Respiratory Syncytial Virus

Baroness Wheeler Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct. In fact, my maiden speech was in a debate about how we can bring life sciences to bear more. The point about NHS clinical trials and the fact that we are not using this massive potential asset was very much a feature of that. It is key to the work we are doing—I had a meeting on it just this week—so I agree with the noble Baroness and hope we will see improvements in this space.

[Baroness Wheeler (Lab)]

My Lords, we know that older adults are at greater risk of serious complications from RSV infections in children, because our immune systems weaken as we get older, which can lead to exacerbations of underlying lung and cardiac disease. What action is being taken to address the serious underestimation of older adult RSV infections and to improve testing, reporting and treatment for this key group?

[Lord Markham (Con)]

I thank the noble Baroness. The key risk groups in the elderly as well are, as I mentioned earlier, those with congenital lung or heart disease or spinal muscular atrophy. The problem is that the current vaccination needs monthly immunisation to be effective, and I think most people will agree that it can be used in only the most severe cases because it is not a very practical way forward and is very expensive. That is why I am really excited by the new treatments, particularly nirsevimab, which is 75% to 80% effective, versus palivizumab, which is more around 50%. I think we have a good way forward.

Social Care: Integrated Care Systems

Baroness Wheeler Excerpts

Wednesday 11th January 2023 Lords Chamber

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government what plans they have to ensure that social care is sufficiently represented within Integrated Care Systems.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

ICSs need to include social care fully in planning and strategic decision-making. Local authorities are responsible for social care and have a clearly defined role within ICSs. The Health and Care Act 2022 includes local authorities in its minimum membership requirements for ICBs, giving local government a greater voice in NHS decision-making than ever before. In July 2022, we also published guidance on how ICPs and adult social care providers should work together.

[Baroness Wheeler (Lab)]

I thank the Minister for his response but ICBs and ICSs have been fully operational only since last July—less than six months. The Minister is quite right that, when they were being set up, we argued strongly for the need for effective social care representation in both bodies to ensure that health and social care are integrated and fully embedded in both. However, this just is not happening. The ADASS spring survey found 73% of directors reporting that ICS management has had little impact on local investment in adult social care to date; some even said that ICSs were reducing investment. How does this help ICSs play a key role in their respective areas in, for example, tackling the staffing crisis in both services, prioritising adult social care and producing the urgently needed ICP integrated care strategies, which are due in June?

[Lord Markham (Con)]

First, I think we can all agree on the necessity of making sure that these are integrated and the vital role that social care plays in all this. I must say, my experience from the places I have visited is that they are well integrated, but I will take that point back and would be pleased to look at any particular examples of where we feel that is not the case because, as I think the whole House will agree, it is vital that they are completely integrated.

Care Homes: Severely Disabled People

Baroness Wheeler Excerpts

Wednesday 30th November 2022 Lords Chamber

[Lord Markham (Con)]

The financial health of this sector is an area of interest; we all of course recall some of the problems and failures about 10 years ago. I had a meeting on this subject just this week, identifying the health of the providers to see if that is of concern. The margins made in this space are fairly typical of other industries, so they are not indicative of an area under particular stress. But I have my mind on this issue and will keep an eye on it.

[Baroness Wheeler (Lab)]

My Lords, ADASS reports that in the past four months,

“64% of councils … reported that providers in their area had closed, ceased trading or handed back council contracts”

either through an inability to recruit staff or escalating care home running costs. We all know that the extra funding to councils, which the Minister repeats in almost every response, just about props up existing services and does not provide the sustainable and long-term funding that was promised to commence with the again delayed social care cap. When will the Government fulfil their pledge to fix social care?

[Lord Markham (Con)]

My Lords, the 200,000 extra care places that this funding provides is a solid example of an expansion of supply, and I hope all noble Lords agree that that is a substantial number. I hope they also agree with the work we are doing to recruit from overseas to increase the workforce in this sector, which is indeed increasing. Areas such as these show that we are committed to expanding the supply, and we are seeing that rewarded in the increase in the last few months.

Adult Social Care

Baroness Wheeler Excerpts

Thursday 24th November 2022 Lords Chamber

[Lord Markham (Con)]

I think we all agree on the vital necessity of adult social care—I think the noble Lord has heard me say it many times from this Dispatch Box—and that is what the £2.8 billion and £4.7 billion are about over the two years. The noble Lord is correct that we need to look longer-term, because the whole health service and the care of our elderly are obviously dependent on us getting this right.

