kinship carers—allowances were provided by local authorities, but there was variability. That floor has now been set, which does not mean that local authorities cannot continue to pay more, but there is now a baseline in place. These payments can help people to meet the costs of clothing, hobbies and funding activities and school trips—all the things that help young people to feel included, and not excluded or in any way different. There is also the expansion of the legal definition of “kinship carer”, which has allowed more carers to benefit from the Scottish child payment. We can already see the difference that that is making to the lives of many, whether they are in kinship care or not.

I am acutely aware of the time; nevertheless, it would be remiss of me not to conclude with the words of Scotland’s then Deputy First Minister, John Swinney, in responding on behalf of the Scottish Government to the independent report. He gave this message to the children of Scotland:

“We want you to be safe with the people that you know and love. We want you to be healthy. We want to give you a good education. We want you to know and feel that you are loved.”

As we have heard, the role that kinship carers play in helping to secure those outcomes cannot be overestimated. I very much look forward to listening to the rest of this debate.

14:27

[Helen Hayes (Dulwich and West Norwood) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I congratulate the hon. Member for Twickenham (Munira Wilson) on securing the debate and on the work she does to raise the profile of kinship carers and the issues they face. We have had a high level of consensus in the debate. I welcome the kinship carers to the Gallery today. It is great to have them with us.

I also welcome the Minister to his place. I looked back at our previous debate on this topic about a year ago and I noted that I was welcoming the Minister’s predecessor’s predecessor, so I wish him luck as he hangs on to the revolving door that seems to be the Department for Education. I have no doubt that he will bring commitment to his role, and particularly to this topic, as we think about the needs of kinship carers.

I am grateful to all hon. Members who have contributed to this debate. The hon. Member for Eastbourne (Caroline Ansell) spoke of the pressures on grandparents and older kinship carers, who not only have to bear the costs of looking after children, but are required to expend all that energy in a role that they were perhaps not expecting to perform later in their lives. I was glad to hear her acknowledge the pressures in her area, the pressures on children’s social care more widely, and the grotesque profiteering by private providers of children’s homes and foster placements. I hope the Minister was listening to a colleague on his own side of the House speaking about those pressures, which affect the children’s social care system across the whole country. The pressures bear down on families, which results in increasing numbers of children having to enter the care system.

I pay tribute to my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) and thank him for all the work he does through the APPG on kinship care, of which I was a member until I took up my current role. It is not easy to speak about one’s own personal circumstances It is not easy to speak about one’s own personal circumstances, but he speaks so movingly about his role as a kinship carer for his grandson, Lyle. In doing so, he gives voice to kinship carers across the country, and he is a powerful and important advocate. As I have said before in this Chamber, Lyle is a very lucky little boy to have such fantastic grandparents as my hon. Friend and his wife.

I pay tribute to kinship carers across the country who step in to look after a child when a family member or friend is unable to do so, and to the Family Rights Group, the charity Kinship and the Kinship Care Alliance, which work to support kinship carers and to advocate on their behalf. Stepping in to care for a child when a close friend or family member cannot is an extraordinary and very special thing to do. Yet most kinship carers I have met do not describe it as a choice; they love the children in their care and stepping in to care for them when there was a need to do so was a natural consequence of that love. They would not have thought of doing anything else. It is always humbling to meet kinship carers and hear their stories. The unconditional love for the children they look after and the joy and pride they receive from being able to play a part in their lives is always clear to see—but so are the challenges.

Over half of kinship carers give up work to look after the children in their care. Some 75% of kinship carers experience severe financial hardship. The children have often gone through significantly adverse experiences such as bereavement, abuse or neglect. Looking after children in those circumstances requires support and access to professional help. Kinship carers themselves may also have suffered trauma: the loss of their own child, supporting their child on a journey of addiction, or other challenges that have led to a grandchild, niece or nephew being in their care in the first place. They are sometimes left to manage complex contact arrangements with birth parents. While kinship carers may be in suitable housing, in areas where there is a crisis in the availability of genuinely affordable housing, many will not be, and taking on kinship care may result in overcrowding in a family home that had previously been big enough to meet the family’s needs.

I have met kinship carers who are using their savings to care for children. I remember one grandmother in particular who was so committed to her grandson continuing to play football—it was the one thing he loved that helped with the trauma he had experienced—that she was dipping into her pension lump sum to pay for it, and to meet other costs as well. Support for kinship carers is inconsistent across the country. I recall another kinship carer who had taken on the care of her friend’s children. Contact arrangements with her friend were really fraught, but her local authority told her that because the arrangement was private, they had no role to play and could not support that process. These issues are widespread across the country. Some 180,000 families are in the same situation: they have stepped in to care for the children of a family member or close friend, but they find that enormous personal sacrifice and considerable extra cost are involved, often with little meaningful support.

In thinking about the needs of kinship carers, we must also look at why the number of children who cannot be cared for by their birth families is increasing. We cannot escape the Government’s record on this matter: the Family Rights Group has highlighted the erosion in early help and support for vulnerable families; more than 1,300 Sure Start centres have closed since 2010; and the National Children’s Bureau estimates that Government funding available to councils for children’s services fell by 24% between 2010 and 2020. The pandemic is likely to have made it even harder for councils to offer early intervention services for families. I have certainly been told by local authorities across the country that early help and support that was available more than a decade ago has all but disappeared in many places. The failure of the Government to ensure that early help is always available to the most vulnerable families, wherever in the country they live, has a direct bearing on the extent to which families are able to overcome challenges and avoid a crisis in which it becomes unsafe or impossible for children to remain with their parents.

[Caroline Ansell]

I too am most concerned about support for vulnerable families, particularly to help families stay together. I have some experience of Sure Start centres, and they are focused on those first few, very important, years. The family hub model, which the Government have brought in, looks to extend support from the early years of nought to five all the way through to 18. I know many parents struggle particularly in the teenage years, rather than with tinies. Does the hon. Lady recognise the work of family hubs, and does she have experience with them?

[Helen Hayes]

Certainly, the hon. Lady is right to say that the challenges facing children and young people have changed over the last decade, particularly those facing teenagers and the need for help and support. I absolutely recognise that point, but I would say to the hon. Lady that we had Sure Start centres in every community up and down the country at a very local level. In many places, they have all but disappeared. So far, the family hubs model funds a family hub in only half of all local authority areas, which does not meet the scale of the challenge. If Sure Start centres had been protected and allowed to evolve to meet the changing needs of families and children, we would be in an altogether different position than the one that affects far too many families up and down the country. We have never been committed to an entirely static model of delivery, but the infrastructure of Sure Start centres is a very grave and serious loss, in all those areas where they have not been protected and have closed.

Kinship carers are an essential part of the way in which our society looks after children. They deliver outcomes for children which are as good as, and often better than, foster care or children’s homes, for a fraction of the cost. The Government have been failing children and families for 12 long years. The focus on kinship care in the independent review of children’s social care was very welcome, with a large degree of consensus around many of its recommendations. We are still, however, seeing only piecemeal measures from the Government. It is vitally important that the kinship care strategy is published by the end of the year, as the Government have promised. I hope that the Minister will say more today to confirm that is the case, and that he might also comment on whether that strategy will be cross-departmental, looking at all the areas where kinship carers need support and where it is not being provided.

Kinship carers have waited too long to be fully recognised as a vital part of children’s social care. Their love has not been valued sufficiently. If we are successful in winning a majority in the House of Commons at the next general election, Labour in Government will put children and their families at the heart of everything we do, as we did before. We will support the vital work of kinship carers—support which is so long overdue.

14:38

[The Parliamentary Under-Secretary of State for Education (David Johnston)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank all the Members who have played a part in this well-informed debate today. I congratulate the hon. Member for Twickenham (Munira Wilson) on securing this debate and those she has secured previously. She says it is traditional for those in my role to resign a few days after she has had her debate; I will try my best not to do so, but it probably partly depends on how this debate goes. I also commend her staff member Andrew, who is soon to depart, for all the work he has done in supporting her on this. It is such an important issue, and I too am pleased to have kinship carers in the Gallery—Wendy and others—with whom I hope I can have a little chat at the end of the debate.

I wholeheartedly share the hon. Member for Twickenham’s commitment to championing the important role of kinship carers. They play a vital role in the children’s social care system and in the lives of children up and down the country. Too often, they play that role without people knowing or appreciating it. I think we all agree that too little attention has been paid to this area of kinship carers for far too long. We are determined to change that.

About 17 years ago, I did some mentoring through an organisation that helped primary school children who were showing behavioural problems in the classroom as a result of what was going on at home. I was matched with a nine-year-old boy who had been removed from his parents due to what was going on at home and placed on the child protection register. He had been placed with his gran. In this mentoring capacity, the mentor would take the mentee out each week to do fun activities—football, ice skating, swimming and things like that—while trying to work with them on the behaviour they were exhibiting in school.

When I picked the boy up at the beginning of the day and when I took him back at the end of the day, I got a glimpse of the incredible role that his gran was playing. She was in her 60s, she had raised her children and this was not what she had expected to be doing—a number of Members have said this—and yet, through boundaries, discipline, nutritious food and stable bedtimes, she was transforming the little boy’s behaviour far more than was the weekly session I was having with him. That was my first experience of the incredible role that kinship carers play, so I am determined that we should do as much for them as we can.

I will now set out the steps that the Government are taking to improve the position of kinship carers. Towards the end, I will try to answer as many of the questions as possible; for any I do not cover, Members should feel free to intervene, or I will write to them afterwards.

