National Insurance Contributions: Healthcare
Munira Wilson Excerpts(1 month, 1 week ago)
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Karin Smyth
My hon. Friend makes an excellent point. We have still not heard from the Opposition whether they agree with the extra investment that has gone into the sector or with Lord Darzi’s report that diagnosed their legacy, including why they left that legacy and the serious issues we now have to address.
Munira Wilson (Twickenham) (LD)
Shooting Star children’s hospice in Hampton serves children with life-limiting conditions and supports their families not just in my constituency but across south-west London and Surrey. With the national insurance hike, it faces a bill of £200,000, on top of all the inflationary costs that it has had to absorb. It is also waiting for confirmation as to whether the children’s hospice grant, which this year provided it with £1.8 million, will continue beyond April 2025. Will the Minister commit to making hospices exempt from the NI rise, not just for nursing staff but for all staff, and when will she be able to give Shooting Star and other children’s hospices confirmation on whether the children’s hospice grant will continue? They need to plan now.
Karin Smyth
I commend the hon. Lady for raising the great work done by hospices. We understand the pressures and the precarious situation that many have been left in after 14 years of the last Government. We are willing and keen to talk to representatives from all types of hospice, and others. We are going through the process of the allocations and we will be able to get back to them as soon as possible.
Access to Primary Healthcare
Munira Wilson Excerpts(2 months ago)
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Munira Wilson (Twickenham) (LD)
As well as needing more GPs, our GPs need decent premises from which to deliver high-quality care to patients. Park Road surgery in my constituency has been looking for new premises for more than a decade—it serves 13,000 patients out of an old Victorian house—but there simply is not the budget, and the processes are too complex. Will the Minister commit to both looking at the bureaucracy and pressing the Chancellor for more capital investment in primary care?
Stephen Kinnock
As the Darzi review shows, one of the most egregious examples of the neglect and incompetence of the past 14 years is the underspend on capital. We are clear that a number of premises across the country can be repurposed, and that the bureaucracy needs to be cleared out of its way. As the Prime Minister said earlier this week, we will have a mission about smart regulation and clearing the bureaucratic barriers to change.
We are also cutting red tape so that GPs spend less time pushing paper and more time face-to-face with the patients they serve. We are working to bring back the family doctors and to end the 8 am scramble. We have done more for primary care in the last 14 weeks than that lot did in the last 14 years.
On dentistry, we will introduce supervised tooth brushing for three to five-year-olds in deprived areas, ending the national scandal of tooth decay. And we are rebuilding the bridges that the Conservatives burned with the British Dental Association. I have already met the BDA, and we will deliver a rescue plan that gets NHS dentistry back on its feet, with 700,000 additional urgent appointments, starting as soon as possible, in those parts of our country that need them most.
Oral Answers to Questions
Munira Wilson Excerpts(2 months, 1 week ago)
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Stephen Kinnock
I thank the hon. Gentleman for that question and the passion with which he put it. We are committed to rolling out Young Futures hubs across the country and, of course, we need to prioritise areas of particular need. I would be happy to meet him to discuss that further.
Munira Wilson (Twickenham) (LD)
A recent review of children’s mental health services in my local authority, the London borough of Richmond, found that, staggeringly, children with mild to moderate needs in tier 2 waited on average 15 months before receiving treatment, and those with more severe needs waited on average nine months. The Minister does not need me to tell him that during that time, children’s conditions get worse; they need greater treatment and, sadly, too many present at A&E self-harming and attempting to take their own life. As well as committing to mental health professionals in every school, will he put some money into acute provision, so that children do not end up in A&E?
Stephen Kinnock
We are absolutely committed to the three shifts: from hospital to community, from sickness to prevention and from analogue to digital. The sickness to prevention aspect is important in the question that the hon. Member raises. Treatable mental health conditions such as anxiety and depression should be identified early to prevent them from developing into something more serious and into a crisis, so I absolutely share the sentiment behind her question. They will be at the heart of our 10-year strategy for the future of our health.
