Accrington Victoria Walk-in Centre

Graham P Jones Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Graham P. Jones (Hyndburn) (Lab)]

I should like to raise the not-so-small matter of the closure of Accrington Victoria walk-in centre, a valuable community health asset and a huge support to those in and around my constituency. The people of the area have, with great affinity, taken to their local healthcare services over many decades, and in years gone by, through paying a penny a week, they have funded the local hospital. Yet every decade unelected bodies, supported by the Government, seek to reduce healthcare provision in the area—with the exception of the last Labour Government, who invested in three new health centres, among other things, and rebuilt the local hospital at Blackburn.

“I am grateful for the opportunity to raise the subject of the future of Victoria hospital, Accrington.”

Those are not my words, but those of former Hyndburn MP the hon. Ken Hargreaves, who like his successor, Greg Pope MP—my predecessor—and me, have fought for better healthcare facilities in Hyndburn, particularly the retention of vital NHS services at Accrington Victoria, and in this case today, the GP walk-in centre at that hospital.

On 28 November 1989, under the previous Conservative Government, the honourable and much liked Mr Hargreaves spoke in this Chamber from the Government Benches, stating:

“Thousands of people have signed the petitions and written to their Members of Parliament and to the Secretary of State…we are fighting the same battle now that we fought 11 years”

previously.

“It is equally clear that the people of Hyndburn wish to unite and fight.”—[Official Report, 28 November 1989; Vol. 162, c. 685.]

On the second of this month, I too presented a petition to this place, like my predecessor, with some 24,000 names on it. I can update the House: the petition now stands at 26,000 petitioners. The truth is, the public are not listened to by Governments and unelected bodies, and the people of Hyndburn are, as the former hon. Member Ken Hargreaves described, uniting and fighting once again.

This popular walk-in centre has already survived five attempts to close it. On 16 June, the health authorities—I do not exonerate the Government from this dreadful decision—are going to try to close the Accrington walk-in centre once again. We have a decision that makes little sense and a consultation that was a sham.

My own story sums up why this is the wrong decision. I contracted acute bronchitis—a serious enough illness. I was unaware of it other than feeling very ill. I struggled on until I eventually realised that it was a little more serious than a chesty cough and walked into my local GP surgery. The very helpful staff told me that there was a considerable wait to get a doctors’ appointment—a situation repeated nationally. The average wait to see a GP in the region is 13 days, I am told. If someone needs GP healthcare but cannot get an appointment, what do they do? My constituents widely share my frustration at the lack of GP access. Ringing up the GP first thing in the morning, the person is probably told that they are No. 8 in the queue, and they finally get through to a receptionist only to be told that all the appointments for that day are gone, with the next available slot being at the end of the next week.

The receptionist at my GP surgery helpfully rang through to the new extended-hours GP service to get me an urgent appointment. She told me that unfortunately all the appointments had been filled that weekend. Coughing badly, I had two choices: A&E or the walk-in centre. I went to the walk-in centre, where, following a two-hour wait, my condition was diagnosed. Notes were then sent to my GP and added to my health records. Without the assistance of GPs at the walk-in centre, my health could have deteriorated. I certainly would not have waited 10 days for a GP appointment; I would have gone to A&E.

The value and scale of the service provided by the Accrington Victoria walk-in centre cannot be overestimated. It has received an incredible 42,000 patient visits in the past 12 months. They were people like me who could not get an urgent GP appointment. If it closes, many of those patients will simply go to A&E. This was clearly my next option had the walk-in centre not been open. In fact, figures from the Bury walk-in centre reveal that about 22% of patients will head to A&E—in our case, the A&E at Royal Blackburn Hospital, one of the busiest in the country. This will add considerably to the problems that the A&E already faces, adding some 9,000 extra patient visits at a time when it is overstretched, with ambulances parked outside waiting to refer patients for care. There are financial implications to this, too. An average patient visit to A&E costs about £124 compared with an average patient visit to the walk-in centre that costs about £60.

Mine is not the only story. In fact, the campaign has received hundreds of similar stories through its “SAVE Accrington Walk-in centre” Facebook page. Some of those real-life stories from the people who have benefited from the walk-in centre are incredible. They include people who had to be rushed immediately from the walk-in centre to the Royal Blackburn for life-saving interventions. I must thank the local people for backing this campaign in such huge numbers. I must also thank the three leading campaigners—Chris Reid, Shahed Mahmood and Kimberley Whitehead—for pursuing a more consultative and informative debate than that offered by the clinical commissioning group. I would also like to place on record my thanks to the two local papers: the Accrington Observer, which has been at the forefront of the campaign; and the Lancashire Telegraph. This walk-in centre service means an awful lot to local people. The campaign has included petitions, walks, polls and articles, and has gathered huge support. It has also included letters to GPs.

Since the phased closure started in April, it has been revealed that only 658 people responded to the East Lancashire clinical commissioning group’s consultation—1.6% of the 42,000 patients who have visited. Members should compare that with the 26,000 local residents who signed the petition against the closure.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way; I spoke to him beforehand about this. We cannot ignore his fantastic work on this issue, and I congratulate him on his 26,000-strong petition, which far outstrips the 658 responses that the consultation on this closure garnered. Does he agree that more weight should be given to those opposing the closure, who are 60 times greater in number than those who responded to the consultation, and that the Government should listen to those 26,000 people and not ignore them?