[Baroness Wheeler (Lab)]

My Lords, the backlog of care assessments, estimated at 500,000 by ADASS, lies at the heart of the complaints coming through to the ombudsman. They are all about assessment delays for people and their carers, not enough funding or staffing to deliver those assessments that are agreed and failures in home care and care home support. The latest NHS figures show that 145,226 people in England have died waiting for social care over the past five years, and nearly 29,000 previous self-funders have made a new request for council social care support because they have depleted their funds. Can the Minister tell the House exactly what impact the 200,000 more care packages to be delivered in place of the two-year cap delay will have on the huge backlog of assessments and what percentage of the original money earmarked for social care this actually represents?

[Lord Markham (Con)]

I thank the noble Baroness. As mentioned, 200,000 care packages is a significant number and will make a significant impact on everything we are talking about here, and that is in conjunction with all the other measures we have put in place, including the £500 million discharge fund this year. In terms of the precise percentages of those allocations, I will quite happily commit to write on that, but I can say to your Lordships that the £4.7 billion represents a 22% increase in 2024-25. By any standards, I think that people would agree that a 22% increase is a significant amount.

NHS: Discharge to Assess Policy

Baroness Wheeler Excerpts

Tuesday 8th November 2022 Lords Chamber

Tabled by

[Baroness Wheeler]

To ask His Majesty’s Government what plans they have to announce new measures to ensure that carers are consulted and involved in hospital decisions to discharge patients under the Discharge to Assess policy.

Skills for Care Report

Baroness Wheeler Excerpts

Thursday 13th October 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, the Health Foundation has described the Skills for Care report as yet another signal of a social care system on its knees, with care providers struggling to compete with other employers and, in many cases, unable even to pay the national minimum wage to essential care staff. As we have heard, the figures are that one in five residential care workers in the UK was living in poverty, and that was before the cost of living crisis, compared with one in eight of all workers, which is a shocking figure in itself. When will the Government commit specifically to addressing the appalling low pay and poor working conditions throughout the social care sector?

[Lord Markham (Con)]

My understanding is that the pay of carers is always at least the national living wage. I will look into that, but that is my understanding. That is not to say that where they deserve, and should be paid, more that this should not be the case, but the national living wage is set, as the noble Baroness will be aware, exactly as it says: a national living wage. In terms of the cost of living pressures, the energy price cap is of course about focusing on those people who need it most, so there are a number of measures that we are putting in place to ensure that this happens. Most of all, it is about ensuring that this is a good, safe and enjoyable vocation for people.

Pharmaceutical Research and Development Spending

Baroness Wheeler Excerpts

Thursday 13th October 2022 Grand Committee

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government what steps they are taking to increase the United Kingdom’s share of global pharmaceutical research and development spending.

[Baroness Wheeler (Lab)]

My Lords, I am pleased to open this debate on behalf of my noble friend Lord Hunt, who sadly cannot be here today. As we know, this subject is dear to his heart and I am sure that the expertise of all noble Lords who will be speaking will do this important and vital issue full justice. I welcome the new Minister to his first Lords debate response and wish him well in addressing the mound of questions that he will face.

Our country faces a challenging time as we look to build back stronger from the impact of the pandemic. It has hit our people, our businesses and our growth hard, but here in the UK we already have a globally leading life sciences industry which, if we take the appropriate steps, can be central to unlocking our economic recovery. The industry currently makes up 18% of all R&D investment across the UK economy. It is the largest private R&D spending sector. In 2020, it was worth £5 billion and contributed more than half a million jobs to the UK.

Existing literature suggests that every pound invested in private R&D today leads to a stream of future benefits to the economy as a whole, equivalent to 50p per year in perpetuity. This sector’s R&D brings these benefits across a diverse geographic presence, with significant hubs in the south and north of England, Scotland, Wales and Northern Ireland. With private capital and UK industry playing the largest role in pharmaceutical R&D, they need policy stability and consistency in order to feel confident in investing. The Government must help, not hinder, this.

This kind of R&D has huge value for the NHS and its patients, not just through the end-stage innovation that is produced but through clinical trials. These are a valuable source of revenue to the NHS and provide access to medicines for patients with limited or no-treatment options in routine care, such as people with cancer, dementia and rare diseases.

