Community Pharmacies: Devon and the South-west

Claire Young Excerpts

Tuesday 17th December 2024 Westminster Hall

[Rachel Gilmour]

I thank my hon. Friend for his not particularly concise, but erudite, intervention.

I will turn briefly to the funding model of pharmacies. Some 90% of a pharmacy’s income is derived directly from NHS funding, but when it comes to how that funding is allocated, the system is broken. Community pharmacies across the UK dispense more than 1.1 billion items a year and deal with shortage issues on a daily basis. The Department of Health and Social Care sets reimbursement prices in our system, but due to the reimbursement prices being so low and pharmacies being unable to compete on the international stage, the global market is now a safer bet for pharmaceutical companies than the UK. That means that people in the UK sometimes are not able to get the right medication due to shortages and that even when the DHSC puts together a price concession and allows for a greater reimbursement rate to allow UK pharmacies to compete for those life-aiding medications, there are extraordinary pressures on the NHS and the taxpayer. The realities of the funding model mean that community pharmacies are trying to push up water uphill using tools riddled with holes—in other words, sieves.

[Claire Young (Thornbury and Yate) (LD)]

Does my hon. Friend agree that in addition to the issues with the cost of drugs, the funding model for providing all the other services that pharmacies are expected to provide, including the Pharmacy First approach to avoiding GP appointments, needs addressing?

[Rachel Gilmour]

I will come on to Pharmacy First at the end of the debate, because I see it as the solution, rather than the problem.

The sector is trying its hardest, but without a fundamental overhaul of the system these NHS services, which are much-needed by patients and the public, may fall by the wayside into one of the following pits. There are the hours lost. When the money is not there, pharmacies cannot operate. As we see in many areas across the south-west and the UK, including in Tiverton and Minehead, hundreds of hours have been lost to temporary closures of pharmacies. According to the Company Chemists’ Association, pharmacies across the south-west have cut opening hours to the tune of 130,400 hours over just more than a year and a half by reducing their opening hours. According to Community Pharmacy England, from October 2021 to May 2024, in my constituency alone, more than 520 hours of pharmacy time were lost due to temporary pharmacy closures.

Although pharmacies operate all the services that I mentioned in the first part of my speech—and more, but I do not have time to go through them all—the closures take a toll on the GPs and A&E staff who might be someone’s next port of call if they cannot see their pharmacist. They take a toll on the NHS 111 line if the individual calls in, and they take a toll on the people who might not have any other free time in that day to take care of their health needs. Those lost hours add up. When pharmacies cannot provide those appointments or other services, it leads to bottlenecks elsewhere in the system.

Over the first three months of Pharmacy First, to which I will come shortly, pharmacies took 234 appointments out of the GP system simply by offering consultations for the seven applicable conditions. Pharmacies have fantastic potential to relieve pressure and provide new ways for people to access medical services, receive advice and so much more. Pharmacies cannot fulfil their potential if they are closed. The prospect of local pharmacies closing really does scare people. In a recent poll, 83% of respondents reported that they would be concerned about their local pharmacy closing. Data shows that closures are disproportionately taking place in the most deprived areas, with 50% of the pharmacy closures recorded in areas in the lowest three deciles of deprivation.

NHS Dentistry: South-west

Claire Young Excerpts

Tuesday 12th November 2024 Westminster Hall

[Claire Young (Thornbury and Yate) (LD)]

I thank my hon. Friend the Member for Honiton and Sidmouth (Richard Foord) for securing the debate.

Last year, a staggering 58% of children in south Gloucestershire were not seen by an NHS dentist, despite the NHS recommending that under-18s see a dentist at least once a year. When we talk to dentists, however, that is not surprising. As we emerged from the pandemic, one local dentist stopped NHS work for all, including children. When I spoke to those at the practice, they were clear that the contract was at fault, but they also explained that they would have liked to continue NHS dentistry for children but NHS England in the south-west was not supportive.