[Graham P. Jones]

The hon. Gentleman makes a valuable contribution. I have yet to meet anyone who filled in the CCG’s consultation, and I will return to the issue of guidelines on NHS consultations and listening to the people.

I want to reflect on the CCG’s consultation. I have grave doubts over its credibility and reliability. To my mind, consulting just 658 invisible people with dubious questions is not a consultation. The CCG asked the public whether they wanted extra GP hours. Just to compare, the walk-in centre provides 88 hours per week. The CCG says that the walk-in centre will be replaced by the new extended-hours GP service, which provides just 19 extra hours’ GP access. That is an 80% reduction in GP access.

In the CCG’s foggy consultation, it said that 61% of people were “in support of” its plans for more GP hours. Which resident is not going to say yes to more GP hours? That is not the same as 61% of people saying, “Yes, and also please close my walk-in centre.” This was a devious consultation. The results of it are grossly misleading, and it is important that the Minister takes that point on board.

In response, I ran my own Facebook poll, reaching out to the four corners of my constituency, and an amazing 6,200 people voted. Unlike the CCG’s consultation question, mine was simple: “Do you want the walk-in centre to remain open?” with an explanation about the 19 extended hours of GP access. Of the 6,200 people who voted, 98% voted to keep the walk-in centre open. That poll reflects the true extent of public opinion in my constituency—98%.

The Minister must stop this closure and ask for a new consultation. She knows that consultation and the views of the public are key to the provision of NHS services. She will know that in national surveys, over 40% of the public say they want to be more involved in decisions about their care. I remind the Minister of the 26,000 people who have signed this local petition to keep the walk-in centre open.

The question is: how has this proposed closure put patients first? Under the Health and Social Care Act 2012, CCGs and NHS England have a duty to promote the involvement of patients in their own health and care. The Minister knows that the guidance is statutory and that CCGs must have regard to it. NHS England’s statutory guidance emphasises to CCGs in the NHS England document “Involving people in their own health and care” that patients must be central to decision making. Clearly they have not been in this case.

The Minister will also know that her Government’s health and social care NHS White Paper included a section entitled “Putting patients and the public first” and promised an NHS that is

“genuinely centred on patients and carers”

and

“gives citizens a greater say in how the NHS is run”.

It embraces the principle of shared-decision making, under which patients make joint decisions about their care with their clinicians. That is clearly not the case with the Accrington Victoria walk-in centre. Notably, the statutory guidance is clear in its description of shared decision making, saying:

“shared decision making is a conversation, or series of conversations, that should include evidence-based information about all reasonable options”,

such as a loss of GP hours. The loss of hours and the walk-in centre were never mentioned.

As pertinent is the recent publication of long-awaited guidance by NHS England, which lays out the future of urgent care services and expectations for local NHS commissioners. The guidance, which the NHS has released early, contains a clear expectation and commitment to retain walk-in centres as part of local integrated health services. I note the reassurances given in it that walk-in centres will remain a vital component of health service provision. The new guidance commits to the establishment of GP-led urgent treatment centres, open at least 12 hours a day, with nurses and other clinicians also available, along with a range of simple diagnostic facilities—a walk-in centre by another name, offering the same services currently offered by Accrington Victoria walk-in centre.

In conclusion—I just want to make a final point, Mr Speaker—patients will be able to book appointments in the new urgent care units using the NHS 111 service, through their GP or, crucially, as at the walk-in centre, simply walk in. NHS England wants these new centres to be co-located where possible alongside other health services, such as Accrington Victoria Hospital. If the Minister wants to put patients first, have a meaningful consultation and roll out the urgent care units, she will see that this closure meets none of those or her Government’s ambitions. I hope the Minister has listened, and will not just defend the decision or simply defer it to the powers of East Lancashire CCG, but accept that this closure runs counter to the NHS England guidance.

Finally, I very gently remind the Minister that thousands of Conservative voters backed the hon. Ken Hargreaves’s campaign to save Accrington Victoria services and today thousands of Conservative voters are backing this campaign once again to save one of the most vital services at Accrington Victoria. I hope she recognises that, were he here today, this cross-party campaign would certainly have been led by my honourable predecessor, Ken Hargreaves. He would want the walk-in centre to stay open, and we would be united in that ambition. I look forward to the Minister’s reply.

[The Minister for Care (Caroline Dinenage)]

I congratulate the hon. Member for Hyndburn (Graham P. Jones) on securing the debate. He made a very powerful case on behalf of his constituents and very carefully set out the enormous strength of feeling in his constituency, as of course he should as the local Member of Parliament. I am grateful to him for articulating his case so powerfully.

Following a three-month public consultation, the East Lancashire clinical commissioning group made the decision to close Accrington walk-in centre from Sunday 17 June. Other services provided from the Accrington Victoria Community Hospital, such as the minor injuries unit, and X-ray and in-patient and out-patient services, are not affected by the changes and will of course remain available. I understand that there has in fact been a delay in the closure taking place, as the walk-in centre was due to close in the spring. However, following consultation, the CCG has decided to close Accrington walk-in centre on Sunday 17 June. This extension to the originally planned closure date was made to ensure that there is a smooth transition to the new models of care, once the walk-in centre closes.

