Reforms to NHS Dentistry

Simon Fell Excerpts
Thursday 27th April 2023

(10 months, 1 week ago)

Commons Chamber
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Simon Fell Portrait Simon Fell (Barrow and Furness) (Con)
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I thank the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) for securing this timely debate. Hopefully, as my hon. Friend the Member for Milton Keynes North (Ben Everitt) said, this is the end of the trilogy. I am glad to see the Minister in his place; I asked him about the issue only a few days ago at Health and Social Care questions.

To set this in context, in Barrow and Furness we are not well served by our dental provision. We have excellent dentists, but we do not have enough of them. We also have a problem with practices closing. Bupa in Barrow has announced its closure, as has mydentist in Dalton. One dental practice in Millom, just outside my constituency but serving my constituents, has closed, and Avondale in Grange-over-Sands has handed back its NHS list. So I now have constituents who have not seen a dentist in years and who are in a very poor situation. There are pregnant mothers who are unable to make their appointments, constituents who are self-medicating every night because they cannot find care, seven-year-olds who have never seen a dentist and constituents performing their own dental care with packs they buy from Boots the Chemist. That simply is not good enough.

Before the first of the practices in Furness closed, because of the volume of constituents who came to see me to discuss their frustrations at being placed on waiting lists for waiting lists, or not being able to be seen at all, I hosted a couple of roundtables with local dentists. They were candid with me about their concerns—candidly frustrated, to be honest. I also met the senior management at Bupa and mydentist and spoke to local healthcare leaders, before our ICB came into force.

In those discussions, two issues came up repeatedly. They have been well rehearsed in the debate already, so I will not labour the points. First, there was the inability to recruit the dentists we need to deliver NHS care. Bupa told me that half of its 85 practices currently have vacancies that have been open for over 6 months. It needs over 150 dentists nationwide to provide the kind of NHS care that it would like to provide. In rural, isolated areas such as mine, recruitment is compounded by the additional challenge of trying to draw people into those areas.

Dentists also raised the issue of recruitment from abroad. I fully recognise that we would like to be sustainable and grow our own. I have heard a few pitches for dental colleges in the debate, although I am not asking for one. When demand is outstripping supply, we have to be realistic. I am told that the overseas registration examination does not meet demand, while the process for registering performer numbers is long-winded and overly complex, which puts off some dentists who might be attracted to the UK. We have to look at reforming that.

The second issue raised is that dentists are often put off from practising NHS care in more deprived areas, where the work is more complex and more expensive to deliver. I know we have all seen this. It leads to ever-decreasing circles of care: poor dental health leads to worse provision, which leads to a lack of appointments, which leads to even worse dental care and dental health. I could go on and on, but I am sure Members get the picture. There was hope that the reforms to the UDA system would address this, but practices are telling me that they do not go far enough, certainly in rural and isolated areas such as mine, to address the disparity in the system. The fact is that since the announcement of these changes, I have seen a further two practices close, which I think is testament to the challenges that these issues are throwing up. Following the most recent announcement of closure, I wrote to the Minister, who kindly responded very quickly, saying:

“We are aware that we need to go further in improving the NHS dental system. We are planning further reforms…and discussions are underway with dental stakeholder groups, including the BDA and patients, to improve NHS dental services further.”

I would welcome an update from the Minister on those plans and details as to how my remaining dentists can feed into that process, because they certainly have things to say.

Before I draw to a close, I must say that it is not all doom and gloom. I am incredibly grateful to the current Minister and his predecessors for engaging so openly and actively seeking to find solutions. The movements on UDA pricing are welcome—although they can go further, as can contract reform—and the aspiration to make visa schemes more workable is music to my ears. I am keen to hear what the Minister has to say on that.

However, as I said at the start, what was a bad situation is now a dire one for my constituents in Barrow. We need to act quickly, improving UDAs, streamlining the visa process and working on recruitment as priorities. It is not an unreasonable expectation to hope for dental care to be available closer to where we live. We often chance our arm in here and ask for big projects to come to our constituencies. This is a minor but crucial ask, and it is one that I very much hope we will soon be able to deliver.