NHS Performance: Darzi Investigation
Munira Wilson Excerpts(2 months, 2 weeks ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
I beg to move,
That this House has considered Lord Darzi’s independent investigation into NHS performance.
I am pleased to have the opportunity to open this debate on Lord Darzi’s investigation into the national health service, not just so that we can debate the past and what went so badly wrong, but so that the House can also debate the future of our NHS, how it needs to change and the many reasons to be optimistic about what our health service can be.
We have to start with honesty. For too long, Conservative Governments swept problems under the carpet, more interested in scapegoats than solutions. [Interruption.] I know; it is terrible. That is why I asked Lord Darzi to conduct an independent investigation into our national health service. He is an eminent cancer surgeon, with 30 years’ experience in the NHS, yet what he found shocked even him: some 100,000 toddlers and babies were left waiting for six hours in A&E last year; more than one in 10 hospital beds are taken up by patients who do not need to be there; children are less healthy today than they were a decade ago; adults are living longer but getting sicker sooner; conditions such as diabetes and high blood pressure are rising relentlessly; mortality from preventable causes is far higher than in other advanced countries; almost 3 million people are off work sick; and waiting lists are at record highs while patient satisfaction is at a record low.
The fundamental promise of the NHS—that it will be there for us when we need it—has been broken for a decade. Why? Because of four knock-out blows. First, a decade of under-investment means NHS staff are forced to use pagers and fax machines, with fewer cancer scanners than Greece and buildings literally crumbling. That is not to mention the disgrace that the previous Government’s new hospitals programme was written according to fictitious timetables, with the funding running out this coming March.
Secondly, there was Andrew Lansley’s disastrous 2012 top-down reorganisation that nobody voted for, cost billions and took years. It was an enormous waste of time, talent and money that should have been spent on caring for patients.
Thirdly, there was a failure to reform. The reforms made by the last Labour Government, which delivered the shortest waiting times and highest patient satisfaction in history, were ditched—a golden inheritance squandered.
Fourthly, there was coronavirus. Lord Darzi found that the NHS was hit harder than any other comparable healthcare system because of the damage the Tories had already done. It is not just that they did not fix the roof when the sun was shining; they doused the house in petrol, left the gas on and covid just lit the match. That is why millions are stuck on waiting lists, ambulances do not arrive on time and people cannot see their GP. Never forgive, never forget and never let the Tories do it again.
Munira Wilson (Twickenham) (LD)
Lord Darzi’s report was utterly damning about the treatment of children in our health system. He said that too many children were being let down, and pointed out that they account for 24% of the population, but only 11% of NHS expenditure, and that over 100,000 children wait for over a year to be assessed for mental health treatment. He said we must do better, so will the Secretary of State commit to putting children front and centre of the 10-year plan, and to making them a priority, because for a decade, the Tories let our children down?
Wes Streeting
I strongly agree with the hon. Member. I will talk about the 10-year plan shortly, but I can guarantee that children and paediatric care will be front and centre of that plan. We can do much more to shine a spotlight on paediatric waiting lists, as well as doing much more in practice. She mentioned children and young people’s mental health, on which our parties strongly agree. We will deliver our manifesto commitment to put mental health support in every primary and secondary school in the country, as well as providing walk-in services in every community, so that young people receive the mental health and wellbeing support that they need and do not get to the crisis point reached by far too many of our children.
The hon. Member’s intervention is an example of why I am looking forward to the debate. I hope to listen to contributions and to challenge from all sides of the House. Before I take any interventions from Conservative Members, I advise them that if they want to get a hearing on the NHS ever again, then the first word that should pass their lips is, “Sorry”. Only last week, at the Conservative party conference, we did not see a single shred of remorse or contrition for their appalling record. Indeed, when it comes to the shadow Secretary of State and her party, it seems that sorry is the hardest word.
