Budget for Community Pharmacies

George Howarth Excerpts

Tuesday 24th May 2016 Commons Chamber

[Alistair Burt]

The right hon. Member for Knowsley (Mr Howarth) approached me before, so I will take one intervention from him; I will not get through my answer otherwise.

[Mr George Howarth (Knowsley) (Lab)]

I am grateful to the Minister for giving way. I want him to take two things into account. First, there is a correlation between clusters of community pharmacies and areas of high deprivation and associated ill health, as my hon. Friend the Member for Barnsley East (Michael Dugher) said. Secondly, small, independent, local community pharmacies do not have the ability of the big multiples to negotiate bulk discount deals. Will he take those two factors into account as he moves forward?

[Alistair Burt]

I thank the right hon. Gentleman for his intervention. He has made representations in the past, and I know how keenly he understands the matter. I will come on to discuss access to funds in due course. It will not be based purely on location, but it will take into account what he says about areas of deprivation. We recognise that these are small businesses, and I understand exactly what he says.

The proposed funding cut has understandably created uncertainty and concern. I assure the House that I see a bright future for community pharmacy and pharmacists, so I urge colleagues to see the opportunity that the consultation presents, as well as the inevitable and understandable concern around funding.

The background to the matter lies in the NHS’s five-year forward view. One of its key strategic aims is to break down the traditional barriers between different primary care services, wider out-of-hospital care services and other sectors, such as social care, to deliver a more cohesive, community-based care model that is focused on keeping people healthy and helping people to manage long-term health conditions. Our vision is to achieve a transformation in primary care and out-of-hospital care more widely as we continue to move towards a seven-day health and care service. We want to empower primary care health professionals to take up opportunities to embrace new ways of working with other health professionals to transform the quality of care that they provide to patients and the public. In particular, we want to free up pharmacists to spend more time delivering clinical and public health services to patients and the public in a range of settings.

I have seen at first hand the fantastic work that pharmacists are doing from within community pharmacies, such as in healthy living pharmacies and other settings, and colleagues have also paid tribute to that work. Pharmacy-led services, such as the recently recommissioned community pharmacy seasonal influenza vaccination programme, can help to relieve pressure on GPs and A&E departments and ensure better use of medicines, better health and better patient outcomes. There are real opportunities for pharmacists and their teams to play an even greater role in helping people with long-term conditions and helping people to make better choices to improve their health and to get the maximum benefit from their medicines.

It is not a zero-sum game of accepting the reduction in funding of £170 million—from a budget of £2.8 billion—and ending this degree of high street care and having nothing in its place. I strongly believe that we can still have a network of high street pharmacies based on a financial regime that rewards quality as well as volume while moving pharmacy into different settings. To that end, we have consulted pharmacy bodies and others, including patient and public representatives, clinical commissioning groups and health and social care providers, on how best to introduce a pharmacy integration fund from 2016-17. The fund will help us to transform how pharmacists and their teams operate in the community, bringing clear benefits to patients and the public. The fund is set to rise by an additional £20 million a year. By 2020-21, we will have invested £300 million in addition to the £31 million that NHS England is investing in funding, recruiting and employing clinical pharmacists to work alongside GPs to ease current pressures in general practice and improve patient safety. The integration fund will help to move pharmacy in a direction that supplements what is already done on the high street and in a way it might not otherwise have done.

The chief pharmaceutical officer, Dr Keith Ridge, has commissioned an independent review of community pharmacy clinical services to make recommendations on future models for commissioning pharmacy-led clinical services. I am very keen that what we are doing is seen in the context of where pharmacy is going to go—not a snapshot of how good it is now, but what it can become. Clinical pharmacists will offer complementary skills to GPs, giving patients access to a multi-disciplinary skill set, and helping GPs manage the demands on their time and provide a better experience for patients. This is a great opportunity for pharmacists wanting to make better use of their clinical skills and develop them further.

Let me give a couple of examples. At the Wallingbrook Health Group in Devon, the work of the local pharmacist on all aspects of medicines optimisation has reduced the need for patient GP appointments by 20% to 30%, making a significant impact on GP workloads and patient outcomes. In Cambridge, Sandra Prater is working with patients to optimise their medicines and supporting patients to self-manage a range of conditions, including asthma, high blood pressure and atrial fibrillation.

The reduction in funding for community pharmacy that we have set out was a commitment in last year’s spending review. I want to emphasise that our aim is to secure efficiencies, make savings and improve quality. It is most definitely not our aim to close pharmacies. I accept that it was me who said to the meeting with the all-party group that up to 3,000 pharmacies could be affected. That was me extrapolating the figures. It is not the aim of the Government to close pharmacies and, as I said in answer to the question, we do not know exactly how the funding will fall, because we do not know yet the result of the negotiations and how this will be handled. I accept that I put that figure into the public domain, but it may not happen in that way at all.

I know that many people choose to access health services through community pharmacies, and I want to assure them that our aim is to ensure that those community pharmacies upon which people depend continue to thrive. That is why we are consulting on the introduction of a pharmacy access scheme, which will provide more NHS funds to certain pharmacies compared with others, considering factors such as location and the health needs of the local population, as the right hon. Member for Knowsley mentioned.

Let me deal with another theme that the hon. Member for Barnsley East mentioned. Hand in hand with that approach, we want to ensure that modern community pharmacies reflect patient and public expectations, and developments in technology. Large sections of the population are now accustomed to using digital services through their phones and tablets. Why not do this for people wanting to obtain their prescription medicines? That is why we want to help those patients to get their prescriptions in a way that fits their lifestyle, by promoting the use of online click-and-collect or home-delivery models. We have also consulted on amending legislation to allow independent pharmacies to benefit from hub- and-spoke dispensing models, which facilitate more use of automation and increase efficient dispensing processes. Officials are now carefully considering the responses received and the Government will respond in due course. These are things we want to encourage people to do, but they do not totally replace what is already being done. They might, however, free up more time for the pharmacists to spend on patient contact rather than on doing some of the other work.

The public phase of the community pharmacy consultation may now have ended, but that does not mean that we will stop listening and talking—the hon. Gentleman asked me to keep doing those things. The Department, supported by NHS England, will have further confidential negotiations with the PSNC, and there will also be a final round of confidential discussions with other key pharmacy stakeholders, who take a keen interest in the discussions in this House. Our aim is to communicate the final decisions early in July so that pharmacy contractors are fully informed in advance of the changes being implemented from October 2016.