Oral Answers

Simon Fell Excerpts
Tuesday 25th April 2023

(10 months, 2 weeks ago)

Commons Chamber
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Neil O'Brien Portrait Neil O’Brien
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My hon. Friend is right, and I am particularly seized of the issue of access for new patients.

Simon Fell Portrait Simon Fell (Barrow and Furness) (Con)
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My constituents in Dalton-in-Furness were dismayed to find out that their dentist has closed. This follows the closure of Bupa in Barrow and in Millom, and Avondale in Grange-over-Sands has handed back its NHS contracts. What was a bad situation has got very bad indeed. I am meeting the ICB next week to talk about what it might be able to do, but will the Minister agree to meet me to discuss what levers he can pull to improve dental access in Barrow and Furness?

Neil O'Brien Portrait Neil O’Brien
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I am very happy to meet my hon. Friend, and we have already talked to some extent. The minimum UDA value that we introduced particularly helps rural and coastal areas of the kind he represents, and I am happy to talk further, and to go further, on all these things.

Oral Answers to Questions

Simon Fell Excerpts
Tuesday 14th June 2022

(1 year, 8 months ago)

Commons Chamber
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Maria Caulfield Portrait Maria Caulfield
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As I said, the contract is the nub of the problem; it is currently a perverse disincentive for dentists to take on NHS work. We are serious about reforming it, we are in discussions with the BDA, and we will make the announcements before the summer recess.

Simon Fell Portrait Simon Fell (Barrow and Furness) (Con)
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I thank my hon. Friend for her work on pushing that contract reform through, because it is key to shifting the dial. In areas such as mine, where people are waiting to get on to waiting lists for dentists, there is a huge dearth of dentists to provide treatment. Can she speak about the recruitment challenge that we will have to meet when the reform comes through?

Maria Caulfield Portrait Maria Caulfield
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My hon. Friend is right that the issue is not just about the contract, although that is a key aspect of trying to get more dentists to take on NHS work. We are working on a number of incentives to increase recruitment, including working with Health Education England on centres for dental development to train more dentists in those hard-to-reach areas, which tend to be coastal and rural areas.

We are also looking at how we can reform the overseas dentist policy. We are working with the General Dental Council on that and may be bringing legislation forward towards the end of the year to improve that, too.

GP Appointment Availability

Simon Fell Excerpts
Tuesday 26th October 2021

(2 years, 4 months ago)

Westminster Hall
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Simon Fell Portrait Simon Fell (Barrow and Furness) (Con)
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It is a pleasure to serve under your chairmanship for the first time, Mr Robertson. I thank my hon. Friend the Member for Beaconsfield (Joy Morrissey) for securing the debate; if ever there was a timely debate, this is it. It is always a pleasure to follow my hon. Friend the Member for Bolton West (Chris Green), who often speaks sense. [Laughter.] And did so today, I should say! That was not a back-handed compliment.

About a month ago, I got an email from one of my constituents who is a nurse working in general practice. She was very angry and frustrated with what she sees day to day, dealing with the general public and some of the challenges there. One line from that email really stuck with me:

“We used to clap for our carers, but now it feels like we get a slap for our carers.”

That really illustrates some of the challenges that those working on the frontlines in primary care are facing. It is a very difficult environment, and no one working in public service should have to be in that sort of environment day in, day out.

Many hon. Members have talked about the frustrations faced by constituents trying to access services; my constituents are in exactly the same boat. My inbox is not exactly quiet on that issue. I have experienced it personally, too: calling the surgery at 8 o’clock in the morning and not getting an appointment; being told through various messaging campaigns to send photos in and get diagnoses that way, but with no clear route of access for how to do that. That drives frustration. People are being told that they can go to the pharmacy and, for what it is worth, I think that is an excellent thing to be doing. We should be triaging people. However, we need better communication about why people should be going to the pharmacy, what symptoms they should be displaying and what questions they should have to go there instead of calling 111 or going to their GP.

