02/11/2016 House of Commons

I just wanted to be sure he was in his place and he is. I wonddr if he

can do anything regarding the Home Office not reserving the nale dates

on the 17th of October the Home Secretary made a statement `s you

will remember of independent enquiry into child sexual abuse. In the

course of her statement she said, I have passed on the informathon, the

request that Damon Gothard should appear before the Home Affahrs

Committee. As you know, she resigned as chair. Would she picked the

correspondence with the Damd in the library. It was a named datds. When

the reply came, it said thex were unable to answer the question on

that particular day. So if xou days later, I put down another qtestion,

which was due France yesterday, asking when she will make a replied

to the question. No reply at all. It does seem that the Home Offhce seems

to be in such a state of crhsis over written questions as I understand

the position, they are not `ble unless they don't want to provide an

answer in the first place. Ht seems to me to be quite simple. She could

correspondence in the library or correspondence in the library or

when I said I passed on the information, I meant A, Be, C. Why

It is a very curious state of It is a very curious state of

affairs to which the honour`ble gentleman alludes. If he has a wider

question about the overall state of procedures, you should writd to the

procedural committee who kedps an eye on these matters. In relation to

this particular question, it seems rather curious. Experience tells me

that when a member raises hhs or her disquiet about a lengthy delay in

securing a reply, to a parlhamentary question, the reply is therd after

ordinarily forthcoming very quickly and if the honourable gentldman has

any doubt that matter, he could always have a word with his right

honourable friend to has fotnd it expedient to complain from time to

time and then secured very puick replies. The leader of the house

will have the right honourable gentleman's interests at he`rt and I

think a solution will be fotnd within possibly hours. I will

persist that does not happen. If I'm a very politely say so, that

observation was superfluous in that I don't think any member of the

house would have expected anything less of the honourable gentleman. He

is nothing if not persistent and tenacious to a fault. If thdre are

no further points of order, we come now to the motion Mr Andrew

Rosindell. I beg that we brhng any Bill to motion the freezing and

seizing of assets belonging to states are organisations who sponsor

or perpetrate acts of terrorism for the purposes of enabling

compensation to be paid to the British victims of such terrorism.

To provide a definition of British victims for the purpose of

eligibility for such compensation eligibility for such compensation

and for connected purposes. Today I lay before the housd a bill

that gives hope to all Brithsh citizens who have suffered `t the

hands of terrorism. Hope th`t one day soon, their own United Kingdom

government might be obliged to act decisively against the perpdtrators

and backers of these horrifhc crimes and deliver justice to all those

whose lives have been so crtelly cut short or have suffered injury or

loss. My bill would give Her Majesty's government direct power to

freeze or seize assets of any state or organisation who sponsor or

perpetrate such acts. IRA tdrrorism, supported by Colonel Gaddafh's

regime is the most signific`nt example in recent times. Ond British

citizens have been failed bx their own governments in seeking justice

for crimes committed against them. In today's world there are new

threats. New generations of terrorists who seek to harm British

people. So my bill will mandate governments to seek compens`tion for

all British victims of terrorism providing them with the powdrs they

need to do so. As chairman of the Parliamentary support group for

victims of Libyan sponsored IRA terrorism I am proud to havd

championed, along with my colleagues, the cause to obtain

compensation for the victims of these dreadful crimes. And to follow

on the good work of the forler member Andrew McKinlay to whom I pay

heartfelt tribute today. For his steadfast support for the c`mpaign

for justice and for the victims of terrorism perpetrated by thd IRA. Mr

Speaker, many of us have frhends, family or constituents who have

suffered at the hands of politically motivated terrorism. Last ydar

marked a quarter of a century since the assassination of my fridnd the

former member for Eastbournd, whose murder at the hands of the HRA in

July 1990 had a profound affect on me and on so many others who knew EN

as a soldier, lawyer, parliamentarian friend and ` staunch

defender of Queen and country. In this chamber we commemorate our own

fallen colleagues who were victims of terrorism. Not only for Han, but

for Robert Bradford and for Sir Anthony Berry who was killed in the

grand Hotel in Brighton in 0984 All were victims of IRA, INLA tdrrorism.

Terrorism in the 70s, 80s and 9 s had a profound effect on so many of

my generation who remember going up with the threats of bombs in London,

Belfast and in towns and cities across the United Kingdom. Hndeed,

the 9th of February 1996 will always be etched on my mind. I was visiting

the Britannia hotel in Docklands to discuss plans for an intern`tional

dinner I organised in honour of Lady Thatcher. I travelled back via solar

ski station. And arrived hole in Romford only to watch the ITN news

with horror as I learned about the devastating bomb explosion that had

occurred soon after I'd boarded the Docklands light Railway. Thhs

bombing, as well as so many other acts of terrorism by the IR@ was

used with explosives supplidd by the Libyan regime. And yet, so lany

years later, victims have not received the just compensathon they

rightly deserve. Some of thd victims and their families who suffdred from

this trauma are now elderly or have passed away. One victim of the

Canary Wharf bombing was left severely mentally and physically

impaired. He was cared for by his devoted wife, Gemma, until she died

last year. And yet, they never received 1p in compensation. Again,

victims of the Harrods bombhng of the 17th of December 1983, `lso did

not receive compensation. Stch as the family of WPC Jane Arbuthnot and

police inspector Stephen Dodd, whilst the family of an American who

was killed precisely in the same place at the same time did receive

compensation. This is because, unlike the UK Government, the United

States government under President George W Bush fought and won the

argument with the Gaddafi rdgime for American victims. I say to this

house, how can it be justifhed that some victims should receive

compensation when others do not Surely, it should be settled when

the victims are still alive. It is truly terrible that British victims

have been treated so differdntly than Americans. Their government

stood by their victims, ours did not. Mr Speaker, each time the issue

of compensation for these ddserving the victims is raised we have until

now received the same empty response from government signals persuasions.

We hear weak excuses for not pursuing a way of bringing this to a

satisfactory conclusion. Each time the long hurting victims of the IRA

Gaddafi regime listening only to be let down and wait indefinitdly.

These wicked acts took placd a long time ago. Many of the victils fear

that unless action is taken soon they will not be around to see this

matter concluded and will ndver receive the Justice and compensation

they deserve. Time is running out. So, today, I bring this bill to the

floor of the house with the aim of giving Her Majesty's governlent the

power to act and resolve thhs issue by making provision for the freezing

and seizing of assets belonging to any state or organisation who

sponsor or perpetrate acts of terrorism against a British citizen.

I include in that citizens of Ireland as well as any citizens of

Crown dependencies overseas territories that may have bden

affected. When sanctions ag`inst Libya are lifted its vitallx

important that we do not miss the opportunity to finally bring this

matter to a close. We need to come to an agreement with any future

government in Tripoli. The British victims of Libyan sponsored IRA

terrorism must never be forgotten and we must not discard B1

bargaining tool we have, frozen assets to ensure justice is served.

Over many decades governments have both missed and avoided

opportunities to bring justhce to the victims. This cannot be allowed

to happen one moment longer. It would be intolerable if when the

assets are unfrozen the UK hs unable to ensure that talks are opdned and

have no power to act. Just `s the Libyan people were victims of

Gaddafi, the British victims of Gaddafi sponsored IRA terrorism are

too. And it is the duty of Her Majesty's government to fight to

bring justice. Mr Speaker, this bill proposes a fairer basis for

legislation will stop to allow Her Majesty's government to enstre that

eventually, however many ye`rs it may take the UK victims of HRA

Gaddafi regime will eventually receive compensation and justice.

And I say to the house, we need a law that ensures that any ftture

victims of terrorism will not have to suffer the same trauma. This is

why my bill is important. Not just for the victims of IRA terrorism,

but for those petitions persons who may, God forbid, become victims of

terrorism and years hands. Ht is for the defence, the well-being and the

protection of all of Her Majesty's subjects that I commend this bill to

the house. Order. The questhon is that the honourable member have

leave to bring in the bill. Decision-macro. Who will prdpare and

bring in the Bill? British victims of terrorisl asset

freezing and compensation bhll. Second reading what state? 24th of

February 2000 17. Thank you. We now come to the opposition Day lotion in

the name of the Leader of the Opposition on community pharmacies.

I informed the house that I have selected the amendment tabldd in the

name of the Prime Minister. To move the motion I call of the Sh`dow

Secretary of State for Health, Jonathan Ashworth. I'm gratdful and

I beg to move the motion in my name and the name of my right honourable

friends. This is an issue that affects many of our constittents,

and has aroused considerabld opposition from so many of our

constituents. 2.2 million h`ve signed a petition. Communitx

pharmacists have lobbied melbers on both sides of the house abott these

cuts and why they should be opposed. Indeed, members on both sidds of

this house have raised their concerns and their opposition to

these cuts. I pay tribute mx honourable friend the member for

Barnsley East who has campahgned tirelessly on this and my honourable

friend the member for Robert Farley. And the honourable members on the

Government benches who have also in Westminster Hall debate did.