Our proposals are informed by the discussions that have taken place and by what has been said by those involved in pharmacy in the past—the Royal Pharmaceutical Society and independent studies—about how pharmacy can move in a different direction but that the current funding structure rewards volume not quality and that changes could be made that would widen the reach of pharmacy. I believe that these ideas can be taken forward in the current context. Our proposals can truly place pharmacy at the heart of the NHS and provide a better, more integrated, service for patients and the public. I am confident that the efficiencies we have proposed can be made within community pharmacy without compromising the quality of services or the public’s access to them. I want to thank those in pharmacy, who are working so hard at the moment and making their case very well, and the public who support them. I think pharmacy can have a great future, as can pharmacists.

Question put and agreed to.

Contaminated Blood

George Howarth Excerpts

Tuesday 12th April 2016 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

I start by paying tribute to the 21 hon. and right hon. Members who have today provided a strong voice for the victims of contaminated blood. In particular, I pay tribute to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), who has been tireless in her pursuit of justice. I remember her forceful arguments when she asked an urgent question on the subject about a year ago, to which my right hon. Friend the Member for Leigh (Andy Burnham) responded on the Opposition’s behalf, and when she asked her urgent question in December, to which I responded for the Opposition. She does real credit to the cause of those who are suffering as a result of this scandal. We must never ever forget the personal tragedies behind scandals such as this one, and I want to pay tribute to the families who have travelled down here today to listen to the debate. They deserve their day in Parliament, and I hope that the Minister will carefully consider the points that have been raised by all Members and by the families of the victims.

[Mr George Howarth (Knowsley) (Lab)]

I apologise for not being here throughout the debate; I was chairing a Committee elsewhere in the building. Would my hon. Friend accept that one of the defining characteristics of the modern world is that we have an expectation that an individual, a company or a Government will accept responsibility when things go wrong, and that they will accept the consequences of taking that responsibility? Does he agree that it is high time the Government accepted responsibility in this case?

[Andrew Gwynne]

My right hon. Friend is absolutely right, and I will come on to that point later. We owe it to the victims and their families to find some kind of justice for them.

I am not frequently on the same side as the editorial line taken by the Sunday Express, but I congratulate that newspaper on its tireless campaign for justice. This scandal has seen families torn apart through death and illness caused by the negligence of public bodies. I am willing to accept that, over the years, the response of Governments of all colours has just not been good enough. When the consultation was published in January, I was clear that while no amount of money could ever make up for the impact that this tragedy has had on people’s lives, the victims deserved some form of justice. We have three days until the consultation closes and I want to use my remarks to push the Minister on four points relating to the current proposals.

First, in the 1970s and 1980s, around 7,500 people were infected with hepatitis C or HIV as a result of this scandal. Many of those people were being treated for haemophilia. The viruses have had a devastating impact on their lives and those of their families, not least through loss of earnings and the cost of treatment. The failure of successive Governments to accept liability for this issue means that many of the victims have lost financial security through no fault of their own.

Diabetes Care

George Howarth Excerpts

Thursday 3rd March 2016 Commons Chamber

[Keith Vaz (Leicester East) (Lab)]

Thank you, Mr Deputy Speaker, for giving me the opportunity to debate this important matter. I begin by declaring my interests as a type 2 diabetic and chair of the all-party parliamentary group for diabetes. In 2007, I founded the diabetes charity Silver Star, and I am an active and passionate supporter of Diabetes UK and JDRF—the Juvenile Diabetes Research Foundation—both of which provide secretarial services to the APPG. I would argue that we currently have the best diabetes Minister we have ever had, and I am glad to see her on the Front Bench today. I would like to thank her and her diabetes tsar, Jonathan Valabhji, for all the work that they do.

Diabetes is one of the most important health challenges facing the NHS and indeed the world. Sometimes we get immune to the facts, even though they are so devastating: 3.5 million people in the UK have been diagnosed with diabetes; 700 people a day are diagnosed with the illness; by the end of this debate 15 more people will have been diagnosed with diabetes—that is one every 2 minutes; and it is estimated that by 2025 some 5 million people in the United Kingdom will have diabetes.

Despite the good intentions of the Government, the passion of practitioners and the interest of many Members of this House, I am worried that the prevention, diagnosis and treatment of diabetes is not high enough on the agenda. One in five hospital admissions for heart failure, heart attack and stroke are people with diabetes. Diabetes is responsible for more than 135 amputations a week, four out of five of which are avoidable. Diabetes is the leading cause of preventable sight loss and the most common cause of kidney failure. Every year, more than 24,000 people die prematurely due to diabetes.

[Mr George Howarth (Knowsley) (Lab)]

I echo my right hon. Friend’s comments about the Minister. He cites statistics, and on the amount of money that is spent on diabetes, £7 billion of the NHS budget is spent on dealing with the avoidable complications to which he has just referred. Yet Department of Health spending on research into diabetes through the UK’s Medical Research Council is just £6.5 million, which is by far the lowest level of almost any developed country. Does he think there is a connection between those two things?

[Keith Vaz]

My right hon. Friend, who is a great campaigner on this issue, is right to have raised this, because we need to spend much more on diabetes research. One way of doing that is to make sure the funds are available for the excellent researchers and academics we have in this field, because research has indicated that there is an unacceptable and unexplained disparity in diabetes care in our country. We are failing the very people we are trying to help. Secondary complications are largely avoidable through better care, and we need to ask why this is not being provided. Although the NHS currently spends approximately £10 billion on diabetes, it is estimated that 80% of these costs are spent on dealing with complications. The time for conferences, seminars and good words is over—it is time for a new deal for diabetics.

Earlier this year, the Public Accounts Committee published a report on the “Management of adult diabetes services in the NHS”, and I would like to thank those on the Committee for their very hard work. The report found that astonishing variations still exist across clinical commissioning groups: the percentage of patients receiving all the recommended care processes ranged from 30% in some areas to 76% in others; and the percentage of patients achieving three treatment targets ranged from 28% to 48% in different areas between 2012 and 2013. As well as this postcode lottery, the figures were even worse for type 1 diabetic patients.

In response to my recent written question, the Minister acknowledged that there is no specific budget allocation for public health services related to diabetes. It is up to local authorities to

“assess local needs, prioritise and deploy available resources accordingly.”

I believe that is wrong. My own health and wellbeing board was unable to tell me how much it has spent on diabetes awareness. It should be able to do so. I welcome the Government’s inclusion of diabetes in their proposed clinical commissioning group improvement and assessment framework. That is a vital step in the development of a cohesive national diabetes strategy.

There has been much discussion about how effective the framework will be, and whether it will be released on time. We are already disappointed that the publication of the childhood obesity strategy has been delayed, a pertinent issue of concern for me and many other Members, including the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston). We need an assurance from the Minister today that both the framework and the childhood obesity strategy will be published before the start of the summer recess.

