Community Pharmacies

Greg Mulholland Excerpts

Wednesday 2nd November 2016 Commons Chamber

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

It is a pleasure to follow the right hon. Member for Rother Valley (Kevin Barron), who runs the all-party parliamentary group extremely well. I agree with much of what he says about the value of community pharmacy.

I start my brief remarks by thanking the people I was involved with in pharmacy for their immense courtesy at all times, even though we were talking about some very difficult things. Those people included my local pharmacists, Arif and Raj in Wootton; Graham Phillips of Harpenden, who spent a large amount of time showing me his shops and is still very engaged with me; those on Bedford local pharmaceutical committee, who invited me at a most difficult time to launch their healthy living pharmacies in the area; and of course my team in the Department of Health.

Instead of repeating the Minister’s statement and his commitment to pharmacy, I shall say a little about why we are where we are and what I found when I was dealing with pharmacy, and look ahead to the future. This is the sort of debate where the previous Minister finds that, owing to pressing parliamentary business, he is not able to attend and he is somewhere else because all this is now nothing to do with him, guv. I thought that would be most unfair and I wanted to be here to support my hon. Friend and to give a little background.

The process started with the settlement made in 2015 between the Department of Health and the Treasury. In that settlement, extra money was released for the NHS, particularly in my portfolio—adult social care, mental health and primary care—but as was mentioned by the hon. Member for Leicester South (Jonathan Ashworth) in speaking for the Opposition, efficiency cuts were required throughout the NHS, as advocated by Simon Stevens. Part of that involved £170 million off the £2.8 billion for pharmacy. I thought that this was appropriate and that, once it was announced, we could work through it.

I regret the 3,000 figure that I gave to the right hon. Member for Rother Valley at a meeting with the APPG. It was a worst-case estimate, taking no account of what changes pharmacies might make to accommodate any reductions in finance, and therefore it was absolutely top-end. The reason that I gave it in conversation with colleagues—it was open and public and I have no objection to the figure being used—was to indicate that I was aware of the difficulty and that we wanted to work very hard to mitigate it, which we then started to do. But the 3,000 figure took on a life of its own. With hindsight, it might have been wiser if I had stuck to exactly what the Minister says, which is that we do not know because the Government do not have a plan to close pharmacies. They are not in a position to do that and we do not know what will happen.

I do not believe for an instant that the outcome will be as dramatic as Opposition Members have suggested, because businesses do adapt. One of the things that I found when I arrived, as several Members have said, is that 18% growth had taken place in 10 years. Pharmacies are a business and pharmacists will make adaptations to their business to cope, so we will have to wait and see what happens. I would not use the 3,000 figure again.

[Greg Mulholland (Leeds North West) (LD)]

As Health Minister, the right hon. Gentleman said that 3,000 of the 12,000 pharmacies could close. That has come from pharmacies, not from politicians, so does he not accept that that is the real situation, as he said himself?

[Alistair Burt]

No. I said it, so I know why I said it. I said it because it was an estimate, and it took no account of any business change that people might make. It was a top-end estimate and I said it to indicate that I was aware that there might be closures and that we accordingly wanted to mitigate the effects. With hindsight, I would not have given that figure, because everyone has said that the Minister said that so many pharmacies would close. No, I did not. That figure does not represent the pharmacies that will close. They might have done if we had not had mitigating measures and if businesses had not made changes themselves. I wanted to put that on the record.

Let me say what I found when I took on the role. There was a discussion in pharmacy about its future. There were plenty of voices in pharmacy which said that the funding model that values volume and establishment but not necessarily quality of service was not the right way for pharmacy to go. The pharmacy profession wanted to see some changes. I thought that was relevant. There were differing voices in pharmacy. The Pharmaceutical Services Negotiating Committee represents some, but there are other voices.

The integration fund we suggested as a way to look at how pharmacy was changing to come into GPs’ surgeries was warmly welcomed. There were innovations all over the country in pharmacy in general. There was a growing move towards healthy living pharmacies providing more services. All this was going on at the same time as we were talking about what changes we needed to make to provide the extra funds for the NHS.

So where are we going to go in the future? I think that we will get through this process. I remember saying to stakeholders in December 2015, “The future of pharmacy will not be decided by this letter. The future of pharmacy in 2020, 2025 and 2030 is still to be decided. It won’t all rest on this; it will rest on changes and progress to be made.”

First, the PSNC consultation process needs to be changed; I am not sure whether it works well when other voices are excluded, and that should be looked at. Secondly, the differing voices in pharmacy should find a way to get together and present a view beyond what is happening on the high street to show where pharmacy is going.

Thirdly, the integration of the NHS could be done better. Why are there not pharmacists on every single clinical commissioning group? There should be more commissioning of services; the hon. Member for Central Ayrshire (Dr Whitford) was absolutely right that we need to do more, but the NHS needs to do more, with better commissioning and pharmacists being involved.

Fourthly, there needs to be a thorough review of what pharmacy can do and provide in the future, and that should be a springboard. Sometimes innovation comes out of pressure, not out of great resources, which we would love to see in a perfect world. Finally, we should ensure there is long-term support for a locally based network—there are models that would remove more from the locally based network that we should all resist—and such an approach would be the start of a good future for pharmacy.

--- Later in debate ---

[Norman Lamb]

I thank my hon. Friend for making that point; it was the second one that I was going to make. As the hon. Member for Central Ayrshire (Dr Whitford) made clear earlier, the impact will be arbitrary, and disadvantaged communities and rural areas will feel it most. Only four of the 15 pharmacists in my community will benefit from the pharmacy access scheme; all the others will not, yet they are needed by their local community.

[Greg Mulholland]

There were some outrageous comments earlier suggesting that some of those smaller pharmacies are simply there for dispensing, when they have trained pharmacists helping people. As well as the important village and rural pharmacies—I have village pharmacies in Pool and Bramhope that do excellent work—communities in suburbs rely on smaller pharmacies; those communities will lose that service.

[Norman Lamb]

Absolutely. It is the arbitrary impact of the cut that concerns me so much.

The other aspect of that arbitrariness is—again, a point made by the hon. Member for Central Ayrshire—that the big boys will be fine. They will survive. Surely, the Government should be addressing the excess profits of those organisations, rather than putting in danger—as their own impact assessment says—the small independent pharmacies and small chains. It is completely irrational and makes no sense.

The final issue I want to raise is that, instead of going about cutting preventive care, protecting the big boys and putting small pharmacies at risk, the Government ought to be undertaking a major programme to increase what pharmacies do. We heard earlier about what is happening in Scotland; that is the approach that should be taken. There should be more work on smoking cessation, on sexual health, on substance misuse and on screening and immunisation, and more should be done to promote independent living, encourage healthy lifestyles and support people in their self-care.

The Government’s approach makes no sense. The bottom line is that, as the Government scrape around trying to find enough resources to prop up the NHS, which, as we know, is expecting to receive a reducing percentage of our national income between now and 2020, they are making stupid decisions such as cutting spending on health education, on public health and on community pharmacies. The Government are in a complete mess. We need extra resources for the NHS and a new long-term settlement. The sooner the Government recognise that, the better.