Medical Cannabis under Prescription

James Cartlidge Excerpts

Monday 20th May 2019 Commons Chamber

[James Cartlidge (South Suffolk) (Con)]

It is a pleasure to follow the hon. Member for Glasgow North (Patrick Grady), who made a very good speech. It is always a pleasure to see someone fighting hard for their constituents, as we all are. He is right that all Members are mentioning similar cases, and I will also be doing so, but I first want to pay tribute to my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) and the hon. Member for Gower (Tonia Antoniazzi) for the great passion and tenacity with which they have campaigned on the behalf of those who are suffering such pain. Sufferers are looking for a way to reduce their pain, and they believe that they have found one. That is the key challenge for us.

My case concerns a four-year-old girl called Indie-Rose. Her parents Anthony Clarry and Tannine Montgomery live in Clare in my constituency. Indie-Rose has Dravet syndrome and, as we have heard in other cases, suffers from frequent terrible seizures as a result of her epilepsy. Her parents have found that cannabis-based medicine reduces those seizures dramatically—they estimate by around 75%—but it comes at a huge cost, because my constituents have had to crowdsource thousands of pounds to go over to Holland, pay for the medicine and bring it back. I strongly feel that we must examine this issue because, as others have said, that situation cannot be sustainable, especially in a country that has a free healthcare system that is designed to help not just those in need but the most vulnerable in particular.

The compound that Indie-Rose’s parents have been purchasing is artisanal and unlicensed. It is a mixture of Bedrolite and Bedica, which of course contain THC, and the single greatest issue for me is that while there is evidence about the impact of CBD, there is little evidence about THC. When I first became involved in the case, I felt that I had a duty to understand it more and to appreciate why there was resistance in what we might loosely call the medical establishment to prescribing a THC-based solution, such as that which was already being given to Indie-Rose and which was successfully, in her parents’ opinion, reducing her pain and suffering. I organised a meeting to discuss the situation in April at Addenbrooke’s hospital with some of the most senior clinicians that one could hope to have in a room, all of whom were familiar with Indie-Rose’s case. We are lucky to have hon. Members in this House with serious medical experience, but most of us are not clinicians, and none of us is the clinician in the cases that we are talking about. We are politicians, so I wanted to understand better the barriers to the NHS prescription that my constituents were seeking.

At times in this debate, the situation has been spoken of as if the argument is about whether cannabis-based medicine should be prescribed at all, but it is clearly about the type of medicines that should be prescribed. There is clearly nervousness in the medical establishment about THC. We should not hide from that point, and there is perhaps a very good reason for that point of view.

[Alberto Costa (South Leicestershire) (Con)]

Does my hon. Friend agree that the points he is making are further evidence for why the conclusions of the interim report of the NHS’s review of the situation, as requested by the Secretary of State, should be published as soon as possible? The report will help us to identify answers to my hon. Friend’s points, and it may help my constituents Evelina Lukoševičius, who is two years old, and Maya Fairlie, who is seven years old, to access this life-saving medicine—if, indeed, that is what the review concludes.

[James Cartlidge]

My hon. Friend makes a good point. I would just be cautious about using the term “life-saving”, because this is about easing pain. These medicines are not cures; they relieve the pain of seizures. However, I understand my hon. Friend’s point, as we all did.

The meeting that I organised was instructive for me in many ways. Since then, I have obviously continued to correspond with my constituents to try to explain to them the powers that I have in this case and the next steps that they need to take. When this debate came up, they emailed to ask me to put one question to the Minister. Remember, they are not being prescribed THC-based compounds; they have been offered Epidiolex, which is a CBD-based medicine. They want me to ask whether any other children with epilepsy, or any other condition—of course, it is primarily complex epilepsy—have been prescribed THC-based medicines.

