02/11/2016

:00:18. > :00:28.I just wanted to be sure he was in his place and he is. I wonddr if he

:00:29. > :00:33.can do anything regarding the Home Office not reserving the nale dates

:00:34. > :00:40.on the 17th of October the Home Secretary made a statement `s you

:00:41. > :00:44.will remember of independent enquiry into child sexual abuse. In the

:00:45. > :00:51.course of her statement she said, I have passed on the informathon, the

:00:52. > :00:55.request that Damon Gothard should appear before the Home Affahrs

:00:56. > :01:03.Committee. As you know, she resigned as chair. Would she picked the

:01:04. > :01:10.correspondence with the Damd in the library. It was a named datds. When

:01:11. > :01:15.the reply came, it said thex were unable to answer the question on

:01:16. > :01:19.that particular day. So if xou days later, I put down another qtestion,

:01:20. > :01:30.which was due France yesterday, asking when she will make a replied

:01:31. > :01:34.to the question. No reply at all. It does seem that the Home Offhce seems

:01:35. > :01:40.to be in such a state of crhsis over written questions as I understand

:01:41. > :01:44.the position, they are not `ble unless they don't want to provide an

:01:45. > :01:49.answer in the first place. Ht seems to me to be quite simple. She could

:01:50. > :01:51.correspondence in the library or correspondence in the library or

:01:52. > :02:06.when I said I passed on the information, I meant A, Be, C. Why

:02:07. > :02:11.It is a very curious state of It is a very curious state of

:02:12. > :02:18.affairs to which the honour`ble gentleman alludes. If he has a wider

:02:19. > :02:21.question about the overall state of procedures, you should writd to the

:02:22. > :02:27.procedural committee who kedps an eye on these matters. In relation to

:02:28. > :02:32.this particular question, it seems rather curious. Experience tells me

:02:33. > :02:40.that when a member raises hhs or her disquiet about a lengthy delay in

:02:41. > :02:45.securing a reply, to a parlhamentary question, the reply is therd after

:02:46. > :02:49.ordinarily forthcoming very quickly and if the honourable gentldman has

:02:50. > :02:54.any doubt that matter, he could always have a word with his right

:02:55. > :02:59.honourable friend to has fotnd it expedient to complain from time to

:03:00. > :03:02.time and then secured very puick replies. The leader of the house

:03:03. > :03:06.will have the right honourable gentleman's interests at he`rt and I

:03:07. > :03:15.think a solution will be fotnd within possibly hours. I will

:03:16. > :03:20.persist that does not happen. If I'm a very politely say so, that

:03:21. > :03:23.observation was superfluous in that I don't think any member of the

:03:24. > :03:28.house would have expected anything less of the honourable gentleman. He

:03:29. > :03:33.is nothing if not persistent and tenacious to a fault. If thdre are

:03:34. > :03:45.no further points of order, we come now to the motion Mr Andrew

:03:46. > :03:50.Rosindell. I beg that we brhng any Bill to motion the freezing and

:03:51. > :03:55.seizing of assets belonging to states are organisations who sponsor

:03:56. > :03:59.or perpetrate acts of terrorism for the purposes of enabling

:04:00. > :04:05.compensation to be paid to the British victims of such terrorism.

:04:06. > :04:08.To provide a definition of British victims for the purpose of

:04:09. > :04:09.eligibility for such compensation eligibility for such compensation

:04:10. > :04:20.and for connected purposes. Today I lay before the housd a bill

:04:21. > :04:23.that gives hope to all Brithsh citizens who have suffered `t the

:04:24. > :04:29.hands of terrorism. Hope th`t one day soon, their own United Kingdom

:04:30. > :04:38.government might be obliged to act decisively against the perpdtrators

:04:39. > :04:44.and backers of these horrifhc crimes and deliver justice to all those

:04:45. > :04:50.whose lives have been so crtelly cut short or have suffered injury or

:04:51. > :04:55.loss. My bill would give Her Majesty's government direct power to

:04:56. > :05:04.freeze or seize assets of any state or organisation who sponsor or

:05:05. > :05:08.perpetrate such acts. IRA tdrrorism, supported by Colonel Gaddafh's

:05:09. > :05:12.regime is the most signific`nt example in recent times. Ond British

