Coeliac Disease and Prescriptions

David Mowat Excerpts

Tuesday 1st November 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate the hon. Member for North Durham (Mr Jones) on leading the charge on this subject. There is clearly consensus in the Chamber on the direction the Government should take. I will make a few points about where we are and what I think we need to do, and leave time for him to sum up.

[Mr Adrian Bailey (in the Chair)]

Order. In a half-hour debate, the mover does not have the opportunity to sum up at the end, so you have a little more time than you thought, Minister.

[David Mowat]

Thank you, Mr Bailey.

As the hon. Gentleman said, one in 100 people in the UK suffer from coeliac disease. Interestingly, I was not aware of it until a year ago, when I was tested for the disease—fortunately I was negative. It is a significant disease that benefits from early diagnosis, and the points made about diagnosis were valid. Coeliac disease is an autoimmune condition: gluten damages the small bowel and the immune system feeds on it, resulting in a range of symptoms including diarrhoea, iron deficiency, tiredness and weight loss. It can exacerbate, if not cause, osteoporosis and mental health issues.

As we have heard, the only treatment is a gluten-free diet, which has two components. Meat, fish, fruit and vegetables do not contain gluten and generally do not need to be prescribed, but staple foods such as bread, pasta and flour and non-staple food such as biscuits do contain gluten. Since the 1960s, when the medical community was becoming more aware of the disease, those staple and non-staple foods have been prescribed pretty much, it is fair to say, without limit until recently. We spend something like £28 million a year on these prescriptions and in the great scheme of NHS costs that is not huge when considering the cost of cancer drugs and so on. It is true that we are now seeing a postcode lottery emerge, and I will say a little about why.

The other thing that has happened since the 1960s—I think the hon. Gentleman will concede this—is that the supermarkets and the retail trade have begun to get their act together in selling these products, although of course they are not available to everyone. Many supermarkets now have areas with gluten-free products, including bread and pasta. The products are more expensive than the equivalent non-gluten-free products, but they are certainly more available than in the past and a real alternative. Added to that, the fish and meat part of the diet, which is the same for sufferers and non-sufferers, is available to both.

[Kevin Foster]

The Minister is making valid point about supermarkets. Will he suggest to CCGs such as Torbay in south Devon that there is a halfway house and that instead of scrapping the prescription of gluten-free products they could provide vouchers that could be taken to a local supermarket?

[David Mowat]

That is an interesting idea, which I will consider, but I am not briefed to talk about it. The position of most Members on this issue is very clear from the tone of this debate and the points being made, and we will respond to that.

[Rebecca Pow]

Will the Minister give way?

[Liz McInnes (Heywood and Middleton) (Lab)]

Will the Minister give way?

[David Mowat]

First to my hon. Friend, and then to the hon. Lady.

[Rebecca Pow]

This is highly relevant. I, too, have been contacted by constituents who have suggested this voucher idea—that the bona fide coeliacs get the staples and so many vouchers a month, not for all their products, but for the bread, pasta and absolute staples.

[Mr Adrian Bailey (in the Chair)]

Order. Before the Minister responds, can I point out that he has been very generous in taking interventions, but the debate has to finish at 4.45 pm?

[David Mowat]

I made the point earlier that one in 100 people suffer from coeliac disease, and that £28 million is not a huge amount of money in the context of the entire NHS. I am sure the hon. Lady’s arithmetic stands up to that, and those are fair points.

If I may, I will set out the postcode lottery that has emerged. So far, 11 out of around 200 CCGs have ended all gluten-free prescriptions; 27 offer only bread and flour; 20 offer only bread, flour and pizza; 92, which is still by far the majority, broadly follow the Coeliac UK guidelines and offer a full range based a little on age, gender and other restrictions; and only four CCGs now have no restrictions whatsoever. The arguments about this are clear. Many poorer people, in particular—low-income people—are affected by the need to source their gluten-free products in different areas. CCGs are under pressure—the whole of the NHS is under pressure—and choices have to be made. It is true that £28 million is not a huge amount of money, but with £28 million here and £28 million there, we are soon talking about real money. It is true that choices have to be made, but it is not clear to me that this is an area in which the right choice is always being made.

In the couple of minutes available, I want to set out the actions that I think we should take. First, the hon. Member for North Durham correctly said that the community pharmacy sector has a role in this and is not so far being utilised as much as it could be. I think that he was wrong to say that it has stopped doing this in the transition from PCTs to CCGs. Something like 200 community pharmacies—15% of the total—do stock and sell gluten-free products. We are doing a review into the community pharmacy sector, trying to get it more focused on services. This is a very clear example of the sort of thing that we should be paying it to do, and when the Murray review is complete, I will—I am sure the hon. Gentleman will hold me to account on this—endeavour to make sure that that happens.

The hon. Gentleman mentioned consultations. CCGs should not withdraw gluten-free products without a consultation. My understanding is that in all cases where that has happened, a consultation has taken place. If he can provide me with evidence of that not being so, I will follow up and take action. The information I have been given is that consultations should always have taken place.

Finally, there is the issue of the postcode lottery. It is true that we give CCGs a lot of power in our system, in terms of making clinical decisions. The idea behind that is that they look at local considerations and balance the various options that they have. However, I will see to it that a review is done, hopefully within the next six months, of prescribing policies, and we will endeavour to come together with something that is more consistent, in a way that means we can actually make progress on this. I thank the hon. Gentleman for his contribution, and I thank everybody that has made an intervention in this debate. It has been a good debate, and a useful one for us to have had.

Question put and agreed to.

Health Informal Council

David Mowat Excerpts

Friday 21st October 2016 Written Statements

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

My hon. Friend the Parliamentary Under-Secretary of State for Health (Lord Prior of Brampton) has made the following written statement:

An Informal Health Council meeting was held in Bratislava on 3-4 October 2016 as part of the Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council formation. Lord Prior, Parliamentary Under-Secretary of State for Health, represented the UK.

Food reformulation

During a discussion about food reformulation, the UK updated Ministers on the introduction of a sugar levy on soft drinks and the importance of looking at how to best inform the population on links between sugar and obesity. The UK outlined key parts of the UK childhood obesity and talked about the importance of focusing on children, and influencing behaviour at an early age. The UK also stated commitment to working with others to tackle different issues whilst taking forward an exit from the EU.

Medicine Shortages

There was widespread agreement amongst Ministers on the importance of working together and sharing information to tackle medicine shortages. There was recognition that shortages occur for a wide variety of reasons and that there is no one solution. The UK explained that there was fragmentation within national systems and expressed caution on whether an EU wide solution to these problems was practically possible. The UK expressed recognition of member states’ concerns about pricing, but stressed the importance of a vibrant life-science sector. The UK also underlined anti-microbial resistance (AMR) as an area where action was needed to ensure the development of new drugs.

Tuberculosis

There was support from member states for an EU framework on tuberculosis (TB) which would also include hepatitis B and C and HIV given the significant overlap between the conditions. There was also agreement on the need to share information, to work with the eastern neighbourhood and support for a civil society forum. Current work was outlined, including the EU joint action on TB, the European Commission contribution to the Global Fund and the World Health Organisation (WHO) TB action plan. The UK updated the meeting on the new UK national strategy on TB, which takes a multi-sectoral approach and complements the WHO strategy. The UK also highlighted links with AMR.

Vaccination

During a discussion about how to increase vaccine uptake across the EU, the UK highlighted work undertaken to increase vaccine coverage in the UK — including through action on shortages, communication campaigns and through forecasting and planning. The UK supported further international work on the issue and, with other 4, agreed on the importance of sharing information. The UK also mentioned links between increased vaccine uptake and tackling AMR.

AOB

The Czech Republic invited Ministers to a joint ministerial meeting on health and the environment in Ostrava on 13-15 June 2017. There was also an item about European Commission work on patient safety.

[HCWS208]

National Arthritis Week

David Mowat Excerpts

Thursday 20th October 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Member for Foyle on leading the charge—[Hon. Members: “Strangford!”] I beg your pardon; I meant the hon. Member for Strangford (Jim Shannon).

[Jim Shannon]

I have more hair than the hon. Member for Foyle (Mark Durkan), but not much more.

[David Mowat]

Don’t take it as a compliment. It has been a long day.

It seems extraordinary, thinking about some of the subjects we debate, that it has been five years since we have debated this subject in the House of Commons. The debate has been such a pleasure, and I am sure that hon. Members here will see to it that it is not five years before we debate it again. An objective of having a debate in Westminster Hall is to raise awareness. People watch these things, so it is right that we do that and it is important that we do it again next year.

I have been a Minister for about two months, during which time I have met many people, so it has probably been remiss of me not to have met with Arthritis Research UK yet. I am keen to do that. Its representatives are pushing at an open door if they would like to come and see me. As the hon. Member for Coatbridge, Chryston and Bellshill (Philip Boswell) said, it is about action, not words. We will organise that meeting if Arthritis Research UK would like it to happen.

Several hon. Members have mentioned the statistics, but I will repeat them because they are so important. Some 10 million people in the UK—one in six of the population—have an MSK condition. The most common, with 3 million sufferers, is osteoporosis. One in six is an extraordinary figure, and there are 200 variations of MSK conditions. One in 10 people in the UK suffers chronic pain as a consequence of arthritis.

The numbers are mind-boggling. Some 20% of GP consultations are due to MSK conditions, and this at a time when our GP services are stretched in Scotland and in England. MSK conditions account for 30% of GP consultations for the over-55s, and some 7.5 million working days are lost each year. This long-term condition alone costs the NHS between £4 billion and £6 billion, so it is right that we are having this debate.

There have been a number of interesting and useful speeches. Westminster Hall is sometimes a better place to debate such topics. The hon. Member for Strangford talked about lifestyle factors and preventive factors, and he and another Member made an interesting point about DWP and PIP. We need to be more joined up in how we deal with some of these long-term conditions, particularly as they become more prevalent. He also talked extensively and knowledgeably about research—he has clearly been well briefed—and about what we are doing.

The hon. Member for West Ham (Lyn Brown) made an excellent speech about her personal experience, and she emphasised the overlap with mental health. She talked about first suffering from this during her election campaign last year. In fact, it prevented her from canvassing. I note that she got 36,000 votes and her vote went up by 6%. I do not know whether those factors are related. Well done on 36,000. We pass on our congratulations and awe at her performance.

[Mrs Hodgson]

Maybe it was a telephone canvass.

[David Mowat]

Maybe it was. The hon. Lady also talked about the delays to the start of her treatment and the one-year delay before she got the right drugs, which have been so transformative for her. That is an impressive story.

The hon. Lady also talked about the concerns about the consequences of Brexit. The Government have made it clear that, whatever version of Brexit we end up with, science research will continue to grow in real terms and ongoing scientific programmes will continue. I was a remainer, and we often talk about the money that Europe gives to programmes. She said that £2.5 million was given to a particular programme, which should be seen in the context of the £20 billion that flows in the other direction. The real point is that we understand the need for science and will continue to ensure that that funding happens.

The hon. Member for Neath (Christina Rees) made a good intervention about the consequences of sport and the unpredictable flare-ups that she has. She made the interesting point that arthritis can be invisible for much of the time before flaring up. The right hon. Member for Knowsley (Mr Howarth) is right to remind us of the role of carers. I remind Members that we are putting together a carers strategy, which will focus on unpaid carers in particular. That will come out at the end of this year. We are talking to a number of charities about that because it is important, given the stress and strain on our various systems.

[Mr George Howarth]

I am grateful to the Minister for giving way and for the thoughtful way in which he is responding to the debate. For the sake of completeness, I should say that my impacted disc results from playing rather over-enthusiastic football in the fourth division of the Liverpool Shipping league, which the Minister will know is not a lofty place to play. Unfortunately many of my sliding tackles were badly mistimed, to my detriment.

[David Mowat]

I thank the right hon. Gentleman for his intervention. The fourth division of the Liverpool Shipping league is probably a higher division than I played in during my very short football career.

Due to the time, I will not refer to every speech. The Scottish National party spokesman, the hon. Member for Linlithgow and East Falkirk (Martyn Day), talked about what Scotland is doing on managing obesity and chronic pain. I would like to see England learning more lessons from Scotland’s health system; and, I humbly suggest, vice versa—I also include Wales in that. Health is devolved and we are beginning to do things in different ways. Sometimes things will work well, and sometimes things will work less well. One of the highlights of these debates is to hear what happens in other nations, and those remarks are interesting.

The shadow Minister also gave a good speech. She talked about budgets and health spending, particularly public health spending—she has now been able to tell two Health Ministers about that issue—and it is true that the public health budget was cut. The UK spends above the OECD average on health and adult social care, which has not always been the case. We are not the highest spender—we spend 9.9%, but France and Germany probably spend about one percentage point more—but we are above the OECD average. It matters very much how effectively we spend that money. There are always decisions to be made, and those decisions are sometimes difficult.

What are we doing? I will not be able to answer all the points in great detail other than to say that MSK is a priority because it is so important. MSK is one of the national programmes within NHS England, and in 2013 we appointed a clinical director, a gentleman called Peter Kay, who is running a £5 billion programme covering a number of areas and seven strands of work, which I will briefly run through.

First, we need to ensure good awareness of the signs and symptoms of MSK. That is about public health and things such World Arthritis Day and the UK “Share your Everyday” campaign. It is also about the important Public Health England activities that we have heard about. We ran a successful public health campaign on arthritis last year, and we need to maintain that pressure.

Secondly, we need high-quality clinical guidance to diagnose and manage the disease. Thirdly, we need to provide holistic care, support, and planning in partnership with patients. Fourthly, and this is important, we must spread best practice across the NHS—I would go further and talk about spreading best practice across the health systems of all the Administrations within the UK. Fifthly, we have heard a lot today about the benefits of physical activity for MSK patients, notwithstanding some of the issues experienced by the hon. Member for Neath and the right hon. Member for Knowsley. Fitness and exercise are of course a preventive measure for nearly everything, particularly for MSK diseases.

Penultimately, we need to do more to enable people to remain in work and to return to work. Finally, we need to invest in research. Those are the seven streams of activity, and I will talk a little about the one that has been spoken about most this afternoon, which is what we are doing to keep people in work. As I said, the points about DWP and PIP were well made, and I will see that that is reflected to DWP Ministers.

[Philip Boswell]

I am delighted to hear about the open door to Arthritis Research UK, which has been excellent in championing the rights of arthritis sufferers, preventing the onset of arthritis, developing a cure for arthritis and transforming lives. Arthritis Research UK’s work is considerable, and it is worthy of our support. I thank the Minister for his words and his initial actions.

[David Mowat]

I thank the hon. Gentleman for those words. It occurs to me that I have to give the hon. Member for Strangford time to say a few words at the end. I will write to Members about the various specifics that have been raised. I will now sit down and allow him half a minute or so. I apologise for there being so little time.