The UK has the potential to be a global leader in life sciences R&D. We have a mature ecosystem, have historically been a leader in early-stage clinical research and have made huge strides with early access to advanced therapy medicinal products. However, this debate is vital today because of deep concerns that the UK is slipping against our competitor countries in a number of key areas. Between 2012 and 2019, the UK’s share of global pharmaceutical R&D expenditure fell from 7.7% to 4.1%. This has led to a loss on average of £3.2 billion per year for the past eight years. Since 2009, our manufacturing production volumes have fallen by 29% and 7,000 jobs have been lost and, between 2018 and 2020, the UK slipped down the global rankings across all phases of industry clinical trial delivery.

We can and must do something now. Urgent implementation of the Life Sciences Vision—it has been welcomed by the sector, which co-developed it—is now critical as the UK’s international competitors, spurred on by the pandemic, are moving at pace to enhance their life sciences offer and capture internationally mobile investment. Can the Minister say when the promised implementation plan for the one year anniversary of the vision, due last July, is to be published? Can he also reaffirm that the Government remain committed to the vision, not least its core ambition to make

“the UK the best place in the world to trial and test products at scale”?

The current uncertainty is not helping the deeply worrying situation that we are in. Moreover, an effective, joined-up approach is also needed on the Government’s wider overall science research and development strategy. We have had a number of separate R&D roadmaps, science plans, strategies and sector deals, ARIA and two reorganisations of the UKRI, for example, but without overall coherence across the board.

I will make a few points on specific issues, which I am sure will be followed up by noble Lords. First, as I have said, despite a strong policy ambition to make the UK a destination of choice for cutting-edge research, the delivery of industry clinical trials within the NHS is in crisis. In addition to the impact on patients, this means less R&D investment in the UK. The pandemic obviously had an impact, but it cannot be ignored that the UK was beginning to decline pre Covid.

Secondly, the use of health data is an area of vast potential, but we have had several false starts, for example care.data and the more recent GPDPR incidents. The data revolution is increasingly fuelling new breakthroughs in treatment, diagnostics and patient pathway redesign and is a key tool to support NHS staff. Given its large and diverse patient pool, the NHS has unique potential to be one of the most effective engines for data research. However, although this potential is well recognised, repeated attempts by successive Governments have failed to make best use of this resource, predominantly as a result of failing to engage both public and clinicians. As a result, the current state of play is a disparate data environment, with many custodians, different access arrangements and a lack of interoperability.

The Government’s Data Saves Lives strategy has taken on board many of the recommendations put forward by Professor Ben Goldacre in his independent review. Stakeholders such as the ABPI, which represents the research-based pharmaceutical sector in the UK, are urging that this must be a comprehensive strategy that appropriately balances the need for effective safeguards and public engagement with the ability of accredited researchers to appropriately access data to perform valuable research.

The false starts suffered from a chronic lack of co-ordination and failure to integrate effective communication with policy development and technical implementation. Provided that we can learn from these past mistakes, pressing forward will significantly enhance UK attractiveness as a destination for research. Will the Minister update the House on the action that the Government are taking?

Thirdly, the key issue is how we make the NHS an innovation partner—one of the areas with which we are struggling most. The life sciences sector is a strongly interconnected ecosystem. An NHS that supports innovation is central to this ecosystem and for that reason is one of the preconditions of success for the Life Sciences Vision. However, right now, the NHS struggles to approve these medicines for use and to provide access for patients once they are approved. Just 68% of medicines approved by the European Medicines Agency were made available in England between 2017 and 2020.

Looking at the uptake of medicines recommended by NICE, we see that the use of these in the UK typically lags behind that in other countries for at least five years after launch. For example, between 2016 and 2020, UK uptake was 60% of the average of 15 comparator countries in the first three years and still below average after five years, despite rising to 81%. This is contributing to patient outcomes falling behind those in countries in Scandinavia, as well as the Netherlands and Spain, for example. Recent data highlights how the UK ranks 17th out of 18 countries for life expectancy, is the worst for stroke and heart attack survival and ranks 16th out of 18 for five types of cancer.

Supporting access to and uptake of innovative medicines is critical not only to delivering better patient outcomes but to creating a thriving life sciences ecosystem. It is because of this link that in 2017 this House secured the amendment to the medical supplies Act specifically recognising that, when enacting policy in the scope of the Act, the Government must take due consideration of the consequences for the life sciences industry and the UK economy that depends on it.

Will the Minister say what action he will take to ensure that patients can benefit from the latest medicines and that the NHS supports a thriving life sciences sector in the UK? Specifically on the UK’s vaccination programme, so vital in the battle against Covid, how do the Government aim to deliver their pledge to develop new vaccines within 100 days? Will the Government continue with their plan to sell off our flagship vaccine manufacturing centre in Oxford? Does this not fly in the face of an effective pharma strategy and send out completely the wrong signals abroad?

