Draft Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016

Helen Goodman Excerpts

Tuesday 1st March 2016 General Committees

[Helen Goodman (Bishop Auckland) (Lab)]

It is a great pleasure to see you in the Chair this afternoon, Ms Dorries. My hon. Friend the Member for Denton and Reddish, who sits on the Front Bench, has anticipated the thrust of the argument that I want to present to the Minister.

The draft order looks broadly deregulatory. The Minister has consulted on it and there is support for it, but it should be considered in the context of the 6% cuts to the community pharmacy budget about which I have received significant representations from pharmacists in my constituency. Pharmacists in Bishop Auckland, Kirk Merrington and Cockfield, and the County Durham and Darlington local pharmaceutical committee have written to me and are extremely concerned about the impact of those cuts on their pharmacies.

I wrote to the Minister and he wrote in response that he had a marvellous strategy for pharmacies, which I could not quite square, and that they were going to do all these new, wonderful things. If they are going to do lots of new, wonderful things, it seems odd to be cutting the money, but he can no doubt explain to us what he means. He also wrote that it was not sensible to subsidise pharmacies if they were close to each other and that around two thirds or three quarters of them—I cannot remember the number—were close to another pharmacy. I have to tell him that Kirk Merrington and Cockfield are villages and it takes half an hour on the bus to get from those villages to anywhere else with a pharmacy. It is important that he addresses the rural dimension of not continuing to provide proper support for pharmacists who—as everyone on the Committee is no doubt fully aware—can provide significant benefits to public health.

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[Alistair Burt]

I am grateful to the Committee for its response and appreciate the support for the draft order in that narrow part of our discussion. I did anticipate that one or two other issues might be raised. With your permission, Ms Dorries, if you feel that those contributions were in order, I am happy to respond briefly.

The draft order is set in the context of the changes being proposed to community pharmacy. Let me lay out, as best I can, what the Government have in mind. In essence, we want to see community pharmacy better integrated into primary care, by increasing the number of pharmacists who bring their skills to GP practices, care homes, and urgent care and public health settings. We need a clinically focused pharmacy service, better integrated with primary care and public health, in line with the five year forward view.

We are consulting with the pharmacy sector and patient groups on how to introduce, for example, the pharmacy integration fund. That will transform how pharmacists operate in the NHS, reducing pressure on A&E and GPs by making better use of pharmacists’ terrific clinical skills to help deliver seven-day health and care services. Proposals for discussion include more pharmacists in GP practices, working closely with GPs to optimise the use of medicines and promote healthy living; patients often seeing a pharmacist instead of a GP, particularly for minor ailments, adding capacity to the system and freeing up appointments; establishing a named pharmacist in care homes who can discuss and review medicines and work with the patients to get the best possible outcomes; and integrating pharmacists as part of all care processes as standard, as a key means of maintaining public health and preventing ill health.

We want to see that development in pharmacy, and to an extent we are going with the grain of what the pharmacy sector has been looking for for some time. Studies by the Royal Pharmaceutical Society and the Nuffield Trust say that pharmacy needs to change, and needs to recognise that it can contribute further to the NHS, in addition to the excellent services that are based in more and more high street pharmacies. Not all high street pharmacies provide the same services; one issue is that some 40% of pharmacies are in a cluster of three or more pharmacies within ten minutes’ walk.

To address the point made by the hon. Member for Bishop Auckland, we are proposing an access fund whereby more NHS resources will be devoted to pharmacies in areas where the cluster argument does not apply. Quite sensibly, no one wants to lose a pharmacy; if a pharmacy finds itself having difficulties with the new financial regime, we want to make sure that it is able to continue. Discussions are already proceeding with pharmacy representatives about how the access fund will be set out, because there must be national standards—a set of rules to let people see how things are done.

We feel that the combination of the access fund, which will make sure that pharmacies in key areas can continue their work, with the integration fund, which will assist more pharmacists to work in different settings, is what pharmacy needs. Let me be honest among all colleagues: it would be great if that could be done against a background of no reductions in finance, or ever more finance going in, but we are not in that situation. We need to fulfil the commitment, made by my party at the general election, to put more funding into the NHS. That £8 billion commitment is now a £10 billion commitment by 2020. All colleagues know that it is not just about the extra money; it also depends on the £22 billion of efficiencies set out by Simon Stevens, chief executive of the NHS. All parts of the NHS need to contribute to those efficiencies, and that includes pharmacy. It is the Government’s genuine belief that, even within the new envelope that will provide £2.63 billion to pharmacy this year, it will be possible for pharmacies not only to continue their excellent work, but to develop it in the ways that I have set out and that we believe pharmacy wants as well. That is what we intend.

