Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

The hon. Gentleman is absolutely right; this issue is a very big concern. The only way, in the long run, to reduce those litigation costs is to have safer care. That is why the Government have prioritised safety in everything we do.

[Derek Thomas (St Ives) (Con)]

T3. If someone in St Ives suffers a severe stroke, they will have a far better chance of a full recovery if they get quick treatment and then proper therapy and rehabilitation in the community. That does not happen for everybody. What is the Department going to do to ensure that there will be a national stroke strategy?

[David Mowat]

The current stroke strategy was produced in 2007 and our priority is to implement it fully. Frankly, in my time as a Minister, I would prefer to have detailed implementation plans and not more strategies. My hon. Friend refers to the great differences in performance across the country, in particular in access to speech and language therapy, and we need to achieve better on that.

NHS and Social Care Funding

Derek Thomas Excerpts

Wednesday 11th January 2017 Commons Chamber

[Derek Thomas (St Ives) (Con)]

There is no doubt in my mind that the meaningful integration of health and social care is the most important issue facing the NHS today. The most productive way to address the issue of bed-blocking is by integrating services, pooling resources, and dramatically raising the profile of and support for community health professionals and care and support providers. We often hear of the problems facing the health services, but I am going to try to concentrate on the solutions.

Last November, I set up a local inquiry, identifying a number of people across the constituency and getting them together to investigate what health and social care could and should look like in west Cornwall—this is all part of the STP process in Cornwall and the Isles of Scilly. Together we are asking that question of representatives of health and social care providers. We are talking to GPs, NHS providers and managers, health campaigners, care providers, day-care managers, pharmacists, mental health clinicians, hospital matrons, Age UK and others. I am even including my predecessor in the discussions. All the clinicians we have met have identified savings that can be made through integration that they believe would improve patient care.

The results of the local inquiry will set out clear recommendations to be considered as part of the sustainability and planning process in Cornwall and the Isles of Scilly; however, it is clear from the evidence we have heard that extra funding will be required to implement the planned transformation. The health services in Cornwall and on the Isles of Scilly already have a deficit that runs into tens of millions of pounds. Delivering rural health services is an expensive and underfunded exercise in Cornwall and the Isles of Scilly, and we in that part of the country long for a fair funding agreement for health and social care. People in my constituency agree that we must integrate health and social care. They also agree that extra funds are urgently needed to fund that integration.

In the autumn statement, the Chancellor confirmed Government plans to continue to increase the tax allowance threshold for workers. I completely agree with efforts to lower the tax burden, but my constituents have asked me to look at how we might raise taxes to help the integration of health and social care. On that basis, would the Government consider pausing the increase announced in the autumn statement and using the revenue generated to fund the transformation of integrated services? That could provide just shy of £6 billion over the rest of the Parliament to help health and social care providers to make the improvements they need and to reduce costs in the long run, while improving patient care.

One example of where extra funding would have dramatic results is if the pay and support for care and support workers was increased. In west Cornwall, some community care workers are paid as little as £7.20 per hour, yet they do incredibly important work in keeping people at home and in safe and good conditions. Because of such low pay and the pressure on care workers, we struggle to recruit and retain such valuable employees. Were we to look at pausing the increase in the tax allowance threshold for just a short time, the money saved could help to integrate the services to which we are all committed, thereby helping to make the savings and improvements in patient care that we all want to see.

Accelerated Access Review

Derek Thomas Excerpts

Tuesday 13th December 2016 Westminster Hall

[Derek Thomas (St Ives) (Con)]

The accelerated access review is important because it is designed

“to speed up and simplify the process for getting the most promising new treatments and diagnostics safely…to patients.”

That is good news for all Members of Parliament who have in their constituencies people who need access to innovative treatments. Sir John Bell states that the review

“addresses one of the most important issues the National Health Service is confronting; how best to access innovation for the benefit of patients and to improve health care efficiency.”

It should therefore be welcomed and receive support from both the Government and the NHS.

The report has the dual intentions of improving NHS productivity through better use of technology and of promoting the UK as a destination for life sciences. It is clear about the areas that need to be addressed: horizon scanning, data collection, regulatory decision making, clinical and cost-effectiveness assessment and commercial decision and uptake support.

I shall focus briefly on the data collection element of the report because that is what will enable treatments to come forward and help patients. The accelerated access review sets out a mechanism for collecting data on “strategically important medical technologies”. There is a clear need to collect data on technologies and their impact on the healthcare system. The review suggests that one approach should be a “commissioning through evaluation” system, whereby

“complex medical technologies or diagnostic products that significantly change clinical pathways are rolled out in a number of specialist providers who are well-placed to collect impact data and build expertise around pathway change. Following this period, should the technology prove its value after assessment by NICE, it should enter routine commissioning and benefit from supported uptake”.

In a recent debate that I secured on diabetes, I referred to commissioning through evaluation because I fully support the intent of that objective and believe that collecting data in that manner is an effective means of developing real-world data to support the uptake and use of modern treatments across the NHS. That type of evidence development is currently under way in the NHS, and I would like to look at one current commissioning through evaluation programme, which has been in operation since 2013. The programme launched for several technologies, covering a range of conditions. It included procedures to prevent strokes, improve the mobility of children with cerebral palsy, help patients with heart failure and improve radiotherapy for lung and liver cancer. I recognise that this debate is about cystic fibrosis in particular, but I am trying to make the point that as we collect data and bring forward the treatments, we need to ensure that they get to the people who most need them, including those whom we are talking about today.

