Care Homes: CCTV

Julie Cooper Excerpts

Wednesday 5th September 2018 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Sir David. I am grateful for the opportunity to respond to the debate, and to the right hon. and learned Member for Beaconsfield (Mr Grieve) for bringing this important subject before the House. I feel strongly about it, and I bring some personal experience over many years of sourcing care for grandparents and, most recently, for my own mother. I have seen examples of poor care in nursing homes and care homes, as well as examples of absolutely fantastic care in both. I pay tribute to the carers who have the skills, patience and dedication to do what must be one of the most important jobs, and probably the least valued by our society. We all should take note of that and value such people.

It should be a priority for any civilised nation to promote and ensure the safety and wellbeing of its citizens, and the provision of high-quality care in a safe environment for elderly and vulnerable people should be a given, and something that we can take for granted. Elderly people are the group I have the most experience with in this area, but I expect that it is pertinent to people in other groups who find that they need to move into a care home.

When someone is no longer able to live independently in their own home it is a big deal—for the person themselves and for their close family. Admitting that they, or a family member, cannot cope independently, giving up their home and moving away from familiar surroundings can be extremely traumatic and quite frightening. Having made the decision, everyone involved needs to be reassured that the care home is a safe and genuinely caring facility, adequately staffed by well-qualified, well-supported and well-supervised carers and nurses.

Sadly, that is not always the case, and there are well-publicised examples of poor care, neglect and, in some instances, wilful abuse. It is a shocking state of affairs that is totally unacceptable. There is, rightly and properly, a lot of agreement in today’s debate. We all agree that a single case of abuse or neglect is one too many, and I base all my comments on that point of view.

The combined findings of Care Quality Commission inspections and staff surveys seem to indicate that poor standards of care, delayed care and neglect are widespread, while instances of deliberate abuse are relatively rare. I have seen many cases of neglect and poor levels of care. I have not seen any outright, wilful abuse, but that is not to take away from the fact that it exists. The question for us today is whether the installation of CCTV in communal areas of care homes would eradicate such problems or lead to improvements. The right hon. and learned Member for Beaconsfield and other Members made a powerful case for the contribution that CCTV could make in some instances, but it is perhaps a bit of a search for a quick fix. This is a complex area with no quick fixes, and false reassurances, as has been mentioned, are a worry.

We are talking about introducing CCTV in communal areas, but the majority of care is delivered in private bedrooms, bathrooms and treatment rooms. Introducing overt surveillance into communal areas would only shift any poor practice to areas not covered by cameras. We therefore run the risk, as I said a moment ago, of providing false reassurances to family members.

More broadly, we all live in a world where CCTV is a part of everyday life. In every shop and on every high street, where we go and what we do is recorded—except, that is, in our homes. When we sit down in our lounge, family communal areas or dining room we have privacy. Is anyone suggesting that the routine recording of elderly residents while they sit in their lounge or eat in the dining room should be a requirement in every home in the land? Who among us would like to be filmed while we snooze in front of the TV or sit down to eat? If we are talking about the dignity of the residents in such homes, is that really what we want to see routinely?

[Mr Grieve]

I appreciate the hon. Lady’s point. Equally, perhaps one has to bear in mind that if we move out of the total privacy of a room in which we sit alone, we are observed by other people. That is part of our lives. There is a strange irony in the fact that we are perfectly happy to say, “This is wonderful—the meal time is so well supervised by staff,” but if it is supervised remotely through CCTV, or if there is CCTV available to check whether something has gone wrong, we are troubled by it.

Of course, so much depends on the absolute effectiveness of maintaining the necessary safeguard that material is kept within private circulation. However, provided we have that, I confess that I find it slightly difficult to differentiate between a camera providing some degree of assurance that everything is all right and a person physically sitting there, to which nobody would have any objection.

[Julie Cooper]

I hear what the right hon and learned Gentleman says. There are no right or wrong answers here; it is about creating a balance. I would point out that not all residents in care homes have dementia. Many of them do not and have a very strong awareness of their environment. They would see this as an infringement of their dignity—a dignity that they are fighting to hold on to for the remainder of their life. I take the point, but I do not think the issue is straightforward.

A point was made about CCTV in this building. We accept it, but we do not live here. We accept it in our lives, but if we are to make care homes a genuine substitute home for vulnerable people, we have to bear such points in mind. CCTV may have a role in specific circumstances, for example where a concern has been identified, but it ought to be a last resort, implemented only with the knowledge and full consent of residents, families, staff and professional representatives, because this affects everybody, and observing would definitely affect the relationships in the home.

Acknowledging that it is unlikely that incidents of abuse and poor standards of care would be prevented by installing CCTV cameras in communal areas does not mean that serious problems can be ignored. Abuse of people in care homes, and/or poor care, shames us all. ln many ways, the issue of CCTV is more of a red herring than a solution. I accept that it may have a role in some areas, and there may be justification for using it in some limited ways. However, there is widespread agreement from a range of well-respected organisations that the blanket imposition of CCTV is not the answer.

As the hon. Member for North Ayrshire and Arran (Patricia Gibson) has pointed out, Caroline Abrahams from Age UK said that it is more important

“to raise the quality of care in care homes across the board and ensure that all older people, their families and staff are involved...and are able to raise any concerns, confident that their feedback will be acted on.”

That is not always the case at the moment.

Dr Peter Carter, former chief executive of the Royal College of Nursing has said that the answer to better care is better recruitment, training and managerial supervision of staff; that would be a better way to deal with this. I agree.

The CQC said:

“We would be concerned by an over-reliance on surveillance to deliver key elements of care, and it can never be a substitute for trained and well supported staff.”

I agree with that too, and I know that other hon. Members do too—there is so much agreement in this place on this subject, which is quite unusual. I am sure that the right hon. and learned Member for Beaconsfield has initiated this debate in good faith, but if we are really serious about ensuring the highest standards of care in care homes, which I believe he and other Members here are, he will join me in urging the Minister to consider reversing some of the funding cuts to social care.

It is a sad fact, but a fact nevertheless, that in response to Government funding cuts local authorities have reduced spending on social care by £6.3 billion since 2010. The cuts are now having a huge impact on care quality—a quarter of all adult care services have the lowest safety ratings, 30% of nursing homes in England require improvement or are inadequate and a growing number of private care homes are handing back their contracts, citing insufficient funds. Many more are teetering on the brink of financial collapse, faced with no alternative but to reduce staff numbers and, inevitably, standards of care.

