Community Pharmacies

Jonathan Ashworth Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab)]

I beg to move,

That this House notes that community pharmacies are valued assets that offer face-to-face healthcare advice which relieves pressure on other NHS services; calls on the Government to rethink its changes to community pharmacy funding; and further calls on the Government to ensure that community pharmacies are protected from service reduction and closure and that local provision of community pharmacy services is protected.

This is an issue that affects many of our constituents, and it has aroused considerable opposition from so many of them that 2.2 million people have signed a petition. Community pharmacists, I am sure, have lobbied Members of all parties about these cuts and have explained why they should be opposed. Indeed, Members of all parties have raised their concerns and their opposition to these cuts.

I pay particular tribute to my hon. Friend the Member for Barnsley East (Michael Dugher), who has campaigned tirelessly on this issue, and to my right hon. Friend the Member for Rother Valley (Kevin Barron). Government Members have also raised their opposition in Westminster Hall debates, Adjournment debates and parliamentary questions. Their opposition to the cuts is entirely understandable.

When the Government announced, in December last year, that they were going to pursue the cuts, they talked of cutting the budget for community pharmacy services by £170 million, with further cuts to follow. Opposition to the cuts was clear, and indeed was heightened when the previous Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), who I see in his place and for whom I have tremendous respect, suggested that the cuts could lead to the closure of up to 3,000 community pharmacies.

[Andy Slaughter (Hammersmith) (Lab)]

We have had a lot of correspondence from local pharmacists and their customers worried about essential parts of the local community such as businesses, but is it not also the case that, with massive cuts in acute services and with primary care under pressure, those pharmacies provide an essential and cost-effective part of the local health service, which we simply cannot do without?

[Jonathan Ashworth]

My hon. Friend has anticipated my argument—I could probably sit down now that he has put it so eloquently, but I shall plough on while I have the indulgence of the House.

I was saying that the right hon. Member for North East Bedfordshire had said that the cuts might lead to some 3,000 community pharmacies closing. Then, of course, the right hon. Gentleman left his post in the Department of Health, which we are all very sad about. Now we have a new Minister, and we are delighted to welcome the hon. Member for Warrington South (David Mowat) to his place—not least because in one of his first interventions when he was allowed out, he visited the Royal Pharmaceutical Society’s annual conference in September and said he was delaying the cuts. He said:

“I think it is right that we spend the time, particularly me as an incoming minister, to make sure that we are making the correct decision”.

He continued by saying that

“what we do is going to be right for you, is going to be right for the NHS and right for the public more generally.”

Well, if the Minister had left it there—with that U-turn—he would have won the praise of Labour Members.

Unfortunately, we then had a U-turn on the U-turn from the Minister. When the Minister came before the House last month we found out that, far from having listened, taken account of various consultations and decided to do what was best for the NHS, he intended to impose a 12% cut on current levels to pharmacy budgets for the remainder of this financial year—giving pharmacists just six weeks’ notice—and a 7% cut the year after that.

[Kate Green (Stretford and Urmston) (Lab)]

rose—

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

rose—

[Jonathan Ashworth]

Because she represents my mother’s home town, I will give way first to my hon. Friend the Member for Stretford and Urmston.

[Kate Green]

It is a privilege to represent my hon. Friend’s mother, and he, of course, knows my constituency well. The constituency has high levels of deprivation, and our primary care services face incredible pressure owing to unsuitable practice premises and the difficulty of recruiting GPs. Does my hon. Friend agree that with only seven weeks’ notice, it is impossible for GPs, other primary care providers and pharmacists to accommodate and make provision for these cuts in a way that will allow them to continue to support deprived communities in my constituency and, indeed, the constituencies of all Members?

[Jonathan Ashworth]

My hon. Friend is absolutely right. That is why the cuts have aroused so much opposition from not just Labour but Conservative Members.

[Catherine McKinnell]

My hon. Friend is making an excellent speech. Over the past few years, a significant amount of work has been put into the Think Pharmacy First campaign, whose aim is to take pressure off GPs, ambulances and A & E services, but is “Think Pharmacy First for cuts and closures” really what the Government have in mind?

[Jonathan Ashworth]

My hon. Friend has made a powerful point, which completely blows apart many of the arguments that the Government have advanced in recent years.

[Jeremy Quin (Horsham) (Con)]

Given the clustering of pharmacies, does the hon. Gentleman believe that no better way of funding the service can be envisaged?

--- Later in debate ---

[Jonathan Ashworth]

The cuts are not aimed at clusters. They are completely arbitrary, and they will result in the closure of many pharmacies in some of the most deprived parts of the country.

[Several hon. Members rose—]

[Jonathan Ashworth]

I want to make a bit of progress, because I know that many other Members wish to speak.