When a child cannot remain with their parents, wider family and friends can offer a safe and loving alternative to being looked after and having to move in with strangers. We have discussed how many people are in kinship care, and at this moment in time about 110,000 children in England are being brought up in kinship care, many of whom would otherwise be in local authority care if members of their extended family network had not stepped in. The census data was mentioned, and our 110,000 figure comes from the 2021 census information, which was published in July. I am happy to show Members the source of that after the debate.

Living in kinship arrangements can offer a stable and permanent option for children. Maintaining connections with family and the people they love can contribute to a healthy sense of identity and belonging. Hon. Members will know that I am passionate about social mobility and closing the gap between disadvantaged children and their peers, and, as has been touched on in part, children living in kinship care, on average, achieve better GCSE results, have a greater chance of being in employment and experience better long-term health outcomes than children who grow up in foster care or residential care. For example—this has been quoted already—in 2021, it was found that 69% of adults who experienced kinship care were in employment, compared with 59% or 48%, respectively, for those with a history of fostering or of residential care. The average attainment 8 score for those with a special guardianship order was 33.5, compared with 22.2 for looked-after children. The data therefore backs up the experience that Members have been sharing.

Not only does kinship care offer better outcomes for children—which is the primary concern of everyone present—but it makes better economic sense. Investing in kinship care is considerably more cost-effective for local authorities than paying for residential care homes, for example. I therefore want to create a system that not only helps kinship arrangements to take place, but actively supports kinship families to thrive. What I do not want to hear any more of is the gruelling system that the hon. Member for Denton and Reddish (Andrew Gwynne) is having to go through with Lyle.

The independent review of children’s social care highlighted the lack of focus on kinship care from successive Governments. It has been a problem for some time. The review made a number of ambitious recommendations, which we hope will increase the number of children who can remain within their family networks. My hon. Friend the Member for Eastbourne (Caroline Ansell) touched exactly on the Government’s focus, which is that children should remain with their families if they can, although that will not always be possible. Where possible, that is our primary focus: we want children to be with their immediate or extended family, before they have to go into care homes or other less desirable situations.

The strategy sets out six pillars of action, including unlocking the potential of family networks. In July, we announced that we will start implementing family network support packages through the £45 million Families First for Children pathfinder and family network pilot. Family network support packages will look at how to use financial and other practical means to unlock barriers to family networks being able to provide support for children to stay safely at home. As has been touched on—this is perhaps more relevant to the debate—we have also made a commitment to implement or explore the recommendations on kinship care. I stress to Members that, as I said to my team as soon as I was appointed, we will have no slackening of the timetable. We will publish the strategy before the end of the year, whatever it takes. It will set out a long-term vision for kinship care and how we can better support carers and children. I will not be able to set out all the details of the strategy today, but I will set out some of the progress we hope to make.

I wholeheartedly agree with right hon. and hon. Members who have highlighted that kinship carers need more support than is currently available to them. We have developed a twin-track system, whereby there is much more support for foster carers than there is for kinship carers. There is no great logic to that; it is just where successive Governments have focused their attention. We are trying to bring the two together. Part of that is about helping people to connect with other kinship carers, which is why the Department has supported kinship families through our £2 million partnership with the charity Kinship, whose good work has already been commended, to deliver high-quality peer support groups for kinship carers. Those groups are already supporting kinship carers, and we hope that 100 peer support groups will be established by January 2024. Also to come will be a whole host of face-to-face and online training, and useful resources—some of the things that Members have talked about—to provide access to the type of independent guidance and support that people can get in other areas already.

The independent review of children’s social care recommended a financial allowance for special guardians and carers looking after children under a child arrangement order. I think we all recognise the strain that many kinship families are under, and we are exploring the feasibility of mandating a financial allowance for kinship carers in every local authority. I chaired the national implementation board this week, and some of the local authority representatives said that a number of local authorities are already providing such an allowance. Part of our limitation here, which I will come to, is about data, as some Members have touched on. Part of exploring the feasibility is to get a picture on exactly who is doing what already, but I agree with the hon. Member for Twickenham and my hon. Friend the Member for Eastbourne that finance should not be a barrier, particularly when we want children and young people to remain with their families.

We recognise that there has been a lack of a consistent, recognised definition of kinship care, which can make it difficult to know whether people are in a kinship arrangement and what help they are entitled to. In “Stable Homes, Built on Love”, we published a draft definition of kinship care and sought the views of people with lived experience, as well as those of professionals and charities, on whether the definition helps to create an accurate understanding of kinship. I am grateful to those who have responded to the consultation, and the definition has been pretty well received. I cannot commit to introducing legislation at this time, but the feedback we have had so far has been positive.

Legal support has been mentioned. Again, kinship carers sometimes have to pay extraordinary amounts of money to get the legal advice they need, even though they are doing something that society should want them to do and should enable. From May this year, the Ministry of Justice extended legal aid entitlements to prospective guardians making applications for special guardianship orders in private family law proceedings. We predict that that will benefit thousands of potential kinship carers.

On workplace entitlements, it is important to recognise the employers who are already providing paid leave and so on, and have been doing so without the Government mandating them to do so. Wherever that is possible, we welcome it. The kinship strategy will provide an update on our commitment to explore workplace entitlements for kinship carers.

On pupil premium, which my hon. Friend the Member for Eastbourne touched on, at the moment, children who live with special guardians and were previously looked after by the state are eligible for pupil premium plus, a non-means-tested, non-income-tested benefit. Kinship children who were not previously looked after but have been entitled to free school meals can get pupil premium in the usual way that other children can if they have been eligible within the last six years. We constantly review and assess the effectiveness of pupil premium to ensure that it is supporting the children most in need of it.

Briefly on admissions, in 2021 we introduced changes to the school admissions code to improve in-year admissions. That enables kinship carers to secure a school place for their child in year if they cannot do so by other means.

Finally in this area, children who are living with special guardians and have previously been in state care can access therapeutic support via the adoption support fund. Last year, we made that support available to children who live with relatives under child arrangements orders. We are looking to improve local authority engagement with the adoption support fund, to increase the proportion of eligible kinship carers—

[Andrew Gwynne]

I am grateful to the Minister for covering this point. It is not quite as simple as he is making out, because a number of local authorities—my own included—make it very difficult for people to access those services through that fund, unless they have gone through all kinds of hoops and loops with other statutory services prior to making an application. Will the Minister ensure that all local authorities understand that the message coming from him is that those services should be available to kinship carers?

[David Johnston]

I am grateful to the hon. Member for that point and I will certainly do that. He made a point about assessments, which I will come to. Again, they should be simpler than they have been in his experience.

My Department is also working with Ofsted to improve the visibility of kinship care in inspection reports. Through updated guidance and inspector training, Ofsted will make it clearer that reports should refer to the quality of support being provided to kinship carers and children in kinship care arrangements.

Let me try to rattle through as many of the questions as I can. We have touched on data. I have given the 2021 census figures, but data collection is something that my officials are really working on, because there just has not been enough. Not having that data is inhibiting our ability and some of the things that we want to do in the strategy.

I was asked whether there will be an equalities impact assessment. Yes, there will be a thorough equalities impact assessment as part of the forthcoming strategy.

On the bureaucracy that my hon. Friend the Member for Eastbourne referred to, part of the setting of the definition is to ensure that agencies are better able to provide the right support and remove some of the hurdles that kinship carers experience. We hope that the peer support groups will support that work as well.

I just touched on the point made by the hon. Member for Denton and Reddish about assessments. LAs have the statutory responsibility for assessing kinship carers, because they have the legal duty to safeguard vulnerable children, but those assessments should be proportionate and prioritise the best interests of the child. I encourage local authorities to think about how their assessments could be adapted to be more supportive, and we will reiterate that in our strategy.

I need to leave a little time for the hon. Member for Twickenham to wind up. I thank her again for securing the debate, as well as previous ones, and I thank all hon. Members for their contributions. The debate has rightly focused on the issues that all too many kinship carers face. I put on the record my thanks and admiration for every one of those kinship carers—including Members of this House—for their selfless contribution to the lives of the children they care for. It is a huge commitment, but such an important one. I am proud of the progress that we are already making to support kinship carers, but I know there is much more to do, and that is what the strategy will contain.

I am fully committed to reducing the barriers to kinship care where it is in the best interests of the child and can offer a safe, stable and loving alternative to their becoming looked after. I look forward to publishing our kinship strategy before the end of the year. As I set out, that will be an opportunity to begin to make meaningful and lasting change in the lives of kinship carers and their children.

2.55 pm

[Munira Wilson]

I thank the hon. Members who co-sponsored my application for the debate and all those who have participated in it. The hon. Member for Denton and Reddish (Andrew Gwynne) said that he gets nervous when this issue comes up because it is so close to home, but I urge him: please do not stop talking about it. His passion, love, devotion and dedication to Lyle makes what he says so much more powerful than anything that I or anybody else says, because it comes from the heart and personal experience, and it is always so moving.

I was heartened by the level of cross-party consensus, not least from the new Minister. I was delighted to hear his commitment to the issue and his recognition of some of the key issues we raised. I feel encouraged. I know, however, that the stumbling block for the strategy will be the Treasury; my sense is that children tend to be a much lower priority for it. I make the Minister this offer: if he needs any help lobbying the Treasury, I, and I suspect Members from all parts of the House, stand ready to work alongside him to make the case and ensure that kinship carers and children in kinship care get support.

