Children’s Hospices: Funding

James MacCleary Excerpts

Wednesday 30th October 2024 Westminster Hall

[James MacCleary (Lewes) (LD)]

I thank the hon. Member for Liverpool West Derby (Ian Byrne) for securing the debate.

As a parent myself, with two young children, I live in awe of the strength shown by parents of children with life-limiting conditions. It is incumbent on all of us to ensure that funding and support is there, so that those parents can enjoy those precious years that they will have with their children, those moments of joy that sometimes, perhaps, some of us take for granted with our own children. Such families face immense challenges, yet the support they receive varies drastically, depending on where they live. The postcode lottery they face is simply unacceptable.

Sussex, where my constituency is located, with its population of nearly 442,500 children, has an estimated 2,980 children living with life-limiting conditions. That means that approximately 67 out of every 10,000 children in Sussex require specialist palliative care. Those children and families deserve consistent, high-quality care but, sadly, that is not always the reality. A report from the campaign, Together for Short Lives, has revealed that Sussex is failing to meet its required standard for 24/7 end of life care at home. That means that families in Sussex are less likely to have access to around the clock nursing care and specialist advice when their child needs it most. It is hard to imagine the additional stress and heartbreak that that inflicts on families already coping with the unimaginable.

This situation is sadly not unique to Sussex. The report highlights the fact that only a third of local areas in England meet the required standards for 24/7 end of life care. That points to a systemic problem: a lack of funding, workforce shortages and a lack of accountability for delivering equitable care across the UK. I want to see a roadmap for change. Increased funding is essential to close the gap in NHS spending on children’s palliative care. We need more specialised nurses and paediatricians trained in this field. Most importantly, we need to hold our local NHS and local councils accountable for implementing existing policies, as mentioned by other Members, and ensuring that every child in Sussex and in the rest of the country, regardless of their postcode, has access to the care they need.

I hope we will see some good news in the Chancellor’s Budget statement later this morning to close the funding gap for children’s palliative care. This is not just about statistics; it is about real families facing real challenges. We must act now to end this postcode lottery. Children with life-limiting conditions deserve the best palliative care.

Pharmacy Provision: Hampton

James MacCleary Excerpts

Friday 26th July 2024 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

May I start by congratulating you, Madam Deputy Speaker, on your election? It is a pleasure to see you in the Chair. I also congratulate the Minister on his appointment. We have worked closely together in recent years in the all-party parliamentary group on kinship care, so I have no doubt that he will do an excellent job. I suspect that young Lyle is very proud of his granddad right now.

I am delighted to have secured this Adjournment debate. You might be surprised to learn, Madam Deputy Speaker, that this is the first I have managed to secure since my election in 2019, so I want to use this exciting opportunity to bring to the Minister’s attention the impact of pharmacy closures on the local community in the Hampton area of my constituency, as well as the immense financial challenges facing community pharmacy right across England. I will also raise concerns about the impenetrable bureaucratic processes, which need overhauling, in new pharmacy licence applications and pharmacy closures.

Let me set the scene. Last autumn, two Boots pharmacies in the Hampton area were closed. One of those pharmacies was in the Hampton North ward, one of three wards of relative deprivation in the London borough of Richmond upon Thames. The west of the ward is within the 20% most deprived areas of the country; it is densely populated with a significant amount of social housing. As a result of that closure in Tangley Park, the entire ward is now without a community pharmacy.

Hampton North is poorly served by public transport: there is no station, and the two bus routes serving the area are notoriously unreliable. The nearest pharmacy is now a mile away on foot, a distance that is difficult to cover for the elderly and those with mobility issues. It is certainly more than a 20-minute walk away, which is the measure that previous Ministers liked to use to highlight pharmacy accessibility. Predictably, those closures have put a lot of pressure on the nearest remaining pharmacies, which face queues and stock issues. Again, that is not exactly convenient or practical for elderly and vulnerable patients.

At this point, I pay tribute to Mike Derry and Healthwatch Richmond for their brilliant work championing local patients and giving them a voice. Healthwatch undertook a survey of some 700 residents in the Hampton area at the start of the year to demonstrate the impact of the closures. One person said:

“I have gone without medication as I can’t stand very long. There are queues—I have waited over half an hour.”