The programme to which I have referred was structured in two phases. First was the evidence development phase, in which patients would receive the treatments and data would be collected. Second was the evidence assessment phase, in which data would be analysed and a routine commissioning policy developed. We have now reached the point in the process at which the number of procedures originally commissioned has been reached and patients will no longer be given the procedures until a formal commissioning decision has been made.

However, in answer to a parliamentary question in July, the Department of Health said it would take between one and two years to carry out the analysis. Recently, NHS England has stated that formal commissioning policies will not be in place until 2019. Those patients who would benefit from the procedures face the prospect of a two-year wait.

If we focus on just one procedure, we can see the impact that that will have on patients. Selective dorsal rhizotomy is a procedure that supports children with cerebral palsy to have increased mobility in later life. There is a narrow window in a child’s development in which they can receive the treatment. A two-year gap in commissioning will mean that some children never benefit from the procedure.

This debate was initiated by the hon. Member for Dudley North (Ian Austin), whom I thank for giving me the opportunity to speak. Its title on the Order Paper is “Implications of the Accelerated Access Review for cystic fibrosis and other conditions”. I have referred to other conditions, but I want to finish my speech by reading out a letter from a constituent, Christine Edwards, relating to cystic fibrosis. I need add nothing to what she writes:

“Dear Mr Thomas…My niece’s boyfriend, Taylor, has cystic fibrosis. He is a lovely young man and I think it is tragic that his life expectancy is so short. At the moment he is doing pretty well and his health is strong enough to support him going off to University…he did so this year.

The reality is though he can expect his health to decline and with it, his quality of life. Drugs like Orkambi offer such tremendous hope as slowing lung health decline not only offers him the potential to increase his life span directly but also allow him more opportunity to benefit from future treatment development.”

Christine Edwards also writes:

“The 2,700 people with cystic fibrosis in England desperate to access Orkambi do not have the time to wait for the development of a Strategic Commercial Unit to consider a wide range of commercial arrangements. Nor do they have the time to wait for NICE and NHS England to consult on their processes.”

That letter sums up why the Government must intervene and accelerate access to these transforming medical treatments. As Mrs Edwards states, patients cannot wait.

I therefore call on my hon. Friend the Minister to intervene and ask NHS England to give patients access to these innovations by ensuring a rapid and transparent decision-making process for all the innovative treatments currently undergoing commissioning through evaluation. That process should be supported by examining all available evidence and delaying while a small sample of data is analysed. I also call on the Minister to ensure patient access throughout the assessment phase by continuing to fund the procedures until a routine commissioning policy is in place, and to look at the operation of the system in the future and ensure that the design of any programme delivers continued patient access from the start of the programme through to a routine commissioning policy being in place. Finally, I call on the Minister—this is extremely important and will help large numbers of patients with cystic fibrosis and other conditions—to support wider stakeholder input into the system from those who have experience. That would include working with patient groups and industry representatives and would ensure that the NHS had the most accurate information.

Diabetes Technologies

Derek Thomas Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I beg to move,

That this House has considered access to diabetes technologies.

It is a pleasure to serve under your chairmanship, Mrs Gillan. It is also good to see the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), in her place; I served under her chairmanship when she chaired the Select Committee on Science and Technology. I intend to use this debate to consider what can be done to accelerate access to new, innovative diabetes technologies.

This is a complex subject. I know there are patients who would benefit from technologies such as insulin pumps and glucose monitoring systems but are not able to access them. For many, access to diabetes technologies will have a transforming effect on their lives, enabling them to live full lives, be economically active and reduce the burden on primary and secondary care.

First, I recognise that progress is being made in this area. The intention behind the debate is to highlight the opportunity we have dramatically to transform people’s lives by accelerating access to diabetes technologies. I am here not to criticise but to say, as my schoolteachers regularly said to me, “You could do better,” because I believe we can in this area. Secondly, I want to use this opportunity to pay credit to the work of the all-party parliamentary group on vascular disease, and in particular its inquiry into patient access to technology last summer. The APPG recognised that access to technology facilitates the earlier and more accurate identification of people at potential risk of diabetes-related complications.

I want to refer to three of the 12 recommendations listed in the APPG’s report. The first is that the NHS must consider steps to become more flexible when commissioning or supporting the commissioning of new technologies designed to improve patient outcomes. Its second recommendation is that the NHS and industry should work together to harness innovation and promote better treatment for patients. Thirdly, it recommends that NHS England should consider how to introduce measures to incentivise the screening and diagnosis of patients at risk of peripheral arterial disease in primary care settings. Those recommendations help me to impress on the Minister a matter of great urgency, importance and opportunity for diabetic patients in the UK.

I would like us to consider the need to accelerate access to existing technologies; how the NHS can accelerate the development, testing and application of new technologies; and how information technology can be used to inform and educate patients, giving them greater power to manage their condition and lead full and free lives.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on obtaining this debate. He will be aware that in our schools today there is a problem with young children administering insulin where teachers are not trained to do it and cannot, because of child protection rules. If new and innovative technologies were used, we could perhaps get over that difficulty.

--- Later in debate ---

[Derek Thomas]

I thank the hon. Gentleman for his intervention. I will speak later about the opportunity as regards children. If we do not help them to manage their condition, the complications later on are significant indeed.

I do not intend to go over the sheer scale of the problem of diabetes in the UK and its impact on people’s quality of life, our health system, community and social care services and economic productivity. We all know the stats. Despite that, it is my belief that the NHS fails to take full advantage of the latest technology available to patients, including flash glucose monitoring technology, known as FGM. That issue is being targeted by NHS England via the national obesity and diabetes prevention programme. The programme is a joint initiative between NHS England, Public Health England and Diabetes UK, and it aims significantly to reduce the 5 million people in the UK expected to have diabetes by 2025.

