Hypermobility Syndromes: Healthwatch Calderdale’s Report

Holly Lynch Excerpts

Monday 7th October 2019 Commons Chamber

[Craig Whittaker]

The hon. Gentleman is right in a lot of what he says, but the thing about hypermobility syndromes is that they are incredibly complex. As I said earlier, things like the digestive system, the immune system and teeth can all be factors. It is not like when someone goes to hospital with a broken leg, and we know what the problem is. There are multiple complexities around this disorder, so it is difficult from a professional point of view, which I will speak about later, but he is right in much of what he says.

From the Healthwatch work on the subject, it is clear that many people—specifically those with hypermobile Ehlers-Danlos syndrome or hypermobility spectrum disorder—are not receiving the appropriate NHS care, as the hon. Member for Strangford (Jim Shannon) indicated. It is not clear how many people in the United Kingdom are affected by hypermobility syndromes. Hypermobility is often misdiagnosed as fibromyalgia, osteoarthritis, seronegative arthropathy, psychogenic rheumatism, depression or chronic fatigue syndrome. I do not know about you, Madam Deputy Speaker, but after that description, I need to lie down in a darkened room. So imagine how patients with hypermobility-related problems feel when they have to battle alone with immense health problems, often for years before obtaining a diagnosis, only then to face immense difficulties in accessing appropriate NHS healthcare to manage their complex and multi-system disorders and conditions. These patients describe feelings of being let down by the system, as well as huge frustration at both the widespread lack of understanding about their condition from medical professionals and the lack of appropriate care for their condition.

[Holly Lynch (Halifax) (Lab)]

Will the hon. Gentleman give way?

[Craig Whittaker]

It would be an honour to give way to my neighbour.

[Holly Lynch]

I am grateful to my neighbour for giving way. I thank him for securing the debate and congratulate him on articulating a number of those medical conditions incredibly well. I have two constituents I am aware of who have a diagnosis of Ehlers-Danlos syndrome. I was incredibly disappointed earlier this year when the clinical commissioning group informed me that Manchester Royal Infirmary, which had been delivering a degree of care for those with hypermobility, was going to have to stop accepting tertiary referrals for that support. Not only are people struggling to get a diagnosis after years, but regional specialist care is then not available once they have received a diagnosis. We really need to address that.

[Craig Whittaker]

My hon. Friend and neighbour is right. Because there is a lack of understanding about this syndrome and because, not only at GP level but in some specialist areas, areas that do particularly well on this issue are now having to close the list to outsiders because they are becoming over-subscribed. She is absolutely right; that is one of the issues. When I get to the end of my speech, one of my recommendations, which the Minister can hopefully address, is having a regional centre for this condition.

Healthwatch’s report was published in July this year, and it focuses primarily on patient experiences. It presents the overwhelming negative NHS experiences of adults with hypermobility syndromes, and it makes for challenging reading. It is 70-odd pages, and it is not a pleasant read at all. The report took evidence from 252 people via focus groups and a questionnaire. Approximately 86% of the participants had a diagnosis of hypermobile Ehlers-Danlos syndrome, or what would now be termed hypermobility spectrum disorder. A further 13% had other diagnoses linked to hypermobility syndromes. It is precisely those people who are presently excluded from NHS specialised rheumatology services, and it is those people on whom I would like to focus this evening.

The report identifies problems with NHS care in many different areas. It highlights that people are experiencing difficulties obtaining a diagnosis: 76% of respondents indicated that obtaining a diagnosis had been challenging; 22% described the process as difficult; and a staggering 54% stated that it had been very difficult. Frequently, people described the diagnostic process as leaving them feeling depressed, alone and isolated as a consequence of the lack of understanding that appeared to be the norm among professionals. This and the level of disbelief by professionals, as the hon. Member for Strangford pointed out, have led to people doubting themselves, despite their symptoms and, of course, their experiences.

Common terms used to describe how the diagnostic process made people feel included being angry, belittled, desperate, and feeling like a liar or a fraud, and some even said they were feeling as though they were going a little crazy. By contrast, obtaining a diagnosis generated feelings of hope and reassurance, and the feeling that they had been vindicated or were relieved at having an explanation of their difficulties.