That information is in the public domain in the form of a written answer. As I understand it, 110 items—items, not people—of CBD-based medicine have been prescribed, along with 16 items of THC-based compounds, six of them on the NHS. That is an important point, as my constituents want to know whether others have been granted such medicines, and clearly they have. Where is the consistency? That is the confusion. Of course we cannot know the unique personal medical facts of each case, which must always be down to the clinicians, but we now know that THC-based solutions have been prescribed.

[Sir Mike Penning]

It is fantastic that we have the time to talk these things through. We do not have one NHS because, as my hon. Friend says, some people have been prescribed this. My constituent has been completely refused CBD, and the letter came back saying, “No, Mr Penning, we don’t give homeopathic therapies.”

The fear for those who use CBD is whether the European Commission will consider banning not the prescription but the public purchase of CBD. Apparently the Commission sees it as a novelty food, which we need to discuss because a lot of our constituents use non-THC products, which are perfectly legal, to ease their pain. My constituent has just texted me to say thank you because the medical company has given her some more oil, which the CCG has refused and thus her GP cannot write a prescription.

[James Cartlidge]

I am sure my right hon. Friend’s constituent is very pleased by that intervention. He underlines the key challenge, which is that these medicines are what is known as “artisanal”. They are unlicensed, and they are not standardised pharmaceutical medicines, which can be a problem for doctors who want to know their standard chemical make-up. Doctors feel they cannot entirely rely on these medicines. The nub of it is to what extent we in this place should be pressing those who have to make clinical decisions.

My hon. Friend the Member for Henley (John Howell) said that this has to be a clinical decision, and my hon. Friend the Member for Reigate (Crispin Blunt) made the brilliant point that, if not for us, we would not be in this position and what has been prescribed so far would not have been prescribed. Let us be honest about it: this has been the result of campaigning, which is why I congratulate all those who have campaigned.

Nevertheless, this ultimately has to be clinically based. We cannot have political prescribing. It may be that applying maximum pressure has resulted in some prescription decisions. I hope that is not the case but, in reality, it may have been. We must have a consistent, transparent system that we have faith in and that leads to clinical decisions delivering the best outcomes for our constituents.

[Sir Mike Penning]

That is exactly why NHS England is reviewing the blockages in the signing of prescriptions. The Minister can confirm this, but I understand that the interim report will come out by the end of this month, and I believe the full report will go to the Secretary of State by mid-June, which is very quick for the NHS.

There has to be a level playing field. It is not for us to tell the doctors but, if a suitably qualified doctor is prescribing it, what is the blockage for my hon. Friend’s constituent and for the rest of them?

[James Cartlidge]

That is what I have been trying to understand. If I were to hazard a guess, I think there has been institutional resistance to CBD in general, but particularly to THC. In a sense, we have helped to force an open-mindedness towards it. When people say there is no evidence, what they mean is that there is no evidence from standard clinical tests. The idea there is no evidence is not true, because the evidence is our constituents’ lives and what they are seeing every day. My constituents do not go to Holland, having crowdfunded all that money, to buy something that does not work. They are parents, and we must have faith in them—by the way, all the doctors put a lot of store in that—but nevertheless, the institutions whose guidance lays the foundations for medical decisions ultimately need clinical trial evidence for it to be sustainable, in addition to individual circumstances.

I welcome the Minister to her position, which she very much deserves. My appeal to her is that we put everything we possibly can into getting that empirical evidence and undertaking those trials so that we can say to our constituents that everything is being done to ensure that clinicians can make decisions with the greatest confidence and without the nervousness we have all encountered.

Finally, and this needs to be said, I was asked in my meeting, “You do realise we are being trolled?” We have had debates in this Chamber about the horrible abuse we receive—some of us, particularly female colleagues, have received obscene abuse—but members of the medical profession are now getting the same thing. I understand the frustration of a parent who has done everything they can to support their child and who feels that the system is not helping them. That is why we are having this debate, because we want them to be supported by the system, but there can be no justification for people in the medical profession being subjected to trolling and the sort of abuse I know they have received because they feel they have to make an objective decision. They have the best interests of the patient at heart, and I have faith in the medical profession. It is nervous because of the lack of evidence, so we need to move on with trials as quickly as possible. We need to be able to give our constituents confidence that the system is fair, transparent and consistent, and is not acting in an ad hoc fashion.

