Budget for Community Pharmacies

Michael Dugher Excerpts

Tuesday 24th May 2016 Commons Chamber

[Michael Dugher (Barnsley East) (Lab)]

I am grateful for the selection of this debate on the budget for community pharmacies, which the Government announced in December would be cut by £170 million in 2016-17—a cut of 6%.

I thank all right hon. and hon. Members, from both sides of the House, who attended the parliamentary event today organised by the Pharmaceutical Services Negotiating Committee, Pharmacy Voice, the National Pharmacy Association and the Royal Pharmaceutical Society to stress the importance of safeguarding a strong community pharmacy sector. I also thank the cross-party delegation of Members of this House and the other place, as well as patients and pharmacists, who came together to deliver a petition to 10 Downing Street today against the Government’s planned cut. The petition was signed by more than 1.8 million people, making it the most signed petition on any health issue in history.

It is clear, therefore, that there is massive opposition out there to the Government’s planned cuts, and it is entirely right, given the huge public interest, that we should have this debate today. The Government must now listen to the public and consider the mounting evidence showing that the cuts will be bad for many of our local communities, the pharmacy sector, public health and the wider NHS. Just yesterday, Pharmacy Voice published a comprehensive analysis of the merits of community pharmacies. The report, “Dispensing Health Equality”, found that community pharmacies

“are not just an invaluable community asset, dispensing medicines and vital public health services, they are potentially a key to unlocking deep-rooted health inequalities.”

[Keith Vaz (Leicester East) (Lab)]

I congratulate my hon. Friend on securing this debate. Instead of cutting the budget for pharmacies, we could use them much more effectively—for example, in combating diabetes. Rather than getting GPs to test patients for diabetes, pharmacies could do it more efficiently and effectively.

[Michael Dugher]

My right hon. Friend is absolutely right. Given the success of community pharmacies, we should be doing far more with them, not cutting them. I shall come to some of the arguments for that during my remarks.

In the course of this campaign, I have been lucky enough to visit some excellent community pharmacies in almost every part of my constituency, campaigning with local councillors, listening to residents who rely greatly on the services these pharmacies provide and meeting staff who are among the very best healthcare professionals in the country.

[Bill Esterson (Sefton Central) (Lab)]

I congratulate my hon. Friend on securing this debate. Like him, I have visited several pharmacies in my constituency. They make the point that we are short of GPs and that, in that environment, it makes no sense to cut a service that can provide the support necessary to make up for the challenging circumstances that GPs face. Pharmacists can often provide advice and support to those who otherwise would go to their GP. In the absence of those GPs, pharmacies are essential.

[Michael Dugher]

My hon. Friend is of course absolutely right. One of the successful community pharmacy operators in my own constituency, Lo’s pharmacy, which has 20 community pharmacies across Yorkshire, was set up by a fantastic individual, Mr Steve Lo, who was brought up in Hoyland Common in my constituency and remains the firm’s managing director. Of the Government’s proposals, he told me:

“There is a real and present danger that these cuts will make many pharmacies unviable. That can only mean a longer trip, not just for your prescription, but for free advice on minor ailments or medicines as well as a number of other NHS led services, and is only going to put more pressure”,

as my hon. Friend just said,

“on GP surgeries and Accident and Emergency departments.”

I wholeheartedly endorse his comments.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate my hon. Friend on securing this timely debate. Pharmacists have become very much like GPs—they are part of the community. This Government are always telling us all how they are taking big government out to the communities, but here they are again cutting another community facility, as well as cutting local government facilities.

[Michael Dugher]

My hon. Friend is right. A modern community pharmacy of the type he referred to has so much to offer patients—from free medical advice and dispensing prescriptions to, crucially, reducing strain on other NHS primary care services.

Community pharmacies are of growing importance. Figures from the Health and Social Care Information Centre show that since 2005, the number of prescriptions dispensed has risen by 50%, with over a billion items dispensed in the community last year. There have been increases in the number of items dispensed every year for the last decade, as community pharmacies have become more important for public healthcare. Staff at community pharmacies, trained pharmacists, technicians, dispensers and counter assistants are often the first port of call for an unwell patient or indeed a carer. Some 1.2 million health-related visits are made to community pharmacies across the country every single day—more than to any other primary care provider. The average person visits a pharmacy 14 times a year, and there are 11,500 community pharmacies across England.

[Holly Lynch (Halifax) (Lab)]

Where we have seen quite serious reorganisations of NHS services and A&E departments downgraded, part of the justification for it has been the role of pharmacies in delivering the “care close to home” agenda. If we see anything in the region of 3,000 pharmacies close across the country, that will raise very serious questions about how we have reorganised our existing NHS structures.

[Michael Dugher]

My hon. Friend is exactly right. I know what a formidable campaigner she has been on this issue in her local community. I pay tribute to her, and not simply because she is also my Whip and occasionally allows me to go home—though I would not rule it out as a contributing factor!

The community pharmacy network is made up of trusted local chemists who are rooted in the communities they serve. I do not doubt that the Minister and his Department share with me an understanding of the vital importance of community pharmacies. Indeed, in the Government’s own letter last December to the Pharmaceutical Services Negotiating Committee, which announced the cut, it was stressed that community pharmacies must be at the “heart of the NHS”. The letter went on to praise the excellent work of community pharmacies

“in prevention of ill health; support for healthy living; support for self-care for minor ailments and long-term conditions; medication reviews in care homes; and as part of more integrated local care models.”

That is all true, so why on earth are the Government pressing ahead with a massive arbitrary budget cut for community pharmacies that will, by the Minister’s own admission at a meeting of the all-party pharmacy group in January, potentially force up to 3,000 local chemists to close?