Flash glucose monitoring technology is available to support the NHS and NHS England to achieve their objectives related to diabetes. Today’s debate is an opportunity to see how the Government might take full advantage of that and other technologies in the future. It is timely therefore to concentrate our minds briefly on the benefits of technologies such as flash glucose monitoring. Just a few years ago, who would have thought that someone with diabetes could turn their back on routine finger pricking to test their glucose readings and instead rely confidently on readings taken via a small sensor worn on the body?

Just a few years ago, diabetics must have dreamt of a day when they could take a glucose reading as many times a day as they liked, without having to worry about pain, discomfort, inconvenience or running out of test strips. Imagine a world where schoolchildren or people in full-time employment avoided the interruption of finger prick testing and the stigma of testing in public. That world exists, and accelerated access to FGM, which delivers those benefits, could help to improve people’s health, avoiding the need for people who are in work to take extra sick leave by simply enabling better management of their condition.

Flash glucose monitoring provides a current glucose reading, an eight-hour history and information about the direction glucose is going in. That allows people to monitor whether their glucose levels are rising or falling quickly and can support them to take action before their condition worsens. That can only be a plus for patients, GPs and the wider health system. Furthermore, long-term accurate data on glucose levels must be invaluable for clinicians and patients as they make choices about how they manage diabetes.

I would like to ask the Minister a few questions. How confident is she that patients are accessing the treatments and technologies that are available today? What action is required of the Department of Health to ensure that the patient pathway is smooth, well signposted and not too long? Are clinicians fully aware of what technologies are available and how to operate them? Are they equipped to train patients to operate these technologies and make the best use of any data provided? What more can the Minister do to apply pressure to clinical commissioning groups to make diabetes technologies such as insulin pumps and glucose monitoring systems available? I know of patients in my constituency who have waited and waited before getting an insulin pump. In the meantime, their condition has been unbearable, and living any sort of normal life has not been possible. I am glad to say that once they get the insulin pump, their lives are transformed. However, I know others who still wait.

I want to move on to the opportunity we have to embrace emerging technology. One of the greatest developments in healthcare and public health must be the availability and use of emerging technologies. In 2004, Derek Wanless described the NHS as a “late and slow adopter” of innovation. I know that the Government are committed to improving that and to taking advantage of the opportunities on offer from innovative technologies. An excellent example of that is the commissioning through evaluation programme, launched in 2013, which was an innovative solution to the problem of developing real-world data to support the use of innovative medical procedures. I would like the Minister to shed some light on where we are with that programme.

I recognise that CTE set out to accelerate treatments for a far wider group of illnesses and conditions and should be a subject for another Westminster Hall debate. However, commissioning through evaluation is an example of good forward thinking that has been successful in accelerating access to treatments for patients and is the perfect tool for accelerating diabetes technologies and treatments. The reality is that patients, the NHS and UK plc will see the benefit if we find ways quickly to develop the technologies and give patients accelerated access.

Finally, I am keen to know what role the Department believes information technology has in informing and educating people so that they can play a greater role in managing their condition. If a diabetic only gets to see a specialist once a year, can online information help to close the gap? What responsibility does the Department of Health have to ensure that patients with diabetes are signposted to reliable, safe and helpful information? Should the Department actively back charities such as Diabetes UK, so that people have confidence about to whom they should turn? I would also like the Minister to outline what role she believes information technology can play in informing and educating people with diabetes.

I am glad to have secured the debate. This is one of the most pressing issues facing us today, and there is a great opportunity ahead of us. It is an opportunity for patients, because if we get this right, they will be able to manage their condition much more effectively and will be much more likely to be active in the world of work. We will be able to hold off lower limb amputations and sight loss and offer a much brighter future for people with diabetes.

There is also an opportunity in relation to health and social care. One in five hospital admissions for heart failure, heart attack and stroke is of a person who has diabetes, so by getting this right and ensuring that patients have access to advanced technologies, we can reduce the burden on primary and secondary care and reduce the £14 billion spent annually on diabetes in the NHS. The savings potentially go further when we consider the costs associated with adapting people’s homes and workplaces following amputations or sight loss, for example.

There are also opportunities for UK plc. If we get this right, the UK will be seen as the place to do research and development, and manufacturing. It must be the aspiration of the Government for the UK to become a hotbed of innovation, and I am certain that the NHS could exploit its sheer size and buying power much more effectively, giving UK patients the best access to the latest treatments.

--- Later in debate ---

[Derek Thomas]

I am grateful for the opportunity to have this debate under your chairmanship, Mrs Gillan; I think I have 37 minutes left.

I thank the Minister for the information she has given today. I have learned things, and the challenge now is for us to make sure that patients and clinicians will also know what is available to help them. We want acceleration in technology and the integration of services so that patients can be diagnosed as early as possible, have reliable online information about what is available and how to look after themselves and also get the specialist care they need, as well as access to the most appropriate technology. It seems to me that we are all singing from the same song sheet, and I am encouraged to hear that the Government are doing and will do all they can to support patients.

I appreciate that there have been distractions in the House today, but I think this debate has been a useful exercise; I am sure there will be others in future about how to continue with this important matter.

Question put and agreed to.

Resolved,

That this House has considered access to diabetes technologies.