We have not talked much about the funding implications of CCTV. Given that the sector is short of funds to start with, I am not sure who exactly would pay for CCTV installation and the ongoing monitoring, if it were to become mandatory; if it were to have any value at all, that would be expensive.

Before this debate, the Department of Health and Social Care said:

“Closed circuit television should not be...a substitute for proper recruitment procedures, training, management and support of care staff, or for ensuring that numbers of staff on duty are sufficient”.

I agree, but proper recruitment, training and adequate numbers of care staff have an associated cost, which it appears the Government are not prepared to meet. Quality care for the elderly and vulnerable cannot be delivered on a shoestring by poorly paid and overstretched carers. Our old people, our parents and grandparents deserve better. I look to the Minister to bring forward the promised Green Paper, to embrace the points made in this debate and to ensure that we have the kind of social care and care for our elderly that we can all be proud of.

--- Later in debate ---

[Caroline Dinenage]

I thank my right hon. and learned Friend for that legal advice, which would probably have cost me a fortune in the outside world. I am grateful for that clarification. The provider should consult those affected on the use of surveillance wherever it is possible to do so. It would have to meet the cost not simply of the equipment and the monitoring of it if it is done by a third party, but of the training, staff time, legal advice and consultation activity. There is no point in having such a system unless it is monitored and routinely checked.

The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) spoke compellingly about early years settings. I have experience of that, not just as the former early years Minister but as a mother who has been in exactly the situation that she mentioned. It certainly rings bells with me—leaving children screaming their heads off, and five minutes later being told they are all perfectly fine. As she says, that can be very comforting for parents. CCTV is not compulsory in early years settings either, but there are many similarities between the two sectors: they are both predominantly run by private companies. I hope that early years and residential care businesses see the benefits.

I have an apology to make to the hon. Lady. She asked about the letter that we sent, which suggested it might have to be up to the Ministry of Justice to change the law. That was incorrect, and we have subsequently sent her a letter clarifying that. I apologise.

Ultimately, CCTV can have benefits, but it simply cannot be a substitute for well-supported, well-trained staff and excellent management. We have made it clear in statutory guidance to support the implementation of the Care Act 2014 that we expect local authorities to ensure

“the services they commission are safe, effective and of high quality”.

We also expect those providing the service, local authorities and the Care Quality Commission to take swift action where anyone alleges poor care, neglect or abuse. We have backed that up with more than £9 billion of investment in the sector in the past three years,[Official Report, 11 October 2018, Vol. 647, c. 4MC.] which equates to an 8% increase in funding. That incredible amount of money highlights the challenge we face in the sector.

[Julie Cooper]

Does the Minister not accept that, as a result of cuts to local authority funding, there has been a reduction equivalent to £6.3 billion of spending in the sector?

[Caroline Dinenage]

I accept that there were cuts to local government funding during the time of the recession that we all endured. That was incredibly regrettable, but was one of those very difficult decisions that Governments have to take.[Official Report, 11 October 2018, Vol. 647, c. 4MC.] In the last three years, we have increased funding by £9.4 billion, which equates to an 8% increase. It demonstrates the challenge of this ageing population—people are living longer with much more complex needs, and many vulnerable people need an enormous amount of support and care. It is an enormous amount of money, and yet we still see the sector facing great challenges and stress, which is why we have a Green Paper coming out later this year. We hope it will help address the sustainability of the adult social care sector. Successive Governments have wrestled with this incredibly challenging issue, and we need to find a long-term solution.

We expect serious allegations of abuse and neglect to be thoroughly investigated and prosecutions to be brought where that is warranted. The abuse of people who depend on care services is completely unacceptable and we are determined to stamp it out. That is why we introduced the new wilful neglect offence, which came into force in April 2015. The hon. Member for North Ayrshire and Arran said that we must get the very best quality of staff into this demanding and challenging profession. I could not agree with her more. We have made changes to help services recruit people with the right values and skills, and introduced a care certificate for frontline staff to ensure older and vulnerable people receive the high-quality care they deserve.

The Department for Health and Social Care has commissioned and funded Skills for Health, Skills for Care and Health Education England to develop a dementia core skills education and training framework, which is very important to me. There is also a fit-and-proper-person test to hold directors to account for care. Let us not forget that 82% of adult social care providers are rated as good or outstanding as of August 2018, according the Care Quality Commission. That is a testament to the many hundreds of thousands of hard-working and committed professionals working in care, to whom we owe a debt of gratitude. Surely the best way of building on that is not to say to them, “We’re watching you in case you do the job wrong,” but rather to say, “How can we support you to do the job better? How can we invest in skills training, continuous professional development, great management and more staff on better wages?”

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 24th July 2018 Commons Chamber

[Matt Hancock]

I certainly will. I pay tribute to the NHS workforce and the social care workforce who, every day of their working lives, give up their time to serve their community, to serve their fellow man and woman, and to ensure that we have the healthiest nation we possibly can. I love the NHS, as does everybody in the House. Almost everyone is touched by the NHS at some of the most difficult times in their lives. I pay tribute to the workforce.

[Julie Cooper (Burnley) (Lab)]

I, too, welcome the Secretary of State to his new position. I note his intention to extend online NHS services, but I hope that he will provide more detail about how he intends to guarantee patient safety, given that the Care Quality Commission reported this year that 43% of online GP and pharmacy services are currently unsafe. Will he reverse the cuts to capital funding so that safe technology can be installed? Furthermore, what steps will he take to ensure that elderly and vulnerable patients, who find it difficult to access online services, will still have the certainty of sustainable community surgeries?

[Matt Hancock]

Those are really important questions. On funding, I announced only last week £487 million to improve technology and technology services to ensure that they can be as high quality as possible. On patient safety, the key is to keep improving technology so that it gets better and better. On universal access, we must use technology in such a way that patients who want to access services through technology can do so, as that frees up resources so that more can be done for those who do not want to use technology, meaning that we preserve universal access.

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 8th May 2018 Commons Chamber

[Jackie Doyle-Price]

I can add no more to what I have already said in answer to my hon. Friend the Member for Boston and Skegness (Matt Warman). We will do everything we can to make sure that we can recruit sufficient paediatricians for that hospital.

[Julie Cooper (Burnley) (Lab)]

What plans does the Minister have to increase the role of community pharmacies in meeting the health needs of rural and urban communities? In 2016, the Government promised to develop an extended role for community pharmacies. In particular, they committed in the House that the national roll-out of a minor ailments scheme would be implemented by April 2018. Given that it is now May 2018 and that has not happened, and that there has been an overall reduction in services commissioned via community pharmacies in both rural and urban communities, will the Minister tell the House when exactly the Government intend to honour their commitment?

