There have been 6 exchanges between Holly Lynch and Department of Health and Social Care
|Tue 8th September 2020||Covid-19 Update||3 interactions (117 words)|
|Mon 13th July 2020||Independent Pharmacies||3 interactions (132 words)|
|Mon 7th October 2019||Hypermobility Syndromes: Healthwatch Calderdale’s Report||5 interactions (123 words)|
|Wed 2nd October 2019||Community Pharmacies (Westminster Hall)||4 interactions (1,714 words)|
|Tue 25th June 2019||Living with Dementia (Westminster Hall)||3 interactions (1,095 words)|
|Wed 28th June 2017||Health, Social Care and Security||3 interactions (783 words)|
This is another important question about how we can provide support locally, especially in the west midlands, where it is so important, especially with cases rising, not only that we have the national response that we are discussing in this Chamber, but that we ensure that the local community, which my hon. Friend supports so effectively, can get the support it needs. I am happy to write to her with details of the extra funding that we have put into her area and to discuss with her what more might be done.
We look at the issue of restrictions in Halifax every week. Calderdale has seen a fall in the number of cases; it is an example of a local lockdown being effective. I was really pleased that we were able to take some parts of the local authority area out of the restrictions 10 days or so ago now, and it was very good to be able to make that progress. I accept that we had to leave Halifax in the restrictions and I look forward to working with the council and with the hon. Lady and other local colleagues. We shall consider the matter again this Thursday.
It is a pleasure to open this debate, which was prompted by a letter from an independent pharmacist in my constituency, Mr Tim Gibbs, who runs the Yarmouth pharmacy. Those who know it will know that it is not far from our beautiful harbour in Yarmouth and just opposite Yarmouth castle. I am delighted that this Minister is on the Front Bench, as I know she is a great supporter of pharmacies, pharmacists and indeed independent pharmacists. I am aware that the Health Secretary spoke at the National Pharmacy Association today. He spoke eloquently on the need for a major winter flu vaccination programme, which, clearly, we would welcome.
I will not speak for too long, as I am aware that one or two others wish to speak and it is getting late in the day, but I wish to cover some of the issues of concern to not only pharmacists, but independent pharmacists, who are especially important in isolated and rural communities, as other Members here, including those from places such as Cornwall, will testify. I have six independent pharmacists in my patch and all are highly valued. They include Tim in Yarmouth, Freshwater, Seaview, Ryde and Regent, which covers both East Cowes and Shanklin. I am grateful to Gary for taking the time to chat last week about some of the issues that have faced him.
Although many healthcare providers closed their doors during the covid pandemic, pharmacists stayed open, often at risk to themselves and their staff. For many people in our communities, NHS pharmacies were the visible face of healthcare on the high street. It is to their great credit that they stayed open and continued to serve their patients, often delivering medicines, at their own cost, to the homes of vulnerable and at-risk patients to make sure that those patients had what they needed. Pharmacy staff saw patients in person and ensured that the public—particularly vulnerable patients—had a consistent and safe supply of medicine. In doing so, they took considerable pressure off other elements of the health service, including GPs, who were often answering calls on the phone, and A&E.
However, I know from talking to Tim, Gary and other pharmacists in my patch that they face considerable financial insecurity on top of all the other problems. That is worse for pharmacists such as Tim who have to rely on over-the-counter trade. In Yarmouth, where there are a lot of yachts at weekends, he can usually make up the decline of income in other areas by selling soap and all the other good things that chemists sell, but in the covid period those sales took a significant hit. The same has been true for the independent pharmacies and many of the chemists in my patch. They have incurred many thousands of pounds in additional monthly costs from staying open and serving the community, and some of my independent pharmacists have even relied on volunteers.
Pharmacies have paid for the costs of installing screens, buying PPE—although I think the Isle of Wight Council helped Tim out after he requested it on a couple of occasions—hiring locums, paying overtime and absorbing the increases in the wholesale prices of medicines, which pharmacists are not allowed to pass on to their customers. That has created serious cash-flow problems.
I am very grateful, as we all are, that the Government provided £300 million in emergency loans to the sector at the outset of the crisis and have provided an additional £70 million since. Those are significant sums of money. The loans are, however, something of a sticking-plaster solution to cover the immediate covid costs that pharmacists have incurred and to make up for the longer-term shortfall. If pharmacists are left holding the bag for the costs that they have incurred through serving their communities in the past few months, many of them, including Tim, are worried that they will be forced to shut down in the next year or two. I believe that that would be a national shame. The ongoing uncertainty is an additional burden that pharmacists just do not need.