On the road to diagnosis, many tests and procedures were commonly performed—sometimes repeatedly, sometimes in isolation and sometimes in conjunction with others. Many people reported that they had had many blood tests, scans and X-rays. A number of respondents spoke of being tested exhaustively over many years. For some people, this extensive testing was a route to an eventual diagnosis and, in some cases, supported interventions, but for others, this resulted in delaying the diagnosis, misdiagnosis and delayed support. A pathway would not only be beneficial to patients, but would also reduce the costs and associated wastage to the NHS of all the unnecessary tests, which are often carried out on a repetitive basis, as they are not giving the anticipated results at the time.

Participants reported that between one and six health professionals were involved in the diagnosis. One significant theme of the responses generally was the failure of medical professionals to link together the variety of symptoms and health issues being reported and a focus on the presenting symptom only. Perhaps unsurprisingly, many participants said that they had received other diagnoses, rather than a diagnosis of hypermobility syndrome. Altogether, a staggering 62 other conditions were named during the process.

The complex and diverse symptoms resulting from hypermobility syndromes have led to many people being misdiagnosed. They were told, for example, that their symptoms were related to mental health issues or mental illness, such as depression, anxiety or stress, and this resulted in subsequent referrals to mental health services, as health professionals could not find a physical cause of the symptoms. People also reported that health professionals had ascribed the symptoms to excess weight, clumsiness or lack of physical exercise. Misdiagnosis, partial diagnosis or stereotyping left people feeling upset and patronised by health officials and led to feelings of anger, frustration, rejection and defeat.

Inadequate knowledge among health professionals was another key theme of the report, and that also emerged from the data. The majority of the respondents referred to health professionals as not aware of, not knowing about or not believing in the wide-ranging symptoms and the health and life impact of hypermobility syndromes on the patients. GPs were specifically mentioned in this regard, and rheumatologists and physiotherapists also received mixed feedback about their knowledge. Some people who had a diagnosis also talked of medical professionals disbelieving the conditions, with some being told, “It’s all in your head,” or assuming that people were just after drugs, rather than genuinely being in pain, despite the diagnosis.

Another key theme that emerges from the data is poor communication between health professionals, both between departments in the same service and between one medical facility and another. Communication between professionals is by no means consistent. Communication failures occur frequently and conversations are repeated at consultation. Again, this experience is described as exhausting and demoralising. A number of participants also reported difficulties in persuading GPs to refer them to consultants. Most people who responded to the survey said that they had either no NHS care or inadequate NHS care. The life impact of these difficult NHS experiences is significant, with people having to give up work, experiencing difficulties in education, having problems with social relationships, the breakdown of families and financial problems, too.

Community Pharmacies

Holly Lynch Excerpts

Wednesday 2nd October 2019 Westminster Hall

[Holly Lynch (Halifax) (Lab)]

I beg to move,

That this House has considered the role of community pharmacies.

May I say what a pleasure it is, Sir David, to serve under your chairship this morning, and to have you join us for this important debate?

Between the ages of 14 and 18 I worked in a local chemist shop two evenings a week and some Saturday mornings. There were the usual first job responsibilities: restocking shelves, cleaning, and meeting and greeting customers and patients who were not always well, for a variety of reasons. I loved it, because there is never a dull moment in a pharmacy. I remember a frantic mother handing me dead headlice taped to a piece of cardboard, and someone asking me to run a pregnancy test on a bottle of cough medicine, before discreetly letting me know that it was actually a urine sample rather than cough medicine and that that was the only secure way she could find of transporting it to the chemist shop.

The shop was exactly what it said on the tin. It was a community pharmacy, and the whole community would walk through those doors for advice, medication and reassurance. I remember the older people, whose relationship with the pharmacist was the longest-standing and most trusted relationship they had with a clinical professional. I remember a long-term recovering addict, who would bring his daughter with him every day. We watched her grow up, and supported him as he worked hard to stay the course on his journey to recovery.

That is why community pharmacies matter, and it is why they work. However, it appears from the community pharmacy contractual framework announced in October 2016 that that was not appreciated. There was a reduction from £2.8 billion in 2015-16 to £2.68 billion in 2016-17 and £2.59 billion in 2017-18. That represented a 4% reduction in funding in 2016-17 and a further 3.4% reduction in 2017-18. When inflation is factored in, as well as all the services that pharmacies already offer free and whose costs they absorb, that was a near fatal blow to the service nationwide. The then Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), told the all-party parliamentary group on pharmacy that he expected between 1,000 and 3,000 pharmacies to close, as they would no longer be viable in the face of the cuts, with multiples and chains of pharmacies best placed to survive, and independent and more rural chemists left at a disadvantage.