[Jackie Doyle-Price]

The provision of community pharmacies is an important part of integrated primary care. We will continue to make sure that we direct sufficient resource to address the particular challenges caused by rural sparsity. I remind the hon. Lady of what we have already done: we spent £175 million from the Prime Minister’s challenge fund to transform GP access, and that is increasing access in areas such as North Yorkshire, Devon and Cornwall. We will continue to look into the particular challenges that rural communities face and make resources available.

GP Recruitment and Retention

Julie Cooper Excerpts

Wednesday 28th March 2018 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Moon, and I thank my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson) for securing this important debate and for the strong case she made.

To set the debate in context, the NHS has the equivalent of 28,960 full-time GPs, which is 1,300 fewer than two years ago, despite the fact that the Government promised in the NHS Five Year Forward View to deliver an additional 5,000 GPs by 2020. The situation is getting worse as fewer medical students decide to enter general practice, while at the same time more GPs are opting for early retirement. The average age of retirement among GPs is 59, and given that 20% of all GPs are approaching that age, it is no exaggeration to say that there is a ticking retirement time bomb. The situation is set to get a whole lot worse as the number of GP vacancies continues to rise.

In 2011, the number of GP vacancies stood at 2.1%, but by the end of 2017 that had risen to a worrying 12.2%. NHS Digital data showed that, between 17 March and September 2017, the number of full-time equivalent GPs decreased by 166. Over the same period, the number of GP partners fell by 638. I spoke to one young GP and former practice partner who gave his reason for leaving. They said

“no one wants to be the last man or woman left standing.”

When GP recruitment was raised during Health questions in December, the Secretary of State said:

“One of the best things about the NHS is that people have a GP who knows them and their family.”—[Official Report, 19 December 2017; Vol. 633, c. 894.]

I agree, but increasingly that is not the experience for many people. For the elderly, the mentally ill and the chronically ill, that lack of continuity is troublesome. I have elderly constituents with complex needs who rarely see the same GP twice, and because no single GP really knows the whole person, they are constantly bounced back and forth between the surgery and A&E. Too often, that leads to hospital admissions that could have been avoided.

In many areas across the country, patients report that they have experienced difficulty getting to see any GP—that point has been made forcefully by a number of Members today. Indeed, it is not just patients who say that: 71% of doctors surveyed feel that patient access to services has decreased. I have spoken with GPs across the country—including some with 30 years’ experience or more—who declare that there is a crisis in general practice, the like of which they have never seen. The traditional service is struggling to cope with the ever-increasing demand from an ageing population, and GPs face unprecedented workloads. In addition, the harsh economic environment has negatively impacted on the wellbeing of many of the poorest people. Depression and stress-related illnesses have increased, further adding to the demand for GP services. Inadequate mental health resources mean that GPs are often unsupported, with patients in need of specialist support. Cuts in adult social care budgets have meant that many old people are left at home without the support they need and with no one to turn to except their local GP.

In the face of all those pressures, it is no wonder that doctors are choosing early retirement. The more who leave, the greater the pressure on those who have been left behind. The downward spiral of retention is particularly evident in the most deprived parts of the country, where the challenge of recruitment is reaching nightmare proportions. I spoke to one GP in such a community. He said that he had had only one week’s leave in three years because he had been unable to recruit either a partner or a salaried GP to help. Other GPs have told me that they feel like they have their finger in a hole in a dam holding back a tsunami of demand.

It is clear that this situation is unsustainable. The BMA says:

“With an insufficient workforce, a funding plan that is no longer sustainable, a growth in population and a sea-change in the level of complex cases being presented, urgent steps need to be taken to save general practice.”

It tells me that eight out of 10 GPs feel unable to deliver safe care. For the benefit of patients and the long-term future of the general practice that we all know and love—the service that was the envy of the world—the Government must heed these severe warnings from the professionals.

The Government have taken little action to date. When I raised this with the Secretary of State in December, he said that we must

“encourage more medical school graduates to go into general practice as a specialty”.—[Official Report, 19 December 2017; Vol. 633, c. 895.]

I agree, but progress is poor. The recently announced new medical schools are welcome, but they will not in themselves make the profession more attractive. If the Government are serious about delivering 5,000 additional GPs, they must demonstrate that they truly value the service. At a time when morale in the profession is low, the Government must stop adding to the pressures by demanding seven-day access, which is not a priority for patients.

The offer of an additional £2.4 billion is welcome but does not go far enough. The Government must increase the proportion of NHS funding that goes into general practice. They must put general practice at the heart of a primary workforce strategy. Instead of having ill-equipped private companies foisted on to surgeries, GPs should be offered comprehensive support with everything from surgery premises to professional indemnity. If the sector is properly resourced and supported, it will be a more attractive proposition for medical graduates. Such measures would not only attract new graduates into the profession, but help to retain existing practitioners. The current GP retention scheme for doctors who are approaching retirement and considering leaving the profession for personal reasons is helping, but reducing the daily workload would do more to stem the tide of retirement.

Finally, the service cannot be viewed in isolation. There is no doubt that properly funded adult social care, and public health and mental health services, would alleviate pressure. I also make the case for greater utilisation of community pharmacies, which are not to be confused with the welcome addition of pharmacies in GP practices. They would help in so many ways. A nationwide roll-out of minor ailment services would be a good first step that would help enormously, leaving GPs time to see patients with more serious medical needs.

GPs across the country, the excellent Royal College of General Practitioners and the BMA will be listening. I take this opportunity to pay tribute to our GPs for their exceptional dedication. I want GPs across the land to know that the Opposition appreciate the work they do, which so often goes above and beyond the call of duty. They want the Minister to go beyond warm words and wish lists and to outline a detailed, properly funded plan to save general practice. I hope the Minister will not let the professionals and our constituents—the patients—down.

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 20th March 2018 Commons Chamber

[Steve Brine]

I will not pre-empt what the NHS in Yorkshire and the Humber will say to my hon. Friend or to the hon. Lady, because this is a local decision, but I will say that the 13 Starting Well areas—the programme was a manifesto commitment for us—were selected nationally based on overall need and using a wide range of data including access to NHS dental services.

[Julie Cooper (Burnley) (Lab)]

The Minister seems to be in denial. The British Dental Association reports that almost half of all NHS dentists are not accepting new patients—either adults or children. In several regions right across the country, from Yorkshire to Salisbury, patients are having to rely on the third world dental charity, Dentaid, with its now-famous wheelie bin dental surgeries. Does he think that that is an acceptable state of affairs? Will he outline what action he intends to take to improve access to NHS dentists?