The burden of care for diabetes is currently left overwhelmingly to one group: the GPs. It is unrealistic to expect GPs alone to manage this. We acknowledge that GPs are under increasing pressure, and the demand for their services far outweighs the supply. In some places, it takes weeks to get an appointment. The financial incentives given to GPs are clearly not working. Some 16% of GPs’ contracts is supposed to be spent on incentives, with 15% of this sum being directly allocated to diabetes testing. That equates to £94 million, yet an estimated 549,000 people have type 2 diabetes, but remain undiagnosed. A recent study by Pharmacy Voice found that 40% of GPs would like more support for their patients in managing diabetes. We need an action plan from NHS England that will assess the practical support that clinical staff need to care properly for their patients.

We are often told that it takes a village to raise a child. That phrase was recently given re-emphasis by Hillary Clinton. In my view, it takes a whole town of healthcare professionals to deal with the diabetes tsunami. Instead of placing the entire burden on GPs, we need to utilise a network of different professionals to attack the diabetes epidemic on all fronts in an efficient and cost-effective way.

At an international conference organised by the all-party group last month, we heard evidence to that effect from specialist GP Dr Paul Newman, endocrinologists Dr Sam Rice and Dr Abbi Lulsegged, diabetes nurse Sara Da Costa, diabetes specialist dietician Julie Taplin and lifestyle expert Emma James. However, we did not have time to hear from other parts of the network—the podiatrists, ophthalmologists and pharmacists. Their enthusiasm knows no bounds, but they are limited by the availability of funds and the lack of specialist staff. We must mobilise our political will to give them the support that they so desperately need.

Diabetes specialist nurses are vital in the fight against diabetes. Evidence shows that these nurses are cost-effective, improve clinical outcomes and reduce the length of patient stays in hospital. I am extremely concerned that the number of trained diabetes specialist nurses has stagnated. The latest national diabetes in-patient audit stated that one third of hospital sites still have no specific diabetes in-patient specialist nurses. With the predicted increase in diabetes cases to 5 million by 2025, it is alarming that forward-thinking plans to train such nurses are not being put in place now. We need a commitment from the Minister that there will be future provision for diabetes specialist nurses.

Community pharmacies are ideally placed to provide care at a time and in a place convenient to patients. The NHS diabetes prevention programme could be a great opportunity to get community pharmacies involved in supporting GPs and other healthcare providers. Janice Perkins, the pharmacy superintendent of Well Pharmacies, advised me that this could be done as part of a care plan package, where appropriate tests are provided to the patient based on their personal need, without their having to access numerous sites.

The proposed cuts to the community pharmacy budget could see the closure of up to 3,000 sites. My local pharmacist, Rajesh Vaitha of the Medicine Chest in Leicester, informed me that up to 60 out of 227 sites could close in Leicester alone. The closure of these pharmacies will have an adverse effect on patients and will place greater pressure on our already strained health infrastructure. Pharmacies are on the high street, and no appointment is needed to see the pharmacist. Like many patients, my late mother Merlyn, a type 1 diabetic, had great faith in her local high street pharmacist. I believe that the cuts to community pharmacies could be shelved if pharmacies were properly utilised in diabetes care.

Last Friday I visited the Steno Diabetes Centre in Copenhagen. Steno is a world-leading out-patient facility that cares for 6,500 diabetics a year. It is a one-stop centre for diabetics, with the main focus on prevention and secondary complications. The Steno centre is run by a team of remarkable diabetes specialist nurses led by Professor John Nolan. This is extremely cost-effective—the centre has an annual clinical budget for 6,500 patients of £9 million. Steno has reduced avoidable blindness in its patients by 90%—a service that is provided by a team of just six nurses and one ophthalmologist. The centre’s foot clinic has reduced avoidable amputations in the past 10 years by 82%. The savings from avoiding just two amputations funds the entire foot clinic’s annual budget. The Steno centre is an ideal model of how diabetes care should be facilitated. I urge the Minister—not that I want her to spend too much time abroad—to look at the incredible work that is being done there and bring a network of such centres to the United Kingdom.

In my own constituency, we are very fortunate to have not only the best football team in the country—many thanks to West Ham, Swansea and Liverpool for what they did last night—but the Leicester Diabetes Centre, a centre of true excellence in diabetes care. It is one of the largest facilities in Europe for clinical research into diabetes. Run by the dynamic duo of Professor Melanie Davies and Professor Kamlesh Khunti, it provides an innovative partnership between the NHS and academia—the very people in whom we should put more faith and behind whom we should put more funds, as my right hon. Friend the Member for Knowsley (Mr Howarth) said. We are extremely fortunate to have such experts, but we need more centres of excellence.

We need an holistic approach to public health, tackling the medical complications of diabetes and the contributory lifestyle factors that increase the prevalence of type 2. Other countries have taken a lead on this issue. Dr Francisco George, director general for health in Portugal, told me that data sharing is one thing we can do. I have also heard from Dr Pablo Kuri Morales, the Minister responsible for health promotion in Mexico, that a sugar tax actually works. Press speculation is that the Prime Minister has shelved the sugar tax until after the European Union referendum. In my view, the two matters are entirely separate, so why can we not have a sugar tax now?

I have been vocal in my support for a sugar tax and for clearer labelling of sugar content. Industry leaders such as Waitrose and Asda have made commitments to reduce sugar in their products, but I am afraid that the Government’s responsibility deal, which pledged to do all kinds of things, has not had much effect in reality, as recent reports by Professor Graham MacGregor and Action on Sugar have shown. We are, however, fortunate to have an NHS chief executive—Simon Stevens—who has imposed his own 20% sugar tax across the NHS, and that is an important start. I call on the Minister, when she returns to Richmond House, to ban high-sugar products from the canteens in her own Department.

I recently visited a brilliant juvenile diabetes centre in Tangiers, which was based in the Centre de Santé Saïd Noussairi. I nearly wept when I saw young type 1 diabetics having to rely on charitable funding just to get their daily insulin injection—something we can get absolutely free from our NHS. Yet, astonishingly, even in our country, whose healthcare system is the envy of the world, we have stark variations in diabetes treatment and unfocused resources.

We have world-leading medical professionals, nurses, healthcare professionals and researchers who are capable of doing, and willing to do, so much more, provided they get the funding and are backed by an iron political will. That is why we need to achieve a new deal for diabetics, and now is the time to start.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I should start by saying that, as a Spurs season ticket holder, I shall dwell on the kind words of the right hon. Member for Leicester East (Keith Vaz) about my time in office and ignore his cruel jibes about what can only be described as a disappointing night last night.