In March this year the Pharmaceutical Services Negotiating Committee found that 233 community pharmacies have closed in England since the Government funding cuts were introduced. Sixty-nine were independent pharmacies and a further 22 were independent multiples. The number of closures anticipated by the right hon. Member for North East Bedfordshire has not yet been reached. However, I have spoken to people in pharmacies, and others contacted me ahead of the debate, and many are operating at a loss, clinging to the hope that the funding arrangements will improve, but with a business model that, as the right hon. Gentleman predicted, is not viable.

The impact that the funding cuts have had on patients is really difficult to justify. The cost of delivering prescriptions to those who find it hard to leave the house was previously absorbed by local chemists, but that is no longer possible. Boots was the last of the big four chain pharmacies to start charging for delivery over the summer, with all patients having to pay £5 for delivery, or £55 for a 12-month delivery subscription, by the end of the year. All have some exemptions for particularly vulnerable customers, but Boots, LloydsPharmacy, Rowlands Pharmacy and Well have all reduced free deliveries, or started charging for delivery.

There is no funding for arranging drugs in trays. When I worked in a pharmacy, it was a big undertaking to arrange medicines in trays by time and day, predominantly for older people who needed that degree of support if they were to live well for longer by taking their medication at the right time and in the right doses. Pharmacies were delivering a degree of invaluable social care, and that is no longer possible in the present financial climate. We can all see what the consequences will be. Ultimately the result will be more costly clinical interventions.

In addition to the financial pressures that pharmacies face, drugs shortages are now becoming debilitatingly resource-intensive across the NHS. Pharmacies have no ability to absorb the costly hours spent sourcing drugs or speaking to GPs about possible alternatives. A Bristol GP, Zara Aziz, recently wrote in The Guardian of her experience of medicines shortages. She explained that EpiPen users in Bristol are now being told to use their old EpiPens up to four months after the expiry date. She also tells the story of a patient in acute distress from arthritis pain when a commonly used anti-inflammatory, Naproxen, suddenly became unavailable. Eventually, a very small quantity was found, but the patient was forced to use it sparingly, not as she had been prescribed, as none of the alternative anti-inflammatories would have been suitable for her.

My hon. Friend the Member for Redcar (Anna Turley) shared with me a photo of a poster from Pharmacy Magazine, which has gone up in her local hospital. It says, “Please don’t blame us for the NHS medicine shortages. It is a nationwide problem. Please ask your local MP to help.” The poster included contact details of local MPs handwritten on the bottom. We very much hear those concerns, and we are here to ask the Minister to get a grip on this problem.

Shortages are caused by a combination of different issues. The implications of Brexit are inevitably a factor that will play out over the coming weeks and months. However, we know that the NHS and the UK are potentially losing out to more profitable and attractive markets. In addition, the stockpiling, as a precaution, of certain drugs that are harder to source, coupled with the deliberate and more alarming manipulation of the markets by some wholesalers to deliberately push up prices, is having a detrimental effect. New regulations are also having an impact on manufacturing processes.

On top of that, cash flow is a massive challenge in community pharmacies. Community pharmacies pay out for drugs and are reimbursed by the Government the following month. The situation is made even tougher still, however, because they are not always reimbursed what they have paid out for drugs, particularly for drugs that are in short supply. By law, pharmacies have to do everything in their power to source a drug and dispense it, even where prices have become inflated due to a shortage. Let us take Naproxen as an example. One of my local pharmacies tells me that earlier this year the cost of a box shot up from about 26p to about £15. The tariff price paid by the Government to reimburse pharmacies for Naproxen peaked around February, at £12.50 a box. The medicines shortage is having the perverse effect of forcing pharmacies to dispense at a loss. In previous budgets, there might have been just enough for the pharmacy to absorb this cost. Those days are long gone. The system is clearly no longer fit for purpose.

Earlier this year, the Government introduced the serious shortage protocol in the Human Medicines (Amendment) Regulations 2019. It was intended to be a safety mechanism to help cope with any serious national shortage. It gives pharmacists the ability to dispense a reduced quantity, alternative dosage form or generic equivalent to that stated on the prescription. There would be a small payment to pharmacies for undertaking that process. Despite pharmacists and GPs feeling that they are spending unprecedented amounts of time sourcing medicines or researching alternatives, not a single drug has appeared on the list, which means that pharmacies and GPs do not get paid any extra to compensate them for the time they now have to dedicate to that element of dispensing.