Community Pharmacy in 2016-17 and Beyond

David Mowat Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

With permission, I would like to make a statement on the future of community pharmacy. In December 2015, the Government set out a range of proposals for reforming the sector. Our intent was to promote movement towards a clinically focused pharmacy service that is better integrated with primary care and makes better use of pharmacists’ skills. I now wish to update the House on the outcome of this consultation and the measures we intend to take forward.

Let me be clear at the outset. The Government fully appreciate the value of the community pharmacy sector. There are now more than 11,500 pharmacies, an increase of over 18% in the past decade. Indeed, the overall pharmacy spend has increased by 40% over the past decade and now stands at £2.8 billion per annum. However, we do not believe that the current funding system does enough to promote either efficiency or quality; nor does it promote the integration with the rest of the NHS that we, and pharmacists themselves, would like to see.

The average pharmacy receives nearly £1 million per annum for the NHS goods and services it provides, of which about £220,000 is direct income. It includes a fixed-sum payment—the establishment fee—of £25,000 per annum which is paid to most pharmacies, regardless of size and quality. This is an inefficient allocation of NHS funds when 40% of pharmacies are now in clusters of three or more, which means that two fifths are within 10 minutes’ walk of two or more other pharmacies. There are instances of clusters of up to 15 pharmacies within a 10-minute walk of each other. When the overall NHS budget is under pressure and we need to find £22 billion in efficiency savings by 2020, it is right that we examine all areas of spend and look for improvements.

The measures that we are bringing forward today have at their heart our desire more efficiently to spend precious NHS resources. Community pharmacy must play its part as the NHS rises to this challenge. I am today announcing a two-year funding settlement. In summary, contractors providing NHS pharmaceutical services under the community pharmacy framework will receive £2.687 billion-worth of funding in 2016-17 and £2.592 billion in 2017-18. That represents a 4% reduction in 2016-17 and a further 3.4% reduction in 2017-18. Every penny saved by this re-set will be reinvested and reallocated back into our NHS to ensure the very best patient care.

Furthermore, separately commissioned services by NHS England, clinical commissioning groups and local authorities will not be affected by this change. I want to see this commissioning of services to continue to grow. From 1 December, we will also simplify the outdated payments structure; introduce a payment for quality so that for the first time we will be paying pharmacies for the service they provide, not just for the volume of prescriptions they dispense; and relieve pressure on other parts of the NHS by properly embedding pharmacy for the first time in the urgent care pathway.

As we continue the path of reform, we will be informed both by the review of community pharmacy services being carried out by Richard Murray of the King’s Fund and by other stakeholders such as the Royal Pharmaceutical Society. NHS England is investing £42 million in a pharmacy integration fund for 2016-17 and 2017-18, which will facilitate the movement of the sector faster into value-added services.

Last week, for example, I announced two additional initiatives to improve our offer to patients. First, those who need urgent repeat medicines will be referred by NHS 111 directly to pharmacists—not to out-of-hours GPs as at present. Secondly, NHS England will encourage national roll-out of the minor ailment schemes already commissioned by some CCGs. This is expected to be complete by April 2018.

We are confident that these measures can be implemented without jeopardising the quality of services. In fact, we believe the changes will improve them. To safeguard patient access, we will be introducing a pharmacy access scheme in areas with fewer pharmacies and higher health needs. We are today publishing the list of pharmacies that will be eligible for funding from this scheme. Copies are available on gov.uk and from the Vote Office. The list includes all pharmacies that are more than 1 mile from another pharmacy. Those pharmacies will be protected from the full impact of the reductions.

In addition, we will have a review process to deal with any unforeseen circumstances affecting access, such as road closure. We will also review cases where there may be a high level of deprivation, but where pharmacies are less than a mile from another pharmacy, if that pharmacy is critical for access. This will cover pharmacies that are located in the 20% most deprived areas in England, are located 0.8 miles or more from another pharmacy and are critical for access. Additional funding over and above the base settlement will be made available as needed.

We have already announced NHS England’s proposal significantly to increase the number of pharmacists working directly in general practice. A budget of £112 million has been allocated and will deliver a further 1,500 pharmacists to general practice by 2020.

As Members will know, the Government consulted the Pharmaceutical Services Negotiating Committee and other stakeholders, including patient and public groups. I am grateful for the responses that we received, which reinforced the value of community pharmacy and confirmed its front-line role at the heart of the NHS. The consultation also confirmed that there was a potential for the sector to add even more value. However, we are disappointed by the final response from the PSNC. We endeavoured to collaborate and listened to the committee’s many suggestions over many months, but in the end, sadly, we were unable to reach agreement. Ultimately, the committee’s role is to represent the business interests of its members, and I respect that. My role is to do the right thing for the taxpayer, the patient and the NHS.

Let me end by stating my firm belief that the future for community pharmacy is bright. These vital reforms will protect access for patients, properly reward quality for the first time, and integrate care with GP and other services in a far better way. That is what the NHS needs, what patients expect, and, I believe, what the vast majority of community pharmacists are keen to deliver.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the Minister for allowing me advance sight of his statement.

Community pharmacies play a crucial role in our health and social care system: indeed, 80% of patient contact in the NHS is in community pharmacies. The Government’s decision to press ahead with damaging cuts which represent a 12% cut for the rest of the year, on current levels, and a 7% cut in the following year will therefore cause widespread concern and dismay. The public petition that was launched when the funding cuts were first proposed became the largest petition ever on a healthcare issue. It now bears 2.2 million signatures. The message is clear: people want their community pharmacies to be protected.

In the face of unprecedented demands on health and social care services, the importance of local pharmacies is greater than ever. They help to safeguard vulnerable people and signpost them to other services; they are very important to carers; and, crucially, they reduce demand on GPs and out-of-hours services. Do Ministers not recognise the extent of the support that those pharmacies offer, and the impact that their loss will have on communities?

As the Minister said, the Government’s latest funding offer was rejected by the Pharmaceutical Services Negotiating Committee, because it was clear that there was little substantive difference between that settlement and their original proposal in December 2015, and that the outcome would be the same. Earlier this year the Minister’s predecessor, the right hon. Member for North East Bedfordshire (Alistair Burt), said that up to 3,000, or 25%, of community pharmacies could close, and clearly the thousands of remaining pharmacies could be forced to scale down their services. If the Minister does not agree with his predecessor, will he now tell us how many community pharmacies he expects to close as a result of the Government’s cuts? Pharmacies that do survive the cuts will be under significant pressure, which will result in job losses and service reduction. That is putting patient safety and welfare at risk.

The Government’s plans are not only deeply unpopular; they are short-sighted, and will hit the areas with the greatest health inequalities hardest. A study by Durham University has shown that pharmacy clusters occur most in areas of greater deprivation and need. Will the Minister reassure us that the areas of greatest deprivation will not lose pharmacies on which they rely, and will not be disproportionately hit by the cuts? I was not reassured by what he said in his statement.

The cuts will have a significant impact on older people, people with disabilities or long-term illnesses, and, I reiterate, carers, who do not have time to look after their own health and often do not even seek GP appointments. The Minister has said nothing today about releasing an impact assessment. Given that the effect of the cuts is likely to be substantial, with rural, remote and deprived areas most affected, when will we see an impact assessment to justify them?

Community pharmacies help to relieve pressure on our already overstretched health and social care services, and in recent years they have delivered more than 4% of savings for the NHS in cost reduction and quality improvement year on year.

It seems to me that Ministers are ignoring the conclusion of a recent PricewaterhouseCoopers report showing that community pharmacies contribute a net value of £3 billion through just 12 of their services—not all of them; just 12. Therefore, if one in four community pharmacies were to close, that value would be lost and the cost to the NHS would be significantly increased. Has the Minister considered the long-term impact that that will have on other NHS services?

We know that there is concern in many parts of the healthcare sector about these proposals. Can the Minister reassure us that all parts of the health service, including NHS England, support the proposals? Earlier in the week, he said that no community would be left without a pharmacy, but he was then unable to say which pharmacies would close and where. Will he repeat the pledge that no community will be left without a pharmacy?

We recognise the need, as does the Minister, to integrate pharmacy services better with the rest of primary care, but introducing cuts on this scale to community pharmacy services will not improve health services—it will damage them.

[David Mowat]

Frankly, a lot of that was scaremongering, which does not help what we are doing here and does not help with some of the difficult decisions we have had to make. Those difficult decisions are directed at modernising the service, bringing it up to date, making it much more dynamic in terms of added value and less static in terms of dispensing and all that goes with that.

I will answer some of the specific points that were made. There is a full impact assessment and it will be released immediately after the statement.

The hon. Lady asked about the PwC report. I have said on the record on a number of occasions that the report is an excellent piece of work. It does drive home yet again the value of community pharmacies, which we on the Conservatives Benches and in the Government accept. What it does not address is the extent to which those services could be delivered for less cost to the NHS. That is what I have to address and that is what we have done.

The hon. Lady asked whether NHS England supports the changes we are making. She might have heard the comments made by Simon Stevens, but I will read out, in answer to her question, a quote from the chief pharmaceutical officer of NHS England:

“NHS England, as the national commissioner of community pharmacy services in England, can reassure the public that the efficiencies which are being asked of community pharmacy will be manageable and there is sufficient funding to ensure there are accessible and convenient NHS pharmacy services in every community in England.”

[Barbara Keeley]

How many are closing?

[David Mowat]

The answer to that question is, I do not know. It is possible that none will close. I do not believe that 3,000 will close. However, I would say this. The average operating margin that the pharmacy makes on the numbers that I quoted earlier is 15%. That is after salaries and rent. The cuts that we are making, or the efficiencies that we are asking for, are significantly lower than that. Of course there is no such thing as an average pharmacy, which is why I cannot guarantee that there will be no changes. What I can say is that, if there are mergers and if there is some consolidation, that demand does not go away—it goes to the other pharmacies in the cluster. To say that those pharmacies will be put under more pressure is plain wrong.

I say again that what we are doing is building an industry that is fit for the future, that is modern and that is adding value in a way it has not been able to do in the past.

[Several hon. Members rose—]

[Sir Alan Haselhurst (Saffron Walden) (Con)]

Does my hon. Friend the Minister acknowledge that the NHS has become such a part of the nation’s DNA that doctors’ surgeries are frequently overloaded, that absolutely the right way forward is to have a rational, well-spaced network of pharmacies and that that is of particular importance in rural areas?

[David Mowat]

I do recognise that. My right hon. Friend made the point that the network is well spaced and that rural areas are protected. I would also make the point that, as I said in my statement, we are recruiting a further 1,500 pharmacists into the GP network. They will also play a big part in that integration.

[Mr Ben Bradshaw (Exeter) (Lab)]

Are not these cuts the latest evidence of the unprecedented financial pressure the national health service is under? Is it not the case that cutting community pharmacy services is the very last place we should begin, as they take pressure off GP surgeries and hospitals and offer an excellent service? The Government should be investing more in them, not cutting them.

[David Mowat]

This year we invested a further £5 billion in the NHS, three times the rate of inflation. In June the OECD noted we are now above average in terms of NHS and social care spend in the OECD. However much we spend, it is right we look to do it as efficiently and effectively as possible, to modernise this service and make it better for patients, and that is what we are doing.

[Anna Soubry (Broxtowe) (Con)]

The Minister knows my views: I do not think this 4% cut is a wise move. But I do note—and it is important that everybody reports this accurately—that that money is going to stay within the NHS, so it is not a cut. Can the Minister assure us about any incentives for pharmacies in the delivery of public health measures, notably preventive measures?

[David Mowat]

I thank my right hon. Friend for that comment and reassure her that for the first time we will be allowing pharmacists to access a quality fund, which means that the average pharmacy could earn up to £6,000 or £7,000 over and above what it gets just for dispensing. The fund will include specific measures around public health.

[Mr Speaker]

My apologies to the hon. Lady; I call Dr Philippa Whitford.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Thank you, Mr Speaker.

We discussed this on Monday and, as I pointed out, Scotland has had a national minor ailments service, a chronic medicine service and public health prevention for many years within community pharmacies, and we have found them to be very effective. Research showed they could cut 10% of the pressure on GPs and 5% on accident and emergency.

The problem with the Government’s proposal is that it is going to be a bit random; pharmacies are just going to be shutting on the basis that they cannot survive. Should there not be a planned system, to look at and discuss where they should be? It is not just a question of rural or deprived. It is also about transport; a mile away may be a real problem for those who are elderly and frail and for whom there is not a bus going in that direction. I welcome England taking forward these services, but my concern is the way in which it is going to be done; if it is just done due to cuts, it might not give England the answer it really wants.

[David Mowat]

I thank the hon. Lady for her point. She mentioned Scotland’s minor ailments programme. The announcement I made on that about a week ago was in many ways modelled on the Scottish model, because we know that pharmacies can do much more on minor ailments than at present. That will be commissioned separately from the other things we are talking about today, and paid for separately from the integration fund. We are a little behind Scotland in that regard, and we are going to catch up.

[Michael Gove (Surrey Heath) (Con)]

I congratulate the Minister on recognising what Labour failed to: that NHS money is taxpayers’ money and the priority should always be patient care, not the profits of private equity firms. May I further congratulate him on making it clear that those living in our most deprived communities will be protected and have services enhanced as a result of this change, and may I invite him to say more?

[David Mowat]

I will not say much more because of time constraints, but I thank my right hon. Friend for his comments. He is right to remind the House that this sector is quite concentrated towards public companies. That is not to say there are not some individual pharmacists that will be affected, but about 25% of pharmacies are owned by two or three public companies.

[Kevin Barron (Rother Valley) (Lab)]

I should declare my interest as chairman of the all-party group on pharmacy. I do not want to speculate about closures, as that has been done already, but if we get to a point where it might make sense for pharmacies to merge in different communities, my understanding is that the regulations are not yet in place for that. Is that true, and, if that is needed, when will it happen?

--- Later in debate ---

[David Mowat]

The right hon. Gentleman makes an extremely good point. They are not yet in place, but they will be by 1 December.

[Mr Edward Vaizey (Wantage) (Con)]

I congratulate the Minister on his statement. It is worth reminding the House that many urban pharmacies are located in clusters and are very close to one another. It is therefore quite right that we should look at how they are subsidised. I am pleased that, as a result of these savings, he will be looking out for rural pharmacies, which are more dispersed. They are the ones that really need the help.

[David Mowat]

The access scheme to which I referred will apply to rural and urban pharmacies. Indeed, there is more urban than rural in it, but it will protect rural pharmacies in the way my right hon. Friend mentions.

[Norman Lamb (North Norfolk) (LD)]

There is no escaping the fact that this amounts to a significant cut in prevention services, which is what always happens when the finances of the NHS are under pressure. I absolutely accept the need for reform of the financial incentives involved, to ensure that we get the best outcomes from the money being spent, but surely we should be investing more in prevention in order to ensure that the NHS is sustainable.

[David Mowat]

The quality system that I have mentioned is about potentially investing more in prevention and linking the best pharmacies—the high quality pharmacies—more closely to local authorities, public health schemes and all that goes with that. I make the point again that there is a requirement for efficiency savings, but we do not believe that they will affect access overall. We do not believe that this will affect the public’s ability to use pharmacies as they do now. This will be part of modernising and digitising the service and providing resources for other parts of the NHS that need them very much.