:05:13. > :05:18.citizens have been failed bx their own governments in seeking justice

:05:19. > :05:23.for crimes committed against them. In today's world there are new

:05:24. > :05:30.threats. New generations of terrorists who seek to harm British

:05:31. > :05:34.people. So my bill will mandate governments to seek compens`tion for

:05:35. > :05:39.all British victims of terrorism providing them with the powdrs they

:05:40. > :05:43.need to do so. As chairman of the Parliamentary support group for

:05:44. > :05:48.victims of Libyan sponsored IRA terrorism I am proud to havd

:05:49. > :05:51.championed, along with my colleagues, the cause to obtain

:05:52. > :05:57.compensation for the victims of these dreadful crimes. And to follow

:05:58. > :06:02.on the good work of the forler member Andrew McKinlay to whom I pay

:06:03. > :06:07.heartfelt tribute today. For his steadfast support for the c`mpaign

:06:08. > :06:13.for justice and for the victims of terrorism perpetrated by thd IRA. Mr

:06:14. > :06:17.Speaker, many of us have frhends, family or constituents who have

:06:18. > :06:21.suffered at the hands of politically motivated terrorism. Last ydar

:06:22. > :06:27.marked a quarter of a century since the assassination of my fridnd the

:06:28. > :06:35.former member for Eastbournd, whose murder at the hands of the HRA in

:06:36. > :06:41.July 1990 had a profound affect on me and on so many others who knew EN

:06:42. > :06:47.as a soldier, lawyer, parliamentarian friend and ` staunch

:06:48. > :06:50.defender of Queen and country. In this chamber we commemorate our own

:06:51. > :06:59.fallen colleagues who were victims of terrorism. Not only for Han, but

:07:00. > :07:04.for Robert Bradford and for Sir Anthony Berry who was killed in the

:07:05. > :07:13.grand Hotel in Brighton in 0984 All were victims of IRA, INLA tdrrorism.

:07:14. > :07:18.Terrorism in the 70s, 80s and 9 s had a profound effect on so many of

:07:19. > :07:25.my generation who remember going up with the threats of bombs in London,

:07:26. > :07:30.Belfast and in towns and cities across the United Kingdom. Hndeed,

:07:31. > :07:36.the 9th of February 1996 will always be etched on my mind. I was visiting

:07:37. > :07:41.the Britannia hotel in Docklands to discuss plans for an intern`tional

:07:42. > :07:49.dinner I organised in honour of Lady Thatcher. I travelled back via solar

:07:50. > :07:55.ski station. And arrived hole in Romford only to watch the ITN news

:07:56. > :08:00.with horror as I learned about the devastating bomb explosion that had

:08:01. > :08:05.occurred soon after I'd boarded the Docklands light Railway. Thhs

:08:06. > :08:11.bombing, as well as so many other acts of terrorism by the IR@ was

:08:12. > :08:18.used with explosives supplidd by the Libyan regime. And yet, so lany

:08:19. > :08:22.years later, victims have not received the just compensathon they

:08:23. > :08:25.rightly deserve. Some of thd victims and their families who suffdred from

:08:26. > :08:33.this trauma are now elderly or have passed away. One victim of the

:08:34. > :08:38.Canary Wharf bombing was left severely mentally and physically

:08:39. > :08:43.impaired. He was cared for by his devoted wife, Gemma, until she died

:08:44. > :08:50.last year. And yet, they never received 1p in compensation. Again,

:08:51. > :08:56.victims of the Harrods bombhng of the 17th of December 1983, `lso did

:08:57. > :09:01.not receive compensation. Stch as the family of WPC Jane Arbuthnot and

:09:02. > :09:05.police inspector Stephen Dodd, whilst the family of an American who

:09:06. > :09:12.was killed precisely in the same place at the same time did receive

:09:13. > :09:17.compensation. This is because, unlike the UK Government, the United

:09:18. > :09:21.States government under President George W Bush fought and won the

:09:22. > :09:28.argument with the Gaddafi rdgime for American victims. I say to this

:09:29. > :09:32.house, how can it be justifhed that some victims should receive

:09:33. > :09:39.compensation when others do not Surely, it should be settled when

:09:40. > :09:44.the victims are still alive. It is truly terrible that British victims

:09:45. > :09:48.have been treated so differdntly than Americans. Their government

:09:49. > :09:55.stood by their victims, ours did not. Mr Speaker, each time the issue

:09:56. > :10:00.of compensation for these ddserving the victims is raised we have until

:10:01. > :10:06.now received the same empty response from government signals persuasions.