--- Later in debate ---

[Seema Kennedy]

I apologise to the hon. Lady, because she did ask me that, and I am afraid I forgot to send a note to the Box. I am happy to write to her about whether that analysis has been done.

Many hon. Members, including my hon. Friend the Member for South Suffolk, talked about funding. Funding decisions are local decisions with clear local procedures. The process review is looking at this, and as I have said, it will report shortly. I call on the industry to invest in more trials, and to publish the results and the full underpinning data, because we all want to see licensed products that doctors can use with confidence.

Where there is supporting evidence, the Government and the NHS will work with companies to make the products available. Indeed, more than 110 patients are now being treated with a pure CBD extract product—Epidiolex, which numerous hon. Members have referred to—on an early access programme, ahead of a licensing decision by the European Medicines Agency. In developing a licensed product, the evidence has been generated on the safety profile and effectiveness of the product. It is this that provides clinicians with the confidence to prescribe and the system with the evidence it needs to make decisions on routine funding. The NHS does not routinely fund any new medicine until it has been through a process of evaluation to ensure that it is safe, effective and represents value for money.

On another point that the hon. Member for Gower brought up, about one of her constituents going on the Epidiolex trial, the specialist centres around the country are referring patients to GW Pharmaceuticals. There are certain criteria and a certain number of places, but if she wrote to me, I would be happy to meet her and we could discuss that further.

We need to develop further our knowledge base on these products. That is why good-quality clinical trials are imperative. We need to know more about the scale of the benefit of cannabis-based products across a wide range of indications. We also need to understand how this compares with existing treatments and, indeed, other promising new drugs that may be as effective.

[James Cartlidge]

The Minister is obviously aware that Epidiolex is a CBD-based medicine. Many parents believe, based on their anecdotal experience, that those compounds do not have as much impact on reducing seizures as THC, so can she assure me that the trials will also look at THC-based products?

Access to Medical Cannabis

James Cartlidge Excerpts

Monday 8th April 2019 Commons Chamber

[James Cartlidge (South Suffolk) (Con)]

My right hon. Friend will be aware of the case of my constituent Indie-Rose Clarry. She is a four-year-old girl who suffers from Dravet syndrome, a very severe form of epilepsy. Her parents, Anthony and Tannine, are also crowdfunding on the internet to raise thousands of pounds to buy drugs from Holland. That is not because they are criminals, but because they love her, they want to ease her pain and they are desperate.

On Friday, as it happens, I met Indie-Rose’s consultant—not only her consultant but one of the leading specialists in the country in severe forms of child epilepsy. He made the point that there is a barrier to prescribing cannabinoids that include THC, because there is insufficient evidence in that case. Will the Secretary of State confirm that there is evidence on CBD but not THC, which Indie-Rose’s parents have found has the greatest impact in reducing seizures?

[Matt Hancock]

Characteristically, my hon. Friend makes an excellent point. The clinicians consider that there is a much less evidence on THC, as opposed to CBD. I have therefore instructed the National Institute for Health Research to do the research. Doing the research will of course require some cases where the drugs can be legally tested. I had already put that in place, and I am telling the House about it today.

Oral Answers to Questions

James Cartlidge Excerpts

Tuesday 15th January 2019 Commons Chamber

[Jackie Doyle-Price]

I know that the hon. Lady is very passionate about all this, and I can say to her that, in rolling out this additional support, we do not want to crowd out anything that is there already. It should genuinely be working in partnership with the provision that has already been undertaken, but we recognise that we need to be rolling out further investment. We are introducing a new workforce that will have 300,000 people when it is fully rolled out, but we must ensure that we invest in the training in such a way that it will be effective.[Official Report, 16 January 2019, Vol. 652, c. 8MC.]

