Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 14th November 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Sustainability and transformation plan footprints were determined as a result of discussions between local areas, NHS England and NHS Improvement. They reflect a number of factors including patient flow, the location of different organisations in the local health economy and natural geographies. We stated in the next steps of the “Five Year Forward View” that adjusting STP boundaries is open to discussions between us and NHS England when that is collectively requested by local organisations, and we mean that.

[Julie Cooper (Burnley) (Lab)]

Last month, Lloyds announced the closure of 190 community pharmacies. The company’s managing director was very clear that this action was a result of recent cuts to pharmacy budgets. Does the Minister have any idea how many community pharmacies are at risk of closure as a result of Government cuts, and what assessment has he made of the likely impact of these closures directly on patients and the wider NHS? Will he join me in asking the Chancellor adequately to fund this vital service?

Children’s Oral Health

Julie Cooper Excerpts

Tuesday 31st October 2017 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone. I am grateful to my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) for bringing this important issue to the House’s attention. This debate is long overdue, as has been said by Members on both sides of the House. There is much agreement, and it has been really useful to hear from experts in the field—our dental and paediatric colleagues in particular.

We cannot say too loudly or too often how shocking the current state of affairs is. The hon. Member for South West Bedfordshire (Andrew Selous) quite rightly said that we have a health emergency. We cannot stress too often the truly shocking statistics that have been touched on. The biggest cause of hospitalisation for five to 10-year-olds in England—bigger than broken arms, asthma, appendicitis and all the other things that we think about children being taken to hospital for—is teeth extractions. Up to 160 children a day are undergoing general anaesthetics in our hospitals for what is preventable, and a quarter of all our five-year-olds have decaying primary teeth. In some areas of the country the situation is far worse. Deprived children are seven times more likely to suffer from tooth decay than their peers. Indeed, in some areas of Lancashire, 56% of children are affected.

Another shocking statistic I came across in preparation for the debate relates to the shortage of dentists. The hon. Member for Erewash (Maggie Throup) rightly said that NHS dental checks are free for under-18s, but accessing an NHS dentist is not easy in many parts of the country. Only this week, Cornwall has reported a backlog of 14,000 people waiting to access an NHS dentist. Some people are having to travel 70 miles to see a dentist.

What effect is that having? We have heard extensively from Members of all parties about the effect on children. There is obviously suffering in terms of the pain of dental decay, and we have heard about the effects on childhood confidence. We have also heard about time lost from school. This goes beyond the suffering of children. We cannot afford to ignore the issue, given its effect on our economy. Even if we wanted to ignore the effect on our children—I am sure none of us does—all the evidence suggests that last year 1.2 million working days were lost as parents took time out of work to care for children who had oral health issues.

Of course, we cannot ignore the pressures on the NHS. We hear every week in this House about funding issues in the NHS and how it does not have the funding it so desperately needs. This preventable issue costs the NHS £5 million a year. That cannot go on—it makes no sense.

What are the answers? There are no quick fixes. Many Members have raised interesting ideas, and I think the answer lies in a combination of them. I hope the Minister will talk about his plans to reform the dental contract and that that will result in a dental contract in England that has prevention and public health at its heart and that builds in an element of sustainability for dental practices. I hope we will adequately fund more dentists. There is a massive shortage of NHS dentists, and Health Education England has cut funding to train dentists by 10%. Dentists have raised concerns with me about that this week. In particular, 17% of our NHS dentists come from the EU, and agencies that supply them to our NHS are already reporting a 90% fall in EU-citizen dentists willing to sign up to support our NHS.

As has been said, we desperately need a public health education programme. It was heart-warming to hear about the work done in Scotland through the Childsmile programme. I would like to see us go further in England, and I hope the Minister will assure us on that. It could be done in an affordable fashion by reinvesting the savings and ensuring that every health professional—everyone who comes into contact with a child from their earliest days, such as the midwife—plays a part in making sure that parents fully understand the oral needs of their children. We must ensure that every nursery schoolteacher is reinforcing that message. And, yes, in the same way as has happened in Scotland, and in some cases in Wales, toothbrushes and toothpaste, as well as fluoride washing, should be provided in the more deprived areas. We have heard about the positive impacts that fluoridisation can have, but that in itself is not an answer.

The wider benefits are hard to measure, but the impact on the NHS and on child wellbeing is crucial. As the chair of the British Dental Association said:

“These shocking statistics are rooted in an abject failure by government to tackle a preventable disease.”

I look to the Minister to assure us on those points and to tell us that we will go beyond pilots. As many Members have said, the evidence is there. This is an urgent situation. For the sake of our children, our NHS and the wellbeing of future generations, we need to tackle this as a matter of urgency.

[Mr Peter Bone (in the Chair)]

Before I call the Minister, I remind him that the convention is to let Mr McCabe wind up at the end.

Healthcare in Oxfordshire

Julie Cooper Excerpts

Tuesday 17th October 2017 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I begin by thanking the hon. Member for Witney (Robert Courts) for securing a debate on this important subject. It gives us an opportunity to discuss a subject that I would suggest goes beyond Oxfordshire.

Forgive me if I am not as familiar with the healthcare scene in Oxfordshire as many of the hon. Members who have spoken today, but I have listened closely and what they have described resonates with similar situations across the country. I applaud their commitment and dedication on behalf of their constituents, which, by the sound of things, are quite justifiable. It is clear from what hon. Members have said that the people of Oxfordshire seem to be very unhappy about the proposals, and my research shows me that perhaps they have good reason to be.

The proposed changes will mean less hospital beds; changes to acute stroke services; changes to care at the Horton General Hospital, as the hon. Member for Banbury (Victoria Prentis) has just explained to us in great detail; changes to critical care; changes to maternity services; and changes to the special baby care services. I gather that there has been lots of vociferous opposition to these proposals on the ground, which has been reflected in hon. Members’ comments today. I understand that local people have said in a petition that they believe these proposed changes will lead to poor services, a cheaper service, overcrowding and long waits. I particularly noted what a local A&E doctor said about the process way back in August:

“This is just awful. Working in A&E is particularly difficult, and has been all year. We often have significant nursing and medical rota gaps, and long waiting times. Despite it being August, every shift has patients on trolleys in the corridor, with the time waiting for a bed over 12 hours…We are not coping”.

I also note that there is a proposal to reduce the number of hospital beds in the first instance by 110 further beds. Clearly, no one is listening to the NHS staff there in Oxfordshire.