Healthwatch England highlighted the plight of 87-year-old Gill. She used to just about be able to get across the road from her house to the Tangley Park pharmacy. Now the nearest pharmacy is over a mile away, and Gill, who does not drive, cannot access that service because of the distance that she would have to walk to get there. She even paid the nearest pharmacy to deliver her medicines to her home each month, but in the eight months since she purchased the delivery service, it has shown up only twice. Her carer has to travel to collect the medication in person for her.

Hampton is not unusual in losing pharmacy provision. I am sure that the Minister is aware of the crisis facing the community pharmacy sector. Data from the Community Chemists’ Association shows that there has been a net loss of over 1,200 pharmacies—1402 closures and only 179 openings—since 2015. More than a third of those losses have been in the most deprived areas of the country. The National Pharmacy Association reports that the number of pharmacies that have closed so far this calendar year—the equivalent of 10 pharmacies a week—is nearly 50% higher compared with the same point in 2023. As well as independent pharmacies, big chains such as Lloyds Pharmacy and Boots have significantly accelerated closure numbers over the past 18 months. A big driver of these closures is a significant real-terms reduction in funding for pharmacy; that funding has dropped by around 30% since 2015.

[James MacCleary (Lewes) (LD)]

Is my hon. Friend aware of the issue of overwhelmed surgeries referring increasing numbers of patients to local pharmacists? I have seen it in my Lewes constituency. Does she agree that this will only contribute further to closures?

[Munira Wilson]

I thank my hon. Friend for his intervention, and I congratulate him on his excellent maiden speech. I completely agree with him. We want doctors to use community pharmacy more to alleviate the pressure on other parts of the health service, but frankly, if the pharmacies are not there, the remaining ones will be overwhelmed. I talked to local GPs in the Hampton area following these closures, and they were desperate to see more provision. They thought about trying to set up their own community pharmacy provision, but they just could not make the numbers add up because of the funding shortfall.

The Company Chemists’ Association estimates an average funding shortfall of £67,000 per pharmacy. That is based on an analysis of data published by the Department of Health and Social Care in a written parliamentary answer at the beginning of last year. Many pharmacists are left out of pocket, as they are reimbursed less for a number of medications than the price they pay, and there are stories of some using credit cards and overdrafts to purchase medication.

These funding pressures are coupled with major workforce challenges. When I met Boots following the news that it is closing two branches in Hampton, it cited a lack of pharmacists as a major reason for closing some 300 pharmacies across the UK, although commercial pressures were clearly the main driver. Layered on top of these issues are regular medicine supply shortages, which add more work and create more stress for already overstretched pharmacists. Community Pharmacy England reported last year that 92% of pharmacies were having to manage supply issues daily.

It is a perfect storm for community pharmacy at a time when we need preventive healthcare and self-care more than ever. The potential of community pharmacies to improve patient health and reduce the pressure on NHS hospitals and GPs is immense, yet they are closing in their hundreds every year. We should be relying on pharmacies even more to keep the nation healthy. The previous Conservative Government’s announcement of the Pharmacy First initiative was very welcome in its ambition, but if pharmacies are not even funded for the basics right now, with big gaps in provision opening up all over the country, it is hard to see how Pharmacy First’s ambitions will be achieved.

The Liberal Democrats would like to see the Government building on the Pharmacy First principle and giving pharmacists more prescribing rights and public health responsibilities. As in so many areas of public health, the “invest to save” argument is compelling, and I look forward to hearing the Minister’s comments on what the new Labour Government will do on funding to enable community pharmacy to not just survive, but thrive and grow as an essential part of our primary care infrastructure.

Having addressed the causes of these closures, I will spend some time exploring the processes involved in local communities being informed of pharmacy closures, and their input, or lack thereof, in them, as well as discussing the complete lack of transparency or accountability in relation to applications for new pharmacy licences. For starters, only those organisations designated as “interested parties” in the regulations are informed of new applications, and only their feedback has to be taken into account. Anyone else who is interested, such as me as a local MP, needs to make a freedom of information request, unless someone in the local health community passes on the information. My views, and the views of other people in the community, can be ignored.

