Oral Answers to Questions

Oliver Colvile Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

The formula is based on the better care fund formula, which is based on the spending power of local authorities. Let me tell the hon. Lady that, over the next year, that improved better care fund is going up by 35%, and Surrey’s allocation is going up by only 5%.

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

T8. As the Secretary of State knows, I am the vice-chairman of the all-party group on pharmacy. Will he update the House on the progress of the decriminalisation of dispensing errors by pharmacists? What is the hitch?

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

There is no hitch. The Government remain committed to putting this into place, and the legislation will be brought forward shortly.

Health and Social Care

Oliver Colvile Excerpts

Monday 27th February 2017 Commons Chamber

[Meg Hillier]

The key thing, of course, is how that figure comes through the pipeline and how we fill the gap. While the Minister is on his feet at the end of the debate, it would be helpful if he said what analysis the Department of Health has done of the impact of Brexit and any changes it may herald for our NHS workforce, because a high percentage of them are from Europe. We are hearing the right sounds from the Government, but we have not yet had any action on securing the future of those European citizens currently resident in the UK. If the Minister is able to give us any comfort on that, it would be very welcome.

I am heartened that so many Members are in the Chamber to discuss this important issue. I should mention that the Public Accounts Committee has also been working with the Procedure Committee to try to ensure that the House can discuss the financial details of estimates rather than just the general principles, although I have obviously strayed into those, too. Hopefully, we can base these debates on the figures we have spent so much time looking at in the Public Accounts Committee. It is unedifying for the public to hear anonymous briefings and public argument; that does not wash with them. We need to be on top of this issue so that we hold the Government’s feet to the fire and make sure that, every step of the way, they know we are watching the budget. We will not let you get away, Minister, with raiding the capital budget to fund the accounts this year.

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

The hon. Lady is making a very interesting speech. One thing we should make much greater use of is pharmacies, especially to try to take some of the pressure off GPs. We should also ask GPs to go into pharmacies and to be located in them.

[Meg Hillier]

The hon. Gentleman makes a good point, and I visited one of my local pharmacies only a few weeks ago and saw at first hand the work it does to help ease the pressure on GPs, where people are waiting a long time for appointments, and on A&E. The Minister has taken a keen interest in pharmacies, but there is nevertheless a cut to their base budget. While we are on that point, it is interesting to note that that base amount allowed them to have the certainty to employ a member of staff to conduct appointments directly with patients. If they rely just on the revenue income they get from selling products, they cannot be sure that they can maintain that salary every year. That solid base of funding was important in a constituency such as mine, where, for all sorts of reasons—culture, language and convenience—people often find their local pharmacy more readily than they do their GP practice, and they find it very useful. The Minister therefore has questions to answer on that point as well.

A cross-party group of us recently met the Prime Minister, and I was heartened that she at least acknowledged the need to look at the long-term issues around health and social care. She has made a pledge that her adviser at No. 10 Downing Street will meet a cross-party group of MPs to discuss this issue further. I hope that heralds a change of attitude in the Government that will see no more anonymous briefing and silly bickering, but a strong, concerted effort to make sure that we future-proof our NHS for us and our children and that it is the beacon to the world that we all believe it is.

Pharmacies and Integrated Healthcare: England

Oliver Colvile Excerpts

Wednesday 11th January 2017 Westminster Hall

[Mrs Main]

Absolutely. Rachel Solanki and her colleagues are not necessarily critical of change—that is important. Pharmacies are nervous about some of the things that may be coming along, but they are not critical of change. Indeed, they would welcome a debate on the innovative services that other pharmacies are operating around the country. The fact that we do not all know about these services in other places shows that there is not an integrated approach. The services include anticoagulation monitoring in Knowsley; medicines optimisation work for respiratory diseases in South Central; sexual health screening, including for hepatitis, syphilis and HIV, on the Isle of Wight; oral contraceptive supply in Manchester and other contraceptive provision in Newcastle; alcohol screening and brief intervention on the Wirral; healthy lung screening in Essex; pneumococcal immunisation in Sheffield; a reablement service on the Isle of Wight; and phlebotomy services in Coventry and Manchester. That is a long, diverse list of services that are provided by pharmacies in those areas.

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

Will my hon. Friend recognise that some innovative things are taking place in the west country, especially in my constituency?

[Mrs Main]

I am happy to acknowledge that some fabulous things are happening in the west country. That list was given to me. I make no excuse for the fact that I thought it seemed fairly long already, but I am certain that there are a lot more services that hon. Members do not realise are out there—perhaps even in pharmacies in their own constituency or the one next-door that they go shopping in or visit with their families. The fact that we do not know about them shows that there is no integration in the system. We should be aware of it if these services are being rolled out. Perhaps there should be a directory that we could consult to find out what is going on in certain areas.

That list shows hon. Members the exciting possibilities that could be open to pharmacies, including those in the west country that were just referred to, if we just gave them the chance to embrace them. Rachel, the director of the Quadrant pharmacy, ended her observations with a positive endorsement of the “Community Pharmacy Forward View”. She told me that it has

“been developed and signed up to by all national community pharmacy organisations about the types of services that either need to be commissioned at a national level or pressure put on Sustainable Transformation Plans (STP) leaders locally to commission a service package to patients”.

My hon. Friend the Member for York Outer (Julian Sturdy) said that there is reluctance in some areas to embrace this. We need a strong steer from the Government that this is where we are going and that they had better wise up, get around the table and come up with a suitable model.

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

May I say what a pleasure and a delight it is to serve under your chairmanship, Mr Bailey? I congratulate my hon. Friend the Member for St Albans (Mrs Main) on securing the debate. I should warn the House that I am the Government’s pharmacy champion. I have been following this issue quite closely for about the last 20 years —not that I have been in the House of Commons for the last 20 years, but I have followed it consistently since being involved in the community pharmacy group action campaign, which was to do with resale price maintenance on non-prescription medicines in the 1990s, when I was doing a commercial job. I became a vice-chairman of the all-party pharmacy group when I was elected to the House, so this is an issue I feel quite strongly about and have been very involved in.