[Steve Brine]

It is interesting that the hon. Lady should raise this; it is one of the things that we might be discussing shortly. According to the GP patient survey for January to March last year, whose results were published later last year, 59% of the adults questioned had tried to get an NHS dental appointment in the past two years, and of those, 95% were successful. Those are not bad figures.

Hospital Car Parking Charges

Julie Cooper Excerpts

Thursday 1st February 2018 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

I am pleased to have the opportunity to respond to this debate on a very important subject. I am grateful to the right hon. Member for Harlow (Robert Halfon) for bringing this subject forward. He and I agree on most aspects of the issue, and he has campaigned passionately on it for so many years.

[Robert Halfon]

As you have.

[Julie Cooper]

I thank the right hon. Gentleman for that comment.

I am grateful to Members on both sides of the House because it seems that there is much agreement on the matter. It is heartening to hear Members mentioning—and fully understanding—its impact on patients, visitors, carers and NHS staff. My hon. Friend the Member for Great Grimsby (Melanie Onn) mentioned the effect on the greater transportation system.

The hon. Members for Telford (Lucy Allan) and for Cleethorpes (Martin Vickers), and my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) made powerful speeches, as did my hon. Friend the Member for Colne Valley (Thelma Walker), who accused the system of profiteering. My hon. Friend the Member for Heywood and Middleton (Liz McInnes) made an important point on behalf of staff. The right hon. Member for Hemel Hempstead (Sir Mike Penning) referred to the burden of having to pay to go to work. My hon. Friends the Members for Batley and Spen (Tracy Brabin) and for Enfield, Southgate (Bambos Charalambous) mentioned personal family issues when people are taken away from a sick family member’s bed to replenish parking meters.

No one likes to pay to park, but to pay to park at a hospital really does add insult to injury. We are not talking about a luxury experience, a shopping trip or a fun night out; we are talking about paying to visit a hospital. People are not queuing up to go to the hospital café, as the hon. Member for Telford pointed out. No one goes to hospital because they want to. People go because they are sick. They go for treatment, for surgery, for chemotherapy and for kidney dialysis, and they go to visit loved ones. In short, hospitals are not destinations of choice: people go because they must. I am quite shocked that it is free to park at Trafford shopping centre yet I must pay to park at my local hospital.

During the past three years, I have spent hours and hours visiting my mother in hospital. I have often gone backwards and forwards two or three times a day, juggling hospital visiting around work and other commitments. I have to say that it has all been very distressing. As I leave the hospital each night worried, wondering what tomorrow will bring, the last thing I want to do is to stand outside in the cold queuing to pay for my parking. This burden is, of course, in addition to the actual cost.

Some hospital car parks demand payment in advance, as we have heard. This brings its own set of problems, because patients and visitors have to judge how long each hospital visit will last, and then often have to leave the ward or treatment room to feed the ever-hungry parking machine. Of course, running to and fro between the car park and the hospital is impossible for someone hooked up to a dialysis machine. Many dialysis patients suffer with multiple conditions and are unable to work, so paying to park three times a week for dialysis sessions that each last four to five hours is a real financial burden for them and their carers.

Paula in my constituency relies on the weekly £62.70 carer’s allowance she has received since she was forced to give up work to provide round-the-clock care for her husband, who suffered a severe stroke. He has been in hospital for the past month. She has visited every day, often staying for two to three hours to support and comfort him. This costs her more than £20 a week. By the time she has paid for her petrol, half her carer’s allowance is gone.

We have a national health service that was set up to be free at the point of delivery. It was established in 1948 to make healthcare a right for all, but that is not what is happening. Even though hospital car parking is free in Scotland and Wales, here in England, hospital users are forced to pay often extortionate rates, with charges varying from £1.50 an hour to £4 an hour. We are charging the chronically ill, the terminally ill, and their carers and visitors. More than half of all people over 76 have conditions that require regular hospital appointments, and hospital car parking charges are an extra burden for them and their families. The Alzheimer’s Society reports that patients with dementia stay five to seven times longer in hospital than other patients aged over 65. Hospitals can be frightening places for people with that condition. They rely on family and carers visiting them to give support. Parking charges are an extra burden that these families could well do without.

The Patients Association has commented:

“For patients, parking charges amount to an extra charge for being ill…Hospital appointments are often delayed or last longer than expected, so even if you pay for parking you could end up being fined if your ticket runs out. Visiting a hospital can be stressful enough without the added concern of whether you need to top up the parking.”

Macmillan Cancer Support says:

“The core principle of the NHS is to provide free healthcare for all at the point of access. But sadly some cancer patients in England are paying extortionate hospital car parking charges in order to access treatment for a life-threatening illness.”

Bliss, the charity for babies born prematurely or sick, says in its “It’s not a game: the very real costs of having a premature or sick baby” report that these charges can contribute to the financial burden that many families face when their babies need neonatal care.

In the midst of all this misery, the average hospital trust is making £1 million of profit from car parking charges, and several hospitals the length and breadth of the country report profits of over £3 million. Last year, NHS hospitals made a record £174 million from charging patients, visitors and staff. In addition, 40 trusts report additional income from parking fines.

Some people point out that public transport is an option that avoids parking charges. Public transport provision has been reduced in response to funding cuts, but even where it exists, there are many for whom it is not an option. Some patients are too unwell or too frail to travel on a bus. Others, including cancer patients attending for chemotherapy, have reduced immunity and must avoid contact with the general public.

[Sir Mike Penning]

The hon. Lady is making a compelling case, as have most Members. Public transport has its place for out-patients and so on, where it is available, but imagine someone going into labour and saying, “Can I wait for the No. 2 bus, please?” This is farcical. We need car parks to be there for people when they need them, rather than being a cash cow.

[Julie Cooper]

I entirely agree and thank the right hon. Gentleman for his intervention.

Patients and carers are often balancing work and other commitments, and have tight time schedules that preclude public transport. I have spoken to the parents of a terminally ill child who left their child’s bedside only to tend to the needs of their other children. They do not have time to wait for a bus.

No discussion of hospital car parking charges would be complete without a consideration of their impact on NHS staff, which Members have spoken about eloquently. These staff pay to go to work and are still not even guaranteed a space. That can lead to them being late for the beginning of their shift. Some hospital staff whose shift overruns because they are tending to patients’ needs face fines for overstaying their parking time. That is clearly no way to treat our health professionals. It is no wonder we face a crisis in recruitment and retention.

