National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021

Baroness Barker Excerpts

Monday 26th April 2021 Lords Chamber

[Baroness Barker (LD)]

My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for introducing this debate. It is a most timely and important one. As I sat down to prepare my speech for today, I thought back to a year ago, and two places. One was the relatively affluent suburb of south London where I live. It is very fortunate. It has a major teaching hospital, a number of excellent primary care facilities and, if anything, an oversupply of pharmacies, both chain and independent. Contrast that to a small place up in Lancashire, where there is a district general hospital but where the GP services have not had any permanent staff for the whole population of a small town in over 15 years. The high street chain pharmacies there have bailed out and just one or two community pharmacies remain, and they are struggling.

From watching people at that time when it was not possible either to go to hospital or to a GP, I saw people visiting their local pharmacy services and relying on them. In south London they were very well served; up in Lancashire they were not. That is the important thing for the Government to recognise. We are talking about a sector that is both a key part of the front-line delivery of healthcare services but also, in part, part of the retail sector, which we know was under severe stress even before the events of the last year. It behoves the Government to take a strategic view of services for the public and to begin to work out exactly how we make sure that the population as a whole has access to this most important of services.

I am no Pollyanna about the pandemic. I do not take the view that there are any great silver linings. It was terrible. However, the pandemic has highlighted those things that are contributing factors to health inequalities as well as new ways of working for the NHS which we need to—and have shown in the last year that sometimes we can—adapt and accelerate at pace.

The important thing to understand is the unique role of high street pharmacies. They are not on the web. They are physical presences where people can go as a walk-in and talk to trained professionals. That, I believe, makes pharmacies a very significant part of the overall pattern of health provision, which I think may change. I think the way in which people will access GP services in future may change. However, we have to have some consistency and some understanding on the part of the public, who, by now, after a year, are very well versed in understanding how we best use the resources of the NHS and do not waste them but who really want to be sure that they can use pharmacy services and can rely on them to be there.

The all-party parliamentary group held an inquiry in 2020. We have known since 2016 that we have lost about 400 pharmacies, disproportionately in those poorest communities. In 2020 we found that the cost of staying open and offering services when other NHS services were under the cosh has had a disproportionate effect on pharmacies. Some 95% of independent pharmacies believe that they are under financial pressure. We really should not allow that to continue.

I also want to talk about the distinction between community pharmacies and the chains. Chain pharmacies have a difference that arises from their ability to operate at scale and that is very valuable. It is now the case that the majority of people with eye problems go to their opticians. I know that in this last year GPs were signposting people to go to opticians if they had minor eye problems; so, too, with audiology services and other services which are primarily being done in pharmacies rather than in the NHS. If that works effectively and efficiently for people, we should make sure that it remains.

I am the co-chair of the All-Party Parliamentary Group on Sexual and Reproductive Health. One of the biggest changes that we have witnessed during the pandemic is the change to telemedicine for women seeking abortion and access to contraceptive services. Data that has been subject to two different reviews—in Scotland and England—shows that that move has been extremely beneficial to patients. It has cut waiting times. It has enabled women to be seen much more quickly than they would otherwise have been. It has beneficial health outcomes. I know the Government are in the middle of a consultation but I hope that they will make that move permanent simply because it is in the best interests of the health of women and girls. I also hope that the Government will come through on the suggestion that we should make access to contraception much easier and allow young women to go to pharmacists and for that to be the primary route for accessing oral contraception but that the oral contraception should be free. We should not be cost shifting as we do that.

I want to make one other point. It has always seemed to me that one of the biggest barriers to integrated healthcare care at whatever level—acute, primary, community—is that of information and data sharing. I believe that if we are to make more progress on that—as I think has been hinted at or has been mentioned in passing in the White Paper—we need to come back to how data is shared responsibly across different providers so that we can enable people to have access to services without any leaking of their private data. I believe it is safer for people to have their data shared with NHS-approved pharmacists than it would be for them to seek other services on the web from unlicensed providers.

I want to echo the views of the noble Lord, Lord Hunt of Kings Heath: pharmacies have played a tremendous role this last year, but they cannot sustain it and continue to provide the services that they have. If we imagine that, this time next year, the NHS is again having to deliver a vaccination programme on the scale that it is now, it is impossible to think that pharmacies could continue to bring up the slack. So in the meantime, I back the noble Lord, Lord Hunt, in his request that pharmacies are not asked to return the £370 million that was put in on an emergency basis, and that, secondly, as a matter of urgency, we have a plan for integrating pharmacy services in a clear and thought-out way, proactively taking part in prevention and also enabling people to deliver emergency front-line telemedicine services to people who need acute access.