[Alistair Burt (North East Bedfordshire) (Con)]

Bearing in mind my responsibility for the difficult equation that my hon. Friend has had to solve by coming to the House this morning, I should like to thank him and welcome his statement, which finally brings clarity to these long discussions. Will he repeat very clearly the Government’s absolute commitment to a strong community pharmacy network and to doing all they can to ensure that the NHS delivers on the essential commissioning of quality services? Looking ahead to the future, now that we have got past this, will he ensure that a good review of community pharmacy services is carried out, so that we can see what value they bring to the NHS? I am sure that, like me, he will find that sector extremely valuable to work with.

[David Mowat]

I thank my right hon. Friend for his fantastic work with the pharmacy sector. He makes the important point that we are trying to move the sector more into services and added value. The two announcements that I made two weeks ago are part of that, as is the work currently being done by Richard Murray from the King’s Fund. That will inform how we spend the integration money and enable the sector to move more quickly into the sorts of services that my right hon. Friend is talking about.

[Sue Hayman (Workington) (Lab)]

Allison’s pharmacy in Cockermouth in my constituency helps to promote good health because it has a deep knowledge of the patients and their families. My concern is that, as a small pharmacy, it will be under more pressure from these cuts than the larger ones will be locally. Does the Minister recognise this pressure? Does he also recognise the vital community role that local pharmacies can play?

[David Mowat]

I repeat that we absolutely recognise the vital role that community pharmacies can play, and we want to make them move towards an even more vital role by providing more services, which is what pharmacies want to do, rather than getting all their money from their dispensing activities, as they do at the moment. High quality pharmacies will be in a position to really prosper in the new world that we are talking about.

[Mark Pritchard (The Wrekin) (Con)]

I warmly welcome the Minister’s statement. If there are closures, what additional support will be given to the pharmacies that are left, particularly to enable them to take pressure off GPs in the community?

[David Mowat]

The volume of business is gradually increasing. If a pharmacy in a cluster should close, that business will be redirected to other pharmacies in the cluster. They will then be in a position to expand, take on more people and all the rest of it.

[Keith Vaz (Leicester East) (Lab)]

I declare my interest as a type 2 diabetic and as chair of the all-party parliamentary group on diabetes. The Minister is wrong to say that Leicester has too many pharmacies. The fact is that the population demands those services. Instead of making these cuts, why does he not spend that £25,000 on diabetes prevention, thus saving the national health service a huge amount of money in the future?

[David Mowat]

I have never said that Leicester has too many pharmacies. What I said in answer to the urgent question was that one road in Leicester—Loughborough Road, I think—has 12 pharmacies within half a mile, and that is quite hard to justify.

As for the right hon. Gentleman’s other point about diabetes and long-term conditions, I mentioned the King’s Fund work being done by Richard Murray and addressing long-term conditions is the sort of value-added service that pharmacies need to provide in future. The £42 million integration fund that we have set aside will enable that to happen.

[Nusrat Ghani (Wealden) (Con)]

I welcome the news that this Conservative Government are spending £150 million more a year on pharmacies than the last Labour Government and will be paying pharmacies for not only dispensing prescriptions, but their quality of service. In Wealden, pharmacies have the double whammy of being rural and serving an older community, but they provide much-needed services and home deliveries. What news can the Minister share with me that I can share with pharmacies in Wealden?

[David Mowat]

The news that I can share is that pharmacies that are more than 1 mile apart from each other, many of which will exist in rural constituencies such as the hon. Lady’s, will be largely protected under the scheme.

[Paul Blomfield (Sheffield Central) (Lab)]

The Minister was right to describe community pharmacies as the essential front line of the NHS. What assessment has he made of the additional pressures and costs that will be put on other parts of the NHS as a result of this decision?

[David Mowat]

The King’s Fund study and the £42 million integration fund are directly focused on services and on enabling pharmacies to become more integrated with GPs. In addition, I repeat that 1,500 more clinical pharmacists than we have now will be working for GPs in 2020. That is a huge difference.

[Wendy Morton (Aldridge-Brownhills) (Con)]

I thank the Minister for coming to the House today and welcome his statement and update. It is right to consider improvements, but in doing so I urge him to ensure that the reforms are part of a broader policy on community pharmacies that seeks better to integrate with the NHS the vital services that they provide.

[David Mowat]

I give the hon. Lady that assurance. She used the word “integration”, which is right at the core of the proposals, as is modernisation. This is a patient-first initiative and we are going to make it happen.

[Toby Perkins (Chesterfield) (Lab)]

It is interesting that the Minister keeps referring to the evils of major chains, because it is impossible to listen to his statement and not realise that he is talking about supporting big pharmacies. Smaller pharmacies, which do not have such a wide patient base and do not offer such a wide range of services, will suffer. Does he acknowledge that small pharmacies will close as a result of the changes? Will he say more about where the savings will come from?

[David Mowat]

The scheme that we are putting into place is blind to ownership, so we will not take into account whether a pharmacy is a Boots, a LloydsPharmacy or something smaller. Given the gross margins that are currently being made by the average pharmacy, including smaller ones, I do not believe that the efficiency savings that we are asking for will cause widespread closures. It is scaremongering to imply that.

[Richard Benyon (Newbury) (Con)]

Those of us who represent constituencies with both remote rural and urban communities understand the difficult issues that the Minister and his Department have wrestled with. Does he agree that this decision is one that would have to be taken by whichever party was in government at the moment because it is right to ensure that the service is modern, efficient and that it represents security for people in rural communities?

[David Mowat]

Yes—modern, efficient and oriented towards excellent patient care.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

My constituency lies within the South Tees clinical commissioning group’s area, which is one of the pilots for the roll-out of the minor ailments service. The scheme was brought in due to the closure of minor injuries units at Guisborough and East Cleveland and medical centres at Park End, Skelton and Hemlington —all in my constituency. We are now seeing a shortfall in national vanguard funding for the minor ailments service and lack of GP provision in the region. What on earth is going on with primary care?

[David Mowat]

I do not wholly understand the thrust of that question. I assume that the hon. Gentleman, like others in this House, is welcoming the fact that we are rolling out a national system on ailments, delivered by pharmacists. As the hon. Member for Central Ayrshire (Dr Whitford) said, that is the future.

[Helen Whately (Faversham and Mid Kent) (Con)]

The Government are right to require pharmacies to make efficiencies, as the NHS is. I welcome the pharmacy access scheme, which I hope will help my local village pharmacies. I urge the Government and NHS England to press ahead with rolling out the minor ailments service, because it is important to make the most of the skills and capacity of pharmacies, in order to provide valuable services to patients and to relieve the burden on GPs.

[David Mowat]

I thank my hon. Friend for that comment, and I reinforce what I said earlier: NHS England plans to have this rolled out nationally by April 2018.

[Martin Vickers (Cleethorpes) (Con)]

I recognise the difficult decisions the Minister has had to make, but rural pharmacies are going to be particularly hit. He has attempted to sweeten the pill with his access scheme, but it is only a two-year scheme. What support will be forthcoming beyond that?

[David Mowat]

This is the first time ever that we have given pharmacies a two-year planning horizon; usually, these negotiations relate to a one-year period. After the completion of this period, there will be further negotiations, at which point we will take forward what is right to do.

[Mr Steve Baker (Wycombe) (Con)]

I congratulate the Minister on the way he has sorted out this mess. Is this unnecessary and wasteful clustering of pharmacies not a direct consequence of the former Labour Government’s broken payment model?

[David Mowat]

I am not sure that takes us forward, but it is right to say that spending NHS money on payments of £25,000 to many pharmacies within half a mile of one other is the wrong way to spend money when we need more in cancer drugs funds, in GP surgeries and in accident and emergency—that is what we need to be doing.

[Edward Argar (Charnwood) (Con)]

A large number of rural villages and small towns in my constituency are served by individual local pharmacies, which play an important role in the community. I welcome the Minister’s comments about the access scheme. Will he reassure me that small pharmacies in rural areas such as mine will be among those to benefit from the access protections he has outlined?

[David Mowat]

Yes, I can reassure my hon. Friend on that. Indeed, I can make the specific point that the 25% that make up the largest pharmacies will not be in the access scheme; it is directed more at smaller pharmacies.

[Lucy Frazer (South East Cambridgeshire) (Con)]

The Minister is right to identify that those areas with fewer pharmacies will benefit from protection, not only because the travel time to a pharmacy will be longer, but because the travel time to all support services will be longer. Will he therefore confirm that pharmacies in my rural constituency will benefit from the access scheme?

[David Mowat]

I do not have the specifics for my hon. and learned Friend’s constituency in front of me. We have published the full list and it is in the Vote Office, and I am sure that when she has a look at it she will find that some pharmacies in her area are protected.

[Sir Desmond Swayne (New Forest West) (Con)]

It is right to protect services by being more focused, but is there any other kind of commercial retail enterprise to which Government hand an establishment fee of £25,000?

[David Mowat]

Not that I know of, but there may well be. The facts are that the £2.8 billion that we currently spend is for services and for disbursing £8 billion-worth of drugs. It is a valuable service, but it is right that we look to see that that money is spent effectively and as effectively as in other parts of the NHS. It is the Government’s job to make sure that every penny that we give the NHS provides maximum value for patients.

[Nigel Mills (Amber Valley) (Con)]

May I declare an interest, in that my wife is a community pharmacist? I should therefore probably be cautious in welcoming this statement, for obvious reasons. Will the Minister confirm that the proposals to have a hub-and-spoke model, which would have been even more damaging to community pharmacies, are not part of this step forward?

[David Mowat]

I can confirm that no part of what we are talking about today is in respect of the hub-and-spoke model that my hon. Friend talks about.

[Mr Speaker]

I am most grateful to the Minister and to colleagues for their helpful co-operation in facilitating progress on this important matter.

Bill Presented

Housing Standards (Preparation and Storage of Food by Tenants in Receipt of Universal Credit or Housing Benefit)

Presentation and First Reading (Standing Order No. 57)

Frank Field, supported by Jeremy Lefroy, Caroline Flint, Dr Philippa Whitford, Sir Edward Garnier, Stephen Timms, Caroline Lucas, Sir David Amess, Tristram Hunt, Sir Peter Bottomley, Ruth Smeeth and Helen Jones presented a Bill to require landlords of tenants in receipt of universal credit or housing benefit to ensure that their rented accommodation meets minimum standards for the hygienic storage and preparation of food; contains adequate appliances, equipment and utensils for the cooking of food; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 4 November, and to be printed (Bill 79).

Earlier Cancer Diagnosis: NHS Finances

David Mowat Excerpts

Tuesday 18th October 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mr Nuttall, in my second Westminster Hall debate since I became a Minister. I start by congratulating my hon. Friend the Member for Basildon and Billericay (Mr Baron) on securing this debate and raising the valid points that he did and on his stewardship of the APPG on cancer, which is highly effective and has provided a large part of the briefings that I have received since becoming a Minister. I very much hope that he will carry on that work, and I am sure that he will.

My hon. Friend mentioned several times the phrase “pushing at an open door,” and I reassure him that the door is open. We have discussed this issue twice in fairly formal circumstances, and I am keen to take him up on his offer of meeting him and colleagues to discuss it further and make progress over and above what we can do in Westminster Hall debates and oral questions. I also look forward to speaking at the event in December.

I will talk, as Ministers do, about the progress that we are making in this area across England, but my hon. Friend reminded us that we are not best in class or among the best in Europe, and he is absolutely right. He gave us the statistics for Sweden, where the one-year survival rate is 82% versus our 71%. That is a target; it is where we need to get to. As we have made progress, we have got to where the best in Europe were several years ago. We need to keep progressing in that respect.

My hon. Friend rightly talked about CCG accountability, and I will talk a little about that. I want to emphasise the power of what was done last month, when we published the four indicators for every CCG in the country. That is a massive commitment to transparency. We were quite open that many CCGs needed to improve. My hon. Friend mentioned the figure of, I think, 80%, which we agree with. It is worth analysing the data and spending a bit of time looking at that, because small differences in percentages against the indicators, one of which is one-year survival, make a big difference to how a CCG is perceived. Accountability comes from transparency, and we have made big steps in that regard, last month in particular.

I want to thank the Members who intervened in the debate. As ever, my hon. Friend the Member for Bosworth (David Tredinnick) reminded us of the role that complementary remedies can play as part of an overall solution. There is no impediment to that in the NHS—CCGs can commission what they wish to commission. He mentioned the Barts study. My view is that it needs to be clear that commissioning is science driven, repeatable and all that goes with that, but there is no impediment if CCGs wish to commission complementary therapies.

My hon. Friend the Member for Mole Valley (Sir Paul Beresford), in his capacity as chair of the all-party group on skin, told us how weak some of the training in that area may be at undergraduate level. I was not aware of that, so I will take it up and come back to him. It does not sound acceptable if the skin cancer diagnosis part of the syllabus is the bit that people leave.

[Sir Paul Beresford]

If I could emphasise that a little more, we have a distinct shortage of consultant dermatologists. They are backed up by GPs with a special interest, but a large number of referrals to dermatologists are made due to fear on the part of both the patient and the doctor that they will miss a melanoma or a squamous cell carcinoma when the doctor should be able to diagnose them. Many are dealt with in the early stage with cryosurgery, which is a very effective, quick treatment that I know, having been on the wrong end of it quite often, can be undertaken by a GP who has had the right education.

[David Mowat]

I thank my hon. Friend for that and for reminding us that at the core of the debate is a point we all agree on: early diagnosis is the key, whether it is for cost-saving purposes—I will come on to some of the points my hon. Friend the Member for Basildon and Billericay made on that—or to be cost-effective. There is no question that early diagnosis saves lives and that it is the right thing to do. Whether we argue a bit about precisely how much money is saved is in a way a secondary issue; it saves lives and it is the right thing to do.

I also want to acknowledge the intervention of the hon. Member for Strangford (Jim Shannon), who reminded us about the need for public health and GP awareness. In England we have had a significant increase in the number of referrals and the National Institute for Health and Care Excellence—latterly in England—has changed its guidelines for referral, which, together with the awareness issue, has increased significantly the number of people diagnosed in stages 1 and 2. We need to continue to make progress on that.

[Mark Durkan]

I commend the hon. Member for Basildon and Billericay (Mr Baron) for leading the debate and for the leadership he has provided on one-year survival rates through the APPG. Does the Minister accept the basic premise that value of life and value for money are not in competition? They are perfectly compatible. We can have better use of money with better outcomes because of better-timed treatments, and that also means there is better evaluation and research, which will feed into better education in a virtuous circle, to meet the point made by the hon. Member for Mole Valley (Sir Paul Beresford).