To put things in context, Plymouth, Sutton and Devonport is, uniquely for a Conservative constituency, an inner-city seat. Indeed, I am one of very few Members of Parliament outside London to represent a totally inner-city seat. The only countryside I have in my constituency is the Ponderosa pony sanctuary, which is a rather muddy field. How we can integrate pharmacies is a really important issue. There is an 11-year life expectancy difference between the north-east of my patch—I could probably walk from one end to the other in a couple of hours or so—down to the south-west in Devonport, which is a very deprived community that has real issues with homelessness, drug taking and smoking. People certainly need to be referred to pharmacies for smoking cessation too.

There are several areas of the debate that I am particularly interested in exploring, and I hope the Minister will respond on them. The first is summary care records. A lot of pharmacies want to be able to access the care records for their patients. They also want to be able to populate those records, so that they can review the medicines given to patients. We need to make sure that happens throughout the whole of England. I was very concerned by something I discovered over the Christmas recess. I did not take masses of time off over Christmas, but I did speak to a number of GPs; needless to say, I also did a surgery, with one of my local GPs in the Devonport ward. He told me that GPs—and, I suspect, pharmacies too—cannot access the medical records at Derriford hospital, because it uses a completely different system from the GPs and the pharmacies. The Minister needs to look at that.

The second issue we should look at is using pharmacies much more for minor ailments—a point that my hon. Friend the Member for St Albans made very clearly—so that people are signposted to the pharmacy rather than necessarily going to the GP. I was watching breakfast television this morning while I was getting ready to come and speak in this debate—I think it was Sky television, so I should declare an interest, because my brother is the cricket correspondent for Sky television and I do not want to be accused of doing anything wrong. I was interested to hear the person reviewing the newspapers say that she was doing a programme tomorrow evening on Radio 4 at 9 o’clock—I am giving her a plug—on how, rather than having lots of patients come to see them, some GPs in Plymouth have ended up talking to patients on the phone. Patients do not necessarily always need physically to go to a GP to seek help, which is a useful way of taking some of the pressure off GPs.

I should also make a point about the decriminalisation of prescription errors. At the moment, GPs can get a slap on the wrist or be struck off, whereas pharmacists who fail to give prescriptions properly can face criminal charges. I had thought that the Government were very keen to address that. I was led to understand by the Minister that the matter might have been sorted out before Christmas, but that there were problems to do with the devolved Administrations needing to deal with it first. However, it seems very odd: here we are, at the beginning of the year, and we still have not dealt with it. I must warn my hon. Friend that I have tabled a parliamentary question about it.

My final point is that a great deal of pressure has been placed on the Government and the national health service, especially during the winter. There has been a great deal of discussion about how pharmacies need funding and so on, but in my opinion this is not just about money; it is about ensuring that we use the systems properly, so that we can deliver a better quality of care. We could get pharmacists to go into residential care homes for the elderly, too. It is not just about money; it is about the structure, too. We need to take that into account, because we need to ensure that budgets sweat.

[Steve Double (St Austell and Newquay) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for St Albans (Mrs Main) on securing this debate on what I believe is a very important issue.

There is no doubt that our health service is currently under great pressure, as we have heard already. People are living longer and we are able to treat far more conditions than we could in the past, which adds to the demand on our health services. Although more money is always welcome, I am sure that many of us would agree that simply throwing more money at the health service is not the solution. We need to find better, smarter, more efficient and more effective ways of working to provide the healthcare that our growing population so desperately needs.

I have no doubt that pharmacies, particularly community pharmacies, can play an important role in finding better and smarter ways of providing healthcare to the people of this country. Community pharmacies continue to be an undervalued and underutilised section of our health service. As a country, we really need to embrace the role that community pharmacies can play in delivering health services. They have much more to offer than they are currently seen be to offering.

The Government have started to recognise that, with the current pilot scheme, started in 2015, to increase the presence of clinical pharmacists in general practice. That is clearly a step in the right direction, but I propose that we should also look the other way. We should not only look at integrating pharmacies into GPs’ surgeries; we should be looking to integrate GP services into our community pharmacies. It is quite clear that many of the routine services that people typically go to their local GP for could be provided by their local pharmacists in a much more cost-effective way.

[Oliver Colvile]

rose—

[Jake Berry (Rossendale and Darwen) (Con)]

rose—

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[Oliver Colvile]

I thank my hon. Friend for giving way. He makes a very powerful point. I have thought for some while that we should be trying to put GP surgeries into pharmacies, so that when someone goes to their GP and says, “I have got this ailment and I need some help,” he can say, “Don’t come and talk to me; go and talk to the pharmacist, because he or she can manage the thing properly.” To my mind, that seems a very clever way in which we could take some of the pressure off the finances of GPs, as they would not necessarily have their own lease, but could get the likes of Boots or others to provide facilities.

[Steve Double]

I thank my hon. Friend for that intervention and I agree with him. Clearly, part of the answer is getting GPs and pharmacies working much more closely together, and co-locating can often be one way to help with that.

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[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.

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[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.

[Oliver Colvile]

Is the Minister aware that in Devon about £5 million a year is apparently being wasted on unused medicines? Something needs to happen with that to ensure that the NHS has enough money with which to do things.

[David Mowat]

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

Oral Answers to Questions

Oliver Colvile Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

The hon. Lady talks about council tax, but she does not call out Labour councils like Hillingdon, Hounslow, Merton and Stoke which complain about pressures in the social care system and then refuse to introduce the social care precept that could make a difference to their residents. We are taking the situation seriously. More was done this week and more will be done in future.

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

T7. As my hon. Friend is aware, last week the Murray report was published. When is he likely to consider it, and when will he make a statement?

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

I thank my hon. Friend for that question and commend him for his work as a pharmacy champion. The Murray review was indeed published last week, and NHS England will respond to it in detail early in the new year. It is a very important document because it sets out in some detail how we intend to transform the community pharmacy network into a service-based profession along the lines that my hon. Friend likes.

Reducing Health Inequality

Oliver Colvile Excerpts

Thursday 24th November 2016 Commons Chamber

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

I follow previous speakers in this debate with a certain trepidation. I hope that I can live up to their mark. I congratulate the shadow spokesperson, the hon. Member for Washington and Sunderland West (Mrs Hodgson), with whom I have worked closely on issues around basketball. I should also draw the House’s attention to my entry in the Register of Members’ Financial Interests. I also congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing this debate. As a fellow Devon MP, she might know something about the issues I want to talk about—it would be helpful to have a conversation with her afterwards.