Oxford City Council has also expressed its concerns and has quite rightly commented on the lack of a workforce plan. Interestingly, however, it also said that it understands the position that the clinical commissioning group finds itself in. We have heard a lot of criticisms of the CCG this morning and it has obviously been remiss in its consultation process. However, the council says it understands that the CCG is up against national policy.

That point is very important, because what we have heard this morning is not only a problem that affects Oxfordshire. The hon. Member for Witney spoke about his constituency being one of the few that still has snow. My constituency, too, still has snow—lots of it—and we also have in common a great dissatisfaction with the health services that we are receiving, particularly as we look forward, or maybe dread, the introduction of the sustainability and transformation plans.

At this stage, we have a national health service, and the changes that we have heard about this morning are Oxfordshire’s response as part of the STP group that takes into account Buckinghamshire, Oxfordshire and west Berkshire. The STP ordered by Government is one of the 44 they have ordered. In total, those STPs will look to save the NHS £22 billion and the share of the savings that have to be made by Oxfordshire, Buckinghamshire and west Berkshire is £480 million. That, I would suggest, is at the root of the changes.

[Victoria Prentis]

I accept that I could not possibly expect the hon. Lady, coming from Burnley as she does, to have the encyclopaedic knowledge of Oxfordshire health services that, sadly, we Oxfordshire MPs have to, but the changes to the Horton General Hospital apparently stem from recruitment—the inability to recruit obstetricians—and not a lack of money. Indeed, the changes started when the STP was just a twinkle in someone’s eye, so the situation is slightly more nuanced.

[Julie Cooper]

I note the hon. Lady’s points, and there is another issue we could talk about. Our NHS has a crisis on three fronts—a funding crisis, a workforce crisis and a systemic crisis—and I think that is what we are looking at today: some of the systemic problems.

Going forward, £480 million has to be saved. This is not something that the CCG has decided to do, and it does not matter how transparent the consultation is—it sounds like it needs to up its game on that—because it still has to make its share of that saving.

As for the national health service, I note with absolute horror that, when it comes to the percentage of GDP that we spend on our NHS, we are well down the league—indeed, we are close to the bottom—compared with nations that we would expect to be up there with. We are behind France, Germany, Canada, Switzerland, Denmark, Belgium, New Zealand, Portugal and Japan—I do not have time to list them all, but we are well down the list.

The hon. Member for Henley (John Howell) quite rightly mentioned the issue of beds and how it is not really a bad issue—people ought to receive care at home where possible. I totally support that; the problem is that the cart is being put before the horse. The care, including social care, is not there in the first instance to allow us to reduce hospital beds and provide the excellent care in the community that we all want to see. When it comes to the number of hospital beds per head of population, we are again close to the bottom of the league.

For obvious reasons, healthcare in the modern NHS is delivered in a different way. In all comparable nations, the number of hospital beds has reduced, but nowhere near to the extent that it has been reduced in England. I particularly note with horror the reduction in maternity beds and mental health beds. There has been a lot of talk about standing up for the mentally ill, but beds in mental health care have actually been reduced by over 90%. That is very worrying when we all see that the necessary care is not there in the community. In fact, Oxfordshire County Council has said it is worried that there would be no impact assessment of some of the proposed changes. How was the community going to cope? Were the services in place in the community to provide support when, for example, hospital beds were removed? The council was not convinced that that was the case.

So, we are bottom of the league on spending as a percentage of GDP and close to the bottom—we are just bumping along the bottom—on hospital beds.

[Robert Courts]

I understand that the hon. Lady has her job to do, but I am quite keen that this debate, which is about a much more complicated local healthcare issue, is not reduced to one in which—if she will forgive me for saying so—some rather crude political points are made. For what they are worth, the statistics are that the NHS Oxfordshire CCG has received a funding increase of 2% in 2017-18 compared with the previous financial year, and another 2% increase is forecast for the following financial year, so more money is going into the CCG. What is clear—the CCG was quite open about this in the phase 1 consultations instigated and organised by my hon. Friend the Member for Banbury (Victoria Prentis) and I—is that the issue is not funding. It is about transparency of consultation and organisation, so I would be grateful if the hon. Lady did not reduce this debate to a political or money issue.

[Julie Cooper]

I am grateful to the hon. Gentleman for his intervention. I am sorry that he thinks I am reducing the debate; actually, I am looking at the national health service—we do still have a national health service, and I am thankful that we do. I take the points that he has made. These local reconfigurations of healthcare services are very complex; I understand that. However, underpinning all this—it is well documented—is that the STP for the region must make a saving of £480 million. That will be the funding gap if things continue as they are. The changes are not being made for patient gain, and that is why right hon. and hon. Members are rightly upset. They listen to their constituents, and their constituents, as they begin to see the changes coming forward, know they are definitely not an improvement. There is a financial motivation behind them.

I am grateful to the hon. Member for Witney for introducing the debate. It is really important. I sympathise with the people of Oxfordshire, as I do with people across the country in the 44 different STP groups—we are hearing the same story in each of them. I hope that the Minister will address the points raised and that he will encourage clinical commissioning groups to consult more widely, thoroughly and transparently and will equip them with the tools they need. In case anyone does not believe me, did anyone really think that Simon Stevens, head of NHS England, was lying when he said that the NHS did not have enough funding? When the chair of the Care Quality Commission said that social care was close to its tipping point—that has a bearing on this matter—did anyone think he was lying? Of course not. These are very important issues, and I hope that the Minister is listening, because this is part of a Government’s national plan for our health service.

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Dunne]

I will try to keep this answer short, Mr Speaker.

As the hon. Lady will know, the local joint health overview and scrutiny committee has referred those proposals to the Secretary of State, and it would not be appropriate for me to visit the hospital while the referral is in progress.

[Julie Cooper (Burnley) (Lab)]

On the subject of vital NHS staff, will the Minister join me in congratulating the thousands of community pharmacists on their daily commitment and professionalism? Will he confirm, once and for all, that he has no intention of downgrading their role and putting patients at risk? Surely he agrees that the Prime Minister would have been well advised to seek a cough remedy from a qualified community pharmacist rather than relying on an unqualified Chancellor of the Exchequer.

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 4th July 2017 Commons Chamber

[Steve Brine]

The Government have committed £50 million of official development assistance towards setting up the global antimicrobial resistance innovation fund. We are one of the world leaders on this subject. I am meeting my hon. Friend and my hon. Friends the Members for Stafford (Jeremy Lefroy) and for York Outer (Julian Sturdy) shortly, when we can take this forward.