:10:07. > :10:14.We hear weak excuses for not pursuing a way of bringing this to a

:10:15. > :10:18.satisfactory conclusion. Each time the long hurting victims of the IRA

:10:19. > :10:24.Gaddafi regime listening only to be let down and wait indefinitdly.

:10:25. > :10:28.These wicked acts took placd a long time ago. Many of the victils fear

:10:29. > :10:34.that unless action is taken soon they will not be around to see this

:10:35. > :10:40.matter concluded and will ndver receive the Justice and compensation

:10:41. > :10:45.they deserve. Time is running out. So, today, I bring this bill to the

:10:46. > :10:48.floor of the house with the aim of giving Her Majesty's governlent the

:10:49. > :10:53.power to act and resolve thhs issue by making provision for the freezing

:10:54. > :10:58.and seizing of assets belonging to any state or organisation who

:10:59. > :11:02.sponsor or perpetrate acts of terrorism against a British citizen.

:11:03. > :11:07.I include in that citizens of Ireland as well as any citizens of

:11:08. > :11:12.Crown dependencies overseas territories that may have bden

:11:13. > :11:16.affected. When sanctions ag`inst Libya are lifted its vitallx

:11:17. > :11:20.important that we do not miss the opportunity to finally bring this

:11:21. > :11:25.matter to a close. We need to come to an agreement with any future

:11:26. > :11:29.government in Tripoli. The British victims of Libyan sponsored IRA

:11:30. > :11:34.terrorism must never be forgotten and we must not discard B1

:11:35. > :11:41.bargaining tool we have, frozen assets to ensure justice is served.

:11:42. > :11:44.Over many decades governments have both missed and avoided

:11:45. > :11:50.opportunities to bring justhce to the victims. This cannot be allowed

:11:51. > :11:54.to happen one moment longer. It would be intolerable if when the

:11:55. > :12:00.assets are unfrozen the UK hs unable to ensure that talks are opdned and

:12:01. > :12:04.have no power to act. Just `s the Libyan people were victims of

:12:05. > :12:10.Gaddafi, the British victims of Gaddafi sponsored IRA terrorism are

:12:11. > :12:14.too. And it is the duty of Her Majesty's government to fight to

:12:15. > :12:20.bring justice. Mr Speaker, this bill proposes a fairer basis for

:12:21. > :12:23.legislation will stop to allow Her Majesty's government to enstre that

:12:24. > :12:29.eventually, however many ye`rs it may take the UK victims of HRA

:12:30. > :12:34.Gaddafi regime will eventually receive compensation and justice.

:12:35. > :12:38.And I say to the house, we need a law that ensures that any ftture

:12:39. > :12:43.victims of terrorism will not have to suffer the same trauma. This is

:12:44. > :12:49.why my bill is important. Not just for the victims of IRA terrorism,

:12:50. > :12:58.but for those petitions persons who may, God forbid, become victims of

:12:59. > :13:03.terrorism and years hands. Ht is for the defence, the well-being and the

:13:04. > :13:09.protection of all of Her Majesty's subjects that I commend this bill to

:13:10. > :13:12.the house. Order. The questhon is that the honourable member have

:13:13. > :13:20.leave to bring in the bill. Decision-macro. Who will prdpare and

:13:21. > :14:19.bring in the Bill? British victims of terrorisl asset

:14:20. > :14:27.freezing and compensation bhll. Second reading what state? 24th of

:14:28. > :14:32.February 2000 17. Thank you. We now come to the opposition Day lotion in

:14:33. > :14:39.the name of the Leader of the Opposition on community pharmacies.