East Lancashire CCG has implemented an extended access service in Hyndburn as a new model of service provision. This service is being provided under contract by a local GP provider organisation, the East Lancashire Union of GPs. The contract is for 12 months from 11 December 2017, and the extended access GP scheme in Hyndburn has been operating since December. It is important to note that while the extended access service in Hyndburn is a new model of service provision, it is not meant directly to replace the walk-in centre per se.

GP services are accessible to patients through their own GP practice from 8 am until 6.30 pm, Monday to Friday, as usual. Pre-bookable appointments will also be available in the new extended GP service after 6.30 pm on weekdays and at the weekend. These appointments will be booked through the patient’s own GP practice. This new model of extended GP access meets the principles that were tested and supported by local people through a formal consultation process. In addition, the NHS 111 service can signpost patients to the most appropriate services, including an appointment with an out-of-hours GP, if required. We understand and appreciate that this is a real change for patients who are used to being able to walk in and see a GP, rather than phoning up for an appointment.

[Graham P. Jones]

Does the Minister accept that the consultation had flaws, and will she look at that? Does she accept that replacing 88 hours in a walk-in centre with 18 and a half or 19 hours of extended GP opening hours is a reduction in GP access, which goes counter to what was said in the consultations run by me and the CCG?

[Caroline Dinenage]

I take on board what the hon. Gentleman says about the consultation and also the consultation that he ran on Facebook. I know how worrying it must be for local people when a service closes, but it is the responsibility of the local NHS to follow the Government’s guidelines. The Government’s four tests for any service change are that it should have support from GP commissioners, be based on clinical evidence, demonstrate public and patient engagement, and consider patient choice. The Lancashire overview and scrutiny committee alone has the power to refer the decision to the Secretary of State or the Independent Reconfiguration Panel, and it was minded not to. That is the unfortunate situation.

Alongside improving and extending GP access, East Lancashire CCG has invested significant sums in social prescribing and care navigation. Those additional services are helping to guide patients and co-ordinate their journey through the health and care system to get the right help and support quickly.

There are benefits from the Hyndburn extended access service, including the provision of seven-day access to GP care, the addition of a minimum of 49 additional delivery hours per week, and 162 additional appointments per week. The facilities are linked to the out-of-hours service, with the ability to secure urgent GP appointments at weekends. I understand that that provision is for Hyndburn patients only until the walk-in centre closes in June, but it will then be expanded to cover patients from the wider east Lancashire area.

The extended access service run by the East Lancashire Union of GPs already has robust information-sharing arrangements in place with Hyndburn practices to ensure continuity of care for patients utilising an electronic record. That level of record sharing has not been available to patients attending the walk-in centre. The patient and public involvement network in Hyndburn has been fully consulted, and has assisted in the production of communication materials to ensure that local patients have been informed of the changes and have the information they need to direct them to the most appropriate service for their health needs.

The extended access service will have the ability to generate electronic referrals that core GP practices can review and progress. The service will collate monthly data, including patient profiles and the reasons why people access the service, to shape service redesign and help to build a clear picture of patient health needs locally. That service will be delivered from an existing modern LIFT—local improvement finance trust—building, which is on a local bus route and easily accessible to the public. Use of the service has been building progressively and is being closely monitored by the CCG.

I thank the hon. Gentleman again for bringing this debate to the House and for his ongoing support for his constituents in Hyndburn.

Question put and agreed to.

Privatisation of NHS Services

Graham P Jones Excerpts

Monday 23rd April 2018 Westminster Hall

[Graham P. Jones (Hyndburn) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Graham. I thank my hon. Friend the Member for Hartlepool (Mike Hill) for introducing the petition and the petitioners for instigating a very worthwhile debate.

I will speak briefly, because I know that many Members want to speak, about fragmentation, accountability, privatisation, and how the NHS in Lancashire is going backwards. We will hear from across the United Kingdom —or certainly England—about the fragmentation of the NHS. It is not providing the services that patients expect.

The Health and Social Care Act was introduced in 2012. It was a top-down reorganisation, although it was promised that it would not be, that cost £3 billion and has caused chaos in Lancashire. That was a promise made by David Cameron that he broke. It has fragmented the NHS: we have lost accountability, we have opened the door to privatisation and we have reintroduced the purchaser-provider competition, which has been mentioned. In the 1990s, that was implemented in social care—it failed, and there was a U-turn.

In Lancashire, we have the high-profile case of Virgin Care’s £104 million contract signed by the Conservative Lancashire County Council, which has been blocked by a High Court judge for reasons of “considerable cost and disruption.” We are seeing the fragmentation of our NHS through the desire to privatise and move towards the purchaser-provider model. There has also been the removal of the Lancashire Care NHS Foundation Trust from Calderstones. The trust has been involved in taking up contracts and being relieved of contracts. The Walton jail mental health service unit is in crisis. It is an important service because we are trying to tackle the issue of mental ill health, yet there is a significant problem at Walton jail. Lancashire Care NHS Foundation Trust picked up the contract from somebody else, but it is struggling; it is underfunded, and the provider keeps changing. That fragmentation is having an impact on those who require these services.