The last Conservative Government failed to fix the broken contract, and the new Government have yet to show that they grasp the scale of the challenge. We are calling for an emergency rescue plan, including the use of the underspends that have been referred to today to boost the number of appointments.

I will mention a couple of examples from my inbox. The first I alluded to recently in the Adjournment debate on rural NHS dentistry led by my hon. Friend the Member for Chippenham (Sarah Gibson). A constituent who had to retire from his job due to health and mobility issues is entitled to free NHS dentistry, yet he was unable to find treatment anywhere near where he lives. Facing a dental emergency, he ended up having to seek private treatment, because of the pain he was in. He struggled to afford it, but felt he had no choice.

Later, my constituent experienced another painful dental issue. This time, when he contacted the NHS, he was told that there was provision but, because he was now registered, it was unavailable to him; it was available only to unregistered patients. As a result, he had to pay £95 for a small temporary filling at a private practice. He was then told he was not entitled to be enrolled as an NHS patient, as he was registered as a private patient with the practice. I hope the Minister will agree to look into that situation to ensure that everyone can get the care they need.

Another issue I will draw attention to is people missing appointments. A constituent of mine got in touch to complain that, although he is one of the lucky ones in the area who is still able to access dental treatment on the NHS, he was shocked to see a sign saying that 39 people had missed their appointment last month. Staff confirmed that that was the number of people who missed appointments at the practice with no warning or formal cancellation—and that is just one practice. They also said that number was actually quite low, and that it was regularly much higher.

Because those missed appointments were no-shows, not cancellations, the slots could not be offered to other people desperately in need. That resulted in the equivalent of more than eight days of lost work. That brings us back to the question of the contract and how we can make sure that dentists are rewarded for their time, because it adds to the problem of them not being remunerated in a way that enables them to continue NHS work. It is also a question of making the best use of limited resources. I welcome the Minister’s thoughts on how to ensure that happens.

Over 12 million people were unable to access NHS dental care last year. That is more than one in four adults in England, and three times as many people as before the pandemic. I echo the comments made by my hon. Friend the Member for Torbay (Steve Darling) about the challenges, particularly in rural areas, and look forward to hearing the Minister’s comments on that. We have been warning about the issues for years, yet there has been little decisive action to address the crisis. The British Dental Association has been pushing hard to get the Government to ditch the current failed dental contract and instead move to a more prevention-focused, patient-centred system that rewards dentists for improving the overall health of the communities they serve.

In short, I welcome the warm words from the Government on dentistry, but we need more than words; we need action. I urge this Government not to kick the can down the road as the previous Government did.

Income Tax (Charge)

Claire Young Excerpts

Tuesday 5th November 2024 Commons Chamber

[Claire Young (Thornbury and Yate) (LD)]

While this Budget has some welcome measures, including adopting Liberal Democrat proposals on increasing the earnings limit for carer’s allowance, others raise serious concerns. The previous Conservative Government left our NHS on its knees. People in Thornbury and Yate are fed up with struggling to get a GP appointment or register with an NHS dentist, so I will be holding the Government to account to ensure that the extra funding actually delivers for patients.

On that note, I am deeply concerned about the knock-on impacts of raising employer’s national insurance contributions on those parts of the system that are not in the public sector. GPs and pharmacists play a vital role in preventive health and in detecting serious problems early, yet because many are privately run businesses, they will be left footing a huge new tax bill. I have been contacted by several concerned local GP surgeries. One told me that as it had a large number of part-time workers who were previously exempt but will now be eligible, the national insurance increase alone will wipe 2.5% off its top-line budget. Another told me:

“This change will have a significant financial impact on general practices, including my own, and can only serve to directly undermine access and patient care”.

[Mr Adnan Hussain (Blackburn) (Ind)]

Blackburn has the third highest number of patients per GP. Does the Member agree that, despite the ringfencing of the funding that GP surgeries get, the increase in national insurance will essentially reduce the number of available appointments at GP surgeries?

--- Later in debate ---

[Claire Young]

That is exactly the point that my local GP was trying to make, and I am not clear from the Secretary of State’s earlier remarks whether this will be addressed.

