Clinical Waste Incineration

Anne Main Excerpts

Tuesday 16th October 2018 Commons Chamber

[Stephen Barclay]

The hon. Gentleman is right to recognise that there is a significant impact in Scotland, given the services that HES supplies, and it is worth reminding the House that HES is still trading and clearing waste from a number of NHS sites. However, given that it has been subject to a series of actions by the Environment Agency and is subject to a criminal investigation, it is worth treating HES’s claims with a degree of caution.

The Environment Agency is of course an independent agency, so it is for the Environment Agency to look at how waste is being processed, and a strict legal framework applies to that. The specific concern about Slough has not been raised with me, but I am happy to take that away and write to the hon. Gentleman.

The Cabinet Office has been in active discussion with the NHS and the Department of Health and Social Care, as have Scottish officials, who have worked very constructively with officials in England. This has been seen as an issue that affects Scotland as well as England, and it is one on which officials have worked collaboratively.

[Mrs Anne Main (St Albans) (Con)]

Can my hon. Friend reassure patients who might be concerned that their operations have been delayed in any way, shape or form by this whole fiasco that at no point were any members of the public put at risk by the treatment or non-treatment of this particular sort of clinical waste?

[Stephen Barclay]

My hon. Friend is absolutely right to focus on that. The key risk in respect of this supplier was that the NHS’s ability to continue to perform operations would be affected if it could not clear its clinical waste. I am happy to reassure her that all 17 trusts affected have been able to maintain their services, which ultimately is the key issue for patients and our constituents.

Contaminated Blood

Anne Main Excerpts

Tuesday 11th July 2017 Commons Chamber

[Diana Johnson]

My hon. Friend is absolutely right. This tragedy has taken the life of more than 2,400 people with haemophilia, infected mainly through blood factor concentrates. Many others, without bleeding disorders, infected through blood transfusions and other means have also lost their lives. Thousands more have been left devastated. The survivors have been left to live with a combination of HIV, hepatitis C and a range of other viruses.

My constituent Glen Wilkinson is one such individual. He has haemophilia and was infected with hepatitis C when he was just 19 during a routine tooth operation. Glen is one of thousands of people who have fallen victim to the worst treatment disaster in the history of our NHS, and one of the worst peacetime disasters ever to take place in this country. Indeed, each of the 15 or so non-terrorist related public disasters I have looked at—ranging from the Bradford City stadium fire in 1985 to the Clapham Junction crash in 1988, the Marchioness disaster and, of course, Hillsborough—was a tragic event, and I do not wish to detract from the magnitude of those events, but the House should note that all those disasters led to a public inquiry.

Hon. Members and their affected constituents are entitled to ask why the same has not happened with contaminated blood. Had more than 2,400 people died over the course of one day or one year, it would be inconceivable for any Government to refuse calls for a public inquiry, yet the devastation caused by the contaminated blood scandal has been spread not over days or years but over several decades.

We must also bear in mind the profound effect this scandal has had on one community, those with bleeding disorders, many of whom were provided with contaminated blood factor concentrates sourced from profit-making American firms. Virtually everyone who had haemophilia at the time has been infected.

Hon. Members will appreciate that the impact can be devastating when friends and close-knit communities are hit by a collective tragedy. Consider, for example, the Treloar school for disabled children, a special school with a large number of pupils with haemophilia: 72 of its pupils have died because of this scandal. Many were forced to be silent to the suffering, either for fear of the stigma of having HIV, hepatitis C or other viruses, or because they were not even aware that they had those conditions. Important though that distinction is, it does not excuse the fact that successive Governments of all colours have sidestepped the issue for too long.

Internationally, an investigation saw the imprisonment of the former head of France’s blood transfusion service and his deputy, and a former French Health Minister was found guilty of manslaughter. In Japan, three company executives were imprisoned and an official was convicted on negligence charges. In the United States, the private companies involved in this tragedy paid out millions in out-of-court settlements across the world.

But nothing of that kind has happened in the UK. In 1991, in response to the threat of court cases, the Government set up an ex gratia payments scheme. There was no implication of liability, no use of the word “compensation” and waivers renouncing the individual’s right to the take further legal action had to be signed before they could obtain small sums of money.

[Mrs Anne Main (St Albans) (Con)]

A constituent, who does not wish to be named, wants us to include the remit of the Skipton Fund in this review. She, and many others, feel that the remit was wrongly drawn up, and that she and others have been denied the justice they should have had.

[Diana Johnson]

The hon. Lady makes an important point.

HIV Treatment

Anne Main Excerpts

Wednesday 29th March 2017 Westminster Hall

[Mrs Anne Main (in the Chair)]

Before I call Mike Freer to move the motion, I want to say that our thoughts are with the victims of last Wednesday’s atrocities. I do not think that the House is pausing in its proceedings, but our thoughts are with them today.

[Mike Freer (Finchley and Golders Green) (Con)]

I beg to move,

That this House has considered the all-party parliamentary group report Impact of Health and Social Care Act on HIV treatment.

I associate myself with your comments, Mrs Main, which are exactly right, and it is a pleasure to serve under your chairmanship. I also put on the record my appreciation of the Minister and other colleagues, but especially the Minister, who has been extremely supportive of the all-party parliamentary group on HIV and AIDS and who has always been helpful when I have raised issues to do with HIV/AIDS. I am grateful, too, to other Members on what is a busy day, with other demands on their time. Their attendance at this debate is much appreciated.

Since 2015, when I was elected chair of the all-party parliamentary group on HIV and AIDS, our main objective has been to draw on evidence from clinicians, patients, HIV charities and research groups concerned about the potential impact of the Health and Social Care Act 2012 on HIV treatment in England. In December 2015, therefore, we started to collect written evidence so that we could investigate whether such concerns were based on reality.

Our inquiry took about a year to conclude. We heard from clinicians, local authorities, public health officials, people living with HIV, and the charity sector. We took both written and oral evidence. After a year of gathering evidence, it is fair to say that we concluded that fragmentation has occurred, creating a degree of uncertainty and presenting opportunities for aspects of HIV care to fall through the gaps between the commissioning bodies. I will outline that later.

The purpose of our report, “The HIV puzzle: Piecing together HIV care since the Health and Social Care Act”, was not to turn back the clock, but to reach out to the sector for evidence and recommendations so that we may make tangible improvements to the commissioning of HIV services. We need to work together to make such changes to ensure that people continue to maximise the benefits of the world-class treatment and clinical care service available in the UK.

I emphasise that the majority of the report recommendations focus on the need for clarity and accountability in all parts of the HIV care pathway, because the lack of clarity in the 2012 Act is what came into sharp focus. It was exemplified by the debate surrounding the provision of PrEP—pre-exposure prophylaxis—and the uncertain future of HIV support services. I and my APPG colleagues who advocate central funding for PrEP welcome NHS England’s announcement of a new PrEP trial to reach 10,000 people.

Our report concluded that the Health and Social Care Act increased fragmentation to many aspects of the care pathway, from prevention to long-term condition management. For example, fragmentation has created risks for HIV support services. The separation of sexual health and HIV is another example. There are new potential barriers to testing and prevention. Most importantly, there is confusion over the commissioning of new prevention techniques. I will highlight some of our key findings and offer suggestions as to how the APPG believes the report’s recommendations can help address them.