[David Mowat]

I thank the hon. Gentleman for his intervention and completely agree with the point he made. In this instance, there is no competition between saving money, saving lives and doing the right thing. In a sense, there is a secondary question as to just how much cost is saved, and the balance of cost saving versus doing more diagnostically, because in order to save lives, which is a highly cost-effective thing to do and the right thing to do, we need to do more on early diagnosis.

I have not yet got to the start of my remarks and I have a lot of pages to get through, so I will not be giving too much detail. It is worth acknowledging that cancer survival rates are increasing in the UK. In terms of improvement, between 2011 and 2015 we think something like 12,000 lives a year were saved. That exceeds the goals we set out in the cancer outcomes strategy in 2011.

Last year we saw a 91% increase in urgent GP referrals of patients with suspected cancer—that is another 822,000 patients. That shows a massive increase in NHS resources and all that goes with that, and we are beginning to see those early referrals, and the different guidelines GPs are using to refer, start to come through in the one-year survival statistics. However, as my hon. Friend the Member for Basildon and Billericay reminded us, that does not mean that we are the best in Europe. We need to continue the drive to improve.

The cancer strategy produced by the cancer taskforce is the backbone of what we are trying to achieve. The—I think it is fair to say—acclaimed strategy it produced, “Achieving World-Class Cancer Outcomes”, was published last year. It had 96 recommendations in it, and the Government accepted all 96. We are now putting in place an implementation taskforce. We believe that if we are able to make the progress we expect by 2020, a further 30,000 lives a year can be saved.

Recommendation 96 is the one we are talking about today. It essentially says that we need to do a lot more on early diagnosis because of the cost savings that will potentially arise from that. There are differing views in the Department of Health as to whether for all cancer types in all instances earlier diagnosis does save costs because of the increase in cost and effort associated with the diagnosis—the early screening and all that goes with that. That was not addressed overtly in Cancer Research UK’s “Saving lives, averting costs” report, which was mentioned by my hon. Friend. He quoted numbers of several millions of pounds, and there is no doubt that stage 4 cancer costs massively more to treat than stage 1 cancer, but whether or not there are clear cost savings in all instances and even if we dispute the detail of some of those numbers, we go back to the point made by the hon. Member for Foyle (Mark Durkan) that early diagnosis is the right thing to do. My hon. Friend also mentioned that there are not enough health economists in the NHS; the truth is there are not enough of lots of things in the NHS. Early diagnosis is certainly cost-effective in terms of lives saved, even if there may be some dispute as to whether it saves costs in all instances.

My hon. Friend mentioned the work being done by Macmillan, which I acknowledge. It is a three-year study, which we are looking forward to.

[Mr Baron]

I am conscious that I am eating into the few minutes the Minister has left, but the point about cost savings links to the point made earlier about initiatives and processes for earlier diagnosis. I urge him to think carefully about this, as I know he is doing. There has been no shortage of process targets in the NHS, but the one-year survival figures focus on outcomes, and that is the true measure of whether the processes are having an effect. By using outcome measures, we are leaving a large element of discretion to CCGs to introduce the initiatives they think best fit their local populations. That does not necessarily mean big cost increases to introduce such initiatives. Better awareness campaigns and better screening uptake figures do not necessarily cost a lot of money at a local level; they just take a bit of thought.

[David Mowat]

I agree completely with my hon. Friend that it is right that we use outcome measures. I come back to the point that the Government did a big thing in publishing the statistics for every CCG in the country. That allowed headlines to be out there in the press— we all saw them—that 80% of CCGs need to improve. We used a pretty rigorous test to assess the CCGs. If we reach those levels, we will be close to being the best in Europe as we make progress.

I am coming towards the end of my time. I want to finish by re-emphasising the Government’s commitment to early diagnosis. I have not had a chance to talk about our public health measures and all that goes with them, but I thank my hon. Friend again for getting us this debate. I emphasise my commitment to work with him and the APPG to make progress in this area.

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

Community Pharmacies

David Mowat Excerpts

Monday 17th October 2016 Commons Chamber

[Michael Dugher (Barnsley East) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the budget for community pharmacies in 2016-17 and 2017-18.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

Members will have seen media coverage over the weekend about our consultation on the community pharmacy contractual framework. I shall set out the current position, the process going forward and how the final decision will be announced to the House.

In December 2015—10 months ago—the Government set out a range of proposals for reforming the community pharmacy sector. Our intent was to promote the movement of the sector towards a future based on value-added services, together with much stronger links to the general practitioner sector.

We proposed ways in which to make a reduction to the £2.8 billion currently paid to the sector. Part of the rationale was the increase of 40% in the budget and an increase of 18% in the number of establishments in the past decade or so. Each establishment now receives an average £220,000 of margin over and above the cost of drugs disbursed. Many of the establishments are in clusters.

The 2015 spending review reaffirmed the need for the privately owned community pharmacy sector to make a contribution to the publicly owned NHS efficiency savings that we need to deliver. We are confident that the changes proposed will not jeopardise the quality of services required or patient access to them, but some services will be delivered differently, which is why we have set aside £112 million to recruit a further 1,500 pharmacy professionals to be employed directly by the NHS in GP practices.

The Government have consulted on the reforms since December 2015. On 13 October this year, the Pharmaceutical Services Negotiating Committee rejected our proposed package and sent a list of remaining concerns. We are now in the process of considering its final response, and expect to be in a position to make an announcement to the House shortly.

[Michael Dugher]

Thank you, Mr Speaker, for granting this urgent question. Community pharmacies play a vital role in frontline healthcare. Nearly 12,000 communities in England provide free advice to patients, and more than 1 billion items were dispensed in the community last year—an increase of 50% on 2005. Reports in recent days, however, make it clear that the Government are determined to press ahead with massive cuts to community pharmacies in this and the next financial year.

Serious questions remain about the impact of those cuts. When will Ministers finally publish an impact assessment of the proposed plans? How many pharmacies will close? Which regions will lose the most? Will they be in clusters or not? What will be the rate of loss in urban, as opposed to rural, areas? Will the Minister confirm that only about one in 10 community pharmacies will be helped by the pharmacy access scheme?

Community pharmacies and the cuts to them are a complete false economy for the NHS. They can only add further pressures to our already overstretched A&E units and GP surgeries. What is the Minister’s assessment of the downstream costs to other parts of the NHS as a result of cuts to the community pharmacy budget, especially given the evidence from Pharmacy Voice that one in four people who would usually visit a pharmacy for advice would instead make a GP appointment if their local pharmacy was closed? In areas of higher deprivation, such as those in my constituency, the numbers are much higher.

We have seen massive opposition to these cuts, not just from pharmacies and voices on both sides of the House, but from the 2.2 million people who have signed the biggest petition in healthcare history. To conclude, Ministers have, to be frank, been all over the place. We have had mixed messages and false hope. The Government announced a pause to the cuts. Is not there now a compelling case for that pause to be made permanent?

[David Mowat]

The hon. Gentleman has not had any mixed messages from me. A pause was announced because the original consultation gave the intent to go ahead with this on 1 October. Given the change of Government and of Prime Minister, and given the new Chancellor and new Ministers, we took the opportunity to look at it again, to make sure that we get it right for patients, the NHS and the pharmacy sector itself, and that is what we intend to do.

The hon. Gentleman asked several questions, but first he said that the pharmacy sector is vital, and we agree with him. In some instances, however, there are as many as a dozen pharmacies within half a mile of each other. That is not an isolated occurrence. Each of those pharmacies receives £25,000 per annum, and it is our job to consider whether that money could be better spent in other parts of the NHS.

I am not in a positon today to announce the final format or shape of the GP access scheme.

[Michael Dugher]

It is in the newspapers.

[David Mowat]

That is speculation. We continue to look at the most recent communication that we have received from the negotiating body of the PSNC. I remind the House that 60% to 65% of these pharmacies are owned by public companies or private equity. The fact of the matter is that the Government have a responsibility to make sure that that money is spent effectively, and that is what we are going to do.

Finally, the hon. Gentleman said that GP access needs to remain good. I confirm and repeat the point that I made earlier: 1,500 additional pharmacists will be recruited into the GP sector by 2020. That is a massive investment, and it will make a big difference.

[Anna Soubry (Broxtowe) (Con)]

I should declare that Boots has its headquarters partly in my constituency and partly in Nottingham South. May I gently say to the Minister that there is great concern about the proposals? If there was ever a time to argue to increase the role of pharmacies, it is now. They perform a hugely powerful job in making sure that people do not, to be frank, bother their GPs and A&E with matters that are best dealt with by pharmacies because they are of a minor nature. The Minister makes a good point about clustering, but he has to get this right, because, if he damages pharmacies, there will be fewer of them, not just in poorer areas, but in remote rural areas. I urge the Government to take a hard good look at the issue, to make sure that this is the right approach as the pressures on the NHS increase.

[David Mowat]

I agree with my right hon. Friend. Boots makes a big contribution. It owns 1,724 pharmacies and is the biggest of the big four, which between them own 40% of all pharmacies. The Government’s position is that community pharmacists make a big contribution, but I repeat that the number of locations has increased by nearly 20% over the past decade, and each one gets £25,000 per annum just for being open and for being a pharmacy. One consequence is that we have seen a great deal of clustering, and 40% of pharmacies are within half a mile of three others. It is right that the Government look at that and make a judgment.

[Jonathan Ashworth (Leicester South) (Lab)]

I congratulate my hon. Friend the Member for Barnsley East (Michael Dugher) on securing this urgent question and on his exceptional campaigning on the issue. He is, no doubt, as disappointed as I am by some of the Minister’s replies.

Ministers appear to be intent on pushing ahead with the cuts that have been outlined, under which thousands of community pharmacies could close and patients could lose out on essential medical services. The Pharmaceutical Services Negotiating Committee has described the Government’s proposals as “founded on ignorance” and warned that they will do “great damage”. The National Pharmacy Association says that the proposal is a “dangerous experiment” that

“shows a complete disregard for the well-being of patients.”

Is that not an absolute indictment of the Government’s handling of this matter? The Minister has said that he will make an announcement shortly. Given the concern among Members from across the House, including Conservative Members, can he be more specific and tell us when he will give us a final decision? Will he also be negotiating a solution with the Pharmaceutical Services Negotiating Committee? As the Minister knows, his predecessor talked of the potential for up to 3,000 pharmacies to close. Is that correct, in the Minister’s judgment? If not, can he tell us how many pharmacies he thinks will close, and how many of those will be in deprived areas?

Has the Minister had a chance to study the PwC report that describes the cash savings that community pharmacies bring to the NHS? What will be the financial impact on the NHS of more patients presenting themselves at A&E departments and GP surgeries because pharmacies have closed?

Is not the real reason why Ministers are pressing ahead with these cuts the complete mismanagement of NHS finances? Hospitals ended last year £2.45 billion in the red. We have had continual warnings from experts in the NHS, and over the weekend we learned from the Prime Minister that there is no more money for the NHS. The Secretary of State and the Prime Minister would be wrong to continue to ignore the advice of experts and pretend that everything is going to be okay. Unless the Government get a grip of the funding crisis facing the NHS, I fear that these cuts are just the start and that there is worse to come.

[David Mowat]

The Government spend more than the OECD average on the NHS. We spend more than the commitments made by the Labour party before the last election. That does not mean that we do not have a duty to spend that money as effectively as we can, however, and that is exactly what we intend to do. The money that may be saved by the measures we are consulting on will not go to the Treasury; it will be recycled back into NHS England. That is what NHS England wants to happen.

The hon. Gentleman mentions the excellent PwC report, which reaffirmed the value of community pharmacists to this country. PwC did not consider whether that same value could be still provided after some savings to the network. That is what we are looking at, and it is reasonable and responsible for the Government to do so. To say that that is not the case is simply incorrect.

The hon. Gentleman mentioned that the previous Minister talked about 3,000 pharmacies closing. We do not believe that the number will be anything like that big. In some areas, there are 10 or 11 pharmacies within half a mile of each other. [Hon. Members: “Where?”] Leicester, Birmingham—we can talk more about this. It is quite possible that at the end of the review, some of those pharmacies will merge. If that happens, it will not mean that provision has been reduced. We do not believe that patient provision will suffer at all from the changes that we are considering.

[Rebecca Pow (Taunton Deane) (Con)]

Community pharmacies play a very important role locally. Many of them have taken on useful services, such as eye tests and hearing tests, which definitely help to reduce the workload of GPs and of the NHS. Does my hon. Friend agree that we need a community pharmacy service that is better integrated with primary care and public health in line with NHS England’s five-year forward view?

[David Mowat]

It will not surprise the House to learn that I agree. Last Thursday night, I announced to over 1,000 pharmacists at their annual dinner that we are moving ahead with an urgent access scheme. From the beginning of December, all 111 calls for repeat prescriptions will go directly to pharmacists, not to the out-of-hours GP service. That is a tangible difference. We will do just the same with a minor ailments scheme, which will be commissioned right across the country so that, by April 2018, pharmacists will be paid—over and above any money that comes out of this settlement—for minor ailments work on things such as earache and so on. Those are exactly the sort of sensible steps that need to be taken to integrate pharmacy more closely into GP practice, and that is what we are doing.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

In Scotland, we already have a national minor ailments scheme within our community pharmacies, and it has had a huge impact. The Scottish Pharmacy Board estimated at the beginning of the project that 10% of those making GP visits and 5% of those making A&E visits could be seen in community pharmacies, so our investment has been in completely the opposite direction—in that of developing and strengthening such pharmacies. On top of minor ailments, one of the big areas that has made a difference is in chronic disease management. For people on repeat prescriptions, the pharmacist requests their next prescription and has it ready, while for housebound people, they deliver it, as they do with blister packs.

The concern about these changes is that pharmacists are afraid it will be a case of cutting and then seeing who survives. If it is felt that there are too many pharmacies in one place, reducing their number needs to be done in a planned way, otherwise rural and deprived areas will end up without one. The Government should be making sure that community pharmacy is a real part of the NHS, not slashing it.

[David Mowat]

The hon. Lady made several points. On her last point, the access scheme on which we are currently consulting will protect pharmacies in rural and deprived areas. That is precisely the point of the scheme.

The hon. Lady’s first point was that Scotland has moved ahead on minor ailments, and we agree. I am on the record as saying that the pharmacy first scheme in Scotland is a good model. We want the profession to move away from just dispensing towards more value-added activities, such as services. That is precisely why we are putting into effect the minor ailments scheme that has been piloted. It will be implemented right across the UK—right across England, I should say—from April 2018.

[Kit Malthouse (North West Hampshire) (Con)]

In the lee of Watership down in my constituency, the village of Kingsclere was so alarmed by the Government’s plans that it raised a petition, possibly for the first time in its history, in support of its precious local pharmacy. Will the Minister confirm that, notwithstanding the consultation, the idea of protecting the dwindling number of rural pharmacies will come out at the end of the consultation as part of the access scheme?