Community Pharmacies

Derek Thomas Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Derek Thomas (St Ives) (Con)]

We are all aware of the letter received by pharmacists on 17 December last year, in which the Department of Health discussed the potential for far greater use of community pharmacies and pharmacists. The letter referred to community pharmacists’ role in preventive care, in support for healthy living, in support for self-care for minor ailments and long-term conditions, in medication reviews in care homes and as part of a more integrated local care model. The letter also informed us of plans to reduce funding by £170 million.

I was fortunate enough to be the first MP to raise the matter in a Westminster Hall debate at the beginning of this year. I raised the concerns of community pharmacists about their funding as the plan progressed, as it was intended to do by October 2016. That all came about because the issue was raised in a constituency surgery that I held in St Ives at the start of January. Since then, the general public have been very engaged in this, and they are concerned about the future of their pharmacies. I joined others in this House to present a petition with 2 million signatures to No. 10 in the summer.

I represent a Cornish seat where every effort is being made to integrate health and social care, and community pharmacists see themselves as essential players in a new, modern national health service that is equipped to meet the demands placed on it by today’s society. Community pharmacy is valued and depended on, and it can embrace new clinical responsibilities and meet the demands of an ageing population, but the sector is looking to Government for some reassurance about its future, particularly regarding funding for community pharmacy.

In my constituency, I have several independent community pharmacists. That is because my patch is large and includes areas of social deprivation, which has an inherent impact on health. A car journey from the north to the south of my constituency takes an hour, and a journey from the most westerly point to the most southerly point takes an hour and nine minutes. In a rural area such as mine, community pharmacists provide invaluable access to the NHS and invaluable support to vulnerable people. I am reassured by the fact that the Government have indicated that some protection will be given to rural pharmacies and those in deprived rural areas. That is welcome indeed.

However, funding of community pharmacy remains a concern, and the community pharmacy sector has called for the Department of Health to use funds cut from the community pharmacy budget to fund a minor ailments service from 2017. The service would allow eligible people with a list of common health complaints to visit their pharmacy for advice and, where appropriate, medicines at no cost. That could create significant savings for the NHS by ensuring that patients with minor conditions use pharmacies, thereby preventing unnecessary GP appointments and A&E attendances.

I am well aware of the need to secure better value for money in areas of the NHS. In Cornwall and the Isles of Scilly we are actively involved in drawing up our STP, as directed by NHS England. The NHS has outlined this approach to ensure that health and care services are built around the needs of local populations. I believe that that provides the best opportunity to integrate health and social care in a meaningful way, reduce the pressure on acute services and avoid unnecessary hospital admissions. I also believe that the community pharmacy is central to achieving that objective.

I am aware of the time, so I will just ask a few questions of the Minister. Can the Minister give more details about what support will be given to rural independent community pharmacies and those in deprived areas, many of which operate in Cornwall? Will the Minister comment on the community pharmacy forward view, and the Department’s response to the vision set out by community pharmacy—

[Madam Deputy Speaker (Natascha Engel)]

Order.

Diabetes-related Complications

Derek Thomas Excerpts

Tuesday 7th June 2016 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I congratulate the hon. Member for Dewsbury (Paula Sherriff) on securing this vital debate on diabetes and related complications. This is important to me because my constituency, in particular, has a high level of diabetes-related amputations. As we have heard, diabetes is a significant problem for the UK, and it is right that the Government and the Department of Health have identified tackling diabetes as a priority for this Parliament.

The cost to people’s quality of life is dramatic and an increasing number are having to manage the condition, which can make holding down a job or going about their normal daily business very difficult. Some 3.5 million people have been diagnosed with diabetes and a further 500,000 may have it but have not yet been diagnosed.

Diabetes costs the NHS approximately 10% of its budget, with one in five hospital admissions for heart failure, heart attack and stroke involving people with diabetes. However, the cost of supporting people with diabetes goes far wider when we start to consider the costs associated with adapting people’s homes and workplaces following amputation or sight loss, for example.

The UK is a civilised, wealthy country and if more can be done, there is no real excuse for not doing it. We know that for many people, the risk of developing diabetes can be reduced through good diet and exercise, but this message must be communicated positively and early. Much more must be done to encourage outdoor physical education and activity from an early age. We will not be forgiven for having a nation of children who accomplish good results in year 6 SATS, only for many of them to live with life-limiting conditions. For me, physical education is as valuable as numeracy and literacy.

[Mr Gregory Campbell (East Londonderry) (DUP)]

On childhood obesity, does the hon. Gentleman agree that we need a generational change so that from this generation on we will raise young children with clear knowledge of the issues and the unfortunate and inevitable consequences of a sugary diet—so that we can try to prevent diabetes and make sure this is the last generation to suffer from this horrible affliction.

[Derek Thomas]

That is true, and I welcome that intervention. It is right to make the distinction between type 1 and type 2 diabetes. Type 1 often occurs in younger people and there is little, if anything, we can do about it other than manage the condition well. General practitioners in my area have teenagers and adolescents presenting with type 2 diabetes. The hon Gentleman is right that to address the issue in the long term we must be positive and provide information and education that is sensitive, but honest and truthful. We cannot pussyfoot around when people’s lives are at stake.

We have a responsibility to ensure that both those with type 1 diabetes and those with type 2 diabetes that cannot be avoided have easy access to the best treatment available and the best support, and can access modern devices that manage diabetes and reduce the development of further complications. Since arriving in this place in May 2015, I have attended several meetings and seen all sorts of innovations and devices that can be used, particularly by young people, to help them to manage their condition better.