[James Cartlidge (South Suffolk) (Con)]

11. What steps he is taking to ensure the adequacy of mental health service provision in the long term.

[Nigel Mills (Amber Valley) (Con)]

16. What steps he is taking to ensure the adequacy of mental health service provision in the long term.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

Under the NHS long-term plan, there will be a comprehensive expansion of mental health services with an additional £2.3 billion in real terms by 2023-24. This will give 380,000 more adults access to psychological therapies and 345,000 more children and young people greater support in the next five years. The NHS will also roll out new waiting times to ensure rapid access to mental health services in the community and through the expansion of crisis care.

[James Cartlidge]

I thank my hon. Friend for her answer. She will be aware of the long-running and substantial problems that we have had in our main mental health trust, the Norfolk and Suffolk NHS Foundation Trust. Will she update the House on the latest position there, and in particular, will she tell us what steps the Government are taking to finally turn around this failing trust?

[Jackie Doyle-Price]

My hon. Friend is quite right: I have stood at this Dispatch Box a number of times to address concerns from all the local MPs in Norfolk and Suffolk. I can advise him and the House that the trust is receiving increased oversight and enhanced support from NHS Improvement. It is in special measures for quality reasons. It is also receiving peer support from the East London NHS Foundation Trust, which is an excellent and outstanding trust. We will continue to take a close interest in developments, but I can assure him that the trust is receiving every possible attention to improve its performance.

Health and Social Care

James Cartlidge Excerpts

Thursday 29th November 2018 Ministerial Corrections

The following is an extract from Health and Social Care questions on 27 November 2018.

[James Cartlidge (South Suffolk) (Con)]

Next year marks 10 years since the passing of the Autism Act. What more can the Government do to support people who suffer from autism?

Oral Answers to Questions

James Cartlidge Excerpts

Tuesday 27th November 2018 Commons Chamber

[Steve Brine]

Yes. I would be interested to hear more about anything that can increase access to dentistry in the hon. Gentleman’s part of the world.

[James Cartlidge (South Suffolk) (Con)]

Next year marks 10 years since the passing of the Autism Act. What more can the Government do to support people who suffer from autism?

[Caroline Dinenage]

To mark the fact that it will be 10 years since the Autism Act was passed, we will start a formal review of that piece of legislation and the autism strategy, to ensure that they remain fit for purpose and heading in the right direction.[Official Report, 29 November 2018, Vol. 650, c. 4MC.]

Prevention of Ill Health: Government Vision

James Cartlidge Excerpts

Monday 5th November 2018 Commons Chamber

[Matt Hancock]

They will now. I believe very strongly in parental responsibility as well as personal responsibility and the responsibilities of employers. We all have a part to play. As parents, we have a very big responsibility to bring up our children in a heathy way, too.

[James Cartlidge (South Suffolk) (Con)]

As my right hon. Friend may be aware, one of the benefits of turning 40 is that we become entitled to an NHS MOT every five years. Has he, as part of his very welcome shift towards prevention, considered extending both the age range and frequency of these very important tests?

[Matt Hancock]

Well, you learn new things every day, Madam Deputy Speaker—as someone who only just turned 40, I had no idea. I think we should send everybody a 40th birthday card from the NHS saying, “You can now have these MOTs every five years.” [Interruption.] The shadow Secretary of State would like one, too. We will make sure that that is arranged right away.

Social Care Funding

James Cartlidge Excerpts

Wednesday 17th October 2018 Commons Chamber

[Barbara Keeley]

Indeed. As I said, it is now coming up to a year since that was promised and it is about time that we started to see some plans. However, we have to bear in mind that a Green Paper is only the first stage of change—and a very early stage at that, really.

I want to pay tribute to the care staff I just mentioned. There has been a lot of talk recently about low-paid staff and how they will fare in terms of migration policies. Being low-paid does not mean that caring roles are low-skilled. Caring staff are highly skilled. They are a credit to this country, and without their dedication the problems facing social care would be immeasurably worse. Unfortunately, their efforts cannot paper over the cracks that have emerged because of this Government’s hammer blows to council budgets. I will come on to talk about the impacts that social care cuts have on people.