There will be an opportunity for further discussion and debate about this; I know colleagues are receiving letters about it, so the debate has some way to go. We are in discussion and negotiation with those who represent pharmacies; there is an interesting conversation taking place and we want to see it continue.

[Helen Goodman]

Is the £2.6 billion subsidy partly for medicine, or is it a subsidy for the infrastructure of the pharmacy network?

[Alistair Burt]

I would not say that this is a subsidy. It is payment made by the NHS and the taxpayer for the provision of premises and the work that pharmacists do. It is essentially more about infrastructure. The drugs bill is beyond that; that is the agreement. It is still a significant amount of money that will go into the provision of services. Where we find pharmacy services looking to work in different ways, which is already happening—there are pharmacists in GP surgeries and on some hospital wards—we want to encourage that process, without damaging the exceptionally good high street service that is provided by the majority of pharmacists, which we want to see continue.

The draft order fits in with that approach by changing the rules on the regulation of premises. It will make sure that the regulators can do their job in the way we all want to see—with procedures for guidance, as opposed to strict legislative rules. This is in line with the autonomy of professional regulatory bodies that the profession and the Government are looking for. I am grateful for the Committee’s support.

Question put and agreed to.

NHS (Government Spending)

Helen Goodman Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Spencer]

I thank the hon. Lady for that intervention. What my constituents who are in the unfortunate position of suffering from cancer care about is whether they are going to get better. Is the service going to deliver a service that makes them better and gets them over the disease? Frankly, if it does not cost constituents any money, and if the level of care and service is the highest, I think that is what really matters to them.

It is easy to stand here and talk. Politicians talk—they will always talk—but we have to look at what politicians do. This Government, to their credit, have in this Parliament put in an extra £12.7 billion. Let us compare that with how politicians have operated in Wales, where the budget has been cut by 8%. I think it says a lot to our constituents about how the NHS is going to be managed in future and how much we genuinely care about and want to support the NHS system.

[Helen Goodman (Bishop Auckland) (Lab)]

Is the hon. Gentleman not aware that central Government have cut the Welsh Government’s money by 10% and that health spending in Wales is now at an all-time high?

[Mr Spencer]

Of course, I am the first to admit that there is financial pressure within the system. The previous Government borrowed enormous amounts of money and ran up an enormous deficit. Any Government coming in at that time would have had to take difficult decisions, but the simple fact is that spending in England has gone up under this Government, while spending in Wales under the control of the hon. Lady’s party has gone down. There are some 850,000 extra operations a year taking place in our NHS by comparison with 2010.

The issue that upsets me most and has brought me to attend this debate is the state of my own Sherwood Forest Hospitals NHS Foundation Trust. It “benefited” from a PFI deal signed under the previous Government, which now costs the trust £40 million a year out of its budget. That is where we went wrong under the previous Government. Let us spin that out: we were fortunate enough to invest £320 million in a new hospital, but it will cost £2 billion in repayments. I put it to Members that they would get a better interest rate from Wonga than they would out of that PFI deal. If we look at what happened nationally, we find that £11 billion-worth of investment through PFI matches up with £55 billion-worth of repayments. That means £44 billion being taken out of the NHS because of the shocking PFI deals signed by the previous Government.

Labour Members talk about the cost of our reorganisation being £3 billion, but that is frankly nothing by comparison with £44 billion. It is an enormous amount of cash that could be spent on doctors, nurses, cancer patients and putting our NHS services in the right place.

I am very fortunate that the Secretary of State has agreed to meet me and my hon. Friend the Member for Newark (Robert Jenrick) to try to help Sherwood Forest hospital trust out of the hole that the previous Government put it in. Hopefully, we can assist in dealing with the £40 million a year being sucked out of the trust.

I am conscious that other Members want to speak, so I shall end there. I am grateful for having had the opportunity to speak.