In the past, I spent some time as a youth worker and I know it is a huge challenge to help young people with diabetes to manage their condition through finger prick tests and regular injections, and parents are frustrated that young people often do not realise the consequences of not looking after their condition well. New innovations and new devices must be made more available to them now because I believe they will embrace smart technology, which could be life-changing for children and young people who are managing a life-limiting condition.

We know that when diabetes is not well managed, it is associated with serious complications. I have referred to the cost of health and social care for diabetic patients. The tragedy is not just that 80% of these costs are spent on complications that are largely avoidable through better care, but that people’s health and quality of life are unnecessarily deteriorating because sufferers are not always able to access the care that we know they need.

I was keen to take part in this vital debate and I appreciate the opportunity because the situation in Cornwall and the Isles of Scilly gives cause for concern. One of the most serious diabetes-related complications is amputation. Nationally, an average of 2.6 diabetics in every 1,000 have a diabetes-related amputation. In Cornwall and the Isles of Scilly, the average is 4.4 amputations per 1,000 people with the condition. This suggests that in my constituency alone, eight people each year have a lower limb amputation as a result of diabetes. Last year, 40 people in Cornwall had a lower limb amputation as a result of diabetes. We know that four in five of these amputations could be prevented through better care, so six people in my constituency today could have avoided having a lower limb amputation in 2015 if everything we know about managing diabetes had been correctly applied. Six people’s lives have been changed dramatically and their outcome is grave indeed. It is essential that we reduce the number of amputations, not least because we know that up to 80% of people die within five years of having a lower limb removed.

As the hon. Member for Dewsbury said, NICE is very clear about what CCGs should do to improve treatment for diabetic patients. Earlier this year I wrote to my clinical commissioning group in Cornwall, Kernow CCG, to argue that it should ensure the NICE recommendations are properly implemented. I am encouraged by the action it is taking, which it set out in its response to me. It says that figures to be released this month demonstrate that its efforts have reduced the level of amputations in Cornwall and the Isles of Scilly. That achievement would be a phenomenal and significant success, and something to celebrate.

However, there is a role for the Government in improving patient outcomes and it is not fair to leave everything to the CCGs. I have referred to the need for a positive message about how to improve our own health to reduce the risk of developing diabetes, but those who have diabetes and are at risk of a lower limb amputation need to benefit from a cultural shift in the profession. We need to get to a place where major lower limb amputation associated with diabetes or vascular disease is considered a failure of treatment rather than a treatment choice. A functioning foot with minimal surgery should be a success.

The Government must do more to ensure that patients with a diabetic foot are diagnosed earlier and are on the right patient pathway. More must be done to ensure the right professionals are in place. If patients are seen by podiatrists, diabetologists and interventional radiologists as early as possible, patients can be treated appropriately and their leg can be saved. This means ensuring everyone with diabetes gets good quality annual foot checks. We have talked about what that might mean and perhaps we need clarity on what an annual foot check entails. Everyone with a foot infection should be urgently referred to those specialists.

The best way for patients to have access to those specialists is through a multidisciplinary team, where healthcare professionals meet to discuss patients and treatment choices. That sounds simple, but too often different parts of the healthcare system operate in silos and that is particularly the case in some parts of the healthcare profession in Cornwall. It is crucial that the right members of the team meet regularly and that multidisciplinary teams are fit for purpose. It must not be just a tick-box exercise for NHS trusts.

Clinicians also need access to the right technologies when they intervene on patients with advanced forms of diabetic foot and critical limb ischaemia. Data show that the use of drug-eluting technologies, when used by vascular specialists, can improve outcomes for diabetic patients to the equivalent of those patients without diabetes. NICE is about to review its clinical guidelines for peripheral arterial disease and I hope the updated guidance will include recommendations for the use of drug-eluting technologies for critical limb ischaemia and intermittent claudication.

In conclusion, the Department of Health has said it will assess CCGs on their provision of structured diabetes education as part of the new CCG improvement and assessment framework. I would like the Minister to say today what support the Department will provide to ensure that CCGs identified as underperforming are able to improve access to structured education, and thereby increase the number of people with diabetes who have the skills and confidence to manage their own condition. As was said early in the debate, many people with diabetes across the UK could manage their condition with the right support, education and resources. It is absolutely right that we do everything we can to give every person with the condition the support that should be available to them and that they deserve to have.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 10th May 2016 Commons Chamber

[Jane Ellison]

On this, I am happy to say that I very much agree with the right hon. Gentleman. I encourage all colleagues to look at the evidence deposited with the Committee. Just last year, UK European health insurance card holders—5.5 million people—were able to travel to any other EEA country or Switzerland safe in the knowledge that they would be able to receive free healthcare or reduced costs arising from healthcare if they needed it. That offers great peace of mind and shows that Britain is safer in a reformed EU.

[Derek Thomas (St Ives) (Con)]

13. What support his Department is providing for meeting additional costs incurred by NHS providers in the integration of health and social care.

[The Minister for Community and Social Care (Alistair Burt)]

I concur with the remarks that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), just made.

The Government recognise that the NHS and adult social care face significant demand pressures, and established the better care fund to join up health and care. In 2016-17, the BCF will be increased to a mandated minimum of £3.9 billion, with additional social care funding of £1.5 billion by 2019-20.

[Derek Thomas]

NHS Cornwall has a significant overspend in 2015-16 because of the cost of keeping people in acute hospitals rather than their being cared for in the community. Despite the commitment and enthusiasm in Cornwall to achieve meaningful integration of health and social care, the pressure on NHS Cornwall finances threatens this badly needed integration. Does the Minister agree that investment in this today will lead to significant savings for the future and better outcomes for patients?