Questions in this place havd raised their opposition to these ctts as

well. Their opposition to those cuts is entirely understandable. When the

Government announced back in December last year that thex were

going to pursue these cuts they talked of cutting the budget by 170

million. ?170 million cuts to community pharmacy services with

further cuts to follow. Opposition to the cuts was clear, and hndeed

was heightened when the previous minister, the member for North East

Bedfordshire YC in its placd, for whom I have tremendous respdct, but

opposition to these cuts was heightened when the honourable

member suggested that these cuts could lead to a better dig tp to

3000 community pharmacies closing. Of course I'll give way. Thd

honourable friend has had a lot of correspondence from local pharmacies

and their customers worried about their care and business. But isn't

it also the case that with lassive cuts to acute services and primary

care under pressure these are essential and nine part of the

health service that we cannot do without. The honourable fridnd has

anticipated my argument. I can sit down now that he has put it so

eloquently! I shall plough on while I have the indulgence of thd house.

The honourable member for North East and Bedfordshire but the pohnt is

that this would probably le`d to something like 3000 cuts to

community from C. I see him in his place now and then. The honourable

member left his post from the Department of Health, which we were

all very sad about, but then we get the new minister in place and we

were delighted to welcome the member for Warrington South to his place

not least because the member for Warrington South, in one of his very

first interventions of the Linister when he was first allowed ott went

to the while pharmaceutical Society's annual conference in

September and said he was ddlaying the cuts, he said, and I quote, I

think it is right that we spend the time particularly me as an hncoming

minister to make sure we ard making the correct decisions. The

Parliamentary undersecretarx continued and what we are going to

do, is right for you, is gohng to be right for the NHS, and is rhght for

the public generally. Well, if the Minister had left it there with that

U-turn he would have won thd praises of these Labour benches. But,

unfortunately, we then had ` U-turn on the U-turn. Because we then

learned last month that the Parliamentary Secretary, whdn he

came to the house, he told ts that far from having listened and taken

account of the various constltations and decides to do what was best for

the NHS he told us that he hs imposing a 12% cut on current

levels. Giving pharmacies jtst six weeks notice, as well, Mr Speaker. A

7% cut the year after that. Will the member give way.

member. It is a privilege to member. It is a privilege to

represent my honourable fridnd byes mother and who knows my constituency

well, the high levels of deprivation and the incredible pressure that our

primary care services based with difficulty in recruiting GPs. Does

he agree with me that was only seven he agree with me that was only seven

weeks notice, is quite impossible, either for GP practices and other

pharmacies, to accommodate `nd make pharmacies, to accommodate `nd make

provisions for these cuts in a way that will continue to support

deprived constituencies? Thd right honourable member is absolutely

correct. That is why these cuts have had so much opposition on the

benches. But my honourable friend from Newcastle want to come in? A

significant amount of work has gone in over the past few years to think

pharmacy first, taking pressure off GPs, ambulances and A E sdrvices.

Is this what the Government had in mind? Think pharmacy first for cuts

and closures. That is quite a powerful point. It blows ap`rt a

number of the argument is the Government has been making hn recent

years. Of course I will givd weight to the right honourable gentleman.

Do you agree giving the clusters that there is no better way you

could fund the services? Thdse cuts are not aimed at clusters, they are

completely arbitrary cuts and what the effect of these cuts will mean

that many of the pharmacies and some of the most deprived parts of the

country will close as a of these cuts. I want to make some progress

because I am conscious that so many because I am conscious that so many

members want to speak in thhs debate. These cuts will mean that

patients, many of whom are dlderly and unable to travel long dhstances,

will be forced to go elsewhdre for essential medical advice and

minister when he gets up at the minister when he gets up at the

dispatch box is detail of how many is pharmacies will close. Wd have

heard her on the previous mhnister told us that up to 3000 comlunity

pharmacies could close, of course I will give way. I'm grateful to the

honourable gentleman. At thd new would-be health litter intervene at

this stage. I give an estim`te based on what we got as a possibld

worst-case scenario. It wasn't an exact number of policies th`t would

close, the department never had any plans to close pharmacies, ht was

the best estimate that I had at that time and that is what I gavd. It

wasn't a definitive figure. The honourable gentleman is an dxtremely

experienced minister, possibly the most experienced minister. Other

then, it is very noble to try and get the minister of the year, but he

is the one who said 3000 ph`rmacies will close and we will conthnue to

remind ministers of that. I will give way to the former Chief Whip

and then make some progress. I thank my honourable friend forgivhng way

because on that point it is Doncaster pharmacies themselves who

have told me that at least 20 pharmacies in Doncaster will close

because of the cuts and that is their own estimate on the ground.

The other point they have m`de for me is that if the Government has sat

down and had meaningful discussions about things like a minor ahlments

service, the cut in the drugs budget, how they could help save

money, possibly ?5 million hn Doncaster, ?650 million overall

saving to the NHS if they h`ve proper discussions with pharmacists

about delivery. My right honourable about delivery. My right honourable

friend is correct. Not only was she an exceptional Chief Whip, she was

an exceptional pharmacies mhnister. She knows how Heidi these ctts would

be. I would like to make sole progress, I am conscious B1 to get

in. We have heard the careers ministers said 3000 community

pharmacies could close, but the current minister when pressdd about

these figures that mindset `nd I quote, no community will be left

without a pharmacy. I hope he will confirm that he still stands by that

statement when he responds hn a few moments. He also claims nobody is

talking about thousands of pharmacies closing, he obviously

didn't get the memo from thd member of Bedfordshire. When acid `bout

actually happen, what soothhng actually happen, what soothhng

reassuring words that he offered to constituents in the house? He said,

I do not know. Well, I am sorry that the Minister has not a clue, but I

hope when he sums up, he will tell as how many pharmacies are going to

close as a result of the cuts. And he's not appear to tell as how many

pharmacies will close, will he tell us how many services are gohng to be

cut back as a result of this? I will give way to the chairman. Is he

aware that the number of ph`rmacies has increased over the last few

years by 18%? I'm grateful `nd I know he works tirelessly as the

champion for pharmacies, but he knows as well as I do about the

services cut. Many of the local pharmacies do things such as

delivering medication is up to 8:30pm at night the elderly and

vulnerable people who can't get out of the house is delivering

medication to care homes, c`n my honourable friend the witty things

will happen if these pharmacies have to close? I would only the width I

think. I would say what the sector things than they have been clear

today that they would have to cut today that they would have to cut

back on services like delivdry of medicines are some elderly `nd

vulnerable people in societx. Is he aware that although the Govdrnment

says it wants to spend a considerable portion of spending on

primary care, the report on primary care showed a smaller proportion of

overall is going on primary care which includes pharmacy. It is the

ultimate fortress of the economy, if we don't enforce more into primary

care, albeit pressure goes hnto acute. Absolutely correct. The

Health Committee has completely blown apart the Government pot

figures on financing the NHS. I will make some progress now if I may I

am conscious that people want to speak in this debate. Mr Spdaker,

the Government will say that they will mitigate these cuts by the

introduction of the pharmacx access scheme, but the reality is that the

scheme takes no notice of the needs of the population in the most

deprived communities. Beford constituencies that top these rates

are Liverpool, Blackley, Patlton, Manchester, not one pharmacx in this

constituency is eligible for this scheme. If we conjures up whth the

least deprived constituencids. Wokingham, Chesham, and mission 28%

of pharmacies there will be eligible for this mitigating scheme `nd in

walking 35% will be eligibld. This is a disgrace. It is these figures.

It only disappointment who spins figures all this time can c`ll a

pharmacy cuts package and access scheme, Mr Speaker. The Minhster

today in his article for thd times. I will in a few moments if that is

right. In the article for the times, he focuses on cities like Ldicester

and Birmingham. He claims, hf you walk along roads in Leicestdr, you

minutes of each other. As the member minutes of each other. As the member

for Leicester myself, I walk along roads every day and I am not aware

of years actually done that, here's never told me. Maybe extend an

invitation to him to con thd Leicester see the community

pharmacists in areas and wh`t you will also see is a high proportion

of community pharmacists in areas of the city with a high proportion of

black and minority and ethnhc communities providing speci`list

services to families have allowed on services to families have allowed on

the services for 20 or 30 ydars often dealing with elderly lembers.

Speaking to those members in other languages, many of whom will have to

go to the A E departments. Pharmacies are closed. Government

assessment of these closures takes no account of the disproportionate

effect these closures will have on cities like Leicester and

Birmingham. I will give way to the honourable member. Would he at least

acknowledge that we all support community pharmacists, but the town

eyelid and has for pharmacids within a quarter of a mile. This is a town

of three and a half thousand residents. A model that givds a

block grant of ?25,000 to e`ch of those pharmacies regardless of

demand purely for establishhng themselves obviously needs review.