The NHS is broken. NHS staff do not want to accept that, but it is. According to YouGov, that is what the vast majority of patients say. It is also what staff tell me every time I am on the frontline, but I understand why some people find the word difficult. In the past few weeks, I have met some of the NHS team who happened to be on duty on Monday 29 July. I have listened to paramedics describe the scene they walked into at the community centre in Southport. Children and adults who had been dancing to Taylor Swift were lying bleeding and, in some cases, tragically dying as a result of an unimaginable, senseless, mindless attack. Those paramedics had to make split-second decisions about who to treat and in what order to give the injured the best chance of survival. Security teams cleared busy hospital corridors to shield as many people as possible from the horror. Lab teams mobilised blood supplies. Receptionists fielded calls from panic-stricken patients. Surgical teams across multiple hospitals worked together, fighting to save those young lives. Even now, months later, mental health staff are picking up the pieces for families who are either grieving or going through the unimaginable challenge of supporting their children through what they witnessed.
On that day, those NHS responders—the whole team involved—were the best of humanity confronting the worst. That is who NHS staff are. That is what they do. Let me be clear: the NHS may be broken, but NHS staff did not break it. I want to be clear about this too: what is broken can be fixed. While the NHS may be in the midst of the worst crisis in its history, the biggest asset that we have is the people who work in it. They are up for the challenge, and up for change. The NHS is broken, but it is not beaten. Together with the 1.5 million people working in the health service, this Government will turn our NHS around, get it back on its feet, and make it fit for the future.
Pharmacy Provision: Hampton
Munira Wilson Excerpts(4 months, 3 weeks ago)
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Munira Wilson (Twickenham) (LD)
May I start by congratulating you, Madam Deputy Speaker, on your election? It is a pleasure to see you in the Chair. I also congratulate the Minister on his appointment. We have worked closely together in recent years in the all-party parliamentary group on kinship care, so I have no doubt that he will do an excellent job. I suspect that young Lyle is very proud of his granddad right now.
I am delighted to have secured this Adjournment debate. You might be surprised to learn, Madam Deputy Speaker, that this is the first I have managed to secure since my election in 2019, so I want to use this exciting opportunity to bring to the Minister’s attention the impact of pharmacy closures on the local community in the Hampton area of my constituency, as well as the immense financial challenges facing community pharmacy right across England. I will also raise concerns about the impenetrable bureaucratic processes, which need overhauling, in new pharmacy licence applications and pharmacy closures.
Let me set the scene. Last autumn, two Boots pharmacies in the Hampton area were closed. One of those pharmacies was in the Hampton North ward, one of three wards of relative deprivation in the London borough of Richmond upon Thames. The west of the ward is within the 20% most deprived areas of the country; it is densely populated with a significant amount of social housing. As a result of that closure in Tangley Park, the entire ward is now without a community pharmacy.
Hampton North is poorly served by public transport: there is no station, and the two bus routes serving the area are notoriously unreliable. The nearest pharmacy is now a mile away on foot, a distance that is difficult to cover for the elderly and those with mobility issues. It is certainly more than a 20-minute walk away, which is the measure that previous Ministers liked to use to highlight pharmacy accessibility. Predictably, those closures have put a lot of pressure on the nearest remaining pharmacies, which face queues and stock issues. Again, that is not exactly convenient or practical for elderly and vulnerable patients.
At this point, I pay tribute to Mike Derry and Healthwatch Richmond for their brilliant work championing local patients and giving them a voice. Healthwatch undertook a survey of some 700 residents in the Hampton area at the start of the year to demonstrate the impact of the closures. One person said:
“I have gone without medication as I can’t stand very long. There are queues—I have waited over half an hour.”
Healthwatch England highlighted the plight of 87-year-old Gill. She used to just about be able to get across the road from her house to the Tangley Park pharmacy. Now the nearest pharmacy is over a mile away, and Gill, who does not drive, cannot access that service because of the distance that she would have to walk to get there. She even paid the nearest pharmacy to deliver her medicines to her home each month, but in the eight months since she purchased the delivery service, it has shown up only twice. Her carer has to travel to collect the medication in person for her.