All pharmacists are valuable and they all play an important role. but because independent pharmacists are embedded in their community and represent a friendly, valued and, above all, trusted voice, they take pressure off A&E, GP surgeries and other areas of the NHS. On the Island, the number of GPs sits at roughly the average, but as the Minister well knows, we are struggling somewhat to make sure that there is an adequate supply of GPs to provide the primary care that this country needs.
I know that the Minister is a friend to pharmacists. Can she say something to reassure pharmacists—especially the independent ones—in my constituency and many others that the Government understand their valued and somewhat unique role, over and above chains of pharmacies, and that the Government wish to support them?
I thank the hon. Member for making that point. I was just about to quote those statistics myself, but I thank her for teeing up the next bit of what I would like to say.
As I understand it, the budget for community pharmacies is £2.6 billion—a significant amount of money but quite a small proportion of the NHS’s total budget. It stretches to cover some 11,500 community pharmacies, serving the majority of the population of the United Kingdom—about 56 million people. On average, each one serves about 5,000 people per month and dispenses 7,300 prescriptions.
In the last four years, as the hon. Member says, the funding for pharmacies has shrunk by a significant amount; I am quoted a figure of approximately £200 million. Tim and other pharmacists in my patch are concerned that there is now going to be significant additional pressure, and we have seen statistics to suggest that up to 3,000 pharmacies could close for good. That has not happened yet; these are threats. Some have closed, but the majority are still struggling on.
I believe that would be short-sighted in the extreme. I am sure the Minister agrees that a sustainable pharmacy sector is a critical part of the NHS network in this country because, as I said, it takes pressure off both A&E and GPs. We badly need it. Having used an independent community pharmacy myself, I know the added value of having somebody trusted to talk to, whether about a bunged-up ear because I swim too much—well, not at the moment—or about more serious concerns.
NHS pharmacies are ready and willing to support the test and trace programme—something I have knowledge of in my patch due to our experience trialling the app, which sadly was not taken further. They could help to ensure support for test and trace, for home testing kits, and certainly for the winter vaccination programme, which is likely to be of increased significance this year because of the potential for phase 2 of covid, which clearly we all hope does not happen.
There is strong public support for community pharmacies. A recent opinion poll showed that 81% hold a favourable view of pharmacies, 78% value a face-to-face relationship—I wish Members of this House had those sorts of approval ratings; we live in hope—and more than half want to see emergency covid funding turned into a permanent grant versus the significantly smaller amount who want to see it repaid.
Crucially, the public are ahead of the health bureaucracy in seeing the benefit of having this network of highly trained healthcare professionals in many communities in Britain; 84% say that the NHS should do more to make use of pharmacists’ skills. It does seem to be a bit of a wasted resource when we have people with so much skill and ability in dispensing medicine and in being the first port of call for many when they are feeling under the weather.
Some 71% of people think pharmacies should be able to expand their offering to take pressure off the NHS. I completely agree. I wonder how we can work towards that betterment, which is certainly in all our interests considering the relatively small amount of money compared with the overall NHS budget that goes towards pharmacies, specifically community pharmacies.
I will round up and let other Members speak, but may I tempt the Minister to talk about how she can support community pharmacies—the six in my patch but also the 11,500 across Britain? What can she say to reassure us that the financial support will be there? Losing independent pharmacies would be much more expensive in the long run than providing modest additional sums to ensure that we help keep their pharmacy businesses viable, especially during the covid period, when other elements of their business—the cash trade of the chemist—have clearly been declining. I very much look forward to her response.
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.
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.
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.
Order. I will call the three Front Benchers at 10.30 am. Several Back Benchers wish to speak. I will not put a time limit on speeches, but if hon. Members keep them to about seven minutes or less, everybody will get an opportunity to speak.
Thank you, Mr Paisley, for allowing me to speak in this important debate. It is a pleasure to serve under your chairmanship. I congratulate my hon. Friends the Members for Oldham East and Saddleworth (Debbie Abrahams) and for Cambridge (Daniel Zeichner) on securing this important debate, and commend their work on the all-party parliamentary group on dementia.
The scale of the challenge of dementia is well known, but it bears repeating. In the UK, some 850,000 people live with dementia. That is set to double by 2040. Of course, the figures do not capture the great many other people whose lives are touched by dementia, most obviously family, friends and carers. With so many people affected by dementia, we need a comprehensive and joined-up approach that supports people and their families as soon as they are diagnosed. This must involve health, social care, local government and voluntary organisations.