:14:40. > :14:42.I informed the house that I have selected the amendment tabldd in the

:14:43. > :14:49.name of the Prime Minister. To move the motion I call of the Sh`dow

:14:50. > :14:55.Secretary of State for Health, Jonathan Ashworth. I'm gratdful and

:14:56. > :14:58.I beg to move the motion in my name and the name of my right honourable

:14:59. > :15:02.friends. This is an issue that affects many of our constittents,

:15:03. > :15:07.and has aroused considerabld opposition from so many of our

:15:08. > :15:10.constituents. 2.2 million h`ve signed a petition. Communitx

:15:11. > :15:14.pharmacists have lobbied melbers on both sides of the house abott these

:15:15. > :15:18.cuts and why they should be opposed. Indeed, members on both sidds of

:15:19. > :15:21.this house have raised their concerns and their opposition to

:15:22. > :15:25.these cuts. I pay tribute mx honourable friend the member for

:15:26. > :15:30.Barnsley East who has campahgned tirelessly on this and my honourable

:15:31. > :15:34.friend the member for Robert Farley. And the honourable members on the

:15:35. > :15:39.Government benches who have also in Westminster Hall debate did.

:15:40. > :15:43.Questions in this place havd raised their opposition to these ctts as

:15:44. > :15:47.well. Their opposition to those cuts is entirely understandable. When the

:15:48. > :15:51.Government announced back in December last year that thex were

:15:52. > :15:57.going to pursue these cuts they talked of cutting the budget by 170

:15:58. > :16:03.million. ?170 million cuts to community pharmacy services with

:16:04. > :16:07.further cuts to follow. Opposition to the cuts was clear, and hndeed

:16:08. > :16:11.was heightened when the previous minister, the member for North East

:16:12. > :16:14.Bedfordshire YC in its placd, for whom I have tremendous respdct, but

:16:15. > :16:17.opposition to these cuts was heightened when the honourable

:16:18. > :16:23.member suggested that these cuts could lead to a better dig tp to

:16:24. > :16:30.3000 community pharmacies closing. Of course I'll give way. Thd

:16:31. > :16:33.honourable friend has had a lot of correspondence from local pharmacies

:16:34. > :16:37.and their customers worried about their care and business. But isn't

:16:38. > :16:41.it also the case that with lassive cuts to acute services and primary

:16:42. > :16:46.care under pressure these are essential and nine part of the

:16:47. > :16:52.health service that we cannot do without. The honourable fridnd has

:16:53. > :16:55.anticipated my argument. I can sit down now that he has put it so

:16:56. > :17:01.eloquently! I shall plough on while I have the indulgence of thd house.

:17:02. > :17:05.The honourable member for North East and Bedfordshire but the pohnt is

:17:06. > :17:10.that this would probably le`d to something like 3000 cuts to

:17:11. > :17:14.community from C. I see him in his place now and then. The honourable

:17:15. > :17:19.member left his post from the Department of Health, which we were

:17:20. > :17:23.all very sad about, but then we get the new minister in place and we

:17:24. > :17:28.were delighted to welcome the member for Warrington South to his place

:17:29. > :17:32.not least because the member for Warrington South, in one of his very

:17:33. > :17:37.first interventions of the Linister when he was first allowed ott went

:17:38. > :17:42.to the while pharmaceutical Society's annual conference in

:17:43. > :17:47.September and said he was ddlaying the cuts, he said, and I quote, I

:17:48. > :17:51.think it is right that we spend the time particularly me as an hncoming

:17:52. > :17:54.minister to make sure we ard making the correct decisions. The

:17:55. > :18:00.Parliamentary undersecretarx continued and what we are going to

:18:01. > :18:05.do, is right for you, is gohng to be right for the NHS, and is rhght for

:18:06. > :18:10.the public generally. Well, if the Minister had left it there with that

:18:11. > :18:14.U-turn he would have won thd praises of these Labour benches. But,

:18:15. > :18:20.unfortunately, we then had ` U-turn on the U-turn. Because we then

:18:21. > :18:24.learned last month that the Parliamentary Secretary, whdn he

:18:25. > :18:28.came to the house, he told ts that far from having listened and taken

:18:29. > :18:32.account of the various constltations and decides to do what was best for

:18:33. > :18:40.the NHS he told us that he hs imposing a 12% cut on current

:18:41. > :18:48.levels. Giving pharmacies jtst six weeks notice, as well, Mr Speaker. A

:18:49. > :18:57.7% cut the year after that. Will the member give way.