I do not think that I heard much about employment leave. Again, if the Minister needs to work with the Department for Business and Trade on that, I will be happy to support him in any way. We can follow up the detail of some issues in correspondence, but he started to address many of the questions that I and other hon. Members raised. We look forward to seeing the strategy, and hon. Members from all parts of the House will continue to work alongside him and to champion this issue.

Question put and agreed to.

Resolved.

That this House has considered the matter of support for kinship carers.

Community Pharmacies

Thursday 14th September 2023 Westminster Hall

[Sir Mark Hendrick in the Chair]

15:00

[Peter Aldous (Waveney) (Con)]

I beg to move,

That this House has considered community pharmacies.

It is a pleasure to serve with you in the Chair, Sir Mark. I thank the Backbench Business Committee for granting this debate, the purpose of which is threefold. The first is to thank community pharmacists for the great work that they have been carrying out in towns and cities for around 175 years. It was in 1849 that John Boot opened his first shop in Nottingham. More recently, the sector stepped up to the plate and was a key player in delivering the covid vaccination roll-out.

Secondly, I wish to acknowledge and support the Government for recognising in their delivery plan for recovering access to primary care, published in May, the key role that community pharmacists have been asked to play in the future of planning care.

Thirdly, and probably most urgently, there is a need to address the enormous pressures that community pharmacists currently face. If that is not done, the sector could cease to exist in large swathes of the country and will be in no fit state to perform the role for which it has successfully auditioned. There are clear comparisons to be drawn with the current state of NHS dentistry, and it is vital that action is taken to prevent a repeat of that particular nightmare.

A community pharmacy, previously known as the chemist’s in the UK and still known as the drugstore in the US, is a retail shop that provides pharmaceutical drugs as well as other personal products. There will be a qualified pharmacist available to issue medical prescriptions and to provide advice and guidance to customers on prescriptions and over-the-counter drugs, as well as on general health problems. Community pharmacies should be distinguished from the solely dispensing pharmacies located in medical practices and hospitals.

In my research for the debate I noted, as I have over the years, that in some places and at some times, relationships between GPs and community pharmacists can be fraught and strained. That needs to be addressed if the Government’s plans for improving access to primary care are to be successfully delivered.

In preparing for the debate I visited the Kirkley pharmacy at Kirkley Mill in Lowestoft and Boots in Beccles. I thank them both, as well as Tania Farrow and Kristina Boulton from Community Pharmacy Suffolk, for their advice, information and support.

Community pharmacies are made up of privately run businesses and corporate chains. It is important to emphasise that both those groups are going above and beyond what any business could reasonably be expected to do to keep their shops open. It is the framework within which they have to operate that is at fault, not them. The private businesses often work ridiculously long hours for no reward in the service of their local communities, and the corporate chains use retail sales to subsidise the pharmacy side of their operation. It is clear that if reform is not carried out urgently, the steady stream of closures will turn into a torrent.

On 19 July, my hon. Friend the Minister—it is great to see him in his place—confirmed, in answer to a written question that I had submitted, that in the first six months of this year, the number of pharmacies in England reduced by 222. Yesterday, I was advised that Boots has announced that its shop in Orwell Road in Felixstowe, in the constituency of my right hon. Friend the Member for Suffolk Coastal (Dr Coffey), will close on 18 November.

While their number is falling by the day, there are approximately 10,800 community pharmacies in England. As I have mentioned, they do great work, and it was in recognition of that that the Government announced on 9 May that community pharmacies will play a central role in the delivery plan for recovering access to primary care, with £645 million being provided to support a pharmacy-first service.

That will include expanded treatment options for seven common ailments, including earache, sore throats and urinary tract infections. Community pharmacists will also be able to assess patients and supply certain prescription-only medicines without a prescription from a GP. That vote of confidence is welcome, but there is a concern that, due to a real-terms reduction in funding, about which I shall go into more detail shortly, there is an element of robbing Peter to pay Paul.

We now need the detail of how pharmacy-first will work, so that integrated care boards such as the Norfolk and Waveney ICB can set about its implementation. There have been no further details since May, and I will be grateful if my hon. Friend the Minister can advise us when further information will be published.

An important part of the future of community pharmacy is for pharmacists to be independent prescribers. By 2026, newly qualified pharmacists will be able to start work having received the necessary training to become independent prescribers as part of their qualification. There is a need to ensure enough support to enable existing community pharmacists also to be trained as independent prescribers.

To become independent prescribers, pharmacists will need the support of a designated prescribing practitioner as part of their training. Sufficient investment is needed to ensure that that can happen, as designated prescribing practitioners will be required to support both those studying for their foundation pharmacist year in 2025-26 and the existing community pharmacists wanting to be trained as independent prescribers. Both will require 90 days in a prescribing environment.

Community pharmacists are under extreme pressure on multiple fronts—financial, workforce and regulatory, with many rules dating back to the 1930s. Medical supply instability is particularly acute. That puts operational pressures on pharmacists, imposes financial burdens on their businesses and creates worrying delays for their patients. Two of the biggest and interlinked challenges facing the sector, and indeed the whole of primary care, are access to services and the sustainability of the workforce. An increasing number of pharmacies are now providing core hours only, due to workforce challenges and financial sustainability. That means that fewer are offering services in the evening, at weekends and over bank holidays, and, in some cases, they are having to close much earlier during the day.

While the introduction of pharmacists working in general practice is to be welcomed, it has had the negative consequence of making it more difficult for community pharmacies to recruit pharmacists. A lack of access to pharmacy services cascades through other parts of the health system—to general practice, to the number of calls to NHS 111, to appointments to out-of-hours services and to visits to A&E.

Funding has been cut by 30% in real terms over the past seven years. As a result, so as to remain viable, community pharmacists are cutting back on the discretionary services that they provide. That ultimately leads to permanent closures—461 by Lloyds and 300 announced by Boots in June.

The 30% real-terms funding reduction, accompanied by inflationary pressures and workforce shortages, has driven up costs and has led to reduced hours and permanent closures. The £645 million for the new common conditions service announced in May is welcome, but it does not address the underfunding of existing core services. There is a need for a stable, long-term and sustainable funding commitment that can be delivered through a review of the community pharmacy contractual framework. This means not only additional funding, but alignment of care pathways and provision of incentives within primary care systems. The funding crisis has knock-on implications, including pharmacists being unable to spend as much time with patients as they would like, as well as the withdrawal of services such as free deliveries, particularly to care homes, and monitored dosage system boxes, which are important to many people.

To address these pressures and ensure that community pharmacies can realise their full potential, Community Pharmacy England has come forward with its own six-point plan. First, as I mentioned, pharmacy funding should be reformed to give pharmacies a long-term, economically sustainable funding agreement.

Secondly, a common conditions service should be developed and implemented so as to allow patients to have walk-in consultations for minor conditions. That would provide accessible care and ease pressure on general practice.

Thirdly, community pharmacies should look to build on other clinical service areas, such as vaccinations, women’s health and long-term conditions management for, say, asthma and diabetes, using independent prescribing rights. In this way, pharmacy can do a great deal in key NHS priority areas and will help to get the health service back on a sustainable footing.

Fourthly, the medicines market must be reformed so as to get out of the situation we are now in, where pharmacies are dispensing some medicines at a loss and patients are facing long delays for medicines.

Fifthly, regulatory burdens should be reviewed and where necessary removed, so as to make running community pharmacies easier and to limit the increasing cost of service provision.

Sixthly and finally, a long-term plan for the community pharmacy workforce should be produced to ensure that pharmacies can keep their doors open and to enable them to retain pharmacists in local pharmacies.

In many respects, this debate is a trailer for the main attraction next Tuesday, when Community Pharmacy England launches its vision for community pharmacy, as prepared by the King’s Fund and the Nuffield Trust. In the delivery plan for recovering access to primary care, the Government undertook to continue to engage with the sector, with specific reference to the piece of work that is being published next Tuesday. I urge the Government to adhere to that commitment, which is vital not only to rebuilding primary care but to giving community pharmacies a sustainable and viable future, thereby ensuring that after 170 years they can remain part and parcel of the fabric of our towns and cities.

[Several hon. Members rose—]

[Sir Mark Hendrick (in the Chair)]

Order. May I remind Members that they need to bob if they wish to be called?

15:14

[Sir George Howarth (Knowsley) (Lab)]

It is always a pleasure to take part in a debate when you are in the Chair, Sir Mark. I congratulate the hon. Member for Waveney (Peter Aldous) on the timeliness of this debate and on the typically thoughtful way in which he presented his case. If I repeat some of his arguments, it is not that I am gratuitously copying what he said; the themes need to be emphasised, and I will try my best to do so.

At Prime Minister’s questions on 26 April, I raised the need for a new pharmacy-first approach as a means of providing additional capacity to deal with minor medical problems and consequently help to relieve the pressures on GP and hospital A&E services. I was encouraged by the Prime Minister’s positive response: he declared himself

“a wholehearted champion of and believer in the role that community pharmacies can play.”—[Official Report, 26 April 2023; Vol. 731, c. 732.]

Two weeks later, on 9 May, as the hon. Member for Waveney said, the Health Secretary made a statement to the House that set out the Government’s primary care recovery plan. In the second part of that statement, he announced the adoption of a pharmacy-first approach as part of a new NHS service. Again, it was a potentially positive step forward. He pointed out

“the incredible role that pharmacists played during the pandemic—their capacity to innovate and deliver for the communities that they served, freeing up GP appointments in doing so”.—[Official Report, 9 May 2023; Vol. 732, c. 219.]

