Hypermobility Syndromes: Healthwatch Calderdale’s Report

Jo Churchill Excerpts

Monday 7th October 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I congratulate my hon. Friend the Member for Calder Valley (Craig Whittaker) on securing this debate on such an important issue, and for taking the first step to bring the broader element of education and communication to the Chamber tonight by outlining the report from Healthwatch Calderdale on hypermobility syndromes. I join him in commending the work of local Healthwatches in championing the patient voice and in doing all that they do.

My hon. Friend has rightly highlighted how critical it is for those living with hypermobility syndromes to be able to obtain the right diagnosis and sometimes how challenging that is, because of the nature of all the different elements of the syndrome involved. This is also about people having their symptoms taken seriously by healthcare professionals. As he and the hon. Members for Strangford (Jim Shannon) and for Halifax (Holly Lynch) outlined, sometimes just being taken seriously is the first step on the path to accessing the relevant treatment that they need. Those professionals need to be aware of the spectrum of the condition. All those things are incredibly important so that patients can access the right care at the right time. For example, someone may access physiotherapy if they feel particularly unwell, but if they then feel like they have to go back down the snake, it can often seem like more of a fight, as the hon. Member for Strangford alluded to, so making sure that pathways are streamlined is exceedingly important.

As my hon. Friend the Member for Calder Valley will be aware, the NHS England specialised commissioning team in Yorkshire and the Humber responded to the report only last month. I gather that the specialised commissioning team and the clinical commissioning group continue to engage with Healthwatch Calderdale on the report’s findings. Ensuring that that engagement is beneficial and delivers what patients want, and that it is as broad as possible, is important. I urge both him and the hon. Member for Halifax to make sure that they are engaged with the process and with holding the CCG and Healthwatch Calderdale to account in understanding whether objectives are being met and a better service is being delivered.

We have heard from my hon. Friend that hypermobility syndromes can have devastating effects on quality of life but often go undiagnosed or misdiagnosed for many years, which also adds to the stress. This situation must improve. As he pointed out, good communication and information sharing could make a big difference to how an individual feels their journey is progressing, and I assure him that we are committed to improving the diagnosis of rare diseases and to assisting patients so that their diagnosis feels less like a fight, as the hon. Member for Strangford put it.

[Craig Whittaker]

One of the key problems is that the hypermobility syndromes are treated by NHS England as rare diseases. As we have heard, Healthwatch Calderdale has 11 complaints on the books, but if we times that across Yorkshire and the Humber, it means there are several hundred complaints, and that is only people who have complained, not people who have been diagnosed. My challenge back to the Minister is this: we keep calling it a rare disease, but is it really a rare disease?

[Jo Churchill]

The challenge with rare diseases is that they are collectively common but rare in and among themselves. As my hon. Friend articulated, there are many different elements to this syndrome that may be diagnosed as Ehlers-Danlos or a plethora of other things. That makes treating them more of a challenge and is why there has to be communication and information sharing to make it a proper pathway for an individual. Although for each life it is really challenging, 11 is not a large patient cohort. That is one of the challenges when dealing with diseases and syndromes such as Ehlers-Danlos and hypermobility syndromes more broadly.

Improving the diagnosis using cutting-edge technology is key. The genomic medicine service, which was announced last October, aims to provide consistent and equitable access to the most up-to-date genomic testing in England, which may help, and I am pleased that hypermobility syndromes are included in the national genomic test directory, which underpins this service. That may provide more of the cohesion that my hon. Friend is looking for.

As my hon. Friend points out, improving awareness of hypermobility syndromes among healthcare professionals, particularly general practitioners, is key. It is critical to ensuring better diagnosis and treatment of these conditions and is vital if we are to build trust and confidence in the system and actually help those with rare diseases. As I say, they are collectively common—3.5 million people across the UK are affected—but there is a significant gap in our understanding of their diagnosis because of the number of different ways they can present.

On raising awareness, there is always more that can be done, and we must learn from areas of good practice. For example, Ehlers-Danlos Support UK has developed a toolkit in collaboration with the Royal College of General Practitioners. I am pleased to hear that my hon. Friend’s clinical commissioning group, NHS Calderdale, has issued the links to the EDS toolkit to its GP member practices and encouraged clinicians to consider adding this topic to their learning needs, because building awareness is very much part of the answer.

Recently, a clinical update on Ehlers-Danlos syndromes was published in The BMJ. That is another excellent example of how the clinical community is working to improve knowledge and awareness and help provide positive NHS care for patients by transferring that knowledge into better diagnosis.

NHS England commissions specialised diagnostic services for hypermobility syndromes, including Ehlers-Danlos syndrome, osteogenesis imperfecta and Stickler syndrome. It is currently implementing a new “rare disease insert”, which aims to improve the patient experience through provision of a single person responsible for the co-ordination of care for hypermobility patients; I think that that was one of my hon. Friend’s constituents’ main asks. It also aims to improve the transition pathway from child to adult rare diseases services, including services for those with hypermobility syndromes.

Several centres in England deliver services for hypermobility, although, as we heard from the hon. Member for Halifax, not all of them are always accessible to everyone. They include two centres delivering complex EDS services, four delivering osteogenesis imperfecta and childhood osteogenesis imperfecta services, and a specialist centre for Stickler syndrome. Those centres help to co-ordinate specialist regional care and manage the transition to non-specialist NHS care. I did very much hear my hon. Friend’s request for a more co-ordinated service for his constituents. I encourage him to engage with his clinical commissioning group, as the idea has much merit. It could potentially secure better diagnosis and provide a better pathway for patients through discussion of the single point of contact, giving them much-needed continuity and a timeline for provision in Calder Valley and for patients more broadly.

My hon. Friend said that he thought virtual GP services would help people with hypermobility syndromes, because they would no longer have to travel all the time. He will be pleased to hear that virtual GP services are beginning to be rolled out in general practice. That means that patients will have the right to web and video consultations by April 2021, which I hope will also be of benefit.

As was announced by my colleague Baroness Blackwood this summer, we need a national conversation on rare diseases to help to inform and communicate. We will be engaging with patients, researchers and clinicians, gathering evidence, and identifying the major challenges faced in the field. We welcome the input from the hypermobility syndromes patient cohort and from healthcare professionals, and the work that they have done on the report.

Let me end by thanking my hon. Friend, who has spoken so passionately and so knowledgeably about this issue. I am grateful for the opportunity to discuss such an important report in the Chamber. We are dedicated to trying to improve the lives of all patients living with hypermobility, and, as my hon. Friend said, that is laid down in the NHS long-term plan and our implementation of the UK strategy. I hope that I have given a little reassurance to patients who are struggling for diagnosis that we are here to try to make the pathways stronger and diagnosis easier, and to improve the lives of all those affected by hypermobility syndromes and other rare diseases.

Question put and agreed to.

Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019

Jo Churchill Excerpts

Monday 7th October 2019 General Committees

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I beg to move,

That the Committee has considered the Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019 (S.I. 2019, No. 1247).