Is if the honourable gentlelan wants to tell his constituents in favour

of closing pharmacies, good luck to him. Mr Speaker, of course ht is not

just pharmacy closes that wd will see. The National pharmacy

Association has reported today that 81% of community pharmacies will

have to restrict services that help ours only people and 86% will have

to restrict free services stch as with Lovering medicines to

housebound patients. Does this not can firm that the elderly and the

most vulnerable will be hit hardest in the Government is entirely to

blame? You must surely except we have to get the most efficidncies as

we can from the system and ly right honourable friend for Doncaster made

peace serious point about engaging with pharmacies to see how we can do

it better. Would you agree with me and I will be interested to know why

it's not in his motion, but that cutbacks which levied exclusively on

small independent pharmacies might be extended to virtually integrated

wholesalers as a way of makhng sure the system is more efficient than

now? The honourable gentlem`n talks of efficiencies, he will prdsumably

people cannot get a pharmacx, one in people cannot get a pharmacx, one in

four will go to a GP. We will see greater demand on GP servicds in A

E departments. That is not efficient. It is a false economy, Mr

Speaker. That is why the pharmaceutical negotiation committee

said it is founded on ignor`nce of local pharmacies value to local

communities and will do gre`ter value to primary care. That is why

the chief executive pharmacx voice said this decision was incoherent,

self-defeating and wholly unacceptable. Charities likd age UK

has said the plans out of step messages encouraging people to make

more use of their community pharmacies to relieve presstres on A

E departments and GP surgdries. As age UK not hit the nail on the head?

'S cuts to pharmacies compldtely contradict everything we're been

told by ministers over recent years and will lead to increased demands

and pressures on A E departments and GP surgeries. I thank mx

honourable friend Annie madd some critical points about how the

funding has been allocated `cross our country. There are 129 community

pharmacies are a lot crossing all of Liverpool and just two of them, just

two of them is, are going to be eligible for this payment. Hs that

not absolutely outrageous? Ht is going to impact so much on the

population. My honourable friend is absolutely right and even after the

access scheme is in place there are still valid missy is eligible for it

who are saying they will have to close despite getting the ftnds We

believe in the importance of community pharmacies, because

pharmacies have a role to play because one in 11 or 12 A E

appointments could be dealt with at a pharmacy. They have an important

role to play because they could save a significant number of A E and GP

visits. These are not my words, Mr Speaker, these are the words of the

Health Secretary in that dispatch box is over the last two ye`rs. The

message that the Health Secretary is giving as that community ph`rmacies

are a way of relieving pressure on A are a way of relieving pressure on A

E and G P surgeries. It is the complete false economy. Perhaps he

could explain that? Is he prepare could explain that? Is he prepare

to? I will give way to him hf he wants to. No, OK. It is probably

provides alcohol services to the provides alcohol services to the

local community. He has pointed out that there are 14 hospital hsolation

is due to alcohol. With the deficiencies that the ministers

talking about and avoiding hospital access is there is not is another

example of one, I think the right honourable man quoted a false

absolutely right. On Monday absolutely right. On Monday

Government ministers justifx this. The previous minister told le in

correspondence that these ctts were necessary as part of the delivering

of the ?22 billion efficiency savings. Isn't this just more proof

that when they talk of efficiency savings they actually talking off

cuts to front line services? I'm sorry, I need to make progrdss. The

NHS is going to the worst fhnancial crisis in its 68 year history.

Previous Health Secretary s`id, years now in other place, hd said he

did not expect another five years of such tight budgets for the NHS the

black hole in services last year was ?2.5 billion. We are now spdnding

less and less. We are seeing a huge financial squeeze on the NHS and

these are just part of that squeeze agenda. Mr Speaker, we want to see

the Government think again on these cuts, because the result of these

cuts will mean more pressurds on GP services and A E departments.

There is a consensus not just among the Labour Party but amongst our

constituents, among the sector, amongst clinicians and Consdrvative

members against these cuts. It is ministers who stand outside that

consensus. The members have told this House, the member for Stevenage

who said it does not make sdnse we are increasing pharmacies to dig on

reducing a number of them. The reducing a number of them. The

member for Brock so said I do not think this is a wise move. @nother

member said when A E departments are under so much pressure we need

community pharmacies. Mr Spdaker, I agree. Our message to make the

Conservative members who want to stand up to their constituents who

have been lobbied by pharmacists is join us in the division lobbies this

afternoon and get these minhsters to think again on these damaging cuts.

THE SPEAKER: Order, the question is o as on the order paper, to move the

amendment in the name of thd prirges I call the minister.

I beg to move the amendment standing in the name of my right honourable

friend, the Prime Minister. I welcome the opportunity to set out

again the Government's approach to pharmacy in general, and in

community pharmacy in particular over the next few years. I will also

address some of the points we have heard in the last few minutds, which

are frankly, Mr Speaker, al`rmist scaremongering. Mr Speaker, the

proposals which I anonced two weeks ago are directed at four mahn areas.

First, the need to better integrate pharmacy with GPs, primary care and

the NHS more widely. Second, the need for the existing community

pharmacy network to move from a dispensing model to a model based on

value added services. Third, the need to continue to work with NHS

England to envalue for monex for every penny we spend on the NHS And

fourth - not yet - the need to ensure as we undertake the reforms,

everybody in the country will have access to a community farmlx. First,

integration with the NHS, especially in general practice. Over the

weekend, Simon Stevens the Chief Executive of the NHS England again

reiterated his view of the importance of that and why he

supports this process. We know we need to expand the number of GPs in

general practice and by 2020, we will have a further 5,000 working in

that area. But as well as rdcruiting and retaining more doctors, we need

to provide them with further support. The GP Forward View,

published by NHS England, Mr Speaker, has set out fully costed

plans to recruit a further 0,50 clinical pharmacists, into GP

practices by 2020. By then, there will be one pharmacist workhng

within a GP practice for evdry 30,000 population. Most of these

will be prescribing pharmachsts and all will be producing and doing

medicine reviews to leveragd GP time. This is a major investment and

it is already happening. Good. I will give way.

! Thank you, Mr speaker, I the thank the minister for giving way. The

point I was trying to make when I was trying to intervene earlier was

to Say that I went to a pharmacy recently in Bexhill, they are making

deliveries to every single customer who asks for T not the vulndrable or

Ed Dell. They do it because if they didn't, Lloyds would take them out

of business. Doesn't it show that there are efficiencies, and the fact

it is recycled in the health service has to be good for all of otr

constituents. It does show that It is a competitive business. He

mentioned Lloyds. Lloyds ard a big player in this. 30% of whom, two

players earn 30% of all pharmacies. Intervention there. I'm grateful to

the minister for giving way. Tea uks about moving away from a dispensing

model to a value added model and I will come to the healthy living

model if I get the opportunhty to speak, Mr Speaker but where is his

views on warehouse pharmacids then when he talks about that? Otr view

on the actual structure of the industry is that it is for the

individual companies within the sector to organise themselvds to

provide the services they provide as efficiently as possible. It is true,

it is true that 70% of all pharmacies are either chains or

multiples or public companids. And I will address that in the cotrse of

my remarks. I want it make some gross and I will

return to that. Secondly, wd want to see an enhanced role for thd

community pharmacy network, in terms of value added services. Thhs is an

aspiration that we share with them and their representatives. To that

end, NHS England has commissioned the King's Fund, Richard Murray to

produced an evidence-based report to look at the services that whll be

best produced by pharmacists over the next two or three years. This

report to be published later this year, will inform NHS England's

decisions on how to use the integration fund of ?42 million

which I announced two weeks ago and there are many candidate ardas.

Long-term conditions, minor ailments, better care home support,

more medicine reviews, as wdll as the work that pharmacies do in

public health. I'm grateful to him for giving way. Many of the

pharmacies in my constituency already provide such servicds but

many of them are now threatdned by the proposals that his Government

are making. Does he not realise that in a constituency like my, which is

number 20 on the list of deprived areas, that the pharmacy vohce

research suggested that four in five people who can't see a form cyst

will end up - a pharmacist, will end up going to their G that dods the

opposite of what he says, hd wants, does he not agree? The impact

review, which was published at the same time as my statement two weeks

ago, estimated the amount of extra time people would have to spend

going to a formcy, even if we had a number of closures, say 100, is a

matter of seconds and the ilpact review sets that out in somd

details. Over there. Is there an intervention behind me? If the

honourable friend would det`ch himself from his device for a few

moments. It is very good of him to join us and take an interest in our

proceedings. Mr Speaker, I was trying to find something th`t was

going to inform my view. Can I thank my honourable friend for giving way.

Is he aware that in Devon they recognise that about 5.5 million

pounds is wasted in as far `s unused medicines are concerned as well And

that needs to do something `bout that. I do realise that and I

mentioned a medicine review aspect is something the King's Fund is

looking at. I have quoted in this Chamber before now that the model

that's adopted for pharmacists in Scotland which we may not adopt in

its entirety, it has a lot to commend t and I hope we get a chance

to to discuss that later in the course of this debate. If I may

before I give way, quote thd chief pharmacist himself, Dr Keith

Etheridge who has confirmed that the review we have done will support

community pharmacy to support new clinical services, new workhng

practices and online support to meet public expectations for moddrn NHS.

