Community Pharmacies

Victoria Borwick Excerpts

Wednesday 2nd November 2016 Commons Chamber

[David Mowat]

These are private businesses, each with a different business model and a different amount of income from the NHS, from other retail activities and from services. Each is financed in a different way. Indeed, 30% of them are owned by two public companies, and 70% of them are multiples.

[Victoria Borwick (Kensington) (Con)]

Can reassurance be given that local pharmacies are the frontline of primary care? Will the Minister extend the work and responsibility of those local pharmacies, particularly in deprived areas, and reassure us that that is the focus of this debate?

[David Mowat]

I spoke to 500 pharmacists this morning and gave them that precise reassurance. The changes that we are making to transform the sector into a service-based, not dispensing-based, economy will do just that. That is where pharmacies need to go and it is where they want to go. Frankly, it has taken too long.

Cities and Local Government Devolution [Lords] Bill

Victoria Borwick Excerpts

Wednesday 21st October 2015 Commons Chamber

[Karin Smyth]

I am pleased—along with my neighbour the hon. Member for North East Somerset (Mr Rees-Mogg)—to give the Committee a bit of respite from the subject of Manchester and to talk a bit about Bristol instead. Bristol has been a trailblazer for devolution and, in 2012, it was the only city to choose to have an elected mayor when the question was put in a referendum. I am a keen supporter of devolution and of transferring power closest to the people it affects, and I was proud to make my maiden speech on that subject. I am perhaps not as much of an evangelist as the hon. Member for Altrincham and Sale West (Mr Brady), but I am keen for devolution to happen.

Let me pick up on a unique issue which means that the people of Bristol do not share the same democratic rights as the rest of the country. The Bill started in the House of Lords, where Baroness Janke moved an amendment, now clause 21, which, if passed, would give Bristolians the right, after 10 years, to reverse, if they so wished, the decision we made in 2010 to have an elected mayor to govern our city. If the model is not fit in 10 years, we would like the opportunity to change it. By that time, citizens will have had ample opportunity to assess the value or otherwise of the current model, how it works in Bristol and, crucially, with the changing situation, how it would work across—I will not use the word CUBA, or indeed Avon—the wider Bristol area and with our neighbours in a combined authority.

This is not about personalities or whether we like or dislike the current mayor or would prefer a different person in office; it is about the system that works best for us in the city region. It is not about party politics either, because all the major political parties on the city council agree and supported a joint motion to that effect. I am very grateful to Baroness Janke, a Liberal Democrat peer, who did a lot of work in shaping and gaining support for the clause when it was in the House of Lords. It is about democracy. It is about whether we should have a voice and a new model. We should now be given that say. In an era when we are supposed to be seeing an increase in devolution and empowerment, it feels wrong that we as Bristolians should have to go through a long and tortuous legislation-making process to know whether we have the right to determine the way our city is governed. This clause would allow us to do that much more easily.

I hope the Government are able to support that provision, and give me and the people of Bristol a greater say in how this works for us in the future.

[Victoria Borwick (Kensington) (Con)]

Turning to another aspect of devolution, I would like to talk about the importance of health devolution. I obviously welcome the Government’s devolution revolution, which the Bill will help to deliver. In London, the Mayor has been campaigning for greater fiscal devolution and I know he applauds the recent announcement on business rate reform, as this will benefit our capital.

The devolution revolution that the Bill champions will ensure that Greater Manchester becomes the first English region to have full control of its health spending. However, as the Minister will be aware, London government has also been exploring how a similar model could work in the capital. As we all know, health is no respecter of ward or council boundaries. People live in one area and work in another, and may receive treatment for complex conditions in more than one area. That is why it is so important, in cities such as London and others that have been instanced today, that it should be viewed as a whole.

For a patient receiving many different treatments, it is far more effective for their care to be under one authority. As the previous deputy Mayor of London watching over this brief, I chaired many cross-London forums where councils and health authorities have come together to share resources and work together for better outcomes instead of being able to afford a smaller service in their locality. I would therefore argue that London, like Manchester, should explore ways to reform health and care provision, including a rebalancing towards prevention, early intervention, and proactive personal care and support. The aim should be to reduce hospitalisation, invest more in primary care, and integrate planning and decision-making for both the health and care services. Inevitably, there needs to be a review of NHS properties, including underused facilities, so that new integrated care centres can be opened and we have a more efficient use of the health estate.

There is agreement among London partners that the scale and complexity of health and care issues in London means that a model of reform should include actions at local, sub-regional and pan-London level. As part of their submission to the comprehensive spending review, London government made the case for greater devolution over health and social care. In the interests of brevity as we are short of time, I shall reduce the list substantially and just mention public health powers, including regulatory and fiscal interventions; multi-year allocations of NHS and local authority funding on a borough footprint; and London’s share of national NHS transformation funding.

As the Minister will know, representatives from the Greater London Authority, London Councils, NHS England, the London office of clinical commissioning groups and Public Health England are developing a memorandum of understanding to progress this work and to look at the powers that could and should be devolved to London. The recent London Health Commission report also advocated a London health commissioner, who could focus on the particular concerns of our growing city with its transient population. In London, we see diseases that many of us thought had died out, such as tuberculosis and rickets. They are often seen in people who were born or have grown up elsewhere, bringing pressures to the health system in London.