[James Cartlidge (South Suffolk) (Con)]

The hon. Lady talked about the Green Paper and how we will fund this in the long term. Obviously, we all have to contribute to that. I was interested that in the last debate she said her party was looking at such things as a wealth tax. I wonder whether she has developed her thoughts on how we should pay for this and whether it will be considering a wealth tax.

[Barbara Keeley]

We have indeed been doing more work on this, but we laid out in our manifesto—the hon. Gentleman’s party did not—what our future plans for social care funding were. We said what the three options for funding social care were and that it would either be one of those three options, or perhaps a combination of all three—I think that the party that is being left behind here is his.

The impact of social care cuts means that less care is now available for older and younger adults alike. Four hundred thousand fewer older people got publicly funded care in 2015 than in 2010, and 1.4 million older people now have unmet social care needs. Put simply, that is over 1 million people who are not getting help with washing, dressing, going to the toilet, making meals or taking medication.

--- Later in debate ---

[James Cartlidge (South Suffolk) (Con)]

In light of that, Madam Deputy Speaker, I will be as quick as I can. I will make two quick points.

One point that has to be made—I am sorry—is that in every debate on this issue, those on the Labour Front Bench bang on about cuts to local authority spending in the 2010 Parliament, which we accept, and which have been followed up, since 2015, with higher spending. But what did the Labour manifesto promise in 2010? This is absolutely critical. It promised to:

“protect frontline spending on childcare, schools, the NHS and policing”.

It did not promise to protect local government spending. It went on to say:

“We will drive forward our programme to strip out all waste…We recognise that investing more in priority areas will mean cutting back in others.”

Labour would have cut local government spending, the same as we did. And what did it say about how it would pay for its reforms to social care? It said that they would be paid for

“through savings and efficiencies in the health budget and in local government.”

There is no parallel universe in which where would have been billions more to spend on local government under Labour.

On a far more positive and constructive note, I have one key point on long-term spending that I would like to make to my hon. Friend the Minister. I agree with my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), who has made the point many times about the German system. He has said that we should have more of an insurance-based system for those in the working population. The key issue relates to those who are retired and have assets. My request would simply be for there to be a choice. For example, there should be a choice between relying on your assets if you wish to take that risk, or paying some kind of lump sum or similar insurance fee, which could even be taken from your estate, so that you would be covered. You either share the risk or take the risk. I think that that is a very fair principle. I am not going to say any more than that or take any interventions, because of the time and because I know that others wish to speak. We need to have choice in the system for those with assets.

Education (Student Support)

James Cartlidge Excerpts

Wednesday 9th May 2018 Commons Chamber

[Karen Lee]

I completely agree with that.

There are 40,000 nursing vacancies across the NHS and, for the second year in a row, more nurses are leaving the profession than joining, with one in three expected to retire in the next 10 years. The Government have made much of the nursing associate role and apprenticeships for nurses. Nursing associates provide a support role for nurses, and the RCN feels that diluting and substituting registered nurses with associate nurses has potentially life-threatening consequences for patients. That is the RCN saying that, not me.

This Government also speak in glowing terms about the apprentice nurse role. I do take the points made by the right hon. Member for Harlow (Robert Halfon)—he means well—but it takes four years to train as an apprentice nurse and our health service is, as the RCN says, in crisis right now. Furthermore, this route is not currently providing the 1,000 new nurses per year that the Government planned for, with RCN figures suggesting that there are just 30 apprentice nurses at present—I will give that answer.

I was a mature student. I was 41 when I started my training, and a single parent. We have heard a lot tonight about how we will encourage people who do not want to go down the university route. I worked in Tesco on a checkout. I had been to grammar school and it had failed me, so I had to go to night school to get my A-levels to become a nurse. That took me a year, three nights a week, on top of working. I then worked for three years as a nursing student to become a nurse. I could not have completed my training without a bursary. I also borrowed £5,000 a year from the Royal Bank of Scotland, so I came out hugely in debt, even though I had a bursary, and it took me five years to clear that debt.