HIV support services—non-clinical services—have long been considered a vital part of the care pathway for people living with HIV. The British HIV Association, BHIVA, which is accredited by the National Institute for Health and Care Excellence, provides official guidance on HIV treatment and care. BHIVA states that the following are necessary for effective long-term condition management: peer support; support from other trained professionals; and information about HIV treatment, healthy living with HIV, diet and lifestyle, and optimisation of general health issues. People living with HIV also need support to access general health services, financial advice, and housing and employment support.

That view is endorsed by NHS England:

“The effectiveness of specialised HIV services depends on other elements of the HIV care pathway being in place and effectively coordinated”,

Those elements include:

“Third sector HIV care and support services for treatment adherence, peer support and self management…Social care, mental health and community services for rehabilitation, personal care or housing”.

Not everyone living with HIV requires support, and most will only need to use those services periodically, such as when they are newly diagnosed, experiencing employment issues, pregnant or considering disclosing their status to others, and if they are experiencing discrimination. The UK stigma survey identified that 28% of people diagnosed within the previous 12 months reported suicidal thoughts. Sadly, the suicide rate for HIV-positive men in the first year after diagnosis is more than five times higher than for men in the general population.

Similarly, while the side effects of treatment have improved in recent years, many people still have real difficulty in managing them, especially when starting medication or transferring regimens. People who are long-term diagnosed may experience ongoing and irreversible side effects of older HIV treatments, such as neuropathy and lipodystrophy. Most recently, there is emerging evidence on diabetes.

Support services in those instances not only ensure that people have access to a trained professional or volunteer at the point of crisis, but reduce the pressure on healthcare professionals. The National AIDS Trust reported that 50% of attendees at expert patient groups subsequently reported fewer GP visits. For an investment of £400 per attendee, the average net saving to the NHS for each patient with a long-term condition was £1,800. In addition, Positively UK reports that 88% of people reported that peer support has helped them to adhere better to their treatment plans.

Unfortunately, however, we have heard from the National AIDS Trust and other local support organisations that HIV support services are vulnerable under the 2012 Act, because commissioning responsibility has not been clearly defined. Therefore, the clearly mandated service provision has instead taken priority, in particular where there have been reductions to public health grants for local authorities. Last year, for example, HIV services in Berkshire and Oxfordshire were reduced by more than £100,000. In Berkshire, that equates to a loss of a third of the funding, which will directly affect 300 people living with HIV in Slough and Bracknell.

In Public Health England’s guidance to commissioners, “Making it work”, HIV support services are the only part of the care pathway left “to be determined locally”. That means that either the clinical commissioning group or the local authority can provide such services, but in a number of cases it appears that no one is commissioning services such as community-based HIV clinical nurse specialists.

The value of support services in other disease areas is well recognised. CCGs already commission cancer care, peer support for mental health services and the DESMOND —diabetes education and self-management for ongoing and newly diagnosed—programme for diabetes. The APPG has therefore recommended that the responsibility for providing HIV support services is met by NHS England and CCGs as part of the patient care pathway provided for long-term condition management.

Local authorities have a responsibility to provide public health and social care services, but the ambiguity in the 2012 Act and reduced funding mean that the responsibility has been deprioritised. Support services sit comfortably within the mandate that CCGs and NHS England already have to provide HIV treatment and care. Importantly, what we are asking is that the Department of Health reiterate the need for a mandated whole-treatment plan, from start to finish.

NHS and Social Care Funding

Anne Main Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

Absolutely. It is so difficult to get to a GP, which is why there are all these pressures on our A&Es. Of course, it is only going to get worse, because this year we are going to see cuts to community pharmacies—3,000 will be lost from our towns and streets because of the cuts that are being pursued. Let us not forget that the figure of 3,000 community pharmacies being lost was what the previous Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), told MPs.

[Mrs Anne Main (St Albans) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I will give way one last time, but then I really must make some progress.

[Mrs Main]

I led a debate in Westminster Hall this morning on pharmacies and integrated services in the NHS, and not one Back-Bench Labour MP could be bothered to take part—not one!

[Jonathan Ashworth]

Labour MPs have been raising these matters in this House for weeks, including at urgent questions and in Opposition day debates.

Pharmacies and Integrated Healthcare: England

Anne Main Excerpts

Wednesday 11th January 2017 Westminster Hall

[Mrs Anne Main (St Albans) (Con)]

I beg to move,

That this House has considered pharmacies and integrated healthcare in England.

It is a delight to serve under your chairmanship, Mr Bailey. In the light of the extreme pressures on our health services, particularly in the winter months—much has been made of this recently in the media, although it is not dissimilar to many other years—with our over- burdened frontline services, clogged up A&E departments and congested GP services, I believe it is vital that we explore new models of delivering patient care, particularly an integrated model of patient care.

In 2016, there was an average of 2,500 more attendances at major A&Es a day compared with 2015, which is a 6% increase. People aged 80-plus have the highest rates of A&E attendance. As a country, compared with only a few decades ago, we are now fortunate enough to benefit from innovative drug treatments, greater survival rates from complex surgery, better nutrition and better education; but, as a population, many of our residents are living longer. For example, in my constituency of St Albans, the average life expectancy for a pensioner is over 89 years—it is nearly 89 and a half years. However, for far too many of our constituents, the latter part of their lives brings a prolonged period of frail health, with dementia and diabetes on the rise and an increased incidence of ill health linked to lifestyle choices such as lack of exercise, alcohol, obesity and smoking. That period at the end of our lives is often not characterised as a period of good health.

We need to come up with a seamless, flexible model that makes the best use of precious resources and benefits patients. It is therefore timely to explore in this debate the role that local pharmacies play in local health services and the potential role that they might play to ease the strain on more congested frontline services. I also want to make the Government aware of the continuing importance of pharmacies in communities and their potential to do so much more.

In an ever-changing world, we have a duty continuously to challenge the old models of health delivery systems. In October, the Government proposed to reallocate money to NHS frontline services. We all accept that the NHS is labouring under huge financial pressures, so any areas in which precious resources are dissipated due to inefficiencies or duplications ought to be considered. It is important to integrate community pharmacies into the NHS urgent care system and GP services. We need to promote a pharmacy-first culture for minor ailments to take pressure off frontline services.

Community pharmacies currently see some 1.6 million people a day in the UK. It is worth noting that the recent standard patient experience report for the East of England Ambulance Service NHS Trust in 2016 showed that 0% of respondents in my county of Hertfordshire had contacted a walk-in service, an out-of-hours GP service or a pharmacy service before contacting the ambulance service. I think we can agree that a lot more can be done to take the pressure off emergency frontline services.

Pharmacies are the most accessible health services in most communities: they are found on high streets, in supermarkets and in shopping centres. In St Albans, we have some great independent local pharmacists who want to get more involved and we even have the headquarters of the National Pharmacy Association, which supports independent pharmacies and helps them grow their businesses. We need to look at the current pharmacy model. In St Albans, patients can choose from five dispensing pharmacies within a half-mile area of the high street. Some pharmacies are just over the road from each other, and some have only yards between them. Given the Government’s financial support of £25,000 for those dispensing 2,500 prescriptions per annum, which comes directly out of our NHS budget, it is easy to see why we need to look at the model of provision and ask how we can get a better bang for the NHS buck.