I thank the right hon. Gentleman for bringing this important issue to the House for another debate. He has rightly issued a number of challenges to me and the Government, and it is vital that we keep up the drumbeat of debate, which is key to making sure that we keep this serious and increasingly prevalent disease on the agenda.

Fantastic work has been done by the right hon. Gentleman and other members of the all-party group, by the right hon. Member for Knowsley (Mr Howarth), who is also in the Chamber, by the Silver Star charity and by so many others. There is very high awareness of the issue in Parliament, and I will come back to what more we might be able to do to mobilise Members even more on this important subject.

As the House will be aware, tackling diabetes is of great concern to the Government. The Department of Health is committed to preventing type 2 diabetes and to tackling the variation the right hon. Member for Leicester East highlighted in the delivery of care, because we, too, want the best possible care for those with diabetes.

There were encouraging signs from the latest national diabetes audit that progress is being made in some important areas of management and care. For example, there are clear trends of improvement in blood pressure control for people with type 1 and type 2 diabetes and in glucose control for type 1 diabetes. It is also reported that a far greater number of people are being offered structured education within a year of diagnosis. However, I will come back to structured education, because it is uptake, not offer, that I am interested in.

The report again highlighted a concerning and continuing issue of variation in care process completion and treatment target achievement for people with diabetes. I am particularly troubled by the statistics on younger people and those with type 1. The audit found that in 2014-15 just 39% of people with type 1 diabetes received all eight care processes compared with 59% of those with type 2. There is an even greater contrast with regard to age range.

[Mr George Howarth]

As the Minister will be aware, because I have discussed it with her before, there is a specific group of young type 1 diabetics who manipulate their insulin intake to achieve rapid weight loss. Will she give some thought as to how that group, which is relatively small, can be supported to get out of that problem, which is life-threatening?

[Jane Ellison]

I will certainly take that issue away and reflect on it, and we will speak about it again.

For people under 40, only 27% with type 1 diabetes and 41% with type 2 received all care processes, compared with 58% and 65% respectively for those aged between 65 and 79. I have some sense of why that is, but it does highlight the challenge we face. Encouragingly, 77% of those newly diagnosed with type 2 diabetes were offered structured education, but again the percentage was lower for type 1. That is clearly unacceptable, because everyone with diabetes should receive the best possible care regardless of age, postcode or the type they have been diagnosed with. That is why, in our 2016-17 refresh of the mandate to NHS England, we have made tackling variation in the management and care of people with diabetes a key priority over the lifetime of this Parliament.

Community Pharmacies

George Howarth Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Kevin Barron]

I agree with my hon. Friend. That is one of the reasons I took over as chair of the all-party group more than five years ago. I believe that our pharmaceutical services should be taking that route of travel.

It would help if the Government provided details of how they will ensure access to pharmacy services in remote or deprived communities. If the market will drive closures, there will be chaos, and something substantial needs to be in place.

[Mr George Howarth (Knowsley) (Lab)]

My right hon. Friend makes a powerful case. He mentioned the market. Does he agree that one difficulty that smaller independent pharmacies, such as John Davey in my constituency, have is that unlike the big chains they are unable to negotiate favourable deals on the drugs they dispense and, therefore, they are already at a disadvantage in market terms? Before the Government go any further with the programme they need to address that important issue.

[Kevin Barron]

I do not disagree with my right hon. Friend. I will not use the name of the company, but I can go into the store of one of the major chains, which is not in my constituency but not far away, and it takes me a minute to walk to the prescription counter, whereas in most of the pharmacies in my constituency I can get there in two or three seconds. We must recognise that, at constituency level, we are not comparing like with like.

Another thing is that key payments for pharmacies will be phased out, and there might be a drive towards a commoditised medicine supply service with an increased focus on warehouse dispensing and online services. Again, the possibility of added value in a local pharmacy regarding lifestyle issues potentially goes out of the window, and we really need to look at that. I have no direct experience, but I am told that they have that in the United States.

As well as dispensing medicines, community pharmacy teams help people to stay well and out of GP surgeries, to get the most benefit from their medicines and to manage their health conditions. The NHS spends £2 billion a year on GP consultations for conditions that pharmacy teams could treat. Community pharmacy can and should do more. A national community pharmacy minor ailments service could save the national health service some £1 billion a year. In some of the pharmacies in my constituency, there is already a minor ailments service. I understand that the Government recently changed their mind about developing such a service at a national level, and I would like to know why. Such a service makes great sense to me. It keeps pressure off not only GP surgeries but the local A&E.

In 2014-15, pharmacies delivered more than 3.17 million medicines use reviews, to increase people’s understanding and help them to take their medicines correctly. We get a lot more from our pharmacies than their just turning scrips over. Our communities and our constituencies need that, and if there are to be any changes, they should be carried out in a sensible and planned way, and not in the chaotic way of some of the suggestions of recent weeks.

--- Later in debate ---

[Stephen Pound (Ealing North) (Lab)]

As ever, it is a pleasure to serve beneath your firm but benevolent eye, Mr Streeter. I congratulate the hon. Member for St Ives (Derek Thomas) on bringing this important, relevant and timely matter before us. It is similar to an Adjournment debate I secured in the previous Parliament, to which the right hon. Member for North Norfolk (Norman Lamb) responded, and to a question I put to the Minister the week before last on this very subject. In both cases, the response I received was one of warm words but few concrete proposals and little reassurance for the community pharmacies.

Like everyone else in this Chamber, I happen to believe that the Minister is a good and decent man, but I fear I can see the handcuffs of the Treasury holding him tight. I feel that he is beneath the terrifying thrall of the Treasury. The proposals are nothing to do with improving patient service. They are nothing other than a pathetic attempt to balance the books on the backs of one of the most productive, hard-working, positive and excellent groups of people in our society: the modern community pharmacist. Every day, they perform a miracle on the high street. They have changed from the old-fashioned world of the dispensing retail chemist to the modern world of preventive medicine. In fact, in many ways pharmacies are multi-speciality community providers. It will not have escaped your notice, Mr Streeter, that we have here Members representing the highlands and islands, the Isles of Scilly, the Isle of Wight, Southend-on-Sea, and Members from Armagh to Ealing. This issue is one that the whole nation is concerned about.

[Mr George Howarth]

I am sure it was an oversight by my hon. Friend that he did not include Knowsley in that long list. I hope that the high street pharmacies are not depending on miracles. I rather hope that they are dependent on science.