[Alistair Burt]

I am aware of significant problems in Cornwall that a number of Members have brought to me, and they are very complex. The clinical commissioning group is building on existing work with NHS England to address the financial challenges facing NHS Kernow and the wider local health and care system. Statutory directions were put in place late last year to support the CCG’s work with local partners in ensuring that services are affordable as well as good. An independently led capability and capacity review is being completed and an action plan is being implemented. I encourage the CCG to continue to work closely with NHS England to help to put its finances on a firmer foundation to achieve its integration plans. There is a further meeting planned locally tomorrow.

Community Pharmacies

Derek Thomas Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I beg to move,

That this House has considered community pharmacies.

It is a pleasure to serve under your chairmanship, Mr Streeter. In a letter to community pharmacies on 17 December, the Department of Health discussed the potential for far greater use of community pharmacies and pharmacists. The letter refers to the role of community pharmacists in preventive health, support for healthy living, support for self-care for minor ailments and long-term conditions and medication reviews in care homes, and as part of a more integrated local care model. That is exactly the right direction. As an MP representing a Cornish seat where every effort is being made to integrate health and social care, I see community pharmacists as essential players in a new national health service equipped to meet the demands placed on it by modern society.

Westminster Hall debates are rarely secured in order to praise the Government and celebrate all that is good. I would love to be able to do so, but—wait for it—in the same letter to which I just referred, the Department set out its plans to reduce its funding commitment to community pharmacists by £170 million. Therein lies the problem. We have a front-line NHS service that is valued and depended on and able to embrace new clinical responsibilities and meet the demands of an ageing population, but it is unsure about its future.

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

Does the hon. Gentleman share my concern? As Members of Parliament, we all, I suspect, refer constituents to pharmacy services, because we know the impact that that has on reducing the pressure on the NHS. If we cannot refer them to smoking cessation services, cholesterol testing and blood pressure testing, the NHS and hospitals will have to pick up the burden.

[Derek Thomas]

I welcome that intervention. That is exactly the point that I hope to make, particularly for independent pharmacists in rural areas, where it is much more difficult to access acute services and GP practices.

[Mr John Spellar (Warley) (Lab)]

The hon. Gentleman ought to see that that is true across the whole country. In urban areas, people are finding it more and more difficult to get appointments with their GPs and are going to accident and emergency. The best way to relieve that pressure is to encourage more people to go to our well-resourced local community pharmacies, maybe even rather than chain pharmacies.

[Derek Thomas]

That is absolutely right. The community pharmacist is part of the solution, not part of the problem, in what we want to do for the NHS. I hope to make the point in my speech that we need to do all we can to support the development of community pharmacists rather than take away money that they need.

[Andy Slaughter (Hammersmith) (Lab)]

Urban and rural areas share those problems. It is because people will only wait for so long for GP appointments—my hospital has exceeded waiting times for more than a year—that there is pressure is on community pharmacists. They are stepping up to the plate. Does the hon. Gentleman agree that they are being let down by this cut, when they are trying to do their best?

[Derek Thomas]

I hope to make the point that we need clarity about how the money will be found, if it must be found. I believe that there are other ways to save money, particularly involving the use and waste of drugs.

Community pharmacists are unsure about their future and unclear what support they can expect from the Government. The letter sets out the £170 million reduction in support for community pharmacists and asks them to prepare for the cut, but gives little detail about where the money will be cut, who will lose and what services can no longer be funded.

[Paula Sherriff (Dewsbury) (Lab)]

Does the hon. Gentleman agree that local pharmacies are part of the fabric of local communities? That is particularly the case for independent pharmacies, which are embedded in communities and whose owners and staff often come from those communities. Perhaps the Minister can tell us what impact assessments have been undertaken in terms of health and economic and social wellbeing by individual constituency.

[Derek Thomas]

I welcome that intervention, but I am concerned that the hon. Lady might have read my speech, and I have not yet put it on my Facebook page. In my constituency, I have several community pharmacists, and I am not sure that I have too many. It is simply that my patch is large and includes areas of social deprivation, which has an inherent impact on health. A car journey from the north to the south of my constituency takes an hour. The journey from the most westerly point to the most southerly point takes an hour and nine minutes. In a rural area such as mine, community pharmacists provide invaluable access to the NHS and invaluable support to vulnerable people.

To follow on from the hon. Lady’s helpful intervention, over and above their obvious healthcare roles, I see community pharmacies’ input into society as comparable to that of post offices, police community support officers, libraries, local churches or chapels, local pubs, village shops and our postmen and women. They all play an important part in local communities. They are the glue that holds communities together, the people and organisations that know when things are not as they should be, and the people who look out for our elderly, the sick and the vulnerable. Although it is difficult to put a price on the work they do, without those people and institutions, society would be a poorer place and the added strain on public services would be significant. It is perverse that we judge reducing support for services such as community pharmacists to be a saving.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate the hon. Gentleman on securing this timely debate. It is a pleasure to serve under your chairmanship, Mr Streeter. The loss of pharmacists’ expertise and experience and their knowledge of the people who come in and out could be enormous if pharmacies such as the Whitworth family pharmacy in my constituency are forced to close as a result of this initiative.

[Derek Thomas]

I think we all share those concerns. I am pleased to have secured this debate, so as to give people an opportunity to share their experiences in their own constituencies.