It is a pleasure to serve under your chairmanship, Dame Cheryl. I am confident that we all share the intention to ensure that the high standards of food and feed safety and consumer protection that we enjoy in this country are maintained when the UK leaves the European Union. As my hon. Friend the Member for Winchester (Steve Brine) stated previously, this instrument and the original instrument, which it amends, seek only to protect and maintain those high public health and food safety standards. Changes are limited to the necessary technical amendments to ensure that the legislation is operable on exit day. I stress that no policy changes are made through these instruments and we do not have any intention of making any at this point.

This instrument amends a previous EU exit SI: the Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019. Further clarity was required in setting out the authorisation process for approving products that can be used to remove surface contamination from products of animal origin. The clarification will ensure that the process is robust and can be applied clearly in assessing the risk in respect of new products.

This instrument needed to be in place to support the UK’s application for third-country listed status with the EU, so that the UK can continue to export animals and animal products to the EU. We anticipate that that is due to be voted on by the European Commission on 11 October.

This instrument has been made using the powers in the European Union (Withdrawal) Act 2018 to make necessary amendments to UK regulations to prevent, remedy or mitigate deficiencies in retained EU law that arise as a consequence of the UK’s withdrawal from the EU. The instrument was made on 9 September under the urgent “made affirmative” procedure, which was considered appropriate to meet the deadline for the European Commission’s third-country listing vote on 11 October.

As hon. Members know, the Government have made it clear that our priority is to seek a negotiated deal with the EU, but we are taking sensible action to ensure that we prepare for every eventuality. The UK’s third-country listing application was a particularly important part of our no-deal preparations. Third-country listed status guaranteed that the export of animal products and most live animals from the UK to the EU could continue. That market is worth approximately £5 billion to the UK annually.

I shall expand on the specific detail of the minor and technical changes made by the instrument. The primary purpose of this legislation is to refine an amendment to retained EU law made by the Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019. We considered that the regulation would benefit from further clarity in describing the authorisation process and the appropriate authority responsible for the process to approve substances that may be used to remove surface contamination from products of animal origin. Lack of clarity might affect implementation and has the potential to undermine the responsibilities for authorisation; this instrument rectifies that.

The new instrument makes it clear that the responsibility for approval of substances that may be used to remove surface contamination from products of animal origin rests with the Secretary of State for Health and Social Care and the appropriate Minister in each of the devolved Administrations. This measure introduces no substantive policy changes to what has already been successfully made and passed in Parliament in March 2019.

Food business operators are not permitted to use any substance other than potable water—or, where permitted, clean water—to remove surface contamination from products of animal origin unless that has been approved. This relates to business establishments that handle products such as meat, eggs, fish, cheese and milk and that do not supply to final consumers.

Currently, approval for such substances is given by the European Commission, but after EU exit this responsibility will be carried out by Ministers. The amendment to Regulation (EC) No. 853/2004 made by the Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019 is being further amended to make it absolutely clear that Ministers will be responsible for prescribing the use of any other substances and that the process of consulting the food safety authority is retained. That decision will be based on independent food safety advice from the Food Standards Agency and Food Standards Scotland.

If after EU exit any additional substances are proposed to be approved for this purpose, they will be subject to risk analysis by the FSA, which has established a rigorous and transparent risk analysis process for assessment and approval of any such new substances. Any request for substance approval would be subject to thorough scientific risk assessment and risk management, before being put to Ministers for a final decision.

Let me be clear that neither this instrument nor the instrument it amends introduces any changes for food businesses in how they are regulated and how they run, nor does it introduce extra burden. The overall changes to the food hygiene regulations will ensure a robust set of controls, which will underpin UK businesses’ ability to trade domestically and internationally.

It is also important to note that we have engaged positively with the devolved Administrations throughout the development of this instrument. Further, this ongoing engagement has been warmly welcomed. The devolved Administrations in Wales and Northern Ireland have provided their consent for this instrument; the Scottish Government have been made aware of these regulations, but have not yet had the opportunity to scrutinise them.

I would like to stress that we would not normally make EU exit regulations under this Act, where the policy area is devolved in competence, without the agreement of all of the devolved Administrations. However, as I have explained, this is a very minor drafting change to the regulation, which the Scottish Parliament has previously agreed. Regrettably, the potential impact should the instrument not be in place before 11 October on the third-country listing vote does not constitute a normal situation and could affect the farming industry across the whole of the UK, including Scotland.

Finally, I draw the Committee’s attention to the fact that, in line with informal communications, which the Food Standards Agency has had with the Joint Committee on Statutory Instruments, the FSA will, in accordance with the terms of the free issue procedure, be making this instrument available free of charge to those who purchased the earlier exit SI, namely the Specific Food Hygiene (Amendment Etc.) (EU Exit) Regulations 2019.

The Government accept that this instrument should have been made available under the free issue procedure at the time it was first made, but that did not happen. That situation will now be remedied. I apologise for that oversight and confirm to the Committee that this will be corrected and the Food Standards Agency will, together with colleagues in the national archives, be taking action to ensure that anyone entitled to a free copy of the instrument under that procedure will, where appropriate, be able to apply for a refund or otherwise obtain a copy.

[Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)]

Can my hon. Friend confirm that by laying this instrument the Government are demonstrating, beyond peradventure, that they will not tolerate any reduction in food safety standards as a result of the UK leaving the EU, contrary to what was asserted by some on television yesterday?

[Jo Churchill]

Indeed, that is so.

The action taken will allow one to obtain a copy of this instrument for free on request, in accordance with the usual terms of that procedure.

In conclusion, this instrument constitutes a minor—technical, but necessary—measure, to ensure that our legislation relating to food safety continues to work effectively after exit day. I urge hon. Members to support the amendment proposed, to ensure the continuation of effective food safety and public health controls. I commend the regulation to the Committee.

[Several hon. Members rose—]

--- Later in debate ---

[Jo Churchill]

Thank you, Dame Cheryl. I will resist the temptation to say “Howzat!”

I will first go over some general points that address several of the questions, and then I will address a couple of the specifics. The importance of food safety is paramount, and leaving the EU does not change that. Food safety in all cases remains our key priority; that means that business will carry on as normal. It is important that we acknowledge that, in many areas, food standards in this country are above those of other member states. Hon. Members commented that there will potentially be a race to the bottom, but actually we are trying to spread some of the good practice that goes on in all four parts of the UK in order to get others to raise their standards.

[Sir George Hollingbery (Meon Valley) (Con)]

The hon. Member for Wallasey implied that there is some sort of mercantilist imperative for us to drop standards so that we can sell our goods around the world, but does the Minister agree that to do so would be to shoot ourselves in the foot? It is quite clear that our food standards are what sell our goods overseas. The quality of British produce means that, for example, 35% of Chinese consumers surveyed said that they would particularly buy British products because they are of a higher standard.

[Jo Churchill]

I could not agree more. It is a great tribute not only to producers in this country but to the Food Standards Agency that people feel that our food and brands are to be trusted. I hope that will continue.

On the point raised by the hon. Member for Washington and Sunderland West, this was not missed. This instrument is purely to give clarification—hopefully that is what it does—to make doubly sure that everybody is clear. The devolved Administrations in Wales and Northern Ireland have said that they are fine; it is only Scotland that has not. Once again, I apologise for that. Scotland produces some of the finest quality products that go out of this country, so making sure we have done this properly is important to all the devolved nations.