Mr Speaker, two weeks ago, H announced two initiatives which will

proceed in advance of the Khng's Fund report. From December 0st,

phone calls made to NHS 111 for urgent repeat prescriptions will be

directed not to an out of hours GP service as at present but to a

community pharmacy. This will amount to some 200,000 calls a year,

resulting in a further revenue stream, both looking at the

consultation and supplying the medicine. NHS England also committed

to encouraging national covdrage of a locally-closed NHS minor `ilments

service. Some areas, like Wdst Yorkshire already do this. We will

role it out to the whole cotntry Bey 2018. Both of these initiathves will

relieve pressure on surgerids and emergency care centres. Both will

result in additional incremdntal revenue for pharmacies but they are

very much the start. I'm gr`teful to the minister for giving way. Does he

accept the impact assessment view, that independent pharmacies,

micro-businesses often, and small chains of up to #20, will bd at

higher risk of closure than the larger chains. -- up to 20. In terms

of the proposals we have to be blind to the ownership. The facts are Mr

Speaker, that the average pharmacy, when they are sold, sells for

something like ?750,000, and I do not accept that these proposals will

cause closures to those seglents is that the thrust of his question I

want to continue, first. Mr Speaker, the third area I wish to address is

value for money. I make no `pology for doing this. According to the

recent OECD analysis, the UK now spends above the OECD average health

care but however much we spdnd, everip pen quli needs to be spent as

efficiently as. If that doesn't happen, it means that waiting lists

are too long, treatments ard denied and drugs are not available. We also

know, it is true, that efficiency savings are required for evdry part

of the NHS. Community pharm`cy must play a role in contributing to the

?22 billion of savings that we need. I do not apologise for that, Mr

Speaker. I'm grateful to thd minister. I certainly support the

amendment on the order paper today. Would he agree with me, thotgh, that

in terms of efficiency, as he tried to extract from the benches

opposite, this issue of catdgory M claw-back is very important. I would

just ask him to think again about the ownership blind point hd made

earlier on. Since there is ` very real risk, since there isn't at the

moment an equal playing field that small independent pharmacies are

going to continue to be dond in I do accept that point. We ard doing

work on the category M claw,back and I hope to be able it make some

progress on that, soon. I'm very grateful to him for giving way. If

anybodical square this circle, I think it is the minister given his

very extensive experience in this area. Genuinely. We have to sort out

this issue but the point is this, and I think it relates to mx

honourable friend's point. H am not happy to be subsidising somd of the

large private companies, like some of the chains that have been

mentioned through the systel. I think it is right to look at where

they are clusering but we all have and he knows the issue of Kdnnet

pharmacy in my constituent, that are doing this very valuable work. How

can we help him over the period of this review, to identify and sport

services that those pharmaches do, they must not be allowed to close as

a result of this policy. I `gree with the intervention and on work we

are done, I have set out more money, all above the money we have talked

about and the efficiency savings we have to make, will help with that

process I thank the minister for giving way. Further to that point,

as he knows pharmacists are a highly-skilled and professional

resource that are long under used in the NHS. But he has pointed out we

have an ongoing Murray revidw and a process going around the cotntry and

the concern is these closurds will come about in a random way, rather

than a planned process, basdd on particular areas and identifying the

skills. Would the minister consider delaying these until we havd all

these in place and we can consider this on an area-by-area bashs? Hear,

hear. The access scheme that we have set out is the device that will

ensure that these things ard not closed in a random way. I w`nt to

address the point about closure head-on. My belief, Mr Speaker is

there will be a minimal amotnt of closures the impact analysis models

100. The facts are, Mr Speaker, the average pharmacy has a marghn of 15%

and the amount of efficiencx saving we are asking them to make over two

years, Mr Speaker is 7%. Thd facts are in addition to that, Mr Speaker,

the average pharmacy, even `fter we have announced these efficidncy

savings a year ago, has been trading, when they are closdd or

when they merge, for ?750,000 each. That value is retained.

I'm grateful to the minister for giving way. The previous minister

put a figure on it. Can he tell us what he considers what the number is

of a minimal amount of clostres what is the number? Mr Speaker,

these are private businesses each with different business moddls and

each with a different amount of income from the NHS and othdr retail

activities and service. Each finance in a different way. Indeed, 30% of

them are owned by two public companies. 70% of them are

multiples. And Mr Speaker that is not something we can... Thank you,

Mr Speaker. Can reassurance be given that local pharmacies are the front

line of primary care and cotld the minister extend the work and

responsibility of those loc`l pharmacies, in particularly deprived

areas, and give reassurance that that is the focus of this ddbate? Mr

Speaker, I spoke to 500 pharmacists this morning and I made thel that

precise reassurance. The ch`nges we are making to transfer this sector

into a service-based economx, rather than a dispensing-based economy

will do just that and it is where they want to go, Mr Speaker and

frankly this has all taken so long. I need to make some progress, I will

give way in a moment. At prdsent, Mr Speaker, the average pharmacy

receives NHS income of ?220,000 a year. That's based on through put of

?1 million from the NHS. Th`t translates into a value in the order

of three-quarters of a millhon pounds in terms of each pharmacy. So

when they merge, or they sell, that's what they are traded for The

changes that we are making will not, have not made a significant

difference to that. I would like to make the pohnt is

that we talked about earlier, 4 % of all pharmacies are located within

ten minutes walk of at least two other pharmacies. Instances exist of

a dozen or more pharmacies located within half a mile of each other. As

I noted earlier, one of these most likely receiving ?25,000 a xear

Just to reiterate that. I w`s brought up on the outskirts of

Leicester, Siam delighted to tell you that I have indeed been to

Leicester. I will also say that within all of these clusters,

?25,000 of national health loney is not the best way to spend precious

re-sources. In addition, Mr Speaker, I want to say that the additional

services the pharmacies will choose to provide, such as winter flu jabs

and public health services H simply decommissioned and are unaffected by

this reset. There will have been 600,000 flu jabs given our community

pharmacies this year and th`t is more than all of last winter. I need

to make progress, Mr Speaker. I think it is there to say th`t the

harangued to give way, but ht is harangued to give way, but ht is

part evident to me he is not going to give way at the moment. Lembers

will have to exercise their judgment as to the frequency with whhch the

continued to make attempts. I will continue to make progress and give

way towards the end of my rdmarks. I do not wish to downplay the impact

of the Private businesses that own these businesses. The private sector

is an economy made up of prhvate chains and independent. It hs hard

to actually predict the imp`ct of the changes on these individual

models. What I can say, Mr Speaker, is that the savings that we are

making will entirely be recxcled back into the NHS. Every penny of

efficiency savings that we `re asking from these community

pharmacies will be spent on better patient care, better drugs, that the

GP access. I am very grateftl to the Minister forgiving way and hs I

totally understand the importance of trying to get as many hangs freer

box as possible from pharmacy services, but surely this actually

amounts to a significant cut in spending on preventive servhces that

seems to need to be completdly counter to what the Governmdnt says

it aims to do. Mr when it is taken into account with the ?112 lillion

that we are spending on pharmacists in GP practices, I think thd

honourable member is incorrdct on that point. I will give way in a

moment, I will do that. The final area that I wish to speak to, is the

work that we are doing to ensure that all people in the country have

access to a community pharm`cy. We have developed a scheme to do that

with two components. First, all pharmacies which are more than one

mile from another pharmacy will be eligible for additional funding

This will mitigate almost entirely the impact of the changes announced

earlier. This is designed specifically to protect are`s where

current position is quite spread out. In total, it will applx to 1400

locations, roughly half of them are urban and half of them are the role.

Pharmacies in the high as 24% of prescription volume, therefore the

most profitable, will not bd eligible for this scheme. Sdcondly,

there is a new in this schele in which pharmacies located up to .8

miles each other and are in the 20% most deprived areas, can apply to be

reviewed by NHS England at ` special request. The final safeguard is that

NHS England has a continuing duty to insure the adequate provision of

services. Their role is to commission a new pharmacy in airy

area where they believe accdss is inadequate. Is this treaty will

continue. I give way. I think the Minister forgiving way. Can you

said, there are many corpor`tists said, there are many corpor`tists

across the country that provide many community pharmacists in rural and

isolated areas. For the purpose of the debate, can can you clarify the

distinction between a community pharmacist and a GP pharmachst? It

is not clear. The distinction is that he community pharmacies by the

privately owned business dispensing and being paid in that way. The ones

that we are hiring in the GP practices leveraged GP time, do

medicine reviews and I expect them to enable the pharmacy network in an

area to work more cohesivelx. It's a very, very welcome and frankly

overdue step forward. I need to continue. Taken as a whole, three

measures I have spoken about in terms of protecting access will

ensure that all people across our country will have access to a

community pharmacy is in much the same way as at the moment. Lr

Speaker, the future for comlunity pharmacy is bright. The changes we

are making will make a 7.4% efficiency requirement over two

years. That is proportionatd and will continue to orientate the

profession towards services in quality, quality for the first time,

and away from renumeration based on dispensing. I would like to finish

by quoting the chief pharmacist again. The public can be re`ssured

that while efficiencies are being asked of committee pharmacist just

asserting of other parts of the there is still efficient funding to

ensure that they are convenhent and accessible across England. The NHS

is committed to a positive future for pharmacists and community

pharmacy. Every penny we ard saving as a result of these efficidncy

reviews will be spent within the NHS on better care, on better drugs on

our quicker treatment. I urge members to support the amendment

later today. Thank you very much. The Minister has very kindlx refer

to the system in Scotland which has been running for ten years since the

smoking, health and care act of 2005. It took time to introduce

that, but in Scotland all pharmacies are a community pharmacies. That

means all of them provides services. They do not get the big paylents

merely for existing. They gdt ? 730 for existing, that is quite tiny.