At Calderstones, there was a very large mental health unit on the fringes of my constituency—in fact, it was just inside the constituency of the hon. Member for Ribble Valley (Mr Evans). The unit was rebuilt in 2007, costing £11 million, to provide a cutting-edge mental health service. It was rated “good” by the Care Quality Commission, but it was closed in 2016. How can the £11 million Calderstones unit, which was rated good and moving towards outstanding, be closed in this age and only nine years after that refurbishment? Calderstones Partnership NHS Foundation Trust itself will cease to exist, to be replaced by the Mersey Care NHS Foundation Trust, which will provide services. One service provider is being swapped for another. We are not getting continuity, and there are problems in NHS services, particularly mental health services, in my area.

The public want to say no to the Health and Social Care Act—they do not like these changes. GPs were told that they would hold budgets; I will come to that, but first I want to talk briefly about STPs. Again, there is little democratic involvement; the changes are being ushered in across the north-west and across Lancashire.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

The hon. Gentleman mentions what the public want; is he aware that a slight majority of the public are in favour of third-party private providers providing care in the health service, as long as they demonstrate better value for money?

[Graham P. Jones]

I think the public are primarily concerned not with better value for money but with better healthcare, and they are not getting it.

[Paula Sherriff]

Going back to my hon. Friend’s point about fragmentation, the service I worked in had pathways to the acute trust, so that if somebody came to us with something that looked malignant, we could refer them to the acute trust and the patient would have an appointment within two weeks. When Virgin took over the service, there was no aspiration or desire from the people at the top to create those pathways, so the patient had to go back to the bottom of the waiting list. Ultimately, it is a lose-lose situation for patients.

[Graham P. Jones]

My hon. Friend makes a powerful point and states the case well. My caseload of NHS issues is rising, and often they are about the gaps in service because of that fragmentation. Sometimes it is about poor service, or privatised services that are not providing what people once received when they were under the NHS. It is a complete disaster for my constituents; I have yet to meet a constituent who says that the changes since 2012 have improved the health service and are for the better. Everyone who comes to me—from all parties, of all types and from all walks of life—says exactly the opposite. The fragmentation, the lack of accountability and the cuts need to be looked at again. Healthcare inflation is outstripping the money going into the NHS, resulting in cuts and the STPs.

We are getting a different provider model for our local walk-in centres—it is starting to be swapped again. Our centre is a much-valued service but it is being closed, despite 23,000 people signing a petition. Its 42,000 patient visits will be transferred somewhere else—perhaps off to the second busiest A&E in the country. At the same time as all the fragmentation and chaos, we found out this week that in Clitheroe, the out-of-hours GP service is about to be closed, with patients being told to go to Accrington.

The fragmentation of our NHS is a complete and utter disaster. We are trying to outsource and privatise services or shift them to another trust and shuffle them around to try to save some money, but that will not save money. A patient visit at Blackburn A&E costs £120; it costs £60 at the walk-in centre. The change is a false economy. We shift more patients at the walk-in centre, but it is going to close. Where in all this is a system that is not fragmented, that is holistic and that thinks about the patient and puts them first? I completely agree with my hon. Friend the Member for Hartlepool: it is about time that we revoked section 75 of the Health and Social Care Act.

--- Later in debate ---

[Richard Graham]

That is an interesting point, but the hon. Gentleman may not be aware that I volunteer in my local hospital, and have done for the past eight years. I have not only seen porters in action; I have worked alongside them—and ditto for a variety of wards. The situation he paints about what goes on in Ealing is completely different from what happens at the Gloucestershire Royal Hospital in my constituency, where those services are carried out by employees of the NHS—and will continue to be, whether they are in a subsidiary company or not—effectively and well. I pay tribute to all four of the NHS trusts in my constituency, one of which, Gloucestershire Care Services, received a good rating, alongside the already highly rated ²gether mental health trust. I shall put that issue to one side, but the hon. Gentleman is a distinguished Member of the House and knows better than to scaremonger about privatisation. Real privatisation is what happens in America, as he knows. It does not exist here in the United Kingdom.

The narrative today is, I am afraid, about scaremongering, with the favourite Labour bogeyman, privatisation, to the fore. There is one sentence from the petition that in a sense gives it away:

“Companies should not be profiteering from NHS contracts”.

The logic of that is that every single provider of equipment or services to the NHS, from pencils to EpiPens to imaging machinery to software, should do so at a loss. They should not. It is crucial that businesses make profits, invest and innovate for the future, reduce paperwork, increase scientific solutions to all sorts of difficult health issues and improve the life chances of our constituents. The opposite logic, of businesses making no money at all and going bankrupt, and the state trying to do everything, has been tested to death—literally—in both Russia and China. If Opposition Members, as socialists, want to understand why China has been so successful, I commend to them joining my all-party parliamentary China group, to visit China and understand what socialism with Chinese characteristics looks like and means.

[Graham P. Jones]

I hope the hon. Gentleman takes up the opportunity to visit Ealing Hospital. He argues that this is not the USA, but that is not the point being made. Of course the current NHS is not the US healthcare model. Does he accept that we are not privatising purchasers with insurance policies, as in America, but that what is happening in the United Kingdom is the fragmentation and privatisation of providers? That is the issue we are discussing. Does he agree?