In conclusion, recent analysis suggests that effective endorsement and delivery on the Life Sciences Vision could generate an additional £68 billion in GDP over the next 30 years through increased R&D alone and deliver 85,000 jobs through increased exports. We can also ensure that new medicines in the UK continue to be developed, trialled and launched here, meaning that patients benefit from the most innovative treatments in the world. This should be at the heart of the Government’s priorities to deliver growth and place the NHS on a sustainable footing for the future. The Government must act swiftly and decisively to reverse the very worrying downward trends in our life sciences competitiveness in relation to the rest of the world.

Care Homes: Energy Costs

Baroness Wheeler Excerpts

Thursday 8th September 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, what support will the Government specifically give those care homes whose pre-Covid Care Quality Commission ratings have been downgraded from good to inadequate as a result of staff shortages? This is on top of their deep concerns over energy costs. Recent press reports say that up to three-quarters of care homes in England have been reassessed in this way.

[Lord Kamall (Con)]

Clearly, one of the issues in the overall review of the social care sector is that, when the CQC and others report on care homes and other places, action is taken. One of the things we will do is talk to the right stakeholders and individuals, but we also have to work in partnership with local authorities—as quite often it is their responsibility—to try to make sure we raise the standard.

Thyroid Patients: Liothyronine

Baroness Wheeler Excerpts

Wednesday 6th July 2022 Lords Chamber

[Lord Kamall (Con)]

I am afraid that I am not able to fully answer my noble friend’s question. However, I know that my right honourable friend the former Secretary of State for Health did organise a round table with some of the relevant charities to discuss this and to discuss where they can source elsewhere, outside of the UK, and whether they could build up UK capacity. My honourable friend Maria Caulfield, the Minister, has also met with a number of organisations on this, and they are determined to get as much as they can. One issue is the stock for the future as opposed to for now, and feeding that through, but I know that the department is on to this.

[Baroness Wheeler (Lab)]

My Lords, the evidence clearly shows that many patients with hypothyroidism would benefit hugely from the declassification of T3 as a high-cost drug back to being a drug that is routinely prescribed in primary care. Can the Minister explain exactly what the Government will do to ensure that the actual NICE guidelines that enable T3 to be prescribed by clinicians according to their judgment reflect this position, are implemented consistently across new NHS structures and stop the current postcode lottery? Would this not be better than repeating the record of the majority of CCGs who ignore the guidelines?

[Lord Kamall (Con)]

The noble Baroness raises a really important point about some of the blockages to patients getting T3. It is both the first and second-line advice from NHS England but also the NICE advice too. NICE always reminds us that it is independent, and that Ministers should not intervene, but we can call for meetings. NICE also recognises that a price change does change the equation. It has told me that it is open to new evidence with people able to consult and contact it about this.

Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022

Baroness Wheeler Excerpts

Tuesday 28th June 2022 Lords Chamber

The Minister knows that, during the passage of the Health and Care Act, amendments supported across your Lordships’ House sought to place a duty on the Government to plan and publish key workforce plans for all parts of the NHS. Our pharmacy sector, especially community pharmacies, is stepping up to its new responsibilities, despite decreased funding year on year, increased roles and taking over part of the front-line consultation with the public. Without a clear workforce plan for the pharmacy sector, the Government are setting it up to fail. That is why, if the noble Lord, Lord Hunt, decides to press his amendment to a Division, our Benches will support him.

[Baroness Wheeler (Lab)]

My Lords, this debate has been a welcome opportunity to clarify the role of responsible and superintendent pharmacists, as set out in the SI, and to take a closer look at the wider industry, its workforce and, in particular, the support and funding community pharmacies need to enable them to operate effectively and undertake the extended role they need as an integral part of the local primary care team.

I congratulate my noble friend Lord Hunt on his excellent speech and presentation of the strong case for his amendment. All speakers have rightly paid tribute to the role played by community pharmacies during the pandemic, which remained open and continued to offer their full range of services. We all acknowledge the huge contribution they made then and make now to front-line care: the delivery of mass vaccination programmes for both Covid and flu, providing essential preventive programmes, such as blood pressure checks, providing medicine support for patients discharged from hospital, and supporting patients, particularly those with long-term conditions, with their self-care and self-management. All this takes pressure off GPs and ensures better access for patients to healthcare information and advice, and more efficient use of NHS resources. The estimate that the NHS could save £640 million through nationwide treatment of minor ailments by community pharmacists is an example of how their role should be extended.