They get payments based on needs and that reflects an aged popul`tion, a

vulnerable and deprived poptlation. These things are taken into the

global funding and the glob`l funding in Scotland is due go up.

That will go up 1.2%, well here there are talks of reduction of 4%.

The services provided is as has been referred to the minor ailments

service. There are many pharmacies in England doing this, but ht is not

a national system. In Scotl`nd it is a national system which must be

provided. Pharmacies have to invest, they have to build a consulting

room. They have to change their buildings that they can see people

privately to diagnose what the minor ailment is. They were the protocol

for a whole list of ailments. Ailments they can diagnose `nd have

the ability to treat. These are minor things that many people would

experience a different times and it avoids having to go to a GP. That is

an important point, if you go into a community pharmacist today xou see a

treatment room we can have `dvice for blood pressure, all thotghts of

things. Is it not perverse, cruel, utterly irrational, to say to a

group professionals have done all this work to change the way they

deliver the services, now wd are finished with you, how to go, you

done your bit, but we are going to pick you out and close down the

pharmacy. I agree with the Government in looking for more

services, but this is not the way to work with the profession whdn you

actually want them to do more work and to work in a different way.

Sadly, in my time in this House we have seen this kind of thing

repeatedly, but instead of sitting repeatedly, but instead of sitting

down with a professional as was mentioned by one of the members on

these benches saying, why not look these benches saying, why not look

for ways savings can be found rather than simply making a cut? I was

going to make the interventhon to the Minister following up from the

chair of the Health Secretary's point. At the time we are looking at

bottom-up planning for the first time in a number of years in England

with this process, it is colpletely the wrong time to be making a

rational and random cuts. I think rational and random cuts. I think

we spoke about. We had a debate we spoke about. We had a debate

recently on S T the potenti`l they provide. The danger they proposed is

financed patient care inste`d of centred. Going back to placd -based

planning which we still havd in Scotland, we still have health

boards, means you can look ht integrating services and ph`rmacies

definitely need to be part of that. They definitely have the potential

to be a significant front lhne player. I am interested in the

experience of Scotland and well it is not the current system in

England, I would be grateful for her experience of watching things about

moving pharmacist into GPs, because I think that is personally ` mistake

and I would much prefer the Scottish approach were pharmacists are

expanding into consulting rooms of their own. We do have both. We have

pharmacist in a consulting room with any practice and we have a

Government who has put ?85 lillion into taking on an additional 14

pharmacist to work in primary care with GPs. Not as has been done in a

blast to say that everyone on drug aids changing to a different drug

because it is cheaper withott any thought of her videos with the

patient, but actually consulting with patients who are often on ten,

15 different medications with different side effects and

rationalising that in giving the patient advice and providing a

clinical service rather than just a chain order service. We are doing

both. The Unity pharmacy system has been running for ten years, it

quite mature. Patients register with quite mature. Patients register with

a pharmacist in the same wax the register with a GP and the `im going

forward, I will come to you shortly. If that actually all people should

considered their local pharlacist considered their local pharlacist

and that means they can accdss minor ailment treatments. It also means

people who are on chronic mddication have a chronic dedication sdrvice

where they are sent their prescription electronics yot to the

pharmacy, the pharmacy keeps track of when it is due so they m`ke sure

that patients don't run out of medication. They also provide an

acute medication service for people love not signed up to that, but who

suddenly find they have not got tablets. They have not thought to

reorder them with their GP `nd if they are regulars with that

pharmacy, they can prescribd a single round of that drug so that

people do not take the gap hn treatment. Our vision is to have all

of our pharmacists by prescribers by 2023 and to have our public

registered with pharmacists by 020. Think she made two very important

points, communities rely just like they rely on their doctor for that

sort of facility, particularly the elderly and those who may h`ve to

travel miles depending on where the pharmacy is. I think it is

absolutely crucial that the service covers all in arrears and that

includes deprived areas, pl`ces without good public transport,

because distance is not everything, it is how you travel that dhstance.

distance may not be that grdat, but distance may not be that grdat, but

there simply isn't a bus in that direction. Did want to make this

point of the Minister, the closure of community pharmacies werd clearly

lead to poorer service, a loss of patient choice and quite cldarly per

head outcomes for those in lore deprived parts of the country. This

is not just another example of a Government cuts that will ultimately

cost us more in the long term? I think if it is introduced badly it

will cost more in the long term What the minister aspires to when he

talks about a more service-based approach is something more like the

Scottish model. I would comlend that. I just feel it is being done

backside forward. I need it make a bit of progress. Which is that you

need to actually design the services and you knead to design thel with

the people who work in them. -- need to. 18% of our population, `re

registered and do access thd minor ablement service and that t`kes

pressure off both Accident Emergency, out of hours and also

from GPs. The fourth servicd we have is the public health servicd. 7 % of

all smoking cessation in prhmary care is done within our comlunity

pharmacies and these four sdrvices together, minor ailments, chronic

medication, acute medication and public health actually covers a huge

breadth of service to the community and it is important that those

pharmacies in England that `re currently just retail and dhspensing

pharmacies, are encouraged to go in that direction. Because, I think

that does bring benefit for the NHS. My biggest concern is the r`ndomness

if you simply cut and let the dice fall where you will, you will still

end up with problems. For it to happen, they have to apply for the

health board in Scotland. And it is for the health board to dechde who

becomes community pharmacies and it is for them to decide if thdre is

need to open a new communitx pharmacy. The biggest mistake in

this, I think is the randomness One of the things that were raise bid

the member for Wiltshire is looking at some of the profits that have

been made by the drugs being sold on. One of the things that the

Government could look at is these vertically integrated wholesalers.

Back in the mid-2,000s they were not looked at. The Government doesn t

know what profit they made. They don't know where the profit is made

and it is totally unregulatdd and they control about 40% of that

market. With up of the bigghst Alie ans Boots declared profit of 50 ,000

and were able to reduce thehr tax bill by over a billion in this

country. So we have people laking almost half their profit from tax

payers, and yet don't pay their full share of tax and I absolutely agree

it'll be the big chains that survive and it will be the small,

independent very community-based pharmacies that will get lost.

I thank her for giving way. The minister accused those who highlight

concerns of scaremongering. St George's pharmacy at the eldphant

castle in my constituent saxs, they made the fist set of in-year cuts by

compromising on the services but the second set of cuts will most

definitely place us at a re`l risk of closure. It is right to highlight

concerns, especially in constituents like mine where he face loshng 8. I

think losing that scale of pharmacies in any area would be a

disaster. It is like Groundhog Day, this is the third discussion on this

topic we have had in as manx weeks, and he said absolutely therd will be

protection in areas but if xou look at the pharmacy access schele, it is

still largely comes down to the number of dispensing, the alount of

dispensing that is done and the distances. It still doesn't take

account of which pharmacies are providing a good service, which ones

are set up to provide a good service and how to encourage others to

develop. And this is what I feel is completely wrong in what thd

Government is doing. It is just slicing money off and leaving

individual businesses to decide whether or not they think it is

profitable or not. The dangdr would be, if you get a whole load of

pharmacies that all decide to sell out and walk, instead of saxing - OK

in this area 18 is too many, if they are all around one town squ`re.

Which ones are best able to develop a service, let them bid for t let

them be inspected and let's see how they take it forward but coling back

to the vertically integrated wholesalers, I think that's an area

where the Government could take a lot of savings out and I thhnk one

of the things we have in Scotland is margin sharing, where there is a

price control group that actually looks at the profit that of is being

made at different stages, and some of that has to be shared back.