As part of that approach, the Secretary of State committed to investing up to £650 million over the next two years, so that pharmacists can supply prescription-only medicine for common conditions such as ear pain, a urinary tract infection or a sore throat, without requiring a prescription from a GP. In the time available, I want to explore how that policy is developing and how the resources that the Government have earmarked meet the requirements for pharmacies to deliver such a service. I should add that the Secretary of State’s list could easily be added to, and I hope it will be.

I am grateful to the Company Chemists’ Association, Community Pharmacy England and Pharmacy2U for their comprehensive briefing for the debate, on which I will rely heavily. CPE points out:

“We are currently negotiating on how this funding commitment will be delivered to ensure that community pharmacies can meet patient needs and we welcome the confidence and additional investment in community pharmacy...Until those negotiations are complete, we do not know the extent to which this additional investment will help community pharmacies with these current pressures, but we do know that it will not address all of the pressures as outlined later in this briefing.”

Pharmacists refer to a funding black hole; I do not think the hon. Member for Waveney used that term, but he did use the figures involved. They point out that the recent announcement of funding is welcome but represents

“new money for new workers”.

They go on to say that there is currently an annual funding shortfall of at least £67,000 per pharmacy. Consequently, there is insufficient money in the system to deliver the services that they are already contracted for, let alone to take on new ones.

The CCA also draws attention to the trend between 2015 and 2022, which saw the permanent closure of 720 pharmacies. On a recent visit to Asda in Huyton in my constituency, I saw the consequences at first hand. The Asda pharmacy, which by the way is admirable, is having to fill the gap created by the loss of other smaller, independent local pharmacies, and the pressure on the dispensers while I was there was relentless. There was not a minute to pause for thought or have a conversation with people coming to pick up their prescriptions, because they were so busy.

Of the pharmacies that closed, 40% were in the 20% most deprived areas of England. That is worrying for me as the MP for Knowsley, which is one of the areas of greatest deprivation. One way in which high levels of deprivation are reflected is in the number of people in Knowsley living with long-term health conditions, which account for 70% of the total healthcare spend, 64% of hospital out-patient appointments and 50% of GP appointments. If community pharmacies could be deployed to deal with some of those cases where appropriate, that could help immensely in easing the burden on the NHS services that currently have to deal with them.

As the Minister will be aware, and as the hon. Member for Waveney referred to, there is a workforce crisis in community pharmacies in England. There is estimated to be a shortfall of 31,000 pharmacists. The Asda community pharmacy I visited had vacancies, one of which was for a pharmacist; I think they had been trying for a year, unsuccessfully, to fill the position.

I also want to raise the issue of medical supply chains. The current level of allowable margin is £800 million; it was first agreed in 2014 and has not been reviewed since. That amounts to an annual reduction in the margin available. In practice, all pharmacies are faced with diminishing resources for the purchase of medical supplies. On 18 May, with my hon. Friend the Member for St Helens South and Whiston (Ms Rimmer), I held a roundtable event with local pharmacies. It was pointed out to us by independent pharmacies that they are unable to negotiate lower purchasing rates, as they cannot buy in bulk in the way that larger-scale national pharmacy companies can.

This problem will lead to more local pharmacy closures and reduced capacity to serve the new pharmacy-first policy. As CPE puts it, reforms are needed

“to the medicines market to avoid the situation we are now in, where pharmacies are dispensing some medicines at a loss and patients are facing delays for medicines.”

Pharmacy2U, which is a delivery service, has pointed out that stakeholders now have to deal with the issue. It notes the difficulty with the interoperability of IT systems and points out that

“there is significant variation in the systems used by GPs, and pharmacy services are often unable to easily access patient records, heavily restricting their ability to support patients with their medicines. Ensuring that pharmacists have swift access to this data is vital in empowering pharmacies to play a central role in a reformed and improved primary care system.”

It suggests that

“HSC and NHSE should consult with system-wide stakeholders to ensure all pharmacists are enabled to access and, where appropriate, update patient records in line with data privacy rights, ensuring that GPs and pharmacies have a complete picture of the patient they are caring for.”

I will make one final point before asking some questions. I wrote to the Secretary of State on 17 July, following some written questions that I had tabled concerning hub-and-spoke provisions and the use of third-party hub providers; the answers seemed to indicate a specific problem in Northern Ireland. I would be grateful if the Minister chased up my letter, which has had no response, and if he could give an indication in his speech as to how the issue can be resolved.

I will conclude with a few questions. First, how do the Government propose to address the funding black hole that I have referred to? Secondly, what is the Government’s strategy for halting the alarming number of pharmacy closures? Thirdly, how do the Government intend to address the workforce shortages? Fourthly, will the Minister agree to consult stakeholders on how to deal with the issue of interoperability of IT systems? Finally, how does the Minister propose to enable all pharmacies, including independent pharmacies, to fund the gap between the cost of acquiring medicines and the resources available?

15:26

[Steve Brine (Winchester) (Con)]

It is nice to see you in the Chair, Sir Mark. Well done to my hon. Friend the Member for Waveney (Peter Aldous), my dear friend with whom I entered Parliament in 2010: as always, he has set out the issues beautifully, with the forensic ability for which he is known. The people of Waveney are very lucky to have him, as is this House. It was my hon. Friend who inspired me to speak in this debate: he collared me in the corridor, as he often does. I am only too pleased to do so, both as MP for Winchester and Chandler’s Ford and as Chair of the Health and Social Care Committee.

When I was pharmacy Minister, I spent many happy hours where the Minister is sitting today, answering debates on the subject. We have moved on a lot, and I give credit to the Minister, the Secretary of State and this Prime Minister of all Prime Ministers—if they had not understood community pharmacy, we were never going to get there. All credit to them for the investment and the work that has gone on. As somebody once said, “Much done, more to do.”

My fellow Committee members, one of whom is here today, and I are all too aware of the challenges facing community pharmacies in all our constituencies. Nevertheless, there is great cause to be positive. In my opinion, pharmacies have huge untapped potential to transform the way patients access and receive healthcare services, and to support the building of a preventive healthcare approach, which the Minister knows I am passionate about and which I suggest is central to the future sustainability of the NHS itself.

Earlier this year, the Select Committee launched an inquiry into pharmacy. It will look broadly at pharmacy services including hospital pharmacy, which is often overlooked but is very important, but community pharmacy will form the largest part of it. The terms of reference include specific questions about funding, which my hon. Friend the Member for Waveney and the right hon. Member for Knowsley (Sir George Howarth) both mentioned; the commissioning arrangements for community pharmacy, which I know we will come on to; the locations of community pharmacies; and, of course, achieving the ambitions of Pharmacy First in the primary care recovery plan. I trialled Pharmacy First in the north-east when I was pharmacy Minister; I am a great believer in it, so it is great to see how the Minister has taken it forward.

A key question that our inquiry seeks to answer is, “What does the future of pharmacy look like, and how can the Government ensure that it is realised?” We will be very forward-looking, considering how the challenges of today can be addressed to ensure that the potential is realised. However, we will also look at the services that community pharmacies are already offering or are set to offer through the pharmacy-first approach. Crucially, we will also consider the areas in which there is a chance to go further.

Community pharmacists are highly trained clinical professionals. They are not retailers; they are clinical professionals. They want to do more, they can do more and we should trust them to do more. We will also consider some of the innovations in the sector—for example, how automation and hub-and-spoke arrangements, which we have not talked about much today, will come in and help. We will also look at the workforce challenges, which we have heard about, including issues around the retention of pharmacists in the community pharmacy sector and around training.

The inquiry will be wide ranging. We are looking forward to getting started with oral evidence, hopefully in November. There is no shortage of enthusiastic people in the community pharmacy sector who are willing to share their experiences with us. We are incredibly grateful to all those organisations and individuals who sent in their written evidence, and we hope to continue seeing that positive engagement from the sector when we start the oral evidence sessions.

The Committee has the benefit of drawing upon the work of our expert panel, which is chaired by Professor Dame Jane Dacre, whom the Minister will know. The panel, set up by my predecessor, now the Chancellor of the Exchequer, evaluates the Government’s progress on meeting their commitments on an area that I ask it to look at. It delivers a Care Quality Commission-style rating as to where we are, which can range from “outstanding” to “inadequate”. I asked the panel to look at the pharmacy sector, based on its own members’ expertise and research and submissions by stakeholders, as well as some roundtable events with patients, people in receipt of social care, and pharmacy professionals.

The panel recently published a report on its evaluation of Government commitments in the pharmacy sector. It was assisted by several pharmacy professionals and leaders who steered its decision on which commitments to evaluate. Community pharmacies were an obvious area to focus on. The panel looked at two specific community pharmacy-related commitments, rating the position on both as “requires improvement”. I take a glass half-full perspective. There are good things in the report; I know that the Minister will look carefully at it. The first commitment was to maintain the pharmacy access scheme, which aims to protect access to local, physical NHS pharmaceutical services in areas where there are fewer pharmacies. The chemist may be the only shop in town—that is often the case in coastal communities.

The second commitment was to review the community pharmacy funding model and the balance between the spend on dispensing and new services within the community pharmacy contractual framework, which is negotiated between Community Pharmacy England—formally the Pharmaceutical Services Negotiating Committee—the Government and NHS England. The panel concluded that community pharmacies are struggling to meet increased demand. It is a good thing that demand is increasing, because it means that people are increasingly turning to the chemist, but they are struggling to meet that demand, to deliver services, and even to remain open with the current funding model, which was set in 2019 for five years and has not been reviewed significantly during that time.