Government action to date has been limited to a series of recommendations on hospital car parking. Currently the Government recommend that hospital car parking charges should not be applied to blue badge holders, carers, visitors of relatives who are gravely ill, and patients who have frequent out-patient appointments. In reality, those recommendations count for very little. In fact, the trend is to increase car parking charges and to reduce the number of those who are exempt. Many hospital trusts have even begun to charge blue badge holders.

It is not good enough for the Government to abdicate responsibility. This is a matter of principle. Scandalously, Conservative Members have previously argued in the Chamber that the NHS needs the income from parking charges. I have no doubt that the NHS needs this revenue, as it is common knowledge that the service has been starved of funding since 2010, but is it right that we fund our health service by taxing the sick?

Labour Members will have none of this. I am proud that the next Labour Government will ensure that our NHS is properly funded and will abolish car parking charges at all hospitals. To pay for that, we will increase the premium tax on all private health insurance policies. Crucially, no hospital will lose funding as a result of our policy.

In 2015, I asked the Government via a private Member’s Bill to exempt carers from hospital car parking charges. At the time, that relatively modest proposal was met with derision from Government Members. My attempt to remove this financial burden was dismissed as a worthy aim, but not worthy enough for the Government to support. Indeed, Conservative Members went to great lengths to talk the Bill out.

Times, I hope, have changed. Today I am asking, along with the right hon. Member for Harlow, that the Government remove all car parking charges at NHS hospitals. Today we ask the Government to do the decent thing by removing this tax on the sick and taking action to ensure that we truly have an NHS that is free at the point of access.

--- Later in debate ---

[Stephen Barclay]

I am very happy to look at such cases and to speak to those trusts to understand this better, but I was making a point about the complexity of the issue and how to manage reducing the charges. For example, as the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) will no doubt be aware, there were local media reports over the summer about a hospital car park in Inverness being used by those going to the airport; there was displacement there. We do not want a solution that constrains capacity for those using the hospital and makes access more difficult.

Some of these issues have a very local flavour. That was recognised in the debate: the hon. Member for Heywood and Middleton (Liz McInnes) said that shoppers do not seek to use the car park at the north Manchester site, whereas my hon. Friend the Member for Solihull (Julian Knight) was concerned that simply removing charges would cause displacement at his hospital. The point is that there are local factors, just as there are with legacy PFI contracts, including in Scotland and Wales, where charges are still made under contracts going back to 2008.

[Julie Cooper]

Would the Minister accept, though, that people being ill and suffering distress at hospitals is not a local issue? It is a national issue. The burden of hospital car parking charges, wherever they occur, ought to be a concern of the Government.

[Stephen Barclay]

Of course, but equally the hon. Lady must recognise that the fact that charges are still being applied under PFI agreements put in place by a previous Government in 2008 signals that there are often complexities, in terms of what can be done when different factors apply. As my hon. Friend the Member for Solihull highlighted, there are factors relating to displacement. That is why trusts have local discretion, but as the House has discussed today, we need to understand the transparency around that and how it is applied.

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

I understand the concerns that the hon. Lady raises; they have been raised by a number of Members. There are historical issues on the levels of rent charged by NHS Property Services, which frankly are not fair given the variation in charges to different GP practices across the country. I will be happy to look carefully into the issues she raises.

[Julie Cooper (Burnley) (Lab)]

The NHS has lost 1,300 full-time GP equivalents in the past two years and 200 GP partners during the same period. Given that 20% of the GP workforce is aged over 60, there is clearly a retirement time-bomb looming. What steps does the Secretary of State intend to take to address the growing workforce crisis in general practice? His efforts so far have failed and patients are waiting longer than ever for a surgery appointment.

[Mr Hunt]

I would respectfully say that the figures the hon. Lady has pointed out do not take account of locum doctors. None the less, there is a big problem and she is right to draw it to the attention of the House. What are we doing? I think there are two things. First, we need to encourage more medical school graduates to go into general practice as a specialty, and our objective is that half of all medical school graduates should choose general practice as their specialty. We are making good progress on that. [Interruption.] As she is saying to me, rightly, retention is also extremely important. That is why we are putting in place a number of programmes that will make it easier for GPs who want to work for a limited period of time to work flexibly, and potentially for people who have family responsibilities to work from home. We hope that those programmes will also make a difference.

Draft Pharmacy (Preparation and Dispensing Errors - Registered Pharmacies) Order 2018

Julie Cooper Excerpts

Monday 4th December 2017 General Committees

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Brady, and to respond on behalf of the Opposition to the important order in front of us.

As the wife of a retired community pharmacist—I have no interest that I am obliged to declare—I have to say that 24 years’ experience of owning and running a community pharmacy has given me an in-depth understanding of the sector and the challenges that community pharmacists and their staff face every day. As the Minister mentioned, more than 1 billion prescription items are dispensed every year—the vast majority from community pharmacies—and the trend is that prescription numbers will increase each year, reflecting the general increase in demand in the national health service and the ageing population. An average community pharmacy dispenses between 300 and 500 prescriptions a day.

It is important to consider that that volume of work is only one part of the role performed by community pharmacists. They are an integral part of the primary care team and make a huge contribution, including giving advice on a range of health and wellbeing issues; providing support for public health initiatives, such as those employed to reduce smoking, drug abuse and obesity; medication use reviews; diagnostic testing; diabetic and asthmatic care; and minor ailment schemes. The list is endless.

In that context, genuine errors will happen occasionally. As the Minister mentioned, it is a credit to the profession that those are very few and far between, but it remains a fact that pharmacy professionals are one of the few health professional groups to face criminal conviction and potential imprisonment, for an inadvertent dispensing error—that is, where there is a discrepancy between the prescription and the medication supplied to the patient. The prosecution of pharmacists and dispensing technicians is very rare, but it does occur, so pharmacy professionals always have that fear hanging over them.

The principal beneficiaries of the order will be professional community pharmacists and registered dispensing technicians practising in registered premises—and, of course, patients. The draft order, which will amend the Medicines Act 1968, will be welcomed by community pharmacists, technicians and their professional bodies. I am aware that the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee, the Royal Pharmaceutical Society and patient groups support the proposed changes; I am sure they agree that they are long overdue.

Most products are prepared outside registered premises and arrive ready to be dispensed. Errors in such cases may take the form of selecting the wrong product or providing incorrect dosage instructions. However, there are still many instances in which pharmacy staff members are required to prepare medications on site, in which case errors may take the form of miscalculation of required quantities, addition or subtraction of necessary ingredients or incorrect instructions for use. The order will introduce a new defence against criminal liability that will apply to both preparation and dispensary errors and will be open to pharmacy professionals who can prove that the error occurred when they were acting in the course of their profession.