Hampton is not unusual in losing pharmacy provision. I am sure that the Minister is aware of the crisis facing the community pharmacy sector. Data from the Community Chemists’ Association shows that there has been a net loss of over 1,200 pharmacies—1402 closures and only 179 openings—since 2015. More than a third of those losses have been in the most deprived areas of the country. The National Pharmacy Association reports that the number of pharmacies that have closed so far this calendar year—the equivalent of 10 pharmacies a week—is nearly 50% higher compared with the same point in 2023. As well as independent pharmacies, big chains such as Lloyds Pharmacy and Boots have significantly accelerated closure numbers over the past 18 months. A big driver of these closures is a significant real-terms reduction in funding for pharmacy; that funding has dropped by around 30% since 2015.
James MacCleary (Lewes) (LD)
Is my hon. Friend aware of the issue of overwhelmed surgeries referring increasing numbers of patients to local pharmacists? I have seen it in my Lewes constituency. Does she agree that this will only contribute further to closures?
Munira Wilson
I thank my hon. Friend for his intervention, and I congratulate him on his excellent maiden speech. I completely agree with him. We want doctors to use community pharmacy more to alleviate the pressure on other parts of the health service, but frankly, if the pharmacies are not there, the remaining ones will be overwhelmed. I talked to local GPs in the Hampton area following these closures, and they were desperate to see more provision. They thought about trying to set up their own community pharmacy provision, but they just could not make the numbers add up because of the funding shortfall.
The Company Chemists’ Association estimates an average funding shortfall of £67,000 per pharmacy. That is based on an analysis of data published by the Department of Health and Social Care in a written parliamentary answer at the beginning of last year. Many pharmacists are left out of pocket, as they are reimbursed less for a number of medications than the price they pay, and there are stories of some using credit cards and overdrafts to purchase medication.
These funding pressures are coupled with major workforce challenges. When I met Boots following the news that it is closing two branches in Hampton, it cited a lack of pharmacists as a major reason for closing some 300 pharmacies across the UK, although commercial pressures were clearly the main driver. Layered on top of these issues are regular medicine supply shortages, which add more work and create more stress for already overstretched pharmacists. Community Pharmacy England reported last year that 92% of pharmacies were having to manage supply issues daily.
It is a perfect storm for community pharmacy at a time when we need preventive healthcare and self-care more than ever. The potential of community pharmacies to improve patient health and reduce the pressure on NHS hospitals and GPs is immense, yet they are closing in their hundreds every year. We should be relying on pharmacies even more to keep the nation healthy. The previous Conservative Government’s announcement of the Pharmacy First initiative was very welcome in its ambition, but if pharmacies are not even funded for the basics right now, with big gaps in provision opening up all over the country, it is hard to see how Pharmacy First’s ambitions will be achieved.
The Liberal Democrats would like to see the Government building on the Pharmacy First principle and giving pharmacists more prescribing rights and public health responsibilities. As in so many areas of public health, the “invest to save” argument is compelling, and I look forward to hearing the Minister’s comments on what the new Labour Government will do on funding to enable community pharmacy to not just survive, but thrive and grow as an essential part of our primary care infrastructure.
Having addressed the causes of these closures, I will spend some time exploring the processes involved in local communities being informed of pharmacy closures, and their input, or lack thereof, in them, as well as discussing the complete lack of transparency or accountability in relation to applications for new pharmacy licences. For starters, only those organisations designated as “interested parties” in the regulations are informed of new applications, and only their feedback has to be taken into account. Anyone else who is interested, such as me as a local MP, needs to make a freedom of information request, unless someone in the local health community passes on the information. My views, and the views of other people in the community, can be ignored.
To describe the bureaucratic process that sits around new applications as byzantine would be generous. I hope the Minister, Madam Deputy Speaker and other hon. Members will bear with me while I try to explain what happened in Hampton. We are part of the South West London Integrated Care Board, but NHS England has delegated the pharmacy market entry function for the whole of London to the North East London ICB, which is on completely the opposite side of the city. Officials have no local knowledge of our area, no understanding of local transport links and no relationships with the local health system.