:18:58. > :19:06.member. It is a privilege to member. It is a privilege to

:19:07. > :19:12.represent my honourable fridnd byes mother and who knows my constituency

:19:13. > :19:17.well, the high levels of deprivation and the incredible pressure that our

:19:18. > :19:19.primary care services based with difficulty in recruiting GPs. Does

:19:20. > :19:25.he agree with me that was only seven he agree with me that was only seven

:19:26. > :19:29.weeks notice, is quite impossible, either for GP practices and other

:19:30. > :19:33.pharmacies, to accommodate `nd make pharmacies, to accommodate `nd make

:19:34. > :19:41.provisions for these cuts in a way that will continue to support

:19:42. > :19:46.deprived constituencies? Thd right honourable member is absolutely

:19:47. > :19:49.correct. That is why these cuts have had so much opposition on the

:19:50. > :19:56.benches. But my honourable friend from Newcastle want to come in? A

:19:57. > :20:02.significant amount of work has gone in over the past few years to think

:20:03. > :20:08.pharmacy first, taking pressure off GPs, ambulances and A E sdrvices.

:20:09. > :20:14.Is this what the Government had in mind? Think pharmacy first for cuts

:20:15. > :20:17.and closures. That is quite a powerful point. It blows ap`rt a

:20:18. > :20:23.number of the argument is the Government has been making hn recent

:20:24. > :20:27.years. Of course I will givd weight to the right honourable gentleman.

:20:28. > :20:33.Do you agree giving the clusters that there is no better way you

:20:34. > :20:37.could fund the services? Thdse cuts are not aimed at clusters, they are

:20:38. > :20:40.completely arbitrary cuts and what the effect of these cuts will mean

:20:41. > :20:44.that many of the pharmacies and some of the most deprived parts of the

:20:45. > :20:48.country will close as a of these cuts. I want to make some progress

:20:49. > :20:52.because I am conscious that so many because I am conscious that so many

:20:53. > :20:55.members want to speak in thhs debate. These cuts will mean that

:20:56. > :21:01.patients, many of whom are dlderly and unable to travel long dhstances,

:21:02. > :21:04.will be forced to go elsewhdre for essential medical advice and

:21:05. > :21:08.minister when he gets up at the minister when he gets up at the

:21:09. > :21:13.dispatch box is detail of how many is pharmacies will close. Wd have

:21:14. > :21:18.heard her on the previous mhnister told us that up to 3000 comlunity

:21:19. > :21:24.pharmacies could close, of course I will give way. I'm grateful to the

:21:25. > :21:27.honourable gentleman. At thd new would-be health litter intervene at

:21:28. > :21:33.this stage. I give an estim`te based on what we got as a possibld

:21:34. > :21:38.worst-case scenario. It wasn't an exact number of policies th`t would

:21:39. > :21:41.close, the department never had any plans to close pharmacies, ht was

:21:42. > :21:47.the best estimate that I had at that time and that is what I gavd. It

:21:48. > :21:52.wasn't a definitive figure. The honourable gentleman is an dxtremely

:21:53. > :22:06.experienced minister, possibly the most experienced minister. Other

:22:07. > :22:09.then, it is very noble to try and get the minister of the year, but he

:22:10. > :22:12.is the one who said 3000 ph`rmacies will close and we will conthnue to

:22:13. > :22:18.remind ministers of that. I will give way to the former Chief Whip

:22:19. > :22:22.and then make some progress. I thank my honourable friend forgivhng way

:22:23. > :22:25.because on that point it is Doncaster pharmacies themselves who

:22:26. > :22:29.have told me that at least 20 pharmacies in Doncaster will close

:22:30. > :22:32.because of the cuts and that is their own estimate on the ground.

:22:33. > :22:36.The other point they have m`de for me is that if the Government has sat

:22:37. > :22:41.down and had meaningful discussions about things like a minor ahlments

:22:42. > :22:47.service, the cut in the drugs budget, how they could help save

:22:48. > :22:52.money, possibly ?5 million hn Doncaster, ?650 million overall

:22:53. > :22:54.saving to the NHS if they h`ve proper discussions with pharmacists

:22:55. > :23:03.about delivery. My right honourable about delivery. My right honourable

:23:04. > :23:08.friend is correct. Not only was she an exceptional Chief Whip, she was

:23:09. > :23:12.an exceptional pharmacies mhnister. She knows how Heidi these ctts would

:23:13. > :23:18.be. I would like to make sole progress, I am conscious B1 to get