Although there are no drugs on the serious shortage protocol, there is a separate concessions list, which acknowledges that, due to a shortage of a drug, the price has changed. At the end of September, there were 45 drugs on that concessions list. Again, inclusion on that list does not acknowledge the time involved in having to source the drugs, which is becoming the largest part of the pharmacist’s day. Nor is there any attempt to fund that work.

There was some hope for community pharmacies more broadly in the community pharmacy contractual framework published in July, which takes effect from October 2019 through to 2023-24. The five-year deal commits to not cutting the budget any further. However, when inflation is taken into account, it will still see pharmacies unable to meet costs, for all the reasons I have outlined.

Strangely enough, what the framework does do is realise the potential for pharmacies to alleviate pressures on the wider NHS, paving the way for a much more integrated approach. The 111 service is now able to refer a patient directly to a pharmacy for an appointment. The framework seeks to expand the delivery of clinical services in pharmacies. It is all great stuff, which is very welcome, but I return to the clear warning given by the then Minister back in 2016 that between 1,000 and 3,000 pharmacies will not be viable and will be forced to close if overall funding does not increase.

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

I congratulate the hon. Lady on securing the debate. Given the pressures all our A&Es and acute hospitals face, does she agree that the community pharmacies in many areas across the UK do a magnificent job—particularly those specialised pharmacists who relieve the pressure on A&Es? If community pharmacies are put at risk and we lose them, there will be even more pressure on our A&Es and acute hospitals at a most awkward time for our society.

[Holly Lynch]

I could not agree more. I thank the hon. Gentleman for making that important point. It was very welcome that in the community pharmacy contractual framework—for the first time, I think—the Government really did understand that. However, the funding to allow pharmacies to survive long enough to deliver those services has not been forthcoming. For all its aspirations to deliver more clinical services, a pharmacy that has been forced to close can deliver diddly-squat. Does the Minister accept that community pharmacies’ potential will be realised only when they are funded to survive?

Like many colleagues, I am incredibly concerned about the impact of medicine shortages, both on the NHS and on patients themselves. It is contributing to the mix of factors that are piling unbearable financial pressure on our local chemist shops. I hope the Government have a plan to respond and keep our trusted, effective community pharmacies open.

[Several hon. Members rose—]

Living with Dementia

Holly Lynch Excerpts

Tuesday 25th June 2019 Westminster Hall

[Holly Lynch (Halifax) (Lab)]

As always, Mr Paisley, it is a pleasure to serve under your chairmanship. I join colleagues in paying tribute to my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) for her leadership and for the compassion she shows in everything she does. I am a Dementia Friend because of her, having attended one of her workshops here in Westminster in 2016. I have since become a dementia champion and was asked by the Alzheimer’s Society to run its workshop for Dementia Friends at the 2016 Labour party conference to 80 colleagues and members, which was quite a challenge for my first workshop. I am incredibly proud to have played a very small role in training some of the UK’s 2.8 million Dementia Friends and sending them out into their communities to make them that bit more dementia-friendly. Once again, I pay tribute to my hon. Friend for her role in that.

This debate gives us an opportunity to evaluate where we are against the aspirations set out in the Government’s Challenge on Dementia 2020, but also to shine a spotlight on some of the good work that is being done at a grassroots level—not least in Halifax, thanks to some truly inspirational and passionate volunteers. As we have heard time and again, 850,000 people are living with dementia in the UK, a figure that is expected to double by 2040. One in 14 over-65s is living with dementia. If that is not an incentive to us all to do everything we can while we are able and empowered to do so, I do not know what is.

I recently wrote to older people in the Sowerby Bridge area of Halifax on behalf of the campaign to make Sowerby Bridge a dementia-friendly town, and invited them to a day of action to learn more and see the support available in their area. That campaign is driven by Shabir Hussain of Bluebird Care in Calderdale, who is a thoroughly committed community activist, along with Chris and June Harvey, who are truly dementia champions, and who run the wonderful Memory Lane Café for people with dementia and their carers. With their trustees and volunteers, Chris and June run pop-up cafés in churches and community centres in Sowerby Bridge and Halifax, with a dementia-friendly programme of games and crafts, information and support, cakes, music and conversation. Some 540,000 people in England alone care for those with dementia, and estimates suggest that one in three of us will be involved in caring for someone with dementia at some time in our lives, so a dementia-friendly environment that offers a thoroughly positive experience for all those involved in living well with dementia makes a massive difference to the regular attenders.