[David Mowat]

Yes, I will confirm that. I am not in a position to announce today precisely how the access scheme will work, but I agree with my hon. Friend that a central part of it will be to make sure that everybody has a baseline distance to travel to get to a pharmacy and that everybody in the country will be able to access pharmacies within a reasonable time.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

NHS England’s five-year forward view stresses how important prevention is. Community pharmacies, which are anchored in the communities they serve, are vital in keeping people out of their GP surgeries and out of accident and emergency. The Minister talks about distance. What will the distance be? If I reflect on my own constituency, where the millionth signature of the petition was signed, my constituents really value each and every one of our community pharmacies. How many will he be cutting and how far does he expect people to travel to access one?

[David Mowat]

The hon. Lady mentions the five year forward view. If she reads the “General Practice Forward View”, she will see that central to it is the recruitment of 2,000 pharmacists into GP practices across the country by 2020. That is how we will embrace the pharmacy profession and link it much more closely to GPs. I am not in a position, because we have not yet announced it, to discuss in detail today the final form of the access scheme and how it will work. Let us be very clear, however, that we do not expect people to have appreciably more of a journey to any pharmacy. We are talking about tens of metres, if any. The fact is that we will protect the pharmacies that need to be protected, so that everybody in the country has access within a reasonable time.

[Alex Chalk (Cheltenham) (Con)]

Where sensible savings can be made, it is absolutely right that they should be explored, particularly if they are ploughed back into the health service. However, at a time when people in Cheltenham are turning increasingly to expert pharmacists for minor ailment support, can the Minister assure me that no changes will take place that undermine the welcome trend of going to pharmacies and not GPs?

[David Mowat]

As I said, that is our intention. Our belief is that the package in its entirety, which we will announce shortly, will actually enhance the role of pharmacies in providing services.

[Emma Reynolds (Wolverhampton North East) (Lab)]

How many community pharmacies will close as a result of these cuts?

[David Mowat]

We do not believe that any community pharmacies will necessarily close as a result of these cuts. That will depend on a number of factors. [Interruption.] I will answer the question, which is fair. It depends on the margin they make from their pharmacy activities and on the additional margin they make from their retail activities. Given that 65% of all pharmacies are owned by public companies or private equity, it depends on the position those organisations take to their businesses. That is very hard to predict.

[Tom Pursglove (Corby) (Con)]

Will the Minister say a little more about how he sees these plans tying in with the agenda to better integrate health services? In Weldon in my constituency, GP and pharmacy services work very well together for local patients under the leadership of Dr Sumira. What best practice is out there, and what attention is the Government giving to it?

[David Mowat]

As I said, we are recruiting an additional 2,000 pharmacists into general practice by 2020. We will also link community pharmacists into the NHS 111 system in a way that has never been done in England, so that repeat prescriptions will go direct to pharmacists and not to out-of-hours GPs. By 2018, pharmacists will receive additional payment for looking after minor ailments.

[Kevin Barron (Rother Valley) (Lab)]

I declare an interest as the chair of the all-party pharmacy group. In February this year, the Minister’s predecessor, the right hon. Member for North East Bedfordshire (Alistair Burt), said there would be an impact assessment. In answer to a parliamentary question I tabled last week and the Minister answered, you also said that an impact assessment will be published, so that it would inform the final decision. Can the Minister tell us when that will be published? Will it be shared with representatives of community pharmacists?

[Mr Speaker]

I did not say anything about any impact assessment, but the Minister might have done for all I know. I have a feeling we are about to learn about it.

[David Mowat]

As my predecessor said, an impact assessment is being produced, and when these proposals are published in their entirety, that will be published at the same time.

[Jason McCartney (Colne Valley) (Con)]

On Thursday, my local clinical commissioning group will announce whether it is going to press ahead with plans to downgrade A&E at the Huddersfield royal infirmary. Can the Minister not see that when our A&Es are under so much pressure, we need community pharmacies and GP surgeries to see patients on the front line? I appreciate what he says about clustering, but having seen the last bank branches close in my rural communities, I am sorry but I just do not have confidence in it.

[David Mowat]

All I can do is repeat the point that I made earlier. The Government completely agree that we need community pharmacies. The Government completely agree that they have a vital role to play in keeping patients away from GPs and, potentially, from A&E as well. That, however, is not the same as saying that the 11,800 pharmacies that we have at the moment are precisely the right number, or that the clustering is at precisely the right number as well. It is right for the Government to review this and to establish whether or not the £25,000 of NHS money that every pharmacy receives every year is money well spent.

[Sue Hayman (Workington) (Lab)]

As we have heard, pharmacies have the potential to help the NHS become more efficient and community based. Community pharmacies are an integral part of the integrated care communities that the Success regime in Cumbria is promoting in order to take the pressure off our overstretched GPs and A&Es. We are really struggling to recruit doctors in Cumbria, so any loss of community pharmacies is a serious loss to our community. Can the Minister assure me that these wider health challenges are being taken into account?

[David Mowat]

Yes, I can assure the hon. Lady that we fully understand the issues in places such as Cumbria. To an extent, the access scheme is designed to make sure that large rural communities are properly protected. I can only repeat that we value the services that pharmacies provide and that we do not believe that there will be a substantial detriment to them as a result of a bit less clustering.

[Mr David Nuttall (Bury North) (Con)]

Given that as part of the Greater Manchester devolution deal, the Greater Manchester health and social care partnership has taken control of the £6 billion a year health budget, will Greater Manchester be treated differently? If not, is there not a case for the area to be allowed to determine for itself how best to make use of community pharmacies?

--- Later in debate ---

[David Mowat]

It is my belief that the devolution deal does not include pharmacists, so the responsibility for that sector remains in the Department of Health. The proposals that we shall shortly outline will therefore include proposals for pharmacies that will apply equally to Greater Manchester.

[Tom Brake (Carshalton and Wallington) (LD)]

The Minister may not know how many pharmacies are going to close, but Reena Barai, an award-winning community pharmacy in my constituency, estimates that one out of four pharmacies in the London borough of Sutton, which is 11 pharmacies in total, will be closed. These will predominantly be the independents—not Boots or Superdrug. Why does the Minister think that, for years, successive Governments have encouraged people to visit their pharmacies for certain conditions or tests, instead of GP surgeries and A&E? Was it not because it was better for their health and cheaper?

[David Mowat]

I can only repeat that we value and can see the value in community pharmacies. We do not believe that any reductions will be skewed towards the independent sector; nor do we believe that the sector’s position overrides our duty to look at clustering and to make sure that the money we spend in this sector—£2.8 billion—is spent most effectively and cannot be spent better on other parts of the NHS.

[Mr Philip Hollobone (Kettering) (Con)]

As far as residents in the Kettering constituency are concerned, community pharmacies are a good thing. They relieve the pressure on the overburdened A&E at Kettering general hospital, and they are the only place to go when people cannot get an appointment at their local GP surgery. Can we please make more use of the community pharmacies that we have? If the Minister is right, and he suspects that not many community pharmacies will close, let me tell him in all candour that the process he is going through is completely cack-handed, because it is spreading fear among the community pharmacy community up and down the country?

[David Mowat]

The current process began in December last year, and will be brought to an end shortly. I do not know about the specifies of the pharmacy scene in Kettering, but I repeat that we regard pharmacies as vitally important to the NHS. One of the proposals that we shall announce shortly is a proposal for an integration fund of £300 million, which will be used entirely to provide services and pay for pharmacies to provide them. It will be informed by the review that is being conducted by Richard Murray of the King’s Fund, and Kettering will benefit from those services in just the same way as other parts of the country.

[Keith Vaz (Leicester East) (Lab)]

May I enthusiastically endorse the comments made by the hon. Member for Kettering (Mr Hollobone)? Community pharmacies are an underused resource. We currently spend £10 billion a year on diabetes treatment, 80% of which is spent on treating avoidable complications. Instead of cutting pharmacies, why do we not get them to do more to help with diabetes prevention, and to identify the 1 million people who have diabetes and do not know about it?

--- Later in debate ---

[David Mowat]

We intend to do more to help pharmacists to help with diabetes prevention. Diabetes is one of several long-term conditions that the Murray review is examining. There are ways in which pharmacies can be used to avoid repeat or ad hoc GP appointments, which is precisely what we want to happen, but that is not the same as not keeping under review the amount of money that we pay pharmacists for dispensing, and ensuring that we are getting a good deal.

The right hon. Gentleman said that he agreed with the hon. Member for Kettering (Mr Hollobone). The density of the United Kingdom’s pharmacy network is approximately double the density of networks in Holland, Sweden and Denmark. No one thinks that it should fall to the same level as theirs, but there are opportunities for us to review clustering and ensure that the NHS is receiving value for money, and that is our duty.

[Mr Peter Bone (Wellingborough) (Con)]

I congratulate the hon. Member for Barnsley East (Michael Dugher) on his urgent question, although I am slightly sorry for the excellent Minister, who is having to deal with the question before the Government are prepared to make an announcement. I agree with my hon. Friend the Member for Kettering (Mr Hollobone) that community pharmacies are very important in Northamptonshire, given that the rest of the national health service in our area is under such pressure. If the amount saved is really going to be so small, I urge the Minister to say, “Actually, let’s drop this. It is just not worth the battle.”

[David Mowat]

I can only repeat that we value the contribution that community pharmacies make, and that the savings that we shall propose shortly are needed for other parts of the NHS. We believe that provision will not be affected, and that other parts of the package, including the integration fund and the hiring of an additional 2,000 pharmacists for the GP sector, will make this sector work better than it does at present.

[Paula Sherriff (Dewsbury) (Lab)]

Does the Minister agree that should one in four community pharmacies close, the effect on the elderly, the vulnerable, the poor and those with long-term conditions could be very serious indeed, and potentially catastrophic?

[David Mowat]

We do not believe that the proposals that we will be announcing shortly will do anything to the detriment of any of those patient groups.

[Graham Jones (Hyndburn) (Lab)]

Community pharmacies play a vital role in primary care, and there is a very important relationship between them and our constituents and their patients and customers. My constituency contains a healthy living pharmacy that provides added value. Is not the Minister’s reductionist proposal about price rather than quality, and should we not be looking at the quality of pharmacy provision? Healthy living pharmacies in Hyndburn, and in Lancashire generally, provide an exceptional service, and should not be under the dark cloud that is hanging over them as a result of the Minister’s proposal.

[David Mowat]

The hon. Gentleman has made a good point. A large part of the value added from pharmacies is related to quality, and we need to reward the pharmacies that are trying harder than others to provide it. The hon. Gentleman mentioned healthy living pharmacies, and there are many examples. Part of our package will address the quality issue, which is one of the issues that the Pharmaceutical Services Negotiating Committee asked us to consider.

[Bill Esterson (Sefton Central) (Lab)]

If the Minister wants to make the savings that he has talked about, he should work with the pharmacists and listen to what they have to say, because they have the ideas about how to make those savings. In my constituency, they talk to me about the potential for reducing repeat prescriptions, among other ideas. If he does that, he will play a role in looking after the heart of our community, which is what pharmacists are, and the heart of our NHS, which is also what they are. They also play an incredibly important role in every community in providing much needed footfall for other local businesses.

[David Mowat]

We have been talking to the Pharmaceutical Services Negotiating Committee for 10 months. We have tried to incorporate, in the proposals that we are going to make, some of the points it has put to us. I can only again tell hon. Members, as I have already said to many others, that we value the contribution that the pharmacy sector can make. We wish to see that move over and above what it is now, in terms of dispensing, into more value-added services dealing with minor ailments, repeat prescriptions and long-term conditions. We want to do all those things, and we will.

[Nic Dakin (Scunthorpe) (Lab)]

The Minister should tread with great care. I have visited many community pharmacies in my constituency, and in each and every one I saw lots of value-added activity—preparing medicine trays, delivering medicines or whatever—and a keenness to be involved in wider activities. There is a real danger that the Minister, in seeking savings, will cost the health service and communities more.

[David Mowat]

That would be a danger, had we not spent time over the past 10 months to try to get this right. We are confident and believe that we have done so.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

May I give some advice to the Minister? If he wants reforms—I think that the feeling on both sides of the House is that we need a high-performing, innovative pharmacy sector, which is at the heart of every community, urban and rural—and if he wants to generate enthusiasm in the workforce, he should not demoralise them at the very beginning. His predecessor was the person who said, “Let us cut 2,000 pharmacies.” That is the truth. The Minister should not just reach out to pharmacies at posh dinners—he should come to Huddersfield, which is more exciting than Kettering, and talk to our pharmacies.

[David Mowat]

The hon. Gentleman makes a good point: I should not just reach out to pharmacists at posh dinners. In the past three weeks, I have visited a number of pharmacists. I have even opened a new pharmacy. I bow to no one in my view of the value that they can add, but they agree, and I think most Members in the House agree, that the community pharmacy network must move from a model based on dispensing to a model based more on services. We are going to help pharmacies to do that, and these proposals in the round will achieve that.

[Karin Smyth (Bristol South) (Lab)]

As we have said, primary care is the cornerstone, indeed the foundation, of the NHS, and pharmacies represent a successful public-private model. This proposal does seem to be a totally counter-intuitive one. When I, on the Public Accounts Committee, questioned the chief executive of the NHS last month about the Department of Health accounts, he expressed surprise that there may be a reprieve for pharmacies, because the reality is that this is an in-year cut that is already happening; it is part of NHS England’s delivery of savings this year. Can the Minister clarify the reports over the weekend—what are the figures we are talking about? The reports were that the cuts would be £113 million in 2016-17 and £208 million in 2017-18. Are those the correct figures?

[David Mowat]

The figures to which the hon. Lady refers were announced in the consultation in December 2015. The only change since those figures were announced in that consultation in 2015 is that, because of the delay in looking at this again, the in-year saving this year is likely to be lower.

[Stephen Pound (Ealing North) (Lab)]

Those of us who wish the Minister well would probably best describe his performance at the Dispatch Box this afternoon as “courageous”. I feel that he has been sold a hospital pass on this one. He is responsible for a policy that lurches from the inchoate to the indefensible; that talks on the one hand about recruiting thousands of pharmacists and on the other about closing thousands of pharmacies. I am sorry, but we cannot keep loading, even on to the willing shoulders of the community pharmacies, more and more responsibility while we are draining away the financial lifeblood. Would the Minister care to become the most popular Minister on the high streets of our nation by saying that he is going to have another look at this nonsense?

[David Mowat]

I am always keen to be popular, but I am also keen to do the right thing. Nobody is talking about thousands of pharmacies closing and I do not believe that will happen, but we have talked about hiring 2,000 more pharmacies in the GP sector. That is true, but that is not incoherent; that is the right thing to do.

I just say this to the House: we all need to distinguish at times between the pharmacy profession, which we need and will nurture and help to grow and that can produce all these added values, and those people who own the pharmacy shops, 65% of which are public companies and private equity. The House should just reflect on that.