The new community pharmacy consultation service mentioned by my noble friend Lord Hunt—involving GP surgeries, NHS 111 and pharmacies—for minor illness or medication consultations, and the pilot schemes for NHS Direct cancer referrals to pharmacies for patient scans and checks, are both key developments which we very much welcome.

I also pay tribute to my colleague Peter Dowd MP for his excellent Westminster Hall debate last week, which I commend to your Lordships. It set out a compelling case on the contribution community pharmacists could make with the right support and funding and increased collaboration with GPs, a case which had strong cross-party backing from supporting speakers. However, no part of the extended role we all want to see can be delivered unless the major workforce issues across community pharmacies are acknowledged, and the ongoing discussions with the Pharmaceutical Services Negotiating Committee on the current agreement and future funding acknowledge the scale of the resources needed.

On the SI, we support and welcome the aim of clarifying and strengthening the governance requirements of responsible and superintendent pharmacists. I thank the General Pharmaceutical Council for the reassurances in the note it prepared for this debate on extensive public consultation and engagement with patients, the public and the pharmacy and health sector on the rules and standards to operate under the extended remit the SI gives them.

Like my noble friend and the noble Baroness, Lady Brinton, I await the Minister’s response to the concerns of the Secondary Legislation Scrutiny Committee on the profession’s general distrust of the council on the setting of appropriate standards and concerns about patient safety if the pharmacist is absent from the pharmacy. As the committee rightly stressed, the Government need to improve on the reassurances they offered the committee. How are the profession’s concerns and reservations to be addressed? How will the Minister address the Pharmacists’ Defence Association’s deep worry that the new focus of the GPC in exercising its rule-making powers, minimising the burden on businesses, could lead to less focus on patient safety, which surely must be the council’s number one concern?

On workforce, all the excellent stakeholder briefings we received for this debate point to a crisis across the pharmacy industry. While the numbers of pharmacists on the register and of pharmacy technicians have increased, there has been a serious reduction in the numbers of students in training and of dispensary and counter staff. As we have heard, the primary care networks, with pharmacists working in GPs’ surgeries and away from pharmacies, have had a significant impact on staffing levels in high-street pharmacies, which to cover vacancies have to make increasing use of locums, the cost of which is spiralling. The Company Chemists’ Association’s estimate of a shortfall of 3,000 community pharmacies in England is not the setting or context in which any newly extended role for community pharmacies can develop strongly and flourish.

There is also the PDA’s serious concern about the pressures on staff in some pharmacies, such as unsafe staffing levels, poor pay and working conditions, long hours and suffering physical abuse from customers, which cause them to want to change jobs or leave the profession. What are the Government doing to ensure that risk assessment and preventive safety measures are in place, as well as a zero-tolerance approach when incidents occur? How can the welcome development of primary care networks and pharmacy services in GP surgeries develop hand in hand with ensuring enough staff and resources for community pharmacies to provide the quality of professional care that they want to deliver and we all want to see? How will the Government help pharmacies invest in staff training and development?

On funding, the Minister will have heard the concerns from across the House. The CCA’s estimate of funding last being increased for the sector eight years ago, in 2014, and the cuts of £200 million that it had to find two years later, paint a sobering picture of how the industry has fared. The current community pharmacy contractual framework agreed in 2019 has not been adjusted despite the pandemic and rising inflation and costs. The £370 million from the Government to meet pandemic costs was a loan, as we know from valiant attempts in this House to ensure that the industry did not have to repay it. I understand that it was repaid and then a separate admin process was established for the industry to claim back the extra costs incurred during Covid. Does the Minister have any further information on the sums reclaimed under this procedure? Can he reassure the House that the current negotiations with the PSNC on year 4 of the five-year funding agreement will include funding recognition for the extended and full role that community pharmacies need to play?

The need for an overall strategy for the primary care workforce across GPs, pharmacies and community services becomes ever more urgent, as this debate and the questions from noble Lords have clearly demonstrated. I look forward to the Minister’s response. We will fully support my noble friend’s amendment, should he put it to the vote, highlighting the vital importance of having the clear, long-term strategy and vision for community pharmacies that we have all been calling for.