We also have a young onset dementia and Alzheimer’s group, or YODA for short, which was set up by Julie Hayden and provides support for younger people with dementia and for their carers and families. As we have heard, it is often overlooked that 42,000 people of working age live with dementia. Their requirements can be quite different. People diagnosed with dementia at that time of life usually present between the ages of 30 and 65 and are most likely in work, potentially with dependent children, older parents to care for or financial commitments such as a mortgage to consider. For that group, as other hon. Members have said, living well requires a different support package from that required for over-65s.

I would be remiss not to highlight the work of Inspector Neil Taylor of West Yorkshire police, who is a dementia champion and the chair of Dementia Friendly Todmorden. He has gone over and above in promoting best practice within West Yorkshire police and his local community—all credit to him. West Yorkshire police have introduced the Herbert protocol, named after George Herbert, a veteran of the Normandy landings who lived with dementia. The police and other agencies encourage family and carers to complete a form with useful information that could be used in the event of a vulnerable person going missing. The form includes vital details such as medication required, mobile numbers and places previously located, along with a recent photograph. In the event of a loved one going missing, the form can be handed quickly to the police to speed up the search and assist in supporting that person, who may be lost and confused when they are located. I recommend that all forces adopt such a protocol as soon as possible.

We are blessed with dedicated volunteers who have made Calderdale a better place to live with dementia, but what if Shabir, Chris and June, Julie, Neil and others like them were not there? The environment might be quite different without their leadership. How can we ensure that such work is supported and replicated elsewhere?

I give credit where it is due. David Cameron’s Government launched the dementia challenge in 2012, which sought to create dementia-friendly communities, with work led by the Alzheimer’s Society; drive improvements in health and care; and improve research, with a commitment that funding for dementia research be doubled to more than £66 million by 2015. Under Dementia Challenge 2020, as the programme was called when it relaunched in 2015, the Government committed to investing more than £300 million in dementia research and medical innovation.

It has been estimated that dementia costs the UK economy £23 billion a year, which is more than the costs of cancer, heart disease or stroke. With the numbers of people living with dementia expected to double by 2040, predicted costs are expected to treble alongside that increase. For anyone not yet won over by the human arguments for committing to research for dementia, the economic arguments speak for themselves.

To be fair to David Cameron, I believe that he understood the issue. I hope the Minister can assure us that she will seek to make it a continuing priority for the incoming Prime Minister. However, there are still areas in which I would like to see things standardised across the UK to support people, particularly younger people, who live with dementia, as well as their families and carers. To have a dementia diagnosis in the workplace, with dependants or financial commitments, must be incredibly daunting, but with a renewed focus on that group, and with changes to our understanding of the support that those demographics need to live well, we can make a positive difference. I thank the APPG on dementia for its report “Hidden No More: Dementia and disability”, which calls, quite simply, for

“equality, non-discrimination, participation and inclusion.”

I wholeheartedly endorse those aims.

[Ian Paisley (in the Chair)]

I thank colleagues for their immensely good self-imposed discipline, which will allow the Opposition spokespersons and the Minister 10 minutes each to speak.

Social Care

Holly Lynch Excerpts

Wednesday 16th November 2016 Commons Chamber

[Holly Lynch (Halifax) (Lab)]

I really welcome the opportunity to have this debate today, and we have heard some excellent speeches. I want to pay particular tribute to my right hon. Friend the Member for Leigh (Andy Burnham), who made a powerful speech. I pay tribute to the work he has done, and to his passion and commitment to bringing health and social care together. He deserves credit for that and I wish him all the best as he takes that fight beyond this place. I think he will do great things with it.

My local authority, Calderdale Council, has already written to the Chancellor and the Secretary of State for Health to outline its concerns about the crippling underfunding of social care. Following a motion passed at full council, council leader Tim Swift has called on the Government to bring forward the better care fund, to develop a workforce strategy and to accelerate progress towards establishing a single pooled budget for health and social care in all areas by 2020. The King’s Fund report has recently acknowledged that local authorities are having to make incredibly difficult decisions about where to make service reductions, with no room to make further savings. The report goes on to state that without further funding, most councils will soon be unable to meet even their basic statutory duties.