Oral Answers to Questions

Graham P Jones Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Speaker]

Order. It is always a pleasure to hear the hon. Member for Hyndburn (Graham Jones), but can I just say to him that it is a good idea to bob consistently, and then one knows of the interest of an hon. Member? On this occasion, he looked at me meaningfully but was not bobbing; I am not psychic. But let us hear the voice of Hyndburn: Graham Jones.

[Graham Jones (Hyndburn) (Lab)]

I am very grateful, Mr Speaker, for your asking me to ask a question. Mental health is a really serious, and growing, problem. I have been out with my local police force and I appreciate the emphasis on digital technology, but what are we doing on the frontline as well? We cannot just have digital operations. In the Lancashire constabulary, because of the Government’s cuts, we are removing the mental health worker from the frontline force. While we may be doing something around digital, we are removing mental health services, because that post goes on 31 March. Is this not ridiculous? Is it not the case that the Government do not have a coherent policy on mental health?

[Mr Speaker]

Order. I was quite tough on the hon. Member for Burnley (Julie Cooper), but the hon. Gentleman took his time—he really did.

Community Pharmacies

Graham P Jones Excerpts

Wednesday 2nd November 2016 Commons Chamber

[David Mowat]

It does show that. This is a competitive business. My hon. Friend mentions Lloyds; it is one of the two big players in this industry, in which two players own 30% of all pharmacies.

[Graham Jones (Hyndburn) (Lab)]

The Minister talks about moving away from a dispensing model to a value-added model. I shall say something about healthy living if I get the opportunity to speak in the debate, but in relation to that shift, what is his view on warehouse pharmacies?

[David Mowat]

Our view on the structure of the industry is that it is up to individual companies within the sector to organise themselves and to provide their services as efficiently as possible. It is true that 70% of all pharmacies are either chains, multiples or public companies, and I will address that point later.

--- Later in debate ---

[Graham Jones (Hyndburn) (Lab)]

As many colleagues have pointed out, not just today, but in previous Westminster Hall and other debates, cuts of £170 million to pharmacy funding will decimate NHS primary care. It could force up to 3,000 pharmacies to close their doors to the public. In Lancashire alone, 387 pharmacies are at risk. I am deeply concerned about that. It will put an intolerable amount of pressure on front-line NHS services. When we look at the evidence, we find that 25% of the 2 million people who normally seek advice from their community pharmacy would visit their GP instead if they could not get it from their pharmacy. Other NHS services, which are already facing sustained attack from the Health Secretary, will become even more stretched.

I am particularly concerned about the impact on innovative and pioneering models of primary care that are provided through pharmacies. My local pharmacy in Baxenden, for example, is a healthy living pharmacy, ensuring that its provision is localised and preventive. I believe that all pharmacies should look to achieve such added value. This tiered commissioning framework, of which healthy living pharmacies are part, has been praised by the Pharmaceutical Services Negotiating Committee for its successes in reducing smoking, alcoholism and obesity. The majority of users do not have to go elsewhere for their health advice; they can use their local pharmacy instead of their local GP. Indeed, 70% of people who visit pharmacies do not regularly access other healthcare services. The healthy living pharmacy framework should be rolled out across Lancashire and should be part of the primary care review.

[Jim McMahon]

Does my hon. Friend agree that the pharmacy access scheme is more about the Tories buying off their Back Benchers than delivering the services that he mentions?

[Graham Jones]

My hon. Friend makes a powerful point, which was also made by our Front-Bench spokesperson, who rightly observed that most of the cuts will fall in deprived areas, while the exemptions will be mostly in wealthy areas. The Government must address why they favour those who have the fewest health issues and are almost punishing those who face the greatest health challenges. The cuts will do precisely the opposite of what the Minister claims. The value-added local pharmacies in those areas will be undermined completely by the cuts. As a result, community centre provision in some of the most deprived areas might well be eroded, reduced or lost altogether. The personal relationship between patient and pharmacist will be lost, which brings me to my final point.

If these cuts go ahead, what will be the future of primary care? My right hon. Friend the Member for Rother Valley (Kevin Barron) has stated on several occasions that an Amazon model of delivery could take the place of community-centred pharmacies. Remote warehouses with box shifters driven by profit are proliferating. They are unable to provide a localised service and are unwilling to carry out primary care. They could be a dangerous replacement for community pharmacies, and that is on top of the cuts that the Government are making. This is a double whammy. Instead of promoting a primary care model that includes pharmacies at the centre, we are undermining it with these cuts.

Pharmacies in my constituency have expressed concern about this trend. They inform me that some of the warehouse pharmacies have already used patients’ personal data for marketing purposes. I have seen evidence from a company called Pharmacy4U—a mail order company—of feigned official NHS letters targeting repeat prescription users, many of whom were vulnerable. In reality, these letters were switch approval forms. This is a worrying sign of things to come if the cuts go ahead. I urge the Government to think again.

Community Pharmacies

Graham P Jones Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

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

[Graham Jones (Hyndburn) (Lab)]

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

[David Mowat]

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

Community Pharmacies

Graham P Jones Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Graham Jones (Hyndburn) (Lab)]

I congratulate the hon. Member for St Ives (Derek Thomas) on securing the debate. It is somewhat of a rerun of the post offices debate mentioned earlier. Post offices provide a commercial service, but the key point is that they also provide a public service. My view is that the UK’s pharmacy network must be protected. They are vital because they are accessible and have good geographical coverage: 95% of the population can currently get to a pharmacy on foot within 20 minutes. For deprived populations, the elderly and young families whose car may be taken to work, such services that can be reached by walking are essential.