Student Nursing (Finance)

George Howarth Excerpts

Monday 14th December 2015 Commons Chamber

[Ben Gummer]

I will turn to that point with pleasure, if the hon. Gentleman will give me a few minutes, because I have several things to say about mature students. I accept that this area of the proposals requires close attention, which is why I want to ensure that they are as robust as possible and that the consultation, to which the hon. Member for Ilford North referred, is as good as possible.

I want to answer the questions from the hon. Member for Ilford North about the consultation. We will consult on the full gamut of the reforms, but we will not consult on the principle, because that has been decided, as was outlined by my right hon. Friend the Chancellor. It is unfair to say he sneaked it out, given that it was made evident in his speech and was reacted to by the Opposition, as I know because I heard them. As for the timetable, the consultation will begin in January. We have not determined precisely when it will conclude, but it will be a full consultation. In significant part, it will look at how to ensure that mature students are supported, and I can confirm one element of it: we will allow mature students to apply for a second loan. Of course, that will account for only a small number of the cohort, but we will look at the impact of the changes on mature students, because they make up about a third of the cohort going into nursing.

[Mr George Howarth (Knowsley) (Lab)]

I am a little confused by the Minister’s argument, which appears to be that by removing an existing advantage, he will create an advantage for more people to enter the nursing profession. Most people listening will find that slightly illogical, but he is not normally an illogical person. Would it not be sensible to do as my hon. Friend the Member for Ilford North (Wes Streeting) suggested and have a proper impact assessment followed by a vote in Parliament, so that we can decide the right way forward, on the basis of that impact assessment?

[Ben Gummer]

The right hon. Gentleman makes a fair point, and I can tell him that an economic impact assessment and an equality impact assessment will be published with the consultation. I hope that that will begin to inform the debate. He might imagine that my proposition does not align with what he thinks the effect will be. I just ask him to look at what happened in 2011 when we did the same for the vast majority of other students, when Opposition Members put exactly the same arguments and warnings, and since when the precise opposite has happened.

[Mr Howarth]

The Minister is being generous in giving way twice, but we are not talking about what happened then; we are talking about a particular group that at the time was excluded from the provisions. He has not yet explained why he has now decided to include them in those provisions, other than by saying he is taking away an advantage that already exists.

[Ben Gummer]

It is simply because I wish to see the same advantages that accrue to those already on the new finance system accruing to those who are not. I want to see an expansion in the number of places and I want to see the effects of the changes made by the Office for Fair Access to university admissions in the rest of the sector applied to nursing, so that we see not only an expansion in the numbers of nurses being trained, but a broadening of the backgrounds of those going into nursing, exactly as has happened in all other areas of higher education.

I want to explain, I hope quickly, how this change forms part of a wider reform we are making in student access to nursing. The hon. Member for Ilford North framed his entire speech, understandably so, around the university route into nursing, but he omitted to reflect on the fact that the Government have stated that we will introduce an apprenticeship route into nursing to degree level—level 6. That will provide an alternative route into nursing, whereby nurses will be able to earn while they learn from healthcare assistant level all the way to a full nursing qualification at degree level. It will be possible for them to do so as mature students, which means it might take a bit longer, but they will be able to earn all the way from an existing job to gaining a nursing qualification—an innovation that should be welcomed on both sides of the House and which will mark a real expansion of opportunity for the current NHS.

NHS (Charitable Trusts Etc.) Bill

George Howarth Excerpts

Friday 6th November 2015 Commons Chamber

[Antoinette Sandbach]

That is precisely why I support the Bill, and it is no doubt why my hon. Friend the Member for Aldridge-Brownhills has attracted support from so many Members today. The crucial matter is independence. Unfortunately, in my previous role I had experiences that went the other way when independence was lacking, and that had a negative impact on outcomes for my constituents.

[Mr Howarth]

Will the hon. Lady give way?

[Antoinette Sandbach]

I am afraid not, because I must make some progress.

Alder Hey hospital has been leading the way with regard to what is now happening at Great Ormond Street hospital. I completely support the aims of the Bill relating to the intellectual property rights for “Peter Pan”. That situation is almost unique. The advantage of the Bill, as hon. Members have pointed out, is that successful authors who might wish to allow their rights to go to a local children’s hospital, or indeed other health services, could have confidence that they would be leaving them to an independent charity without any perception of political appointment or interference. I hope that will encourage other authors to consider supporting the great research and work done at Great Ormond Street hospital and Alder Hey hospital when making bequests.

Peter Pan said it best:

“All you need is faith, trust and a little bit of pixie dust.”

I suspect that in this case we need faith, trust and a little bit of Wendy dust. If we can humbly sprinkle a little of our Wendy dust, we can use this Bill to sort out the legislative mess for the children at Great Ormond Street hospital and, I hope, the other 16 charitable trusts to which my hon. Friend the Member for Aldridge-Brownhills referred.

[Mr George Howarth (Knowsley) (Lab)]

I just want to say what I would have said had the hon. Member for Eddisbury (Antoinette Sandbach) allowed me to intervene. First, I associate myself with everything she said about Alder Hey hospital, because many of my constituents have good reason to be grateful for the services it has provided over many years. Secondly, although I am not opposed to the Bill, I want to point out that trustees—I speak as a member of a board of trustees for a charity in my constituency—in addition to exercising independence, are expected to behave responsibly. My concern about unlimited liability is that when trustees do not behave responsibly—we have seen the recent example of Kids Company—they will not necessarily be penalised in any way. There is a slight problem if trustees do not behave responsibly.

Off-patent Drugs Bill

George Howarth Excerpts

Friday 6th November 2015 Commons Chamber

[Alistair Burt]

Because I still do not believe fundamentally that the passage of legislation is what is needed in order to reassure people that they have access to the drugs that they need.

Let me make a little progress and deal first with the concerns expressed by the hon. Member for Torfaen about what has happened since last year.

[Mr George Howarth (Knowsley) (Lab)]

Will the Minister give way?

[Alistair Burt]

No, I will not on this occasion, because I have taken every intervention since I stood up and I cannot do my job unless I explain what people are concerned about.

As the Government promised when similar measures were discussed in the House this time last year, we held a round-table discussion bringing together some of the key stakeholders. We looked at what action short of legislation the Government could take.

--- Later in debate ---

[Alistair Burt]

Oh, shroud waving—thank you very much. That’s all we need.

On action flowing from last year, the Government had an extremely useful meeting that brought together the National Institute for Health and Care Excellence, Breast Cancer Now, the Cure Parkinson’s Trust and Cancer Research UK.