[Toby Perkins (Chesterfield) (Lab)]

It really is possible that the centre-ground in British politics is changing. Here we have a Conservative Minister coming to the Chamber to say, “I’m going to put hundreds of small firms out of business, but don’t worry; I’m going to get them all working for the Government.” It is absolutely bizarre, and the Minister is now trying to convince us by saying, “Don’t worry, they’re all hedge funds anyway.” We know it is not the Boots in the centre of Chesterfield that is going to be shutting; it is the community pharmacies in each of our communities. So will the Minister at least give us the commitment that no community will be left without a pharmacy and that no doctors’ surgery will be allowed to have a pharmacy close on its doorstep?

[David Mowat]

I will give the hon. Gentleman the commitment that no community will be left without a pharmacy.

[Kate Green (Stretford and Urmston) (Lab)]

I cannot impress strongly enough on the Minister the danger of these proposals. In my constituency the pressures on primary care are such that GP surgeries cannot recruit GPs and many practices are now not meeting Care Quality Commission standards because they are in old premises that are unsuitable. The thought that on top of that we would reduce the possibility for people to attend their local community pharmacy for simple healthcare needs is frightening. When the Minister publishes the impact assessment, will it provide any sort of reassurance and clarity that those complex primary care factors have been properly taken into account?

[David Mowat]

We have talked all afternoon about the need to protect access to GPs, and I repeat the point I made earlier: our proposals in the round should increase the degree to which pharmacists are linked into GP practices. The hon. Lady says that many practices are getting poor-quality assessments, but the fact is that over 80% of them are getting good-quality assessments, and we need that to continue.

The proposals we are setting out in the round are expected to make pharmacy access better than it is now, and the orientation of the pharmacy profession towards services and away from just dispensing should happen more quickly.

Hormone Pregnancy Tests

David Mowat Excerpts

Thursday 13th October 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

May I just say at the outset that nobody in the Government has any interest other than in getting to the truth in this matter? We are as keen as the people who have spoken today, and indeed the families that are watching us, to make sure that we do that, and there is a process that is to be followed to make that happen. We have heard some strong words today: “establishment whitewash”, “sham inquiry” and “a blanket over the issues”. I say again: nobody on the Government side of the House has any interest in anything other than getting to the truth, and the process that was put in place two years ago had that at its heart.

Let me join others in congratulating the hon. Members for Bolton South East (Yasmin Qureshi) and for Livingston (Hannah Bardell) on leading the charge on this, not just today, but in terms of the APPG and making sure that this issue is very high on the Government’s agenda. It is massively important that those who feel their lives have been adversely affected by drugs, albeit 40 or 50 years ago, see that processes are in place to make sure that we do what we can.

I would also like to pay tribute from the Government side to the Association for Children Damaged by Hormone Pregnancy Tests, and particularly to Marie Lyon for the work that she has done and continues to do—and should continue to do until we get to the truth of this matter.

I am going to talk in some detail about the progress on the inquiry, but it was very clear, as I listened to the debate, that, at the very least, the association does not have confidence in the work of the inquiry, and that is unsatisfactory. I have heard people talking about letters being unanswered and all that goes with that, and that is unacceptable. I make a commitment at the start to the association, or the APPG, that one of the things that should come right out of what we are talking about today is a letter from them, in as much detail as they want it to be, raising as many concerns as they feel they have about the details of the inquiry—a lot of detailed points have been made, which I will not be able to answer today. That letter will be answered in detail, and after that we should have a meeting to make sure that everyone is content with the direction in which we are going.

[Mr George Howarth]

I am grateful to the Minister for his offer. Does he accept that part of the problem is that if people do not have confidence in the process and do not feel that it is being conducted in a transparent way— there is evidence that that is the case—they will say that the inquiry is likely to be a whitewash? He needs to reassure not just the families and my hon. Friends, but everybody concerned with the inquiry that the process will be transparent and open. In those circumstances, people would have more confidence in it.

[David Mowat]

I accept that, which is why I have made the offer. I guess the caveat is that, in the end, science will play a big part in getting to where we need to be. The science will find its own path, and I want to talk a little about how we are trying to achieve that.

As hon. Members have said, two years ago my hon. Friend the Member for Mid Norfolk (George Freeman), who was then the Minister for Life Sciences, established an inquiry that, at the time, was committed to having an independent review of the evidence and to attempting to find a scientific link between the hormone pregnancy test—in particular, Primodos—and the adverse effects on pregnancy and all that goes with it. It is worth saying at this point that, as hon. Members have said, this is an international issue that has been around for 40 to 50 years. We are the only country to have set up such an inquiry, and the only one to have attempted to find a scientific route to the truth in this way.

[Hannah Bardell]

Will the Minister give way?

[David Mowat]

I will continue to make progress, but will come back to the hon. Lady.

Two years ago, the MHRA was charged with putting the inquiry in place. It worked with the Commission on Human Medicines to set up an expert group, whose job was to establish whether there was a scientific link between the drugs prescribed and the adverse effects. The first meeting was a year after that, which was a long time. I apologise for that on behalf of the Government; I think it was too long. I have inquired why that was, and I have been told that there was the election and the purdah period, but it was too long. The group has met four times, and its next meeting is on Tuesday next week. I think we can all conclude that the members of the inquiry will be watching our proceedings and listening to the points that have been made. At that time, the review’s focus was on the science to establish whether it could be shown that there was a link between the drugs prescribed and the adverse effects. The terms of reference were subsequently altered to cover going into the lessons learned.

[Hannah Bardell]

I absolutely take on board what the Minister is saying—he is being very positive, and has clearly listened to the concerns we have raised—but I have a couple of comments. First, the fact that we are the only such country is surely a good thing given how far behind we lagged. We have an opportunity to lead the world on this and to show how this can be done positively. Secondly, as he says, no Government members want the inquiry to fall down. Is it not therefore his duty to intervene to make sure that it has the right resources, the right expertise and the right processes?

[David Mowat]

There is nothing in that intervention with which I disagree. We all want the inquiry to work. The Government have not established an inquiry in order for it to fail. We have not established an inquiry for it not to have the confidence of the association. We need to get to the truth, but that is a scientific process, and because it is a scientific process, it can be frustrating and long-winded; it can take a long time.

I want to talk about some of the concerns that have been raised. There were three types of concerns. The first was that the independent group of experts is not reviewing the regulatory concerns or the delays that took place at the time, in particular the failures of the then Committee on Safety of Medicines and the five or eight-year delay, which we have heard about. The UK was not the first country to ban the drug, but it was not the last either. The second concern, which I will talk about at some length, was that members of the expert group might not be independent and might not have fully declared their conflicts of interest. We have heard words like “colluding” and “cover-up” from some Members. The third concern was that not all the available evidence is being considered by the group, and we heard about the German material not being translated. I will address all three points.

On the first issue, we have heard that there was a regulatory failure and that the inquiry should look at it. I say to the House that if, when the expert group reports next spring, it finds a clear causal link, that will be the time to take further action on issues such as regulation and liability, and everything that goes with that. The first step we are taking is to establish the science. The group that has been set up is an expert group. It is science-led. It is important to make it clear in the House that we are not criticising individual members, because they are striving to get to the truth. It is a group of eminent people.

It would be quite wrong if we conflated the possible eventual need to look at the regulatory actions that were taken, the legal liabilities and everything that goes with that, with the first step of the process, which is to establish whether the science leads us to that link. In spite of some of the comments that have been made today, that has not been done yet in any country. The first serious attempt to do it is the one that is going on now.

The second concern is that the expert working group is not impartial. The MHRA has taken a vigorous approach to evaluating and handling potential conflicts of interest. No member of the expert working group can have any interest in any of the companies that were involved or their predecessors. Members should not have publicly expressed a strong opinion, favourable or unfavourable, about the possibility of birth defects arising from these drugs. We heard that one of the members had tweeted. If there is evidence of that, we will follow it up. It is true that one member not of the expert group, but of the advisory group was removed because it was felt that he had a conflict of interest that was not properly declared. Action was taken very quickly in respect of that.

The inquiry is chaired by a consultant gynaecologist from the Chalmers centre in Edinburgh. The group has 14 scientists drawn from some of the best universities in the UK. We have no reason to believe that any of them have any more reason not to want to get to the truth than Members on both sides of this House.

[Maria Eagle]

Does the Minister not realise how important it is that, whatever the rights and wrongs of this and whatever the qualities of the members of the panel, the families need to have confidence in it? There is no point in saying that they are all wonderful people. The families have concerns and if they are not assuaged, in one way or another, the outcome will not have their confidence.

[David Mowat]

I said at the start of my remarks that the learning point I have taken from this debate is that, whatever we think about the truth, the science and whether we are doing the right thing, the families are not happy. I also said that we will do what we can to amend that.

As well as that, Members on both sides of the House need to accept that we need to get to the scientific truth. In order to do that, there needs to be a scientific process. That has to happen and that is why some of this is time-consuming and difficult, even though we wish that it was not.

[Mr George Howarth]

The Minister is being generous in giving way. I am not sure that the terminology he is using is necessarily suitable. I do not understand this to be a scientific process per se. I understand it to be an informed judgment about the available evidence and, understandably, that is best conducted by scientists. I think he was a lawyer in a previous existence, so he will understand the difference between the two approaches.

[David Mowat]

I am guilty of many things, but I have never been a lawyer. However, in case I was not clear, I understand the difference between the two processes and accept the distinction that the right hon. Gentleman makes. The point I would make again, however, is that the panel has 14 members who have been chosen for particular skills in the issues involved, plus lay members who are not scientists.

[Yvonne Fovargue]

Will the Minister give way?

[David Mowat]

I will not, as there are only a couple of minutes left and the hon. Member for Bolton South East needs to sum up.

I will now address the third point that arose in the debate, namely whether all the available evidence will be reviewed by the expert group. The answer is yes. That is one reason why the process is taking so long. A specific question was raised about a great deal of evidence that has recently come to light which is in German. All that evidence will be translated, and all the translations will be put before the group. The chairman will be responsible for ensuring that that evidence is looked at and reviewed properly. There is absolutely no intention that the inquiry be anything other than a properly resourced attempt to get to the truth. That is difficult for something that happened 40 or 50 years ago. We all need to accept that point.

I finish by making the same point that I made at the start of my remarks. The Government are responsible for the efficacy of this inquiry, and we need to get to the right answer. It is important, and I accept, that the inquiry clearly does not have the confidence of some of the stakeholders. That is not acceptable or satisfactory. I will make the same undertaking as was made by the then Minister for Life Sciences two years ago when putting the inquiry in place, namely that we will try to put things right. I make the offer again: if there is a letter giving the detail of the points that have been made, that letter will be answered and we will hold a meeting to discuss it subsequently.

European Medicines Agency

David Mowat Excerpts

Wednesday 12th October 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship today, Mr McCabe. I congratulate the hon. Member for Cambridge (Daniel Zeichner) and all the other hon. Members who have brought their experience to bear in the debate. I am sorry to disappoint everyone by not being from the Brexit Department. I will pass that on to those who are in it, but as has been noted, they are otherwise engaged in the main Chamber.

One reason why I am particularly pleased that we have had this debate today—I regret that all the answers may not be clear in 11 minutes’ time—is that often when there is talk in the media about the Brexit negotiations we are about to have, we hear a great deal about the importance of financial services, the City and passporting, and of the need to get those things right and the terrible effect it will have on our economy if we do not. The fact that we have had this debate, and that the hon. Gentleman and others have talked about how important the medicines industry is to our economy—not just in Cambridge, Cheshire or Scotland, but right across the country—is a reminder of the importance of this issue and has rightly put it on the agenda. I am sure the hon. Gentleman will keep it on the agenda, as will Ministers from the Department of Health.

At the start of the debate, the hon. Gentleman quoted the Prime Minister, who said:

“It is hard to think of an industry of greater strategic importance to Britain than its pharmaceutical industry”.

That is on the cover of a report, which I recommend everyone reads, on the structure and future of the life sciences industry post-Brexit. In a moment, I will talk a bit more about the work that the Office for Life Sciences is doing in that area. The pharmaceuticals industry is right at the centre point of where we need to be as a country in development work. It is an area that we are world-class in—an area of advanced manufacturing, which we need to be doing more of. We are leveraging the expertise and brilliant work in universities to actually make money, in a way that we do not do in all industries at all times. It is vital that we do not lose that.

I will repeat fairly quickly some of the statistics that we have heard on the structure of the industry. There are nearly 6,000 companies in the industry in the UK, and two of the major companies are GSK—located in many parts of the country, including Ayrshire—and AstraZeneca, which is located in Cambridge in particular. I have made the point earlier that a larger part of it was located in Cheshire a couple of years ago. Those are major, world-beating organisations, and for us to have an industrial future and a future as a country, we have to nurture them. In fairness, the thought that we would not do that is a nonsense. A fair challenge is to make sure that we do it right and keep it on the agenda, and I will try to address that today.

However, this is not a European industry, it is a global industry. AstraZeneca and GSK also have massive facilities in places such as Sweden and Philadelphia—all over the world. Of course it is absolutely essential that we get our relationship with the EU right. I think the point was made earlier that we have 3% of the EU market in terms of sales, although we are a lot bigger than that in terms of drug production and the importance of the pharmaceutical industry—it is probably more like 10%. GSK’s recent announcement of an £800 million investment in biologic and bioelectronic activity is to be welcomed.

The EMA was formed, as was generously mentioned, in 1995. There are 890 staff, the majority of whom are not from the UK; I think that only something like 60 are UK-based. The hon. Member for Heywood and Middleton (Liz McInnes) made the fair point that those people have families and futures, and asked how they are to be protected. The Prime Minister has said that we hope and expect that all EU nationals who work in the UK will stay here into the future. I have not heard any leader of any other country in Europe make the reciprocal point. I do not know if that is on the Labour party’s list of 171 questions, but it would be reasonable if it were. Having the EMA in the UK is of benefit to us not just because of those jobs but because, as Members have said, it is natural that people like to be close to their regulators. It would be reasonable to suppose that, although that might not be a decisive factor in many investment decisions, it would be a factor.

We also have the UK agencies: the MHRA, which covers medicines, and the Veterinary Medicines Directorate, which covers veterinary medical activities. They have 1,200 staff and 160 staff respectively. The point was made today that their activities are commingled with those of the EMA. Many of the EMA’s major committees are chaired by people from the UK, including from the MHRA and VMD. Equally importantly, the hon. Member for Central Ayrshire (Dr Whitford) made the point that 30% of its activities are done by the MHRA. The figure I have is 20%, but nevertheless, a significant amount of work done for the EMA is done in the UK. That is not just because of location—it is not just because the people who do that work are down the road. It is because they have the expertise, the science base and the people that are needed. Of course, with Brexit, all of that is up for discussion.

We have touched on the university sector, and I will not say a great deal about that. I have already made the point that the industry is an example of us successfully taking a sector with world-class, world-beating innovation and turning that into world-class, world-beating companies, in a way that we do not everywhere. It is of paramount importance that the sort of research that goes on in our universities continues. The Government intend to make sure that happens and, indeed, to increase it.