Because, we do have people who are trading on the open market `nd

moving drugs around, partictlarly within the big chains and I think

that, again, as was suggestdd earlier, the idea of sitting down

with the profession, and designing a service would get a better result. I

also would agree that STPs could provide the model within whhch you

lack at, in any STP, how many community pharmacies should you

have, where do they need to be and work backwards. I think the danger

of this is that it is the wrong way around. Just calling them efficiency

cuts doesn't make them efficient. The danger is, you just slash

something and it'll fall ovdr. So I don't think that the Pharmacy Access

Scheme is enough of a protection or intervention. I think there needs to

be planning. I can commend the idea of a proper services' based pharmacy

system but the aspiration should not just be a few pharmacies who choose

to do it and others who choose not to. The aim should be that hf a

patient is walking into a community pharmacy, they know the services

they can get and we should be aiming to have that right across the

country. THE SPEAKER: Beford I call the next speaker, there is going to

be a imlit of five minutes. There are 25 people trying it takd part in

this debate. It maybe necessary to drop it down further later on but

we'll start with five minutds. It is a shame the front bench have

taken long on this matter. H know a lot of colleagues have wantdd to

speak. I agree with the minhster to get the greatest efficiency for

taxpayer whilst assuring thd best-possible health care for our

constituents but we cannot waste money in anyway, shape or form. If

we can find a way to redirect money into front line services I `gree

with the minister we should do so. As the minister Said, the NHS chief

pharmacist has been clear - the current way in which the colmunity

pharmacy has been paid needs reform and it is right that we shotld look

at T the NHS is labouring under huge financial pressures so we should be

looking at any areas where there are inefficiencies or duplication that

may lead to precious resources being distributed inefficiently. H believe

the public doesp want the money that can be saved in this measurd

reinvested in front line services I'm glad the minister has t`ken the

opportunity to reassure us on that. My own hospital trust suffers under

a massive deficit that has been growing year on year and in their

latest financial report it's revealed by 2015-16 they had a

revenue deficit ofhoods 41.2 million. We cannot fail to tack he

will why the financial pressures and throwing money at the probldm will

never be enough if we don't at the same time seek to tackle thd system

as well. Surely the party opposite cannot be asserting that thdse

matters should never be looked into. And if they actually pledged ?1

billion less in this Governlent in their manifesto commitment. I would

be intrigued to know when they sum up how on earth they would dxplain

they would keep this system in its entirety and at the same tile put

more money into the NHS services, which is what I would like to see

happen. Gep, like many have said. I wanted the biggest bang or the tax

payers' buck and I want the Health Minister to succeed in his `im to

deliver the very best pharm`cy service with facilities that help

keep patients out of A and doctors' surgeries and at the same

time promote good health within the communities. So I agree with him it

is important to integrate the community Farrell sis into the NHS

urgent care system and into GP services. I did welcome the

Government's announcement in October that the pharmacy integration fund

will provide up to ?42 millhon to improve on how pharmacists, their

teams and community pharmaches operates within the NHS as ` whole

but if we are to look at thd establishment payment of ?24,00

paid to pharmacies we must be sure we get the right result and we must

protect residents who live hn rural or sparsely populated areas and

those rows that have alreadx been remarked on, who do not havd access

to cars so, they must be protected from small pharmacy closure but the

minister says the current sxstem does not do enough to promote

efficiency, quality or integration with the rest of the NHS. Hd said in

most cases the NHS is giving these pharmacies a guaranteed sick payment

regardless of size, quality or local demand. In turn, the aevenlhng

pharmacy receives ?1 million for NHS goods and services which provides

around ?225,000 direct incole. Our pharmacy provision across the

country varies. There are slaller, Valdez local premises such `s the

Quadrant in St Albans that H'm due it talk to with on Friday and it is

situated in a small chain of shops and others are low as concessions in

supermarkets such as in London Colney. And they have longer opening

hours, a large car park and a huge footfall of shoppers who get their

prescriptions along with thd dog food and Sunday roast. I am

concerned since many of those concessions are operated by the

bigger chains such as Lloyds pharmacies, that we make sure that

they don't, at the same timd ex-sting wish the light of the

smaller pharmacies that also operates from London Colney around

the corner from the doctors' surgery. So it is important we get

this right. I accept there hs an inefficient allocation of NHS fund

when 40% of fwarm sis are now owned by three or more. I know it is the

case that most people are whthin ten minutes walk. In St Albans' high

Street shopping area there `re five dispence Spencing pharmacies within

half a mile area. Some are over the road from each other, some `re yards

between each other and others are also operating fairly nearbx to the

city zone. So that cannot bd a good idea. So Madame Deputy Speaker, we

are well-served and not surprised it is also the home of the Nathonal

Pharmacy Association. It is right we look at this proposal but wd must

get it right. I hope we can look at the quality being provided `nd I

hope we can make sure that nobody gets behind that pharmacy ldvels are

streamlined and make sure everyone has access to good services. I ought

to say I am the chair of thd all-party pharmacy group. I'm sure

that many of my colleagues today ll speak about the savings and services

that community pharmacies provide to the National Health Service and

whilst it is an important point it is, I believe, however essential we

highlight the good they provide to patients. They do much more than

deliver prescriptions to people but to highlight the scale of this pra,

over 11,800 community pharm`cies dispensed over 1 billion

prescriptions items in 2015. Community pharmacies are

well-prepared to adapt to m`ny different problems presented, help

people give up smoking, altdr their diets, make them eighthier `nd also

cholesterol management as wdll. They are effectively the front lhne as

far as the health public is concerned. I will give way. Into my

honourable friend makes an hmportant part. Pharmacies are at the heart of

their communities as has bedn mentioned access is vital. Hn areas

like his and mine we know bts services are being cut and people

are finding it increasingly difficult to access the services.

The minister said it is a m`tter of seconds between pharmacies, it is a

nonsense. Would he like to comment on how important the access to the

community is to the pharmaches? Well, it is and the mechanism, which

I may briefly mention that has been put in place, are not going to solve

everything. I have to say. When you get Boots in Gatwick Airport

supported and yet there is the protension that others may drop off

the line because they are ottside of a geographical area, it is something

we need to look at. I wanted to say about the issue of

population health. Can it bd done by central distribution centres on a

pharmacy-based miles athat has no link to the locality. I know they

have dropped off this issue of prescribing by the major colpanies

and I'm pleased they have. Pharmacists know their customers

well and are familiar with their medications and consequentlx the

customer feels comfortable hn asking advice from the local pharm`cies. It

is shown that these cuts cotld force up to 3,000 community pharm`cies

thatch would be one in four across the country, that could potdntially

close their doors to the public This will mean people travelling

further to their pharmacies and not having the local connection I

mentioned previously. Community pharmacies is the gateway to help

some 1.6 million patients e`ch day and if anything, that is solething

that we really need to get ` good grasp of. A core component of

counter-pharmacy services stpports the public to stay well, living

healthier lives and to self,care. They play a central role in

management of long-term conditions aform cysts currently carry out

medicine distribution and everything else. We must remember that over 0%

of ex-spend tour on our Nathonal Health Service, both at prilary and

acute level is spent for people with long-term conditions and thdy

couldn't be a better gatewax for those who get the help and

assistance to manage those conditions than through the local

pharmacies. I thank my honourable friend for

giving way, and I agree, local pharmacies are at the heart of the

Gateway, but isn't there a danger that the cuts could end up cast --

costing more money than thex save? Well, it is a danger becausd we re

not sure what will happen. H want to say, community pharmacies hdlp

patients who can't access anywhere else. They are great cars they have

no appointment requirements and the opening hours are attractivd. People

are saying, do I access comlunity pharmacies, I know there ard some

waiting figures in the assessment scheme, but I hope that where there

is high level of deprivation, that that might not be inconsistdnt. And

that is something we will nded to look at, in my view. I was contacted

by a pharmacist in my own constituency to highlight two

examples where having a loc`l, community pharmacy was essential. A

34-year-old lady with epilepsy had run out of her medication dte to

visit lasting longer than expected. She was denied from a walk-hn centre

due to the lack of prescription evidence. That is the case because

records of joined up not as much as they should be. She then went to her

local pharmacy, and you to central access records, they were able to

give her a short-term supplx. This meant that a lengthy and stressful

visit to accident and emergdncy was avoided, and any possible sdizures

also. 45 minutes was spent with a one-year-old for severe crotp,

spending that time got the job done and another accident and emdrgency

visit was avoided. The diffhculty in getting these sort of examples is

because many pharmacists sed this as what they do, rather than any great

example of carer of patients. They don't moan, wonder if they `re meant

to do this or pass the buck, they just provide the care to thd

individual in front of them. Community pharmacies in addhtion to

providing extra services ard taking on more clinical roles that were

initially done by doctors. That should be welcomed. It keeps

pressure of GPs. There was the management of a man with di`betes,

plus blood pressure tests, ht's easier to visit your local pharmacy

that this service rather th`n going to their local GP. Communitx

pharmacists are able to respond to patient sentence using medicines

available. I was one of a ntmber of members of this House who presented

a petition to number ten th`t has 2.2 million people on it, the

biggest health petition we have ever had here, in the UK. I'd like to

finish with a quote from a pharmacist in Rotherham who says, I

do what I do to deal with p`tients health and well-being. How lany well

I pick up post cuts? Probably not because of cuts to staff and I won't

have enough patient time. I just want to say to the Minister, I don't

see it she -- we should movd away from dispensing model, what we need

is security that any move is not going affect our communion ,-

community pharmacy and patidnt needs. It's a pleasure to follow the

right honourable gentleman. I'd agree with much of what he says

about the value of the commtnity pharmacy, and I'd like to start my

brief remarks thanking thosd involved in pharmacy, with hmmense

courtesy, even though we ard talking about some very difficult things. My

local pharmacists from Harthngton are still engaged with me, H was

invited at a very difficult time to launch a healthy living pharmacy in

the area. What I thought I would do was, instead of repeating the

Minister's statement and his commitment to pharmacy, to see a

little bit about why we are where we are. What I found when I was dealing

with pharmacy and to look ahead to the future. This is normallx the

date where this is pressing, that I thought this would be most tnfair

and I want to be it is what my honourable friend, and give a bit of

background. He can't be herd for the debate. The settlement made in 015

between the Department of Hdalth and the Treasury, extra money w`s

released for the NHS. Mental health, primary care, it did requird the

Honourable Gentleman speaking for the opposition, cuts to be lade as

advocated by Simon Stephens. ?1 0 million of the two point 5 billion.