[Julie Cooper (Burnley) (Lab)]

I spoke to one GP last week who told me that because he has been unable to recruit help he has only been able to take one week’s leave in three years. That is clearly not sustainable. The morale of GPs is at an all-time low, the number of GPs continues to fall, surgeries are closing, and patients are finding it harder and harder to get an appointment. The Secretary of State promised an extra 5,000 GPs by 2020, but given that it takes 10 years to train a GP will the Minister tell the House how exactly he is going to deliver on that promise?

[Steve Brine]

I thank the hon. Lady for her question and I look forward to engaging with her on such matters. The “General Practice Forward View” is a landmark document, which was published in April last year. As she knows, it sets out extra investment that GPs have been calling for for years: £2.5 billion a year for GP services. That means investment is rising. The good news, as the Secretary of State said, is that more people are coming into general practice. We want to continue to encourage that, but we also have to take action to prevent early retirements and to bring people back to general practice. We are indeed doing that.

Preventing Avoidable Sight Loss

Julie Cooper Excerpts

Tuesday 28th March 2017 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I thank the hon. Member for Wealden (Nusrat Ghani) for securing this important debate, which is long overdue. I also pay tribute to the excellent work that she does on the APPG to reduce sight loss; I was privileged to attend a recent meeting, and she is doing sterling work, for which I applaud her.

We are fortunate also to have the expertise of the hon. Member for Twickenham (Dr Mathias); I am sure that we were all interested to hear her expert opinion. We also heard very human stories from hon. Members representing constituents all over the country. They made very powerful cases. As I said, a debate on this subject was long overdue. Given the scale of the problem, to which many hon. Members alluded, the fact that it barely gets a mention in Parliament from one month to the next is quite shocking.

It has been said already, but is worth stressing, that more than 2 million people in the UK are living with sight loss. This is not a problem that affects a small number of people; it is a major problem. One in five people over 75 and one in two people over 90 are living with sight loss. With regard to the impact on the wider NHS, every year there are 2.6 million GP appointments for eye-related conditions and 270,000 accident and emergency visits for acute eye problems. And the problem is not going to go away. We have heard that the number of over-85s will double over the next two decades and that problems with sight loss are also set to double. Research by the Royal College of Ophthalmologists shows that there has been a 37% increase in eye clinic attendances in the UK over the past 10 years, and demand is growing year on year, making it the specialism with the second highest out-patient attendance. New treatments as yet unimagined will inevitably add to that demand.

For me and, I am sure, most Members in the Chamber, the most alarming statistic is that more than 20 people go blind unnecessarily every month in England. That is 20 people who did not need to lose their sight. It is a really shocking statistic. Many Members, including the hon. Member for Motherwell and Wishaw (Marion Fellows) and my hon. Friend the Member for Great Grimsby (Melanie Onn)—I only represent great Burnley—have alluded to the horrors of blindness. Particularly affected are the elderly, people with dementia and people suffering from diabetes.

[Jim Shannon]

I have a very good friend back home in my constituency who has diabetes. He decided to go for laser treatment to correct his short-sightedness and, as a result, he lost sight in both eyes. There can be complications for diabetics who try to improve their sight. For my friend, that became a horror story rather than a good story. People who are diabetic need to take special cognisance of the possibility of complications before they do anything. I apologise, Mrs Gillan, for intervening for a wee bit longer than usual.

[Julie Cooper]

I am grateful to the hon. Gentleman for that important intervention. Diabetes brings its own special problems, which we need to be widely aware of and build into any future strategy.

Some 20 people every month in this country—one of the richest countries in the world—go blind unnecessarily; it is not because we lack the ophthalmic expertise to save sight. On the contrary, we have many leading centres of excellence. Indeed, the Manchester Royal eye hospital that serves my constituency is one of the finest centres in the whole of Europe. People are going blind because capacity in the service is failing to keep pace with demand. For many eye conditions, including glaucoma and macular degeneration, early diagnosis and regular treatment are vital if sight is to be retained. For example, if glaucoma is diagnosed early, good sight can be retained, but in the overstretched and under-resourced system that we have now, 17% of those diagnosed lose their sight.

Currently, fewer than half the patients requiring multiple appointments are seen within the optimum timeframe, and the statistics given by my hon. Friend the Member for Great Grimsby about the effect on her constituents are truly shocking. Research shows that more than half a million appointments in England were cancelled by eye departments in 2015-16. It is therefore not really surprising that the Royal National Institute of Blind People reports that 50% of the incidences of blindness could have been avoided. It is undoubtedly a source of misery for the individuals affected, causing untold suffering, restrictions on lifestyle and a host of missed opportunities. In addition, as has been referred to, it places massive additional pressures on social care services and the wider NHS. I think that we all agree, on both sides of the House, that services need to improve.

There are already many examples of pockets of good practice—deploying mobile units and the multi-skilling of staff—where experts are desperately trying to compensate for a lack of resources to deal with increased demand. Clearly, the knowledge that demand will continue to grow means that there cannot continue to be business as usual. The clinical professionals have identified four areas that need to improve. They have said clearly that there is a need for an overall strategy—a direction from above and from Government. It is significant, as the hon. Member for Wealden pointed out, that in Zimbabwe there is a national strategy to prevent sight loss and retain sight, but in England we do not have such a strategy—I am shocked. The professionals also call for improved access to data to make their job easier and more efficient; to avoid duplication and ensure that they have access to the best possible information about their patients in a timely fashion.

In addition, the professionals call for services to be provided locally. That is particularly important because many of the patients are elderly. The current system of geographically distanced centres seems to be in direct contradiction to the aims of the five year forward view, which asks for treatments to be delivered locally. Current financial constraints must also be reduced to increase capacity. That makes sound economic sense, as we heard from the hon. Member for Motherwell and Wishaw, because it is estimated that the failure to tackle this problem actually costs the UK economy a shocking £28 billion—no wonder the parliamentary researchers got the figure wrong. Like me, they probably could not believe the figure when they saw it; £28 million sounds like a lot, but the cost to the UK economy of failing to act on this issue is actually £28 billion.