The work that GPs and those in general practice are doing is just phenomenal. We should not forget that they are delivering not only a programme to work through a backlog of people trying to access services, but the vaccination programme. In my constituency in Barrow and Furness, they are doing a phenomenal job. Their day job is packed and stressful; delivering the vaccination programme before or after hours to get through those essential numbers as well is really difficult.

I held a roundtable with some GPs with my constituency neighbour, the hon. Member for Westmorland and Lonsdale (Tim Farron). I met four GPs from my constituency there, and spoke to another two beforehand. They all talked about having the same issues. After the meeting, one of my GPs sent me an email, and I want to put on record a quote about some of the challenges they are facing:

“During the pandemic we continued to provide face to face appointments despite any personal risk or even PPE in the early days...I have a memory of wearing a bin bag and a visor from B&Q for an early visit! We triaged all contacts as advised…we saw patients in a portacabin in the car park to protect staff… We are aware that not enough patients are being examined, and although we still do phone appointments first, my conversion rate to a face to face…within few days is about 40%...Our workload has increased by about 30% in the last few months. All the patients that ‘stayed at home to protect the NHS’ are now out in force and demanding to be seen, and some are really quite unwell, having suffered from self-imposed medical neglect for many months. Mental health crises dominate every day. Cancers and heart disease are presenting late. And there is a huge bottle neck in the system, as we cannot get anyone seen in secondary care as the waiting lists are so huge…This is a perfect storm”.

Another GP got in touch with me. He is now edging towards retirement. He is contracted to work three days a week, so he is only paid for three days, but he is turning up for six while also delivering the vaccine programme. His concern is not just getting through the waiting list but also the challenge of finding new GPs to backfill afterwards. If we do not get a grip of this crisis, that will be the next problem that we face.

The GP who wrote to me continued:

“If face to face is mandatory, there will be a four to five week wait for an appointment. Is that really the policy outcome anyone wants?”

Those are the challenges that we must lean into, and I would be interested to hear from the Minister what the Government plan to do about them. I know that they have announced money for general practice and the NHS, but we cannot magic up people and resources.

To my mind, we must look at improving access through technology, looking at challenges around phone calls and patient access systems, and easing information flows between GP practices and secondary care. Yesterday in the Chamber, my hon. Friend the Member for Bosworth (Dr Evans) said that 10% of GP time is spent chasing up appointments and medical records. We should be able to use technology to get that out of the way.

However, the crucial point is about communications and signposting. Pharmacies and 111 are fantastic resources, but we must make it clear to people why, under what circumstances and how they need to use those routes. We are not there yet. That responsibility falls on both Government and general practice. Something in the comms space is really important.

If we do not tackle this now, I fear that we are building up a problem for the future and that the recruitment issue is going to come back and bite us. I am interested in the Minister’s views on how we tackle that perfect storm. What we need now is a considered and coherent route out of it; otherwise, we will face a similar debate in six or 12 months’ time.

NHS England Funding: Announcement to Media

Simon Fell Excerpts
Monday 25th October 2021

(2 years, 4 months ago)

Commons Chamber
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Edward Argar Portrait Edward Argar
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I am grateful to the hon. Gentleman. Everyone loves a trier in this place, particularly on behalf of their constituents. I have met him to discuss this, as he alludes to. I think I am overdue giving him an update letter on where we are. As he will be aware, we have had significant numbers of expressions of interest in the opportunity to be one of the next eight hospitals. We look forward to making an announcement on them in the spring of next year. I cannot say any more than that—but, as ever, he makes the point on behalf of his constituents.