[James Cartlidge (South Suffolk) (Con)]

You shouldn’t have.

[Karen Lee]

That is what I had to do to become a nurse. I think I got around £500 of bursary at that time, and I had myself and my 10-year-old daughter to keep.

My friend Ali was a wife and a mum, and she needed her bursary, and my friends Clare, Haley, Adele and Lisa were younger and single, but they still needed their bursaries, because everybody has bills to pay. None of us could have trained without our bursaries and none of those friends would have gone on to be the nurses they are today without them. Please, will no one on the Government Benches talk about encouraging disadvantaged people to train as nurses? When we had bursaries, we did—I did.

The bottom line is that more nurses equals better healthcare provision. We cannot go on with an NHS in the state it is currently in. The Government continue to ignore completely the wise words of those who are experts in their field—like the Royal College of Nursing—when it comes to the support available for future healthcare professionals. They seem to think that they know best, but the reality does not bear out that fantasy. The regulations must be scrapped and the Government should reinstate nursing bursaries immediately.

I stand in this Chamber time and again defending our NHS, and I hear people who have no idea what it is like on the ground. Sometimes they sit looking at their phones when people like me are talking. I despair. If the Government will not listen to me, I hope they will heed the wise words of the RCN, because it is right on this. Please listen to the RCN and please reinstate nursing bursaries.

Austerity: Life Expectancy

James Cartlidge Excerpts

Wednesday 18th April 2018 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Paisley. I thank my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) for securing this important debate and for her excellent and well-informed speech. It is of great interest—not only to me, but to the public, who I am sure will be listening closely to the Minister’s response today. I also want to thank the hon. Members for South West Bedfordshire (Andrew Selous) and for Witney (Robert Courts), my hon. Friend the Member for Vale of Clwyd (Chris Ruane) and the Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford), for their thoughtful and passionate speeches, even though I do not necessarily agree with all the things that were said.

As we heard, life expectancy has always gradually increased. Between 1920 and 2010, it increased from 55 to 78 years for men and from 59 to 82 years for women. However, the improvement began to stall in 2011 when the coalition Government came in. That cannot be just a coincidence. Since then, for the first time in over a century, the health of people in England and Wales has stopped improving, and has flat-lined ever since.

I must emphasise that researchers do not believe that we have reached peak life expectancy. The Nordic countries, Japan and Hong Kong all have life expectancies greater than ours and they continue to increase, so why is life expectancy flat-lining in the UK? Why is Britain being left behind and fast becoming the sick man of Europe? I know that the hon. Member for South West Bedfordshire said that that was not the case, but academic research by Danny Dorling, published in November 2017, which I have here, said:

“Life expectancy for women in the UK is now lower than in Austria, Belgium, Cyprus, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Malta, the Netherlands, Norway, Portugal, Slovenia, Spain, Sweden, and Switzerland. Often it is much lower. Men…do little better.”

I think the hon. Gentleman needs to check his facts.

The life expectancy gap between the richest and poorest in this country is nothing less than shameful. According to the Institute of Health Equity, the longest life expectancy in the country is, not surprisingly, in the richest borough: Kensington and Chelsea. Men in Kensington and Chelsea can expect to live to 83 and women to 86. Unsurprisingly, you will find the lowest life expectancy in my part of it: the north and Scotland. In Glasgow, life expectancy for men is 73 and in West Dunbartonshire it is 79 for women—10 years of difference for men and seven years for women. The difference within the richest borough, Kensington and Chelsea, is even more stark. Despite living in the richest borough in the country, the most disadvantaged within it can expect to live 14 years less than their most advantaged counterparts. Does the Minister agree that this is completely unacceptable?