Local pharmacies provide advice and reassurance.

[Rebecca Harris (Castle Point) (Con)]

Will the hon. Gentleman give way?

[Graham Jones]

No, I will not; I am sorry, but there is not enough time.

Pharmacies are also vital because they are beginning to be part of a better national health service, providing a first point of contact; 1.8 million people visit a pharmacy each day. They are an essential part of the pyramid of care that has been mentioned. Accident and emergency departments are stretched, and the solutions that will bring about better healthcare must start further upstream, with pharmacies. A pharmacist wrote to me:

“Pharmacies need to evolve and we have always engaged with the governments in the past to deliver the targets, and greater use of pharmacies must be made to reduce the hospital attendances in the AE”.

There are 36,000 patient visits to my local walk-in centre, which is a fraction of the number of visits to GPs. Yet A&E, the walk-in centre and GPs are all stretched. Local pharmacies are vital for access and as part of a model of healthcare delivery in the UK that relieves some of the current pressures and dispenses advice that puts prevention rather than cure at the heart of healthcare.

My local pharmacy in Baxenden is part of an innovative model of care: the healthy living pharmacy framework is a tiered commissioning framework, aimed at achieving consistent delivery of a broad range of high-quality services through community pharmacies to meet local health needs, improving the health and wellbeing of the local population, and helping to reduce health inequalities. What that means in plain English is that those pharmacies are the first point at which healthcare and health advice is delivered. That includes workforce and workplace development—developing a skilled team who can proactively support and promote behaviour change and improve health and wellbeing. Work done by the healthy living pharmacy initiative has shown that 70% of people who visit pharmacies do not regularly access other healthcare services. Those pharmacies are well placed to support the health and wellbeing of people in the community by, as has been mentioned, providing improved choice, and access to early interventions on such issues as optimal use of medicines, obesity, alcohol and smoking. That should improve outcomes in the short and long term, and have an impact on the cost of care in the future.

The Pharmaceutical Services Negotiating Committee evaluations of HLPs to date found that they

“demonstrate an increase in successful smoking quits, extensive delivery of alcohol brief interventions and advice, emergency contraception, targeted seasonal flu vaccinations, common ailments, NHS Health Checks, healthy diet, physical activity, healthy weight and pharmaceutical care services.”

The report also indicates that the HLP model is working in areas with different demography and geography. I cannot vouch for the PSNC evaluations, but I welcome the actions taken by my local pharmacy to be available to local people and offer better health advice.

Across Lancashire, pharmacists such as Linda Bracewell at Baxenden pharmacy are keen to see HLP rolled out across Lancashire. That requires support from the Government and the NHS. All pharmacies, including HLPs, are a vital part of the healthier Lancashire agenda. Yet today pharmacies are under threat from two directions. Those threats are the reductions in Government support—the 6.1% cut by the Department of Health in community pharmacy funding, which comes to a total reduction in funding of £170 million—and market forces. I want to move on to consider that other threat.

My right hon. Friend the Member for Rother Valley (Kevin Barron) mentioned changes in the market, such as the growth of warehouse pharmacies that seek profit—this is the Amazon model—at the expense of both the public service element and geographical access points. That is a cause for concern. Not everyone is online, or comfortable with such remote arrangements. There is no guarantee that such a method of providing pharmacy services has a role in a healthy living environment, or a better healthcare delivery system. Will it engage with hard-to-reach communities?

Over Christmas I was shown a letter by Linda Bracewell that was sent to a constituent by Pharmacy4U, a mail order pharmacist. Worryingly, it was passed off as an official letter. People would feel obliged to fill it in and send it off. It was personalised, and, crucially, it redirected customers with repeat prescriptions to Pharmacy4U. Worse, Pharmacy4U is just one of several emerging online mail order warehouse companies—box shifters. It was not clear that the letter was not official but a marketing ploy. It is a matter of great concern that the letter was part of a mass mailing, sent specifically to people with existing prescriptions. Their GP practice was named on the letter as though it came from that practice. That is a worry for pharmacies.

How did Pharmacy4U get access to patient practice details? Is it right that the letter I saw was allowed to look like an official document and a request for detail, when in fact it was simply permission to transfer existing prescriptions—a huge business for local pharmacies—to a warehouse pharmacy? Even more worrying was the fact that all the patients of GP practices with electronic data systems had been mailed, while patients of GP practices without such electronic patient systems had not been mailed. Does Pharmacy4U have business connections to the data company that provides GPs with electronic patient data systems, and the patients of those practices? The Minister should be aware that those issues are serious, and that such sharp business practices and models threaten existing pharmacies. The presence of warehouse pharmacies operating on an Amazon model is of concern to me and, I am sure, our constituents, because it erodes the public service element of the current pharmacy network—particularly the healthy living pharmacies.

In conclusion, does the Minister recognise the public service element of pharmacies? Does he want to preserve the current pharmacy network? Does he see pharmacies as having an increasing role in healthcare delivery? Does he think that there will be more or fewer pharmacies after his review is implemented?