The cuts will mean that patients, many of them elderly and unable to travel long distances, will be forced to go elsewhere for essential medical advice and support. What we need from the Minister now are the details of how many pharmacies will close. The previous Minister, the right hon. Member for North East Bedfordshire, told us that up to 3,000 community pharmacies—a quarter of all pharmacies—could close.

[Alistair Burt (North East Bedfordshire) (Con)]

It may be helpful if I make a brief intervention at this stage. I gave an estimate which was based on what we thought was a possible worst-case scenario. The Department never had any plans to close pharmacies. It was the best estimate that I had at the time, but it was not a definitive figure.

[Jonathan Ashworth]

The right hon. Gentleman is an extremely experienced former Health Minister, possibly the most extreme—[Laughter.] He is definitely not an extremist, but he is possibly the most experienced Conservative former Health Minister apart from, perhaps, the right hon. and learned Member for Rushcliffe (Mr Clarke). It is very noble of him to try to get the Minister off the hook, but the fact remains that he was the one who said that 3,000 pharmacies would close, and we will continue to remind Ministers of that.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

rose—

[Jonathan Ashworth]

I will give way to the former Chief Whip, but then I will make some progress.

[Dame Rosie Winterton]

Doncaster pharmacists have told me that at least 20 pharmacies in the town will close as a result of the cuts. That is their estimate, on the ground. They have also told me that the Government should sit down with pharmacists and engage in meaningful discussions about pharmacy delivery. For example, setting up a minor ailments service and cutting the drugs budget could possibly save the NHS £5 million in Doncaster and £650 million overall.

[Jonathan Ashworth]

My right hon. Friend is absolutely correct. She was not only an exceptional Chief Whip but an exceptional pharmacies Minister in the last Labour Government, and she knows how foolhardy it would be to make cuts in the pharmacy sector.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I should like to make a bit of progress, if I may. As I said earlier, I am extremely conscious that other Members wish to speak.

As we have heard, the former Health Minister said that 3,000 community pharmacies could close. When pressed about the figures last month, the current Minister said

“no community will be left without a pharmacy.”—[Official Report, 17 October 2016; Vol. 615.]

I hope he will confirm that he still stands by that statement. He also claimed:

“Nobody is talking about thousands of pharmacies closing”. —[Official Report, 17 October 2016; Vol. 615, c. 602-3.]

He obviously did not receive the memo from the right hon. Member for North East Bedfordshire. But what did he say when he was pressed by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) about the number of closures? What soothing, reassuring words did he offer to all our constituents? He said, “I do not know.”

I am sorry that the Minister has not got a clue, but I hope that when he winds up the debate he will be able to tell us how many pharmacies will close as a result of these cuts. If he is not prepared to tell us that, will he tell us how many services will be cut?

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

rose—

[Jonathan Ashworth]

I will give way to the vice-chair of the all-party parliamentary group on pharmacy, but then I must make progress.

[Oliver Colvile]

Is the hon. Gentleman aware that the number of pharmacies has increased by 18% over the past 10 years?

[Jonathan Ashworth]

I know that the hon. Gentleman works tirelessly as a champion for pharmacies, but he knows that these proposals will mean cuts in many services.

[Maria Eagle (Garston and Halewood) (Lab)]

Many pharmacies in Halewood deliver medication, up to 8.30 pm, to elderly and vulnerable people who cannot get out of the house, and to care homes. What does my hon. Friend think will happen if those pharmacies have to close?

[Jonathan Ashworth]

I do not need to say what I think; I need to say what the sector thinks, and the sector has made it clear today that it will have to cut services such as the delivery of medicines to some of the most elderly and vulnerable members of society.

[Dr Murrison]

rose—

[Mr Ben Bradshaw (Exeter) (Lab)]

rose—

[Jonathan Ashworth]

I will give way to my right hon. Friend the Member for Exeter, but then I really must make some progress.

[Mr Bradshaw]

Although the Government say that they want to devote a greater proportion of overall health spending to primary care, our Health Committee’s report on primary care, published in the summer, showed that a smaller proportion was being devoted to the primary care sector, which, of course, includes pharmacies. Is that not the ultimate false economy? If we do not invest more in primary care, all the pressure goes into the acute sector.

[Jonathan Ashworth]

My right hon. Friend is another experienced former Health Minister, and he is right. As we learned this week, the Health Committee has completely blown apart the Government’s figures on the financing of the NHS.

[Dr Murrison]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

If I may, I shall make some progress. I promise to give way to the hon. Gentleman in a few moments, but I know that others wish to speak.