There is a great deal of innovation and good practice. We must do all we can to ensure that it is shared as widely as possible, which is why I entirely agree with the Alzheimer’s Society that we need a national strategy on dementia. Of course, it is hugely important that the strategy is fully funded. I urge the Government to consider that in the upcoming spending review.
When thinking about a joined-up approach, we should look at the lessons from the integrated personal commissioning pilots. IPC, a partnership between the Local Government Association and NHS England, aims to integrate healthcare and education services around people rather than organisations. It focuses on an individual’s needs, along with the available community and peer support, to build their confidence and skills for self-managing long-term conditions such as dementia. It seeks to offer choice and control to patients by widening access to integrated personal budgets and developing more options to help people to achieve their goals.
An important point that the Alzheimer’s Society has raised is the need to ensure that people with dementia understand the information that they receive. What is told to people with dementia is not always the same as what they receive and understand. Given the nature of the condition, it is vital that medical professionals and others continually ensure that people are empowered by what they are told.
That point leads me on to the need for improved education about Alzheimer’s and dementia. I pay tribute to the Alzheimer’s Society’s Dementia Friends initiative, which has spread awareness and has seen 2.75 million people—including me and others in my office—become Dementia Friends. However, there is still poor knowledge among much of the public and some medical and care professionals about Alzheimer’s, dementia and what can be done to help people with the disease.
The Department of Health and Social Care should consider implementing a dementia awareness campaign to increase understanding of the symptoms of dementia and the interventions and treatments that can slow the progress of the disease, and to support people with dementia and their carers to lead independent lives for as long as is appropriate. The Government must do more to improve standards within the social care workforce to meet the needs of people with dementia, including by funding training to tier 2 of the dementia training standards framework for everyone who works in adult social care or interacts with people with dementia.
Finally, I turn to the support that we must provide for carers. I pay heartfelt tribute to the many thousands in this country who care for people with dementia and a whole range of other conditions. Out of love, they provide selfless care and deserve our utmost respect. Much more help must be given to those who care for people living with dementia. Carers need a wide range of practical, emotional and financial support. For instance, in its recent report on dementia and disability, the APPG on dementia found that carers need more support to know exactly what financial help they are entitled to, as well as how to make a successful claim. Carers are also time-poor and have little energy and—dare I say it?—headspace left after meeting the demands of caring for someone 24/7. The agencies involved need to take a more proactive approach to ensure that carers can claim the financial help they need, because they are entitled to support for the care they give their loved ones.
As we have heard, the Government’s aspiration to make the UK the best country in the world for dementia care and support is welcome, but it must be met with action and funding to make it a reality. I hope the Minister makes those commitments today.
First, let me pay tribute to the hon. Member for South Antrim (Paul Girvan) for an eloquent maiden speech. He speaks with true pride for his constituency; it is clear that he is very proud of the community he comes from and now represents in this House. Secondly, I wish to thank my constituents for returning me as their Member of Parliament for the second time in 13 months. We are a little election-obsessed in my constituency, although I am hoping for a period of calm, as I am sure are my constituents. Serving in the House of Commons is the greatest honour imaginable, and I am extremely grateful to my constituents for returning me to this place.
In recent months, some of the most dreadful tragedies of modern times have been met with the resolve of those in our public services, who, through their bravery and skill, have surely saved far more lives than were lost. The emergency services in my constituency are world-class. Although they are often strained by the budgetary cuts of this Government, my constituents often remark on how hard-working and friendly our local police, fire and ambulance services are. They have my utmost gratitude and support for protecting our towns and villages, and I am proud to share the same community as them.
I was disappointed that the only mention of the emergency services in the Gracious Speech was in a vague allusion to police powers. We should not take our emergency services for granted, but under this Government I feel that has become the norm. Instead of heaping praise on the police, fire and ambulance services, and listening to their expert advice on how they could be better supported, this Government have cut to the bone at every opportunity. The fire service, whose heroics have been recognised again in the recent Grenfell fire, has seen 10,000 personnel and 41 stations cut since 2010. The police, to whom we personally owe our lives and health for keeping us safe during the Westminster attack just beyond our gates, have seen 20,000 officers cut in that same period. Our armed police, who during the London Bridge attacks neutralised the situation in minutes, have been reduced in number by 1,000.
We live in unprecedented times, and the first half of 2017 will be recorded in history as a time of tragedy for our country. I challenge any Member to stand before this House and say that they believe the Government have best supported our emergency services to tackle such events; the services themselves clearly believe they have not. The Police Federation has made it clear that the police are struggling under Government cuts, saying that there is no ignoring the fact that the police simply do not have the resources necessary in the light of recent events. Previously, as Home Secretary, the Prime Minister accused the Police Federation of “crying wolf” over the impact of the Government’s cuts. Clearly, the Government believe that they know better than the police.