I accept the Government’s assertion that a balance must be struck to ensure that pharmacies remain accessible but are not excessive in number and, importantly, that we have a range of offering. All the local pharmacies on the high street in St Albans are closed on Sunday, whereas the big supermarket pharmacies are open, in line with their shopping experience. It is worth noting that Sunday is the busiest day for most A&E services. However, a recent survey showed that 50% of people prefer, for a variety of reasons, not to use a pharmacy in a supermarket, particularly the retired, the elderly and other frequent pharmacy users. We therefore need to examine the model of opening hours, as well as location and the type of provision on offer. Given that many supermarkets are located outside the town centre, their pharmacies are not accessible to everyone, particularly the most vulnerable in society. Diversity and accessibility of provision are key to integrating pharmacy and health services.

Let us explore what pharmacies could do. Pharmacies should be capable of providing general health services. They could increasingly work beyond the traditional role and offer services to promote sexual health, increase physical wellbeing and give advice on flu immunisations and drug-harm prevention, for example. However, if we expect pharmacies to do more, we need the funding formula to reflect the quality of service they provide. That is what the pharmacies want. Local pharmacists in St Albans believe that they should be the first point of contact for advice on medicines, minor illnesses, healthy living and wellbeing. To facilitate that, the Quadrant pharmacy in St Albans has undertaken a major refit, with a brand new consulting room, and invested heavily in technology, including an expensive automated robot for dispensing medicine.

I visited the Quadrant—I am sure that many hon. Members made similar visits after the Government’s pronouncements in October—in November last year to discuss the opportunities and challenges facing small independent pharmacies. The pharmacy is a friendly, attractive place to pop into and is well regarded by local people. It has the potential to do so much more, but that extra service does not come without a cost. If people spend time talking to their local pharmacist, the pharmacy gains nothing if they then walk out of the door and go off to see their GP. It is important that we recognise the role pharmacies are being asked to play in giving advice, holding consultations and, potentially, dispensing services. There must be some reflection of the cost involved in the staff time that it takes to do those things.

Rachel Solanki, the director of the Quadrant pharmacy, told me:

“General Practice will need to continue to be the gate keeper of referral to secondary care.”

However, she helpfully suggested

“a whole raft of services and support for self-limiting and long-term conditions”,

such as dealing with uncomplicated urinary tract infections in women, impetigo and bacterial skin infections; managing non-complex patients with high blood pressure; performing healthy heart and cholesterol checks; and supporting patients diagnosed with diabetes. The list was quite exhaustive. She proposed that pharmacies could and should act as wellbeing hubs for the communities they serve. She went on to say:

“The community pharmacist, a highly-skilled and trained individual, is the most accessible healthcare professional and is available without an appointment. If a mechanism could be found to incentivise and remunerate, we are confident the mutual agendas would be achieved.”

That is her view, and that of many other local pharmacists. There is a mutual agenda for providing good healthcare for patients that could be achieved if pharmacies were brought into play.

The Government’s proposals in October last year were a step in the right direction, but we need more detail. I want to ask the Minister a series of questions, and hopefully he will be able to answer some of them. How can the Government make smaller and local pharmacies more attractive and accessible for everyone? How can the Government encourage GPs to offload services such as flu jabs on to pharmacies? In saying “offload”, I recognise that where there is a cost to the pharmacy and the GP is in receipt of payment for that flu jab service, that needs to be considered, but I would like to hear the Minister’s views on that. How can the Government promote the pharmacy as an alternative local health provider that can be trusted and deliver a quality service? This is not just about having a shop that you take your prescription to and maybe pick up a few aspirin; it is about the pharmacy being a health provider. How can the Government increase pharmacy capacity to provide a broader range of health services and ensure the correct remuneration for the service provided?

Responding to an oral question on 2 March 2016, the then Health Minister, Lord Prior, stated:

“The big driving force going through healthcare and community pharmacy today is one of integration, which means that community pharmacies must in future work more closely with their local hospitals and GPs.”—[Official Report, House of Lords, 2 March 2016; Vol. 769, c. 817.]

That is the point of today’s debate. The Government have pursued several polices that are intended to lead to better integration of community pharmacies, including the introduction of a pharmacy integration fund as part of the 2016-17 community pharmacy settlement.

Last month, Richard Murray of the King’s Fund published a paper looking into the role of community pharmacies in the NHS. In December 2016, the Minister described that review as

“an essential road map that sets out how we are going to move the community pharmacy network away from a remuneration model based just on dispensing and on to services as well.”—[Official Report, 20 December 2016; Vol. 618, c. 1301.]

When can we expect a response to that incisive review?

The NHS “Five Year Forward View”, which was published in 2014, recognised that GPs are “under severe strain”, and many of us will have met GPs locally who have restated that view to us. It also states that steps will be taken to:

“Build the public’s understanding that pharmacies and on-line resources can help them deal with coughs, colds and other minor ailments without the need for a GP appointment or A&E visit.”

I urge the Government to listen to pharmacists when considering how to take that integration forward, as we do not want to lose what is good in the system, especially where it works well for our local patients. For example, I know that the Government are piloting an urgent medicine supply service. Rachel Solanki, the director of the Quadrant pharmacy, tells me that in Hertfordshire there is a local scheme that is so well regarded that it has now been rolled out again. Her concern is that the proposed national service does not necessarily promote a pharmacy-first culture. The Minister may wish to clarify that that is not the case, but that was the view she expressed to me. She was worried that there might be a perverse incentive to encourage patients to phone NHS 111 in order to get a referral to the pharmacy service.

In an email Rachel wrote to me recently, her view was that the change could have the unintended consequence

“of actually increasing NHS 111 calls for emergency medicines when they should be directed to community pharmacies first. Our local service offers both the facility to help the patients get their medicine but, more importantly; also offers incentivisation of the community pharmacy to promote ordering medicines in a timely way to reduce medicines waste, and hopefully therefore preventing a further incident of need.”

She thinks it unlikely that the proposed 111 service will operate both the services that we have locally and the new model, and she worries about losing the existing local scheme. Will the Minister reassure me by saying whether schemes such as the one operating in my county of Hertfordshire could still operate in tandem, or will they be mutually exclusive?

[Julian Sturdy (York Outer) (Con)]

My hon. Friend is making a very powerful speech. Does she agree that although we must encourage clinical commissioning groups to work closely with community pharmacies—she has highlighted some good examples of that—the practice is patchy across the country? There is reluctance in some areas for clinical commissioning groups to engage with their local pharmacies. We have had that problem in York, where the CCG has been very reluctant to talk to local pharmacies. Local MPs, across parties, have written to it and finally got it to engage but it has been very slow, and we have to speed that up. We have great examples in some parts of the country, but poor examples in others.

--- Later in debate ---

[Mrs Main]

My hon. Friend is absolutely right and completely backs up the point I was making. There is evidence of good practice but other areas could do much better. Without bringing pharmacies to the table and into the ongoing dialogue about this issue, we risk not having the new model that we would all like to see—one that operates consistently wherever people go.