I want to pick up on some of the other points made by hon. Members today, most notably on prevention. Early diagnosis and prevention are extremely important, and it is a fact that in many areas across England school eye tests are becoming a thing of the past. Most of us will have had our eyes tested in school as children and had difficulties picked up then, but many areas are choosing not to commission such tests. In deprived communities, such as those in my constituency, many people simply cannot afford eye tests that are charged for and therefore choose not to prioritise them. As eye sight deteriorates with age, many people make do with cheap, over-the-counter spectacles. The point has been powerfully made that people do not just visit their optometrist so that they can read more efficiently; they also need to check and make sure that there are no early signs of other diseases. That is really important.

I totally agree with the point made by the hon. Member for Twickenham about treatment. How can an expert look a patient in the eye knowing that a treatment is potentially being developed but that, for reasons of resources, in one of the richest countries in the world, it is not a priority for us? I ask the Minister to consider all these points. STPs have been mentioned, and they are an exciting opportunity to address some of the issues raised today. Like the hon. Member for Wealden, I have looked at many of the STPs for many reasons; worryingly, even in the ones that do mention sight loss and eye care services, it is a passing mention—a tick-box exercise—and I hope that the Minister will address that. Today we look to the Minister to outline the action that the Government will take to address the many issues that have been raised, and to address what has become a national scandal.

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

My hon. Friend raises an important point. There is currently no evidence of an increase in the number of doctors going to work abroad, but there is an issue of fairness because it costs around £230,000 to train a doctor over five years. In return for that, there should be some commitment to spend some time working in the NHS, and we are consulting on that at the moment.

[Julie Cooper (Burnley) (Lab)]

GPs around the country are facing unprecedented pressures as they work to deliver the highest possible standards of care, despite underinvestment and increasing patient demand. A record number of GP practices closed in 2016. Are the Government really serious about addressing the problem for the sake of GPs and their patients? If so, why has the promised £16 million resilience fund not been delivered in full, when it was promised by October 2016? There is very little evidence to date of the Government delivering on any of their promises in “General Practice Forward View”, no sign of the extra £2.4 billion, no sign of—

[Mr Speaker]

Order. We have got the general drift. May I gently say to the hon. Lady that the longer the Opposition Front Benchers take, the less time there is for Back Benchers on both sides? This is becoming a worsening phenomenon. It is not only the fault of the hon. Lady, but it really must stop. It is not fair to Back-Bench Members.

GP Indemnity Costs: England

Julie Cooper Excerpts

Wednesday 15th March 2017 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Turner. I thank the hon. Member for Cheltenham (Alex Chalk) for securing this debate on this really important subject, and join him in paying tribute to GPs—including those in my constituency and across the country, many of whom I have had the pleasure of meeting recently. I pay tribute to the excellent work that they do. They are at the cutting-edge of the NHS; in many ways, they are the gatekeepers, taking tough—often the hardest—decisions. They deserve our respect and support at every corner.

It is important to begin by setting this debate in the context of the pressures that GPs face. Undoubtedly, as has been mentioned, the demand for GP services has increased massively. Much of that has been attributed to the ageing population. Many patients suffering from mental health issues find that those are not addressed elsewhere, because specialist services are not as abundant as they might be. The lack of social care provision and funding cuts for social care mean that many unsupported elderly people have to call on their GP to work above and beyond, and on far more occasions, for the vital support that they are denied elsewhere.

We rightly heard about the recruitment and retention of GPs and support staff in practices. That issue is particularly important, because anything that is damaging or makes the situation worse is cause for concern. Recently, the Capita chaos relating to patient records and the national performance list did not help, placing more pressure on our GPs. The criticism relating to this winter’s A&E crisis, including the implication that GPs should somehow be doing more to lift the pressure, did not help either.

The hon. Member for Cheltenham rightly referred to the extra responsibility that GPs have taken on with commissioning. That important role has put extra demand on them. I agree totally with his very good point about the pressures that are coming back upstream because of increasing specialisms in hospitals. I met GPs and some of their staff recently and was concerned to hear them say, “Of all the health professionals, we feel that nobody speaks up for us,” so I welcome this debate. It is right and proper that we in this House recognise and put on the record the value of GPs.

The rising cost of professional indemnity is an added burden, and frankly, doctors do not need anything else to deal with, nor do other medical specialists within GP surgeries. As has been outlined, 95% of doctors report phenomenal increases in indemnity costs. I will not repeat the figures, but the rises have been unacceptably high. I underline that the increases in costs are in no way due to a deterioration of professional standards—absolutely the reverse is true. Standards are at least as high as they have ever been, and in most cases, they are higher. The current situation is, in fact, due to the sheer volume of work done by general practice. When that grows to such an extent, the amount of complaints against the service are bound to go up too.

We live in a different society and a different, increasingly litigious world. People are encouraged to take action for sometimes minor issues, hence the need for doctors to have professional indemnity covering them up to about £20 million, which I think is the figure that people widely acknowledge they need to be covered for. That is why there has been the massive increase in the premiums.

This is an English problem. Although proper analysis has not been done on GP practices elsewhere in the UK, evidence shows that it is less expensive to practise over the border in Scotland and in Wales, where I understand the new contract provides for the out-of-hours work that GPs do, as well as support for the costs of their regular work.

The impact is serious, and the fact that no long-term solution has been found for the problem is having an effect. The Royal College of General Practitioners reported that 80% of GPs say that the time that they are prepared to devote to general practice is affected, whereas 56% said that it would be more likely to deter them from doing out-of-hours work. If the problem is unaddressed, it will undoubtedly affect the long-term recruitment and retention of dedicated people in general practice.

I think we all agree that action is needed. The review group set up in May 2016 introduced short-term interventions, which were really welcome, as has been mentioned. Those will help this year and next towards the costs. The extension of the winter indemnity scheme is also welcome. I understand that the continuation of that led to 500 GPs committing to out-of-hours care, above and beyond the existing number. That surely indicates what the effect of supporting GPs in that way will be.

What action is needed? The Government must begin by demonstrating that they value GPs and recognise the considerable pressure under which most GPs and their staff work. I am sure that hon. Members on both sides of the Chamber agree about that—nor would we find many dissenters among hon. Members who cannot be present today. We must ensure that the Government honour the commitments in the “Five Year Forward View”, including the £2.4 billion extra each year for general practice—we must make sure that is delivered in a timely fashion.