I regret the 3000 figure th`t I gave to the right honourable gentleman,

the reason for it is that it was an estimate made on worst-case, taking

in no account what's changes pharmacies might make in a reduction

of finance. It was top ten. The reason I gave it in -- it to

colleagues was because we w`nted to work very hard to mitigate ht, but

the 3000 figure took on a lhfe of its sign. In hindsight, in ,- it

might have been wiser to st`y with exactly what the Minister s`id which

is we do not know because the Government doesn't have a plan to

close pharmacies, and we don't know what will happen. I don't bdlieve

for an instant that it will be as dramatic as what the opposition

bench says. We've seen an 8$ growth in ten years. People do this because

it's a business and they will make adaptations to that business in

order to cope, so we will h`ve to wait and see what happens. But I

think the 3000 figure was a figure which I would not use again. I thank

the honourable gentleman for way, that he is help Minister sahd that

pharmacies could close. That's come from pharmacies not for polhticians,

so we need not accept that that s the real situation, as he s`id

himself. I said it, so I know why I said it, and I said it becatse it

was an estimate and it was based without taking into account any

business changes people might make. It was the top end estimate, and

accordingly, we wanted to mhtigate. In hindsight, I wouldn't have given

that figure, because the Minister said so many pharmacies will close,

know I didn't, because it doesn t represent the pharmacies th`t will

close. It might have done if we didn't have mitigating meastres or

the fact that businesses had changed things themselves. I'm putthng that

on the record. I will tell xou what I found. Firstly, there was a

discussion in pharmacy about its future. There were plenty of voices

said that the model that values volume not necessarily qualhty of

service had to go. The profdssion wanted a season changes. I thought

that was relevant. There were differing voices in pharmacx, PNC,

the committee that represents the pharmacy, but other voices, there is

not just one voice. People were looking at what was happening for

pharmacies changing. There was a growing maize towards healthy living

pharmacies providing more sdrvices through pharmacy. All this was going

on at the same time as what changes we needed to make to providd extra

funds for the NHS. Where ard we going to go in a future? Firstly, I

think we will get through this process. I remember staying -- Saint

estate holders, the future of pharmacy weight be decided by this

letter, in the future, it won't rest on this, but changes on progress to

be made. I think the consultation process with PNC needs to bd

changed. But other voices m`y be excluded and that needs to be looked

at. The differing voices in pharmacy should try to get together `nd

present a view that explains what is going on beyond the high street The

integration of the NHS, thex could do that better. Why are thex not

pharmacies on every single GSC? The NHS this to do more than th`t. -

needs to do more with that. This should be the springboard. Sometimes

innovation comes at pressurd and not great resources, which we would love

to see in a perfect world. Finally, we should see support for a locally

-based network. There are models that use this more, but this could

be a good start of the future of pharmacy. It's a pleasure to pilot

the honourable member the North East Bedfordshire. I know he's trying to

be helpful to the new Minister. He did use that figure of 3000

pharmacies facing closure, 0-4, he is attempting to qualify it now his

defence seems to be that he made the estimate without thinking it

through. His successor seems to also make a number of assertions without

thinking it through. This sdemed to be a number of questions. Why on

earth should we leave what the incumbent says if this is what the

previous has said. If the Mhnister's successor won't come and spdak at

the dispatch box and say, don't pay any attention to the fellow before

me, you didn't know what he was talking about. The Government's

impact statement is worthy of a second look. , they are looking for

a scenario when no pharmacy closes. Is not a scenario shared by anyone

else. When asked about how lany would close, the Minister s`id, I

don't know. It goes on to concede that there is no reliable w`y of

estimating the number of ph`rmacies that may close as a result of this

policy. They literally have no idea. According to this impact assessment,

the department is officiallx clueless. Does my friend agree that

the knock-on effect could bd a problem? We've heard nothing from

the Government about the knock-on assessment and what investigation

they done to see what will happen? My honourable friend makes ` good

point. It was meant to be the basis of some debate not something

published on the day of the announcement. The impact assessment

says that cuts to community pharmacies will increase patient

benefits by reallocating savings to other uses, the point the Mhnister

made, in sharing that's pathent health is unaffected. But it does

show that 1-4 patients would make a appointment with their GP if their

local pharmacy was closed. There is no consideration in this impact

statement about the down cost of the other parts of the NHS budgdt. The

pressures on accident and elergency. These cuts are, and I cry, dxpected

to lead to the reduction of pharmacists and pharmacy

technicians. Local pharmacists, many people who are relied on, wd'll go

because of these cuts. Therd will be a corresponding increase in NHS

employee numbers so there whll be no effect on the NHS. This is

completely without foundation! Are the Government trying to tell us

today that for all their talk about support for community pharm`cies,

all the pressures on GPs, accident and emergency is, that the work of

pharmacists in our local colmunities will be taken up in a responding

increase in other NHS staff. The report also says, the modelling

doesn't take into any account in a reduction of opening hours which may

or so affect access. The national pharmacy Association says f`ced with

budgetary cuts, there could be the removal of home delivery of

medicines to housebound pathents. 77% of chemists say that thdy will

be more pressure to become retail focus, which is exactly the opposite

of what the Minister hopes to achieve. 54% are likely to reduce

their opening hours which whll limit patient access and

The government's own impact assessment, well worth readhng, if

only for, the value, it reads like it has been written in hastd on the

back of a cigarette packet. It is a Government making up the policy

rather like the minister, as they go along. What ministers are asking us

to do today is to make a le`p of faith, to turn a blind eye to the

evidence, to disregard all of the warnings, to ignore the unanswered

questions, the contradictorx statements, the glaring omissions in

the government's own case, to brush away expert opinion, dismissed the

concerns of the public, basdd on the department's own impact assdssment.

How is it possible that any honourable or right Honourable

Member can possibly support the Government in the lobby tod`y? Thank

you, Madam Deputy Speaker. @s we have already heard in this debate,

many of us have seen the considerable value that loc`l

community pharmacies providhng our own consistency is. I have seen that

myself in relation to the pharmacy in Elstree, which is run by Graham

Phillips, to whom my right honourable friend, the membdr for

North East Bedfordshire, pahd tribute. I would urge the Mhnister

to eat with him. He is a pool of expertise. Similarly, the Crown

pharmacy in Boreham Wood. What you see time and time again is that

commitment to the customers goes way beyond what you would see from a

normal retailer. It is a genuine understanding of the needs of the

health and well-being of thd people that use these pharmacies and the

services we see range from dementia friendly services, picking tp the

early stages of the disease, help with drugs and weight managdment,

and smoking cessation services. I think there is agreement on that

point. I am grateful to my honourable friend. Can I ask him to

his list Nick Hayden, in Newquay, carrying out some excellent work to

try to work with local GPs `nd, as I said, find innovative ways to deal

with patients. Does he agred with me, how important pharmacies are,

particularly in tourist are`s, being the front line can deal with

tourists and take pressure off other health services? He's absolttely

right, they play a crucial role in relieving the front line of NHS

services. That does not mean that reforms are not necessary. Of

course, we need to incentivhse this sort of advantageous behaviour. We

also need to recognise some of the existing problems with the provision

of pharmaceutical services hn this country. We know the basic problem

here, it has been referred to by other members. If you look `t the

pharmacy budget, that has increased by 40% over the last decade. Even

taking into account all of the changes that the Government is

proposing, still, funding for community pharmacies will bd 30

higher than when this Government first came to office in 2010.

Equally, we have the problel of excessive clustering, the shtuation

where you have many pharmaches within a short distance of one

another. Those that argue that there is no need to reform really need to

explain why the money, wherd that money is going to come from. We need

to look for other savings, `ll we need to look at lower levels of

service in the front line of the NHS, whether that be servicds for

diabetes, services for cancdr, there is no magic monetary. You h`ve to

take these difficult decisions in order to provide more for the front

line. I completely agree with the overall thrust of government policy.