There must be a consistent model in the drop-in pharmacy service that we are envisaging. Of course, people often use pharmacies away from where they live, such as where they work or when they are on holiday or visiting friends. If the model is patchy, as my hon. Friend says, the system will not improve and we will end up with a situation like the one that is found in many holiday towns. A few years ago, the Select Committee on Communities and Local Government looked into the fact that many seaside and holiday towns have enormous pressures on their frontline services. If something goes wrong when people are on holiday, although what happens is not necessarily catastrophic, they all end up at the local A&E services in hospitals. That huge problem was recognised, I think, in the 2006 seaside towns report by the CLG Committee. This is all part of evening out the stresses and strains on the system, which for many seaside holiday and tourist destinations are often huge.

[Jo Churchill (Bury St Edmunds) (Con)]

Does my hon. Friend agree that that was largely the point of the Murray review, which she alluded to earlier? Integration throughout the whole of the NHS is vital, so that everybody knows what everybody else is doing and so that there are seamless pathways that everybody knows how to follow. That will ultimately give us benefits not only in pharmacies, but right across the NHS.

[Mrs Main]

Absolutely. Rachel Solanki and her colleagues are not necessarily critical of change—that is important. Pharmacies are nervous about some of the things that may be coming along, but they are not critical of change. Indeed, they would welcome a debate on the innovative services that other pharmacies are operating around the country. The fact that we do not all know about these services in other places shows that there is not an integrated approach. The services include anticoagulation monitoring in Knowsley; medicines optimisation work for respiratory diseases in South Central; sexual health screening, including for hepatitis, syphilis and HIV, on the Isle of Wight; oral contraceptive supply in Manchester and other contraceptive provision in Newcastle; alcohol screening and brief intervention on the Wirral; healthy lung screening in Essex; pneumococcal immunisation in Sheffield; a reablement service on the Isle of Wight; and phlebotomy services in Coventry and Manchester. That is a long, diverse list of services that are provided by pharmacies in those areas.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

Will my hon. Friend recognise that some innovative things are taking place in the west country, especially in my constituency?

[Mrs Main]

I am happy to acknowledge that some fabulous things are happening in the west country. That list was given to me. I make no excuse for the fact that I thought it seemed fairly long already, but I am certain that there are a lot more services that hon. Members do not realise are out there—perhaps even in pharmacies in their own constituency or the one next-door that they go shopping in or visit with their families. The fact that we do not know about them shows that there is no integration in the system. We should be aware of it if these services are being rolled out. Perhaps there should be a directory that we could consult to find out what is going on in certain areas.

That list shows hon. Members the exciting possibilities that could be open to pharmacies, including those in the west country that were just referred to, if we just gave them the chance to embrace them. Rachel, the director of the Quadrant pharmacy, ended her observations with a positive endorsement of the “Community Pharmacy Forward View”. She told me that it has

“been developed and signed up to by all national community pharmacy organisations about the types of services that either need to be commissioned at a national level or pressure put on Sustainable Transformation Plans (STP) leaders locally to commission a service package to patients”.

My hon. Friend the Member for York Outer (Julian Sturdy) said that there is reluctance in some areas to embrace this. We need a strong steer from the Government that this is where we are going and that they had better wise up, get around the table and come up with a suitable model.

[James Cartlidge (South Suffolk) (Con)]

My hon. Friend is making an excellent point and I congratulate her on securing this debate. I have discovered the same thing as my hon. Friend the Member for York Outer (Julian Sturdy) in Suffolk. It is about trying to get the CCG to talk to the pharmacists. The interest of the NHS is our interest—it is a national interest—and not that of acute hospitals, the primary care sector or any particular sector. The NHS must operate in the national interest, and if that means involving pharmacists much more heavily and that we have to be the ones pushing for innovation, it is our job to do that.

[Mrs Main]

My hon. Friend is absolutely right. I shall conclude my remarks soon, because I know that other hon. Members want to take part in this debate. If there is resistance in the system, I ask the Minister to find out what can be done to sort that out. How aware is he of resistance in the system? How much input have pharmacies had into highlighting what they would be prepared to do and their concerns about the fact that they are sometimes not being listened to in this debate? There seems to be broad agreement in the NHS “Five Year Forward View”, the “Community Pharmacy Forward View” and at the King’s Fund that the integration of pharmacies into NHS healthcare is the direction of travel.

[Margaret Greenwood (Wirral West) (Lab)]

The hon. Lady is making a really interesting speech. I have had such a big postbag on this issue because of the threats to pharmacies in my constituency. The fact that local community pharmacies are facing cuts is threatening the level of healthcare that people receive, particularly elderly people who cannot drive, people with children who need to be able to pop in with them after school and people with mobility issues. The cuts imposed by the Government are threatening the quality of the service that is being delivered. They need to address that before they look at further integration.

--- Later in debate ---

[Mrs Main]

I agree that there are concerns. As I mentioned earlier, there are five dispensing pharmacies within half a mile in St Albans. Some are literally over the road from each other, although I know that model is not repeated everywhere. None of them is open on a Sunday and the only pharmacy that is open is in a big out-of-town superstore. We need to look at a model that addresses their proximity to the populations that need to use them and the hours that people are looking for pharmacies to be open. It is no good if people can access the seven-day-a-week pharmacy service only by getting in their car and driving two or three miles out of town. It is all part of the same thing.

That is why I support the point made in the Government’s proposals in October about models such as the one in St Albans, although this is not the case everywhere, where there are the big boys and smaller independents all in the same area. If the hon. Lady were to walk into Boots in my constituency—I have nothing against Boots, which is one of the pharmacies on my high street, as on many others—she could pick up sandwiches for her lunch, as well as a variety of health and beauty products, perfumes and so on. It is a one-stop shop for many things, a bit like a supermarket.

My concern is that we must not lose community pharmacies such as the Quadrant, which is a single pharmacy in a small shopping precinct that many people walk to and use locally. We have to have a balance of availability and opening hours. If we are truly to embrace an integrated system, some pharmacies may need to consider their opening hours and sign up to being open when they would not normally be. They will have to be remunerated for that as well. We need to look at the whole model. I understand that there are concerns, but our current model cannot continue. I want integration, and I want more money and more services directed towards pharmacies to make them viable and to make them the first hub for the community.

There is broad agreement that the direction of travel we need is towards getting people to use the most accessible health provider, which is the local pharmacy. That would keep many smaller pharmacies going. They cannot compete with all the other offerings from supermarkets such as Sainsbury’s, which has a pharmacy in its out-of-town store in London Colney, so we need to ensure that they compete as health hubs.

I look forward to hearing what the Minister has to say about these issues. I am sure that many other Members will make contributions about their local models, because the provision and the pharmacies on offer vary throughout the country. I accept that, in areas such as mine, the current model cannot continue, particularly if it asks for NHS funding, but we must not throw out the baby with the bathwater. I ask the Minister to say what more the Government will do to ensure that pharmacies have a real role in the integrated health service.

--- Later in debate ---

[Steve Double]

I thank the hon. Lady for that intervention, and in many ways I share her concerns. While I respect the desire of Department of Health’s to ensure that money is well spent and delivers value for money, there are cases of over-duplication, as we have already heard. Some changes need to be made to the funding models. I agree that we need to do all we can to protect our community pharmacies, particularly in more rural areas such as my constituency in Cornwall, where they play such a vital role for rural communities. I was pleased that the Department was able to do something to help—certainly many pharmacies in my area benefited from the changes to the funding—but I respect the fact that that may not have been the case in her constituency, and I will be urging the Minister to do all we can to ensure that these vital services in our rural areas are protected as much as possible.