[Helen Goodman (Bishop Auckland) (Lab)]

I am pleased to follow the hon. Member for Sherwood (Mr Spencer). Last Saturday, I sat with my constituent Joanna Redfearn, who is a mother of four. Her 11-year-old daughter, Kelsie, has complex medical needs, including epilepsy. Joanna was telling me about the increasing difficulty she experiences in getting an ambulance to come when her child has a fit. She has been subject to waits of between an hour and two hours—clearly, that is totally unacceptable, because it is extremely dangerous for her child.

A recent low point was when a paramedic turned up, who was told that a St John ambulance—not an NHS ambulance—was about to come. The paramedic rang the North East Ambulance Service to say, “Sorry, that will not do. They are not equipped to deal with this child’s needs. We need a proper ambulance.” My constituent is so desperate that she is considering moving house to be nearer to the hospital.

This is part of a pattern in my constituency. When an elderly woman fell out of her wheelchair outdoors last summer, her husband, whose hearing is very bad, rang the ambulance service. The people on the other end of the phone began to challenge him and ask him a series of questions, but he could not answer them because he could not hear them. He could phone up and say, “I need an ambulance now”, but he could not hear well enough to engage in a long conversation with the ambulance service.

After three phone calls a paramedic turned up, who then called a proper ambulance. The old man had to stand, propping his wife up for over an hour while the paramedics gave her the medical support she needed. It was fully two and a half hours before the proper ambulance came to collect her and take her to A and E. The worst case, however, is the one I raised with the Secretary of State a few days ago: that of Violet Alliston. Her partner rang 999 several times, but the ambulance arrived so late that she died.

Everyone knows that the North East Ambulance Service is in crisis. The patients know, the GPs know and the paramedics know. The only people who do not seem to know are the Ministers. It is a shame that the doctor is no longer with us, because he made a number of comments, and it is unfortunate that he will not hear my response to them. He challenged what had been written by the independent Office for Budget Responsibility, which was set up by the Government to audit their public spending plans. It was the OBR that said that the Government’s plans would reduce spending to 1930s levels, and reduce by 1 million the number of public service jobs. It would be nice if the Minister responding to the debate told us which NHS staff will be included in that 1 million.

Government Members seem to think that this is just a rhetorical device, and that none of us on the Opposition Benches have any such personal experience. That is not true. In the 1930s, my grandmother used to collect for an ambulance friendly society. What happened in the 1930s, under a 1930s system, was that if people did not pay, they did not get an ambulance. No one wants to return to that system.

The problems I have described obviously have knock-on effects in hospital A and E departments. County Durham and Darlington NHS Foundation Trust met the four-hour waiting time standard on only 74% of occasions. Furthermore, services are constantly being removed from Bishop Auckland general hospital. The latest service the trust wants to remove is the maternity unit. Again, I am sorry that the doctor is not here to respond to my account of the problems we are experiencing. We have been told that maternity services are not safe because if something goes wrong during labour, the trust cannot guarantee that an ambulance will arrive to transfer the patient, even though the ambulance station is right next to the hospital. Of course the ambulance service is not working.

I said to representatives of the hospital trust, “You are still dealing with home births. Surely the problems involved in collecting people from Bishop Auckland hospital by ambulance are exactly the same as those involved in collecting people if a home birth goes wrong.” They replied, “It is true that home births are risky, but people expect to be safer in a hospital.” In other words, what they are really bothered about is not health outcomes, but the risk of litigation. That is no way to run the health service.

What the health service needs is a proper, well-funded plan, and that is what Labour’s motion sets out. We need to see changes in the culture, in the resources and in the management. Labour’s plan is honest, truthful, transparent and clear, and it is what the British people want.

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[Jane Ellison]

I will make some progress; the hon. Gentleman has made a contribution.

Not only has NHS funding in England been protected; it has risen in every year of this Parliament. That is an indisputable fact that flies in the face of the Opposition’s financial scaremongering. As a result of the additional £2 billion funding for 2015-16 the Chancellor announced in the autumn statement, funding in 2015-16 will be £16 billion higher in cash terms than in 2010-11. Those are the facts. That equates to an increase of £6.8 billion in real terms. That additional investment is a down-payment on the NHS’s own plan, which was set out in the “Five Year Forward View”. The chief executive of NHS England, Simon Stevens, has said that the autumn statement gives the NHS what it needs for next year.