[Mr George Howarth]

On a point of order, Madam Deputy Speaker. Given the context of the Bill, do you not think that the use of the term “shroud waving” is at the very least inappropriate?

Local Pharmaceutical Services

George Howarth Excerpts

Tuesday 3rd March 2015 Westminster Hall

[Mr George Howarth (in the Chair)]

Before I call the first speaker, it might be helpful if I point out that the time display has been the subject of a technology failure. Although it is telling the correct time, it is saying that the speech time is already 7 minutes 29 seconds. I say that not because I anticipate any pressure on time, but to prevent anybody who is wondering how long they have been speaking from thinking it is 7 minutes 29 seconds longer than they had anticipated.

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is, as ever, a pleasure to serve under your chairmanship, Mr Howarth. I appreciate your pointing out the clock to me. I might have thought I had got stuck in some sort of time warp and was forever on 7 minutes 29 seconds.

I want to put on the record my thanks to Mr Speaker for granting this debate on the essential small pharmacy local pharmaceutical services scheme, which has played and continues to play an important role in supporting small community pharmacies up and down the country. Pharmacies are an essential part of our health care system, and pharmacists play a key role in providing quality health care. They are experts in medicines and they use their clinical expertise and practical knowledge to ensure that medicines are safely supplied to and used by the public.

Over the past few years, a much greater emphasis has been placed on the role of the pharmacist. People have been encouraged to use their local pharmacy as the first port of call for the minor ailments—coughs, colds and skin rashes—that afflict us all from time to time. Pharmacists also play a significant role in programmes such as smoking cessation and emergency contraception, and they do great work with medicine reviews and in ensuring that people use their medicines properly and effectively. They play a huge role in the winter by providing flu jabs efficiently and cost effectively. If I recall correctly, my hon. Friend the Minister supported Westminster flu day last year. Your interest in diabetes is well known, Mr Howarth, and you will be aware of the important role that pharmacists play in helping those with long-term conditions to manage their diseases.

Epilepsy

George Howarth Excerpts

Thursday 26th February 2015 Commons Chamber

[Mr George Howarth (Knowsley) (Lab)]

I add my thanks to the hon. Member for South Thanet (Laura Sandys) for giving us the opportunity to debate this important issue. I wholeheartedly endorse hon. Members’ comments that she will be missed in the House. Her speech was not only informative but unique, because in the many years I have been in the House, I have never before heard a Member declare themselves to be both a law-maker and a law-breaker. Even more alarmingly, she declared her intention to become a repeat offender. Her speech was also unique in that it brought before the House the experience of people who suffer this condition, and she gave us the opportunity to understand more about its dimensions.

I need to say a word about the speech made by the hon. Member for Wycombe (Steve Baker), in which he described a tragic case. Anyone who has experienced the loss of a child knows exactly the depths of misery that the people concerned will have experienced. The hon. Gentleman dealt with a difficult subject in not only a suitably moving way, but with great dignity, and I, too, pass on my sincere condolences to the family.

[Steve Baker]

I am extremely grateful for the right hon. Gentleman’s kind words. I know that the family have heard him and will also be grateful.

[Mr Howarth]

The hon. Gentleman’s speech highlighted a more general point about how chronic conditions are dealt with. I have some knowledge of type 1 diabetes. When someone with that condition reaches a crisis, whether that is a psychological crisis or something that should be dealt with by a diabetologist, they cannot always get to see the right people at the right time so that they can get the right support, prescription or advice. Brilliant though our national health service is, that is one aspect that all too often breaks down, so I hope that the Minister will address that problem.

I want to concentrate on a particular issue, which I do not think has been mentioned, about which one of my constituents has contacted me: how the benefits system makes life very difficult indeed for those people who find themselves on benefits. No doubt the Minister will not be able to respond to my points, but I hope that he will pass them on to his colleagues in the relevant Department.

My constituent, who has asked to be named, Mr Adam Lane, who lives in Huyton, said:

“In regard to my DLA claim I had to go through 6 months with no money for myself, my wife and my two-year-old son. At that time we had to live on £50 a week until I went to a tribunal and won. Now I have to go through the whole process again on 13th of March for PIP. I have a letter from my epilepsy doctor stating how bad my epilepsy is. I fall and convulse without warning and have seriously damaged my knee, and have panic attacks throughout the whole experience. My seizures are occurring every week now and are very serious and now I suffer with migraines where I vomit 14 hours a day and I’m confined to bed through the process for 2 weeks at a time. I’m hoping Atos will not brush me off like last time, hoping to appease Government numbers to get people off benefits. I feel I am in need of benefits. I cannot work with my health conditions. My wife is my carer 24/7. My son has been traumatised though watching my seizures. I’m hoping my Atos interviewer sees what is in front of their eyes and not what the Government want them to see and say. Please, for others out there like me, let there be a way for people who do not abuse the system to be given a fairer crack of claiming what is deservedly theirs. Thank you.”

I thought it was worth reading that out in full because it gives a very clear picture of how this man has had to struggle to keep his family together and to support them in extremely difficult circumstances, where the benefits system seems to mount up against him to prevent him having any kind of reasonable life. I hope that such cases—there are many more of them out there—give the Government cause to think again about how people with chronic conditions are dealt with in the benefits system.

GP Services

George Howarth Excerpts

Thursday 5th February 2015 Commons Chamber

[Stella Creasy (Walthamstow) (Lab/Co-op)]

I congratulate my hon. Friend the Member for Halton (Derek Twigg) on securing what, for me, is an incredibly important debate. I am pleased to follow the hon. Member for Henley (John Howell), because he and I have probably been doing the same thing in going to talk to people in our local community about local health care. I must say that my experience is of a very different health care system—one that is under real pressure and, frankly, very much in danger in my local community.

I wanted to speak in this debate to put my concerns on the record and to ask the Minister and officials at the Department of Health to look at my area, because I am so worried about these issues. As an MP, I see it as my job first and foremost to help the patients of Walthamstow—my neighbours, as well as my family and friends in the area—who can see how our services are falling apart. As their MP, my very real worry is that, as much as I have tried to raise such concerns, all I hear is that those problems are for someone else or for some other organisation to resolve. I want to put on the record some of the issues, and to explain the situation in our local community and how it is having an impact on doctors. By doing so, I hope to convince the Minister to pay special attention to Waltham Forest.

There are 45 GP member practices in Waltham Forest CCG. We have one of the fastest growing populations in the country, but many of the practices are in poorly maintained buildings and are single-handed. They serve a community that has a very high incidence of what we might call lifestyle diseases—diabetes, heart disease, cancer—and GP access is absolutely critical to the outcomes achieved for patients.