--- Later in debate ---

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

As others have said, it is a great pleasure to serve under your chairmanship, Mr Streeter. Thank you for chairing this debate. I also thank my hon. Friend the Member for St Ives (Derek Thomas) for bringing this debate to Westminster Hall and giving colleagues the opportunity to make such a range of comments. They all have a good knowledge of things in their areas, and some have more specialised knowledge. We heard from the right hon. Member for Rother Valley (Kevin Barron), my hon. Friend the Member for Bexhill and Battle (Huw Merriman), the hon. Member for Ealing North (Stephen Pound), my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile), the hon. Member for Ceredigion (Mr Williams), the hon. Member for Hyndburn (Graham Jones) and, not least, the hon. Member for Kirkcaldy and Cowdenbeath (Roger Mullin), in whose constituency I have spent many happy hours—my father was born in Auchterderran, so I know the area very well. Although the hon. Gentleman is from Scotland, his contribution was welcome, and he made some pertinent points.

Before I make some prepared remarks, I want to put some things on the record. I would be foolish if I did not understand the widespread interest in this debate. I would also be naive if I believed that this is the last time we will discuss this issue. Many questions were asked, so this will run for a while. Let me set out the background before I make my prepared remarks.

First, we are having this debate at a relatively early stage of the negotiations between the Government and the Pharmaceutical Services Negotiating Committee, which is handling matters on behalf of the pharmacy profession. Many of the questions and issues raised by colleagues on both sides are at the heart of those discussions. What sort of services will there be? Where is pharmacy going? How exactly will the reduction in finance be handled and distributed? Not all the answers are available at this stage because a proper negotiation process is being undertaken. Understandably, colleagues will look at the most adverse potential consequences to make a point when representing their constituents. I understand that, and the points have been perfectly fair. We are at that point in the process. We think we know what the worst may be, but we do not know the outcome or what changes there will be for the better.

Secondly, on finance, we are all realists here. We would love to work in a world where the status quo is not changed except for improvements, where the only issue with money is where more can be spent and where change, if there is to be any, takes forever to bring in. Life is not like that. The Government’s spending commitment for the national health service—an extra £10 billion a year by 2020—has to start being found early. It is not only about extra money, but about the efficiencies that the NHS chief executive identified, which are to be found across the board and could partly come from the pharmacy sector’s £2.8 billion of funding, which the Government propose to reduce. It may be an appropriate place. Again, we often approach such matters with the view that no possible reduction could ever improve services anywhere. That is not true, as we know from the experience of successive Governments.

The third bit of the background is where we are in relation to where pharmacy is going. The Royal Pharmaceutical Society’s November 2013 report, “Now or never: shaping pharmacy for the future”, states that the traditional model of community pharmacy needs to change due to

“economic austerity…a crowded market of local pharmacies, increasing use of…automated technology to undertake dispensing, and the use of online and e-prescribing”.

The Nuffield Trust’s report, “Now more than ever: Why pharmacy needs to act”, states:

“Community pharmacy is subject to a particularly complex set of commissioning arrangements, which appear to support the status quo and inhibit innovation at scale.”

We would love to be in a situation where, as the hon. Member for Ealing North described, everything is absolutely great and every pharmacy offers all the services and delivers them marvellously, but that is not necessarily the case. Accordingly, change is sometimes inspired by necessity and can be for the better. That is part of the background to where we are.

[Graham Jones]

The Minister makes the point that, to pay for the £10 billion increase in NHS funding, funds are being shifted from other sources, including the £2.8 billion spent on pharmacies. However, the principle should not be to shift funding from primary care to secondary care. Our fundamental principle should be to shift—if we have to—money from secondary care to primary care, which is preventive and will cut costs in the long term.

[Alistair Burt]

The hon. Gentleman makes a fair point, and that is indeed being done in the NHS, but we are looking at where efficiencies can be made and at what different parts of the health sector can contribute. In doing so, we can see what changes are inspired in the service provided to patients.

To emphasise where we are with pharmacy, there are 11,674 pharmacies in England, which has risen from 9,758 in 2003—a 20% increase—while 99% of the population can get to a pharmacy within 20 minutes by car and 96% by walking or using public transport. The average pharmacy receives £220,000 a year in NHS funding. On clusters, which my hon. Friend the Member for Plymouth, Sutton and Devonport mentioned, the Government contend that money can perhaps be saved in one place and used elsewhere for the delivery of new services. That is the reality of life. It would be great if new money was always coming from somewhere, but bearing in mind that the Government are dealing with an Opposition who could not commit to the extra £8 billion that the NHS was looking for, we have to make the changes that others were not prepared to make and still deliver services.

Let me move on to where we are going. Everyone in this room, Government Members included, recognises the quality of the best pharmacy services around the country. We are familiar with the valued role that community pharmacy plays in our lives and those of our constituents. I am grateful to my hon. Friend the Member for St Ives for giving me the opportunity to put on public record the high esteem that we hold them in and to set out our plans for the future.

I am a firm believer that the community pharmacy sector already plays a vital role in the NHS. I have seen at first hand quite recently the fantastic work that some community pharmacies are doing across a wide range of health services that can be accessed without appointment. Many people rely on them to provide advice on the prevention of ill health, support for healthy living, support for self-care for minor ailments and long-term conditions, and medication reviews. There is also real potential for us to make far greater use of community pharmacy and pharmacists in England. For example, I am due to speak at an event tomorrow that is looking at the role that pharmacy can play in the commissioning of person-centred care for vulnerable groups.