Ensuring continuity of trade is important, and ensuring food safety here is hugely important. Mostly, we must ensure that we are open and transparent. The hon. Member for Washington and Sunderland West wanted clarification about the system. If there were to be any other form—the hon. Member for Wallasey alluded to chlorinated chicken, but it might be something else that is brought forward—it would first be risk-assessed by the FSA and would go through its very rigorous programme. It would then come to the Minister, and would come before the House by way of an SI. If there are any issues, that process must be walked through to ensure a degree of safety.

Specifically on chlorinated chicken, any substance used to remove surface contamination from chicken carcases must be specifically approved. Chorine has not been approved, and so cannot be used and could not be approved until it had walked through those processes. Each devolved Administration would then have individual responsibility for it. I feel that the concerns expressed in the media have perhaps over-egged the situation—we are all used to that—because those safety nets are in place. This SI simply helps to ensure that we are ready for Brexit on 31 October, whatever the circumstances, and that we are ready for all eventualities. Making sure we are prepared is the key job.

In closing, I hope I have answered hon. Members’ questions. As I said, the Government are working to agree a deal with the EU, but while we do that and until we have a finalised agreement, it is important that we prepare for the possibility that we will leave without a deal.

[Ms Eagle]

I thank the Minister for her responses, but could she address my question about the speed with which this instrument has had to be dealt with? She mentioned the meeting on the 11th. Is there scepticism about the state of our current law, and does that mean that this statutory instrument had to be dealt with quickly to help us with that meeting? Could she explain whom she is trying to reassure and why?

[Jo Churchill]

I suppose it was belt and braces. We felt that clarification was sensible to make it clear to all audiences that we are maintaining the highest standards. That is why we have done it. Given that we trade £5.4 billion of food and feed with the EU, ensuring that we have clarification before 11 October for third party status is paramount.

To reiterate, this instrument makes no changes to policy or to how food businesses are regulated and run. It is limited to drafting refinements and will ensure that the regulatory controls for food continue to function effectively after exit day if the UK leaves the EU without a deal.

Question put and agreed to.

Community Pharmacies

Jo Churchill Excerpts

Wednesday 2nd October 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Sir David. I thank each and every right hon. and hon. Member who has contributed. Most importantly, I thank the hon. Member for Halifax (Holly Lynch) for securing this debate and allowing us to discuss the challenges and celebrate the opportunities that lie ahead in community pharmacies, as well as how we best deliver to patients. The right hon. Member for Rother Valley (Sir Kevin Barron) and the hon. Members for Scunthorpe (Nic Dakin), for York Central (Rachael Maskell), for Heywood and Middleton (Liz McInnes), for Great Grimsby (Melanie Onn), for Strangford (Jim Shannon), for East Londonderry (Mr Campbell) and for Westmorland and Lonsdale (Tim Farron) all made excellent speeches that gave food for thought, as did the contributions from the hon. Members for Motherwell and Wishaw (Marion Fellows) and for Washington and Sunderland West (Mrs Hodgson). They celebrated exactly what community pharmacies can do if they are embedded in the heart of their communities and what untapped potential there is for moving forward.

I am pleased to have the opportunity to set out the vision for community pharmacy at a pivotal time for the pharmacy sector. As we have discussed, the past three years have been challenging, but there is a new pharmacy sector agreement. I am continually inspired, as everybody has been—we heard about the experience of the hon. Member for Halifax of working in a pharmacy—by the compassion, dedication and commitment of those who work in the NHS family. I saw that myself last week when I met pharmacists and the chief exec of the Pharmaceutical Services Negotiating Committee at the local pharmaceutical committee conference. That underlined to me again what an essential part of the NHS the pharmacy is, working day in and day out on improving outcomes for patients and for the community, which lies at the heart of what they do.

We have heard about the challenges of different communities. The hon. Member for Westmorland and Lonsdale made his point very well, as did other Members who represent rural constituencies. The hon. Members for Strangford and for Motherwell and Wishaw mentioned that the challenges are slightly different in rural, dispersed communities. We hope that the new contract will not be one size fits all but will give additional help to rural pharmacies to help them deliver, because we know that they are an important and integral part of their local community. Ensuring that we maintain a good level of access in England and support pharmacy where there are fewer pharmacies is important and built in.

Community pharmacy always has been an integral part of our communities. We have 11,500 community pharmacies delivering. I pay tribute to the right hon. Member for Rother Valley for his work in chairing the all-party group on pharmacy. He explained clearly how pharmacies are close to 96% of people, who can get to one by foot or on public transport in 20 minutes. The key thing for me was when he said that the majority were in areas of high deprivation. That is hugely important as the contract moves forward, because we are determined to double down on health inequalities, and we know that the pharmacist is a key frontline expert who can help deliver in those communities. Pharmacy can play a greater part in helping people to stay well in their communities.

Today’s debate is timely because the new landmark arrangements for pharmacy—a five-year deal for pharmacies—came into force yesterday. I have heard the deal criticised as flat, but the PSNC said that it wanted certainty; it wants to be able to use its skills better and further, and we have determined the deal in collaboration with it. The deal is the beginning of a programme to transform the sector and to see community pharmacies play a much expanded role in the delivery of health and care across prevention, urgent care and medicine safety. Those new arrangements will support the pharmacy team to utilise all its extensive clinical expertise, further developing new roles and providing the community with the knowledge, skills and support to prevent ill health, manage minor conditions and stay happy and healthy for longer. We have heard from virtually every Member who has spoken about how much that goes on. The hon. Member for Great Grimsby told a moving story of how intimate the relationship is between the community pharmacist and the community that he serves.

The deal sets a programme of work that the Department, NHS England, NHS Improvement and the PSNC have collaboratively developed and agreed—we have worked together to get there. Our direction of travel is clear, and we will continue to work together on the detail, strengthening the role of community pharmacy and the delivery of health and care year on year for the next five years and beyond.

[Nic Dakin]

The Minister is setting out the aspiration well, but does she recognise that having no increase—even by inflation—for five years is a desperately big challenge for community pharmacies?

[Jo Churchill]

On the matter of reimbursement, which was also raised by the hon. Members for York Central and for Westmorland and Lonsdale, we seek to ensure a fairer system of reimbursement for pharmacy contractors and value for money for the NHS. I am sure we would all agree that that is the challenge that we face the whole time. That is why, in July, we launched a consultation on community pharmacy drug reimbursement. We have engaged widely with pharmacy stakeholders and have had an excellent response. We will consider all those responses fully and set out plans for the fairer system in due course. I appreciate that the response will be, “But it’s needed now,” but a pharmacy is a private business, and reimbursement is not pharmacies’ only form of income. What I am talking about will take a shift. There is an acknowledgment that that shift—that transition—will need to be assisted. There is also an independent funding stream from the flu vaccine, for example. I would like to see—and have been discussing with officials—whether a broader vaccine programme could be rolled out through pharmacies as well, and reimbursed. We know we need to do better.

[Jim Shannon]

The Minister has so far given a comprehensive response to our concerns. I suggested in the debate that, when it comes to medical attention, pharmacies could do more to oversee small things such as the flu vaccination that she referred to and diabetes and glaucoma. As other hon. Members have mentioned, there are small things that pharmacists could do to take the pressure off GPs. Is that something the Government would consider—giving more responsibility to the pharmacist and taking pressure off GPs and accident and emergency?