Such a defence really is overdue. In 2009, the chairman of the Pharmacists’ Defence Association warned:

“Inappropriate use of the criminal sanction will lead to defensive practice…less innovation”.

During the passage of the Health and Social Care Bill in 2011, Earl Howe said that the legislation needed to be reviewed so that criminal liability did not arise as a result of genuine dispensing errors.

Ensuring the right to legal defence against prosecution in cases relating to an inadvertent error will undoubtedly remove some of the fear burden and lead to a greater willingness to admit errors. It will also assist in promoting a culture of transparency that will help to inform future learning and improve protocols for the dispensing and preparation of medicines. The better practice learned will result in fewer errors and improved patient safety and is therefore eminently desirable.

The order will offer protection to pharmacists and dispensing technicians, but its main purpose is quite rightly to improve patient safety. Proposed new section 67B(5) will require the accused to prove in their defence that on discovery of the error, every step was taken to report it at the earliest opportunity to the person in receipt of the medication. That provision will give pharmacy professionals the chance to minimise the effect of errors and will positively incentivise them to admit them, as the act of so doing will aid their defence. This new duty of candour has the potential to lead to a major cultural change.

Pharmacy professionals who show deliberate disregard for patient safety will not benefit from any of the defences in the order. Where they are found to be wilfully negligent or intent on causing deliberate harm, they will continue to face criminal prosecution. The order will protect only those practising in registered premises who are already subject to professional regulation. For the sake of the protection of patients, it will not provide a defence for other groups or individuals external to registered premises involved in the medicine supply chain.

The Opposition welcome the order and believe firmly that it is a step in the right direction, but it does not go far enough. Even after it is implemented, pharmacists will still not be on a level playing field with other healthcare professionals; they may benefit from access to improved defences, but as the Pharmacists’ Defence Association maintains, they will still face the prospect of a police investigation and a lengthy trial. They will have to hold on to the hope that they can successfully use the defences, but they may still face prosecution under other provisions of the 1968 Act. I hope that the Minister will consider further legislation to ensure that inadvertent errors are totally decriminalised. I welcome his comment that the situation for pharmacy professionals not covered by the order will be consulted on early next year; I ask that it be looked at as early as possible, because pharmacists in hospitals need these defences.

There is an omission in the order. We know that learning from reported errors is anticipated, but there is no formal requirement in the order to deliver on that. It is reliant upon good will. I am sure that many pharmacists and pharmacy dispensary technicians will want to take it upon themselves to improve their existing protocols so that errors cannot reoccur, but there is no formal requirement in the order for them to so do.

As we all want to prioritise patient safety and wellbeing, I hope the Minister will undertake further work to positively promote patient safety within the pharmacy setting. One really useful suggestion I would like to make is to allow pharmacies full read and write access to patient records. All health professionals involved in the care of a patient surely need access to the fullest information, without the danger of knowledge gaps or incorrect information regarding past medications. That would aid continuity of care and contribute to safer patient outcomes.

There is so much more to do, but we welcome the order as a starting point and look forward to the Minister bringing forward further improvements.

--- Later in debate ---

[Steve Brine]

I thank my shadow, the hon. Member for Burnley, and the hon. Members for Central Ayrshire and for Newport West for their contributions and their support for this measure.

I am well aware that the hon. Member for Burnley has in-depth understanding and knowledge of this issue from her previous life supporting her partner, a community pharmacist. She is absolutely right to highlight the wide portfolio that community pharmacists hold. I sometimes think it is even wider than mine, and I have said in the House, and will say again now, that community pharmacists are absolutely central to me and to the primary care objectives that I hold in this job for primary care and for the public health and prevention agenda. Primary care and public health are pulled together under my portfolio for a reason, and community pharmacists sit together as a hub in the middle of those two bits of my work.

The hon. Lady is absolutely right to say that the order will be welcomed—I think alongside the hashtag #abouttime. For many people in the community pharmacy sector, the changes are long overdue. I spoke to the Royal Pharmaceutical Society’s conference in the summer—I suspect she was there—and I said that this was long overdue and that I would sort it. I have tried to remain true to my word, and I have.

I think the defences in the order strike the right balance, which the hon. Lady outlined coherently, while not leaving the door wide open. We still have to make sure that patient safety is protected—the current Secretary of State above all would say that—but I do believe that it strikes the right balance. I note her request for early work in respect of hospital pharmacists, and I am very amenable to that. I do not want that to drag on for many years; I want it sorted quickly, and officials know that.

On read and write access to patient records, many pharmacists already have read access and some already have write access. I am interested in making the change, and I am exploring more with officials how to make it happen; it is of some frustration to me that it seems to be an IT issue as much as anything else. If pharmacists are to be integrated within our primary care system as much as I want them to be, I suggest that that is very important.

[Julie Cooper]

This all centres on acknowledging that pharmacists are the experts when it comes to medication. I think that most GPs who work alongside pharmacists day in, day out will hold their hands up and say that. GPs used to be regularly on the phones to us saying, “Can I just ask you about this? I am thinking of prescribing this, but I am not sure. Is this best, or would it be better with something else?” That is good teamwork between people who are specialists in their areas.

In the light of that, it is quite ridiculous that pharmacies cannot record their advice and intervention on a patient record for other health professionals to see. It would be entirely in the patient interest, and in the interests of making sure that patients do not fall through the gaps between the different health professionals.

I will make one further point about recognising that expertise, if you will allow me to, Mr Brady. Pharmacists could be used to do more, as I have said many times in the House. When he talked about protections, my hon. Friend the Member for Newport West reminded me of the work that is happening on antibiotics and a recent Westminster Hall debate on their overuse and the development of antimicrobial resistance. Pharmacists could lead on that in the interests of wider patient wellbeing and safety.

[Steve Brine]

The hon. Lady is absolutely right. Pharmacists have been absolutely brilliant, focused and motivated supporters of the “Keep Antibiotics Working” campaign. I responded to that Westminster Hall debate on antibiotics, as she knows.

On the hon. Lady’s wider point, I believe, and I believe the evidence backs me up, that in the best health economies, the three planks—secondary care, primary care and pre-primary care, which is where we could see a community pharmacy as being—work hand in hand. The sustainability and transformation partnerships are supposed to be a one-NHS solution for different areas and different health economies to help the population achieve good health when they become unwell, but also to practise good preventive health. I absolutely agree with her that pharmacists know their patients and customers, and that they spot things because they see those patients much more regularly than GPs do. That is why they are absolutely central.