:23:19. > :23:22.in. We have heard the careers ministers said 3000 community

:23:23. > :23:24.pharmacies could close, but the current minister when pressdd about

:23:25. > :23:30.these figures that mindset `nd I quote, no community will be left

:23:31. > :23:33.without a pharmacy. I hope he will confirm that he still stands by that

:23:34. > :23:39.statement when he responds hn a few moments. He also claims nobody is

:23:40. > :23:42.talking about thousands of pharmacies closing, he obviously

:23:43. > :23:47.didn't get the memo from thd member of Bedfordshire. When acid `bout

:23:48. > :23:54.actually happen, what soothhng actually happen, what soothhng

:23:55. > :24:00.reassuring words that he offered to constituents in the house? He said,

:24:01. > :24:05.I do not know. Well, I am sorry that the Minister has not a clue, but I

:24:06. > :24:09.hope when he sums up, he will tell as how many pharmacies are going to

:24:10. > :24:13.close as a result of the cuts. And he's not appear to tell as how many

:24:14. > :24:18.pharmacies will close, will he tell us how many services are gohng to be

:24:19. > :24:26.cut back as a result of this? I will give way to the chairman. Is he

:24:27. > :24:33.aware that the number of ph`rmacies has increased over the last few

:24:34. > :24:36.years by 18%? I'm grateful `nd I know he works tirelessly as the

:24:37. > :24:42.champion for pharmacies, but he knows as well as I do about the

:24:43. > :24:46.services cut. Many of the local pharmacies do things such as

:24:47. > :24:50.delivering medication is up to 8:30pm at night the elderly and

:24:51. > :24:53.vulnerable people who can't get out of the house is delivering

:24:54. > :24:57.medication to care homes, c`n my honourable friend the witty things

:24:58. > :25:03.will happen if these pharmacies have to close? I would only the width I

:25:04. > :25:05.think. I would say what the sector things than they have been clear

:25:06. > :25:08.today that they would have to cut today that they would have to cut

:25:09. > :25:15.back on services like delivdry of medicines are some elderly `nd

:25:16. > :25:19.vulnerable people in societx. Is he aware that although the Govdrnment

:25:20. > :25:25.says it wants to spend a considerable portion of spending on

:25:26. > :25:30.primary care, the report on primary care showed a smaller proportion of

:25:31. > :25:35.overall is going on primary care which includes pharmacy. It is the

:25:36. > :25:38.ultimate fortress of the economy, if we don't enforce more into primary

:25:39. > :25:44.care, albeit pressure goes hnto acute. Absolutely correct. The

:25:45. > :25:49.Health Committee has completely blown apart the Government pot

:25:50. > :25:54.figures on financing the NHS. I will make some progress now if I may I

:25:55. > :25:58.am conscious that people want to speak in this debate. Mr Spdaker,

:25:59. > :26:02.the Government will say that they will mitigate these cuts by the

:26:03. > :26:06.introduction of the pharmacx access scheme, but the reality is that the

:26:07. > :26:12.scheme takes no notice of the needs of the population in the most

:26:13. > :26:19.deprived communities. Beford constituencies that top these rates

:26:20. > :26:24.are Liverpool, Blackley, Patlton, Manchester, not one pharmacx in this

:26:25. > :26:31.constituency is eligible for this scheme. If we conjures up whth the

:26:32. > :26:38.least deprived constituencids. Wokingham, Chesham, and mission 28%

:26:39. > :26:43.of pharmacies there will be eligible for this mitigating scheme `nd in

:26:44. > :26:53.walking 35% will be eligibld. This is a disgrace. It is these figures.

:26:54. > :26:58.It only disappointment who spins figures all this time can c`ll a

:26:59. > :27:02.pharmacy cuts package and access scheme, Mr Speaker. The Minhster

:27:03. > :27:09.today in his article for thd times. I will in a few moments if that is

:27:10. > :27:13.right. In the article for the times, he focuses on cities like Ldicester

:27:14. > :27:17.and Birmingham. He claims, hf you walk along roads in Leicestdr, you

:27:18. > :27:22.minutes of each other. As the member minutes of each other. As the member

:27:23. > :27:26.for Leicester myself, I walk along roads every day and I am not aware

:27:27. > :27:30.of years actually done that, here's never told me. Maybe extend an

:27:31. > :27:35.invitation to him to con thd Leicester see the community

:27:36. > :27:39.pharmacists in areas and wh`t you will also see is a high proportion

:27:40. > :27:43.of community pharmacists in areas of the city with a high proportion of

:27:44. > :27:48.black and minority and ethnhc communities providing speci`list

:27:49. > :27:51.services to families have allowed on services to families have allowed on

:27:52. > :27:58.the services for 20 or 30 ydars often dealing with elderly lembers.

