Pharmacies and the NHS

Jim Shannon Excerpts

Wednesday 20th November 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Ipswich (Ben Gummer) on bringing this matter for our consideration today. Although I agree with him on many things, his football team, Ipswich Town, is playing my team, Leicester City, on Saturday, so our opinions will differ on that.

[David Simpson]

You’ll get beat.

[Jim Shannon]

Well, I hope we won’t.

To return to the matter in hand, having run my own business, I can well understand the pressures on businesses—the need to make profit and to pay the bills at home. I can also understand the principle behind paying for what you get and that a good service needs to be paid for. At the same time, however, from what I have read in the media and the considerable background information to the debate today, the scandal of double-invoicing and cashback to the detriment of the NHS cannot ever be accepted.

I take my hat off to the whistleblowers who have highlighted the practice, which it is claimed has robbed the NHS of up to £120 million. The headlines are clear: “Pricing scandal sees NHS pay £89 for cod-liver oil capsules”; “Firms boast of profits on drugs that cost ‘pennies’”; “‘There’s a lot of flexibility over prices’”; “Pharmacies and suppliers accused of price rigging”, and last, but not least, “The NHS, the drug firms and the price racket”. All those headlines are cause for concern.

I have asked several questions of the Secretary of State regarding the provision of new cancer drugs, Alzheimer’s drugs or any number of other new drugs that are not accessible on the NHS. How do I tell my young constituent suffering from cancer that there is no funding for a drug that has been proven in other countries to help when she is reading about double-invoicing? Is the cost of her life so little for the House that we can allow the practice to continue? I have asked those questions of myself and my constituents ask me them, too.

I was angered when I read about £10,000 monthly kickbacks and other horror stories. It is clear that any agreement needs to stop that from being able to happen. I have the greatest respect for the Minister and I am sure he will hit on such issues in his response. If we need new legislation that enables the NHS to go deeper than merely checking invoices, so be it. It concerns me greatly to think of the number of families who could have received life-changing help this year with the money—our money, our constituents’ money—that has been lost to those who are working the system. That has to stop.

Many heads should hang in shame over how bills have been creatively put together by providers, but I cannot simply allow the Government not to understand that they need to do more.

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

Does my hon. Friend agree that one of the most significant recent statements in the press was when a senior executive of one of the large companies said that it would be more than happy to agree to a 70% discount if that is what it took to get the contract? That is a damning indictment of the original price.

[Jim Shannon]

I thank my hon. Friend for that helpful contribution. The contributions from him, my hon. Friend the Member for Upper Bann (David Simpson) and others may focus the Minister’s attention.

On the availability of medicines, I have read that the National Institute for Health and Care Excellence has approved fewer than one in three medicines since 2005. A recent letter from nine major pharmaceutical companies to The Daily Telegraph started with something that I agree with. I am sure that any Member and, more importantly, any doctor or care worker in the NHS, will also agree with it:

“Medicines should not just be seen as a cost.”

They should first and foremost be about healing and curing illnesses. The letter continues:

“They are an investment and an essential part of improving patient outcomes. Yet…the proportion of medicines refused by NICE is only increasing.”

That is a concern for me, too. Jonathan Emms, UK managing director at Pfizer, has said:

“Right now NICE is saying ‘no’ too often. It is blocking many innovative new medicines from reaching the UK patients who need them most, medicines that are often readily available in Europe.”

Will the Minister say what contact he has had with NICE about not making available in the UK drugs that are available in other parts of Europe?

Although it is hoped that the agreed deal will save the NHS £1 billion over two years, it is essential that that saving goes into making more drugs available for the healing of those who need them and not simply the healing of the deficit. Will the Minister assure me and the House that the savings made will go into the provision in the UK of drugs that have been widely tested and that are widely available in Europe?