Our vision is to bring pharmacy into the heart of the NHS. We want to see a high quality community pharmacy service that is properly integrated into primary care and public health in line with the “Five Year Forward View”. I cannot answer all the questions that the hon. Member for Worsley and Eccles South (Barbara Keeley) asked, but she did at least mention the integration fund for the first time in the debate.

Oral Answers to Questions

Graham P Jones Excerpts

Tuesday 5th January 2016 Commons Chamber

[Alistair Burt]

The mental health taskforce will shortly bring forward its recommendations. It will be looking very carefully at what is provided in A&E. It was the subject of the crisis care concordat review by CQC earlier last year. I am looking specifically at psychiatric liaison, because I saw my hon. Friend’s written question very recently.

[Graham Jones (Hyndburn) (Lab)]

What demographic impact assessment has the Secretary of State’s Department made of the potential withdrawal from the European Union on health and social care, and the consequent result it would have on demands for its services?

[Mr Jeremy Hunt]

None whatever.

A and E (Major Incidents)

Graham P Jones Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I am happy to do that. One of the things that this Government are most proud of is what we have done to turn around hospitals with entrenched low standards of care following the terrible tragedy at Mid Staffs, with 18 hospitals put into special measures and six of them turned around. Despite all the pressure on me and on this Government to hit targets, we are sending out signals to the system, loud and clear, that targets matter, but not at any cost, and that we do not want corners cut when it comes to patient safety.

[Graham Jones (Hyndburn) (Lab)]

Last weekend at Royal Blackburn hospital’s A and E, which I have been concerned about for quite a while, 18 ambulances were waiting outside. That was revealed not by the NHS but by a whistleblower, who described the situation as “chaos”. Is it happening because there are too many patients putting too much pressure on the NHS or because of mismanagement of the NHS by the Conservatives?

[Mr Hunt]

It is because of unprecedented demand caused by a range of factors. If the hon. Gentleman looks at the facts, he will see an NHS that is treating more people more quickly, with more doctors, more nurses and more operations than ever before. Sometimes, though, as I said yesterday, people on the front line feel that they are running just to stand still because there is so much pressure. That is why the £700 million in our winter plan and the money we are putting in to back the five-year forward view next year are so important.

Five Year Forward View

Graham P Jones Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

If I possibly can, I will be delighted to do so. This is the pattern in many parts of the NHS that we do not hear from the Opposition Benches—where there have been problems in care year after year, they are finally being addressed. In my hon. Friend’s constituency and the hospitals that serve it he will be seeing more nurses and more doctors being employed and giving a higher standard of care, particularly to vulnerable older people. That is the kind of NHS that we should all welcome wholeheartedly.

[Graham Jones (Hyndburn) (Lab)]

The Secretary of State talks about holistic care and a range of issues that affect people, but active participation in sport, recreation and cardiovascular activity is declining. In constituencies such as mine, that is a real problem. What will he do to integrate CCGs with district councils? He seems to be saying nothing about this.

[Mr Hunt]

In my earlier comments I spoke a bit about childhood obesity, which is a very important issue. I was the Secretary of State responsible for the Olympics, and as part of the Olympic legacy we set up the school games movement, which now has about two thirds of schools in the country doing Olympic-style games every year, and we have put an extra investment into school sport. We need to work closely with the Department for Education on this, and I agree that it is very important that we do so.

Special Measures Regime

Graham P Jones Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

To be frank with my hon. Friend, the situation at Medway is still troubling. It has made some improvements to maternity services and has about 100 more nurses, and the dementia unit has made progress, but we have not had the stability of management and leadership that will be necessary to sustain improvement. It always takes a very long time to make such improvements. We will therefore work hard to do that. I hope that the partnership with UHB will be a part of that change, because Julie Moore is one of the best chief executives we have in the NHS. I will work closely with my hon. Friend, because I know he takes a great interest, to ensure that we get the lasting changes we need at Medway.

[Graham Jones (Hyndburn) (Lab)]

Sir Bruce Keogh focused on the A and E at Royal Blackburn, which I have had the privilege of visiting. However, Hyndburn faces significant NHS cuts, such as cuts to the walk-in centre, which 36,000 people have been through; cuts to the NHS GP practice in Accrington Victoria; and cuts to personal medical services GP contracts, which GPs are deeply concerned about, and which will lead to a reduction in hours. GPs tell me that that will impact on A and E. Is the shadow Secretary of State right to say that we should look not only at hospitals, but at the broader picture, if we are not to neglect patients and let them down?

[Mr Hunt]

If the hon. Gentleman is worried about cuts, perhaps he might talk to the shadow Secretary of State and ask him why he said it was irresponsible for us to increase the NHS budget as we did.

On the particular issue the hon. Gentleman raises, I actually agree with the shadow Secretary of State. It is not always possible to solve these problems simply by reference to the institution. Sometimes we have to look at the broader health economy. That is particularly true of A and E, but it is true for many other parts of the NHS too. Where there is a broader health economy issue we must look at that as well, but this process means that Ministers are held to account for finding a solution, whatever that solution is.