[Jo Churchill]

If the hon. Gentleman will just bear with me for a second, he will hear me largely repeating what the right hon. Member for Rother Valley said when he so beautifully laid out the skills and expertise that lie in the pharmacy sector, and how they can be utilised better.

As I said, the deal sets out a programme of work we shall be working on. Our aim is that collaborative working across the system will deliver an integrated and accessible community health service for all. I want to name-check the hon. Member for Strangford here because, as he articulated, communication lies at the centre of this issue. One instance might be the digital expertise that the hon. Member for Washington and Sunderland West said exists in Gateshead, where people’s greater readiness to get services from pharmacists, and the fact that pharmacists can do more, is having a positive effect for patients.

First, pharmacists told us that we must utilise and unlock the potential of the highly skilled pharmacy teams that are embedded in communities throughout the country, including in the constituency of the hon. Member for Halifax, with everyone celebrating what pharmacists can deliver. That is why the settlement aims to deliver more fulfilling, patient-facing careers for community pharmacists and technicians, as highly valued members of the NHS team. Additionally, populations will be helped by much better services.

Secondly, pharmacists told us that they wanted continuity. The settlement funding over five years gives certainty, and gives community pharmacists the confidence to invest in their business. However, there is no one size fits all. Being in the centre of a town is not the same as being in a rural village. Looking at these things in the round is why we want this to be collaborative.

[Rachael Maskell]

How will the Minister measure the impact of the settlement, particularly on independent pharmacists? If more of them close or are struggling financially, what other interventions does she plan to make?

[Jo Churchill]

As I said, there is no one size that fits all. As the hon. Lady articulated in her speech, the difficulty is that we are not looking at a system where businesses are run on the same scale model. At any one point, there are single pharmacists. She stated that the pharmacy she visited was part of a seven-strong business. Then there are the multiples. We need to look at what is the best scheme. However, I would argue that independents have a much higher footfall from their local population, because they are more trusted than many of the multiple pharmacies due to the continuity that comes from their having been in their communities for longer. There are opportunities there for independents.

We know we will need to design new ways of working to make a success of this, and we will need patients to be confident in how they use the services. The enhanced role for community pharmacy will support patients in getting access to help where required and in using the NHS in the best possible way. When people are suffering from minor conditions such as earaches or sore throats and need health advice, we want them to think “Pharmacy First”.

We want to build on that, with other parts of the NHS proactively signposting to local pharmacists. We want everyone to recognise the high-level skills held by pharmacists and to get people to understand that we need them as a first-line service to go to. That will grow trust in the system and spread the load. We will, of course, need to reform the way we work to free up pharmacists’ time so that they are able to deliver these new services.

[Liz McInnes]

I am sorry to interrupt, but the Minister has not referred to delivery times yet, and we have only two and a half minutes to go. Will she mention what she is going to do about those?

[Jo Churchill]

I thank the hon. Lady, but I would like to push through and to come on to the supply of medicines, which the hon. Member for Halifax spent much of her speech discussing.

We must recognise that we need to work in partnership and that this is not only about treating ill health. One of the first services to come online under the new arrangements will be the community pharmacist consultation service, which will start on 29 October. It will establish the first ever national triage system, which will look at community pharmacies referring patients into pharmacy directly from NHS 111 for minor illnesses, wellbeing support and self-care advice, as well as urgent problems. It is important that everybody involved makes this work a success, because we want this to be a two-way process. Over the next five years, we want to include referrals from GPs, urgent treatment centres and NHS Online, but we want to do that based on evidence, sensibly and in collaboration with those in the sector. Registration opened only last month, and more than 2,000 pharmacies have been signed up.

Additionally, by 2020, being a level 1 healthy living pharmacy is expected to be an essential requirement, so that pharmacies can give advice. Integration across primary care is hugely important; the new contractual framework is about not moving minor illness, but about using the whole system better. Community pharmacies are a vital part of the picture if we want to think “Pharmacy First”.

Coming on to the question of medicine supply and shortages, I appreciate the issues that the hon. Member for Halifax mentioned, but, as recognised in last week’s National Audit Office report, we have done an enormous amount in collaboration with pharmaceutical and medical device companies. There are always ongoing shortages, but the Department works all the time to ensure that they are mitigated and that a proper supply of medicine can be got to people. With the issues of Brexit, we know that that is doubly important, and that is what the Department has been doubling down on.

[Sir David Crausby (in the Chair)]

I do not think there is really time for Holly Lynch to wind up.

Question put and agreed to.

Resolved,

That this House has considered the role of community pharmacies.

Improving Healthcare: Isle of Wight

Jo Churchill Excerpts

Tuesday 1st October 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Mr Betts.

First, I thank my hon. Friend the Member for Isle of Wight (Mr Seely) for bringing forward this important issue and securing this debate. I recognise his support for the trust and his desire, and the desire of others, to improve services. Today, however, he has highlighted three specific issues.

We recognise that the Isle of Wight faces different challenges from those on the mainland. As my hon. Friend said, the Island represents a very distinct healthcare environment. It is heavily dependent on acute services close by, but there is the difficulty of travelling across water and the challenges that that lack of accessibility brings to the Island.

I know that the local Sustainability and Transformation Partnership is considering how to put healthcare on the Isle of Wight and in Hampshire on a sustainable footing, with the high-quality care that my hon. Friend has asked for, in the interests of the system as a whole and for the long term.

The impact that those challenges have on local NHS systems needs to be discussed. I reassure my hon. Friend that we are committed to providing the high-quality care that he seeks to meet the needs of people across the Island and to accommodate people irrespective of where they live.

It is important that we do not let the NHS stand still, and my hon. Friend alluded to telemedicine and to making use of all such technologies in the future. We know that people are living longer, and the Island has an elderly population that is higher than the national average. That elderly population is living with multiple co-morbidities, which puts a higher pressure on the service, as he said. However, he also spoke about how the Island is beginning to address those challenges, using blue boxes and using the whole system to help the entire system to work better.

The long-term plan sets out how we will provide high-quality healthcare for all and ensure that people live longer, healthier and more independent lives, which is what we all want. The plan recognises that the NHS needs to change and implement new systems to meet 21st-century challenges, so we are actually at a point of opportunity.

We are committed to delivering high-quality universal care, irrespective of location. That is particularly important given the challenges that Island life brings and that my hon. Friend outlined. He knows that there are benefits of being on an island, but that there are also some constraints, which we must now sit down and work through.

We accept that there are additional costs for providing healthcare on the Island. It has individual challenges, arising from delivering care on the Island with the diseconomies of scale that my hon. Friend spoke about so well. Earlier this year, we committed £2.7 million in extra funding for the Isle of Wight under the fair funding review, to help to start working through some of these issues. This money is to support the plan of the clinical commissioning group, the NHS trust and the local council for integration of public services, which will improve the care that patients receive. I hear what he says about how we must work together to find solutions for the long term.

As my hon. Friend said, the Isle of Wight will also benefit from the announcement of the 20 hospital upgrades, and I am grateful that he mentioned the £48 million for the Island. This extra investment will lead to improvements in patient care, and hopefully will allow flexibility for Maggie Oldham, the trust’s chair, and the rest of the team to progress their ideas further, allowing the Island better to utilise innovative technology, improve efficiency and improve the quality of care, which he has highlighted is his key objective.