As my hon. Friend the Member for Waveney suggested, pharmacies are also struggling as their staff are encouraged to take up roles in primary care, funded by the additional roles reimbursement scheme. The right hon. Member for Knowsley touched on the fact that IT systems can make it difficult for patient information to be shared between community pharmacies, hospitals and general practices. Taken together, those challenges can negatively impact community pharmacies’ ability to deliver services and support other parts of the health and care system.

The National Pharmacy Association does great work in this space and has been in touch with us. It commissioned an EY report, which found that almost three quarters of pharmacies in England face a risk of closure if a serious funding shortfall is not addressed, with 72% of them forecast to be loss-making within the next four years. The Minister will be aware of that report. It is sober reading, but it would be wrong to overlook it. It is a serious piece of work.

Going back to the expert panel, members also raised concerns about the lack of data collected on the performance of schemes designed to improve community pharmacy services, especially whether they were delivering the positive outcomes that we want for patients and people in receipt of social care. There is a lot for the Government to consider in the panel’s report. We still await their response, which, I hasten to add, has not timed out yet. We look forward to that.

I want to touch on a couple of other points. First, I co-chair the all-party parliamentary group on HIV and AIDS. We are calling for the HIV prevention pill, PrEP—pre-exposure prophylaxis—to be available through community pharmacies, with clear financial accountability for its provision. I think that would be a game changer for HIV prevention. It would be a critical part of ending new cases of HIV by 2030, urged by the HIV Commission, which I commissioned as the Minister and, after leaving Government, became a commissioner on, along with the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting). The Opposition Front Benchers have signed up to that 2030 ambition, and the Government have committed to it too.

Community pharmacies are well placed to prescribe PrEP. They carry out medicine use reviews for patients, and I think that they would be well placed to counsel on PrEP and to manage the prescriptions alongside other medications, because it is critical that medicines are prescribed in conjunction with each other. Community pharmacies are well connected to other parts of the health service, where integrated care boards have ensured that the IT is right and that the relationships are right. Furthermore, services provided by pharmacies act as a bridge between secondary and primary care, so that would complement sexual health prevention and treatment services and the advice that goes on. Will the Minister, in his summing up, touch on what progress has been made towards the commitment to make PrEP available beyond sexual health services and when it will be available in community pharmacies?

On the supply side, we have talked a lot about the bricks and mortar and the workforce, but the medicines supply chain, also mentioned by both previous speakers, is in need of serious love from Ministers. Pharmacies often have no idea of the prices being charged by wholesalers for some key generics, so they have no idea what is short, while pricing of products is often much higher compared with other European countries; consequently, margins in community pharmacies are often being eroded by uncertainty in the supply chain. I urge the Government to look at a robust system to plan for future pandemics and address shortages of key pharmaceuticals, because that undermines the sector and some of its great work.

There are so many things we could talk about, such as the ill-health prevention inquiry by the Select Committee, where I see pharmacies playing a key role. Much has been achieved. When I walked into the Department, I asked the special advisers what should be on my worry list, and they said: “General practice, Minister.” Some things never change. However, I passionately believe that community pharmacies are part of primary care, or pre-primary care as I used to call it. When I talked to parts of the primary care sector as the Minister, they would say to me: “We want to do more. We can do more. We are trained clinical professionals who can be trusted to do more.” The Government have picked up the mantle of that through the reform of, and new investment in, the contract, with the Prime Minister putting his personal authority behind the sector.

There is therefore much to be proud of, but we have to be careful that we do not end up losing community pharmacies. If we lose them, once they have gone, they will not come back, and we will have a supply-side problem in the bricks and mortar, as well in some of the pharmaceuticals. I thank my hon. Friend the Member for Waveney for securing the debate—it is, as always, an excellent subject for the House to discuss—and thank you, Sir Mark, for calling me to speak.

15:38

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Mark.

I congratulate the hon. Member for Waveney (Peter Aldous) on securing this important and timely debate. I say “timely”, because only last week I delivered a petition to Parliament on this very subject, with the support of hundreds of people in my constituency. I know the strength of feeling across Bradford South on this issue, and about the value people place on community pharmacies.

I speak in defence of funding for our community pharmacies’ core services, which have been cut in real terms in recent years. Furthermore, I reiterate the point made by my right hon. Friend the Member for Knowsley (Sir George Howarth) that our remarks cover many of the same areas, because they are so important to our constituents.

Community pharmacies are essential pillars of our national health service. The Government’s independent review described the open secret that community pharmacies are an “under-utilised resource”. As many of my constituents have put it to me, they are far more than just a place to get medicines; they are part of the very fabric of our local community. They are valued. Community pharmacies offer vital, immediate face-to-face services, often supplementing GP services, though without some of the vital resources that they need and deserve. When this country faced the covid pandemic, community pharmacies were there for us all. They stepped up bravely, maintained access to vital medicines, provided healthcare advice and delivered a record number of vaccinations. Now is the time to both thank them and show them that we value our community pharmacies, and not to abandon them to what one of my local chemists described to me as “funding starvation”.

After 13 years of under-investment, the NHS is at breaking point, and pharmacies are suffering from lack of funding. More than 700 pharmacies closed permanently between 2015 and 2022, and over 40% of these closures took place in the 20% most deprived areas of the country—cuts, yet again, where services are most acutely needed. In the words of one of my Bradford South chemists, James Currie, this

“is yet another clear demonstration by this Government of their detachment from the realities and needs of the communities we serve.”

Pressures on pharmacies have been worsened by a workforce crisis, with an estimated shortfall of 3,000 community pharmacists in England. I will be grateful if the Minister clarifies how the additional roles reimbursement scheme will be “carefully managed” to ensure that we are able to recruit, train and, importantly, retain the pharmacists we so desperately need. We know that pharmacy funding was cut by 30% in real terms between 2015 and the beginning of this year. More and more work is now being piled on our community pharmacies, without adequate additional resources—a familiar pattern for our public services in the UK today. That has created a serious funding black hole, with an annual shortfall in England of an estimated £67,000 per pharmacy.

The pattern of reckless under-investment is simply not sustainable, so it was welcome news that NHS England’s delivery plan for recovering access to primary care said that further funds will be devoted to community pharmacies to expand their services. The new Pharmacy First common conditions service is a strong step towards easing pressures on GP services, but pharmacies are already overstretched and support for their delivery of core services is still inadequate. I ask the Minister to clarify the extent to which the additional investment will be earmarked for addressing existing pressures on core services.

In preparing for the debate, I found it useful to look back at the Government’s independent review of community pharmacies, published seven years ago. In the report, it was made clear that community pharmacies would be urgently required to help deal with

“immediate financial and operational pressures”

in the wider health service. Seven years later, however, the NHS is still struggling to deal with an historic backlog. I am sure that all right hon. and hon. Members present will recognise that community pharmacies are part of the wider solution to this very serious problem.

It is high time that we broke the cycle of crisis after crisis, followed by rushed solutions. Fair funding for community pharmacies will not only help support the local communities they serve, but strengthen the wider national health service and enable a vital and much-needed “prevention first” approach.

15:43

[Esther McVey (Tatton) (Con)]

It is a pleasure to speak in today’s debate with you as Chair, Sir Mark. I thank my hon. Friend the Member for Waveney (Peter Aldous) for securing this important debate on community pharmacies, which are a crucial part of our healthcare ecosystem. I also thank him for his thorough explanation of the current state of community pharmacies and their needs.

I am often reminded that when we feel unwell or something has gone a bit wrong, our first point of call is often to walk into a pharmacy to get advice, support and medicine. Somebody there can put one’s mind at ease. Those who are vulnerable or elderly can also get their medicines delivered to them, which adds to the wellbeing of the local community. However, despite community pharmacies’ immense importance, they face huge challenges. Increasing demands and ongoing pressures are threatening their sustainability. Tatton currently has a healthy number of local pharmacies—18— supporting nearly 70,000 residents. However, pharmacies are disappearing across the country—and in Tatton, too. Government figures show a decrease of 222 between December 2022 and June 2023. The reasons for those closures include inadequate funding, rising operational costs and difficulty in recruiting and retaining community pharmacists.

Tatton community pharmacist Lee Williams, along with his wife and fellow pharmacist Caroline, were two of the first constituents I met at their pharmacy in Knutsford when I became the MP for Tatton back in 2017. They have since had to close their pharmacy. Lee explained to me that, despite it being a busy community pharmacy and having a good reputation—I can vouch for that, as I went there, too—they had very much a hand-to-mouth existence as funding fell and things such as rent, utilities and wages increased, squeezing their profit margin to the point where their business became unviable and the only thing they could do to safeguard their 12 years of tireless work was to sell it. It was a sad day for them, because their dream was for the two of them, married, running this community pharmacy and supporting the local community, but it had become abundantly clear to them for some time that the only way for such pharmacies to exist was to find efficiencies through having multiple branches. But now, even the large multiple retailers such as Lloyds and Rowlands have had to sell off their community stores as they move to remote delivery and go online in an attempt to become profitable. Even they cannot make community pharmacies work.