Similarly, the majority of social care providers are privately run companies. They play a huge part in reducing pressure on hospitals, and raising employer’s national insurance will deal a hammer blow to struggling providers. That is why I urge the Government to think again and provide them with the same support they have provided for publicly owned NHS services. They should instead look to raise the money needed by reversing Conservative tax cuts for the big banks, or by asking the social media giants to pay their fair share. I was disappointed that the Budget made little or no reference to social care, and I urge Ministers to start cross-party talks on social care now.

The other area that I want to touch on is flooding. I draw the House’s attention to the letter I sent ahead of the Budget about the need to support local authorities to prevent and respond to flooding. My Thornbury and Yate constituency recently endured 50% of its annual rainfall in just one month. The council has had to respond to that within its already overstretched budget. While I welcome the funding for flood resilience projects, it needs to be recognised that years of underfunding under the last Government have left councils struggling to maintain their infrastructure to prevent surface water flooding.

Given more time, I would like to cover other topics, including the concern that the additional SEND funding will barely touch the sides, the impacts on farmers, bus users and small businesses, and the ongoing financial crisis in local government. Instead, I will conclude by noting that the unintended consequences lurking in this Budget put at risk much-needed improvements to our public services. I hope the Government will think again and make the right decisions now for the long term, including fixing social care and delivering long-term infrastructure improvements.

NHS Dentistry: Rural Areas

Claire Young Excerpts

Tuesday 5th November 2024 Commons Chamber

[Sarah Gibson]

I agree with my hon. Friend. As I have mentioned, the ICB that represents my constituency has quite a significant underspend in its dental budget. That is quite often because dental practices do not wish to take up the contract as they find that the payments system, and its use of units of dental activity, fails to support them in a way that allows them to make a living. As we said earlier, small businesses are struggling across the country. They find that they are subsidising their NHS dentistry with private dentistry, to the point that it is no longer sustainable.

Another issue that is prevalent in most rural areas, and certainly in the south-west, is recruitment. While NHS dentistry does not pay, it is extremely difficult for dental practices to find dentists who will take on NHS contracts. Many of the dentists who took on NHS contracts have left—some were European citizens—or are simply no longer prepared to spend that many hours in a dental surgery and have decided either to retire or to take on easier work elsewhere. This ongoing problem will continue unless the dental contract is reformed quickly.

[Claire Young (Thornbury and Yate) (LD)]

Does my hon. Friend agree that it is wrong that patients who have been forced to seek private care in an emergency are then refused NHS registration, because they are considered to already be registered as private patients? Should this not be addressed in any revised contract?

[Sarah Gibson]

My hon. Friend makes an interesting point that I was not aware of. From discussing this matter with dentists, it was my understanding that these days, nobody is actually registered with a dentist; they are merely allowed to come regularly, and if they do not, they are taken off that dentist’s lists. My understanding was that it is quite difficult to register, so that is an interesting point that I hope the Minister will note.

A particular concern to dental practices, and a point that Denplan made very clear to me, is that once a dental practitioner has handed in their NHS provider number, even if the dental contract is improved, they are unlikely to come back to the NHS because of the complications involved in getting that provider number reinstated. That is why we need the Government to act now, before more dentists leave the NHS. Another issue for dental practices is that when qualified dentists come over from the EU, their qualifications are valid, but they have to spend an extra year training before they are allowed to register as NHS practitioners. That is slowing down any chance of increasing our intake from our European partners.

Cancer Strategy for England

Claire Young Excerpts

Thursday 31st October 2024 Westminster Hall

[Claire Young (Thornbury and Yate) (LD)]

It is a pleasure to serve under your chairship, Mr Betts. I thank my hon. Friend the Member for Wokingham (Clive Jones) for securing the debate. Some 2.2 million people are expected to be diagnosed with cancer during this Parliament, and almost one in two of us will get cancer in our lifetimes, so we should all be concerned about the crisis in cancer care that was highlighted by the Darzi report.