I was concerned to hear the royal college express dissatisfaction that up to Christmas, only £2.4 million of the £16 million designated for resilience for GP practices had been committed. We must do better on that. As a matter of urgency, the Government need to carry out a comprehensive review to find a long-term solution. The hon. Member for Cheltenham made sensible suggestions on legal reform. Perhaps a centralised payment for out-of-hours care would support all that. It seems vital that any costs are in line with NHS treatment and not that in the private sector.

The previous Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), said in March 2016 that the Department of Health would begin to consult GPs, patients, lawyers, medical defence organisations and commercial insurance to look for a long-term solution. That was a year ago, so I look forward to the Minister telling us what progress has been made. Although Chaand Nagpaul, the chair of the British Medical Association GP committee, welcomed the short-term help, he went on to say:

“There is a need for a definitive solution to rocketing indemnity costs”.

Will the Minister tell us what progress has been made? What action has he taken in all those areas to ensure that GPs feel fully valued, and to show that we feel for them when it comes to this extra burden and have taken action to deal with it?

--- Later in debate ---

[David Mowat]

I had forgotten to talk about MOD locums. My hon. Friend raised that issue, and I do not know the answer, but I will write to him and give him the information he needs, and he can talk to his wife about that. I was surprised by that example. I am sure that between the various parts of the Government, we can get an answer.

In the hour available to me, I will discuss in more detail the environment in which the NHS finds itself, the impact and the Government actions we are taking, but I will start with this: we all want access to justice. That is a fundamental of our country, and we should do or say nothing that causes people who have been badly treated to lose out. Lawyers have to be part of how they get access to justice, and that is right, but we also need to protect the viability of our NHS.

We are spending towards £2 billion a year in this area. That is £2 billion a year that we are not spending on nurses, doctors and the improvements we would all like to see. We often have debates about the level of NHS spend compared with other countries in Europe and different parts of the world, but one area in which we can say we are a leader in Europe is the amount of money we spend on litigation and all that goes with that. That is not because our NHS is less safe than other systems; it is to do with some of the points that were made earlier about the litigation culture that has built up. To an extent, that has been encouraged to build up because of our treatment of costs and some of those things. That spend of £1.5 billion to £2 billion has been increasing by something like 20% a year in the past three or four years. We cannot afford to continue to spend money in that way.

GPs are not the most expensive part of the system, but as my hon. Friend the Member for Cheltenham said, GPs typically have to spend £7,900 out of their own pocket on indemnity. That figure is increasing by 10% a year. Indemnity costs for GPs who do out-of-hours work are increasing by 20% a year, which has knock-on effects for the attractiveness of that work. As we discussed earlier, it also impacts on people in other ways, such as propensity not to become partners in GP practices.

What has made the acceleration in legal costs evident is not so much the major claims that everyone would agree need to be sorted out and dealt with—for example, babies who are damaged at birth and need to be looked after for their entire life—but the significant increase in the number of minor claims, which tend to have a higher proportion of associated legal costs. As I said, claims of around £10,000 would typically have legal costs in excess of three times the amount that the patient would receive. My hon. Friend the Member for Cheltenham said that many claims are successfully defended, and the fact is that 99% of all claims are settled out of court. There can be a tendency to settle minor claims for relatively small amounts—claims under £100,000—just because of the volume that are coming in and because it is cheaper to settle than fight to the end. All of that takes money out of our NHS.

We have talked a little bit about why this is happening. The life expectancy of people with complex needs is increasing, so if someone is damaged at birth, typically the awards they need go on for much longer than in the past. That is a good thing in terms of life expectancy, but it drives cost. There is a view that the best-quality care becomes more expensive. Technology is a part of that. We also have an environment in which, for whatever reason, there has been an explosion in small claims against the NHS, which particularly affects GPs, and there is a legal environment in which even unsuccessful claims or claims without merit can sometimes be rewarded. All of that is made worse, as we have heard, by the change to the discount rate made by the Lord Chancellor, which will come into effect next week on 20 March.

The time value of money essentially was 2.5% and is now going to be -0.75%. That will have a significant impact on all insurers in the private and public sectors. It particularly affects the health sector. The £59 billion reserve that the NHS has for central litigation costs will increase because of the change that has been made by something in excess of £5 billion or £6 billion. Those are significant and serious sums of money in the public purse. The Government’s position is that doctors will not have to pay as a consequence of the technical change in discount rate. We are working through how that will work in the central litigation authority and the three insurance companies that my hon. Friend the Member for Cheltenham mentioned. Nevertheless, the cost is significant in the context of all the other pressures on the health system.

A couple of Members talked about the fact that the issue affects not only doctors in primary care but pharmacists. Increasingly, clinical or prescribing pharmacists are working in primary care and they need indemnity, as do nurse practitioners. We need to remember that that is all part of the picture.

[Julie Cooper]

On that point, is the Minister prepared to acknowledge that professional indemnity is a significant burden for community pharmacists? That is something he might want to consider before going ahead with his funding cuts.

[David Mowat]

I will not be dragged into the issue of community pharmacists other than to say they are extremely valued and have a major part to play as we integrate them with the clinical pharmacists working in GP practices. I will simply say, since the hon. Lady has raised it, the Government are committed to getting community pharmacists to move into a much more service-oriented way of working. We will not do that by overpaying for prescribing or by acknowledging or encouraging clustering, which is what the reforms we have talked about will address.

So what are the Government doing? First and foremost, we need to continue the drive to improve standards and quality in the NHS. I made the point earlier that accidents happen and negligence takes place. When it happens, we need to learn from it and ensure that there is a duty of candour within the service. Doctors and nurses need to do what they can to make sure that the systems failure or breakdown that occurred does not happen again. To use a rather trite management consultancy-type phrase, the NHS needs to become a learning culture. It is true, however, that people need to learn from errors and continually try to improve standards. We need to avoid errors as much as possible, but at the same time we cannot have the medical profession being overly defensive, because that is not the right answer either.

My hon. Friend the Member for Cheltenham discussed what we have done so far in the “General Practice Forward View” to protect GPs from the rising costs of indemnity. Some £30 million a year is being paid out for the year just gone. There is a clear commitment in the forward view. The increases in indemnity costs, which are not a consequence of GP actions or failures or whatever, will be indemnified by the Government. I repeat that again today. I have already made the point about specialist nurses and pharmacists.