I pay tribute to all those who have been involved with the trust, given the difficult circumstances it faced when it received a rating from the Care Quality Commission of “inadequate”. It has begun the positive journey to make things better. I recognise the hard work that everybody has put in across the health and social care system in the area, which is a really positive start.

We will now look at the local system, supported by NHS England and NHS Improvement, to protect and build on those achievements. I have already spoken to the Minister for hospitals, my hon. Friend the Member for Charnwood (Edward Argar), who is more than happy to arrange a meeting at which he and his officials would be present, so that some of the specific questions may be given the proper and appropriate attention, because my hon. Friend the Member for Isle of Wight would not expect specific answers today.

Moving forward, it is vital in the medium term that the Island develops a strong joined-up plan across its health and care system to deliver the vision of a person-centred, co-ordinated health and social care system that gives patients the support they need. That is a unique system that cares for people from birth to end of life. My hon. Friend highlighted the challenges around the ambulance service, for example, such as not being able to use the overlay ambulance services available more easily to those on the mainland. I have also heard his request about patient travel costs. I have been assured by my hon. Friend the Minister for hospitals that NHS England and NHS Improvement have been involved in the development of plans and will continue to work closely with colleagues on the Isle of Wight. I therefore hope that my hon. Friend the Member for Isle of Wight realises that we are all here to support both him and the development of the broader health system on the Island.

While I recognise the concerns of Members who represent island constituencies, I hope that they will be reassured by our ongoing work to ensure that appropriate NHS resources are available, both on the Isle of Wight and on similar islands, to support patients and to meet CCG obligations to commission the best possible care. The Government are committed to ensuring that all patients receive high-quality healthcare that meets their needs, irrespective of where they live. Whether it involves me or my hon. Friend the Minister for hospitals, I look forward this constructive dialogue continuing.

Question put and agreed to.

Maraviroc and Progressive Multifocal Leukoencephalopathy

Jo Churchill Excerpts

Monday 30th September 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I thank the hon. Member for Feltham and Heston (Seema Malhotra) for raising this matter in the House, and for the comprehensive and sensitive way in which she has set out problems that will certainly be well recognised by many patients—not only her constituent, but people throughout the rare disease community. A number of the issues that she has raised affect what are often very small cohorts trying to put their case for particular drugs.

As we have heard from the hon. Lady, progressive multifocal leukoencephalopathy is a terrible disease which can have devastating effects on patients whose immune systems are already impaired, often as a result of taking medicines. Maraviroc is an antiretroviral drug approved by the Medicines and Healthcare Products Regulatory Agency for the treatment of HIV. In this case, the hon. Lady’s constituent, who unfortunately has multiple sclerosis, has been paying privately for the drug, which I understand she feels has a positive effect on her condition.

The use of Maraviroc for people with MS is “off-label”. Medicines sold and supplied in the UK must, rightly, have a licence, which specifies the medical conditions that they are approved to treat, and also specifies the recommended doses, contra-indications, and special warnings as specified by the MHRA. All that is intended to ensure the safety of the patient. Off-label use, as I am sure the hon. Lady is aware, describes that situation where the licensed medicine is used for an indication other than that for which it is licensed originally. However, as she said, a decision to use a medicine off-label is one for the individual clinician. In each case, it is for that professional to make that decision if they think the treatment is appropriate for a patient and they are satisfied that there is robust evidence to support their prescribing decision.

As the drug in question is a licensed medicine for the treatment of HIV, not PML, it has not been fully tested with PML patients in clinical trials. Therefore, it has not been approved as safe and effective. Crucially, it is important to note that the use of this drug to treat Natalizumab-induced PML currently has an evidence base limited to small observational studies where no conclusive evidence of patient benefit was found. However, I fully appreciate that it is a real challenge to establish a clinical evidence base when the patient population is so small.

In fact, as the hon. Lady mentioned, NHS England and NHS Improvement were asked in 2018 to develop a commissioning policy on the use of Maraviroc for the treatment of Natalizumab-induced PML. They concluded, however, that there was insufficient evidence of benefit and advised against routine commissioning. Maraviroc is not currently appraised or recommended by national bodies for the treatment of PML, because there is a lack of evidence of effectiveness and a lack of any evidence-based clinical support in the treatment of PML. NHS England has therefore concluded that there is not sufficient evidence to support the routine commissioning of the drug—a conclusion that clinical commissioning groups are minded to follow. Of course, that position would be reviewed should further evidence become available.

Despite Maraviroc not being routinely commissioned by the NHS, it remains possible for patients to access the drug through the individual funding request, which, as the hon. Lady has said, her constituent did. An independent panel would have considered the circumstances of the request before making a decision. In this case I understand that the IFR was rejected, which I know would have been upsetting for the hon. Lady’s constituent. Following the outcome of the IFR, the reasons for the decision would, I am sure, have been explained to her constituent. If not, I urge the hon. Lady to ensure that they are explained in full.

[Seema Malhotra]

I understand that this is a technical matter in some respects, but I am a little surprised that I have not heard the Minister say anything new compared with the responses I have received to parliamentary questions. I have laid out the evidence and shown that there are nuances. In the case of my constituent, the medical benefits have been clear. I am surprised that the IFR was denied, including subsequently on appeal, and, given that I have laid out the evidence, that the Minister is not in a position to give advice on how we can move forward so that we do not keep going around in circles.

[Jo Churchill]

I think that part of the confusion has come from the fact that the NHSE advice not to commission is different from the independent funding route process. Clinicians can always apply for IFR funding in exceptional circumstances. The MHRA parliamentary question was about availability. One offer I can make is that we will try to unpick those four answers and to understand a little more in the round how we can be of assistance and give the hon. Lady’s constituent clarity, if nothing else.

[Seema Malhotra]

The Minister is very generous in giving way. Rather than restating the policy, will she support the request for the medical advice that was the reason for the treatment and funding being refused? There must have been some medical input into the decision made by the panel at NHS England. Will she also be able to meet me to review the process and what my constituent has been through? Clearly my constituent is in a very rare circumstance—she is possibly one of fewer than 10 people in the country—but surely we are able to work a bit faster and with more agility in a situation where, in a sense, the patient and the experts in the field should be leading.

[Jo Churchill]

I am, of course, happy to meet the hon. Lady, but we must be led by clinicians. As she says, her constituent has been supported by her clinicians, and it is up to them to make clinical judgments and to put the case for the best course of treatment in each particular case. The first thing to do is to seek clarification on where we know we are going, and hopefully we can move forward from there.

As the hon. Lady says, the PML group is around 10 in number, so getting robust evidence is obviously a challenge—that is all part and parcel of the issue. As she knows, another challenge is that the Department of Health and Social Care does not have direct responsibility for what is routinely commissioned. Instead, it is the responsibility of NHS England, NHS Improvement and the CCGs. Faced with an unprecedented level of demand for services, all those involved have to make difficult decisions about commissioning cost-effective care on a daily basis. They make those decisions based on patient need and clinical evidence, which I acknowledge can feel very cyclical for the rare disease community.