Simon Fell Portrait Simon Fell (Barrow and Furness) (Con)
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I warmly welcome this funding announcement. A few weeks ago, I visited the biochemistry department in Furness General Hospital. It is one of the best in the country, so I am glad that there is this focus on diagnostics capacity. Can the Minister confirm that funding will go to centres that already have capacity and the will to do more, rather than creating additional units that may draw it away from them?

Edward Argar Portrait Edward Argar
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My hon. Friend makes an interesting and important point. These will be new diagnostic hubs, but he alludes to a central point. For example, there could be a hub in the car park of an existing hospital where these services are delivered to allow it to deliver them in a covid-free environment, rather than having the same front door for A&E or similar. We are working through the exact detail of how these new hubs will be delivered, but we will be looking at how they can potentially fit with existing services.

Health Incentives Scheme

Simon Fell Excerpts
Friday 22nd October 2021

(2 years, 4 months ago)

Commons Chamber
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Maggie Throup Portrait Maggie Throup
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My hon. Friend makes a very good point. Kids are excited by new technology, but the pilot will be for people aged 18 and over. I take on board her suggestion and perhaps we can look at other ways to encourage kids to use technology to improve their outcomes.

Simon Fell Portrait Simon Fell (Barrow and Furness) (Con)
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I welcome this announcement. We cannot, unfortunately, all have the iron will of my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), but study after study shows that gamification really does drive positive behaviour. Can my hon. Friend confirm that this is just one part of the Government’s strategy and that we are also looking at changing physical infrastructure to improve cycling and walking access?

Maggie Throup Portrait Maggie Throup
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My hon. Friend makes a very good point. We cannot do this with one action alone. To me, it is very much cross-departmental. Whether it is through planning legislation or encouraging people to be more active, there are lots of different ways we can tackle obesity and the health disparities it brings with it.

Oral Answers to Questions

Simon Fell Excerpts
Tuesday 19th October 2021

(2 years, 4 months ago)

Commons Chamber
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Maggie Throup Portrait Maggie Throup
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I assure my hon. Friend that the Environment Agency takes the situation very seriously and is working with the operators of the site to address it as quickly and effectively as possible. I am sure that he will be pleased to learn that the Environment Agency has re-evaluated its regulatory approach following the outcome of the judicial review, and on 14 October published its plan to reduce the levels of hydrogen sulphide emissions at the site.

Simon Fell Portrait Simon Fell (Barrow and Furness) (Con)
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6. What estimate his Department has made of the number of people with Dandy-Walker syndrome in the UK.

Maria Caulfield Portrait The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
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I thank my hon. Friend for raising a question on this rare but important condition. Public Health England’s national disease registration service contributed data to a European Dandy-Walker syndrome epidemiology study back in 2019. The results identified that the condition occurs in about 2.7 live births per 100,000. More work is currently being done to report on the number of people living with the condition in the United Kingdom.

Simon Fell Portrait Simon Fell
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I thank my hon. Friend for doing the research on this question. One of my constituents, Steven Forster, came to see me during a surgery last summer. His granddaughter, Mia, is suffering with Dandy-Walker syndrome. As there is not the knowledge in the NHS about how best to treat the condition, like many families, when they do eventually find a doctor who has that knowledge, they have to travel a long way to see them and there is a huge cost attached to that. With that in mind, will my hon. Friend agree to meet some of the families across the UK who are trying to get together a support group on the issue, and consider putting together an NHS centre of excellence so that parents and carers know where to go for help?

Maria Caulfield Portrait Maria Caulfield
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I thank my hon. Friend for raising his constituent’s granddaughter Mia’s case. With over 7,000 rare conditions, awareness among healthcare professionals can be difficult. That is why in January this year the Government set up the UK Rare Diseases Framework whereby officials are working with partners including Health Education England to raise awareness of rare conditions such as Dandy-Walker so that we provide training for staff and target education for healthcare professionals. I would be happy to meet him and his constituent to talk about this and listen to some of their concerns and experiences.