Winter is always challenging for the NHS. This year, it comes on top of a significant increase in A and E attendances, which have been higher than in any year since 2010. On average, 3,000 more patients each day are being seen and treated in under four hours than under Labour. As my hon. Friend the Member for Stourbridge (Margot James) set out clearly in going back over the past few years, the additional funding the Government have put in emphasises the priority we place on the NHS. That makes utter nonsense of the claim that we are going back to 1930s levels of funding. That is ludicrous, and Opposition Members parroting that because they have been told to insults the intelligence of every Member of the House. It is nonsense.

[Helen Goodman]

The OBR says that the Government’s plans involve cutting 1 million public service workers. Will the Minister say from the Dispatch Box which 1 million public service jobs are going to be cut?

[Jane Ellison]

I remind all Opposition Members of their predictions about employment at the beginning of this Parliament. If any of them wants to remind us of those, they can be my guest.

We recognise the significant and continuing pressure on services in the short term and the need to invest in new ways of providing care for the future.

This Government have put more performance data in the public domain and have put an unprecedented emphasis on transparency. Indeed, some of the statistics Members quote in these debates are in the public domain only because the Government have put such an emphasis on transparency. Transparency is one of the key drivers of safety in our system.

As public health Minister, I welcome the focus on prevention in the “Five Year Forward View”. I think this is common ground across the parties. Prevention has to be a key part of the NHS’s plans. When we keep people healthy and out of hospital, it is a win for them and a win for the NHS. Mention has been made of the national diabetes prevention programme. We will be the first country in the world to implement such a programme at scale to help prevent the onset of the disease and reduce demand on the NHS. Investing in the NHS with a focus on prevention is one of the keys to a sustainable footing for the NHS in the long term.

Thanks to the work of NHS staff and the funding protection provided by the Government, the NHS is treating more patients than ever. Again, that flies in the face of all the dire threats about its peril. There are 9,000 more doctors and 3,300 more nurses. The additional funding announced by the Chancellor in the autumn statement will enable the NHS to continue to meet the rapidly rising demand in the short term, while making investments in new services and facilities to transform care for patients and ensure that the NHS is sustainable in the long term.

A and E (Major Incidents)

Helen Goodman Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

We absolutely do that. Telephones and the internet provide different ways to get the right advice to people quickly. The 111 service is taking a considerable amount of strain at the moment, and we have put in more money to support it. We are investing a lot more in tele-health and tele-medicine, and a lot more to help GPs who want to give people out-of-hours appointments. In the long run, that is the way we will reduce the kinds of pressures that my hon. Friend talks about.

[Helen Goodman (Bishop Auckland) (Lab)]

Over three years ago, I raised with Ministers problems about the North East ambulance service that had been pointed out to me by the paramedics, but unfortunately they were brushed aside. My constituent, Violet Alliston, had the terrible experience of her partner ringing for an ambulance three times in the course of an hour before the ambulance came. She then died. This is obviously completely unacceptable. Why will not the Secretary of State look again at the resources he is taking out of the North East ambulance service, the skills base of the call handlers, and the triage system?

[Mr Hunt]

I am extremely sorry to hear the story that the hon. Lady talks about, and I know that the NHS will investigate it fully. We are not cutting resources to ambulances, though. We have 2,000 more paramedics than four years ago, and £50 million is being put in this winter. Of course, we need to look very carefully into the particular case that she mentions and make sure that any lessons are learned.

NHS Services (Access)

Helen Goodman Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham]

Many questions are raised by that decision. Areas of the country where services were being run well would say that they did not get money and instead the money was given to areas where things were not working properly. The situation my hon. Friend describes is what is happening across the NHS in England. The Government have cut the GP budget, the mental health budget and the social care budget, and all that has led to increased pressure on hospitals. There are too many people in hospitals right now in England. The wards are full and people cannot be sent back home because the social care is not there. So the wards do not become free, and A and E cannot admit people to the wards because no beds are available. A and E therefore becomes blocked. Ambulances cannot hand patients over to A and E so they end up queuing outside, meaning that ambulance response times get worse. That is the knock-on effect of the Government’s policies across the NHS, and the deteriorations she is seeing for her constituents are mirrored right across the country.

[Helen Goodman (Bishop Auckland) (Lab)]

My right hon. Friend describes it brilliantly. Does he agree that he is describing a system that shows exactly why privatisation and competition is completely inappropriate in the NHS?