[Seema Malhotra]

Does the Minister agree it is slightly more problematic in this case, because the cost of Maraviroc is arguably a bit less than the MRI scans and the steroids every month that the NHS would otherwise prescribe or suggest to my constituent? The negative health impact of that treatment should also be taken into account.

[Jo Churchill]

I thank the hon. Lady, but I return to the fact that it is a judgment for clinicians to make; it is not one for me to make at the Dispatch Box.

My colleague Baroness Blackwood rightly said this summer that we need a national conversation on rare diseases to identify the big areas on which we need to focus so that we can offer the best possible care for rare disease patients and their families, who are often affected by what their loved ones are going through. I could not agree more so, starting this autumn, we will be engaging with patients, researchers and clinicians to gather evidence and identify the major challenges faced in this field.

[Jim Shannon]

I am pleased to see the Minister in her place. I offer her congratulations; it is well deserved.

Will money be set aside at the end of the consultation to address the medicines that are needed for those rare diseases? If money is not set aside, it will not go anywhere.

[Jo Churchill]

I am not in a position to say. Although each cohort is small, the overall rare disease community is large. That is why such debates make an important contribution to the broader conversation. I am grateful for how they raise awareness of the rare disease community, which comprises some 3.5 million people in this country.

[Seema Malhotra]

I will make this my last intervention. I just want to welcome the work that will be done in respect of the rare disease community. May I add to the comments in this House in welcoming the Minister to her place? I know that her experience will be extremely valuable in the work that she does in the Department.

[Jo Churchill]

I thank the hon. Lady sincerely for that and for speaking so passionately here today about the situation on behalf of her constituent. I know that her constituent may not feel that this is the answer that she wanted, but I cannot emphasise enough the positive effect of bringing this issue to the Chamber. Not only will it raise awareness, to help inform Government strategy, but it will support others in the rare disease community. As the hon. Lady said, allowing their voice to be heard is what is important here.

Question put and agreed to.

Oral Answers to Questions

Jo Churchill Excerpts

Tuesday 21st March 2017 Commons Chamber

[David Mowat]

One of the criteria by which STPs are being judged is the extent to which they are making this tilt from secondary into primary care, exactly as the hon. Lady suggests. That is precisely why the extra funding for primary care that I have set out is so important and why it is happening.

[Jo Churchill (Bury St Edmunds) (Con)]

“General Practice Forward View” talks about supporting general practice to improve digital technology for patients. Given the recent data challenges, does the Minister agree that putting a national data guardian on a statutory footing to protect patients and professionals is becoming an imperative?

[David Mowat]

I know that my hon. Friend has introduced a private Member’s Bill in this area, and the Government intend to support it.

Health and Social Care

Jo Churchill Excerpts

Monday 27th February 2017 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

Let us be clear: estimates are a serious business; they must be realistic. Every year, Parliament votes on how much can be spent. If excess is needed, Departments have to go back to the House, so getting estimates right is mission-critical.

The challenge I have with these estimates is that I have little faith that the assumptions they are based on are realistic. As my hon. Friend the Member for Totnes (Dr Wollaston) said, there is an assumption that demand will go down. As the population increases, and as immigration increases, that seems a very unrealistic view to take. The Government need to look long and hard at the assumptions they have made, because I for one am not convinced that they have got them right.

We also need to look at what these estimates assume in terms of the negatives. They assume we can keep on course if we reduce public health spending. If we start reducing that spending, which prevents the need for NHS intervention—the most expensive form of intervention—will we really save money? It seems to me that we will not. The other assumption made in these estimates is that central administration will be cut. We should bear in mind the complexity of what is going on at the moment, with 44 STPs coming on board, as we all hope they will, and I agree with my hon. Friend that they are a good concept, although I have some real concerns about delivery. Overall, I am concerned that these estimates are not based on realistic assumptions, and Ministers will need to seriously address that.

As the hon. Member for Hackney South and Shoreditch (Meg Hillier), who leads the Public Accounts Committee, and my hon. Friend have said, the estimates must take into account what we need for health and social care. If we cut spending on social care, or do not adequately fund it, we will increase spending in the NHS.

However, underpinning all of that is the need to have measurements in place across the whole system, as my hon. Friend indicated, so that we know what the full scope of the demand is. We must measure the results achieved by the resource we put in and the outcomes for the population as a whole. We all talk about measures around A&E and the NHS. We all talk about waiting times, and the targets that are set are all around waiting times. However, nobody is looking at what impact that has on primary care—on our GPs—or on social care. If an estimate is to be right, therefore, we need to look at the whole system of measurement.

[Jo Churchill (Bury St Edmunds) (Con)]

My hon. Friend is making powerful points. At my local district general hospital, West Suffolk, winter preparedness plans included a 5% uplift in demand—this is exactly the point she is making—but there was a 20% increase. I have exactly the same thing in social care, where my social care providers tell me people are older and more poorly. We have increased demand across the piece for that reason.

[Anne Marie Morris]

I thank my hon. Friend for that helpful example. She is absolutely right.

If we look at the whole measurement system—this was acknowledged in one of our Public Accounts Committee sessions by the Department of Health—we see that there is limited measurement, and that there probably should be more. When I challenged the individual concerned on whether the Government would be looking at that, he stood from one foot to the other and could not give us much of an answer. These estimates have to be based on proper measurement of need, on what is operationally put into practice, and on the outcome for patients, but that simply is not the case.

We need to look at the differences between the NHS and social care as regards how the money is allocated. In the NHS, we have some ring-fencing, while in social care we do not, but because the two are inextricably linked, unless we look at the way in which each of those pots is managed, never mind how much is in them, we give rise to problems for the future. Social care is not ring-fenced. I am sure we are all grateful for the additional moneys that have been provided, but frankly they do not go far enough. The first chunk of money might cover the living wage, and the ability of local authorities to increase the precept by 3% is welcome, but as the Chair of the Public Accounts Committee said, that is taxpayers’ money.

Oral Answers to Questions

Jo Churchill Excerpts

Tuesday 7th February 2017 Commons Chamber

[Nicola Blackwood]

We have continual discussions with the Welsh Government to make sure that these issues are kept under review. I shall definitely write to my hon. Friend about this. I shall also be happy to meet him if he would like to discuss it in further detail.

[Jo Churchill (Bury St Edmunds) (Con)]

Does the Minister agree that not one subject that we have discussed today would not be improved by the better transfer of patient data? How is the Department working towards linking social care with the acute sector, with GPs, with mental health services, with innovation and with cancer drugs in order to understand where we can best target patient outcomes and spend our resources?

[Nicola Blackwood]

My hon. Friend has a leading role with her private Member’s Bill so she is well aware that we are working very hard to improve the connection of patient data, particularly through the role of the national data guardian and her 10 safeguarding rules, which will make sure that we not only protect patient data more effectively but are able to share it in an effective way that improves patient care.

NHS and Social Care Funding

Jo Churchill Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dr Whitford]

Public consultation is important, and not just in the way it has often been done in the past—“We’ve made a decision, it’s a fait accompli, and we’re coming and telling you about it.” Unfortunately, that is very much what we have heard about the STP process, partly because it has been so short and partly, I am afraid, because it is about budget-centred care, not patient-centred care. Areas have been given a number and told, “If you’re not reaching this number, don’t bother submitting your plan,” and they are working back from that. That will not achieve an efficient, integrated service, so the public must be involved.