Coronavirus

Simon Fell Excerpts
Wednesday 16th June 2021

(2 years, 8 months ago)

Commons Chamber
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Simon Fell Portrait Simon Fell (Barrow and Furness) (Con)
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I do not think anyone envies the tasks and decisions that this Government and this Prime Minister have to make. We have a vaccination programme that is the envy of much of the world, with 30 million adults now having had two jabs, which offer 90%-plus protection against hospitalisation from the delta variant. We also have a road map that is clear and is linked to the success of that same vaccination programme, but against that backdrop, we are being asked to approve a further delay today.

I spoke to local health leaders in Cumbria and in Barrow and Furness over the past few days, and the message from them was clear: they support this delay. Our director of public health was stark: because we are trying to cover and backfill 5 million people on an NHS waiting list, even a small fraction of covid-19 patients going into hospital risks the NHS being overwhelmed. On that basis, and on the basis of the rationale advanced by the Secretary of State, I support these measures as one final push—one last heave—before we return our freedoms.

However, we need to be absolutely clear about what this delay means. It extends impositions on our liberty, our livelihoods, people’s health and the future of young people. While the state has a duty to protect its citizens, our objective cannot be zero deaths. As my hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates) so eloquently wrote this week—I apologise for bastardising her words—“We don’t live to avoid death; we live to enjoy life,” and it has to be on that basis that we make the final judgment to unlock next month.

Steve Baker Portrait Mr Steve Baker
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I am listening carefully to my hon. Friend, and it is a good argument for voting for these restrictions, of course it is, but has he considered the possibility that, very sadly, the NHS will now be under pressure for years, dealing with the backlog?

Simon Fell Portrait Simon Fell
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My hon. Friend makes a good point. I am making the judgment based on my local knowledge and that of my director of public health, but we all have to make that decision in this place today.

We cannot afford for schools to close again, for young people to miss any more of their lives, or for any of our businesses to close as a result of further impositions, so it has to be one more heave, to protect more people, and then we have to accept that, in the face of a virus that we are not going to get rid of, and which will continue to mutate and challenge us while we are on this Earth, we must vaccinate as many people as possible and then give people back their freedom.

There is a more fundamental issue at play here—public acceptance. We made a delicate compact with people over the last year. We restricted their liberties to keep them safe, and already we are seeing compliance with that law beginning to fray. We must accept that people expected their liberty to return as vaccinations were rolled out, but as we vaccinate more, acceptance of that compromise falls. If we cannot maintain that compact, our response to it has to change.

So I hope and expect that after this final surge of vaccinations, we will return on 19 July to a society where people are able to make their own choices. It is easy to sloganise about freedom. I, for one, am deeply uncomfortable about living in a country where we dictate to newly married couples whether they can cut their wedding cake or not.

I believe that this Government have acted honourably and with good intentions throughout this horrible pandemic, so I am giving them my support tonight for one last heave to finish the job, and then we must return all of our freedoms on 19 July.

Peter Bone Portrait Mr Peter Bone (Wellingborough) (Con)
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On a point of order, Mr Deputy Speaker. I wonder whether you could help me in regard to social distancing. There is not a single Labour Member on the Opposition Benches. There are no SNP; there are no Liberal Democrats; there are no Plaid Cymru. Of course there are the DUP. Would it be appropriate, because the Conservative Benches are packed, for half of us to move over to the other side of the House to improve social distancing?

Health and Social Care Update

Simon Fell Excerpts
Thursday 18th March 2021

(2 years, 11 months ago)

Commons Chamber
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Matt Hancock Portrait Matt Hancock
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I am very happy to provide the hon. Lady with a briefing, because she should be very proud of her country. AstraZeneca is providing the Oxford vaccine free of charge—it is not charging for any intellectual property rights—right around the world. That is not true, as she implies, for all the vaccine companies, but she should be really, really proud of ours.