We are trying to make progress on the law and address the level of costs awarded in some cases. The 12-week consultation on fixed recoverable costs began on 30 January this year. In the case of smaller claims, proposals include a cap on solicitors’ fees and on the hourly rate for expert witnesses and locums. It is also proposed that both sides share a single joint expert witness, because it is not always sensible to have two expert witnesses arguing with each other: it is possible to do that in a more effective way. The direct aim of the consultation is to reduce the ratio of the amount of money that the patient gets to the amount of money that the lawyer gets, particularly in the lower-value cases. The Government look forward to the results of the consultation and we hope we can move forward.

Another aim—this applies less to GPs, but is also very important—is to do what we can to keep cases out of court altogether by means of the rapid resolution and redress scheme. I have talked a little about maternity cases, but because of the level of the costs and the complexity of the case it can take many years for payments to start being made. That is not right because, from a justice point of view, the baby or the baby’s family needs the money more quickly. It can sometimes takes nine, 10 or 11 years until the legal side is sorted out, and that is not just.

We began a consultation on the rapid resolution and redress scheme in October last year. The scheme tries to keep the whole thing out of court by attempting through mediation and working together to come up with a sensible and fair solution much quicker so that the 11 and 10-year court cases are avoided. We will try and make progress on that. We have not talked about tort reform. The Government are not currently working on that in respect of indemnity, although that was implied in some of the remarks that my hon. Friend the Member for Cheltenham made.

I will finish where I began. Indemnity is a very important area for the NHS. We are spending towards £2 billion a year. That cost is accelerating and will potentially undermine the level of care that we can give. We need to do what we can to moderate costs.

Draft National Health Service Commissioning Board (Additional Functions) Regulations 2017

Julie Cooper Excerpts

Wednesday 1st February 2017 General Committees

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I am grateful to the Minister for outlining the detail of this statutory instrument. I am happy that this is an operational procedure involving a transfer of functions, and that there are no greater implications. We will not oppose the regulations, but I would like to make a few brief comments.

The regulations provide for the relocation of an operational unit from the Department of Health to the NHS Commissioning Board, and in so doing confer additional powers and duties on the board. No substantial change is envisaged in the way those duties and activities will be carried out, nor will there be any material change in the end result.

Regulation 4 gives the board a new power to manage contract agreements with suppliers and manufacturers of services, drugs, medicines and other products for the purpose of preventing, diagnosing and treating both physical and mental illness. That will result in the sharing of expertise and a co-ordinated approach between the team responsible for the function and teams responsible for specialised commissioning. That potentially will have a beneficial impact on value for money and quality of services and lead to reductions in geographical inequalities, which we welcome.

[Michael Fabricant]

Does the hon. Lady share my view that if the ownership of that department, which is currently based in London, is to change, it would be rather nice if it could be moved to the provinces?

[Julie Cooper]

I am always happy to see departments move out into the provinces, particularly the northern provinces.

We have no objection in principle to the transfer of these functions from the Commercial Medicines Unit. We recognise that the board will still be bound, by virtue of the connected functions outlined within the 2006 Act, to promote a comprehensive health service in England that is designed to secure improvement in the physical and mental health of the people of England and in the prevention, diagnosis and treatment of physical and mental illness.

Obtaining value for money within the NHS is a priority for us. There is now widespread acknowledgment that the NHS is underfunded. All contractual efficiencies are therefore welcome, provided they do not compromise patient access to medication and so on. We are aware that the use of framework agreements to purchase secondary care medical services and products has led to considerable savings for the NHS to date.

Our primary concern is always to ensure the greatest possible access to medication and other therapeutic and diagnostic products for patients. We would not support any attempt to ration treatments and put financial interests before medical need. We welcome the requirement in regulation 6 that places a duty on the board to consult and collaborate with every NHS trust and NHS foundation via a registered pharmacist. This will ensure that there is no loss of effective communication channels and will guarantee continuity of supply of medicines and related services for patients. I am satisfied that all staff will be guaranteed continuity of employment, and terms and conditions will be protected upon transfer. I can confirm that we will not oppose this statutory instrument.

Pharmacies and Integrated Healthcare: England

Julie Cooper Excerpts

Wednesday 11th January 2017 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I thank the hon. Member for St Albans (Mrs Main) for securing this debate on a very important subject. It is pleasing to hear so much agreement around the room; I hope that the Minister is listening. I agree with most of what hon. Members have said.

This subject is very dear to my heart. My husband is a community pharmacist, and I worked with him for 24 years in our own community pharmacy in my constituency of Burnley; I have to add that we no longer have any financial interest in community pharmacy, but what I retain is a very deep understanding of the value of community pharmacy to patients, the community and the wider NHS, so I appreciate the hon. Member for St Albans securing this important debate.

I cannot think of a better way to demonstrate the value of community pharmacies than to talk about my experience. Coopers chemist in Burnley—a deprived constituency in many ways, where life expectancy is closer to 80 than 90—serves a community along with four other pharmacies in very close proximity, all of which are really busy and serve a big demand. On a typical day, we dealt with 600 prescriptions and 100 minor ailments, and ran many other services—forgive me if I forget some, because there were so many—including medication use reviews designed to maximise our use of medication, make sure patients understood it, encourage compliance and save money on wastage; smoking cessation programmes; dietary advice; emergency hormonal contraception; methadone programmes; and support for diabetics and asthmatics. It was an ever-increasing list. Those are the kinds of services that are at risk if the Government pursue their plans.

I appreciate the value of community pharmacies. I am also a former private business owner. Let us not forget that that is what community pharmacies are; they are not provided for and paid for by the NHS.

[Oliver Colvile]

That is a very good example of how the private sector, working in the national health service, can deliver good-quality services.

[Julie Cooper]

I do not disagree with the hon. Gentleman’s point.

It is important that we recognise that community pharmacies provide their own premises and train their own staff. As a former business person, I totally get the point about value for money, but this is not just about money; it is about the efficient use of money. We all understand the pressures that our NHS face, and we have to look at that. There are a lot of myths floating around, so it is important that we clarify that.

There has been a lot of talk about the clusters. Again, because pharmacies are private businesses, they respond to demand in the community.

[Julian Knight (Solihull) (Con)]

The hon. Lady brings her expertise to the debate. Does she agree that we need more innovative approaches? The Grove surgery in Solihull has a symbiotic relationship with its local GP services, but in parts of the UK we seem to have run into the sand. We need greater public awareness and encouragement to take such innovative approaches forward.

[Julie Cooper]

I will come on to that very point in a moment.