Frontline clinicians must also be involved. They work in a service and know exactly what the bottlenecks are and exactly what horseshoe nail is missing and holding a service back. If we have clinician-led redesign, such as I was involved in for breast cancer in my health board 17 years ago, we can track a patient’s path. We can quickly imagine ourselves as a patient, see the bottlenecks and focus investment on them.

I read an article yesterday stating that three hospitals in Manchester have spent £6 million on management consultants to say, “Shut a ward, sack hundreds of people and jack up the parking charges.” I am sorry, but that was not good value for £2 million each.

[Jo Churchill (Bury St Edmunds) (Con)]

I thank the hon. Lady for, as ever, eloquently expressing issues that face us all, no matter where we come from and who we are. Does she agree that having good healthcare data for clinicians enables patients to be put through the system seamlessly? Many individuals do not realise that their data do not go from their GP into acute care and then back into social care. If we could improve that—I make a plug for my private Member’s Bill on Friday—it would help patients.

--- Later in debate ---

[Jo Churchill (Bury St Edmunds) (Con)]

I pay tribute to all who work in our national health service and welcome this important debate. I hear the Secretary of State not blaming, but looking for solutions; that is more what we should be about. I have called for an honest debate about the NHS since I came to this place. The NHS is 70 years old next year, and if it is going to reach 100 we need to look after it.

But I want to start with the positive. My own hospital, West Suffolk, saw a 20% increase between Christmas and new year in the number of patients admitted. Those patients were poorly—very poorly; that point was made earlier. The hospital had prepared a resilience plan for a 5% uplift in patient numbers, but it has coped spectacularly well. To refer to a point made by the hon. Member for Tooting (Dr Allin-Khan), who is no longer present, people come into A&E with ingrowing toenails and dry skin, and it is important that we make sure we see the most poorly people in the most appropriate way and use resources most effectively.

My constituency has the second oldest population in the country. There is an ageing population with comorbidities, and in the next 10 years the number of those aged 85-plus will rise by 45%, so the allocation of resources as we go forward is important.

But my hospital has been one of the most resilient in the east, at 85%, and its resilience is in most part due to its fantastic staff. West Suffolk hospital has been innovative. It pays for 20 beds in Glastonbury court, a facility owned by Care UK to provide a step-down facility. In January, it will be doing a bridging care service with the councils. Improvement will come through prevention and integration, and not always by shouting for more money.

My hon. Friend the Member for Faversham and Mid Kent (Helen Whately) said that what we need is good integration. Good working in Suffolk needs to be copied. As my hon. Friend the Member for Wells (James Heappey) and the hon. Member for Central Ayrshire (Dr Whitford) said, STPs need to be looked at as a force for good, and I urge Labour not to knock them, but to work with them. They are clinician-led, which is what everybody was asking for.

We cannot have everything we want in life—we never can—and we cannot have everything we want out of the NHS. That is why we need an honest conversation. With rising expectations and an ageing population, the private sector has been in use in the NHS since 1948. If we are going to get more bang for our buck, we should perhaps look at parts of the private sector, to be able to enhance what we give patients through these critical periods.

[Simon Hoare (North Dorset) (Con)]

My hon. Friend is absolutely right about the need for a grown-up debate about integration and about learning from best practice. Does she share my concern that as Labour Members fan the flames of their artificial indignation, all they are doing is proving yet again that they are either unwilling, ill-equipped or ideologically—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Thank you. Jo Churchill.

[Jo Churchill]

I agree in that since we last debated this with the Opposition on 23 November, apart from asking for £700 million to be brought forward, they have put forward very little in the way of tangible plans. We are talking about everybody here, and just slinging bows and arrows across the Chamber will not get us to the solution we need.

If this is about money, why do some areas do better than others? It is actually about the allocation of resources and good leadership. I have received three letters about good healthcare. A resident in my constituency saw the GP on 28 October, the consultant on 8 November, and had their operation on the 29th. That was at my district general hospital that used the private facility locally to enhance the patient experience.

We need a long-term solution. I am pleased that the Prime Minister has spoken about tackling the difficulties of mental health. The right hon. Member for North Norfolk (Norman Lamb) has championed that and shares a mental health trust with me. I am pleased to see that another 49,000 people are being treated for cancer—that is something that I came to this place to champion—and another 822,000 people are receiving specialist cancer treatment. We have seen huge increases in demand, and we need to admit that we cannot just carry on. There have been advances in drugs, but we need to take into account comorbidities and an ageing population.

We need to understand what is wrong, and we will do that by having better data throughout the system. The Richmond Group wrote in support of my private Member’s Bill that information held in healthcare records has a huge potential to provide better care and improve health service delivery within the service. Paramedics have asked me for better access to data so that, when they find someone on the floor, they will know what meds they are on and what the most beneficial treatment would be. GPs want their information to flow through the system to help social care and the hospital sector. Pharmacies need to be able to read and write, and those working in social care need to be able to look at someone’s pathway. Patient outcomes should be the thing that we are all talking about, but we have to make decisions. At the centre of all this, we need to support those colleagues who are working above and beyond at this time. We need to behave in a grown-up, responsible way, just as they are, in caring for our NHS.

Pharmacies and Integrated Healthcare: England

Jo Churchill Excerpts

Wednesday 11th January 2017 Westminster Hall

[Mrs Main]

My hon. Friend is absolutely right and completely backs up the point I was making. There is evidence of good practice but other areas could do much better. Without bringing pharmacies to the table and into the ongoing dialogue about this issue, we risk not having the new model that we would all like to see—one that operates consistently wherever people go.

There must be a consistent model in the drop-in pharmacy service that we are envisaging. Of course, people often use pharmacies away from where they live, such as where they work or when they are on holiday or visiting friends. If the model is patchy, as my hon. Friend says, the system will not improve and we will end up with a situation like the one that is found in many holiday towns. A few years ago, the Select Committee on Communities and Local Government looked into the fact that many seaside and holiday towns have enormous pressures on their frontline services. If something goes wrong when people are on holiday, although what happens is not necessarily catastrophic, they all end up at the local A&E services in hospitals. That huge problem was recognised, I think, in the 2006 seaside towns report by the CLG Committee. This is all part of evening out the stresses and strains on the system, which for many seaside holiday and tourist destinations are often huge.

[Jo Churchill (Bury St Edmunds) (Con)]

Does my hon. Friend agree that that was largely the point of the Murray review, which she alluded to earlier? Integration throughout the whole of the NHS is vital, so that everybody knows what everybody else is doing and so that there are seamless pathways that everybody knows how to follow. That will ultimately give us benefits not only in pharmacies, but right across the NHS.

[Mrs Main]

Absolutely. Rachel Solanki and her colleagues are not necessarily critical of change—that is important. Pharmacies are nervous about some of the things that may be coming along, but they are not critical of change. Indeed, they would welcome a debate on the innovative services that other pharmacies are operating around the country. The fact that we do not all know about these services in other places shows that there is not an integrated approach. The services include anticoagulation monitoring in Knowsley; medicines optimisation work for respiratory diseases in South Central; sexual health screening, including for hepatitis, syphilis and HIV, on the Isle of Wight; oral contraceptive supply in Manchester and other contraceptive provision in Newcastle; alcohol screening and brief intervention on the Wirral; healthy lung screening in Essex; pneumococcal immunisation in Sheffield; a reablement service on the Isle of Wight; and phlebotomy services in Coventry and Manchester. That is a long, diverse list of services that are provided by pharmacies in those areas.