Adding to the problem of underfunding is, as we have heard, a shortage of medicines, which often results in community pharmacists dispensing medicines at a loss. Even when the NHS decides to increase the price it is willing to reimburse pharmacists for those medicines, it often comes after weeks of pharmacists gambling on what price they will have to pay, which creates huge uncertainty for them and their businesses. Ironically, it is the very low prices that the NHS is willing to pay that drive the shortages. If a manufacturer can sell those medicines for a higher price in other countries, it will prioritise those markets over our own. Community pharmacists find that their staff, in their role as pharmacists, are spending a lot of their time trying to find stock, on top of their crippling workload.

Community pharmacy is therefore at a low—the pharmacists would say an all-time low—which corresponds to much of the results of Community Pharmacy England’s 2023 pressures survey. It found that 92% of pharmacies are dealing with medicine supply issues daily, which was an increase from 67% in 2022; 97% of pharmacy owners reported significant increases in wholesaler and medicine supply issues; 81% of pharmacy staff said they were “struggling to cope” with the significant increase in workload; and 84% had experienced aggression from patients due to medicine supply issues. Worse—if things could be worse—pharmacists face more abuse from the public because of drug shortages.

To keep our community pharmacies afloat, Lee Williams advocates a complete overhaul of how community pharmacies are viewed and remunerated. I therefore welcome the Government’s announcement of £645 million of new funding for Pharmacy First. The Government realise that things need to be done. Much has been done but more needs to be done, and they need to pursue that as well as they can. We can say that with our Prime Minister as an advocate. However, in the light of the first-hand experience of my constituents that I have just shared and those survey results, how is the Minister ensuring the security and consistency of supply of medicines? How will the Government compensate pharmacies for the extra costs of offering additional services such as annual health checks, which require more skilled staff? I appreciate the difficulty of finding more funding for the sector, but I know that the Government will be looking to do that, so will the Minister explain how? Local pharmacies want to be at the heart of the health sector and take more of the workload off the NHS, but in order to do that they need to be adequately recompensed. They provide a vital service, and I know that they want to do even more.

15:51

[Taiwo Owatemi (Coventry North West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Mark. I thank the hon. Member for Waveney (Peter Aldous) for securing this important debate and highlighting the challenges faced by the pharmacy sector. He spoke with great knowledge about many of the challenges around funding, and the opportunities for the pharmacy sector to address some of the primary care challenges faced by the NHS. I highlight the points made by the Chair of the Health and Social Care Committee, the hon. Member for Winchester (Steve Brine), who has been very supportive of the pharmacy sector and has played a key role in pushing for the Committee to publish a report on the role of the sector and the challenges it faces.

I declare an interest as a registered pharmacist, the chair of the all-party parliamentary pharmacy group, and a member of the Health and Social Care Committee. I apologise to Members present, as I might end up repeating some of the points that have already been made, but I will try my best not to focus on them.

The first challenge I will highlight is the massive issue of the medicine supply chain. Every time I speak to pharmacy owners and pharmacists they raise the impact that uncertainty has on their profit margins. I recently started engaging with the pharmaceutical sector to understand the issues. There are issues around medicine distribution in this country, and there are middlemen supply chain distributors who keep hold of medicines and who are sometimes involved in driving up the prices, but we also have challenges around the manufacturing of generics, which account for about 80% of medicines used by the NHS.

About 2.2 million generic drugs are prescribed every single day in this country and used by the NHS. Despite that, it seems there were some oversights in this area when we negotiated our exit from the EU. Currently, legislation allows EU generics to be recognised in the UK but does not allow the EU to recognise UK generics. That means that British manufacturers are unable to submit their marketing authorisation applications easily within the EU. Therefore, they have no incentive to produce these medicines, or increase their manufacturing of these medicines, in the UK. It also means that they are unable to compete with their European competitors.

A great example of what is happening is that the EU has started investing about £20 billion in the manufacturing of generics since we left. So far, the UK, according to figures that I have seen recently, has invested nothing. Essentially, our UK manufacturers are being left at a competitive disadvantage. Aside from that, the Medicines and Healthcare products Regulatory Agency is facing significant challenges. It has lost a large amount of its workforce and is currently unable to process the regulatory applications coming through its doors—again, making it difficult for generic drugs to enter the UK. Essentially, there are regulatory difficulties and there seem to be limited financial incentives.

Secondly, I want to address the challenges of finance, which have been a massive issue facing the pharmacy sector. The sector has not been adequately funded in line with inflation for a very long time. That has led to many high street pharmacies closing down. In my constituency, Boots in Jardine Crescent had to close down because it was not financially viable for the business to continue. That has had a significant impact in an area of great deprivation and high health inequality.

Despite the challenges that community pharmacies face, there are also wonderful opportunities, which I have to admit the Government have started to recognise. I welcome their more than £600 million investment in the Pharmacy First programme, but there is a long way to go to fully take advantage of the potential that community pharmacies can offer.

Community pharmacies play an important role because they are the first point of call for patients, but they can play a bigger role in healthcare. Not only can they deliver the Pharmacy First scheme—I hope that will be rolled out and that the Government will add more clinical conditions to the list—but they can play an important role in other primary care services, such as vaccination, sexual health and the management of conditions such as cardiovascular disease.

I have always found it weird how a patient will come up to me in the pharmacy and say, “I have high blood pressure. I’m a bit concerned.” I say, “Sit down. Let’s check your blood pressure” and then I have to message the doctor to let them know. Then I will tell the patient to go to their GP to get a medication. In reality, that could have started and ended in a community pharmacy. That is something that hospital pharmacists easily do, and we regularly do it, so I encourage the Minister to look into the wider roles that community pharmacists can play in supporting GPs and primary care and in reducing some of the challenges it currently faces.

Many Members have spoken about the workforce crisis. To be able to fully take advantage of the potential of community pharmacy, we have to acknowledge the fact that, like many other healthcare professions in this country, pharmacies face a significant workforce crisis. We do not have enough pharmacists, and we are struggling to recruit and train more and to retain the community pharmacists we have.

Again, I welcome the Government’s workforce plan, but unfortunately it lacks the finer details of how community pharmacy will be supported in the long term. An integrated and funded workforce plan for pharmacy is needed if we are to enable pharmacies to support the community as well as the rest of the NHS. A larger number of designated prescribing practitioners is needed if community pharmacies are to assist with the provision of primary care. A clear pathway to ensure that that happens is important.

I know that the Government aim to ensure that we get as many prescribers as possible by 2026, and that is something I welcome. I am really happy that pharmacists are able to graduate with the ability to prescribe. However, there are many pharmacists in the workforce for whom there is no clear plan as to how they can become prescribers by 2026. I have spoken to many different pharmacy schools and they do not know how that is going to happen.

As the hon. Member for Waveney has explained, the process for getting sign-off is not easy. People have to ensure that they have found the right healthcare professional to shadow, as well as take time off work to do all the documentation and paperwork that is needed. Changes therefore need to happen, and further funding needs to be made available to incentivise healthcare professionals to take on more pharmacists and to mentor them and train them to become prescribers.

I also want to address areas that have not been mentioned in the debate so far. The first is technology, which has played a significant and positive role in the provision of the healthcare system. Since covid, technology has played an important role in allowing patients to have easy access to healthcare and allowing them to feel empowered. That is the reason we have seen an increase in the number of online pharmacies that are available, which has been quite positive.

However, I have some concerns. Figures recently published by the General Pharmaceutical Council, which is responsible for inspecting community pharmacies and online pharmacies, show that at least one in five of the online retailers it inspected in the past year did not meet at least one standard. If that was a community pharmacy, the store would be put on a clear supervision pathway to ensure that patients’ health was not put at risk. I would like to see the same happen to online pharmacies to ensure that they are better regulated as they continue to provide better access to medicines for patients.

I welcome the fact that the Government are looking at the supervision rules, which are outdated and were created at a time when we were making medicines in pharmacies and playing around with different active pharmaceutical ingredients. Pharmacy has changed since then, and the information available and the regulation around drug manufacturing has significantly improved. I welcome the consultation that is being carried out, and I encourage as many pharmacists as possible to give their feedback and engage with the consultation.

Lastly, I want to turn to the regulation of non-clinical managers. Community pharmacies either have a pharmacist as a manager or have non-clinical managers leading them. In the light of the Lucy Letby case, which highlighted the important role that non-clinical managers play, it is important that community pharmacists are also considered. Any new regulatory framework for unregulated management and leaders in healthcare should apply to not only those working in the NHS but those who have direct involvement in the provision of healthcare in our communities, such as community pharmacy.

Before I end, I would like to ask the Minister a few questions, which I hope he can answer today or respond to in a letter. Has any consideration been given to the generic industry, which, as I said earlier, accounts for a large amount of medicine supplies within the NHS? Can he direct me to the Minister who is responsible for drug manufacturing in this country, the changes in EU legislation and how we can bring about positive changes for our generic manufacturing industry? Do the Government have any plans to prevent future medicine shortages? I am already hearing pharmacies expressing concerns about the fact that winter is coming and they are expecting to have further shortages.

Are there any updates on the mutual recognition of medicines within the EU, and are any negotiations happening? Can the Minister provide an update on the prescribing scheme for healthcare professionals and whether any steps have been taken to address the issues I have raised? On funding, it would be helpful for many pharmacists to know whether there are any plans to help address some of the financial challenges they face. Lastly, as the chair of the all-party parliamentary pharmacy group, I wonder whether the Minister could spare some time to come and speak to key stakeholders in the sector, who would love to meet him and share some of their experiences.

[Sir Mark Hendrick (in the Chair)]

I thank Members for keeping to time. I call the shadow Minister.