The north-south divide remains as relevant as ever when we look at healthy life expectancy—the years that people can expect to live a healthy life. In the south-east, the healthy life expectancy is 65.9 years for men and 66.6 years for women. However, people can expect a shorter healthy life expectancy in the north-east, where men have a healthy life expectancy of 59.7 years and women 59.8 years. That is significantly lower than the England average. Looking after those people during that unhealthy part of life means a huge cost to the NHS. It also means that the inequality gap in healthy life expectancy at birth between the south-east and the north-east is 6.2 years for men and 6.8 years for women.

What will the Minister do to address the life expectancy and healthy life expectancy gap between the rich and poor, and the north and south? It is simply unacceptable that the least advantaged in our society bear the brunt of this Government’s policies—wherever they live. Austerity is not a choice. It is a political ideology, which harms the poorest and the most vulnerable in our communities.

[James Cartlidge (South Suffolk) (Con)]

Rubbish!

[Mrs Hodgson]

It is not rubbish. Professor Sir Michael Marmot warned:

“If we don’t spend appropriately on social care, if we don’t spend appropriately on health care, the quality of life will get worse for older people and maybe the length of life, too”.

Sadly, we have seen this across the board. Despite the growing pressure on our health and social care service, the Government are responsible for spending cuts across our NHS, social care and public health services. While demand continues to increase, the Government have taken away vital funding, which could close the life expectancy gap.

Since local authorities became responsible for public health budgets in 2015, it is estimated by the King’s Fund that, on a like-for-like basis, public health spending will have fallen by 5.2%. That follows a £200 million in-year cut to public health spending in 2015-16. Further real-term cuts are to come, averaging between 3.9% each year between 2016-17 and 2020-21. On the ground, that means cuts to spending on tackling drug misuse among adults of more than £22 million compared with last year and smoking cessation services cut by almost £16 million. Spending to tackle obesity, which the hon. Member for South West Bedfordshire mentioned as a cause of shorter life expectancy, has also fallen by 18.5% between 2015-16 and 2016-17 and further cuts are in the pipeline. These are vital services for local communities and could benefit their health and lifestyle, but sadly they continue to be cut due to lack of funding.

How does the Minister expect to close the life expectancy gap without investing properly in vital public health services? An ounce of prevention is better than a pound of cure. The Government must invest in public health and prevention services, as that could play a significant role in closing the life expectancy gap that we are discussing.

When the Prime Minister made her first speech on the steps of Downing Street—the Minister is nodding, because she knows the quote—she said:

“if you are born poor, you will die on average nine years earlier than others.”

We were all pleased that the Prime Minister highlighted that issue, but I have been left disappointed with her Government’s lack of response to tackle it. We on this side of the House are committed to ensuring that our health and care system is properly funded, so that all children are given the best possible start in life and older people are treated with the respect and dignity that they deserve. I hope that the Minister will clearly outline what the Government will do to close the life expectancy gap.

Pharmacies and Integrated Healthcare: England

James Cartlidge Excerpts

Wednesday 11th January 2017 Westminster Hall

[Mrs Main]

I am happy to acknowledge that some fabulous things are happening in the west country. That list was given to me. I make no excuse for the fact that I thought it seemed fairly long already, but I am certain that there are a lot more services that hon. Members do not realise are out there—perhaps even in pharmacies in their own constituency or the one next-door that they go shopping in or visit with their families. The fact that we do not know about them shows that there is no integration in the system. We should be aware of it if these services are being rolled out. Perhaps there should be a directory that we could consult to find out what is going on in certain areas.

That list shows hon. Members the exciting possibilities that could be open to pharmacies, including those in the west country that were just referred to, if we just gave them the chance to embrace them. Rachel, the director of the Quadrant pharmacy, ended her observations with a positive endorsement of the “Community Pharmacy Forward View”. She told me that it has

“been developed and signed up to by all national community pharmacy organisations about the types of services that either need to be commissioned at a national level or pressure put on Sustainable Transformation Plans (STP) leaders locally to commission a service package to patients”.