[Oliver Colvile]

Does the hon. Gentleman recognise that drugs and medicines can be dangerous if they get into the wrong hands? Pharmacies also have to face people using the internet to acquire drugs, which is an option that does not carry the same regulation that we expect in the domestic market.

[Jim Shannon]

I thank the hon. Gentleman for that contribution. It is something that many of us have highlighted and I know that the Minister has spoken about it in the past. The availability of drugs on the internet is an anomaly in the system, and perhaps the Minister can give us an indication of how best to deal with it.

Back in April, we were told that the number of cancer drugs on the approved list was to be halved. Will the Minister commit to ensuring that the savings will be used to increase the amount of drugs that might save lives and give a better quality of life?

I read the story of a mother with terminal cancer, who was forced to fund herself a drug that she believed would give her extra time with her young children, after being refused by a special Government fund. I find such stories incredible, hearing about the real heartache and issues that impact on family lives, and yet we—as collective representatives—are unable to help and assist as we should. In America, Obama is trying to bring in a health care system similar to ours. It is referred to as Obamacare—people say that it will make or break him, and it probably will. We, however, seem to be turning ourselves into an American system, whereby we have to fundraise to get treatment. That is certainly not what my constituents or I pay our taxes for, and I am sure that others agree with me.

I want to make a quick comment about Northern Ireland, where our Health Minister abolished prescription charges. That was done on the understanding that cheap generic drugs were not prescribed. Health is a devolved matter in Northern Ireland, and our Minister made a decision, which I support entirely. Will this Minister—I ask this with respect—liaise with the Northern Ireland Minister, Edwin Poots, to ascertain how the scheme is working and how we have been able to stick within our budget in Northern Ireland on prescription drugs?

The right hon. Member for Rother Valley (Mr Barron) made a valuable contribution today. One of the things that he referred to was the drugs that people have and do not use; they sit until they go out of date and are then dumped. In Northern Ireland, the Minister, the GP surgeries and so on have taken steps to ensure that the prescription of drugs is better controlled. Sometimes, people might run out of drugs, rather than having extra in the cupboard, but such steps help and take away wastage in the system. The right hon. Gentleman made that clear in his contribution.

Over the years in Northern Ireland, through the Minister and in co-operation with the pharmacies, we have also tried to reduce the number of people attending accident and emergency. If people have a minor ailment, they should go to their pharmacist or chemist; he or she will be able to give some direction on what needs to be done. There are ways and means of good practice, to which I have referred on many occasions. I say what we do in Northern Ireland with humility, but we actually do some things very well. If such things are done well, they can be a marker for elsewhere.

Time is flying past, but changes clearly need to be made soon. Yes, pharmaceutical companies and pharmacies need to make a profit, but that must be done in the right way; we need legislation in place to ensure that that is done in such a way. Yes, NICE must protect people from drugs that promise all, but deliver nothing, and yet that cannot be used to count pennies and to justify saying no to drugs that will make a difference.

Finally, yes, Government must make savings, but those cannot be taken from the most vulnerable by denying them treatment; any savings should be used for new drugs, to give people a better chance of life, for the sake of our constituents in the whole of the United Kingdom of Great Britain and Northern Ireland. We are not talking simply about numbers on a hospital list—the changes need to be made, and made soon.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

We have had a wide-ranging debate today on issues such as the deregulation and regulation of pharmacies, the local provision of pharmaceutical services and the extension of the role of pharmacists and what they do in our communities. Importantly, we have also discussed pricing and behaviour that, if not fraudulent, is certainly very irregular on behalf of some pharmacists and drugs companies. I hope that I will have time to deal with all those issues, but I will write in more detail to any Member here today who feels that more points need to be answered.