On the point about the obligation to report, which was mentioned by the hon. Members for Central Ayrshire and for Burnley, I said in my opening speech that the Government are already working with the regulators and professional bodies to ensure that pharmacy professionals are supported in the implementation of the order. An absolutely critical part of that is making sure that they report errors, because if they do not, this will all be somewhat wasted. There are a huge number of examples that I could give; maybe I can write to the hon. Member for Burnley with the details. The national reporting and learning systems were established in England to collect data and report on safety incidents. The health service safety investigations Bill, which is in draft and undergoing pre-legislative scrutiny at the moment, also adds power to this argument.

I think that, with this order, we have something of a rare gem in Committee Room 9: it is something that we all agree is needed. We are delivering it as a Government, as I promised we would. It will add further impetus to the work already under way to reduce medical errors across the health service and will provide much-needed assurance to pharmacy professionals that they can do their job with confidence. I know they have that confidence, but there has been this little niggling thing undermining them. I hope the order addresses that.

As the Whip next to me coughs—I am sure that was purely accidental, as opposed to a hint—I will finish by saying that, should both Houses approve the order, commencement orders will be drafted to enact the changes in England, Scotland, Wales and Northern Ireland. I thank hon. Members for their attentiveness, their interest and their contributions, and I commend the draft order to the Committee.

Question put and agreed to.

Deafness and Hearing Loss

Julie Cooper Excerpts

Thursday 30th November 2017 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Buck. I thank my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) for bringing this important subject to our attention.

I begin by saying how delighted I am to see that we have a signer in the room. It must be really easy for us to extend that service across the business of the House—that would be a really quick win, I think we all agree.

It is a real privilege to respond to the debate on behalf of the Opposition. I have been genuinely moved by some of the powerful and personal speeches we have heard today. They prepared me far better for my contribution than the research I did ahead of the debate. We can look at the statistics, such as the fact that 11 million people in the UK are living with deafness, but we have heard today about the extent of it. The hon. Member for Rochester and Strood (Kelly Tolhurst) courageously shared a very personal story and enriched the debate. We thank her for that. My right hon. Friend the Member for Wolverhampton South East (Mr McFadden) talked movingly of his constituent. We heard about a family having to raise £44,000 to let a little four-year-old boy have a chance in life.

I think we all agree that we must do more. The best thing about the debate is that it has raised awareness of a massive issue. We are talking about deafness and hearing loss, people who were born deaf and people who become deaf, sometimes through illness and sometimes through the ageing process, and how are we going to support them all, beginning with the children. The fact that only a third of screening processes for newborn babies are up to standard and accredited is of great concern. That needs to be addressed, and soon

Bearing in mind that 50,000 children in the UK are deaf, we must serve them well and make sure they are not isolated. We must make sure that their isolation does not begin with being isolated from their parents. The majority—90%—of children born deaf are born to hearing parents. If their parents are not supported, there are implications for the child’s language development. We know there are ways of providing support, such as radio aids, and we must make that available to parents and support them. We hear a lot in the House about early intervention for all children to address all issues in the early years, and there can be no more important an issue to address than this.

My hon. Friend the Member for West Lancashire (Rosie Cooper) stressed powerfully that deaf children and deaf adults do not have learning disabilities. Our education system must address this. It cannot be right that deaf children are 42% less likely to get five decent GCSEs. We are hindering their progress for life at that early stage. I was alarmed to learn that since 2011, the number of specialist teachers for the deaf has reduced by 12%. That cannot be the right way forward.

Members have rightly stressed the importance of British Sign Language. I have to admit, I never realised until this week—I never thought it through, and I am sure I am not the only one—that British Sign Language is some people’s first language. I thought of it as something separate that helped, but this debate has increased my awareness. The more this is talked about, the better. It is vital that BSL is taken seriously and given recognition. The UK is a signatory to the UN convention on the rights of persons with disabilities, but we must do more and give this language the equal validation it deserves. Why can British Sign Language not be a GCSE subject? I know this is beyond the remit of the Minister and his Department, but I am sure he will pass it on to his colleagues in the Department for Education. If BSL were a GCSE subject, people would take it seriously, more people would learn it and there would be more access to it, and therefore deaf people would be able to participate more fully.

Members have rightly mentioned the human cost as well as the financial cost of isolation not being addressed. The health statistics are quite clear—for example, on the number of people who retire early or suffer from anxiety and depression because they can no longer cope in the world of work. As has been mentioned, many elderly people who lose their hearing lose their social circle and cannot communicate with family. There is the cost of not supporting them with hearing aids and, as the hon. Member for Milton Keynes South (Iain Stewart) mentioned, with a telecommunications relay service. We should be looking into such systems to maximise inclusion for old people.

The world of work is obviously a massive issue. The Access to Work scheme is absolutely brilliant. It is shocking that it is probably the DWP’s best kept secret. I recently hosted a Disability Confident employers event, and many of the employers admitted that they had not known about the scheme at all. There are two aspects to the world of work when it comes to deafness. The person who is deaf or hard of hearing needs support to cope at work, and the employer—in particular, the small or medium-sized employer—needs support to understand that that need not disadvantage their business. As has rightly been mentioned—I think my right hon. Friend the Member for Wolverhampton South East said this—when a disabled person is employed and supported in their workplace, it reduces workforce churn. The support does not have to be expensive. Sometimes it is about awareness, moving someone’s seat so that they can lip-read, or letting them sit in a quiet corner of the office where background noise is not such an issue for them.

The message from the Government about Disability Confident employers is very strong and very useful, but now, with the capping of Access to Work support, they seem to be sending a contradictory message. Can we afford not to support people in work? What is the cost of not supporting them? What a loss of talent. As we have said, this debate covers many areas and not just one Department, but not least is the Department responsible for economic development, because what is the cost to our economy of not utilising and maximising the potential of all our citizens, including people who are deaf or hard of hearing?

What can we do? What concrete action can we take? The recommendations in the 2015 action plan were very welcome. I think there is agreement on both sides of the House that that is a sensible plan, so let us see it put into action. The “What Works” guides published this year were an excellent piece of work that we need to build on. Concrete action is needed at every stage. We need to ensure that newborn babies are properly screened and that the screening is always of high quality. We need to support parents of deaf children with early intervention. We need to support schools and ensure that there are specialist teachers and that children are not allowed to feel like second-class citizens. We need to promote British Sign Language in schools and allow it to become a GCSE subject. We should look to the Scottish example—an excellent job is obviously being done there. As someone who is half-Scottish, I say, “If the Scots can do it, so can we,” and I am sure we will do it at least as well.