--- Later in debate ---

[Jo Churchill (Bury St Edmunds) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I add my congratulations to my hon. Friend the Member for St Albans (Mrs Main) on securing not only a timely debate, given the current circumstances, but one that is important because we need to look at the whole system and integration, rather than at each specific service.

Interestingly, on 6 December, Lord Prior said:

“The Government recognise the vital importance of community pharmacy.”—[Official Report, House of Lords, 6 December 2016; Vol. 777, c. 593.]

It is from that positive stance that I wish to make my points. Pharmacists have been identified as one of the professions that are highly qualified and not in short supply. Some very advanced GPs are bringing pharmacists into their surgeries to help to alleviate some of the pressure. Some clever thinking is going on out there. I hope the Minister can tell us how we are capturing that innovative thinking and how it is being spread throughout the system.

The “Five Year Forward View” identified that the British public need to be made more aware of what pharmacies can do and how they can help people keep healthy. However, the Government need to give a steer and ensure that people with minor ailments understand that the pharmacist should be their first port of call.

When I visited my pharmacist there was concern about the 111 service, which was my hon. Friend the Member for St Albans mentioned. We need to keep an eye on that so that we do not unintentionally put pressure on different parts of the service. We need to look at it in the round and incorporate all key roles into pharmacies in order to provide additional services. I had my flu jab at a pharmacy this year, which is a useful use of resources within the system and within the community. We could make that more available and perhaps incentivise individual pharmacists to go out into care homes, which have a proliferation of need because of age and comorbidities, and give flu jabs and so on. Moving our workforce around, rather than driving ever-greater demand into smaller places such as hospitals, must be a consideration.

The Murray review, which has been mentioned, found that poor integration with other parts of the NHS was a significant barrier, and the Royal Pharmaceutical Society agreed. I like to think that the Government are taking a good look at what was said in the review and taking the issues on board.

I love the term “pharmacy-first culture”, which is a good motto for everybody to live by. I want to concentrate on my Bury St Edmunds constituency for a couple of minutes. We have 21 pharmacies and a cluster of Superdrug and Boots shops, which are volume providers that have other things such as make-up and lunches; they have optical services and Boots has audiology services. They provide everything needed from the cradle to the grave and they have considerably greater footfall than my excellent independent pharmacist, who puts more prescriptions through than any other pharmacist in the town. The 100-hours rule meant that I got local surgeries with pharmacies dispensing in them. We need to take a little bit of care, step back and get the right things in the right place. The last thing my local community wants is my independent pharmacy not being able to survive through these important transitions.

An ageing population is a challenge in rural areas such as Bury St Edmunds. Within the next decade, 40% of Suffolk’s population will be over 85. We know that that age group lives with comorbidities that need a degree of monitoring. That can be done most effectively in the pharmacy and in the GP’s surgery, but out of the big NHS pie the GPs get only about 8% and the acute sector gets about 92%. We need to show that we are spreading the money throughout the system, because a lot of the pressure will be coming down on the pharmacies, the GPs and the care sector.

Pharmacists are often not used to their full value. Delayed discharge from hospital often comes about because people do not get their meds, and pharmacies in some hospitals are not available throughout the weekends. There could be more joined-up thinking.

[Bill Esterson]

I do not think I disagree with anything the hon. Lady has said. She is making a very good case for the excellent practice in her constituency and for pharmacists more generally. Does she agree that the logic of her argument is that money is saved by investing in pharmacies? That is a strong argument. She is arguing that cuts should not be made and that the Government should invest in pharmacies to support the whole health system, which is what this debate is about.

[Jo Churchill]

I thank the hon. Gentleman for his intervention and agree with his final point. This is about the whole system and making efficiencies. We are talking about evolution. We are no longer looking at the service as it was perceived in 1948. There was a private element to it even back then, because that is what GPs wanted. We need a 2017 solution to the challenges of a larger population, an ageing population and so on. Pharmacists must play their part in that. They are really keen to step up and deliver more for the Government and more for the patients and people in their communities.

There are issues in the town, but there is an interesting rural situation, where there are rural payments for Elmswell and Thurston, but the GP surgery in Woolpit, which dispenses more scripts, does not get one. There seems to be a bit of discrepancy. I echo the point made by my hon. Friend the Member for St Austell and Newquay (Steve Double): looking at rural constituencies is a very different thing from looking at the whole ecosystem.

There is a Day Lewis pharmacy in my town. An exceptional local resident, Ernie Broom, is keen to note that that pharmacy, because of its location, cannot offer a lot of peripheral things. The local residents are largely mature or on lower incomes, which means that the pharmacy is vital to the community. We also have really poor bus services into town—it would take a young mum or an elderly person nearly an hour and a half to cross town. I want the Government to look at a weighting system, which takes into account what local pharmacies can deliver. They would get points for being in certain areas, or incentives for delivering more. I know that is something that is being looked at.

My questions are similar to those posed by my hon. Friend the Member for St Albans. What more can pharmacies be incentivised to do? How much more capacity can they provide? With people living longer and with comorbidities, how can we remunerate for services? How can we ensure that that is included as part of sustainable transformation plans? It is not something that should be added at the end as an afterthought, but is a hugely integral part of how we make our NHS better and more able to look after the health of us all.

--- Later in debate ---

[David Mowat]

That is of course a valid concern. We are trying to make progress on having GP services open for much longer than they have been historically, including weekend opening. Several colleagues have made the point—the Murray review also addressed this—that there is occasionally a barrier between the attitudes of some GPs and what can be done by pharmacists. That is true. We must be conscious that it behoves us to try to encourage the breaking down of that barrier, and misplaced professional pride must not prevent us from doing things to the best extent. Putting some pharmacists in GP practices—particularly with new models of working in which more disciplines tend to work together and a GP does not just work on his own—is an important part of that.

[Jo Churchill]

There is a barrier, but again, those services are used in different ways. My independent community pharmacist in Bury St Edmunds dispenses around 18,000 or 19,000 prescriptions in the town and provides all these ancillary services. He also has a dispensing practice in a GP surgery, which he is looking to automate, to make it more streamlined and cost-effective. Those services are two slightly different things, and I would worry if there were too much of an idea that they service the same thing.

[David Mowat]

They are different, but my point was somewhat different: optimising the use of the pharmacist profession could facilitate the breaking down of barriers and some of the care home activities that have to happen.

I will leave a couple of minutes for my hon. Friend the Member for St Albans to respond, so I will not talk in detail about the value for money aspect, other than to repeat the point—Opposition Members made a couple of interventions about this—that overpaying for a dispensing service is not the way to facilitate a much more clinically-based and service-based approach. The way to facilitate that is to get the appropriate remuneration models and revenue streams in place, and that is what we are determined to do. In the end, that is what we expect to be judged on, and I hope that we will be judged on it. With that, I will let my hon. Friend summarise.