With the right support, and indeed the right funding streams, our pharmacies could play a role that would take pressure off the parts of our health service that are clearly under severe pressure, in particular primary care and acute and urgent care. We are all aware of the pressure that our A&E departments are under at the moment. I believe that many times, when people go to A&E—perhaps because they cannot get to see their GP as quickly as they would like or feel they need to—they could actually get what they need from their local pharmacy.

Part of this is about increasing people’s awareness of what our pharmacies can offer. Part of the learning curve that I have been on since becoming an MP has involved going to see our local community pharmacies and getting a better understanding of exactly what services they provide, which I was not aware of before. More could be done to promote the role that pharmacies can play and the services that they can offer by making the public more aware of those services. That in itself would take pressure off our GPs.

[Mrs Main]

I did not make this point in my speech, but my hon. Friend is almost making it for me—it is that our pharmacists are hugely qualified, but too often they are the most under-utilised highly qualified local health professional. It is nonsense that their expertise is not being used routinely, challenged or made available, because people do not seek to use it and are not even necessarily aware that it is there for them to utilise.

[Steve Double]

I thank my hon. Friend for making that point, which I completely agree with. There is much more we could do to increase the general public’s awareness of exactly how highly qualified our pharmacies’ staff are and of the excellent services that pharmacies can provide.

My hon. Friend the Member for Plymouth, Sutton and Devonport talked about the need to integrate IT systems better, which I believe is part of the solution we seek. My understanding is that community pharmacies can access summary care records, but on a read-only basis. Many pharmacists I talk to say that if they had read-write access to that information, so that they could input data about treatments they have given to patients, that would be better. For example, if they could take a patient’s blood pressure and input that reading into the patient’s care record, that would save the patient time as they would not then have to go their GP to have the same reading taken and put into their record. I urge the Government to consider carefully whether read-write access could be granted to pharmacies, because I believe it would save a huge amount of time and reduce what I believe is often duplication of work within our health system.

An interesting fact that I discovered in my discussions on this subject is that the average time that someone waits when they go to see their pharmacist—that is, the time between entering the pharmacy and actually getting to see the pharmacist—is eight minutes. Many people in this country would be absolutely delighted if they could see a health professional within eight minutes of asking to see one. I am sure that many hon. Members here today have in-boxes full of people’s complaints about how long it takes them to see their GP. If people were aware that if they went to see their local pharmacist they would only have to wait eight minutes on average to see a very well qualified health professional who has a good chance of providing them with what they are looking for, I believe they would be delighted. That is another example of how we can promote the work of pharmacists, which would provide a far better service to the people of this country and take pressure off the other parts of our health system.

--- Later in debate ---

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I thank the hon. Member for St Albans (Mrs Main) for securing the debate. I found much that I agreed with in her contribution, and I echo her call for a pharmacy-first culture.

It is a pleasure to take part in the debate, although I must admit to feeling a bit of an observer, as the debate is about pharmacies and integrated healthcare in England. We have heard from a number of speakers about the different practices that affect their parts of England; I hope that my observations from Scotland may also be of interest to Members. I have commented in a few debates that there are often lessons that we can learn from one another and good practices that can be shared. This issue provides an excellent case in point.

Community pharmacies were developed in Scotland 10 years ago and are there for minor ailments, chronic medication and public health services. The Scottish Pharmacy Board has stated that more than one in 10 GP consultations and more than 1 in 20 accident and emergency attendances could be managed by community pharmacists using the minor ailments service; that represents huge potential for the future. Although we await the full evaluation of the minor ailment service later in the year, estimates suggest that as much as £110 million could be saved. Further expansion of the MAS is planned.

[Mrs Main]

I do not often agree with what is said by Scottish National party Members, but I looked at the Scottish service, and one of the key things, which I think other hon. Members have raised, is the software functionality that in Scottish pharmacies are obliged to have. That is something we do not have in England—I do not know about Wales—and I wonder if the hon. Gentleman could let the Minister know about that. The ability to input into scripts and the remuneration that comes through that software functionality in Scotland is something that I found very interesting.

[Martyn Day]

The hon. Lady has emphasised the point very well. There is a considerable degree of integration in the Scottish service. It has been around for 10 years and is a fairly mature service.

The Scottish Government work side by side with the medical professions in Scotland and recognise just how important community pharmacies are. They are interested in exploring new ways for pharmacies to offer primary care services to help deliver care across our communities. There are some 1,200 pharmacies throughout Scotland, providing a range of services on behalf of the NHS. As well as dispensing prescriptions, they offer four NHS pharmaceutical care services, which have been gradually introduced since 2006. These are the minor ailment service, which I have mentioned, the public health service, the acute medication service and the chronic medication service. Those new services involve pharmacists more in the community in the provision of direct, patient-centred care, with every community pharmacy in Scotland having patients registered for the minor ailment service by March 2015.

Patients register with a pharmacist in the same way as they register with a GP. The aim is for all people to be registered with their local pharmacist, wherever they consider that to be, by 2020, and for all our pharmacists to be independent prescribers by 2023. Approximately 18% of the population of Scotland are registered for the minor ailment service—a total of 913,483 people. More than 2.1 million items have been dispensed under the service, which is some 2.2% of all items dispensed by community pharmacies in Scotland. Almost 500,000 patients are registered under the chronic medication service.

It is important that retail and dispensing pharmacies in England be encouraged to go in a similar direction to Scotland, because that would bring great benefit for the NHS. In Scotland, we recognise just how important community pharmacies are. We are committed to supporting and developing local GP and primary care services and have recently announced a three-year, £85 million primary care fund to help develop new ways of delivering healthcare in the community, which will involve pharmacists delivering aspects of patient care.

Looking at pharmaceutical services across the two nations, one of the significant differences appears to be how the services have developed, partly as a result of the funding structures. In Scotland, pharmacists do not get a large payment merely for existing, such as the £25,000 in England. Instead, they receive a modest establishment payment of £1,730. However, payments are based on needs that reflect a population’s age, vulnerability and deprivation. That model will see funding in Scotland rise by approximately 1.2%, while it looks likely to decrease by around 4% in England.

Another difference is the almost random way in which pharmacies in England appear to have opened, as a result of anyone being allowed to do so if they open 100 hours a week. A concern must be that there could equally be unplanned random closures, if they are allowed to shut down simply because they can no longer afford to survive. In Scotland we have a system of controlled entry for those who want to open a community pharmacy. Need must be demonstrated and applications approved by health boards. Consequently, we find community pharmacies in areas of deprivation, serving those most in need. Often health boards refuse applications because demand is already met.

Pharmacists are located throughout communities in Scotland, from rural areas to deprived inner-city areas, providing pharmaceutical care on behalf of NHS Scotland. The Scottish Government policy remains that, wherever possible, people across Scotland should have local access to NHS pharmaceutical care. There is much in the Scottish model that is working well and may provide a useful example for study on this side of the border. It is imperative that this successful model of community pharmacies across Scotland should not be put under threat by UK Government health budget cuts, which would impact on the Scottish Barnett formula.

--- Later in debate ---

[David Mowat]

I completely agree. Pharmacists have a big role to play in saving money, and medicines optimisation is very important in that. NHS England has established an integration fund, which will provide £42 million—a significant amount, even in the context of the rebalancing that has occurred—of seed money between now and the end of the next financial year to address just those sorts of things and take that work further.