16:04

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Sir Mark. I thank the hon. Member for Waveney (Peter Aldous) for securing this important debate, and I congratulate him and Members on both sides of the Chamber on putting forward a compelling argument for supporting our community pharmacy sector and increasing its role in the provision of localised community healthcare. I thank my right hon. Friend the Member for Knowsley (Sir George Howarth); the hon. Member for Winchester (Steve Brine), who chairs the Health and Social Care Committee and who made some excellent contributions; my hon. Friend the Member for Bradford South (Judith Cummins), who has been campaigning on this issue; the right hon. Member for Tatton (Esther McVey); and my hon. Friend the Member for Coventry North West (Taiwo Owatemi), who is a pharmacist and who shared her first-hand experience of some of the challenges. We have heard some great contributions in this debate.

It is a great pleasure to take on this important portfolio covering primary care and public health. In this year—the NHS’s 75th—its founding mission, to deliver care to everyone who needs it, when they need it, free at the point of use, is clearly under threat. Thirteen years of Conservative Government have left the NHS flat on its back, and the rightful expectation of my constituents and people across the country of an NHS with time to care for them when they need it is being trampled. We see longer waiting times, a postcode lottery in care and, shamefully, for the first time in decades, healthy life expectancy falling in many regions across the United Kingdom, including the west midlands, which I represent. That is one of the starkest indicators of how this Government, far from levelling up the country, have let it down.

The NHS is Britain’s greatest institution and my party’s proudest achievement, and nothing gives me fire in my belly like the prospect of what a Labour Government will do to fix it. Community pharmacy is a huge part of that, relieving pressure on overstretched GPs and delivering first-class care and advice to patients. As many hon. Members have highlighted during the debate, it is high time we realised the potential of pharmacies; as with the vaccine roll-out during the pandemic, they have proven time and again that there is so much more they can deliver as part of the primary care mix.

Pharmacists are the third biggest profession in the NHS, with around 13,000 community pharmacists across the UK, and together they prescribe more than 1 billion medicines a year. Not only are pharmacists medicine experts within the NHS, but colleagues have acknowledged their wider skills and knowledge, which are under-utilised. It is estimated that pharmacists give around 58 million informal consultations to walk-in patients a year, saving 20 million GP appointments. We also know that drug-related problems, often resulting from poor medicine management, cause around 15% of hospital admissions and cost the NHS hundreds of pounds a night, so pharmacies have an enormous contribution to make to the wider system.

Chemists do far more than just dispense repeat prescriptions and sell shampoo. They provide a range of clinical services in prescribing for common ailments and have a key role to play in public health and preventive services. There are great examples of innovative public health work that pharmacists are doing, such as in Bradford, where the “Wise Up to Cancer” initiative promoted health literacy among south Asian women, or the Jaunty Springs Health Centre in Sheffield, where a shared care agreement between the pharmacy and GP surgery meant that a majority of health interventions could be delivered in the pharmacy consultation room, freeing up the GP and cutting waiting times.

There is good practice in pockets across the country that we should be building on. I know that Ministers have belatedly acknowledged that, and there has been some expansion of the clinical services that pharmacies offer in recent years. However, a few sticking-plaster proposals really miss the opportunities that are there. Will the Minister update us on how negotiations with the sector over the Pharmacy First launch are progressing, and can he promise that it will be operational in time for the flu season? What consideration has he given to expanding Pharmacy First to establish a community pharmacist prescribing service covering a broader range of common conditions?

The Minister will know that in some countries, which are way ahead of the Government on this, such as Canada, pharmacists can prescribe for dozens of common conditions, freeing up millions of appointments in general practice every year. What is his long-term strategy to equip pharmacies for a future where their talents, capacity and expertise can be fully utilised and to fix the front door of the NHS?

Hon. Members have also raised a number of concerns about the financial pressures facing pharmacies. I know that the sector appreciates the additional funding announced in May, but that is of course tied directly to its expanded responsibilities as part of the primary care recovery announcement and does not recognise how current cost pressures are impacting the sector. Since the community pharmacy contractual framework was signed in 2019, the cost of doing business has continued to rise—especially since the right hon. Member for South West Norfolk (Elizabeth Truss) crashed the economy.

The result has been many pharmacies closing their doors for good, disproportionately in the most deprived areas, as analysis from the Company Chemists’ Association has found. Last year alone, 110 pharmacies shut up shop, and many more have had to reduce opening hours, services and staffing. Will the Minister say what assessment he has made of the risk of more pharmacies closing down and reducing operations before the end of the current funding settlement in 2024 and what impact that will have on the NHS medicines supply, the knock-on pressures on other parts of primary care and the prospects for extended clinical services in the community setting?

As the Minister will know, the 2019 funding agreement was made on the promise that the Government would drive wider efficiency savings and regulatory changes across the system. For many community pharmacies, the roll-out of the hub-and-spoke model was an answer that would allow them to streamline their services. However, it has been 14 months since the Department of Health and Social Care’s consultation on hub-and-spoke dispensing closed, and we have still had no response from the Department, nor the secondary legislation that was promised. Can the Minister please give us answers today about the considerable delay in progressing with hub-and-spoke reform? What is the hold-up?

I would also like to raise the issue of staffing with the Minister. The community pharmacy workforce survey released last month revealed that, compared with 2021, there was a 6% reduction in the full-time equivalent workforce in 2022. The vacancy rate for pharmacy technicians was about 20%, whereas it was 16% for pharmacists and 9% for dispensing assistants. Two thirds of contractors said that they found it very difficult to fill pharmacist roles last year, and in turn, the bill for locum pharmacists rose by 80% last year alone. Many chemists are struggling to cope with those pressures, contributing to thousands of unplanned closures every month. That is bad for the taxpayer and bad for patients, so what assessment has the Minister made of the challenges faced by community pharmacies in hiring, training and retaining skilled pharmacy staff? Does he recognise that the Government’s workforce strategy has not kept pace with the scale of change in the sector? Does he share my concern that without a functioning community pharmacies network, the Government’s primary care recovery plan is built on very shaky foundations?

The next Labour Government have a plan to reform the NHS to shift care from acute settings to the community. As part of our plans to build a neighbourhood health service, we will realise the potential of community pharmacies, giving people services that they can rely on and access earlier on their doorstep. That will mean accelerating the roll-out of independent prescribing to establish a community pharmacist prescribing service that covers a broad range of common conditions. It will mean cutting unnecessary red tape to allow pharmacy technicians to step up, ensuring that pharmacists can work to the top of their licence and make more of their considerable expertise in prescribing and medicines management, rather than having repetitive dispensing processes. All of that will be supported by greater digital interoperability, allowing the profession to support GPs in the management of long-term conditions.

The Minister will have heard the broad support for the sector in today’s debate, as a trusted and cost-effective measure for addressing some of the chronic challenges we have come to expect under this Government. I look forward to his answers on what more he is doing to support this important sector and realise the potential of the pharmacy profession.

16:12

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

It is a pleasure to serve under your chairmanship, Sir Mark, and I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing this important debate. I start by echoing his thanks to our hard-working pharmacists, who do such a brilliant job. He raised six main points in his speech, and I can confirm that we are working on all of them.

Community pharmacies play a crucial role in our health system and a greater role in looking after people’s health than ever before. Pharmacies are easily accessible, and about nine in 10 people who visit one are positive about the advice they receive. The Government are investing in pharmacy to do much more. The delivery plan for recovering access to primary care announced an investment of up to £645 million in a new Pharmacy First service—a whole new NHS service will be created—as well as an expansion of the existing blood pressure check and contraception services. Pharmacy First will enable patients to see a community pharmacist for seven common conditions and be supplied with prescription-only medicines without the need for a GP. We are consulting Community Pharmacy England on the proposals in that delivery plan, with the aim of starting Pharmacy First this winter.

Pharmacy First builds on the community pharmacy contractual framework 2019 to 2024 five-year deal. That deal commits £2.592 billion a year to the sector and sets out how community pharmacy will be more integrated into the NHS, delivering more clinical services and effectively becoming the first port of call for minor illness. Under that deal, we have introduced minor illness referrals from GPs to community pharmacies, which have been a great success. A&E and NHS 111 can also now refer patients for an urgent medicine supply without a prescription from their GP. More than 2.8 million consultations have been provided at community pharmacies for a minor illness or urgent medicine supply since the start of those services.

We also introduced blood pressure checks, and community pharmacies have delivered 1.4 million checks since October 2021 and more than 150,000 in May 2023 alone. Huge numbers of potentially life-saving checks are being done. NHS England estimates that in 2023, more than 1,300 heart attacks and strokes will be prevented thanks to those checks, so I repeat my thanks to this fantastic sector.

In April this year, we introduced an oral contraception service, making it easier for women to access contraception.

In addition, community pharmacies now support and advise more than a quarter of a million people a month when they start new medicines, through the new medicine service, and 10,000 patients every month who have had their medicines changed following a visit to hospital, through the discharge medicines service. That supports medicines adherence, prevents GP visits and hospitalisations, and gives people a much better sense that they are taking the right medicines.

Community pharmacies are also playing a growing role in our vaccination programmes. Last winter, they administered 29% of adult flu vaccinations and more than a third—36%—of covid-19 vaccinations.

We have talked about the funding issue. In addition to the £2.592 billion a year, we added an extra £50 million last and this financial year, and we have made the additional sum of money that I mentioned available for Pharmacy First and the expansion of existing services. On top of that, we pay separately for flu and covid vaccinations, which, as I suggested, provide an increasingly important income stream for pharmacies.