Before I go any further, may I say that it is a pleasure, as always, to serve under your chairmanship, Dr McCrea? We took part in many sittings together when the Health and Social Care Act 2012 was considered in Committee, and it is always a pleasure to serve under your chairmanship. I congratulate my hon. Friend the Member for Ipswich (Ben Gummer), my constituency neighbour, on securing today’s debate. It is important to recognise that our NHS is not only about doctors and nurses, but about midwives, physiotherapists, occupational therapists, heath care assistants and all the other people who contribute to the health of the nation every day, including pharmacists, who play an increasingly important role in delivering high-quality local health care and who are embracing the enhanced role that they have been offered under the 2012 Act. It is right that we put on record our thanks for the work that pharmacists do every day.

The right hon. Member for Rother Valley (Mr Barron), in an excellent, considered speech, made some very good points. In particular, he said that community pharmacists are the face of our NHS in many communities. He is absolutely right in saying that because, particularly in more deprived areas of the country, pharmacists are often the first point of call for advice—whether on simple details about medications or for important primary health care advice. Pharmacists perform that role every day. We should be grateful to them for what they do, and I put on record my thanks for that work.

It is important to put on record that pharmacies are in robust health. Although we debate deregulation and difficulties, we know that there are more NHS community pharmacies than ever before—more than 11,400 in England—and they are offering health care, treatment and healthy lifestyle advice and support throughout the country. They dispensed more than 900 million prescription items last year, which is up 53% from 10 years ago, and about 2 million prescriptions are handed out every day by pharmacists. Therefore, we have an industry, as part of our NHS and in its commercial activities and other work, that is in robust health and is performing a valuable service for our NHS.

Of course, we could get into the issues that the right hon. Gentleman rightly raised on the appropriateness of prescribing medication. The chief medical officer talked in some detail in a report about the need for GPs to look sometimes at the appropriateness of the antibiotics that they prescribe and about how we need to look at antimicrobial resistance in this country. The right hon. Gentleman made his points very well, but I hope that he will forgive the fact that I shall not address them directly in today’s remarks. However, he was right to make them and the chief medical officer certainly agrees with him, as do I.

I shall deal with other points that have been made, but initially, I would like to address the important points made by my hon. Friend the Member for Ipswich. We rightly value the innovation and the opportunities that pharmacists have to innovate and support their local communities in different ways. Because they are centred in the community, only pharmacists are able to use such methods. I had the pleasure of attending the annual pharmacy awards and looking at some of those ways. I saw pharmacies, embedded in local communities, making a real difference in providing health and lifestyle advice and improving the quality of care available to local patients.

At the same time, although we want to encourage and support innovation—the pharmaceutical price regulation scheme, or the PPRS, was recently renegotiated and enhanced to give pharmacists the opportunity to innovate exactly as I have described—we also need to recognise that we have a publicly funded national health service, which is a point that has been made across the Chamber today, and we are very proud of it. It is free at the point of need, and it is important to ensure that the money that is given to the health service, whether to pharmacies or to other parts of the NHS, is properly spent, and there is also a role in ensuring that services are provided in a safe and effective way. I shall come on to some of those points later.

My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) has been a consistently strong advocate for the role of pharmacists, and he made his points very well today. The hon. Member for Strangford (Jim Shannon) also made a useful and powerful contribution, which was picked up by the hon. Member for Copeland (Mr Reed) a few moments ago, about the importance of ensuring that there is no fraud in the system and that pharmacists always behave appropriately. I am sure that the majority of the time pharmacists behave appropriately and make a very valuable contribution. When there may be fraudulent behaviour, it is right to pick up on that and investigate it. I will come back to that in a moment, because we all want to see high value for money from our NHS and to make sure that the money is spent on patients and not wasted. I think that that is something that we all agree with and believe in across the House.

I turn to the important issue of pricing. The vast majority of drugs that are prescribed are either covered by the PPRS or are generics, where competition helps to keep the price down. We recently introduced a price for common specialists, but a small number of prescriptions, as has been mentioned in the debate, fall outside the pricing mechanisms that are in place. We are working with the Pharmaceutical Services Negotiating Committee to find a better mechanism to encourage pharmacists to seek lower prices.