A properly funded and well-resourced community pharmacy sector is vital for enhancing public health, reducing risk to the public and mitigating downstream costs to the NHS. This is the key argument. In his response, the Minister will no doubt rightly draw on the financial pressures facing the NHS, but is not this cut in the community pharmacy budget a false economy? By contributing to improved public health—frankly, by heading off some people at the pass—our community pharmacies prevent patients from resorting to visits to the GP surgery or the local hospital.

The Government’s timing could not be worse We need our community pharmacies more than ever, given that we have an NHS that is so self-evidently in crisis. A&E departments are under enormous pressure on the Government’s watch. In the three months to March this year, only 87.9% of patients visiting them were seen within four hours, which missed the Government’s own target of 95%. Despite the brilliant efforts of NHS staff in my own area—which was visited recently by my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), in his capacity as shadow Minister—the figures were even worse, and, indeed, were going backwards. Just 86.7% of patients were seen within four hours in Barnsley Hospital’s A&E department, down from 87.2% in February and 89% in January.

Cutting the budget for community pharmacies will do nothing to alleviate the crisis. In fact, Ministers risk deepening the problems that face our A&E departments by removing access to the medical advice that those pharmacies offer before patients feel the need to go to hospital.

[Sue Hayman (Workington) (Lab)]

Allison’s chemist in Cockermouth, which is in my constituency, provided a very important resource for local people after the floods. Rather than people going to hospital because they needed care, Allison’s visited them in their homes or where they were staying. This cut means that we shall risk losing that kind of important support.

[Michael Dugher]

My hon. Friend has given a compelling example of the contribution made by community pharmacies—not just those in her constituency, for there are similar stories in many other parts of the country.

Another argument for arguing against the proposed cuts is the crisis relating to GP access. Millions of people are waiting longer for appointments: 14.2 million patients had to wait for a week, or were not given an appointment at all, when they last tried to see their doctors in 2015. The truth is that the GP access crisis can only be made worse by the Government’s plan to cut the community pharmacy budget.

The findings of new research carried out by YouGov, commissioned by Pharmacy Voice and published in the report yesterday, show that one in four people who would normally visit a pharmacy for advice on common ailments would instead make an appointment with their GP if their local pharmacy faced closure. The report also states that the impact of the cut would be much more severe in areas of higher deprivation, such as my constituency, and that as many as four in five people would visit their GP if their local pharmacy closed. According to the National Pharmacy Association, that would mean approximately 1 million extra people per month using GP and alternative local NHS services.

In a recent letter to the Pharmaceutical Services Negotiating Committee, the Government said that they wanted

“a clinically focussed community pharmacy service that is better integrated with primary care. That will help relieve the pressure on GPs and Accident and Emergency Departments”.

I could not agree more, but how can an arbitrary cut—because that is what it is—in community pharmacies on such a scale possibly do anything other than make a bad situation in our NHS even worse, and how do the Government plan to introduce a “hub and spoke” dispensing model against a backdrop of thousands of closures in the sector?

Particularly in recent days and weeks, the Government have tried to argue that this is not the arbitrary cut that we all know it to be, and that it is not a raid on the community pharmacy budget in the Department. They now say that it is all about making the pharmacy sector stronger by eliminating what Ministers call “clusters” of chemists. However, in response to a written question on 4 May in which I asked the Government to

“make an assessment of the effect of the budget reduction for community pharmacy in 2016-17 on high street vacancy rates”,

the Government conceded that they could not accurately assess the impact of the cut. They could not say how many community pharmacies would close, or, indeed, where they would close. The Minister said that the Government were

“not able to assess which pharmacies may close or what the effect on high street vacancy rates might be because we do not know the financial viability of individual businesses or the extent to which they derive income from services commissioned locally by the NHS or local authorities or have non-NHS related income.”

As I have already highlighted, the Minister previously said that he estimated that up to 3,000 community pharmacies—a quarter of all those in the country—could close as a result of this cut. However, with no planning, no strategy and no impact assessment, it is painfully obvious that the Government have not the faintest idea which community pharmacies are at risk of closure. It could be a chemist that is located in a so-called cluster, but it might well not be.

[Kevin Barron (Rother Valley) (Lab)]

Does my hon. Friend agree that the petition that went to Downing Street today was not just about 1.8 million people being concerned about their local pharmacy? Those 1.8 million people are also taxpayers who feel that this efficiency drive is going to have a negative effect on what they believe to be an important part of their communities.

[Michael Dugher]

My right hon. Friend makes an interesting point. I have seen the cuts to community pharmacies described as a Treasury-led process. A lot of people are paying their taxes, including the 1.8 million who have already signed the petition. I pay tribute to my right hon. Friend for the leadership he has shown as chair of the all-party parliamentary pharmacy group.

This is not a clear, well-thought-through strategy. It is a reckless leap into the unknown, and it is the NHS, patients and every community in the country that will pay the price. For those of us who were here during the last Parliament, this is painfully reminiscent of the process involved in the passing of the Health and Social Care Act 2012, with the Government making things up as they go along and ending up in a situation where things are worse for the NHS and more money is once again wasted.

I implore the Minister to listen to Members from both sides of the House and from the other place who have voiced their real and sincere concerns. I urge the Government carefully to consider the overwhelming body of evidence from our healthcare professionals who do so much to serve our local communities and our NHS. The Government must now listen to the unprecedented 1.8 million people who have signed the petition, which states:

“We, the undersigned, believe that local pharmacies are a vital frontline health service and part of the fabric of communities across England. Under new Government proposals, many pharmacies could be forced to close—depriving people of accessible medicines, advice and other valuable support from trusted professionals. It would also put more pressure on GPs and hospital services. In the interests of patient care, we urge the Prime Minister and the Health Secretary to abandon plans that put pharmacy services at risk.”

The Government must now think again.