The current five-year deal is of course coming to an end, and we will need to consider what comes next for pharmacy. As part of that, NHS England has committed to commissioning an economic study to better understand the cost of delivering pharmaceutical services. That study will feed into any future funding decisions on community pharmacy.

Several hon. Members raised the issue of the number of pharmacies, and we monitor that very closely. Our data shows that despite a number of pharmacies closing since 2017, there are about 10,800 pharmacies today, which is still more than in 2010. Despite the things that have happened to other high street businesses, we still see that there are more pharmacies and there are an awful lot more pharmacists—I will come on to that when we talk about the workforce.

However, rather than focusing merely on numbers, we should look at access. We know that 80% of the population live within 20 minutes’ walk of a pharmacy, and that there are twice as many pharmacies in more deprived areas. The right hon. Member for Knowsley (Sir George Howarth) is right that they play a crucial role in providing access in deprived areas. We ensure that that continues to be the case. Proportionally, the closures that we have seen reflect the spread of pharmacies across England.

We are seeing changes in the market, with some of the large pharmacy businesses divesting. That has an impact on the make-up of the sector: we are seeing the number of small independent pharmacies increase, while the number of pharmacies that are part of bigger businesses decrease. We are monitoring the market very closely as it evolves.

As my hon. Friend the Member for Waveney mentions, through the pharmacy access scheme, we are financially supporting pharmacies in areas where there are fewer pharmacies and where there might be a challenge in getting access. To address the disproportionately high rate of closures of pharmacies that must be open for a minimum of 100 hours—the so-called 100-hour pharmacies—legislation was amended in April to allow those pharmacies to reduce their hours to a minimum of 72, which is still a huge number of hours to be open. That will support those pharmacies to remain open, providing extended hours, particularly for weekend access.

The same legislation gave integrated care boards the possibility of introducing local hours plans. That enables the local co-ordination that will ensure that there is something available locally at all times when people need it. It allows temporary closures in an area if there are significant difficulties with access and ensures that a pharmacy is always open somewhere in an area.

Some pharmacies struggle to find staff, and in some instances they have had to close temporarily, because a pharmacy cannot open without a pharmacist. There is more demand than ever for pharmacy professionals—an issue raised by various hon. Members, including the hon. Member for Bradford South (Judith Cummins) and my right hon. Friend the Member for Tatton (Esther McVey). Since 2010, the number of registered pharmacists in England has increased by 82%, from 28,984 to 52,780. That means nearly 24,000 more pharmacists registered in England this year than in 2010. It is a huge increase, even compared with the huge increases elsewhere in the NHS.

On top of that, we have published the “NHS Long Term Workforce Plan”, backed by more than £2.4 billion to fund further additional increases and more training places over the next five years. The plan sets out the steps that the NHS and education providers will take to deliver an NHS workforce who meet the changing and growing needs of the population over the next 15 years. Our ambition is to increase training places for pharmacists by nearly 50%—building even further on what we have already done—to around 5,000 by 2031-32, and to grow the number of pharmacy technicians.

Employers clearly have a key role in retaining staff and making jobs in community pharmacy attractive. To support employers, we are investing in training to help private contractors to deliver high-quality NHS services. NHS England has provided a number of fully funded training opportunities for pharmacists and pharmacy technicians—the hon. Member for Coventry North West (Taiwo Owatemi) raised an interesting and important point on this matter. That is why we are providing 3,000 independent prescribing training places—applications for this year are now available to pharmacists—and, on top of that, another 1,000 fully funded training places for designated prescribing practitioners, or DPPs. As well as growing the number of people entering the workforce, we are making provisions to upskill those who are already in the workforce. We are as just excited as other hon. Members present about the huge potential of independent prescribing in pharmacy to build even more on what we are doing to grow the range of services in community pharmacies.

I have talked about what we are doing on funding and the workforce, but I also want to talk about structural reform and efficiencies, and enabling pharmacists to do more with the skills they have—an important point raised by a number of hon. Members. The plan for primary care sets out some of the things we are doing, including modernising legislation to make it clear that pharmacists no longer have to directly supervise all the activities of pharmacy technicians, who are, in fact, registered health professionals in their own right.

Hon. Members are right to point out that the nature of work in pharmacy has changed, and we must change the legislation to match that. We also plan to enable any member of the pharmacy team to hand out appropriately checked and bagged medicines in the absence of a pharmacist, remedying frustrating instances where patients are delayed, having to wait perhaps because the pharmacist has popped out for lunch. We are also consulting on changes to the legislation to enable pharmacy technicians to use patient group directions, which would enable pharmacy technicians to do more.

Last week, the House debated legislation to give pharmacists the flexibility to dispense medicines in their original packs, so that pharmacists use their high-end clinical skills rather than spending time snipping out blister packs, which is not a good use of their time. We are progressing legislation to enable hub-and-spoke dispensing—the Chair of the Health and Social Care Committee, my hon. Friend the Member for Winchester (Steve Brine), rightly mentioned that—following public consultation on the changes.

Finally, we are also working with medicine suppliers to identify medicines that could be reclassified from being available only on prescription, known as “POM”, to being available in a pharmacy, known as “P”.

This is a huge package of structural reforms and a huge liberalisation of the structure of pharmacy, enabling pharmacists with ever-growing clinical skills to do more and not be caught up in bureaucracy.

The Government are thinking beyond that about what pharmacy can do in the longer term. Hon. Members are right that Pharmacy First, the fantastic new NHS service, could be added to over time. NHS England is also starting independent prescribing pilots, with a view to implementing pharmacy prescribing services in the future, based on what we learn from them. That has huge potential to take further pressure off GPs and make the best possible use of all the new skills in the pharmacy workforce.

The Chair of the Health and Social Care Committee, my hon. Friend the Member for Winchester, raised an important point about access to PrEP, as an example of an advanced service that pharmacies could provide. As he will know, partly because of his work in initiating this, the PrEP access and equity task and finish group was established in 2022 as a sub-group of the HIV action plan implementation steering group, to improve access to PrEP. That steering group is working to develop a PrEP road map based on the task and finish group’s recommendations. I can say today that the road map will be out before the end of the year, and it will deal with how we will work through all the knotty issues in enabling community pharmacy to provide PrEP.

I thank my hon. Friend the Member for Waveney for raising these hugely important issues, which are crucial to community pharmacy. The sector is doing more than ever before, seeing more people, providing a wider range of services and becoming more clinically advanced than ever. There are pressures in the sector, but we are injecting further funding. We have grown the workforce hugely. We will continue to build on what community pharmacists do to further improve community pharmacy across the country.

[Taiwo Owatemi]

Will the Minister give way?

[Neil O’Brien]

I will pause at the point of my peroration, because there is a question.

[Taiwo Owatemi]

There is a question: will the Minister return to my earlier question about whether he can come to the APPG to meet key pharmacy stakeholders?

[Neil O’Brien]

That is a brilliantly timed question, to which the answer is yes.

16:25

[Peter Aldous]

This has been a very informative and helpful debate. We clearly have an enormous challenge in this country in improving access to primary care, and the key role played by the community pharmacy in addressing that challenge will be vital. We have heard about the three shortages that the industry faces, and I urge the Minister to reflect on those: the shortage of funding and finance, the shortage of staff, and the shortage of medicines.

The right hon. Member for Knowsley (Sir George Howarth) highlighted the impact of community pharmacy closures on deprived areas. It is clear from the maps that have been produced that the impact is disproportionate, including in some coastal communities, such as the one I represent. He also highlighted the key role that community pharmacies play in treating the long-term health conditions found in such areas.

My hon. Friend the Member for Winchester (Steve Brine), the Chair of the Health and Social Care Committee, rightly showed that this issue is on its register. I looked at the registers in the Select Committee report and I look forward to the amber and red warnings turning into green notices in due course. He highlighted the importance of PrEP being available for community pharmacies—the Terrence Higgins Trust brought that to my attention—and I welcome the update that the Minister provided.

The hon. Member for Bradford South (Judith Cummins) clearly emphasised the importance of a prevention-first approach. We got the first-hand knowledge that is so important in forums such as this from the hon. Member for Coventry North West (Taiwo Owatemi). I was particularly struck by her emphasis on the importance of using technology and the specific problem with the manufacture of generic medicines—she made her point very well. The shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), reinforced the potential of the sector and what an alternative Labour Administration would do.

The Minister highlighted the whole range of work that community pharmacies can do. He touched on the closures but said that there are actually more community pharmacists now than in 2010. I just highlight, from talking to community pharmacists, that when there are closures, getting consolidation of the sector across the country, so there is an even spread and we retain community pharmacies within 20 minutes of people, is not straightforward with the current regulations. I urge the Minister and his Department to look at that.

The Minister also said there has been an 82% increase in registered pharmacists since 2010, but a lot of that increase may have been in hospitals and medical practices. The feedback that I get from community pharmacists is that they have challenges with recruitment and retention in their settings, and we need to address that. I was heartened by what the Minister said about regulatory reform; it appears that the Government are embracing that particular challenge.

Let me say, in the few seconds I have left, that this debate has served the purpose of highlighting the key role of community pharmacies and the challenges they face. I urge the Minister to continue to engage with the sector—I know he will—particularly when the extra report is produced on Tuesday.

Question put and agreed to.

Resolved,

That this House has considered community pharmacies.

16:29

Sitting adjourned.