The Government will say that they are mitigating the cuts by introducing a pharmacy access scheme, but the scheme takes no account of the needs of the most deprived communities. The four constituencies that top the health deprivation and disability indices are Liverpool Walton, Blackpool South, Manchester Central and Blackley and Broughton. Not one pharmacy in those constituencies is eligible for the pharmacy access scheme. The least deprived constituencies are Chesham and Amersham and Wokingham. In Chesham and Amersham, 28% of pharmacies are eligible for this mitigating scheme, while in Wokingham 35% are eligible. [Interruption.] The Minister says that it is a disgrace, but those are the figures. Only this Department, which spins figures all the time and which has been discredited for the way in which it uses them, can call a pharmacy cuts package an “access scheme”.

Today, in an article in The Times, the Minister himself focuses on cities such as Leicester and Birmingham. He claims that if you walk

“along roads in Leicester you will see 12 pharmacies within ten minutes of each other”.

As the Member of Parliament for Leicester South, I walk along roads in Leicester every day. I do not know whether the Minister has actually walked along any of those roads; he has never told me that he has. Let me therefore extend an invitation to him to come to Leicester, where he will see numerous community pharmacists in areas with a high proportion of black and ethnic minority communities providing specialist services for families who have relied on them for 20 or 30 years, often dealing with elderly people and speaking to them in Gujarati, Urdu and Punjabi. Many of those people will have to go to GPs’ surgeries and A & E departments if the pharmacies are closed. The Government’s assessment takes no account of the disproportionate effect that the cuts will have on black and ethnic minority communities in cities such as Leicester and Birmingham.

[Dr Murrison]

rose—

[Robert Jenrick (Newark) (Con)]

rose—

[Jonathan Ashworth]

I will give way to the hon. Member for Newark.

[Robert Jenrick]

Will the hon. Gentleman at least acknowledge that we all support community pharmacies? The town I live in has 3,500 residents and there are four pharmacies within a quarter of a mile. Will he at least acknowledge that a model that gives a block grant of £25,000 to each of those pharmacies purely for establishing themselves regardless of demand obviously needs review?

--- Later in debate ---

[Jonathan Ashworth]

If the hon. Gentleman wants to tell his constituents he is in favour of closing pharmacies, good luck to him.

Of course it is not just pharmacy closures that we will see. The National Pharmacy Association has reported today that that 81% of community pharmacies will have to restrict services that help elderly people and 86% will have to restrict free services such as delivering medicine to housebound patients. Does that not confirm that the elderly and the most vulnerable will be hit the hardest by the cuts to community pharmacies, and the Government are entirely to blame?

[Dr Murrison]

rose—

[Jonathan Ashworth]

I give way to the hon. Gentleman, who has been very patient.

[Dr Murrison]

Surely the hon. Gentleman accepts that we have to get the most efficiencies we possibly can from the system? His party colleague the right hon. Member for Doncaster Central (Dame Rosie Winterton) made a serious point about engaging with pharmacies to see how we can do it better. Does he agree—I would be interested to know why this is not in his motion—that category M clawbacks, which are levied exclusively on small independent pharmacies, might be extended to vertically integrated wholesalers as a way of making sure the system is more efficient than at present?

[Jonathan Ashworth]

The hon. Gentleman talks of efficiencies; he will presumably have seen the research that says if people cannot get to a pharmacy one in four will go to a GP. We will see greater demand on GP surgeries and A&E departments. That is not efficient. It is a false economy, which is why the Pharmaceutical Services Negotiating Committee has said the proposals are

“founded on ignorance of the value of pharmacies to local communities, to the NHS, and to social care, and will do great damage to all three. We cannot accept them.”

It is why the chief executive of Pharmacy Voice described the decision as

“incoherent, self-defeating and wholly unacceptable”,

and it is why charities such as Age UK have said the plans are

“out of step with messages encouraging people to make more use of their community pharmacists, to relieve pressure on overstretched A&E departments and GP surgeries.”

Age UK has hit the nail on the head: these cuts to community pharmacies completely contradict everything we have been told by Ministers over recent years and will lead to increased pressures and increased demands on GP surgeries and A&E departments.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

My hon. Friend has made some crucial points about how the funding has been allocated across our country. There are 129 community pharmacies across the whole of Liverpool, yet just two of them will be eligible for this payment. Does my hon. Friend agree that that is absolutely outrageous and will impact on the entire population of Liverpool?

[Jonathan Ashworth]

My hon. Friend is right, and even after this scheme is in place pharmacists who are eligible for the mitigating funds are still saying that they will have to close despite them.

We believe in the importance of community pharmacies, because

“pharmacies have a big role to play in this, as one in 11 or 12 A and E appointments could be dealt with at a pharmacy”—[Official Report, 25 February 2014; Vol. 576, c. 162.]—

and:

“Pharmacies have an important role to play, because they could save a significant number of A and E and GP visits.”—[Official Report, 23 October 2014; Vol. 586, c. 1049.]