In my constituency of Thornbury and Yate, just over half of cancer cases are diagnosed early—that is around 2,500 people a year—but just over two thirds of those diagnosed are able to start treatment within two months after being referred. That is far lower than the 85% NHS target. This Government have promised to do more to tackle the delays in cancer diagnosis and treatment, and I think a specific cancer strategy is the way to achieve that. I will illustrate that with two examples from my constituency.

The first constituent suffers from a rare cancer condition and sought treatment at Cheltenham general hospital, where they received immunotherapy treatment. However, they have since been informed that their treatment will cease on 31 January 2025, due to financial considerations. It simply is not acceptable to have a situation in which a patient is told that they need a particular treatment and then has it halted part way through, not because it needed to stop for their own best interests but because of financial constraints. That is absolutely appalling, and it is a glaring example of where the system is failing. Everyone who has cancer deserves timely and consistent treatment. That is the first thing I highlight for Ministers: when they are looking at producing a cancer strategy, will they look at the treatment and how it is delivered, to make sure that decisions are being made in the best interests of patients, rather than the accountants?

My second example shows how early treatment can save lives. This constituent told me how, in 2021, they were diagnosed with cancer in their eyes. They are one of the lucky ones: it was caught early by their optician and they got an urgent referral. Because they got treatment quickly, they are still cancer-free today. However, it is fair to say that they are not out of the woods; there is a high chance of recurrence and possible metastasisation in the coming years. They told me how that is hanging over their head every day, and made the point that one small change could have meant that, instead of living their life, they would no longer be with us.

That shows exactly why identifying and treating cancer as early as possible is vital. It highlights, in particular, the importance of professionals who are not specialists in cancer but play vital roles in identifying possible signs of cancer at the early stage. There are probably people up and down the country who can give examples of how pharmacists, opticians, dentists and so forth have been the ones who set them on the road to that all-important diagnosis. As we know from other debates in Parliament, all those professions are under strain. We know that people cannot get dental appointments, yet we know how important that is for identifying oral cancers. As I raised in the Chamber this morning, we also know about the issue of pressures on community pharmacists. When the strategy is drawn up, will Ministers look at the importance of non-cancer specialists in referring people for diagnosis, and ensure that that forms part of the strategy?

My hon. Friend the Member for Wokingham identified Denmark as a good example of a country that had been where this country is, but has managed to race ahead. The point is that it had a series of cancer strategies. Reference has been made to delays, or to the idea that we should make this part of a wider strategy. Let us get something done, as a starting point, and then it can be an iterative process. The strategy can be looked at again, and gradually we can make the improvements we need.

A dedicated cancer strategy would complement the Government’s 10-year health plan by offering a clear road map for an integrated approach to improving outcomes across cancer prevention, diagnosis, treatment, research and care. That is why we need a dedicated cancer strategy and a wholesale review of the system, to ensure that everyone gets an early diagnosis and the treatment that they need, when they need it, and are fully supported in their journey with cancer.

Access to Primary Healthcare

Claire Young Excerpts

Wednesday 16th October 2024 Commons Chamber

[Claire Young (Thornbury and Yate) (LD)]

Given the time constraint, I will skip some examples, such as Thornbury health centre and Three Shires medical practice, which are already safely lodged in the Secretary of State’s inbox. Instead, I want to focus on the inter- dependence in the primary care system—an ecosystem in which strains in one part have knock-on effects in others—and to illustrate that with an example from my constituency.

This summer, I met a community pharmacist in Abbotswood, an area with significant health inequalities. He raised the same concerns about the flawed funding formula for pharmacies that we have heard today, but he has an additional challenge: the next-door GP surgery, with which his pharmacy has had a symbiotic relationship for many years, has been incorporated into a larger group. The other surgeries are in another urban area some miles away and difficult to access by public transport, and the local surgery now offers patients only limited hours. Understandably, many of them are switching to surgeries in central Yate, which has an impact not only on the viability of that local GP surgery but on the community pharmacy, which is missing out on the Pharmacy First referrals that it might have expected. Also, once people have travelled into town, generally they will use the pharmacies there. If that pharmacy is unable to continue, people will miss out on its many valuable preventive services: monitoring medications, providing services to those with diabetes and administering vaccinations. That will increase pressure on GPs and our hospitals.