[Lord Kamall (Con)]

My Lords, I thank all noble Lords for their contributions and once again apologise for the delay in bringing this matter before the House. I welcome the essential role that your Lordships play in scrutinising measures. I experienced that during the passage of the Health and Care Bill, and I think we have a better Act as a result of the scrutiny from across the House. I will try to address as many as possible of the points raised before I conclude. I will try to cover most of the points but I pledge to write to noble Lords if I have missed any specific points.

If we look at the overall picture of the NHS, I am sure noble Lords recognise that we seem to have more doctors, nurses and pharmacists than ever before. As someone said to me the other day, that is all very well but the supply is not keeping up with the demand. If we consider our whole understanding of health, some of the things we ignored many years ago are now things we deem as needing treatment. For example, the whole area of mental health was ignored for many years. PTSM, which people talk about now, was officially recognised only in the 1980s. I know that we will probably talk about that in the next debate.

Before a debate the other day about neurological conditions, I asked my officials to give me a list of all the conditions. They said, “Minister, there are 600 of them.” Let us think about this. We were not even aware of that previously. It shows the great complexity as we become more aware of conditions and issues, putting even more pressure on our health service and health professionals, even though we have more health professionals than ever before.

The Secretary of State recently pledged to start with pharmacies when it came to overall primary care. The community pharmacy contractual framework, to which the noble Baroness, Lady Wheeler, referred—the 2019 to 2024 five-year deal—set out a joint vision for the sector, and an ambition for community pharmacies to be better integrated in the NHS and provide more clinical services. We saw this during the pandemic when pharmacies provided vaccines and we have seen recently that they will be providing more initial advice on issues such as cancer—and they welcome this.

At the same time, we are seeing an overhaul of the overall model. It is time to move away from the old model, in which you see your GP for five minutes and then hope for a referral somewhere else. Services previously considered part of secondary care are now being taken over by primary care centres. Areas previously considered the work of GPs are now being taken over by nurses and physiotherapists, as well as by pharmacists in the community.

Despite the challenges of the last few years, we have jointly delivered the introduction of a new range of clinical services at the community level. These are important in their own right and we are negotiating with the Pharmaceutical Services Negotiating Committee on the expansion of additional services to be introduced in the fourth year of the five-year deal. I very much hope that my right honourable friend the Secretary of State will be able to make an announcement soon. Longer term, we want to build on what has already been achieved and make better use of existing skill sets and those that are developing; for example, the prescribing and assessment skills that all pharmacists graduating from 2026 will have acquired during their training.

I turn to some specific points. We now have more pharmacists than ever before. Data from Health Education England shows that we now have an additional 4,122 pharmacists employed in the community compared with 2017, and the number of registered pharmacists has increased year on year. The number of primary care pharmacy education pathway trainees coming from community pharmacy increased by nearly 2,500. Reforms to initial education and training of pharmacists means that pharmacists qualified from 2026 will be qualified to prescribe at the point of registration. On top of the £2.5 billion that we are spending on the sector, Health Education England is investing £15.9 million over the next four years to support the expansion of front-line pharmacy staff in primary and community care.

We are also supporting a significant expansion in primary care capacity through the additional roles reimbursement scheme, enabling primary care networks to recruit clinical pharmacists and pharmacy technicians, two of 15 roles that PCNs can choose to recruit to. We saw the strength and potential of community pharmacies —many noble Lords referred to it—during the Covid vaccination campaign and the role that community pharmacies played in it. It is not yet known whether recurrent boosters will be required annually. We are looking into that and whether pharmacies will be once again called on.

Noble Lords will recognise—we had this debate many times during the stages of the Health and Care Bill—that to support long-term workforce planning, we are looking first at the long-term strategic drivers of workforce demand and supply. Building on this work, we have commissioned NHS England and NHS Improvement to develop a long-term plan for the workforce for the next 15 years, including long-term supply projections. Once this work is ready, we will share the conclusions and start to home in on what it means for recruitment, skills needed and skill gaps.

A number of noble Lords raised fears or concerns about what the regulators will do with their new powers. This is understandable: community pharmacies are private businesses and increased regulatory burden will be a concern for many of them. However, once again, we have to get the right balance between regulation and making sure of safety. The proposals include safeguards to ensure that any changes the regulators make are subject to full consultation, in much the same way as is expected from the Government. This will ensure that patients, the public, pharmacy professionals and the pharmacy sector have their say on what the standards should say.

There were some concerns about remote supervision. It is important to emphasise that a lot of the issues raised today do not affect this legislation, but I completely understand the point about taking advantage of the situation to debate the wider issues.