Reform of community pharmacies is not something that we can afford to get wrong. Many of the community pharmacies in my constituency are independent businesses that have been established for decades. A wrong move by the Government now might make those community resources unviable. We all know that community pharmacists provide important services, including the safe dispensing of medicines. They are often the first port of call for people with minor ailments and health concerns, and are a key support for elderly and vulnerable patients in the community.

[Alex Chalk (Cheltenham) (Con)]

General practitioners in my constituency are under significant strain. Although no one is against sensible savings, does my hon. Friend agree that nothing should be done to undermine the excellent job done by community pharmacists in diverting patients from primary care, or to add to the burden on hard-pressed GPs?

[Derek Thomas]

That is absolutely superb—my next line is: “Community pharmacies have a vital role in giving advice and in diverting patients from GPs and emergency departments,” exactly as my hon. Friend said. In tourist areas such as Cornwall, they take their share of the extra demand during the height of the season. Most recently, my local community pharmacists administered flu jabs to increase uptake. Pharmacies regularly get prescriptions to patients out of hours when no alternative is otherwise available, and Cornwall has led the way, with ground-breaking work in enhanced services. That is an example of how community pharmacists are very much part of the solution to integrated community health provision.

Healthwatch Cornwall recently surveyed Cornish residents about access to community pharmacies. Some 69% of participants said that they regularly visit their pharmacy, and 74% of those felt comfortable talking to the pharmacist about their health, while 78% felt well informed by their pharmacists when taking new drugs and 93% said that the pharmacist was polite and helpful.

One constituent of mine, a retired doctor, Professor Dancy, wrote to me as follows:

“I am a warm supporter of Nigel, our local pharmacist, and proud to be so. He is always ready to help when I forget (as one does at the age of 95) to re-order a medicament, and when my doctor is unavailable, or just pushed for time, I do not hesitate to ask Nigel for advice, which I follow with a confidence that is always rewarded.”

Community pharmacists are highly trained and trusted healthcare professionals, qualified to masters level and beyond. Their knowledge base covers far more than just drugs, making them the ideal healthcare professionals to relieve pressure on GPs and other areas of the NHS. Equally importantly—perhaps even more importantly—community pharmacists are welcoming change and embracing new clinical opportunities.

However, the proposed funding cut will not sustain the transition from a supply-based service to the more clinically focused service that the Government desire and our patients deserve. Cuts will discourage progress and can only result in small, independent and much-loved businesses failing, at the expense of patients, the public and the wider NHS.

[Rachael Maskell (York Central) (Lab/Co-op)]

In York, the local authority has made cuts to smoking cessation services, as well as NHS health checks, and the community pharmacists I have spoken to have said that they see their future role as filling some of those gaps. However, with further cuts to community pharmacy itself, where are people meant to go—back to queues in GP surgeries?

[Derek Thomas]

I thank the hon. Lady for that intervention. That is exactly why we are having this debate. I want the Government to examine the value of community pharmacists and to consider how they can do some of the work—in fact, a large part of the work—that would save money for NHS acute services.

I am well aware that there is a need to secure better value for money in areas of the NHS. Over the weekend, I met four community pharmacists and they all talked of the opportunities to make savings that they have identified. They are willing and able to see more patients. Pharmacists give free, over-the-counter advice to thousands of people every day, promoting self-care and diverting patients from GP and urgent care services. However, it is estimated that £2 billion-worth of GP consultations a year are still being taken by patients with symptoms that pharmacists could treat.

Pharmacists want to have a greater role in prescribing drugs, so as to reduce waste. Last year in Cornwall alone, £2 million-worth of unused drugs were returned to community pharmacists to be destroyed. Pharmacists are best placed to reduce this waste. They want to do more to support people with mental illnesses; they are keen to provide continued care of people with diabetes and other long-term conditions; and my local community pharmacists want to work with the Department of Health to improve services, engage in health and social care integration, reduce drug waste and improve access to records, in order to support the giving of prescriptions.

[Peter Dowd (Bootle) (Lab)]

On that point, does the hon. Gentleman agree that what is needed is a joint, co-ordinated approach to planning investment and implementing change, in partnership with national and community pharmacy bodies, rather than pushing things through at a great pace?

[Derek Thomas]

I thank the hon. Gentleman for that intervention. In my experience so far of looking at this subject, I have found that those in the pharmacist community do not feel that they have been properly consulted or engaged with. Pharmacists believe that they have many of the solutions that the Government wish to see.

Before I conclude, I will read one final letter that I received on Monday from a GP in my constituency. Dr Rebecca Osbourne writes:

“As you will no doubt be aware, General Practice is facing a crisis with too few GPs managing an ever-growing demand. Demand for appointments outstrips availability of doctors and allied surgery staff, and patient needs are increasingly complex with an ageing population with multi-morbidity.

A good Pharmacist helps to take some of the pressure off a local surgery—offering advice about self-limiting conditions, and prescribing over the counter medications for presentations that do not need to be taken as ‘on the day’ appointments with a GP; patients who are on complex medications can receive education and advice from their pharmacist regarding their regime, including the importance of compliance, which can further reduce the burden elsewhere in the system; vulnerable patients, whether elderly or experiencing mental ill-health, have an extra professional keeping watch over them, and a pharmacist may be better placed than a GP”—

it was a GP who wrote this—

“to see a trend developing or a change that requires further attention.”

[Tom Brake]

I do not know whether the hon. Gentleman is aware from the conversations he has had with pharmacists that they often do things that are outside the terms of their contract. A couple of examples were cited to me. First, a pharmacist was involved in spotting someone who was having a cardiac arrest in their pharmacy, and then in helping someone else who had fallen outside the pharmacy and damaged their face quite severely. If we lost pharmacists and their extra input, that would have a significant impact on patients in a way that has really not been explained so far.