In my constituency, there is an 11-year life expectancy difference between the north-east of my patch, where the professionals live, and the south-west, in Devonport, which is best known for its dockyard. Last week, I chaired a supper in Plymouth with health practitioners and academics on the subject of iron-deficiency anaemia in Devon. I will not pretend to be a medical expert—as hon. Members can probably tell, that is something that rather bypassed me—but it is a condition where the body has a low red blood cell count, resulting in less oxygen getting to organs and tissues. It can have serious consequences and often leads to more admissions to hospital or a deterioration in health.

The condition is a result of poverty—especially, but not exclusively, among the over-75s. I was horrified to learn that Plymouth is top of the national list of iron deficiency. The rates of iron-deficiency anaemia are four times the national average. In the Northern, Eastern and Western Devon area, which includes Plymouth, there were 1,530 in-patients with IDA in 2014, a 19% increase on 2013, following a steady rise over the previous few years. I understand that in 2014 this amounted to an avoidable cost to the local health economy of just over £1 million.

I want to focus on NHS England’s desire to close three GP surgeries in my constituency by next March. I fear that this action will serve to put greater pressure on the principal acute hospital at Derriford, in the constituency of my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer). I am told that the reason why NHS England is considering the closures is the size of the GP practices. I understand there is a Nuffield report that says that that should not be the only thing taken into account. The Cumberland GP practice has 1,800 patients, Hyde Park has 2,800 and St Barnabas 1,700. They are considered by NHS England to be unsustainable and too small, despite the fact that they are growing practices. I have mentioned some of these issues before, but I have no problem repeating them. I was told that closing the practices is not down to saving money, but is about delivering better value for money. However, before I speak about those issues, let me put my constituency in some context.

Plymouth, Sutton and Devonport runs from the A38 down to sea, and from the River Plym to the River Tamar. It is home to one of the largest universities in the country, with more than 27,000 students, thousands of whom live in the city centre. It is a naval and Royal Marines Commando garrison city, as the Minister of State, my hon. Friend the Member for Ludlow (Mr Dunne), for whom I was previously a Parliamentary Secretary, knows only too well. Before the November recess, the Ministry of Defence sadly confirmed that it would be releasing Stonehouse Royal Marines barracks and announced that the Citadel, which is where 29 Commando is based, would be released back to the Crown Estate. Fortunately for Plymouth, the MOD also announced that the Royal Marines and their families would be transferred from Chivenor, in the north of Devon; Arbroath, up in Scotland; and Taunton, just up the M5. While the city’s population is growing, this announcement will almost certainly put even greater pressure on our schools, our hospitals at Derriford and Mount Gould, and our GP practices.

Although Plymouth has a global reputation for marine science and engineering research, it is a low-wage, low-skills economy. It is an inner city—something pretty unique for a Conservative to represent, if I might say so. Indeed, I do not have a single piece of countryside in my constituency, unless we include the Ponderosa pony sanctuary, which is a rather muddy field. In the run-up to the 2010 general election, when I won the seat on the third attempt, the Conservative party pledged to do something about healthcare in deprived inner cities. We have started to make good our word, and in 2014 my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—one of the Minister’s predecessors —came to Devonport to open the Cumberland GP practice, which is now very much under threat. Other facilities on the Cumberland campus include a minor injuries unit, the Devonport health centre and a pharmacy.

The Cumberland GP practice was set up by Plymouth Community Healthcare—now Livewell Southwest—and the Peninsula medical school. There was, and is, a desperate need to provide a tailor-made alternative service to the existing GP practice—then the Marlborough Street practice, now the Devonport health centre—for this deprived Devonport community and a need to look after drug users and the city’s homeless in hostels such as the neighbouring Salvation Army hostel. The practice also offers practical placements to students at the Plymouth medical school. Until earlier this year, it was funded by Livewell Southwest, a social enterprise, which found it too expensive to maintain.

Despite Devonport’s real deprivation, NHS England did not want to get involved in providing a contract to the Cumberland GP practice, which has consequently been operating without a formal contract and is managed by Access Health Care. I understand that in the past the neighbouring Devonport health practice has not been interested in offering facilities to homeless people and drug users—it may change its mind, though. Indeed, I understand that some of the Cumberland practice’s patients were not keen to transfer back to the Devonport centre, which is where they came from in the first place.

NHS England’s reason for putting the Cumberland GP practice under threat is because it considers it to be too small and to be operating in unsuitable, cramped premises. Unless we are careful, we could put more pressure on Derriford’s acute emergency unit, which is already under enormous pressure.

I became aware of NHS England’s proposals for these three GP practices in August, during the summer recess, when NHS England no doubt expected me and other MPs to be away on parliamentary trips or taking a holiday—hard luck; I was there! I immediately put together a series of meetings with the city councillor director of public health, the leader of the council, the cabinet member for adult social care, people from NHS England, the dean of the medical school and Dr Richard Ayres, who runs the Cumberland GP practice. At that meeting, I suggested that the Cumberland GP practice should share the Devonport health centre’s brand-new building, which has space and operates as a federation, sharing the receptionists and backroom staff. This was supported by everybody present. Indeed, the city council’s health and wellbeing board also supported it, following an inquiry that recommended measures to allow the Cumberland GP practice to continue.

However, I understand that Devonport health care might not be willing to do that, so it appears that the Devonport community might be deprived of a second GP practice and patients will have no choice over which doctor they go to. The Northern, Eastern and Western Devon CCG is looking at ways to try to keep the Cumberland GP practice open, but it needs space in the short term while it considers alternative locations. I have also received representations from patients at both the Hyde Park and St Barnabas surgeries.

At Hyde Park, although Dr Stephen Warren is keen to continue as a GP, following a heart attack, he has transferred the ownership of his practice to Access Health Care because he no longer wishes to deal with the backroom tasks of administration, which is part of running a practice. He argues that his and his partner’s growing 2,800-patient practice—the Cumberland is growing as well—has attracted outstanding reviews, and that he would not be able to inform his patients where he was going if he relocated to another practice. He also thinks that some patients like to have a relationship with an individual doctor whom they can see speedily rather than having to wait weeks. It is rather like having one’s own personal bank manager, which I feel is quite important.