I have set out the regulatory and industry structure, but we are just about to impose Brexit on all of that. That is where we get into the territory of speculation and conjecture, and I apologise that I cannot be more definitive. Many of the questions that have legitimately been raised, in particular by the Labour spokesman, the hon. Member for Ellesmere Port and Neston (Justin Madders), will be central to any negotiation that the Government take part in. It is not possible for a Minister to address the House of Commons and say, “This is our position, these are our red lines, these are the things we are going to give a bit on and these are the things that really matter to us.” That would be nonsense. That is not how any of the commercial companies located in Cambridge or other places would deal with things. What we have to do—this is the role of Members here today—is make sure that the issues are raised with and understood by the negotiating team, because there will be trade-offs in any negotiation.

With respect to some of the Members who have spoken, I have to say that we do pay £20 billion a year to the EU. We may all vary in our view of how much value for money that provides, but the fact is the £350 million on the side of the bus was not an entirely made-up number. That did not influence how I voted in the referendum, but it was not an entirely made-up number. We pay £20 billion a year for the things that we get from the EU, one of which is the EMA and the activity around it. There is a dialogue to be had both on that amount of money and on issues such as the location of the EMA and all that goes with it. Of course, its location is one point to be discussed, and I have no idea how that will end up. The point has been made that it regulates not just for the EU but for Liechtenstein and Norway—I think there was another country as well, but I have not written it down. The UK could be another such country. For me to say it is an absolute line in the sand that the EMA must stay in the UK would be a nonsense.

A number of Members have asked what we are doing to prepare for the negotiations that will happen. That question can be divided into two parts: what are the agencies—the VMD and the MHRA—doing, and what are the Government doing? The agencies have set up groups looking at the opportunities and at how regulation might carry on into the future. A number of Members have made the point that there might be a time lag in medicines coming to the UK if they have to be regulated by more than one body, or if in the future the EMA does it separately from how we do it in the UK. That is really a decision for the UK. It is about how we choose to regulate, and that decision has not yet been made. It would be disappointing if that happened, and many of us will be working hard to ensure that it does not.

The Government have set out fairly clearly that we intend to underwrite EU payments to academic projects even after we have left the EU, to protect the important activity of research programmes. Through the Office for Life Sciences, we have set up a steering group charged with informing how we make the transition. The group is chaired by the Secretary of State, Sir Andrew Witty and Pascal Soriot from AstraZeneca, and over the next few months it will be responsible for informing our negotiating position.

I do not know how many colleagues know about the report, “Maintaining and growing the UK’s world leading Life Sciences sector in the context of leaving the EU”. I think it was put together by PricewaterhouseCoopers. It is a good start in setting out a number of issues we have heard about today and the importance of getting the process right. I very much recommend it. It does not answer all the questions, but it sets out the issues in areas such as trade, people, research, funding and regulation.

A whole string of points were made in Members’ contributions this afternoon. I do not want to spend too long on them, but the hon. Member for Cambridge mentioned that not being part of the EMA’s marketing authorisation might cause delays. That depends on how we set up regulation in this country, and there are a lot of choices. A lot of other countries, including Switzerland and Japan, regulate in different ways, and it would be premature for me to say too much about it. The hon. Gentleman also made the valid point that the EMA and the MHRA are completely intermingled, and that both benefit from the current arrangements. It is not just about the EMA contracting and hiring the MHRA. We do a lot of the work that leads to that top-level and highly professional European legislation.

The hon. Member for Strangford (Jim Shannon) reminded us that whatever we think, the country has voted and we are going to leave the EU. There is no ambiguity about that, and we have to make the most of it. That is a mature reflection, because it forces us to address the negotiations, and not to continue to go over what was on the side of the bus and all the rest of it. We are where we are, and we need to make the situation the best that it can be.

The hon. Member for Heywood and Middleton used her experience and knowledge as a research scientist to make a good speech. She made a point about people, which I tried to answer by reflecting on other EU states. She mentioned the Nobel prize winners’ remarks. I heard those remarks as well and thought that there was a slight irony in that they were asking us to remain in the EU and so on from the University of Chicago. That shows that we live in the world, not just in Europe, and we must reflect on that.

[Dr Philippa Whitford]

Those Nobel prize winners represent the last time we had a major brain drain, when, in the ’80s, we lost some of the best minds from the UK. That is one of the dangers: the people who want to be at the cutting edge will not see this as the place to be.

[David Mowat]

That is a fair point. It could be a danger. The point I was making was that they made the plea to remain in the EU from the United States, which is the leader in many aspects of science. I think we can agree that science is international—it operates in Japan, the US, the UK, Germany, France and elsewhere—and that, however we achieve Brexit, we should do what we can to avoid creating barriers to internationalisation.

[Liz McInnes]

Will the Minister give way?

[David Mowat]

Maybe we cannot agree on that. I give way to the hon. Lady.

[Liz McInnes]

There is no irony in the comments of the Nobel prize winners just because they were made by British scientists working in the United States. That fact only emphasises how international science is. We must not fall into the trap of taking the line that was spread before the referendum:—that this country has had enough of experts. Those people are experts, and we should listen to what they have to say because they are the people who know what is going on. They know what the effect on British science will be if the EMA and its principles are lost.

[David Mowat]

We can agree that the scientific principles at the core of our world-leading science must not be lost in regulation. We can also agree that science is international. It is in all our interests, and in the interests of our communities and our children, that this country continues to do world-class science as part of an international collaboration. That is the Government’s intent and will.

I will finish by talking about our world-class industry.

[Jim Shannon]

I have asked a couple of questions about muscular dystrophy on behalf of my constituents. I do not expect the Minister to give me a response today, but I remind him gently to provide a written response and perhaps make it available to other hon. Members who are here.

[David Mowat]

Clearly when I used the word “finish”, people sprang into action. I will ensure that the hon. Gentleman gets a written answer to his questions on muscular dystrophy.

We do world-class science in this country. We must continue to do so, and to have a world-class pharmaceutical industry, with all that means for value added and input to the Exchequer. Governments are not the reason why we are among the best in the world in gene therapy and cell therapy, and they are not the reason why we have built £60 billion pharmaceutical organisations GlaxoSmithKline and AstraZeneca. It is important that we get the regulatory environment right, and the Department of Health and the Department for Exiting the European Union will ensure that the negotiations we are about to have address those issues.

[Dr Wollaston]

Does the Minister agree that the reason why we have such world-class expertise is the workforce? We must be absolutely clear and send a message to the world that, within our science and research community, we will not be maintaining a list of who is here from the EU and who is a British scientist. We must unequivocally send a message that Britain is open to scientists, researchers and the medical and healthcare workforce from around the world and the EU, not just from Britain.

[David Mowat]

That last intervention—I say “last” somewhat hopefully—unites us all. It would be ridiculous if the world-class science that we must continue to do compromised on matters like that. I completely agree with my hon. Friend’s point, and there is agreement across Government about that. If we need to make that clearer, we should.

I will finish now, as nobody is springing to their feet. I thank all hon. Members, particularly the hon. Member for Cambridge, for putting the issue on the agenda. It is right and important that the topic is at the forefront of our negotiations, and that we get the right answer in the end.

Oral Answers to Questions

David Mowat Excerpts

Tuesday 11th October 2016 Commons Chamber

[Johnny Mercer (Plymouth, Moor View) (Con)]

2. If he will visit Plymouth to discuss how its city council has pooled health and social care budgets.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

Plymouth has gone further and faster in integrating health and social care than many parts of the country have done. The integrated fund that it has set up covers housing and leisure as well as health and care. I would be delighted to visit Plymouth and to learn more about how the fund is working in practice.

[Johnny Mercer]

As my hon. Friend points out, Plymouth has taken innovative steps to try to address some of the funding inequalities at play within the Northern, Eastern and Western Devon clinical commissioning group. However, between the calculated spend and the actual spend, there is a funding shortfall of £30 million. Will he agree to work with local MPs, stakeholders and those involved in the wider Devon sustainability and transformation plan to develop a written agreement to address these inequalities?

[David Mowat]

My hon. Friend refers to the time lag that can exist between target and actual funding. When I visit, I will be delighted to meet stakeholders not only to understand the allocation issues to which he refers but to congratulate the health and social care leadership on the progress they have made with their fund and on the above-average satisfaction ratings that have been achieved in Plymouth.

[Mr Ben Bradshaw (Exeter) (Lab)]

12. When the Minister is in Devon, will he meet patients’ groups and NHS staff, who are very worried about the proposals under the Government’s Orwellian Success regime, which include the closure of scores of community hospital beds, including the only community hospital beds in Exeter at Whipton hospital? Although it may make sense to integrate, and it certainly makes sense to move money from beds and buildings to better care for people in their homes, does he accept that it is simply not deliverable against a backdrop of massive cuts in social care budgets?

[David Mowat]

Yes, I am happy to meet in that context. The right hon. Gentleman is right that the Success regime is about a transfer of resources from the community hospitals to care at home and domiciliary care. That is not necessarily the wrong thing to do, but it must be done right, and I am happy to meet.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome greater integration, but the Minister will be aware that there are grave concerns about the effect of cuts to social care on the NHS. More and more patients are spending greater time in more expensive settings in hospital when they could be better looked after in their own homes or in the community, but cuts to social care make that impossible. Will the Minister set out what appraisal the Government are making of the effect and the damage to the NHS of cuts to social care?

[David Mowat]

My hon. Friend is right: social care funding is tight. It is also true to say that those parts of the country that do the best in this regard—there are some that do considerably better than others—have integrated social care and health most effectively. On the budget itself, there is some disparity among different local authorities. About a quarter of local authorities have increased their adult social care budget by 5% or more this year.

[Simon Danczuk (Rochdale) (Ind)]

3. If he will publish the full scientific evidential basis for his Department’s alcohol consumption guidelines; and what representations he has received on those guidelines.

--- Later in debate ---

[Mr Steve Baker (Wycombe) (Con)]

5. If he will take steps to ensure that clinical commissioning groups publish their proposals for implementing the NHS “Five Year Forward View”.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The “Five Year Forward View” will be delivered through sustainability and transformation plans which are currently being developed by clinical commissioning groups in collaboration with local authorities and providers. NHS England expects that all STPs will be published, although in some areas discussions are already taking place.

[Mr Baker]

I am led to understand that in Wycombe we should expect no dramatic changes and possibly no publication of a strategic plan. Does my hon. Friend agree that public confidence would be much enhanced by the clear articulation in public of a strategy for meeting the “Five Year Forward View”?

[David Mowat]

I agree with my hon. Friend, and I will try to give a clear answer. NHS England is determined that all 44 areas will publish their plans shortly. For those that have not already done so, publication will take place after the formal checkpoint review at the end of October. Areas are working to different timescales, but the plans will all be published by the end of November. For the avoidance of doubt, that includes the STP for Buckinghamshire, Oxfordshire and Berkshire West.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

The NHS “Five Year Forward View” called for a radical upgrade in prevention and public health. How does the Minister square that with the Government’s subsequent cuts to public health, including £200 million in-year cuts and further cuts expected by 2020?

[David Mowat]

The STP process is an attempt to upgrade our public health and mental health provision and cancer outcomes. Every STP will be expected to provide an assessment of local public health priorities and the timetable for progress towards that.

[Mr Edward Vaizey (Wantage) (Con)]

Wantage community hospital in my constituency has recently closed because of the threat of Legionnaires’ disease, and it will not reopen until we have finally concluded consultation on the sustainability and transformation plan—if it reopens at all. This consultation has been delayed, and that naturally worries my constituents. Will the Minister join me in urging Oxfordshire to get on with consulting on this very important plan, so that we can have a reasonable discussion?

[David Mowat]

I will join my right hon. Friend in doing that. I am not familiar with the specifics of the Wantage case, but it does not sound right that it is an ongoing thing that is not fixed quickly.

[Keith Vaz (Leicester East) (Lab)]

May I congratulate the Minister on his appointment to the Front Bench, as well as the Under-Secretary of State for Health, the hon. Member for Oxford West and Abingdon (Nicola Blackwood), on hers? I am sure that they will do a terrific job in their posts.

As a type 2 diabetic, I am very concerned about the fact that local clinical commissioning groups are just not providing information on preventive work against diabetes. Will the hon. Gentleman confirm that diabetes will be referred to once these plans have been published?

[David Mowat]

I will confirm that. There is a national diabetes plan, as the right hon. Gentleman will be aware. Diabetes is one of a number of long-term conditions in which these plans are charged to deliver improvements, and it would not be acceptable for a plan to be signed off or completed unless progress on diabetes had been made.

[David Tredinnick (Bosworth) (Con)]

When the Minister looks at new treatment options in the forward view, will he consider the example of Velindre NHS Trust in south-east Wales, which treats 1.5 million cancer patients every year and is now using reflexology, reiki healing, aromatherapy, and breathing and relaxation techniques to alleviate anxiety, pain, side effects and symptoms? If that was more widely spread over the health service in England, cost savings and patient satisfaction would increase.

[David Mowat]

The STP process is locally led, not led from the centre, but I would expect clinical judgments of the type mentioned to be made if they could be confirmed on the basis of scientific and trial-based evidence.

[Julie Cooper (Burnley) (Lab)]

Central to the aim of the five year forward plan for the NHS is a sustainable health service in which all patients receive the right care at the right time in the right place. With that in mind, can the Minister tell me what action he is taking to address the problem of delayed hospital discharges, which have risen by 20% so far this year? That amounts to an additional 926 people every day condemned to stay in hospital longer than is medically necessary.

[David Mowat]

First, may I welcome the hon. Lady to her post and wish her luck in the new job? There has been an increase in delayed discharges in England over the past year. Only a part of that increase is due to difficulties in the integration between social care and the NHS—a large part of it comes from within the NHS itself—but it is not uniform across local authorities. Indeed, many local authorities are improving in this regard. What is very clear is that those making the most progress the most quickly are those that have gone furthest in integrating social care and healthcare.

[Michelle Donelan (Chippenham) (Con)]

6. What the timetable is for the review of the diagnosis, treatment and transmission of Lyme disease announced on 10 May 2016.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The Department of Health has commissioned three separate reviews on the diagnosis, treatment and transmission of Lyme disease. The work will be carried out by the epicentre of University College and be clinically driven and evidence-based, and it will be published in late 2017.

[Michelle Donelan]

Although I am delighted that the Government are looking into this serious and important disease, as the reviews progress thousands of people contract Lyme disease each year, particularly in areas such as Wiltshire, and they can receive inadequate treatment, so will the Minister look into speeding up these reviews?

[David Mowat]

It is fair challenge that this work is high priority, and we need to go as fast as possible, but we are working with research teams. The work will be trial-based and needs to be as definitive as possible. In the meantime, early diagnosis is the key way to make progress. Public Health England continues to work with GPs and the public on it.

[Richard Arkless (Dumfries and Galloway) (SNP)]

My mother recently died of motor neurone disease. In some areas of my constituency, there are 13 sufferers per 10,000 people, whereas the UK average is two per 100,000. Will the Minister please agree to meet me and representatives of the Motor Neurone Disease Association to discuss how the UK Government could lend their weight to combating this awful and debilitating disease?