[Derek Thomas]

I thank the right hon. Gentleman for that intervention. What I have learned from many patients and from the pharmacists themselves is that patients see pharmacists as the first port of call for health, so there is no doubt that there will be times when pharmacists are picking up things that otherwise would have to be picked up in A&E.

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

Does my hon. Friend agree that it is important not to confuse the role of pharmacists with the number of pharmacies? It is vital that we protect the pharmacists, who are very important in delivering in the national health service.

[Derek Thomas]

That is exactly right: it is pharmacists’ skills that we must be careful to maintain and develop.

I know that you have concerns about this matter as well, Mr Streeter, especially concerning the pharmacy in Modbury in your constituency, so I appreciate your support on this issue and the way you are chairing this wonderful Westminster Hall debate.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on securing this debate. The letter that he read out hits a lot of the points. Removing the funding will make waiting lists longer, when GPs are already under pressure; in fact, we are losing hundreds of GPs every year, as they go to other countries. Pharmacies can see people at the point in time that they would usually see GPs; sometimes people have to wait two or three weeks to get an appointment with the GP. So this proposed cut seems to defeat the purpose of the planned change.

--- Later in debate ---

[Derek Thomas]

I am pleased that we are so supportive of the community pharmacists, and hopefully we will get a good result from this debate.

I have three straightforward questions and a personal plea to put to the Minister, if you will bear with me, Mr Speaker—[Interruption.] Sorry, Mr Gary Streeter. [Laughter.]

[Mr Gary Streeter (in the Chair)]

It is okay, I will let you off.

[Derek Thomas]

Have the Government made any impact assessment in relation to their position of reducing community pharmacy numbers and the impact that this change might have on the health, and economic and social wellbeing of people living in our area? What assessment have the Government made of the impact that such a reduction would have on the workload of GPs, those in A&E and those providing out-of-hours services, if patients cannot access their regular pharmacy and then visit these other services?

[Caroline Ansell (Eastbourne) (Con)]

I congratulate my hon. Friend on securing this timely debate on an important issue that could have far-reaching consequences, should the decision go through. Equally, I join him in urging the Minister to ensure that during the consultation—we understand that there is still to be consultation with patient groups—we will take, to echo a comment by a former Member, a constituency-by-constituency approach. I am sure that everybody will bring to the fore the particular characteristics of their own constituency. My constituency has the record number of octogenarians in the country and the fastest growing town in the south-east, and it routinely hosts tourism-driven events such as Airbourne, when 600,000 people come into the town. Pharmacies are a sometimes uncelebrated and unseen force that we rely on.

[Mr Gary Streeter (in the Chair)]

Order. Interventions should be brief.

[Derek Thomas]

I thank my hon. Friend for her intervention and she is absolutely right to say that in a tourist area, where the population increases dramatically at times, we need to be careful that the core services are available for everyone who needs them.

My second question is: what assurances can the Government give to independent community pharmacists? The third question is: what consultation has been conducted with pharmacy patients, and what would their concerns be if community pharmacies were to close?

My personal plea to the Minister is please not to write pharmacies off until they have been given the resources to realise their full potential in society. I feel excited about the potential opportunity that exists for the NHS through the proper use of community pharmacists. While reforms to NHS services are essential and the way that community pharmacists are utilised needs to be reviewed, a blanket removal of funds to pharmacies will only hinder progress and limit this opportunity.

[Several hon. Members rose—]

--- Later in debate ---

[Derek Thomas]

Thank you, Mr Streeter, and I thank Members for their contributions, which have been really helpful. I thank my right hon. Friend the Minister for seeking to tackle the many issues that have been raised. We all agree that the NHS is a fantastic institution. Community pharmacists hold some of the keys to improving patient care in the community and reducing pressure on GPs and other NHS services. I hope that the debate has gone some way to empower pharmacists to offer the solutions that the Government are seeking in order to secure a modern-day NHS, but this is all about the best care for patients, which we all agree is what really matters.

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

[Mr Philip Hollobone in the Chair]

[Mr Philip Hollobone (in the Chair)]

Will those who are not staying for the next debate please leave quickly and quietly? We now come to a very important subject to be addressed by the Member for the sunniest place in the United Kingdom, Caroline Ansell.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

The evidence is very clear that safer hospitals end up having lower costs, because one of the most expensive things that can be done in healthcare is to botch an operation, which takes up huge management time as well as being an absolute tragedy for the individual involved. My message to the NHS is this: the best way to reduce your costs and deliver these challenging efficiencies is to improve care for patients. Our best hospitals, like Salford Royal and those run by University Hospitals Birmingham NHS Foundation Trust, do exactly that.

[Derek Thomas (St Ives) (Con)]

T2. Bringing health and social care together in meaningful integration is a priority for me and my constituents in St Ives. What can the Secretary of State do to help achieve this for the good people of west Cornwall and the Isles of Scilly? Will he accept an invitation to come to west Cornwall to discuss this challenge and see some of the good work that is already being done?

[The Minister for Community and Social Care (Alistair Burt)]

May I welcome my hon. Friend to his place? Among the many good reasons to go to Cornwall over the next few months will be to visit the Cornwall better care fund, which is part of the Government’s £5.3 billion better care fund, and get the opportunity to see the work of the Cornwall pioneer. Integration of social care and healthcare is extremely important, and it will be great to see it in Cornwall.