The St Barnabas surgery, which is also run by Access Health Care, was set up in a new development next to a residential care home for the elderly where patients do not have to walk very far to get to it. In all three cases, NHS England, for supposedly technical reasons, gave patients only 24 hours’ notice of its initial engagement. I must say, frankly, that I found the public consultation process utterly appalling. I wrote to NHS England asking it to give more time to engage with local communities, and I am grateful that it bothered to listen.

Recently, at my weekly constituency surgery, I was asked to write to NHS England to ask whether it had engaged with other GP surgeries and with Derriford hospital, and whether it had consulted them, because some GPs will have to accommodate more patients. That is a very big issue.

There are wider issues in all of this, too. At the moment, the commissioners in Northern, Eastern and Western Devon spend a higher amount of money in eastern Devon than in the more deprived western locality. The Government’s success regime is keen to correct that, so that resources are focused on deprived communities such as Devonport.

[Rebecca Pow]

I wish to make an observation. Given the detail that my hon. Friend has gone into and how he seems to be representing his community in these deprived areas, I wish to observe how very fortunate they are to have this Conservative MP in that inner-city area.

[Oliver Colvile]

It is generous of my hon. Friend to say that, and I shall try to intervene on similar lines later! [Interruption.] I also observe that there have been no mentions of hedgehogs in this debate.

Finally, as the Minister may know, I am the Government’s pharmacy champion, and the Government are reviewing the role of pharmacy to take pressure off our GPs and major acute hospitals such as the Derriford. Much has been made of the 6% cut, but there has been very little publicity of the £19 million that will be made available through the Government’s pharmacy access fund. My hon. Friend might like to use her winding-up speech to give us a little more information about all this, and to explain how the Department of Health will provide the resources for pharmacies to take pressure off GPs by delivering flu jabs, opticians, mental health services, anti-smoking measures and a nationwide minor ailment facility. If she cannot do that now, perhaps she would like to write to me about it.

Plymouth’s health service is under real pressure. Like the rest of the country, the town does not have enough GPs. Parts of my constituency are very deprived and we need to do something about the 11-year life expectancy difference. The Government must ensure that resources follow health needs. We also need to make much more use of pharmacies. As my hon. Friend the Minister knows, I am the Government’s pharmacy champion, so may I ask how we will ensure that pharmacies have funding, and how they will be able to operate?

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[Rebecca Pow (Taunton Deane) (Con)]

I am very pleased to follow the hon. Member for Bradford South (Judith Cummins), who gave such a shocking account of oral and dental health. I am also delighted to follow my hon. Friend the Member for Totnes (Dr Wollaston). I commend her for raising this important issue and for so ably highlighting the impacts and causes of health inequality.

I want to focus on an area my hon. Friend did not mention, and to bring it to the Minister’s attention: natural and green solutions to help to reduce and prevent the disparity and inequality in health outcomes. I am not suggesting that the things I am going to mention are the only solutions, but I really believe that our natural environment has an important and often underestimated role to play in our health and wellbeing. Health inequality can cost up to £70 billion a year, with those below the wealthiest levels in society suffering the greatest degrees of inequality. Many of my colleagues have expanded on that point today. I have a particularly deprived area in my constituency called Halcon, which is among the 4% most deprived parts of the country. Many of the factors being described today apply to that part of Taunton Deane.

Interestingly, people living in deprived areas are 10 times less likely to live in the greenest areas. That seems more than a coincidence. There must be a link. In fact, I can tell the Minister that research shows that disadvantaged people who have greater access to green spaces are likely to have better health outcomes. A good-quality natural and built environment can have a significant positive impact on mental and physical health. Not only that, but some of the solutions that I am going to mention can be cost-effective. I know that the idea of cost savings will always make a Minister’s eyes light up. Many people are beginning to realise the important link between health and wellbeing and the natural environment, and I am heartened that many service providers are already thinking about that and putting people in place to deal with it. For example, the Somerset Wildlife Trust, of which I am very proud to be a vice-president, has appointed Jolyon Chesworth as its first health and wellbeing manager. That is heartening, and I shall watch with interest to see how that role develops and what the trust will do to highlight this issue.

The natural world can have a really positive impact on mental health. I am a firm believer in the therapeutic power of a brisk walk in the beautiful Somerset countryside. Maybe we can stretch that to include Devon.

[Oliver Colvile]

Does my hon. Friend agree that one of the great problems is that mental health care has been a Cinderella service in the NHS for far too long? Does she also agree that the Government are trying to do something about that?

[Rebecca Pow]

My hon. Friend is right; it has been a Cinderella service.

The solutions that I am outlining are free. I am giving the House ideas for free therapy, because nature is free. It is a beautiful thing, and it really does have power. What could be more relaxing than a walk up to the Wellington monument on the Blackdown hills in my constituency? Hundreds of thousands of people go up there, including lots of people with disabilities, because it is easy to get to and it is all flat. Those walks to the monument are really beneficial. I know that it is not quite relevant to the debate, Mr Deputy Speaker, but the Government raised my spirits yesterday by announcing that they were giving £1 million to the Wellington monument’s restoration project from the LIBOR fund. That will have loads of spin-offs for the public, and health and wellbeing will be part of that. We are going to build a big community project to encourage more people to go up there.

When I was looking for somewhere to live in London—obviously, I have to stay up here during the week—one of my criteria for the flat was that I had to be able to see a tree from my window, and I can. I could not live without one.

--- Later in debate ---

[Rebecca Pow]

That is absolutely true, and I shall give the House a few more statistics as I go on. I am not making this up. This is not wishy-washy; it is actually coming into our psyche.

[Oliver Colvile]

May I encourage my hon. Friend, when she is in London, to take a boat from Chelsea Harbour down to Greenwich? She will see the magnificent layout of trees that occurs beautifully in the west, although there seem to be fewer of them in east London.

[Rebecca Pow]

rose—

Community Pharmacies

Oliver Colvile Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth]

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

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

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

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

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

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

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

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

rose—

[Jonathan Ashworth]

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

[Oliver Colvile]

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

[Jonathan Ashworth]

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

--- Later in debate ---

[Mr Speaker]

Perhaps the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) could detach himself from his device for a matter of seconds. It is very good of him to drop in on us and to take a continuing interest in our proceedings. They certainly interested him greatly a few seconds ago.