To return to value for money, it is important that the Government take a responsible attitude and review funding for pharmacies, and I think that professional community pharmacists across the country accept that. Much has been made of the clusters. Pharmacies are independent businesses that arise and stay in business where there is demand. I do not know whether this is widely understood—hon. Members will have to forgive me if they already know this—but the global sum allocated to pharmacies is what pharmacies cost the Government. The Government know what community pharmacies are going to cost. If a new one opens, it does not cost the Government any more; it just means that the same amount of money is shared out more thinly. That is a bit of a red herring. We can be sure that if there is no demand for the services that a pharmacy provides, it will close.

Much has been made of the £25,000 payment, but that does not cover the cost of putting a van on the road and paying for a driver to deliver and administer a prescription delivery service. Those services are absolutely invaluable to communities with many elderly people. I had a conversation with practice managers and general practitioners in my constituency recently, and they were absolutely horrified because they use that service—there is a lot of repeat ordering—and if it were lost, they could not cope.

The Government are suggesting that in-surgery pharmacists are a substitute, but that is another red herring. I welcome the use of well-qualified pharmacists in GP surgeries, but that is a totally separate issue. It is like comparing hospital doctors with GPs. Community pharmacists are at the heart of the community and are accessible for many hours. The hon. Member for St Austell and Newquay (Steve Double) made the point very well earlier when he said that eight minutes is the average wait to see a qualified professional who can help with most things. We have got to embrace that and use what is already there.

I have had conversations with the National Pharmacy Association and the Royal Pharmaceutical Society, and just last night the chair of the English Pharmacy Board said, “We want to work with the Government. We want to sit down and look at how we can do more.” There is the idea that integration is a new thing waiting to happen, but we were proud as community pharmacists to be at the heart of the primary care team, working with GP surgeries, hospital discharge teams, community nurses and district nurses. They often came to us. GPs came and went—that is even more the case now, given the problems with retention in GP practices—so we provided the only continuity in healthcare for many chronically ill people. Particularly for the elderly, that was a vital part of the service, and we were really proud to provide it.

Many community pharmacies are proactive. When this business of moving towards a clinical approach was suggested, community pharmacies accepted it without it needing to be mandated. We invested in a purpose-built consulting room to provide a more clinical environment. That is the way forward, and most community pharmacies accept that.

What is the alternative to what the Government are proposing? For a start, we need a proper assessment of what the cuts will mean. There has been no impact assessment of which pharmacies will close. I agree with the hon. Member for Bury St Edmunds (Jo Churchill) that it will not be the multiples that will close; it will be the independent pharmacies that rely on the £25,000 to provide their core services. That is an absolute fact. Not a single pharmacy in my constituency qualifies for access payments, and only three in the entire city of London do. I can say with absolute confidence that in my constituency it will not be Boots that closes or cuts its hours; because of the volume of business, it has other ways of covering its overheads.

I ask the Government not to throw money willy-nilly at pharmacies, but to look at their value and assess the impact of the cuts. If they think that the best way forward is for some pharmacies to close, they must ensure that the right ones close. We must do what the professional organisations are asking for and come to the table. Pharmacies are begging to take on extended roles. There is so much good will there. The minor ailment scheme, which we were privileged to provide, is an important service. Busy families who have children with minor ailments do not have time to be at the GP surgery. GPs accept that, without that service, they could not manage. We all know that GPs work hard and are overstretched. This is not about criticising the work they do; it is about supporting them, saving the NHS money and taking off pressure.

I ask the Minister not to reconsider the funding, but to look at the way he works with pharmacies in the NHS. I ask him to look at their role, as many Conservative Members have said, and at how they can work with the Government to support other areas of the NHS, thereby saving money. Let us avoid a knee-jerk reaction with no proper assessment of the impact. Let us deliver a better integrated service. The way to do that is not to make blind cuts with no proper assessment.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for St Albans (Mrs Main) on leading the charge on what we all agree is an important subject. We have heard some very useful speeches, although I would make the point in passing that the subject is apparently so important to the Opposition that there have been no speeches from their Back Benchers on any aspect of the reforms during the last hour and a half.

My hon. Friend used an important word in introducing the debate: integration. I will talk about that, because if we are to fulfil the potential of the sector, which we need to do, it needs to be integrated. We have heard other important words too. We have heard about “pharmacy first” and also the phrase “wellbeing hub”, which I think sums up where we want to be in time. I will try to address many of the points made in all parts of the Chamber, but I will also set out what the Government are planning. When we boil it down, however, there is a huge amount of agreement about where we need to get to and the direction of travel. We also heard about Scotland, which is not perfect—the Murray review made some points about IT integration in Scotland, which is not yet working as well as it might—but as I have said in the past, I think we have things to learn from Scotland.

Everyone in the Chamber, Government or Opposition, can agree on three things. First, we need to move funding and the profession from a model based principally on dispensing to one based much more on services. Of course it is true that, to an extent, we are already going in that direction, but the funding model is not facilitating that, and it needs to. The Government must address that and take it forward.

Secondly, we all agree that services are a good thing per se, but that they are better if integrated with the primary care pathway much more than has been the case historically, and that is about working much more closely with GPs. I do not agree that employing more clinical pharmacists in GP practices is a “red herring”; it is part of how we bring the professions together, although I accept historically there have been difficulties doing that.

The third thing we all agree on—this must apply to the Opposition as well—is that we need to get value for money for the £2.8 billion that we spend on dispensing around £8 billion-worth of drugs. It is right to look at doing that as efficiently and effectively as possible. For example, the existing funding model encourages clusters to develop. I note that the establishment payment in Scotland is £1,700 per annum—I think I heard that right—while ours is £25,000, which has encouraged clustering, so that NHS money is not being spent on frontline services.

It is worth reminding the House that none of the efficiency changes that we announced before Christmas represents a cut of money going back to Treasury; the money is being reallocated to other areas of the NHS. The impact analysis talks in some detail about how money can potentially be spent more efficiently. In parallel with that, we need to make progress on services. I completely agree with that, and I will talk about the pharmacy integration fund and the Murray report, an important piece of work which my hon. Friend the Member for St Albans talked about and which will inform our policy.

We all agree not only on those three things, but on others. For example, there is a big benefit in diverting activity away from GPs. Various reports have been produced by the sector itself, and the Government accept that up to 30% or 40% of GP appointments could possibly be handled by pharmacists. That is a massive number. If we can achieve that, it will be of great benefit to us all. More can be done in pharmacies, such as medicine reviews and medicine optimisation, let alone how they can help us with the public health agenda, which we have not covered in particular today. A lot could be done with smoking cessation, obesity and sexual health programmes.