I am asking the Minister to welcome the approach being taken by London and support the aspiration for the greatest possible speed of reform to improve the health of Londoners.

[Mr Steve Reed (Croydon North) (Lab)]

I start by putting on record my condolences to the family and the many friends of Michael Meacher on the very sad news we have heard this afternoon. I am sure that we will have the opportunity to pay our respects to him properly and recognise the huge contribution he made to politics, Oldham and the life of this country and this House.

Turning to the Bill, this is a very exciting and long-overdue agenda. The UK, and England in particular, is deeply over-centralised. This holds back our regions, cities and communities. We welcome the Bill. It is a positive step forward. It is broadly, as the Minister said, of a consensual nature and I welcome his readiness, as he expressed it earlier, to listen to this debate before coming back with his final proposals. That does not mean, however, that there are no areas where the Bill could not go further or be improved. We have heard, across the Chamber this afternoon, plenty of examples of such areas.

Listening to the Minister, it struck me that he was on his weakest ground on the issue of mayors. A number of MPs from all sides spoke very eloquently about imposed mayors. It is right that areas that want mayors should have mayors. The Greater Manchester combined authority made it absolutely clear that it supports its mayoral model and we absolutely back it on that. When that applies to other areas, that is absolutely fine: if that is the model they want, that is the model they should have. However, the Secretary of State should not be able to force mayors on areas that do not want them. He has not been at all clear on how a metropolitan area that wants to proceed with devolution but without a mayor, is able to do so. He has made the one conditional on the other.

Clause 3, as it stands, is an important clause. It ensures that mayors cannot be made a condition of devolution and we believe the Government are wrong to seek to remove this important safeguard. We will wish to test the opinion of the Committee on that.

--- Later in debate ---

[James Wharton]

We have had an interesting and wide-ranging discussion that none the less has retained the cross-party support for the Bill’s broad objectives that I detected on Second Reading. There are concerns about some of the amendments, and the shadow Minister has indicated his intention to test the will of the Committee on some of them, but on others I have listened carefully to, and will consider, the informed contributions of hon. Members on both sides. However, I do not think that detracts from the fundamental truth that many Members of different political views would like the devolution agenda advanced and the Bill to succeed. I am pleased that that is the case and hope that we can move forward in that vein. I want to touch on some of the specific comments made in today’s debate.

The hon. Member for Nottingham North (Mr Allen), who kindly described me as a benign Minister—I have been described as benign and as a velvet glove this afternoon, although at least one Member indicated from a sedentary position disagreement with at least one of those statements—is on the record as a supporter of devolution. I have discussed the issue with him in this place and outside it. I recognise that through his amendments he wants to make his position clear that devolution should go further—he anticipates that in due course it will go further—and wants to entrench elements of devolution as part of our constitutional settlement. I understand his desire to deliver that, but some of his amendments may go a little too far from the nature and scope of this Bill in respect of what he wants to deliver constitutionally. I listened carefully to what he had to say and I recognise his expertise in this area and welcome his contributions.

My hon. Friend the Member for Amber Valley (Nigel Mills) talked about his desire to see local government reorganisation tied in with some of the devolution deals that are being delivered. We do not resile from that prospect—it is not something that we are necessarily against—but we are cautious when it comes to any proposal that would move towards imposition of that sort of reorganisation. This is going to be a consensual process—the Bill is designed to allow for that—and that is what it must be if devolution is to be a lasting settlement. I recognise the point of my hon. Friend’s amendment 39 and the consultation that he envisages within it, but I do not think that it is a step that we want to include at this time.

The hon. Member for Bristol South (Karin Smyth) made a cogent argument about the mayor and the provisions for people to have a say about that mayor, bringing the provisions into line with requirements and legislation that exist for mayors in other areas. I recognise what she said and hope that we can find some agreement on this area that she will support. I have certainly taken note of her comments and her useful contribution today.

My hon. Friends the Members for Altrincham and Sale West (Mr Brady) and for Hazel Grove (William Wragg) commented on a range of issues and a range of amendments, including on their desire for referendums. I talked about the issue in my opening remarks and set out why I think the process we are talking about here is different, with different types of mayors from those we have seen before and differences in the nature of what we are doing, with the transfer of powers down rather than up. I have listened to my hon. Friends’ comments and hope that, while we may disagree on some of the specifics, we will find broad agreement, and I look forward to having further discussions with them about how best to achieve that.

[Victoria Borwick]

I want to return to the point, mentioned across the Chamber, about the work that can be done collaboratively on health issues. We saw the work done on dealing with violence against women, and I want to reiterate the importance of devolving health to these larger areas.

[James Wharton]

My hon. Friend brings a wealth of experience to this place, and I welcome her comments and interventions. She has stated her position very clearly on the record. As we move through the course of today’s debate, we will have further opportunities to discuss the potential for health devolution. I recognise my hon. Friend’s case particularly in respect of London. The Government have the capacity to discuss and continue to discuss with the Mayor of London and London local authorities the sorts of changes they would like to see to the existing settlement. It is important to recognise my hon. Friend’s comments, to welcome the co-operative spirit in her approach and her desire for London to benefit from the sort of changes that are going to be delivered to other areas through this Bill.