My hon. Friend the Member for York Outer (Julian Sturdy) said that there is reluctance in some areas to embrace this. We need a strong steer from the Government that this is where we are going and that they had better wise up, get around the table and come up with a suitable model.

[James Cartlidge (South Suffolk) (Con)]

My hon. Friend is making an excellent point and I congratulate her on securing this debate. I have discovered the same thing as my hon. Friend the Member for York Outer (Julian Sturdy) in Suffolk. It is about trying to get the CCG to talk to the pharmacists. The interest of the NHS is our interest—it is a national interest—and not that of acute hospitals, the primary care sector or any particular sector. The NHS must operate in the national interest, and if that means involving pharmacists much more heavily and that we have to be the ones pushing for innovation, it is our job to do that.

[Mrs Main]

My hon. Friend is absolutely right. I shall conclude my remarks soon, because I know that other hon. Members want to take part in this debate. If there is resistance in the system, I ask the Minister to find out what can be done to sort that out. How aware is he of resistance in the system? How much input have pharmacies had into highlighting what they would be prepared to do and their concerns about the fact that they are sometimes not being listened to in this debate? There seems to be broad agreement in the NHS “Five Year Forward View”, the “Community Pharmacy Forward View” and at the King’s Fund that the integration of pharmacies into NHS healthcare is the direction of travel.

--- Later in debate ---

[Steve Double]

Although I agree with some of what the hon. Gentleman says, I believe the funding model for pharmacies needs to be looked at because there is a great deal of duplication. The money spent could be better utilised, so the funding model needs to be reviewed. Some of the recent changes are a step in the right direction, but I will always make the case that, particularly in our rural communities, we need to be careful how those changes are applied so that our local pharmacies continue to be viable and able to provide the services that are needed.

[James Cartlidge]

My hon. Friend is making an excellent speech. I understand why Labour Members want to focus on the potential savings that once again the Government are having to make, but I point out that the two pharmacies that I visited in Clare and Hadleigh in my constituency accept the changes, provided they are balanced by their having a more positive role in the healthcare system and doing more for our communities. That is what they want.

[Steve Double]

I agree absolutely. This is not only about money; it is about reviewing the way we provide our healthcare services, embracing a greater role for our pharmacies, and understanding and promoting the role that they can play.

I want to pick up on the point about tourist areas made by my hon. Friend the Member for St Albans. I represent the constituency of St Austell and Newquay in mid-Cornwall, and tourism is the biggest part of our economy. Hundreds of thousands of tourists come every year, which puts a great deal of pressure on our A&E and local GPs, because if people fall ill on holiday, they try to get to see a GP.

I commend the work of one of my local pharmacists, Nick Kaye, in Newquay. The Secretary of State visited a couple of years ago and saw the excellent work that he does working closely with the local GP surgery to provide a frontline service particularly for tourists. By doing so, he takes pressure off the other parts of the health service. We could see more of that if we supported pharmacists and promoted the excellent work that they can do.

We have already touched on my final point. We cannot have a one-size-fits-all approach. The services provided in urban metropolitan areas are very different from those provided in more rural parts of the country. As we have heard, there might be multiple pharmacies in a town, all falling over one another to compete for business—so different from the many rural villages that have one local pharmacy, which is struggling to make ends meet and to provide an ongoing service to the community. Another fact I have learnt is that there is an oversupply of qualified pharmacists in many areas, whereas in Cornwall we have a shortage. We cannot get enough into Cornwall to meet demand, so we cannot have a one-size-fits-all solution. I encourage the Minister to look carefully at the specific needs of different parts of the country, particularly with regard to pharmacies, to make sure that funding streams meet need and that we can sustain the vital role that community pharmacies play in our rural towns and villages.

I am pleased to have been able to contribute to this important debate. As we continue down the path of integrating pharmacies into the health service, we must value and promote the role they play and make sure they are able to provide a service. They are part of the solution that we need to make sure our health service is fit for purpose.