To describe the bureaucratic process that sits around new applications as byzantine would be generous. I hope the Minister, Madam Deputy Speaker and other hon. Members will bear with me while I try to explain what happened in Hampton. We are part of the South West London Integrated Care Board, but NHS England has delegated the pharmacy market entry function for the whole of London to the North East London ICB, which is on completely the opposite side of the city. Officials have no local knowledge of our area, no understanding of local transport links and no relationships with the local health system.

Let me start with the closures. The Minister will be aware of the statutory three-month notice period for pharmacy closures; last August, Boots would have had to give NHS England three months’ notice of its intentions in Hampton. That information was not passed by NHSE to the Richmond health and wellbeing board. I find that utterly staggering. The first that local councillors, the local health community in the area and I as the MP knew about the planned closures was when Boots placed signs in its windows to inform customers, and concerned constituents started to contact me about the likely impact of the closures.

At the end of August 2023, while this was going on and we were all in the dark, the local health and wellbeing board published a pharmaceutical needs assessment, but it was inaccurate and failed to identify an imminent future gap in need in the Hampton North area because it had not been notified of the closures. The Tangley Park Boots subsequently closed in late October. The Priory Road Boots, which was directly opposite a busy GP surgery, closed in early November.

In November, an application was received for a new independent pharmacy licence on the Tangley Park Boots site. Once again, the local health and wellbeing board was not notified of the application—this time, for two whole months. During this period of complete silence, the health and wellbeing board issued a supplementary statement to the local pharmaceutical needs assessment, which identified the gap in Hampton. However, because the application for a new pharmacy was made in November, and it referred to the original needs assessment that was made before the supplementary statement was published, it was rejected, even though the application itself identified the gap, which was officially made clear in the supplementary statement subsequently published in December. Not only that, but it took the North East London ICB a full eight months to issue the rejection; tht happened earlier this month, even though the decision used evidence received in December to justify the rejection.

Madam Deputy Speaker, if you and other hon. Members are still managing to follow this sorry story, I hope you will agree that this decision is utterly perverse. It is also utterly unreasonable that timely applications to open pharmacies in response to multiple closures should be inherently prevented in this way. The delays in sharing information with the local health and wellbeing board and the delays in decision making are unforgivable. During the lengthy delay, the local authority received a planning application to change the Tangley Park pharmacy site into a fast food outlet. Thankfully, that was rejected earlier this month after representations from the public health team and councillors, but I am sure the public health Minister will agree that it would be unfortunate, to put it mildly, if a pharmacy were replaced with a fast food outlet.

One local official told me yesterday that the systems architecture is too complicated, and that there is a need for clearer responsibilities and accountability. Amen to that, I say. Healthwatch Richmond has demanded answers from the North East London ICB, but it has received a frankly woeful response that does not address the substantive question of why the application was so badly handled. The response passes the buck and blames regulations. To be clear, Healthwatch and I are not qualified to comment on the merits of an application; what we are doing is challenging the unfathomable process.

I say to the Minister that the huge funding challenges facing community pharmacy are pressing. I appreciate that they may be extremely difficult for him to address, given that the Chancellor has an iron fist as far as any additional public spending is concerned, but the Minister must wage a campaign to improve the funding situation. It makes financial sense. We will not grow the economy without improving the nation’s health. In that campaign, he will have cross-party support from Members on the Opposition Benches.

Revisiting the regulations and how NHS England is implementing them will cost next to nothing. There should be proper consultation with and involvement from the local community on closure notices, and changes in the process for new licences could ensure that we can quickly plug pharmacy gaps when they open up in areas such as Hampton. Crucially, those powers need to be delegated to the local ICB, with full involvement from the local health and wellbeing board. They know their communities and their geography best—trust them.

Finally, if the Minister could step in on the specific issues in my constituency—the application that has been rejected and is going NHS Resolution on appeal—simply to ensure a common-sense approach, the residents of Hampton North and I would be very grateful. We desperately need a new pharmacy for our community. I look forward to his response.