[Oliver Colvile]

Thank you, Mr Speaker. I was just trying to find something that was going to inform my intervention. Is my hon. Friend the Minister aware that in Devon, about £5.5 million is wasted on unused medicines? We need to do something about that.

[David Mowat]

I do realise that, and I mentioned the fact that the King’s Fund is looking into medicine reviews.

As I have said before in the Chamber, the model that is adopted for pharmacies in Scotland has a lot to commend it, even though we might not adopt it in its entirety. I hope that we will get a chance to discuss that later.

--- Later in debate ---

[Paul Scully (Sutton and Cheam) (Con)]

During the past year, I have visited a number of local, independently run community pharmacies across Sutton. They add much to our local healthcare provision, and they have the potential to add so much more, as we have heard. We therefore need to tread carefully when looking at changes to funding and configuration. When I spent time in those pharmacies, I saw a steady stream of customers. The pharmacist knew most of them by name, as well as their background and wider circumstances. Such a special relationship takes time to build, but it can be so valuable in assessing health needs and pre-empting any problems. We need to look at how we can develop community pharmacies further as a neighbourhood health and wellbeing hub, so that they become the go-to destination for support and advice and act as a gateway for other healthcare services.

As a number of hon. Members have done, I have been to A&E and seen people who have not had an accident or do not appear to be an emergency, so it is right to look at how we push people towards GP services. However, there seems to be less discussion in public about encouraging people to look to their pharmacist, rather than to their GP, for healthy lifestyle advice, minor ailments care and routine support. The all-party parliamentary group on pharmacy heard some great evidence from the LloydsPharmacy group about its diabetes foot service and inhaler check service, which enable people to get the most out of their treatment and can make their medication far more effective. Those kinds of extra services make community pharmacies incredibly valuable.

[Oliver Colvile]

Does my hon. Friend recognise that we need to make greater use of things such as opticians as well?

[Paul Scully]

My hon. Friend makes a very good point.

Independent pharmacies in Sutton conduct medicine reviews, which we have heard about, and often deliver to their patients’ homes. They therefore see people in their own environment, rather than in a GP surgery. They get to see what is left in the bathroom cabinet, forgotten about or set aside. Ignoring or forgetting to take prescribed medicines causes such a lot of waste. There is an estimated £300 million a year that could go to other front-line services. By seeing the patient in their own environment, the pharmacist can make an assessment based on the patient’s everyday life, rather than just a snapshot, which might be affected by things such as white coat syndrome.

Consultation room services, such as sexual health, smoking cessation and minor ailment services, have to be a good thing for the NHS and should be encouraged. From what I have seen in pharmacies, there is still too much of a disconnect in the exchange of patient information between GPs and pharmacists. If advice and treatment are to work, they must be done in full knowledge of the patient’s background and medical history.

I understand the concerns that have driven the review and the changes that we are debating. The current funding system encourages pharmacy companies to open numerous low prescription volume sites, especially with the guaranteed fixed payment of £25,000 a year, regardless of size, quality or local demand. Some 40% of pharmacies are in clusters of two or more, with 20% being within 10 minutes’ walk of at least two others. That is reflected in Sutton. There are three in Worcester Park, four in north Cheam and six in and around Sutton High Street.

My concern is that any closures that result from these changes are more likely to come from the independent portion—those pharmacists who go beyond the corporate approach, often offering services at no cost or at a loss, because it is the right thing to do; those who prioritise the service that patients need, rather than shareholder value. Responding to customers on a personal basis allows independent pharmacists to consider savings such as generic substitution. We talk about a seven-day NHS, but pharmacists need to be set free to offer a high street NHS.

The Government’s changes recognise much of what pharmacists’ bodies have been raising. The changes seek to move pharmacists away from being reliant primarily on dispensing income, which is more vulnerable in the long term, towards services. Repeat prescriptions and those who come in via the 111 service will be directed to pharmacies, rather than out-of-hours GPs. For the first time, pharmacies will be paid for the quality of the services they provide, not just the volume. There is much to be welcomed, but I urge the Minister to keep the impact of the changes on independent pharmacies, which are often family run, under constant review.

--- Later in debate ---

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

The first time I became involved in this area of policy was in the 1990s. I was working commercially for pharmacies on the Community Pharmacy Action Group resale price maintenance campaign. One of my very great friends who was very much involved in that campaign, Sharon Buckle, is on the English Pharmacy Board and has been incredibly helpful in providing me with advice. I am vice-chair of the all-party pharmacy group and the Government’s pharmacy champion, which is a great honour and privilege.

My concern is that we seem to be discussing buildings and pharmacies, rather than talking about how we can protect pharmacists. I understand that the Department of Health and Keith Ridge, the chief pharmaceutical officer, are very keen to ensure the pharmacists, the people who serve and have the expertise, are looked after, rather than the buildings. That is very important. We need to ensure there is significantly better integration between the NHS and pharmacies, including on summary care records, when the Government will deliver on decriminalisation for dispensing errors and so on.

Finally, if the likes of Boots will be expected to release their leases, could they kindly have a condition that those leases cannot be re-let to other pharmacies? What we do not need is to end up replacing one form of pharmacy with another. If that is not possible, it is very important that those leases are given to independent community pharmacies rather than the big boys.

I represent a constituency with real deprivation. There is an 11-year gap in life expectancy between one part of my constituency and another. I therefore know at first hand what the issues are. We need to ensure that pharmacies work more closely together, so they can work together on delivering medicines.

Healthcare (Devon)

Oliver Colvile Excerpts

Tuesday 18th October 2016 Westminster Hall

[Sir Hugo Swire (East Devon) (Con)]

I beg to move,

That this House has considered healthcare provision in Devon.

It is a great honour to serve under your chairmanship, Mrs Main, which I am sure will be fair and impartial; if only that were the case elsewhere in the House. It is a particular pleasure to welcome the Minister of State, Department of Health, my hon. Friend the Member for Ludlow (Mr Dunne); I fear he has had quite a few outings already this week, and will have more. I make no apology for summoning him here, on behalf of my colleagues from Devon, to address an issue that will not go away any time soon. I suspect that this will be one of many occasions on which we will seek to ask pertinent questions on behalf of our constituents across the county.