[Mr George Howarth (Knowsley) (Lab)]

Will my hon. Friend be a bit more specific? Type 2 diabetes is lifestyle-related, but type 1 is not.

[Stella Creasy]

I apologise for using shorthand. My right hon. Friend is completely right. I am talking about type 2 diabetes. For example, many people from the south Asian community in my constituency have type 2 diabetes.

We are told that our local GP work force needs to grow by 40% by the end of the next Parliament if it is to serve the community I represent. However, I can already see very real problems with our local community service, and that is bad for the patients and for the rest of the NHS. We know how difficult it is to recruit and retain doctors, but in my part of town, with the high cost of living in London, it will get even harder.

Since 2011, complaints about GP access have rolled into my constituency office. Let me give the Minister some examples. Just the other day, a resident rang me and said: “Look, the receptionists were perfectly polite. They said call at 9 o’clock or queue up before the surgery opens to get an appointment, but the line was constantly engaged from 9 o’clock. My phone shows I called 28 times between 9 am and 9.30 am, and I could not get through. When I did get through, it was only to be told that there were no more appointments left.” That is not unusual in my community.

Little wonder that residents in Walthamstow routinely report that it takes two weeks to get an appointment with a doctor. Nationally, we know that one in four people wait a week or more. The problem—this is why I disagree with the hon. Gentleman—is that it is very hard for people to know whether or not they need to see a doctor, especially if they are worried about a child.

Let me give another example of a complaint I received just the other day: “I have had constant problems trying to get a GP appointment for my 13-month-old daughter since she was born. A couple of times, even only last week, I was asked by reception staff at the doctors why I hadn’t gone to A and E.” That is the constant question for residents in my local community when they cannot get through to the surgery—should they wait or should they go to A and E?

I agree with the hon. Gentleman that not everybody needs to see a doctor, but another resident told me: “I fell and cut my hand deeply on glass. I went to the doctors to ask if a nurse could check that there was no glass left in. They told me to go to hospital. The cut was really not that bad. But they said they don’t have any nurses on a Friday and I would have to make an appointment to see a nurse—two weeks as usual, no doubt—so I just left it, as I do with most pains, coughs or small lumps, and hoped it would sort itself out. My hand is healing now and seems to be glass-free. I hope so anyway.” That is not unusual in my area. At least that elderly lady could have seen a nurse, but many constituents tell me that they do not bother to see a doctor because of how long that takes, and they take the risk of waiting.

--- Later in debate ---

[Mr George Howarth (Knowsley) (Lab)]

Let me begin by congratulating my hon. Friend the Member for Halton (Derek Twigg), first on securing the debate—with the agreement of the Backbench Business Committee—and secondly on the typically well-argued way in which he put his case. I agree with every word that he said about the problems, both local and national, that have resulted from the reorganisation and the policies that the Government have pursued since 2010.

I want to draw attention to problems in two general practices in my constituency, particularly in respect of the buildings in which they are housed. I should mention that they are used both by my constituents and by those of my hon. Friend the Member for Liverpool, West Derby (Stephen Twigg). I know that my hon. Friend wanted to be present, but he is having to perform other duties elsewhere in the House.

The two general practices, which I visited last October, are the Roby medical centre and the Pilch Lane surgery. About five years ago, the primary care trust acquired a site close to four surgeries which it originally planned to move into new purpose-built premises. Unfortunately, the development did not go ahead, for two reasons. First, the proposals were caught up in the abolition of the PCT and its replacement by a clinical commissioning group. Secondly, there were some problems with the lease on the premises where one of the practices is currently housed, as a result of which the PCT could not contemplate proceeding with the move. However, both practices are still keen for it to go ahead, and they have the strong support of the CCG: it hopes to develop the site, which is conveniently placed near the existing surgeries.

Let me say a little about those two surgeries. The Roby medical centre has about 1,900 patients, and, because of local housing development, is still growing on an almost daily basis. As well as providing the normal GP services that we all expect, it is involved in the teaching of medical students, and is working towards becoming a training practice. It already provides a wide range of services, but would like to provide quite a few more if it had more suitable premises. Obviously, some of the pressure on hospital services would be removed if patients could visit their GPs instead.

The building itself consists of two converted semi-detached houses. It lacks consulting rooms, and the waiting area is restricted, with the inevitable result that patient confidentiality suffers. Some of the staff are housed in a totally inadequate conservatory which is tacked on to the back of the premises. It is clearly not suitable for the staff, and certainly not suitable for the patients. Because of the size restrictions, it is impossible to conduct two surgery sessions at the same time. There is not enough space to accommodate the patients, or to allow movement from the waiting area to a consulting room. Moreover, very little parking is available.

The Pilch Lane surgery has 4,700 patients. Like the Roby centre, it is very successful in that regard. However, it does not meet the current NHS dimension criteria. The toilets are inadequate, one treatment room doubles as a consulting room, and access for disabled patients is almost non-existent. The building is, in fact, wholly inadequate for the needs of both the patients and the people who work there. Earlier today I talked to one of the patients, who, by coincidence, had had an appointment at the surgery yesterday evening in connection with a minor problem. She summed up the position by saying that, although the service that she had received from medical and other staff had been exemplary, the building was simply not equipped to provide the sort of service that we should expect in the 21st century.

In December, I wrote to the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), to put all the arguments to him. He will be aware of the problems I have referred to; if he refers back to the correspondence, he will recognise some of the problems I am concerned about. In January I received a response from his ministerial colleague, Earl Howe, which was quite interesting. He basically said that he could not intervene and that there was no action he could take. He concluded with a rather odd use of words; he said that he could not be directly helpful, for which he apologised. The reason he could not be directly helpful is that Ministers have absented themselves from the process and left it to others. I am interested in whether, if Earl Howe could not be directly helpful, the Under-Secretary of State could be indirectly helpful, because this situation cannot be allowed to continue.

I do not want to detain the House any longer. There is a real problem for patients and for the staff in the two surgeries concerned. That problem has been recognised by the CCG—the chair and excellent chief executive have recognised it. I hope that Ministers will use whatever influence they have, whether direct or indirect, to ensure that this long-standing problem is resolved as quickly as possible.

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is pleasure to follow my right hon. Friend the Member for Knowsley (Mr Howarth). I congratulate my hon. Friend the Member for Halton (Derek Twigg) and his supporters on securing this important debate.

I first raised this question on behalf of GP practices in Poplar and Limehouse on 13 May last year and the issue has not gone away, as the Minister is aware. The motion states that the House

“notes the vital role played by local GP services in communities”.