Where there may be cases of fraud, it is right that we investigate them, and they are investigated. NHS Protect exists to safeguard—to protect—against fraud in the NHS. That has been a consistent policy; it was followed by the previous Government, and it has been followed by the current Government. The reason why we need services such as NHS Protect is to ensure that if there is fraudulent practice—in this case, potentially in the behaviour of a small number of pharmacists in dealing with small, unique areas of pricing—it is investigated properly. I will ensure that either I or Earl Howe, who is the Minister responsible, writes to the hon. Member for Copeland to inform him of where we have got to with the investigation.

The other point, which was made by the hon. Member for Strangford and is very important, is that we want to ensure that money goes on patients. There is increasing demand for drugs. It is very good that the NHS is continually innovating and developing more treatments, better surgical techniques and improved drugs and mechanisms. Of course, when drugs are used in the NHS, they need to be evidence-based, but I hope that he will agree that it is good that we have set up the cancer drugs fund, which has helped to increase the speed at which people with cancer receive drugs. More than 30,000 people have benefited from the cancer drugs fund and received cancer drugs. We should all be pleased about that and proud of it.

[Jim Shannon]

I thank the Minister for that positive response. I outlined in my contribution a couple of examples of people who did not access the cancer drugs fund, but in my mind clearly should have qualified. Is he prepared to look at that issue to satisfy those people who need drugs urgently because of the time they have left on this earth?

[Dr Poulter]

On how drugs are accessed, one of the problems—this was why the cancer drugs fund was set up—was that some people, as the hon. Gentleman rightly outlined, had been receiving drugs in other countries for many years, but we in this country were a little slower to respond to some of those innovations. But of course we need to ensure that, whatever fund we set up for providing medications, those medications are shown to be effective and there is an evidence base for them. However we do things, there will always be new treatments on the horizon that we would like to get through to people more quickly, and we need to ensure that those treatments are always evidence-based. I think that we can be pleased that the cancer drugs fund has made a significant difference by providing treatments in a more effective and much quicker manner, but if the hon. Gentleman would like to discus the matter further, I would be very happy to see him and talk it through in more detail.

I think that it would be useful for me, picking up on the points raised early in the debate, to outline the processes involved in opening a pharmacy. Anyone can open a pharmacy anywhere, subject to the premises being registered with the General Pharmaceutical Council, when the owner’s service model includes the sale or supply of pharmacy medicines or prescription-only medicines against prescriptions from that pharmacy. However, there are extra criteria for providing NHS pharmaceutical services. Anyone wanting to provide NHS pharmaceutical services is required to apply to the NHS to be included on a pharmaceutical list.

Before September 2012, there were control of entry requirements. The NHS (Pharmaceutical Services) Regulations 2005 determined whether a pharmaceutical contractor could provide NHS pharmaceutical services. In England, no new contractor could be entered on to a PCT pharmaceutical list unless it was “necessary or expedient” to secure the adequate provision of pharmaceutical services locally. That was the control of entry test. If a new service provider was judged neither necessary nor expedient, the NHS, or the PCT in question, had to refuse the application. There were rights of appeal to the family health services appeal unit, which is run by the NHS Litigation Authority. That was available if there was a concern.

Part of the reason for the strict criteria relates to the pricing mechanism and how pharmacists are paid, which I will come to later. Obviously, the local health economy is an issue, and pharmacists are not paid just for the number of prescriptions that they provide; they are also given a baseline fee. When we have a publicly funded health service and we need to ensure that need and demand are aligned, it is important that we look at this in the round. I sympathise very strongly with the points about the need to de-bureaucratise the NHS where possible—those were good points well made—but we also have to recognise that this is not just about arbitrary mapping; it is about aligning need and demand for a service within the pricing framework in place. That is not just about the number of prescriptions that are provided; it is a much more complex mechanism. I will come to those points later.