Simon Fell Portrait Simon Fell (Barrow and Furness) (Con) [V]
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I was listening to the excellent “Covid Confidential” podcast on the BBC and was surprised and delighted to find out that when the various vaccines were nearing production they were named after submarines built in my constituency, so may I first thank my right hon. Friend for his choice of names? Secondly, not to labour this analogy, a good defence rests on having a good range of options, and Kate Bingham recently said that not having monoclonal antibodies as part of our defence is the gap in our armour, so can my right hon. Friend give an update on where his Department is on this?

Matt Hancock Portrait Matt Hancock
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Yes, this is an incredibly important subject and we are working very hard on it with clinical leads and external experts. I said earlier that success has many fathers, and I am sure that the people of Barrow are very proud of their role in making sure that we could keep what needed to be kept confidential confidential. We have now had to change all those names, because everybody knows about it.

Covid-19: Community Pharmacies

Simon Fell Excerpts
Thursday 11th March 2021

(2 years, 12 months ago)

Westminster Hall
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Graham Brady Portrait Sir Graham Brady (in the Chair)
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The sitting is resumed. The debate may now continue until quarter past 3.

Simon Fell Portrait Simon Fell (Barrow and Furness) (Con) [V]
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It is an honour to serve under your chairmanship, Sir Graham. I thank my hon. Friend the Member for Thurrock (Jackie Doyle-Price) for securing this important debate.

The pandemic has shone a light on some of the more extreme challenges that we face as a society, but it has also highlighted the role of some of the institutions that support our communities—quietly, day in and day out. They are there for advice and support and offer a friendly and welcome face to those who are not reassured by going through online channels. Some people want a relationship but do not want to trouble their GP, and community pharmacies fill that role. These institutions have long been at the heart of all our constituencies, offering so much more than just prescriptions.

It would be remiss of me not to mention a few of the local pharmacies in my community and the incredible work that they have done and continue to do as part of the NHS family. Cohens, Coward’s and Murray’s, among others, are Furness institutions that have been remarkable in the support they have offered the community over the past year. Not only have pharmacies remained open over the past year; they are now supporting the vaccination programme.

A local pharmacist, Ben Merriman, was out vaccinating in Millom yesterday. I was told this morning of one pharmacist who was doing the same and, at the end of a very long day, found that their final patient was needle-phobic. It took an hour of gentle persuasion to get that final needle into the patient’s arm, which shows in one simple act the generosity and forbearance of the community pharmacist. This is a sector that we need to nurture and support, especially now.

Let us be honest: community pharmacies are struggling. While they have never been busier—significantly busy at the moment—90% of their business is pharmacy work and not retail, and that part of their business has dropped off. They have also seen a significant increase in their workload as the number of consultations they have taken on has increased since the start of the pandemic. Some of that is due to the approachability of community pharmacies, and some of it is due to word of mouth. If someone has had a good service, they are more than likely to tell their friends and family.

The Government’s support for this arm of the NHS is welcome, and the £370 million helped to deal with some of the immediate cash-flow issues at the start of the pandemic. I am sure my hon. Friend will continue to engage with the PSNC to ensure that this vital arm of the NHS has the support that it needs to stay afloat. Ultimately, if pharmacies close—that is what is happening now and it will continue at a faster rate if it is allowed to progress—the patients of Furness and those in constituencies around the country, along with the rest of the NHS, will suffer.

No one could have predicted the pandemic and the massive impact that it would have on the NHS, the Exchequer and the country as a whole, but pharmacies were already under massive financial strain before this. I have already lost one pharmacy in Barrow and several others have cut their hours because of financial cutbacks. It is worth looking at where the bulk of pharmacy closures have taken place in the past four years. The vast majority sit in the most deprived areas of our country, where we need to level up healthcare the most. Squaring that circle is the challenge that my hon. Friends in the Treasury face—one that they are no doubt alive to.

As my hon. Friend the Member for Thurrock said when she opened the debate, community pharmacies are the front door to the NHS. We need to make sure that that door stays firmly open.