The Murray review, which was commissioned by Dr Ridge, the chief pharmaceutical officer at NHS England, and published in December, sets out in some detail what we believe the direction of travel should be. Someone asked earlier when the Government will respond to that review. I expect NHS England to respond this month—if I may put that on the record in that way. NHS England will respond, not me, but there is not a lot in the review that is controversial. There are a lot of very good points, many of them about IT integration and the care record. I agree completely that some of the progress we need to make with services involves the ability to both read and write to the summary care record. That will be part of where we have to get to. Frankly, technology is an area in which the NHS could improve. That is true in Scotland—it is true everywhere. I will not spend a lot of time talking about what we need to do, but we could facilitate an awful lot of progress on integration between pharmacy and primary care, and primary care and secondary care, if we had stronger technological and IT solutions.

Colleagues have talked about the need to have more pharmacy involvement in medicines optimisation, and care homes are part of that. Pharmacists could do an awful lot with a more structured approach to care homes. One strand of work that has come out of the integration fund is a care homes taskforce, which is chaired jointly by the Royal Pharmaceutical Society and NHS England and is setting out a direction of travel for doing the sorts of things we have talked about, such as medicines optimisation, in a more structured way in care homes right across the country. There are more than 50,000 qualified pharmacists across our country. There are also 23,000 qualified pharmacy technicians, who are part of this too. The pharmacist profession is not as short as some, and it can and needs to do more to make progress in this area.

One part of the Government’s approach to this whole area that has been mentioned and I do not think enough is made of is the GP forward view. Everyone understands how much pressure GPs are under. There are something like 400 clinical pharmacists working in GP practices. We have committed and budgeted £112 million to increase that to 2,000 clinical pharmacists, many of them dispensing pharmacists. Parts of the community pharmacy network, which we have heard a little about, regard that as potentially in conflict with what they do. I think that is wrong. It is not in conflict; it is a way of breaking down the barriers that I accept there have occasionally been between CCGs and GPs and the pharmacy profession. Those are not in anyone’s interests, and we need to get over them.

[Mrs Main]

The only concern I have about too much of a drift towards putting pharmacists in GP surgeries is that GP surgeries have limited opening hours. Many pharmacies have a drop-in service. My hon. Friend the Member for St Austell and Newquay (Steve Double) mentioned the average waiting time of eight minutes. Having a link between booking a GP appointment and going to the pharmacy would start to bring people back into GP services rather than keeping them outside those services. That is the only concern I have about that matter.

[David Mowat]

That is of course a valid concern. We are trying to make progress on having GP services open for much longer than they have been historically, including weekend opening. Several colleagues have made the point—the Murray review also addressed this—that there is occasionally a barrier between the attitudes of some GPs and what can be done by pharmacists. That is true. We must be conscious that it behoves us to try to encourage the breaking down of that barrier, and misplaced professional pride must not prevent us from doing things to the best extent. Putting some pharmacists in GP practices—particularly with new models of working in which more disciplines tend to work together and a GP does not just work on his own—is an important part of that.

--- Later in debate ---

[Mrs Main]

This has been an excellent debate. I echo the Minister’s sadness about the fact that the two Opposition Members who made interventions did not stay for the whole debate. Unfortunately, some did not even arrive for the beginning of the debate, let alone stay for it all. That is disappointing, because this issue has filled my postbag and this debate is timely. There has been a lot of news about whether the NHS is under massive strain now more than ever. The reality is that we need a new model of working. Many hon. Members have put forward positive suggestions and have obviously been engaging with their local pharmacists. I am pleased that so many Government Members have made that effort and are so knowledgeable about their pharmacies.

The very fact that many private independent pharmacies like Quadrant have put money into their businesses—the hon. Member for Burnley (Julie Cooper), who leads for the Opposition, stressed her role in that—shows that there is a private model that can work with the NHS. It shows that those two models can be mutually beneficial and can learn from and give to each other. I am delighted that the Minister said that the emergency prescription system would not necessarily rule out the excellent system that Quadrant pharmacy operates, and I am delighted that we will soon hear the response to the Murray review, which contains many positive aspects about the way forward for pharmacies.

I am glad that there is so much consensus that keeping the model in which small, private independent pharmacies support the public NHS is an excellent way forward, and long may it reign. I am just concerned that we must ensure that small independent pharmacies in rural areas like the one that my hon. Friend the Member for Bury St Edmunds (Jo Churchill) represents are supported, perhaps with a weighting system. It is hard for them to compete with the big boys on the high street and the concessions in out-of-town supermarkets with parking and Sunday opening. I am glad that the Minister has been so frank with us, I am glad that there is so much consensus, and I am really looking forward to a great future for the NHS.

Motion lapsed (Standing Order No. 10(6)).

Community Pharmacies

Anne Main Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Mrs Anne Main (St Albans) (Con)]

It is a shame that the Front-Bench speakers took so long because many colleagues want to contribute to the debate.

I agree with the Minister’s thrust of ensuring that we get the greatest efficiency for the taxpayer and the best possible health service for our constituents. We cannot afford to waste money in any way, shape or form, but if we can find ways to redirect money into NHS front-line services, I agree that we should do so. As the Minister said, the NHS chief pharmacist has been very clear throughout the consultation that the current way in which community pharmacy is paid and organised needs to be reformed, so it is right that we should look at it.

The NHS is labouring under huge financial pressures, so we should look at any areas in which inefficiencies or duplications lead to precious resources being distributed inefficiently. The public want the money that could be saved through this measure to be reinvested in front-line NHS services. I am glad that the Minister has taken the opportunity to reassure us about that.

My own West Hertfordshire Hospitals NHS Trust struggles under a massive deficit that has been growing year on year. Its latest financial report revealed that it had a revenue deficit of £41.2 million by 2015-16. We cannot fail to tackle the huge financial pressures on the NHS, but just throwing money at the problem will never be enough if we do not seek to tackle the system at the same time. Surely the Opposition cannot be asserting that these matters should never be looked into. Their manifesto pledged £6 billion less than this Government have committed, so I am really intrigued to know how on earth they would keep this system in its entirety and, at the same time, put more money into NHS services, which is what I would like to happen.

I, like many, want the biggest bang for the taxpayer’s buck. I want the Health Minister to succeed in his aim of delivering the very best pharmacy service, with facilities that help to keep patients out of A&E and doctors’ surgeries and, at the same time, promote good health within communities. I agree that it is important to integrate community pharmacies into the NHS urgent care system and GP services.

I welcomed the Government’s announcement in October that the pharmacy integration fund will provide up to £42 million

“to improve on how pharmacists, their teams and community pharmacy operates within the NHS as a whole.”

If we are looking at an establishment payment of £25,000 to pharmacies, we must ensure that we get the right result. When it comes to the closure of small pharmacies, we must protect residents who live in more rural or sparsely populated areas, as well as those who do not have access to cars. The Minister has said that the existing funding system does not do enough to promote efficiency and quality, or to promote integration with the rest of the NHS. He has also said that in most cases the NHS is giving each of these pharmacies a guaranteed fixed payment of £25,000 per year regardless of their size, quality or local demand, and that in total the average pharmacy receives nearly £1 million for the NHS goods and services that it provides, of which around £220,000 is direct income.