:27:59. > :28:04.Speaking to those members in other languages, many of whom will have to

:28:05. > :28:08.go to the A E departments. Pharmacies are closed. Government

:28:09. > :28:13.assessment of these closures takes no account of the disproportionate

:28:14. > :28:15.effect these closures will have on cities like Leicester and

:28:16. > :28:23.Birmingham. I will give way to the honourable member. Would he at least

:28:24. > :28:26.acknowledge that we all support community pharmacists, but the town

:28:27. > :28:31.eyelid and has for pharmacids within a quarter of a mile. This is a town

:28:32. > :28:34.of three and a half thousand residents. A model that givds a

:28:35. > :28:39.block grant of ?25,000 to e`ch of those pharmacies regardless of

:28:40. > :28:44.demand purely for establishhng themselves obviously needs review.

:28:45. > :28:47.Is if the honourable gentlelan wants to tell his constituents in favour

:28:48. > :28:54.of closing pharmacies, good luck to him. Mr Speaker, of course ht is not

:28:55. > :28:58.just pharmacy closes that wd will see. The National pharmacy

:28:59. > :29:03.Association has reported today that 81% of community pharmacies will

:29:04. > :29:09.have to restrict services that help ours only people and 86% will have

:29:10. > :29:13.to restrict free services stch as with Lovering medicines to

:29:14. > :29:18.housebound patients. Does this not can firm that the elderly and the

:29:19. > :29:24.most vulnerable will be hit hardest in the Government is entirely to

:29:25. > :29:28.blame? You must surely except we have to get the most efficidncies as

:29:29. > :29:33.we can from the system and ly right honourable friend for Doncaster made

:29:34. > :29:37.peace serious point about engaging with pharmacies to see how we can do

:29:38. > :29:42.it better. Would you agree with me and I will be interested to know why

:29:43. > :29:48.it's not in his motion, but that cutbacks which levied exclusively on

:29:49. > :29:54.small independent pharmacies might be extended to virtually integrated

:29:55. > :30:00.wholesalers as a way of makhng sure the system is more efficient than

:30:01. > :30:03.now? The honourable gentlem`n talks of efficiencies, he will prdsumably

:30:04. > :30:08.people cannot get a pharmacx, one in people cannot get a pharmacx, one in

:30:09. > :30:13.four will go to a GP. We will see greater demand on GP servicds in A

:30:14. > :30:19.E departments. That is not efficient. It is a false economy, Mr

:30:20. > :30:26.Speaker. That is why the pharmaceutical negotiation committee

:30:27. > :30:30.said it is founded on ignor`nce of local pharmacies value to local

:30:31. > :30:35.communities and will do gre`ter value to primary care. That is why

:30:36. > :30:40.the chief executive pharmacx voice said this decision was incoherent,

:30:41. > :30:45.self-defeating and wholly unacceptable. Charities likd age UK

:30:46. > :30:48.has said the plans out of step messages encouraging people to make

:30:49. > :30:54.more use of their community pharmacies to relieve presstres on A

:30:55. > :31:00.E departments and GP surgdries. As age UK not hit the nail on the head?

:31:01. > :31:03.'S cuts to pharmacies compldtely contradict everything we're been

:31:04. > :31:07.told by ministers over recent years and will lead to increased demands

:31:08. > :31:12.and pressures on A E departments and GP surgeries. I thank mx

:31:13. > :31:15.honourable friend Annie madd some critical points about how the

:31:16. > :31:21.funding has been allocated `cross our country. There are 129 community

:31:22. > :31:26.pharmacies are a lot crossing all of Liverpool and just two of them, just

:31:27. > :31:30.two of them is, are going to be eligible for this payment. Hs that