[David Mowat]

Yes, I would be happy to meet the hon. Gentleman to discuss that subject.

[Mr Speaker]

I am extremely grateful to the Minister for his response on that matter.

[Jim Shannon (Strangford) (DUP)]

Bearing in mind that cases of Lyme disease have quadrupled in the past 12 years, and that some of those cases have been in my constituency of Strangford in Northern Ireland, what has been done with the devolved Assemblies in the United Kingdom of Great Britain and Northern Ireland to ensure that a UK-wide strategy is put in place to address this trend and to provide effective diagnosis and treatment?

[David Mowat]

The principal thing that we need to do with Lyme disease is to make progress on diagnosis, treatment and transmission through a definitive approach. When the results of the study that I mentioned are published, of course they will be available across all parts of the United Kingdom.

[Andrew Bridgen (North West Leicestershire) (Con)]

7. What steps his Department is taking to improve NHS procurement.

--- Later in debate ---

[Mr John Baron (Basildon and Billericay) (Con)]

10. What steps his Department is taking to model the potential cost savings to the NHS budget of earlier diagnosis of cancers.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The independent cancer taskforce highlighted the report “Saving lives, averting costs”, which identified cost savings resulting from earlier diagnosis, in particular for colon, rectal and ovary cancers. We have committed to a further £300 million for earlier diagnosis, one major product of which will be the 28-day diagnosis standard to which the Secretary of State referred earlier.

[Mr Baron]

In welcoming the Minister to his post, may I highlight evidence to show that early diagnosis, in addition to making for better survival rates, offers substantial cost savings? Colon cancer costs £3,000 per patient per year to treat at stage 1, compared with over £12,000 if it is diagnosed and treated at stage 4. We have a shortage of health economists in the NHS, so will the Minister go further and actually commission a study to look at this issue on behalf of the taxpayer, because it requires further detail?

[David Mowat]

We agree that early diagnosis saves lives and can lead to cost savings. Just as an example, we know that GP referrals are up by 91% since 2010—an additional 800,000 people are getting early diagnosis—and we are beginning to see the results of that coming through in the one-year survival figures. On my hon. Friend’s specific point about further study, Public Health England and Macmillan have commissioned recent studies on modelling, one part of which will be on the cost impact of earlier diagnosis, and we look forward to seeing the results of those studies.

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

GPs play a central role in the early diagnosis of cancer. In the 1990s, Sunderland was one of the most under-resourced areas in England in terms of the GP workforce, and we now face a similar and growing problem, even though action was taken then. Will the Minister set out how he intends to make sure not only that we train more family doctors, but that they are encouraged to work in areas where there is an acute shortage?

[David Mowat]

We are training 3,250 extra GPs every year, and we have a target of 5,000 additional doctors working in general practice by 2020. However, as well as new GPs, we must do much better with retention. That means keeping the GP population that we have, and there are a number of steps that the Government are taking to do that. On the specific point about Sunderland, there is a bursary scheme that is aimed at attracting GPs to areas where they may not necessarily have wished to work previously.

[Sir Simon Burns (Chelmsford) (Con)]

11. What estimate his Department has made of the amount accrued to the public purse from efficiency savings in the NHS since May 2010.

--- Later in debate ---

[Oliver Dowden (Hertsmere) (Con)]

14. What clothing and other support the NHS provides to elderly people discharged from hospital into care homes for the first time.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

Every patient discharged from hospital into a care home should have a care plan or discharge assessment. This should include a clear assessment of their needs, covering transport, carers, GP notification, medication and, where necessary, clothing requirements.

[Oliver Dowden]

I have been approached by a number of constituents concerned about cases of elderly and vulnerable people who have been discharged from hospital straight into care homes, often without any basic personal effects or clothing because their family cannot or are not willing to supply them. Does the Minister recognise this, and what can the Government do to tackle it?

[David Mowat]

As I said earlier, there is a national process in the form of the care plan. Where the family is not able to or will not provide support, typically the voluntary sector is asked to do so. If that does not work, local authorities can increase the personal expenses allowance to provide clothing. I am interested to hear about the cases that my hon. Friend mentions in his constituency, and I am very happy to talk to him to understand better why the process has failed there.

[Mr Speaker]

And have a cup of tea with the fella.

--- Later in debate ---

[Paula Sherriff (Dewsbury) (Lab)]

T2. Last October, the then Health Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), confirmed that my constituency fell far below the national average in terms of NHS dental provision. In fact, it is one of the worst in the country. Unfortunately, nothing has changed since then. Does the Secretary of State believe it is acceptable that my constituents, including many children, are unable to get an NHS dentist?

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is clearly unacceptable if the situation that the hon. Lady sets out is the case. I am happy to meet her and work with her to take the action that is needed to make things better.

[Fiona Bruce (Congleton) (Con)]

T6. The Government have provided a welcome increase in funding for mental health support, yet it does not appear to be reaching my constituency effectively, particularly for children. Now there are concerns that the Millbrook unit at nearby Macclesfield hospital might close. Will the Secretary of State look into those concerns?

--- Later in debate ---

[Danny Kinahan (South Antrim) (UUP)]

T3. I know that this is a devolved matter, but I look forward to the Union working together on it. In Northern Ireland, the health service is in crisis. To give cancer as an example, 6.7% of those with breast cancer are called in to be checked within 14 days—not 100%—and yet we have 392,000 people on the waiting list. Will the Secretary of State or his officials meet us to find a better way forward, so that we can all work together?

[David Mowat]

I have made it clear that we should all be working together to defeat cancer. We know that the best way of doing so is early diagnosis. We have made a lot of progress on that in England over the past few years but have a lot further to go. We are of course willing to talk to the devolved Administration about what they can learn from us—and perhaps vice versa.

[Maria Caulfield (Lewes) (Con)]

T7. Will the Secretary of State look again at the decision not to fund second stem cell transplants for adults and children with blood cancers, given the significant clinical evidence of their benefit for those who relapse? He should not just take my word for it but should take it from the Anthony Nolan Trust and the 36 specialists who have written to him asking him to review the decision.

[David Mowat]

This is a very difficult area, but decisions on priority are clinically driven and must continue to be based on peer-reviewed data. The most recent review determined that less than one third of second transplants would result in survival after five years; that is why they were not funded. There will, however, be a further review next April, and to the extent that the data have changed there will be a new evaluation at that time.

[Fiona Mactaggart (Slough) (Lab)]

T5. Deer Park medical centre in Witney faces closure, and patients will be dispersed a long way into other practices in an area where one in four already waits more than a week to see their GP. Duncan Enright, who is Labour’s candidate in the Witney by-election, is campaigning to save the centre. Will the Secretary of State reward his campaign by saving it today?

--- Later in debate ---

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I heard the Minister’s response earlier. He was of course right that sustainability and transformation plans are led locally, but he failed to acknowledge that the Government have given a mandate to make cuts attached to STPs. Without consultation, my local hospital has been downgraded. What on earth will the Secretary of State say to my constituents who may lose loved ones because they have had to travel miles further to another hospital?

[David Mowat]

If I may, I will give a quote:

“To reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides.”

That comes from the 2015 Labour manifesto. The STP process is designed to bring about better care and health, and better productivity. We should be critical friends of the process because we all want a better national health service.

[Lucy Allan (Telford) (Con)]

Local health commissioners have concluded that Telford’s brand new women and children’s centre, which serves some of the most deprived populations in the country, should be closed and moved to a more affluent area where health is better than the national average. The commissioning process has lost the confidence of local people. Will the Secretary of State intervene and ensure that local health commissioners fulfil their legal duty to reduce health inequalities?

NHS Sustainability and Transformation Plans

David Mowat Excerpts

Wednesday 14th September 2016 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I want to start by saying that I very much agree with the point made by the hon. Member for Central Ayrshire (Dr Whitford) that this ought to present a real opportunity. It has brought people together, and discussions have started across organisations that in the past have not talked to each other nearly enough—both across the health and social care divide, and also bringing in people from outside the health service and social care system—but I fear that the opportunity will be fatally undermined for three central reasons.

First, there is the point that I made in my challenge to the Minister, on mental health: unless every STP addresses the burden of mental ill health in every community centrally as part of its plan, it will fail. There is no doubt about that. I noted the Minister’s attempt to reassure me, but the parliamentary answer I received recently did not reassure me, because it appears that it is not going to be a requirement that every plan must centrally address this problem. I understand that the more developed plans will do so, but if this is not done, it will absolutely fail. We are dealing often with some of the people who are failed most by the system, and who use A&E departments more than any other people, yet my fear is this will be a massive missed opportunity in that regard.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

I thank the right hon. Gentleman for giving way, because I want to make the point again—I will say it very clearly—that if an STP does not come forward with very clear plans as to how the mental health and dementia programmes are going to move forward quickly, it will not go ahead. That cannot be clearer.

[Norman Lamb]

I am grateful to the Minister for that, and I hope that that message goes out across the country, because Andy Bell from the Centre for Mental Health today has again raised concern about the process in many parts of the country.

The second issue that causes me very real concern is the financial backdrop and the ability to deliver on the plans given the finances that are available. We have already heard that the bulk of the money that is available is going into clearing the deficits of providers, rather than into the transformation that is so necessary in order, as the hon. Member for Spelthorne (Kwasi Kwarteng) made clear, to spend money more efficiently and effectively in delivering care for our communities.

Chris Ham, chief executive of the King’s Fund and a well-respected commentator, says that its assessment of the draft plans

“shows that, in the absence of eye-watering efficiency improvements, there will be a financial gap running into hundreds of millions of pounds by 2020/21 in most of the footprints”—

not across the country, but in most footprints. This is completely unachievable, and he questions the deliverability of plans which include the closure of cottage hospitals in many areas—the very things that can keep people out of acute hospitals, yet we are planning in many areas to close them down. This seems to me to make no sense at all.

There is a related concern about governance. Currently in the NHS we regulate organisations, not systems, so within an STP footprint every organisation still has to focus on its own financial survival, rather than looking at the best approach for the entire health and care system in that locality. I fear that that in itself will be a central flaw.

Finally, there is the question of openness and transparency. I note the point that there will be a consultation process, but let me just tell the Government that if they really think that a formal consultation process after full draft plans have been produced in a secret process will in any way convince the public that they are being properly involved, it will fail. It is inevitable that it will fail. People are so suspicious of consultation processes that they simply do not believe that they are being properly engaged in them.

The hon. Member for Spelthorne made a good point: people are often prepared to go on a journey. They are prepared to listen to potentially radical changes and potentially to use money more effectively, but the only way they will do that is if they are involved from the start—involved in shaping the proposals, rather than responding to something that has been fixed behind closed doors. The hon. Member for Bedford (Richard Fuller) knows full well how the public react when they are presented with what looks like a fait accompli. If the public are not involved in the development of plans to close cottage hospitals, to slim down acute hospitals and to merge hospitals around the country, we should be in no doubt that those plans will be rejected. The Government will be facing a political disaster if they plough on in this way. They must, for example, open up and involve the non-executive directors, who have been told that they cannot even be part of the discussions. That is ridiculous. For goodness’ sake, if we are to take people with us, we have to take them on a journey, engage with them and involve them in the plans.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

In the six minutes available to me, it will not be possible to respond to the 40 or so speeches that we have heard today. I shall just pick out two contributions for special mention. First, so far as I can see, the shadow Secretary of State genuinely believes that an organisation that provides care to 45 million people on a budget of £100 billion should not do planning. That really appears to be the view of the hon. Member for Hackney North and Stoke Newington (Ms Abbott). Secondly, the hon. Member for Central Ayrshire (Dr Whitford) made an excellent speech, in which she used the word “opportunity” in connection with STPs, which is what they provide. She also said usefully that healthcare systems were about “more than buildings.” As we go forward with this process, it is important that we all think about what that means.

The health service is not static. Technology is changing; drugs are changing; expectations are changing; and, as we have heard, demography is changing. It is right to try to make it evolve and help it to change. The STP process is the planning mechanism to do so. It is a planning mechanism to put in place a five-year view—this was in the manifesto—that NHS England has developed. If it is to work, it must have three things: it has to be care driven; it has to be properly funded; and it has to be locally driven. It is all those things.

[Mr Jamie Reed (Copeland) (Lab)]

rose—

[David Mowat]

I shall not take interventions; I now have only five minutes left.

When it comes to funding, we have put in an extra £10 billion, and it is real money. If that money had been available in Wales, some of the points raised in the debate about the interface between us and Wales would have been quite different. This year, the increase in health funding is 4% in real terms—three times the rate of inflation. The real point, however, is not to do with money—however much the Conservatives put in and however much Labour says it might put in, although we have not heard that yet. But however much is put in, it does not detract from the need for the health service to be managed effectively and properly so that it can improve and innovate.

There is a prize from these STPs. At the end of the process, we will have a health service that is more oriented towards primary and community care where people live. The health service will provide better access to GPs, emphasise prevention more than ad hoc responses, properly address long-term conditions such as diabetes and begin to address more quickly our mental health and dementia commitments. I say again that if STPs do not address those things, they will not go forward. Perhaps the most important of all the advantages is that the unacceptable gap that currently exists between healthcare and social care will be breached. That is at the centre of the whole process.

[Karin Smyth (Bristol South) (Lab)]

Will the Minister give way?

[David Mowat]

No, I will not. I have only four minutes left, but the hon. Lady, who worked with me on the Public Accounts Committee, can come and see me.

It is also true to say that if we achieve all those things, there will be lower hospital admissions and more humane and timely discharges. That might save money, but it is not being driven by the need to save money. It is driven by care needs because that is the right thing to do.

Let me deal quickly with the STP process. We have been told that it is a secret process and a Trojan horse for privatisation, and we have heard that we are not going to consult. Well, let us talk about consultation first. The right hon. Member for North Norfolk (Norman Lamb) made some good points about the difficulties involved in change programmes on which proper consultation does not take place. However, we must have something on which to consult that is reasonably agreed and reasonably stable, because if we do not, we shall give rise to expectations that cannot necessarily be fulfilled—in both directions, positive and negative.

When the STPs come back in October after being signed off, they will be consulted on. A document that will be in the House of Commons Library by the end of the week will describe in detail how all the stakeholders will be consulted and what we will do, but in any event—this point was made by my right hon. Friend the Member for Chelmsford (Sir Simon Burns)—no consultation and no engagement will take away the statutory commitments, the need for configurations to be looked at properly, and the requirement for nothing to proceed that has not been locally agreed.

We were told that the plans were secret. In fact, they were so secret that they were announced in December 2015, in the NHS planning guidelines. They were so secret that 38 Degrees, which was responsible for the principal leak, obtained its information from the websites of the organisations that were keeping it all secret. If we ever do something in secret in future, it really will be done better than this.

The STP process is complex. It will not work equally well in all the locations, and there will be issues to resolve. Some plans, if they are not adequate, will not be proceeded with in the same way as others. I say this to Members, however: we need you to engage with the process—

[Dame Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put.