The pharmacist also commented on the impact of the dental desert in my area, as in others around the country. People cannot access NHS dentistry, which leads to other health issues not being picked up. I want to stress that the Government cannot fix just one part of the system—they have to look at the system as a whole. That is what the Liberal Democrats recognised in our manifesto. I urge the Government to look at our plan for the NHS and work constructively with us to fix all aspects of primary care.

Maternity Services: Gloucestershire

Claire Young Excerpts

Wednesday 9th October 2024 Westminster Hall

[Claire Young (Thornbury and Yate) (LD)]

I thank my hon. Friend the Member for Cheltenham (Max Wilkinson) for securing this debate.

Although my constituency is in south Gloucestershire—which I have spent many years as a unitary councillor explaining is a unitary authority, not a district of Gloucestershire—some of my constituents access health services north of the border in Gloucestershire. The serious concerns about maternity services in Gloucestershire are causing people to travel the other way across the border, into Bristol, where many other of my constituents use services, so they have a significant impact on my constituency.

I welcome this debate because I know from my own experience the impact that overstretched maternity services can have on outcomes for the mother and baby. I had the misfortune of giving birth in a hospital that had too many simultaneous emergencies. Even now, more than 20 years later, I vividly remember the feeling of abandonment, the horror when my newborn baby was rushed to the neonatal intensive care unit, and the panic as I felt myself losing consciousness and a team of doctors rushed into the room to deal with me. It was many hours before I was reunited with my son, six months before he was discharged from consultant care, and more than two years before I was discharged. My experience of early motherhood was blighted by trauma, pain and seemingly endless follow-up appointments for both of us with a huge range of specialists. Five or more years later, doctors still considered my son’s birth relevant to his health. Sadly, for some families the outcomes are far, far worse. I cannot begin to imagine the pain of losing a child or partner in childbirth, but for some that is the tragic reality. How hard it must be to bear if there is the possibility that better care may have changed that reality.

Let us not forget the impact on the wider family. The hon. Member for Gloucester (Alex McIntyre) spoke about the support he received from staff when his son was born. The family, too, can be traumatised by what they see family members going through, so I understand how important it is to have good maternity services, and I am deeply concerned about the impact that the current shortage of midwives is having on outcomes for mothers, babies and their wider families. Stroud maternity unit is affected by the shortage, so people are choosing to travel to Southmead, which many of my constituents already use, and that extra pressure will make it harder for staff there to deliver the service that people need.

Being continuously supported by a midwife during labour can prevent a situation from escalating dangerously. Proper support after the birth, however it went, can set families up for the early months by helping mothers to recuperate, establish feeding, talk through concerns and get to know their baby in a supportive environment.

The hon. Member for Stroud (Dr Opher) made a very good point about the importance of choice. There can be a sense that it is a luxury—people make these choices because they have an idealised view of how birth should go—but, as my own experience demonstrated, the manner of the birth can have significant, long-term consequences for the mother and baby, so choice is not a luxury. It is important to understand that in childbirth feeling comfortable allows hormones to flow, and that promotes the best chances of a successful, uncomplicated birth, which is obviously the ideal. Some people take comfort in knowing that they have the very best, high-tech facilities on hand in case there is an emergency. For others, it is about knowing that they are in a familiar environment—their home or a birthing unit that they feel comfortable in. Choice is important, not because it is a nice thing for mothers to have but because it has potentially long-term consequences on the physical and mental health of the mother and baby.

I am concerned that two years after the joint report on safe staffing from the all-party parliamentary groups on baby loss and maternity, staff levels are still frequently inadequate. We want to see a cross-Government target and strategy, led by the Department of Health and Social Care, for eliminating maternal health disparities, providing guaranteed mental health support and establishing a new workforce plan, backed up with adequate funding and an expansion of the maternity and neonatal workforce.