At a time when we are having yet another rethink about how we organise and structure NHS services with the sustainability and transformation plans, the NHS Confederation, which brings together all the different organisations that make up the NHS, has said in its representation to the Treasury that if the Government continue to fail to provide the right conditions to transform the service into one that is sustainable for the future, a tough challenge will become an impossible one. It cites the decisions to cut spending on public health through the local authority grant and to delay much needed social care funding until later in the Parliament as examples, saying that while there is no doubt that these decisions have made short-term savings for the Treasury, there are strong indications that this will come at the expense of significant long-term costs and could hinder the transformation that we all want to see. Rob Webster, the chief executive officer of South West Yorkshire Partnership NHS Foundation Trust and the lead on the West Yorkshire and Harrogate sustainability and transformation plan, made this clear when he said:

“We must invest in social care and public health. Our STP shows quite clearly that modern health and care services focus on the whole person—and that means their mental, physical and social care needs. If we do not invest in social care and prevention, we may not have a sustainable NHS at all.”

I recently spent time with the Yorkshire Ambulance Service in my constituency, and I was particularly interested in how the paramedics would be affected by the proposed downgrade of services at Huddersfield royal infirmary. It was clear to me just how many ambulance call-outs, and consequent hospital stays, could have been avoided if appropriate mental health provision and social care had been in place. We visited an older gentleman who had initially simply become dehydrated. He had grown increasingly confused and, in his confusion, he had stopped taking his medication. His neighbours called an ambulance when they realised that he had become quite unwell as a result. According to the paramedics, that was not unusual and they would expect to see a number of similar calls over the course of a 12-hour shift. He was a proud man and was clearly distressed to think he had caused a fuss. That ambulance call-out and hospital stay could have been avoided had social care been in place, empowering him to live well in his own home and saving the NHS the cost of more serious interventions later on. That experience reinforces the case made by the NHS Confederation to the Government that without the appropriately funded delivery of mental health support and social care services, attempts to transform the NHS into a more sustainable model are doomed to fail.

Another issue that I want to touch on is respite care. My constituent, Mrs Burrows, came to see me in tears last week. Her elderly mother has Alzheimer’s and a variety of related health complications. Following an assessment, Mrs Burrows was allocated eight weeks of respite care a year for her mum. Despite this allocation, she has to work with social services to find an appropriate establishment that is able to care for her mother. She also has to make the arrangements, but she struggles to find a place for her mother in residential care because temporary beds are just not available. Part of the problem is that she is able to book respite care only a week in advance, which means that she cannot plan ahead. She finds it difficult to book holidays or confirm her attendance at family events such as weddings. Mrs Burrows was particularly distressed because her daughter required urgent medical treatment and she desperately needed to find respite care for her mother so that she could look after her grandchildren while her daughter had the treatment. However, there were just no beds available.

I want to take this opportunity to commend the Alzheimer’s Society for the work it has done with its Dementia Friends programme, which, as of 1 pm today, has trained 1,752,419 friends, all of whom now have an enhanced awareness of what it takes to support someone to live well with dementia. It is a massive achievement, and I am proud to be one of those dementia friends. Worryingly, however, research undertaken by the Alzheimer’s Society found that 38% of homecare workers do not receive any dementia training and that 71% do not receive dementia training that is accredited—despite the commitments made in the Prime Minister’s challenge on dementia. Some 850,000 people are living with dementia in the UK and an estimated 400,000 of those are in receipt of some form of home care. The scale of the challenge is huge, but if we do not start working on finding the answers to both the availability and the quality of social care now, imagine the crisis we will be facing in five, 10 or 20 years’ time.

Without an injection of investment into social care, we will have no chance of balancing the demands on the NHS. Good, proactive social care would require investment but it is not just the right thing to do; it would ultimately be cost-effective and prevent more costly and avoidable interventions later on.

Budget for Community Pharmacies

Holly Lynch Excerpts

Tuesday 24th May 2016 Commons Chamber

[Michael Dugher]

My hon. Friend is right. A modern community pharmacy of the type he referred to has so much to offer patients—from free medical advice and dispensing prescriptions to, crucially, reducing strain on other NHS primary care services.