[Andy Burnham]

All the evidence from around the world tells us that more market-based health systems cost more than systems such as the NHS, and are more complex and fragmented. The clear conclusion I draw is that the market is not the answer to 21st-century health and care. The Government believe it is, which is why they must be defeated if we are to protect our national health service.

A and E Departments

Helen Goodman Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

Of course. I have visited Kettering hospital myself and seen just how hard people are working there. They are doing a terrific job. My hon. Friend is right to say that the significant increase in attendance has been driven by changes in the local population.

[Helen Goodman (Bishop Auckland) (Lab)]

The basic problem with the 111 service is the national specification of the triage system. The ambulance drivers in my constituency warned of this two years ago when the service was trialled, and last year the north-east local medical committee also told the Department of Health that the system was not working. It is the Secretary of State who has his head in the sand. Why does he not listen to the professionals on the ground?

[Mr Hunt]

I am listening. I have said that we have teething problems and that we want to sort them out. I am prepared to look at the whole of the 111 service to see whether it is delivering the service that the public need. However, I would say to the hon. Lady that the issues with 111 have focused public attention on the poor standard of out-of-hours care in many parts of the country. There is a particular issue of enabling people to speak out of hours to a GP who can, with their permission, look at their medical record, which is a pretty basic starting point. Until we sort that out, we will not be able to sort out the wider issue of confidence in 111.

Oral Answers to Questions

Helen Goodman Excerpts

Tuesday 26th February 2013 Commons Chamber

[Dr Poulter]

I assure my hon. Friend that we will look carefully at anything that he wants to put forward, but any treatment on the NHS needs, of course, to be evidence-based.

[Helen Goodman (Bishop Auckland) (Lab)]

Every year 18,000 epileptic fits are triggered by video games and screen-based activity. Can the ministerial team tell us what research is being done on that and what discussions they have had with the industry to make video games safer and improve the labelling?

[Norman Lamb]

I would be happy to look into that further. I recognise the significant concern that the hon. Lady raises. Often the diagnosis of epilepsy is not good enough and there needs to be much better co-ordinated care. The issue that she raises is important and I am happy to look into it further.

NHS Commissioning Board (Mandate)

Helen Goodman Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

I absolutely agree. That can be hugely transformational in terms of patient outcomes. Many patients would be astonished to know that a full medical record is not available to consultants in hospitals before they operate on them. We need to put that right because it could transform the decisions that surgeons take in extreme cases. So my hon. Friend is right, and we must press on with this very fast.

[Helen Goodman (Bishop Auckland) (Lab)]

The Secretary of State and the whole Government are keen to deliver public services using the internet and online. He mentioned in particular people with long-term conditions being able to communicate with their doctors online. The Department for Work and Pensions has found that 6.5 million people who will be entitled to universal credit have never used a computer. Has he any knowledge at all of how many of those with long-term conditions are computer literate?

[Mr Hunt]

Some will be, some won’t be, but the hon. Lady should not underestimate the computer literacy of people who are adopting the internet at breakneck speed, including the 40% of pensioners who now do their banking online.

Oral Answers to Questions

Helen Goodman Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Speaker]

I thought that the hon. Gentleman wanted to come in on this question. That is what I have been told, but never mind: we will wait to hear his dulcet tones in due course.

[Helen Goodman (Bishop Auckland) (Lab)]

15. Whether he has made an assessment of the effectiveness of the 111 non-emergency number; and if he will make a statement.

[The Minister of State, Department of Health (Mr Simon Burns)]

NHS 111 is currently being piloted in County Durham and Darlington, Nottingham city, Lincolnshire and Luton, and a full independent evaluation of these pilots will be available in spring 2012.

[Helen Goodman]

In Durham, 111 calls are being answered by telephone receptionists without any medical training. They run through a list of pre-scripted questions and frequently divert ambulance paramedics away from 999 calls. Clearly that is risky. Will the Minister look into that before the number goes nationwide?

[Mr Burns]

I am sorry, but the hon. Lady is a little bit confused. She says, rather dismissively, that the calls are being answered by telephonists. These are non-medically trained people who have nurses and GPs available to give them help and advice as and when the callers demand it, because of the complaint or problem that they are raising. The beauty of the 111 service is that people do not have to wait to be called back, as they do with NHS Direct. Instead, the people trained to help callers will point them towards the appropriate care—which in some cases will be the emergency services—and they are right to do so when this has been clinically determined.