[Julie Cooper]

The Minister is contradicting himself. Pharmacists are already planning to reduce the hours that they are available to provide these services—the very services that he tells us he values and wants to see more of. Does he accept that if he persists with the cuts, there will be less of them? Some pharmacies will close, while others will reduce services, and are already planning to cut opening hours and reduce staff.

[David Mowat]

What we are not reducing is the amount of money available for services, as opposed to dispensing. Some pharmacies use part of their dispensing money to provide services on a discretionary and ad hoc basis, but I make this point again: overpaying for dispensing is not a good vehicle for getting more and better services.

I want to talk about some of what is already happening. We have heard about flu jabs this morning—I, too, had a flu jab at a pharmacy—and at the end of last year, we had had more flu jabs in pharmacies by October than we had in all of the previous year. The money available for that and similar service-based allocations has not been affected by the changes we announced. The community pharmacy sector has received £10 million for flu jabs up to the end of October. We want to see more of that happening, and that direction of travel is important.

A number of hon. Members made the point, which I agree with, that the public need to understand that pharmacies represent an important first port of call—it should not always be GPs. The Government can do more to make that clear. When I was preparing for this debate last night, I saw a television advert from NHS England for its “Stay well this winter” campaign. The campaign is running TV and newspaper adverts, and its theme is for people to visit their pharmacy as soon as they feel unwell. The people running the campaign have told us they think the advertising campaign has generated about 1.2 million additional pharmacy visits that would not have happened otherwise. That was a good challenge and we need to do more of that.

We also need to go further with services. There are two approaches. I recommend that anyone interested in this subject—as everyone present clearly is—reads the Murray review, which was produced by the King’s Fund. NHS England commissioned the review to inform it and us on how to spend the integration fund, the budget available to drive services more deeply into the system. I will talk about some aspects of that and about some announcements that I made in October as part of the package we are discussing.

One of the announcements was about urgent or repeat prescriptions. At the moment, NHS 111 gets about 200,000 phone calls a year asking for a further prescription, and those callers are told to see an out-of-hours GP to issue a prescription, which in due course goes to the pharmacy. We are changing that so that people will be directed to a pharmacy immediately. That is a stream of revenue for the pharmacy, which will provide both a consultation, for which it will be paid, and then the drug or prescription, as necessary.

My hon. Friend the Member for St Albans asked whether that scheme would somehow affect a good local scheme in her area. There is no reason why that should be the case. The new scheme is supplementary to anything that might have been commissioned already. It sounds as if her scheme was commissioned by the CCG, and that is good, although it takes us to the fact that things are patchy—different CCGs do different things in different areas, which I will come to. However, that is an example of where we need to be.

Another example is the minor ailments scheme. As I have said, 30% to 40% of GP appointments could be dealt with in pharmacies. Parts of England already have minor ailments schemes, but the service is very patchy and it need not be. It is true that different CCGs and indeed different GPs have different attitudes to such schemes, but NHS England has made a commitment that by March 2018 it will have encouraged all CCGs to be commissioning minor ailment schemes in pharmacies across their patch.

[David Mowat]

Yes. Throughout the country, the number is far more than £5 million—

[Julie Cooper]

Will the Minister give way?

[David Mowat]

If I may answer the previous intervention, I will certainly give way again. I have talked about medicine optimisation and pharmacies doing reviews, in particular in people’s homes, for example, and they are part of that solution. Pharmacists in GP surgeries are part of the solution too, and a way of achieving that—as I said earlier, I do not agree that that is an irrelevancy.

[Julie Cooper]

I thank the Minister for giving way. A highly trained pharmacist, who often has a trusted relationship with his patients in the community, is better placed than any other health professional to lead on saving money on wasted drugs. Patients quite often say in a close conversation when they collect their prescription, “Actually, I’ve not been taking that,” but they quite often do not say that to their GP. The pharmacist will then take it upon themselves to say either, “Actually, do you realise you should be taking this?” or, “Let’s speak to your GP and, effectively, avoid waste.” The pharmacist is best placed to do that.

[David Mowat]

I completely agree. Pharmacists have a big role to play in saving money, and medicines optimisation is very important in that. NHS England has established an integration fund, which will provide £42 million—a significant amount, even in the context of the rebalancing that has occurred—of seed money between now and the end of the next financial year to address just those sorts of things and take that work further.

The Murray review, which was commissioned by Dr Ridge, the chief pharmaceutical officer at NHS England, and published in December, sets out in some detail what we believe the direction of travel should be. Someone asked earlier when the Government will respond to that review. I expect NHS England to respond this month—if I may put that on the record in that way. NHS England will respond, not me, but there is not a lot in the review that is controversial. There are a lot of very good points, many of them about IT integration and the care record. I agree completely that some of the progress we need to make with services involves the ability to both read and write to the summary care record. That will be part of where we have to get to. Frankly, technology is an area in which the NHS could improve. That is true in Scotland—it is true everywhere. I will not spend a lot of time talking about what we need to do, but we could facilitate an awful lot of progress on integration between pharmacy and primary care, and primary care and secondary care, if we had stronger technological and IT solutions.

Colleagues have talked about the need to have more pharmacy involvement in medicines optimisation, and care homes are part of that. Pharmacists could do an awful lot with a more structured approach to care homes. One strand of work that has come out of the integration fund is a care homes taskforce, which is chaired jointly by the Royal Pharmaceutical Society and NHS England and is setting out a direction of travel for doing the sorts of things we have talked about, such as medicines optimisation, in a more structured way in care homes right across the country. There are more than 50,000 qualified pharmacists across our country. There are also 23,000 qualified pharmacy technicians, who are part of this too. The pharmacist profession is not as short as some, and it can and needs to do more to make progress in this area.

One part of the Government’s approach to this whole area that has been mentioned and I do not think enough is made of is the GP forward view. Everyone understands how much pressure GPs are under. There are something like 400 clinical pharmacists working in GP practices. We have committed and budgeted £112 million to increase that to 2,000 clinical pharmacists, many of them dispensing pharmacists. Parts of the community pharmacy network, which we have heard a little about, regard that as potentially in conflict with what they do. I think that is wrong. It is not in conflict; it is a way of breaking down the barriers that I accept there have occasionally been between CCGs and GPs and the pharmacy profession. Those are not in anyone’s interests, and we need to get over them.