Our pharmacy provision varies greatly across the country. The Quadrant pharmacy in St Albans, which I am due to visit on Friday, is situated in a small parade of shops and provides a valued local service. Other pharmacies are located as concessions in huge supermarkets such as Sainsbury’s in London Colney, which have the added attraction of longer opening hours, a large car park, being surrounded by other out-of-town superstores, and a huge footfall of shoppers who can get their prescriptions along with the dog food and Sunday roast. As many concessions are operated by the bigger chains, such as LloydsPharmacy, we must ensure that they do not extinguish the light of the smaller pharmacy that also operates in London Colney, just around the corner from the doctor’s surgery. It is important that we get this right.

I accept that there is an inefficient allocation of NHS funds when Government figures show that 40% of pharmacies are now in clusters of three or more. That means that two fifths are within 10 minutes’ walk of two or more other pharmacies, and I know that that is the case in certain areas of my own constituency. In the St Albans high street shopping area, there are five dispensing pharmacies within a half-mile area. Some are just over the road from each other, some have only yards between them, and some are also operating fairly near to that tightly packed city zone. That cannot be a good idea. St Albans is certainly very well served by pharmacies—not surprisingly St Albans is also the home of the National Pharmacy Association.

It is important that we look at the proposal on offer, but we must get this right. I hope that quality can be provided, that nobody is left behind when pharmacy services are streamlined, and that everyone has access to good services.

NHS Funding

Anne Main Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Speaker]

Order. I did not hear the offending term, but if it has been reported to me accurately, and the Clerks are invariably accurate in these matters, it seems to me to be a matter of taste, rather than of order.

[Mrs Anne Main (St Albans) (Con)]

It is regrettable that the Chair of the Select Committee, my hon. Friend the Member for Totnes (Dr Wollaston), has led this attack on a Government who are doing so much. Will my right hon. Friend tell me what more is being done to recoup the money that should have been clawed back from those who had health insurance and who should not have used our system?

[Mr Hunt]

My hon. Friend is right to point out that problem. For years, under the previous Government, there was a total resistance anywhere in the NHS to ensuring that the only people who received care free at the point of use were people paying for the NHS through the taxes that they or their families pay. That is something to which we will put a stop. There is much more work to be done. We have the second biggest aid budget in the world. That is the way that we help developing countries, but we cannot have an international health service.

Healthcare (Devon)

Anne Main Excerpts

Tuesday 18th October 2016 Westminster Hall

[Peter Heaton-Jones]

I thank the Minister for his intervention and I welcome it, but I say gently to him and NHS England, which I am sure is monitoring this, that all that good work will be entirely undone if we then lose our acute services at North Devon district hospital. This is not about figures on a spreadsheet; it is about the services and healthcare provision that my constituents will receive in Barnstable.

I am aware of the time, Mrs Main, but I want to raise a second issue, which is important and recognisable to us in North Devon, but perhaps not to those beyond: our unique geography and the distances. An Australian historian once referred to the tyranny of distance, and I think we suffer from that in North Devon. If one looks at a map, it is all too easy to think that there is a decent road network between Barnstaple and Exeter. I can give several reasons why that would be a wrong assumption. First, vast numbers of people live in isolated regions far north of Barnstaple. Secondly, the road network is not all it is cracked up to be—although that is a subject for another day and one on which I am fighting heavily.

My main point is that what no map or distance table shows is that in North Devon we have pockets of serious deprivation. In Ilfracombe, I have two of the most deprived wards in the south-west and by some metrics the most deprived in south England. In those areas car ownership is less than 80%. Put another way, one in five households do not have access to their own private transport and, because of the demographics, some of those who do are elderly and perhaps have their own vehicle but simply would not feel comfortable or up to going long distances to Exeter or Plymouth. Those two reasons alone are sufficient to argue strongly that the last place where we should be looking to make cuts to acute services is at North Devon district hospital.

I am aware of the time, Mrs Main, so I will conclude. I welcome the fact that the Government are looking at the funding. I welcome the repeated assurances that local clinicians will make the final decisions. However, I want it to be in no doubt whatever—the community of North Devon are very clear about this—that North Devon is a special case and needs to be treated as such. In that regard, I make no apologies whatever for fighting for North Devon and for appealing for there to be common sense and no cuts at North Devon district hospital.

[Mrs Anne Main (in the Chair)]

We have approximately 35 minutes before the winding-up speeches and there are five speakers. I am sure we can do the maths.

--- Later in debate ---

[Julie Cooper (Burnley) (Lab)]

I thank the right hon. Member for East Devon (Sir Hugo Swire) for tabling a debate on this important issue. It is heartening to see Members for Devon coming together with a unified voice on this subject. I, too, will mention Members who are not here today: the hon. Member for Totnes (Dr Wollaston), who has been mentioned, and my right hon. Friend the Member for Exeter (Mr Bradshaw). As we speak, they are questioning the Secretary of State for Health on finance for the NHS—a subject that cannot be totally separated from the issue at hand.

The healthcare challenges that Devon faces are immense, but I disagree with some of the points that hon. Members have made. I do not believe that the challenges are limited to this region; I believe they are systemic. Demand for NHS services is increasing nationally faster than ever before, fuelled in part by an increase in social deprivation and an ageing population. The need to address the increased demand, together with the need to keep pace with new technologies, is placing hitherto unseen financial pressures on NHS providers.

There are 280,000 people in Devon living with one or more long-term conditions, such as asthma, diabetes, hypertension and cancer; 150,000 people have a mental illness; and there are 40,000 people with cancer who need rapid access to high-quality services. Alongside that increased demand, there have been cuts to adult social care, and to public health and prevention budgets. If we are just to stand still, funding needs to be increased by an extra 2.6% above inflation. I am interested to see whether the Minister’s promised extra funding matches that; I doubt that it will. If no changes are made by 2020, the NHS in Devon will face a deficit in excess of £440 million.

In 2015, the Northern, Eastern and Western Devon success regime was introduced by Simon Stevens, the chief executive of NHS England, in an attempt to address the rising deficit and the failure to meet important health targets, including cancer waiting times. There is no doubt, as I am sure hon. Members agree, that there is a compelling case for change. Change is desirable; it would indeed be better for care to be more patient-centred, and of course it would be better to have more care needs met in the community. It is also true that the majority of patients receiving end-of-life care would prefer to die at home.

But, and it is a big “but”, change on this scale—massive, transformational change—needs leadership, transparency, a whole system change and, above all, investment. Making changes of this order—closing community hospitals with no proven plan for care in place—is downright reckless. That is why so many GPs in Devon are opposing the proposals, and have stated that they have

“grave concerns over patient safety.”

They say:

“we are concerned that the untried, untested closures of so many community hospital beds in this area could prove dangerous for a significant population of patients who might need to rely on community beds”.

The well-respected Chair of the Health Committee, the hon. Member for Totnes, has declared that she also cannot support the plans without an assurance that services will improve as a result of the changes.

People the length and breadth of Devon have expressed their concerns. The very active women’s institute in Devon has raised objections, as have communities across Devon. As we have heard from Members today, the consultation process has been woefully inadequate; there have been undersized rooms, and an online consultation. Frankly, it is not good enough.