Healthcare is one of the biggest issues in Devon, largely for two reasons. The first is the demographics of the county: 17.7% of the UK population are aged 65 and over; that rises to 21.1% in the south-west and, in my part of the south-west—East Devon—to 27.7%, which is 10% more than the national average. Secondly, reforms are coming down the line, involving bed closures and so forth, that are sometimes seen as controversial. They are a result of the perilous state of Devon’s NHS, which is there for us all to see. Before we start our long list of asks and demands, it is worth remembering that the Northern, Eastern and Western Devon clinical commissioning group’s financial deficit is due to hit £490 million by 2019, which is clearly unsustainable.

Before I launch into my pleas and points, I point out the absence of some colleagues from Devon from across the political spectrum who I know feel passionately about this. The right hon. Member for Exeter (Mr Bradshaw) and my hon. Friend the Member for Totnes (Dr Wollaston) are both detained in the Select Committee on Health. I believe that they have either just interviewed, or are interviewing as we speak, the Secretary of State for Health and the chief executive of NHS England. Of course, my hon. Friend the Member for Central Devon (Mel Stride) is unable to take part in the debate on account of his particular office. He has an excellent relationship with the GPs in his constituency, and he is supportive of wellbeing hubs, provided they serve the local community appropriately.

On the whole, we welcome the Government’s intervention in Devon’s NHS in the form of the success regime. If followed properly, it will help to solve some of the underlying problems that beset Devon’s national health service. As part of its work, the success regime, along with the CCG, has recently published proposals to close 72 hospital beds in Exeter and East Devon. The Minister will quite properly respond that that is under consultation, but I think this is the only way that we can raise these points in a public forum to make sure that everybody knows what we are thinking.

I understand that recently, the success regime, although it has a preferred option, which includes the rather expensive Labour deal on Tiverton hospital, has now introduced a “none of the above” option. If that is now an option, it creates a whole new range of possibilities. If that is not an option, I argue—my colleagues will argue for other things—that option B, which sees the beds retained in Tiverton, and also in Sidmouth and Exmouth, is the option worthy of support. Sidmouth has an extremely high proportion of over-85s, with people increasingly living longer, and of people with dementia. Exmouth is the biggest town in Devon with more than 35,000 people.

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

Thank you, Mrs Main, for allowing me to serve under your chairmanship. Plymouth has around a quarter of a million people, and is the largest urban conurbation in the whole of Devon.

[Sir Hugo Swire]

As my hon. Friend knows, Plymouth is a unitary authority; Exmouth is the biggest town in Devon. Local people—my constituents—are hugely supportive of our community hospitals. We have beds in Exmouth and Sidmouth; in Ottery St Mary we have 16 stroke beds, although they are eventually to be replaced by a health hub; and Budleigh Salterton hospital, which I will talk about in due course, will, we hope, be turned into a health and wellbeing hub.

Over the years, many local residents have donated significant sums to the hospitals. In Sidmouth alone, the Sidmouth Victoria hospital comforts fund has raised over £5 million. Local people are prepared to invest in ensuring first-class local health services. I pray in aid the position of Sid valley Admiral nurse—the Admiral nurse helps people with dementia—which was hugely supported locally. I am pleased to say that I was able to play my part in obtaining additional funding for that position from the Big Lottery Fund. If there is an identifiable health issue locally, people are prepared to back care with their own money.

If the Minister will allow me, I will talk about the consultation process and the lack of documentation. As I understand it, the consultation process has been overwhelmingly carried out online; there are very few paper copies of the consultation. Elderly people, who may have no access to the internet and who are disproportionately likely to be affected by the changes, are therefore disadvantaged. The consultation period ends on Friday 6 January. I ask the Minister to do everything he can to look at the issue, and to work out how we can get more people involved in what is, after all, an extraordinarily important process.

The potential closure of hospital beds raises the issue of 21st century healthcare, which obviously includes preventive as well as curative care. My constituents—like many across the country, we are told—prefer to be treated at home for as long as possible. They understand, on the whole, that community hospitals need to change and adapt in order to offer a service fit for the 21st century. In Budleigh Salterton, we have been working very hard to try to ensure that the community hospital is transformed into a health and wellbeing hub, which will involve bringing together the health, social care and voluntary sectors. I think that is a good template that can possibly be used across the country. In fact, if it works, there will be far greater footfall through the community hospital than there has been while it has been just a hospital. I remain very supportive of that.

There is, of course, a negative side to keeping people in hospital beds. According to Angela Pedder, the lead chief executive of the success regime, the cost of running a 16-bed community hospital ward is £75,000 a month. Home care could look after 82 people for the same money. However, we are in danger of putting the cart before the horse. Until we can absolutely ensure that we have got social care right, we should not look at unnecessarily closing community beds that some people will have to use. Equally, I am nervous that, just because we have well-supported community hospitals across East Devon, we are being targeted unfairly, so as to rebalance the books across other parts of the county.

If we are reducing the number of hospital beds, it is absolutely essential that the social care system is able to compensate for that loss. In the past five years, council budgets for social care have fallen behind demand by £5 billion, and 150,000 fewer people receive at-home help than five years ago. Social care can take the financial pressure off the NHS. For instance, the installation of a simple grab-rail in an elderly person’s home can help to prevent the falls and broken bones that cost the NHS £2 billion a year. The option of making greater use of technology remains hugely under-exploited, in terms of how we ensure that people are getting a first-rate service at home.

I am sure my colleagues will want to raise the whole issue of rurality this afternoon. Government policies are meant to be rural-proofed. Frankly, social care is far easier to administer in a conurbation such as Plymouth than in other parts of the county, where people are spread over much greater distances.

Another issue that I am sure some of my colleagues will want to talk about is recruitment. We are told that social care will be one of the big growth industries in future. That is all to the good, and it is inevitable. However, currently, people find it very difficult to recruit. It is much easier, I am told, for the NHS to recruit people to work in social care than it is for the private sector. It is all very well transferring people back home, but only provided that there are the people to carry out the social care.