The Fire Brigades Union has made it clear that firefighters do not have the resources that they need. It says that cuts have put the public at risk, which is evidenced by the increased number of fire deaths. It says that firefighters could soon lose their lives as a result of cutbacks, and that many no longer feel safe or supported. The Government believe that they know better than the fire service and have pressed on with austerity measures regardless.
In the Gracious Speech, there was no indication of increasing resources for emergency services. Instead, the Government signalled that there would be legislation to paper over the cracks with increased powers. I will wait until the Bill is debated before giving my further thoughts on increasing police powers, but I am concerned that yet again, this ignores the lack of funding and resources.
Only last week, the Home Secretary conceded to this House that police resources are very tight. Austerity may initially have been driven by ideology, but now that even the Home Secretary understands the strain, it is only dogma that continues to drive implementation of the cuts. It does not have to be like this, and under a Labour Government, it would not be. As long as the Government ignore our emergency services and their cries for increased resources, they cannot pretend to protect our country.
I thank the people of Wirral West for returning me to this place.
We learn from this Queen’s Speech that the Government intend to do nothing to stop the fragmentation and undermining of the national health service that the last Conservative Government pursued with so much determination. In my constituency, many are very concerned about Cheshire and Merseyside sustainability and transformation plan’s shortfall of just under £1 billion and what that will mean for the service. The Government could have chosen to address that, but instead they have left services in Wirral and elsewhere across England to struggle to maintain levels of care. Board meeting papers of April 2017 show Wirral University Teaching Hospital NHS Foundation Trust with an operating deficit of £11.9 million in 2016-17. The effect is being felt by patients and staff, and targets for A&E waiting times, bed occupancy rates and GP referrals are being missed.
Staff morale is rock bottom across the NHS, bringing with it recruitment and retention problems. We have seen junior doctors striking and looking for work abroad. The Royal College of Nursing criticised the Prime Minister’s failure to scrap the public sector pay cap in the Queen’s Speech, and warned that failure to do so will result in an historic ballot of 270,000 nursing staff, signalling a summer of protests by nurses. But it is not only clinical staff who deserve fair pay. In my constituency, NHS administrators from the Wirral Community NHS Foundation Trust are seeing their roles downbanded from band 3 to band 2, which would mean they are paid below the Living Wage Foundation’s voluntary living wage for the first five years of employment. I recently met some of the women affected and they told me of how clinical staff, some on band 7, are being required to carry out some of their administrative tasks. That cannot be an efficient or effective way to run a service. It is an attack on the pay and conditions of administrative staff who play a vital role in the delivery of safe patient care. Hardworking clinicians should receive the full administrative support that they need to deliver care, from staff who should be valued for the important part that they play in the delivery of services in our NHS.
In addition to the cuts and rationing of the STP programme, the Government have quietly ushered in further initiatives, putting the squeeze on the national health service. The Naylor report recommends the accelerated sell-off of NHS land and buildings. The capped expenditure programme undermines the very founding principles of the NHS and requires senior health managers in 14 areas of England to think the unthinkable and impose strict spending limits in their areas. That will result in longer waiting times, closure or downgrading of services, job losses, ward closures and rationing of care. Essentially, the Government are no longer saying, “Do more with less.” They are just saying, “Do less.” Less care and fewer treatments will lead to poor health outcomes for our nation.
While the Tories’ NHS privatisation agenda has been clear for years now, their policy on adult social care, announced in the manifesto just a few weeks ago, demonstrates their approach to social security. Instead of pooling risk and developing a collective response to shared societal problems, they are replacing that approach with an ideology of, “Sort yourselves out. You’re on your own because this Government won’t help you.” Labour Members take a different view. We would restore and protect the national health service and establish a national care service of which we can all be proud.
During the general election I heard from hospital consultants from Arrowe Park hospital, the Royal Liverpool and Alder Hey, and their shocking testimony revealed a picture of overstretched staff in an under-resourced service. One consultant I spoke to said he felt that in future only the rich will have access to doctors. That is indeed a bleak vision for the future of the NHS from people on the frontline, and the Government must now take responsibility. I urge Conservative Members to change course, restore our NHS as a public service and give NHS staff the reward they truly deserve. Today we are asking colleagues to vote to end the public sector pay cap. In the light of all that public sector workers do for us, that is the very least they deserve. We owe it to them, but we also owe it to ourselves and the next generation. As we approach the 70th anniversary of the founding of the national health service, our finest social institution, let us cherish it, protect it and show how we value the staff who work in it.