Let me start with the closures. The Minister will be aware of the statutory three-month notice period for pharmacy closures; last August, Boots would have had to give NHS England three months’ notice of its intentions in Hampton. That information was not passed by NHSE to the Richmond health and wellbeing board. I find that utterly staggering. The first that local councillors, the local health community in the area and I as the MP knew about the planned closures was when Boots placed signs in its windows to inform customers, and concerned constituents started to contact me about the likely impact of the closures.
At the end of August 2023, while this was going on and we were all in the dark, the local health and wellbeing board published a pharmaceutical needs assessment, but it was inaccurate and failed to identify an imminent future gap in need in the Hampton North area because it had not been notified of the closures. The Tangley Park Boots subsequently closed in late October. The Priory Road Boots, which was directly opposite a busy GP surgery, closed in early November.
In November, an application was received for a new independent pharmacy licence on the Tangley Park Boots site. Once again, the local health and wellbeing board was not notified of the application—this time, for two whole months. During this period of complete silence, the health and wellbeing board issued a supplementary statement to the local pharmaceutical needs assessment, which identified the gap in Hampton. However, because the application for a new pharmacy was made in November, and it referred to the original needs assessment that was made before the supplementary statement was published, it was rejected, even though the application itself identified the gap, which was officially made clear in the supplementary statement subsequently published in December. Not only that, but it took the North East London ICB a full eight months to issue the rejection; tht happened earlier this month, even though the decision used evidence received in December to justify the rejection.
Madam Deputy Speaker, if you and other hon. Members are still managing to follow this sorry story, I hope you will agree that this decision is utterly perverse. It is also utterly unreasonable that timely applications to open pharmacies in response to multiple closures should be inherently prevented in this way. The delays in sharing information with the local health and wellbeing board and the delays in decision making are unforgivable. During the lengthy delay, the local authority received a planning application to change the Tangley Park pharmacy site into a fast food outlet. Thankfully, that was rejected earlier this month after representations from the public health team and councillors, but I am sure the public health Minister will agree that it would be unfortunate, to put it mildly, if a pharmacy were replaced with a fast food outlet.
One local official told me yesterday that the systems architecture is too complicated, and that there is a need for clearer responsibilities and accountability. Amen to that, I say. Healthwatch Richmond has demanded answers from the North East London ICB, but it has received a frankly woeful response that does not address the substantive question of why the application was so badly handled. The response passes the buck and blames regulations. To be clear, Healthwatch and I are not qualified to comment on the merits of an application; what we are doing is challenging the unfathomable process.
I say to the Minister that the huge funding challenges facing community pharmacy are pressing. I appreciate that they may be extremely difficult for him to address, given that the Chancellor has an iron fist as far as any additional public spending is concerned, but the Minister must wage a campaign to improve the funding situation. It makes financial sense. We will not grow the economy without improving the nation’s health. In that campaign, he will have cross-party support from Members on the Opposition Benches.
Revisiting the regulations and how NHS England is implementing them will cost next to nothing. There should be proper consultation with and involvement from the local community on closure notices, and changes in the process for new licences could ensure that we can quickly plug pharmacy gaps when they open up in areas such as Hampton. Crucially, those powers need to be delegated to the local ICB, with full involvement from the local health and wellbeing board. They know their communities and their geography best—trust them.
Finally, if the Minister could step in on the specific issues in my constituency—the application that has been rejected and is going NHS Resolution on appeal—simply to ensure a common-sense approach, the residents of Hampton North and I would be very grateful. We desperately need a new pharmacy for our community. I look forward to his response.
The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
May I start by welcoming you to the Chair, Madam Deputy Speaker? I congratulate you on your election earlier this week. I also congratulate the hon. Member for Twickenham (Munira Wilson) on securing a debate that is absolutely crucial, not just given the specifics of the case in her constituency, but for the precedent that it sets as we plan community pharmacy provision across England. I assure her that although Lyle missed out on his week in London for Whitsun half-term, because somebody called a general election, he is on his way to London as I speak, with Allison, so that we can do London as tourists this weekend.