Everybody is right to be worried. Only last week, the Care Quality Commission published its report, entitled, “The state of health care and adult social care in England”. The report states that

“the sustainability of adult social care is approaching a tipping point”.

In addition to the financial pressures, the sector is also experiencing massive problems with recruitment and retention of staff. The people of Devon are being asked to place their trust in a system that is on already on the brink and, quite understandably, they are not going to—and nor should they.

Local GPs have described the proposals as a “hasty cost improvement process”. This is the crux of the matter: the proposals as they stand, without adequate funding for alternative care, will save money, but they will not improve patient care, and may even compromise patient safety. I agree with the right hon. Member for East Devon that the cart is being put before the horse; that absolutely hits the nail on the head. Local NHS trusts in Devon are on their knees, desperately crying out for more funding to enable them to plan for the increased demand and changing needs of the population in the 21st century. This is not just about extra funding, but about making the kind of transformational change that is needed to deliver high-quality, excellent healthcare in the 21st century. It needs proper planning and proper systems in place, and that cannot be achieved on the cheap.

I am shocked that in this context, the Prime Minister is refusing to give the health and social care sectors more funding, which they desperately need. We have one of the lowest percentages of health and social care funding, as a proportion of our GDP, in the entire region of Europe. That cannot be right. I urge the Minister to use whatever influence he has with the Prime Minister to get her to revisit this issue, for the sake of the people of Devon, and for people across the country. This situation is not unique to Devon; we face many of the same problems in my region of Lancashire and, as I know from my work with the Health Committee, across the country.

I also ask that the consultation process be firmed up, and that people be offered a full, transparent and real consultation, rather than lip service being paid to having one. During Health questions the other day, the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), promised to visit Devon and to listen at first hand to stakeholders. I urge this Minister to take that away with him, and to look at making sure that the Government listen properly to the voices of Devon and the very legitimate concerns being raised in this debate. No one is trying to say that change is not needed, but one system cannot be taken away until there is a fully proven plan in place.

[Mrs Anne Main (in the Chair)]

I call the Minister. If possible, could you leave a minute or two at the end for the right hon. Member for East Devon (Sir Hugo Swire) to respond, Minister?

Junior Doctors Contracts

Anne Main Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

The hon. Gentleman has made many memorable contributions in the House, but that was unworthy of his track record. Let me tell him exactly what the Government have been trying to do to solve the issue. We have been talking to the BMA for over three years. We have had three independent processes. We have had 75 meetings to try to resolve the issues. He may be interested to know that we made 74 concessions in those meetings. There has been a huge effort. It is about not just talking, but both sides compromising to reach a solution. The BMA’s junior doctors committee was not willing to have constructive discussions, which is why we face the tragic situation that we face now. When the hon. Gentleman says that it takes “two sides”, I hope he recognises that we need a counterparty with which we can have sensible negotiations. We have not had that this time.

[Mrs Anne Main (St Albans) (Con)]

I met some junior doctors on Saturday morning, and they said that they wanted to go back to talking, which perhaps means that the union is not representing doctors as well as it could—I do not know. They also said that they had genuine concerns about a couple of issues apart from pay. Will the Secretary of State look at concerns relating to rostering and timing and whether a daytime shift should finish at 1.30 am or 2 am with the next day continuing as normal? Some issues are open to discussion, and my doctors want those discussions to happen, so perhaps the union is not being as helpful as it could be.

[Mr Hunt]

I am afraid that junior doctors, who work incredibly hard and are the backbone of the NHS, have not been well represented by their union. The BMA is currently telling junior doctors not to co-operate with trusts in any discussions about the implementation of the new contract. The kinds of issues mentioned by my hon. Friend are exactly those that we want to sit down and talk to the BMA about. I wrote to Mark Porter, the chair of the BMA’s council—in fact, I talked to him earlier this afternoon—about the possibility of talks to go through all those extra-contractual issues and the contract itself to ensure that we implement it in the best possible way. That is the kind of dialogue that the Government are willing to have and that we would welcome, but we need another party to come to the table if we are to succeed in doing so.

Mental Health Taskforce Report

Anne Main Excerpts

Wednesday 13th April 2016 Westminster Hall

[Mrs Anne Main (St Albans) (Con)]

It is a pleasure to serve under your chairmanship, Mr Wilson. Congratulations are due to my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) on securing the debate.

The report is very important. In the short time available I want to touch on two problems that people with mental health issues have, which the report focuses on and which many of us will have encountered in our constituencies. If people are young their problems are with schooling, family disruption and access to services. If they are older they may struggle to get work. There is often a lack of support to enable people with mental health issues who are in work to keep their job, and a lack of employers who understand the often sporadic nature of mental illnesses.

I am a patron of Mind in mid-Hertfordshire and a supporter of its “Time to Talk” campaign, and I welcome the investment in talking therapies discussed in the report. However, the employment rate for people with mental health issues is still far too low. In 2012 I and, I am sure, many other Members of Parliament, supported the “Way to Work” campaign that Mind championed. I presented a little trophy to an employer that took on employees with mental health conditions, but sadly the take-up among employers in St Albans was very low, and nothing further happened.

It is worrying that too many companies find ways not to employ someone with mental health issues, particularly if an episode of ill health has resulted in absenteeism. I would like to know what more the Government can do to work with employers and show them how they can manage a workforce in which there may be mental health issues in much the same way as they would if there were people with disabilities. I do not think enough is done to bring people into the workforce and show how they can be supported in their periods of good health and ill health.

On the subject of young people, I have been told of people having trouble in dealing with CAMHS. A recurrent theme is having sporadic meetings with a lot of different people. I learned of the sad case of a very young lad who experienced extreme mental health problems. He had problems going to school, and in the end it became too difficult for him to get there. With regard to getting home schooling, he has almost dropped off the teaching rota. The lad is housebound because of his severe anxiety. There is not enough support for his parents, or for other families with young people living with mental health issues. The mother had to give up work, and the family could never go anywhere. They could not go on holiday. There was no real support for the family in their situation. We need a more holistic approach that deals with the family rather than just treating the young person with the mental health issues.

I have a few questions for the Minister. What will the Government do to improve access to talking therapies and specialist back to work support for older people who have mental health problems? What more is being done to help people find and stay in work? What more is the Department for Work and Pensions doing to integrate services for young people, to make sure that when they have problems with the education system and getting access to services, they get the right information in a timely fashion? If someone recovers from a mental illness that they had when young, whether that was self-harming or, as in the case I mentioned, agoraphobia, they may be set up for a life of failure because their education went out of the window during a formative period.

What more can be done to help people who had mental ill health when they were younger and did not have a good experience in the education system? What more can be done to support them to get their lives back on track when their mental health improves? I would like a co-ordinated approach. At whatever age a person presents with mental illness, they should be assessed holistically. If there have been gaps in their training to get into work or in their education, extra resources must be put in to ensure that when they are well, they can move on with their lives like the rest of us. That would be much like our approach to people in prisons, who often have mental health issues.

We are subjecting many young people to a life in prison if we do not allow them to be trained up and get the help they need. Otherwise, they will end up in a life of crime, because when they leave school or are at school leaving age they will have little to offer any employer. We need to ensure that those people’s lives are not snuffed out and wasted at an early age, and that they have the chance to form a life for themselves and their families.