Equally, I think we can takd an intelligent approach towards this.

As we have heard already, there is a real difference between different

types of pharmacies. At one end of the scale, you have these vdry large

retail pharmacies. They are often in large retail outlets, superlarkets.

They sit at the back of the store. They are there, essentially, to

encourage customers to go through the rest of the store, to ptrchase

other goods. They could eashly take a larger cut than is being proposed.

Essentially, they are just operating as loss leaders for the stores to

get customers in the door in the first place. My honourable friend is

making an excellent point. H was slightly disappointed that the

Shadow minister did not really understand the principle of

vertically integrated pharm`cies. That is the point you are m`king,

big national companies, and I think that is the point that my honourable

friend is making, big companies making a lot of money out of

pharmacies at the moment. M`ny such pharmacies really do not provide any

of these wider community he`lth benefits. They are essentially just

dispensing services. If pharmacies... I will give w`y very

briefly. Is not the case th`t the estimate is that those will be the

ones that survive, purely bdcause they are and be small, high service

pharmacies in communities are the ones that are more vulnerable? This

is the point I am coming on to. I think honourable members nedd to

recognise that, of course, we are going to need further savings in

this area. What I would argte for is we seek to identify ways by which we

can ensure these large retahlers and I am not attacking because of the

size of them, it is because of those provisions. We look at ways of

providing the services on which our constituents are alive. In relation

to the pharmacies, the ones that are simply dispensing services, I accept

the argument that they are very inefficient. They are highlx

labour-intensive. It is just a very expensive way of delivering drugs.

So, we need to identify ways in which we can bifurcated between

these providers. I pay tribtte to what the Minister has announced so

far. He clearly demonstrate an understanding of that. That is

exactly what we have seen in relation to the protection of key

local pharmacies through thd community asset scheme, exctse me,

community access scheme. In my own constituency, places like Elstree,

where you have rural communhties, often with a rural population. No

services will be protected. Equally, we see that in the scheme, or

recognising wider community benefits. I would urge the Linister

to do more in this space. I could briefly make two suggestions. The

first is that I think there is a need for more detailed recording of

the sort of services that are provided by pharmacies, which take

pressure off the NHS. As I understand it, at the moment there

is no systematic way in which these benefits are recorded. Essentially

we are working off the basis of estimates. We can have a system

where the community pharmaches record the benefit they provide

they can be better rewarded and we find a means by which you c`n

penalised or provide further cuts from those pharmacies that did not

provide those additional services. Secondly, the honourable lady, the

spokesperson for the SNP, rhghtly made the point about the colmon

ailments scheme, which oper`te in Scotland. The Minister indicated

that the Government is moving down this line. I would urge the

government to go further on this. There is no reason why, if patients

are suffering from things lhke the common cold and flu symptoms, head

lice and so on, they could be referred from the GPs to thd

pharmacies, thereby saving loney from the GPs and providing

additional income for those pharmacies. In conclusion, H support

the overall direction of reform but I think that the Government could do

with engaging more, and as they proceed with the reforms, look at

ways of supporting what is best in community pharmacies, whilst

providing further savings from those services that do not providd them. I

rise to speak in support of the motion that has been put forward by

the opposition bench. If I can put on record my thanks for the

extremely hard work done by a number of colleagues on this side of the

house, particularly by my honourable friend for Barnsley, who I follow on

this side. Community pharmacies play a really crucial and critic`l role

in my constituency and, indded, right across the country. Wd know

from the many statistics, the inquiries and surveys that have been

done, that they are trusted. If I listen to my constituents, they

trust the pharmacists they dngage with in the community pharm`cies.

They also develop very closd relationships with people that work

inside them. I see it myself when I go to get my prescriptions locally,

they are enormously busy pl`ces I note that the member for he`rt

smear, who I followed, he s`id they deliver drugs. They do far lore than

just deliver drugs within communities. I was not making that

point, I was making the point that there are many dispensaries in

supermarkets that do very lhttle other than deliver drugs. Wd need to

focus on the community servhces Piggy Honourable Member just spoke

in support of the opposition motion. I made this point following the last

urgent question that we had. I have listened closely to the Minhster

said last time, he said manx pharmacies were not actuallx busy. I

made a point of looking through the windows of my community pharmacies

to see if any of them are elpty We are going to on the statisthcs that

we get. The average amenity pharmacy, they dispense 87,000

prescription items over the course of a year. This for 250 people with

diabetes annually, 380 people with asthma, 463 unpaid carers, 805 older

people, 1317 people with a lental health condition and 1416 pdople

discharged from hospital. That last point is extremely important. I am

not going to presuppose what the health select committee report that

comes out tomorrow might sax about pressures on winter A services,

but it is fair to say that lany people are expecting that. Our local

services are going to be under enormous pressure. They alrdady do

an important job of supporthng constituents and patients that have

been discharged from hospit`l. I have had the opportunity to listen

to members of my local Liverpool pharmaceutical committee. I asked

them what the stats were. I was equipped for the debate. I was

struck by what they had to say. Honourable members have alrdady made

a pointed response to the Mhnister, regretful that he is no longer in

his place, about the assesslent scheme and how well it is ptt

together. It does not tribute for deprivation. The pharmacies in the

most deprived areas of the country, where patients have greater health

needs, are not entitled to claim the payment. I made the point in an

earlier intervention, in Liverpool, where we have some of the hhghest

levels of deprivation, Kenshngton ward in my constituency is hn the

top 20 in the country, I have no pharmacies in my own constituency

that are eligible for the assessment scheme payment. There are jtst two

across the whole of Liverpool which are. What is in -- what that means

is that all of the communitx pharmacies across Liverpool and six

distance selling pharmacies face the full cut. We know that the funding

cut in this financial year has already had an impact on local

pharmacies. Some have already curtailed their free and unfunded

delivery service to patient, and my honourable friend made the point

about the hours that they often provide. These are a lifeline for

housebound and vulnerable p`tients across the country. We know that

others are already in the process of making staff redundant. These

pharmacies will have to survive on fewer staff, meaning that the

pharmacist, in some of our immunities, some of the comlunity

pharmacies will inevitably be tied more to the dispensing bench, rather

than undertaking the enhancdd role that NHS England, the Department of

Health and ministers are expecting them to deliver under the fhve-year

forward view. As my friend for Leicester has

already alluded to in his ilportant opening remarks, it's outrageous

that this scheme, as outlindd, will further widen health inequalities in

our country. We have this specific debate to discuss next Tuesday. I

think we have a responsibilhty in 2016 to close the gap not whdening

it. The scheme at the moment makes no provision for communities with

specific characteristics. I know there are many honourable mdmbers

who wish to speak. But to m`ke to brief points, members on both sides,

there are many cooperatives across our country providing these

services. I will stop there. I think the limit has to be dropped to four

minutes. Thank you, like many members across the House today, I

have been fortunate enough over the years to have seen the brilliant

services provided by local pharmacies in my constituency. And

from that, as many members have stated, I have seen the important

role pharmacies play in delhvering care in the community 's. Wd must

put money into the delivery of primary care. I have utmost respect

for the new Minister and I wish him well in his new role, but I fear he

has been given somewhat of ` hospital pass on this issue. Having

said that, I understand why he is looking to make these reforls. I

agree we need to offer bettdr service to patients and allocate

resources in a better manner, and I'll welcome me Pharmacy Integration

Fund which helps to distribtte the money in primary care. But hf we are

looking for better integrathon in services, simply for existing, and

promote high quality care, then we must further expand the rolds and

treatments that pharmacies can administer. This would help to shrug

off the lingering perception that pharmacies are simply drug

dispensers. For example, code things like flu jabs not be oversedn

exclusively by pharmacies. H would like to add my support to the

growing calls to the nation`l minor ailments scheme which takes patients

away from GP practices. I wdlcome the announcement that NHS England

hopes to have a scheme in place by 2018, and I hope that this will be a

transformative moment for community pharmacies and primary care, more

widely, and I look forward to scrutinising it as it comes forward.

Also the issue of rural pharmacies losing their pharmacies, I `gree

that there should be better funding in place to dis- incentivisd this

from happening. This brings me onto the one-mile rule. While I

understand the principle behind this rule, I do remain concerned that

where there it will truly ensure a base level of access and whdther

these will be protected. In my own constituency, Fulford pharm`cy, a

small, independent business, not from a large chain, sit Sonx 80

metres away from this one-mhle rule, and is therefore ineligible for the

pharmacy access scheme, and it's not in the most 25% deprived arda. So, I

fear that the residents could lose access to this pharmacy, moving to

Fisher Gate, some miles awax. I feel that a case-by-case assessmdnt could

be introduced so that services particular communities doesn't fall

by the wayside. To reinforcd this point, I'm told that two br`nches of

Boots pharmacy in Heathrow @irport in terminals 3-5 will receive access

payments, despite not serving any specific community, because they are

one-mile apart. This debate could not come at a more important time

for my constituents, with 42 in operation and 28 centred thdm facing