We must ensure that equipment is enhanced and not restricted. I was shocked to hear of clinical commissioning groups that are beginning to restrict the provision of hearing aids. The criteria for cochlear implants must be reviewed. We must look to aid people’s hearing and support them to live full lives, rather than looking for ways to limit them. We have to go back and review those criteria.

Let us invest in unlocking the potential of the deaf and the hard of hearing. Our economy depends on the talents of all our people. The cost of not acting not only causes misery for individuals who are discriminated against and excluded from society and the world of work, but stores up for the future huge costs for our health, support services and, of course, our economy. The failure to support deaf people to fulfil their potential is costing the economy. We cannot afford not to act.

World Antibiotics Awareness Week

Julie Cooper Excerpts

Thursday 16th November 2017 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for York Outer (Julian Sturdy) for securing this debate on a really important subject during the week when we are focusing attention on the value of antibiotics and the challenges of antimicrobial resistance.

We have heard some interesting contributions, and I think there is widespread agreement across the Chamber. To reiterate some of the problems, we all agree that antimicrobial resistance is arguably the biggest challenge facing our health system. It is worth taking a moment to reflect on how fantastic antibiotics have been. We take so much for granted. Alexander Fleming’s discovery of penicillin heralded a golden age in health. Penicillin was the first of many antibiotics; it alone has saved countless lives and was rightly hailed as a wonder drug. Wide-scale access to antibiotics changed the nature of medicine forever: wounds would heal and operating theatres became safe places where life-changing and, indeed, life-saving operations could be carried out without fear of deadly infection.

However, that was a long time ago and we now too often take antibiotics for granted. We have become blasé about their use. We have become careless and irresponsible. Too often at the first hint of an infection—a cough, a sneeze or a headache—GPs come under pressure from their patients to prescribe antibiotics. Too often antibiotics are the first port of call. Too often they are made available as a precaution. Through overuse and inappropriate use we have allowed the development of resistant bacteria on a global scale.

That is not just confined to their use on humans, as has been mentioned by several hon. Members. In fact, the use of antibiotics in animal husbandry is widespread and is not just to treat infection, nor even to protect against infection. Until relatively recently it was permissible for sub-therapeutic doses to be added to animal feed to promote growth. That practice was banned globally in only January of this year. Even without that, 44% of all antibiotics used in the UK are used on animals and often inevitably find their way into the food chain and domestic water supplies. Cat McLaughlin, chief advisor to the National Farmers Union on animal health and welfare, stated:

“Arbitrary restrictions on the use of antibiotics…could have a detrimental impact on animal and plant health.”

That might be all well and good; however, the scientific consensus is that if we fail to place restrictions on the use of antibiotics, there will be a catastrophic effect on human health.

It is worth stressing that, as we have heard, antimicrobial resistance is the cause of 700,000 deaths globally each year, and that figure is predicted to rise significantly, to horrific levels, by 2050. Here in England, 5,000 people die every year from infections that have developed resistance to antibiotics. We must not underestimate the full impact of antimicrobial resistance. Let us be absolutely clear: without resort to effective antibiotics, there will be no treatment for complex infections, no chemotherapy for cancer and no treatment for cystic fibrosis, heart transplants or joint replacements. I recently visited the microbiology laboratory at the Royal Blackburn Hospital in Lancashire and the consultant microbiologist I spoke with said, “If you take one thing from your visit here today let it be this: we are so close to being unable to perform even the most minor, the most simple, operations, and so close to being unable to treat commonplace infections.” She impressed on me the need for urgent action.

The World Health Organisation identified the need for co-ordinated global action back in 2011. I am pleased to say that the UK has been a leader in responding and that at the time it published the five-year antimicrobial strategy and commissioned the O’Neill report, which has already been mentioned. It is clear that our focus should be two-fold.

First and foremost, we must raise awareness of the danger of overuse and focus on the reduction of demand. There is a lot that we can and must do. I agree with other hon. Members that we must start with a public education programme to manage expectations and to highlight the issues of inappropriate use and too frequent use. We should increase the use of diagnostic testing so that only efficacious targeted antibiotics are used.

In both those areas we should look to community pharmacists to lead. Qualified pharmacists are well placed to provide antimicrobial stewardship. Every day 1.6 million visits are made to community pharmacies in the UK, which provides ample opportunity to advise the public on appropriate treatments for ailments, to ensure full awareness of remedies other than antibiotics that may in many cases be more appropriate. The Royal Pharmaceutical Society has offered to support its members to take on new and extended roles. Why not take it up on that offer? Why not make mandatory the roll-out of minor ailment schemes in community pharmacies? Why not support community pharmacists to carry out diagnostic testing to support GPs and other dispensing health professionals? Reducing the prescribing of antibiotics is not just the responsibility of GPs.

We must also regulate to reduce the amount of antibiotics used routinely on animals that are not sick. The National Office of Animal Health refutes the call for extended regulations and rejects the call to reduce antibiotic use in food products. However, we must act to promote a global reduction, because we are not talking about insignificant amounts of antibiotic use. Here in the UK, as I have mentioned, 44% of all antibiotic use is on animals. In the USA that figure is more than 70%. Many nations do not even record the figure and there is every reason to suppose that it is far higher. We must acknowledge that this is a global problem and play our part in identifying new incidences of antimicrobial resistance.

We must invest in research and development, promoting innovation to discover the next generation of antibiotics. At the moment, fewer than 100 scientists are working in the pharma industry to develop antibiotics, due mainly to a lack of adequate reimbursements. Not only would that ensure antibiotic protection for us in future, but investment in this sphere has the potential to make a significant contribution to the UK economy. We must see the challenges as opportunities.

The UK has an opportunity to be a world leader in life sciences and antibiotic development, but the reality is that, contrary to the O’Neill report’s recommendations, there has been insufficient progress, and incentives to promote this innovative work are not forthcoming. We should stop focusing on the cost of new antibiotics and focus on the cost of not developing them. The British Society for Antimicrobial Chemotherapy maintains that the UK has failed to address the issues in three main areas: education and public awareness; veterinary and agricultural use; and incentives for antibiotic discovery, research and development.

As we mark World Antibiotics Awareness Week, I ask the Minister to outline what steps the Government will take on three fronts. What steps will he take to reduce the inappropriate use of existing antibiotics in the treatment of human illness? What action will he take to regulate the use of antibiotics on healthy livestock? What action will he take to stimulate the research and development of new antibiotics? Will he demonstrate to us that the Department is determined to take this subject by the scruff of the neck? A world without antibiotics is unthinkable.