I am responding on behalf of the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), who leads in this area. I start by paying tribute to pharmacists. It is a credit to them that surveys show that nine in 10 people who visit pharmacies feel positive about their experience. Colleagues appreciate how accessible pharmacies in towns and villages across our country are, but for too long, Governments have failed to recognise their essential role in safeguarding the nation’s health, not least in my constituency of Gorton and Denton. This Government know that people who work in pharmacies are highly trained specialists, and we are committed to helping pharmacists and pharmacy technicians reach their full potential.
Pharmacies already provide vital advice on prescriptions, over-the-counter medicines and minor ailments, but they do not just dispense medicines and proffer advice, important though that is; they must do much more than that. Many already offer blood-pressure checks, flu and covid-19 vaccinations, contraception consultations and treatment for the seven conditions covered by the Pharmacy First service. I supported Pharmacy First when I was in opposition, as I think the hon. Lady did, and my party pledged to build on the programme by making prescribing an integral part of the services delivered by community pharmacies. For that reason, in the next two years, we will ensure that every newly qualified pharmacist has a prescribing qualification, while we train up the existing workforce.
This year, NHS England is working closely with all integrated care boards on pilots to test how prescribing can work in community pharmacy, because like the hon. Lady, we want pharmacies delivering services that help patients to access advice, prevention and treatment more easily; services that ease the pressure on general practice and in other areas in the NHS; and services that unlock the knowledge and expertise that our pharmacists have to offer. This Government take the view that pharmacies can and should play an even greater role in providing healthcare on the high street. That is why we stood on a manifesto that promised to shift resources to primary care and to community services over time. Community pharmacies will play an important part in moving our health service from hospital to community, from analogue to digital, and from sickness to prevention. But we have only been in office for three weeks; this cannot happen overnight, and colleagues have been absolutely right to raise concerns with Ministers about the closure of pharmacies.
As we speak, well over 10,000 pharmacies in England are dispensing medicines, offering advice and delivering care, and despite closures, access to pharmacies remains good across most of the country. Four out of five people live within a 20-minute walk of their local pharmacy, but as we have heard in this really important debate, that is not the case everywhere in the country. I know, having listened to the hon. Lady, that in Twickenham it is higher than four in five, but in other parts of the country it is below one in two. In the most deprived parts of England there are almost twice as many pharmacies—a good thing—than in the least deprived, but we need better access across the country. To take the example of my own constituency, where access to pharmacies is fairly good, almost the entire population is within a 20-minute walk from a pharmacy. However, in certain rural areas, and in a growing number of urban areas because of the closure programme, that is not the case. In those rural areas, there are dispensing doctors who can supply medicines to patients, and patients across the country can access around 400 distance-selling pharmacies that deliver medicines to patients’ homes free of charge. It is true that experiences vary depending on where people live, but I am aware of the specific problem in Hampton following the closure of the two Boots pharmacies that she described.
Munira Wilson
On the point about the 20-minute walk and the four in five statistic, does the Minister recognise that a 20-minute walk for me or him is actually much longer for an elderly person or somebody with multiple health conditions or mobility issues? We have to work out what measure we are using. Yes, the Twickenham constituency may have many pharmacies, but we must look at that highly localised level. That is why we need the local authority and local health boards to be involved, because actually in Hampton, as a community, the transport links are terrible.
Andrew Gwynne
I completely understand the case the hon. Lady is making. I ask her please to understand that she is pushing on a bit of an open door. It is a completely different subject, but I have had exactly the same arguments about bank closures in my constituency. I am told that as long as the nearest bank branch is half an hour away by public transport, that is acceptable. Unfortunately, computer says no when it is two buses that do not meet up in between. I agree with her that there are complexities around drawing up arbitrary limits, but generally access to pharmacies is good. We need to maximise the use of the pharmacy network so that we get more pharmacists coming in.