Stephen Dorrell, a former Health Secretary, has said:

“Fetishising the NHS budget and imagining it’s the only public service that relates to health is fundamentally to miss the point…It is not true to say we are supporting the health service by asking it to do social care. We are using the health service as a very expensive social care service and then talking about efficiency. It’s insane economics and very bad social policy.”

I would like to know if the Minister agrees, and what he feels can be done to ensure that we have first-class social care in place before we start to close community beds. Given the closure of residential homes, and the fact that local authorities are increasingly unwilling to pay the fees demanded by residential homes, we might end up in a situation where, although a person can no longer be cared for at home and needs some kind of hospital bed—we want to keep them away, of course, from the main hospitals—we have got rid of all our beds, or a disproportionate number, and so have created an unnecessary problem.

I want to say something about NHS Property Services. Since the NHS provider in Devon changed from Northern Devon Healthcare NHS Trust to Royal Devon and Exeter NHS Foundation Trust—at least in my part of the county—on 1 October, ownership of the community hospitals has transferred to NHS Property Services. NHS Property Services, as we know, charges commercial rents, meaning that many hospitals will have to pay higher rent. Along with the planned bed closures, that has understandably made some of our constituents nervous. What happens if hospitals cannot pay the rent? Given that the Department of Health has committed to meeting any increased property costs for 2017 and 2018, the big question is what happens thereafter.

My general practitioners at the Blackmore health centre in Sidmouth increasingly feel that they have little influence over the redevelopment of the surgery, which I champion, as a result of the involvement of NHS Property Services. The practice wants to buy the building off NHS Property Services, either now or at some stage in future. It is proving extremely difficult to make that happen. It should be a simple move, as it is supported by local GPs and the local community.

There is some concern about Exmouth—Devon’s biggest town—losing its out-of-hours GP services, which will be replaced with use of the 111 service, in line with the new integrated urgent care commissioning standards. Perhaps the Minister could write to me to reassure me that my constituents in Exmouth will receive exactly the same cover that they did under the previous arrangement.

One thing that affects all of us across Devon is the lack of provision of mental health facilities, which has exercised us for a long time. In my patch, I am concerned about St John’s Court, which is the only mental health and recovery facility in Exmouth. Two years ago, Devon Partnership NHS Trust spent £300,000 on a move from Danby Terrace, which was not at the time fit for purpose, to St John’s Court. On top of that, £140,000—this is all taxpayers’ money—was spent on refurbishing St John’s Court. Now the trust is pushing ahead with closing and selling St John’s Court. It has assured us that Exmouth will not experience a reduction in healthcare provision, and that St John’s Court will not be sold until an alternative venue can be found. We are talking about a growing town with a lot of mental health issues. I seek reassurance from the Minister that before anything is closed, something will be put in place to reassure the local community and my constituents that we have the same, if not a better, level of mental ill-health prevention and cure.

I wanted to speak for longer, but I am conscious that my colleagues will probably want to articulate their own slightly different visions for the future of healthcare in Devon. I say to the Minister in the friendliest manner possible that we are a pretty quiet bunch in our part of the world, and we do not seek trouble, but we do fight tenaciously to protect the livelihoods of our constituents. Too often, we feel that people forget about us in the south-west, and that money is diverted to all kinds of infrastructure projects in the huge urban conurbations, the northern powerhouse and so forth. This time, we will speak as one to ensure that whatever comes out of these consultations, and wherever we end up after them, we can argue these points in a mature way. It is simply no good saying, “It’s a lack of money. It’s Tory cuts.” That is an immature conversation to have. We have to, between us, design a health and social care service that is fully integrated, makes use of technology, and cares for all of us as we get older and more dependent. We need to be brave, but political sloganising is not the answer.

--- Later in debate ---

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

I, too, congratulate my right hon. Friend the Member for East Devon (Sir Hugo Swire) on securing the debate. Over the next few moments, I want to concentrate on NHS England’s proposals to close three GP surgeries in my Plymouth, Sutton and Devonport constituency and how I hope we can take some pressure off the principal acute hospital at Derriford in the constituency of my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer).

I am told that the reason why NHS England is considering the closures is the size of the GP practices. The Cumberland GP practice has 1,800 patients, Hyde Park 2,800 and St Barnabas 1,700. They are considered by NHS England to be unsustainable and too small. It also tells me that closing those practices is not down to saving money, but to deliver better value for money. However, before I speak about those issues, let me put my constituency in context.

Plymouth, Sutton and Devonport runs from the A38 down to the sea and from the River Plym to the River Tamar. It is the home of one of the largest universities in the country, with more than 27,000 students, thousands of whom live in the city centre, and it is a naval and Royal Marine Commando garrison city, as my hon. Friend the Minister, for whom I was a Parliamentary Private Secretary in a previous life, knows only too well.

The city’s population is growing. Although it has a global reputation for marine science and engineering and research, it is a low-wage and low-skills economy. It is an inner-city seat. I do not have a single piece of countryside in my constituency, unless we include the Ponderosa pony sanctuary, which is a rather muddy field. Between Compton and Peverell in the north-east of my constituency and Devonport in the south-west, there is an 11-year life expectancy difference. Compton and Peverell is where many of the university lecturers and hospital consultants live. In the run-up to the 2010 general election, when I won the seat on the third attempt, the Conservative party pledged to do something about healthcare in deprived inner cities.

We have started to make good our word. In 2014, our hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), one of the Minister’s ministerial predecessors, came to Devonport to open the Cumberland GP practice, which is now under threat. Other facilities on the Cumberland campus include a minor injuries unit, the new Devonport health centre and a pharmacy. The Cumberland GP practice was set up by Plymouth Community Healthcare—now Livewell Southwest—and the Peninsula medical school. There was and is a desperate need to provide a tailor-made alternative service to the existing GP practice—then the Marlborough Street practice; now the Devonport health centre—for this deprived Devonport community, and a need to look after drug users and the city’s homeless in hostels such as the neighbouring Salvation Army’s.

The practice also offers practical placements to students at the Plymouth medical school. Until earlier this year it was funded by Livewell Southwest, a social enterprise, which found it too expensive to maintain. Despite Devonport’s real deprivation, NHS England did not want to get involved in providing a contract to the Cumberland GP practice, which has consequently been operating without a formal contract and is managed by Access Health Care.