I am sure that we all feel that we do more than note those services—we are very appreciative of them, we value them and have high regard for them. Doctors at the Ettrick Street practice on the Aberfeldy estate in east London, especially Dr Phillip Bennett-Richards, do a first-class job for us and are highly regarded by the local community.

I was grateful last year when the Minister’s colleague, Earl Howe, agreed to meet me and a small delegation from two practices in my constituency.

[Mr George Howarth]

Earl Howe refused to meet me to discuss the problem I described earlier, which is an unusual thing for a Minister to do.

[Jim Fitzpatrick]

I am surprised that the Minister declined to meet my right hon. Friend. The Minister certainly showed me every courtesy and I was grateful for the opportunity to meet him, his officials and officials from NHS England. As a result of that meeting, we identified solutions for both the Jubilee Street practice and the St Katharine’s Docks practice, which were under severe pressure at that time. Indeed, last Friday I had the pleasure of attending the opening of the refurbished St Katharine’s Docks practice, which is run by Dr Sarit Patel. I pay tribute to Ms Sue Hughes and the Friends of St Katharine’s Docks for the central role they played in supporting their local GP and his practice. The Jubilee Street campaign, also supported by its local community, was also effective.

Now we have a borough-wide save our surgeries campaign, with banners across Tower Hamlets outside every GP practice. The Jubilee Street and St Katharine’s Docks practices have solutions, but they are not permanent. On Tuesday, I received an e-mail from Sue Hughes. She reports, among many other matters, that

“Dr Patel has found it impossible to have a meaningful dialogue with our local representative of NHS England to discuss in detail the future funding of the Practice. NHS England insist on using one size fits all formulas to calculate additional financial support for GP Practices which clearly have differing requirements. NHS England are not paying the Practice for work they already do over technicalities which NHS England refuse to discuss with them. NHS England disregard ‘quality of outcomes’ when deciding on funding formulas—why is this?”

Having received that e-mail, I wrote to the Minister and I look forward to a response in due course.

The Limehouse practice in Gill street is also struggling to secure its future and is under great threat. I have written separately to the Minister on the Limehouse practice. Other GP practices are under huge pressure. In addition, there is the worry over the future of the walk-in centres at the St Andrews and the Barkantine health centres.

I wrote to the Department of Health about Barkantine because it combines a walk-in centre with a 10-handed GP practice and as a result is able to offer 8 am to 8pm, seven-day-a-week services to patients, which are under threat. The Prime Minister announced some time ago that the Government were going to spend significant sums trialling 8 am to 8pm, seven-day-a-week services, but there was not any need. The Department could have easily sent officials to east London and we could have shown them how such services can operate efficiently and effectively. However, that is all under threat.

During recent years, when the PCT was in charge, we had the fastest improving GP services in the country. The CCG has done excellent work and is staffed by first-class people. It is doing all it can to assist but we need NHS England and NHS England London to provide reassurances that all will be well.

Yesterday I received this e-mail in response to my correspondence on the walk-in centres—I thank my hon. Friend the Member for Halton for securing this debate because it is a great coincidence that the e-mail arrived the day before it. The response from the Department of Health is efficient and I am grateful for it. It has some good news. It says:

“NHS England have agreed to extend the existing break clause”—

this is in relation to the walk-in centres—

“in each of these two contracts by 9 months moving this date from 30th September 2015 to 30th June 2016.

Tower Hamlets CCG has applied to become the commissioner of primary care services under delegated approval arrangements from NHS England. If approved, this will become effective from 1 April 2015 and this will become a matter solely for the CCG.”

That is good news as it lifts the immediate threat to the walk-in centres, but it is not a permanent solution; it is a temporary reprieve. However, this is clearly new, certainly to me, and shifts the focus from the Department of Health and NHS England to the local CCG, which I hope will be able to fund the right decisions for local residents on a permanent basis.

On the temporary solution for the Jubilee Street practice, the practice manager, Virginia Patania, reports that meetings have been held with Department of Health officials, including Simon Stevens. She says that there should be protections for

“practices whose MPIG”—

the minimum practice income guarantee—

“has been removed”,

and that

“NHSE is completely ignoring the issue of cumulative losses. In any reply to our challenges to NHSE, there is no mention of the cumulative effect of losses—this has not been addressed by NHSE in any correspondence or response. It is unfathomable to us that NHSE is not or cannot be held to account for having only looked at 25%...of overall losses and estimating these as final.”

She concludes that

“we can demonstrate that populations of the most deprived adults attend GP surgeries up to twice as often as populations of the country’s wealthiest adults. This makes the Carr Hill formula entirely inadequate for areas such as Tower Hamlets”.

Tower Hamlets GPs have offered solutions and we have asked for another meeting with Earl Howe. I hope that we will be successful in that.

Like other colleagues, I have received briefings from the BMA, the RCGP and Londonwide LMCs. What is significant are the stats they all have in common, which my hon. Friend the Member for Halton and others have mentioned. Only 8.3% of the overall NHS budget goes to GPs but they are dealing with 90% of patient contacts. The royal college has estimated that at least 500 practices are at risk of closure and that nationally we need to recruit 10,000 more GPs, which has also been mentioned. I got a sticker from Londonwide LMCs this morning saying, “I love my GP.” I refer to it cautiously because I do not want to suggest that I am trying to have a relationship with my GP, no matter how much respect I have for him. Everybody does love their local GP, however, on the basis of the service we receive in east London.

The most threatened practice in Poplar and Limehouse is Limehouse. I have mentioned that I have written in detail about its problems, and I would appreciate a response. There has been extensive contact with NHS England and between NHS England and the practice manager Mr Warwick Young on the minimum practice income guarantee, the quality and outcomes framework and other issues. It is looking like it will lose more than £600,000 over the next seven years. That makes a great deal of difference and the practice could close.

Last year I began my remarks by saying the debate I had asked for was about three things. The first was to find out the nature of the problems facing GP services. The second was to determine whether the Government accepted there was a problem. The third was, hopefully, to identify a solution. We are still looking at the problem. The Government seem to accept that there is a problem and are trying to find solutions, but they have only been partly addressed and not resolved. There is still great concern not only among clinicians and staff, but among patients and residents in Tower Hamlets, that their GP services are not safe.

I know the Government have their five-year forward review and their focus on giving GPs a more central role. I look forward to hearing more about that from the Minister in due course, but the issues are not resolved, and I would be grateful if he would take back my request to Earl Howe for a meeting with him, or at least with his officials, on the three main practices I have mentioned and collectively on GP services in Tower Hamlets.