Those are not my words: they are the words of the Health Secretary, said from that Dispatch Box over the last two years.

If the message the Health Secretary has been giving at that Dispatch Box is that community pharmacies are a way of relieving pressure on A&Es and GP surgeries, why is he now coming to the House to support cutting community pharmacies? It is a complete false economy. I will give way if he wants to explain that. He does not, probably because he knows it is a completely false economy.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

Arundhati Patel runs the Jamaica Road pharmacy in my constituency and an alcohol cessation service is one of the services it provides to the local community. He pointed out there were 1,400 hospital stays in Southwark due to alcohol harm. On the point about efficiencies and avoiding visits to hospital that Members have talked about, is this not another example of what my right hon. Friend the Member for Exeter (Mr Bradshaw) called a false economy?

[Jonathan Ashworth]

My hon. Friend is right, and Government Ministers, including the Health Secretary even on Monday, justify these as part of a package of efficiencies. Indeed when I raised this a few months ago with the previous Minister, the right hon. Member for North East Bedfordshire, he told me in correspondence that these cuts were necessary as part of delivering the £22 billion-worth of efficiency savings. So this is more proof that when they talk of efficiency savings, they are actually talking of cuts to frontline services.

[Huw Merriman (Bexhill and Battle) (Con)]

rose—

[Jonathan Ashworth]

I am sorry, but I need to make progress.

The NHS is going through the worst financial crisis in its 68-year history. Even the previous Health Secretary, who is now in the other place, said he did not expect another five years of such tight budgets for the NHS.

The black hole in hospital finances last year was £2.45 billion. Under Labour, we spent the European average on health as a proportion of GDP; we are now spending less than Greece. We are seeing a huge financial squeeze on the NHS and the cuts are part of that squeeze agenda.

We want the Government to think again on the cuts, because they will lead to more pressures on GP surgeries and A&E departments. There is a consensus not just among the Labour party, but among our constituents, the sector, clinicians and indeed Conservative Members against the cuts. It is Ministers who stand outside that consensus. The hon. Member for Stevenage (Stephen McPartland) has said:

“It does not make sense that we are encouraging pharmacies to take on a bigger role in the NHS, while potentially reducing the number of them.”

The right hon. Member for Broxtowe (Anna Soubry) has said:

“I do not think this 4% cut is a wise move.”—[Official Report, 20 October 2016; Vol. 615, c. 974.]

The hon. Member for Colne Valley (Jason McCartney) said

“when our A&Es are under so much pressure, we need community pharmacies”.—[Official Report, 17 October 2016; Vol. 615, c. 598.]

I agree and our message to Conservative Members who want to stand up for their constituents and who have been lobbied by pharmacists is, “Join us in the Division Lobbies and get Ministers to think again on these damaging cuts.” I commend the motion to the House.

--- Later in debate ---

[David Mowat]

The access scheme is the device that will ensure that pharmacies are not closed in a random way. I want to address the point about closures head on. It is my belief that there will be a minimal number of closures. The impact analysis talks about 100 and it models 100. The average pharmacy has a margin of 15%, and the amount of efficiency savings that we are asking pharmacies to make over two years is 7%. In addition, the average pharmacy is trading for £750,000 when it closes or merges, even after we announced these efficiency savings a year ago. That value is being retained.

[Jonathan Ashworth]

The previous Minister put a figure on this. Will the hon. Gentleman tell us what he means by a “minimal” number of closures? What is the number?

[David Mowat]

These are private businesses, each with a different business model and a different amount of income from the NHS, from other retail activities and from services. Each is financed in a different way. Indeed, 30% of them are owned by two public companies, and 70% of them are multiples.

--- Later in debate ---

[David Mowat]

I need to make some progress. I will give way in a moment.

At present, the average pharmacy receives NHS income of £220,000 a year, which is based on throughput of £1 million from the NHS. That translates into a value of the order of £750,000 for each pharmacy. When pharmacies merge or are sold, that is what they are traded for and the changes will not make a significant difference.

Returning to an earlier point, 40% of all pharmacies are located within a 10-minute walk of at least two others. Instances exist of a dozen or more pharmacies located within half a mile of each other. As I noted earlier, each one will most likely be receiving £25,000 a year just for being there.

[Jonathan Ashworth]

Has the Minister been to Leicester?

[David Mowat]

I was brought up on the outskirts of Leicester, so I am delighted to tell the hon. Gentleman that I have indeed been there. Giving all these clusters £25,000 of national health service money is not the best way to spend precious resources.

In addition, the extra services that pharmacies will choose to provide, such as winter flu jabs and public health services, are commissioned separately and will be unaffected by the reset. For example, 600,000 flu jabs have been given in community pharmacies this year—more than all of last winter.