I understand that in the past the neighbouring Devonport health practice has not been interested in offering facilities to homeless people and drug users. Indeed, I understand that some of the Cumberland practice’s patients were not keen to transfer back to the Devonport centre, which is where they came from in the first place.

NHS England’s reason for putting the Cumberland GP practice under threat is because it considers it to be too small and is operating in unsuitable, cramped premises. Unless we are very careful, we could potentially put more pressure on Derriford’s acute emergency unit, which is under enormous pressure. I became aware of NHS England’s proposals for the three GP practices in August, during the summer recess, when no doubt NHS England expected me and other MPs to be away on parliamentary trips or taking a holiday. I immediately put together a series of meetings with the city council’s director of public health, the leader of the council and the cabinet member for adult social care, people from NHS England, the dean of the medical school and Dr Richard Ayres, who runs the Cumberland GP practice.

At the meeting I suggested that the Cumberland GP practice could share Devonport health centre’s brand-new building, which has space and operates as a federation, sharing receptionists and back-room staff. This was supported by everyone present. Indeed, the city council’s health and wellbeing board also supported it following an inquiry that recommended measures to allow the Cumberland GP practice to continue. However, I understand that Devonport healthcare might not be willing to do this, and it appears that the Devonport community may be deprived of a second GP practice and that patients will have no choice in which doctor they can go to.

I have also had representations from patients at both Hyde Park and St Barnabas surgeries. At Hyde Park, although Dr Stephen Warren is keen to continue as a GP following a heart attack, he has transferred the ownership of his practice to Access Health Care, as he no longer wishes to deal with the back-room tasks of administration, which is part of running a practice. He argues that his and his partner’s growing 2,800 practice—the Cumberland is growing as well—has attracted outstanding reviews and he would not be able to inform his patients where he was going if he relocated to another practice. He also thinks that some patients like to have a relationship with an individual doctor who they can see speedily rather than having to wait weeks.

The St Barnabas surgery, which is also run by Access Health Care, was set up in a new development next to a residential care home for the elderly where patients do not have to walk far to get to it. In all three cases, NHS England, for supposedly technical reasons, gave patients only 24 hours’ notice of their initial engagement. I must say I found the public consultation process utterly appalling. I wrote to NHS England asking it to give more time to engage with local communities, and I am grateful that it bothered to listen.

On Friday, at my weekly constituency surgery, I was asked to write to NHS England to ask whether it had engaged with other GP surgeries and with Derriford hospital and whether it had consulted them, because some GPs will have to accommodate more patients. That is a big issue.

There are wider issues in all this. At the moment, commissioners in north, east and west Devon spend a higher amount of money in east Devon than in the more deprived western locality. The Government’s success regime is keen to correct that, so that resources are focused on deprived communities such as Devonport. Finally, we need to make much more use of pharmacies. As my hon. Friend the Minister knows, I am the Government’s pharmacy champion. What are we going to do to make sure we have pharmacy funding and how will that operate?

Junior Doctors Contract

Oliver Colvile Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

We are, of course, willing to have those discussions with colleagues in other parts of the UK. The hon. Gentleman is right to say that having a seven-day service does not just involve junior doctors; it involves widespread changes across the service. I should say that nurses, healthcare assistants, porters, cleaners—other people who work in hospitals—already operate on 24/7 shifts, so the changes necessary to those contracts are much less profound than they are to some of the doctors contracts, which is why it is important that we change not just the junior doctors contract, but the consultants contract. The fact that we have been able to reach a negotiated agreement with the junior doctors bodes well for the consultants contract, which is the next step.

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

I congratulate both my right hon. Friend and the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer) on their hard work in dealing with this protracted dispute with the BMA. Patients up and down the country, including those in my constituency, were somewhat concerned about the cancellation of operations, and I am delighted that the Department is going to try to ensure that we catch up on that. One thing that came out of this dispute was that some senior consultants ended up getting on to the front line for the first time in a long time. What can be done to try to make sure that that happens on a regular basis, so that they are getting experience on the front line, too?

[Mr Hunt]

If I answer that question directly, I will dig myself into rather a deep hole. I echo my hon. Friend’s thanks to my hon. Friend the Member for Ipswich, who has done an outstanding job by my side at every stage throughout this difficult period. I can certainly say that we would not have had yesterday’s agreement without his strong help and support at every stage. It is true that there are A&E departments across the country that, in having to plan for the two-day withdrawal of emergency care, found that having consultants more visible to patients had some positive impacts. I know that studies are going on to see what lessons can be learned from that going forward.

Junior Doctors Contracts

Oliver Colvile Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend—the one Conservative who signed up to that proposal—when he was Health Minister proposed a contract that was much tougher on junior doctors than the contract we have ended up introducing. This has been a very interesting U-turn on his part.

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

To take pressure off GPs, A&E units and junior doctors, may I urge my right hon. Friend to make full use of the pharmacy network and ensure that it can play its full part in a seven-day national health service?

[Mr Hunt]

No health statement would be complete without a mention by my hon. Friend of the important role that pharmacies can play in solving absolutely any problem that the NHS faces. Once again, I commend his excellent contribution.

Junior Doctors Contracts

Oliver Colvile Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

The difference between those of us on the Government side of the House and those on the Opposition side is that we do not have an ideological view about a trust wanting to offer some private treatment in order to benefit its NHS patients. That is what some trusts are doing, within very strict constraints. I think that most people know that all the scare stories that were put out about the Health and Social Care Bill in 2012 have not materialised. We are finding that trusts are being very sensible about making sure they get that balance right. Indeed, in certain circumstances it makes a big difference to improving NHS care.

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

The key thing is looking after patient safety, so will my right hon. Friend consider changing the law so that hospitals such as Derriford hospital can make use of dedicated military doctors to fulfil that service if it is needed?

[Mr Hunt]

My hon. Friend always makes important suggestions that can benefit his constituency, and rightly so. I do not think that there is a need to change the law for that to happen; if military help were needed, I think the military would stand ready to offer it. At the moment, we are making contingency plans by drawing on the consultant workforce, who are not involved in industrial action, and our hope is that A&E departments throughout the country will be covered by that extra support.