Community pharmacies are of growing importance. Figures from the Health and Social Care Information Centre show that since 2005, the number of prescriptions dispensed has risen by 50%, with over a billion items dispensed in the community last year. There have been increases in the number of items dispensed every year for the last decade, as community pharmacies have become more important for public healthcare. Staff at community pharmacies, trained pharmacists, technicians, dispensers and counter assistants are often the first port of call for an unwell patient or indeed a carer. Some 1.2 million health-related visits are made to community pharmacies across the country every single day—more than to any other primary care provider. The average person visits a pharmacy 14 times a year, and there are 11,500 community pharmacies across England.

[Holly Lynch (Halifax) (Lab)]

Where we have seen quite serious reorganisations of NHS services and A&E departments downgraded, part of the justification for it has been the role of pharmacies in delivering the “care close to home” agenda. If we see anything in the region of 3,000 pharmacies close across the country, that will raise very serious questions about how we have reorganised our existing NHS structures.

[Michael Dugher]

My hon. Friend is exactly right. I know what a formidable campaigner she has been on this issue in her local community. I pay tribute to her, and not simply because she is also my Whip and occasionally allows me to go home—though I would not rule it out as a contributing factor!

The community pharmacy network is made up of trusted local chemists who are rooted in the communities they serve. I do not doubt that the Minister and his Department share with me an understanding of the vital importance of community pharmacies. Indeed, in the Government’s own letter last December to the Pharmaceutical Services Negotiating Committee, which announced the cut, it was stressed that community pharmacies must be at the “heart of the NHS”. The letter went on to praise the excellent work of community pharmacies

“in prevention of ill health; support for healthy living; support for self-care for minor ailments and long-term conditions; medication reviews in care homes; and as part of more integrated local care models.”

That is all true, so why on earth are the Government pressing ahead with a massive arbitrary budget cut for community pharmacies that will, by the Minister’s own admission at a meeting of the all-party pharmacy group in January, potentially force up to 3,000 local chemists to close?

A properly funded and well-resourced community pharmacy sector is vital for enhancing public health, reducing risk to the public and mitigating downstream costs to the NHS. This is the key argument. In his response, the Minister will no doubt rightly draw on the financial pressures facing the NHS, but is not this cut in the community pharmacy budget a false economy? By contributing to improved public health—frankly, by heading off some people at the pass—our community pharmacies prevent patients from resorting to visits to the GP surgery or the local hospital.

The Government’s timing could not be worse We need our community pharmacies more than ever, given that we have an NHS that is so self-evidently in crisis. A&E departments are under enormous pressure on the Government’s watch. In the three months to March this year, only 87.9% of patients visiting them were seen within four hours, which missed the Government’s own target of 95%. Despite the brilliant efforts of NHS staff in my own area—which was visited recently by my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), in his capacity as shadow Minister—the figures were even worse, and, indeed, were going backwards. Just 86.7% of patients were seen within four hours in Barnsley Hospital’s A&E department, down from 87.2% in February and 89% in January.

Cutting the budget for community pharmacies will do nothing to alleviate the crisis. In fact, Ministers risk deepening the problems that face our A&E departments by removing access to the medical advice that those pharmacies offer before patients feel the need to go to hospital.

Cosmetic Surgery

Holly Lynch Excerpts

Tuesday 20th October 2015 Commons Chamber

[Ben Gummer]

I am afraid I do not have an answer to the hon. Gentleman’s question, but I will make sure we write to him if such figures exist, although I suspect they may not. Let me inquire, and then I shall reply to his question.

Let me turn to the broader policy issues to which the hon. Member for North Durham referred. He referred to Sir Bruce Keogh’s review. It began in January 2012 after the PIP breast implant scandal. It covered the rapidly growing non-surgical cosmetic market. He published that review in 2013 and it highlighted the rapid growth of cosmetic interventions, and suggested safeguards among 40 recommendations to protect patients. The aim of those was to improve how surgical and non-surgical interventions were done, to set standards for training practitioners and surgeons and for how supervision from regulated healthcare professionals can support self-regulation of the industry, and to improve the quality of the information clients have to ensure they are able to make informed decisions about their treatment. The Government published their response in 2014.

By the time of the publication the Government had already started work on a number of the recommendations. To address the issue of proper training for cosmetic practitioners, the Royal College of Surgeons set up an inter- specialty committee with representation from the relevant specialty associations and professional organisations including plastic surgery, ear nose and throat, oral and maxillofacial surgery, breast surgery, urology, the Royal College of Obstetricians and Gynaecologists, the Royal College of Ophthalmologists, the General Medical Council and the Care Quality Commission. The committee also includes patient and provider representation, and representatives from the devolved Administrations are invited as observers.

The committee established three sub-groups which are taking forward the work to implement the recommendations. They cover standards for training and certification, clinical quality and outcomes, and patient information. The committee is also in the process of developing an overarching framework for certification to improve the safety and delivery of cosmetic surgery. Individuals performing cosmetic surgery will be expected to practise within their field of specialty training. The framework for certification takes into account equivalence for non-UK-based surgeons.

[Holly Lynch (Halifax) (Lab)]

I thank the Minister for giving way, and I thank my hon. Friend the Member for North Durham (Mr Jones) for bringing this important debate to the Chamber. PIP has been mentioned, along with the regulations that are in place in this country. I want to ask how we need to work with our European neighbours to ensure that we get the regulation right. We have heard about doctors coming from Italy to practise in this country, for example, and we know how PIP, which started in France, has impacted on patients in the UK. What work is the Minister doing to ensure that we co-operate across Europe to close any loopholes in this area?

[Ben Gummer]

The hon. Lady has touched on a complicated and diverse subject. I will happily talk to her when we have more time about what the Department is doing and what we are doing within the European Union to ensure the transferability of qualifications. A considerable amount of work is being done, and the GMC has tightened up a whole number of areas to ensure that we allow only the highest quality of practice in this country, while allowing people to travel through the European Union to practise using their qualifications.

I want to turn now to training for non-surgical interventions. We asked Health Education England to develop a new qualification framework for providers of non-surgical cosmetic interventions, and for those required to be responsible prescribers, that could apply to all practitioners regardless of previous training and professional background. Health Education England has now completed its review of the qualification requirements and will publish its recommendations shortly.

The issue of breast implants initiated the review by Sir Bruce Keogh. The review placed particular importance on systems that can precisely identify the complete cohort of patients in which a specific implant has been used. It recognised that being able to monitor the device implementation and performance for clinical outcomes and tracing of patients at risk of device failure was an important safety issue. There has been a range of responses, involving the Medicines and Healthcare Products Regulatory Agency, the Health and Social Care Information Centre, the Committee of Advertising Practice and the Broadcast Committee of Advertising Practice, and a whole series of recommendations has been enacted following the review.

Turning to legislation, we know that there are examples of high-quality surgical and non-surgical intervention, as I am sure the hon. Member for North Durham would agree, and it is those standards that we must make universal. I am aware of the arguments in favour of legislation as a way of reaching those standards—for example, through the statutory regulation of the non-surgical sector or new powers for the GMC. However, it does not follow that we must depend on legislation alone to meet the fundamental objectives of the Keogh review. Much has been achieved already and there is much more to do.

I know that the hon. Gentleman understands the pressure of competing priorities on parliamentary time. The calendar for legislation is full at the moment, as he knows, but we now have an opportunity to review and monitor the impact of non-legislative action before confirming whether new legislation would add significant value to safeguards for people choosing cosmetic procedures. We will continue to be advised on that by Sir Bruce and others as the safeguarding framework continues to develop. I can give the hon. Gentleman a personal assurance that I will ensure that the review of the non-legislative remedies is thorough, and that if it is found wanting, we will immediately look again at the subject with a view to taking further action.

We are grateful for the support of the Royal College of Surgeons and its partners and for the extremely thorough work that they have done so far. We are also grateful to the General Medical Council and the Care Quality Commission. In the light of the continuing work that I have outlined, I hope that the hon. Gentleman will agree that we are in a far better position now than we were before Sir Bruce’s review to help to protect the public and ensure proper training and oversight of non-surgical as well as surgical cosmetic interventions.

On the specific questions that the hon. Gentleman raised about his constituent, I commit to returning to him with an answer on the doctor he mentioned and the insurance that he will be required to have. I will also give him a specific answer on the cost to the NHS and any work that we might do on cost recovery, and on the specific guidance on the advertising of surgical procedures. I hope also to be able to get to the bottom of the nature of the sales techniques and the claims made by the hospital that he has mentioned, to ensure that it is practising in accordance with the standards that would be expected of a decent, reasonable organisation doing what it purports to do. I thank the hon. Gentleman very much for bringing this case to the Government’s attention.