:31:31. > :31:35.not absolutely outrageous? Ht is going to impact so much on the

:31:36. > :31:39.population. My honourable friend is absolutely right and even after the

:31:40. > :31:42.access scheme is in place there are still valid missy is eligible for it

:31:43. > :31:50.who are saying they will have to close despite getting the ftnds We

:31:51. > :31:54.believe in the importance of community pharmacies, because

:31:55. > :31:58.pharmacies have a role to play because one in 11 or 12 A E

:31:59. > :32:02.appointments could be dealt with at a pharmacy. They have an important

:32:03. > :32:07.role to play because they could save a significant number of A E and GP

:32:08. > :32:11.visits. These are not my words, Mr Speaker, these are the words of the

:32:12. > :32:15.Health Secretary in that dispatch box is over the last two ye`rs. The

:32:16. > :32:17.message that the Health Secretary is giving as that community ph`rmacies

:32:18. > :32:24.are a way of relieving pressure on A are a way of relieving pressure on A

:32:25. > :32:26.E and G P surgeries. It is the complete false economy. Perhaps he

:32:27. > :32:31.could explain that? Is he prepare could explain that? Is he prepare

:32:32. > :32:41.to? I will give way to him hf he wants to. No, OK. It is probably

:32:42. > :32:47.provides alcohol services to the provides alcohol services to the

:32:48. > :32:53.local community. He has pointed out that there are 14 hospital hsolation

:32:54. > :32:57.is due to alcohol. With the deficiencies that the ministers

:32:58. > :33:01.talking about and avoiding hospital access is there is not is another

:33:02. > :33:05.example of one, I think the right honourable man quoted a false

:33:06. > :33:13.absolutely right. On Monday absolutely right. On Monday

:33:14. > :33:16.Government ministers justifx this. The previous minister told le in

:33:17. > :33:20.correspondence that these ctts were necessary as part of the delivering

:33:21. > :33:23.of the ?22 billion efficiency savings. Isn't this just more proof

:33:24. > :33:28.that when they talk of efficiency savings they actually talking off

:33:29. > :33:34.cuts to front line services? I'm sorry, I need to make progrdss. The

:33:35. > :33:40.NHS is going to the worst fhnancial crisis in its 68 year history.

:33:41. > :33:45.Previous Health Secretary s`id, years now in other place, hd said he

:33:46. > :33:51.did not expect another five years of such tight budgets for the NHS the

:33:52. > :33:57.black hole in services last year was ?2.5 billion. We are now spdnding

:33:58. > :34:02.less and less. We are seeing a huge financial squeeze on the NHS and

:34:03. > :34:08.these are just part of that squeeze agenda. Mr Speaker, we want to see

:34:09. > :34:14.the Government think again on these cuts, because the result of these

:34:15. > :34:17.cuts will mean more pressurds on GP services and A E departments.

:34:18. > :34:22.There is a consensus not just among the Labour Party but amongst our

:34:23. > :34:27.constituents, among the sector, amongst clinicians and Consdrvative

:34:28. > :34:32.members against these cuts. It is ministers who stand outside that

:34:33. > :34:36.consensus. The members have told this House, the member for Stevenage

:34:37. > :34:40.who said it does not make sdnse we are increasing pharmacies to dig on

:34:41. > :34:44.reducing a number of them. The reducing a number of them. The

:34:45. > :34:49.member for Brock so said I do not think this is a wise move. @nother

:34:50. > :34:53.member said when A E departments are under so much pressure we need

:34:54. > :34:56.community pharmacies. Mr Spdaker, I agree. Our message to make the

:34:57. > :34:59.Conservative members who want to stand up to their constituents who

:35:00. > :35:03.have been lobbied by pharmacists is join us in the division lobbies this

:35:04. > :35:08.afternoon and get these minhsters to think again on these damaging cuts.

:35:09. > :35:18.THE SPEAKER: Order, the question is o as on the order paper, to move the

:35:19. > :35:22.amendment in the name of thd prirges I call the minister.

:35:23. > :35:25.I beg to move the amendment standing in the name of my right honourable

:35:26. > :35:29.friend, the Prime Minister. I welcome the opportunity to set out

:35:30. > :35:31.again the Government's approach to pharmacy in general, and in

:35:32. > :35:35.community pharmacy in particular over the next few years. I will also

:35:36. > :35:41.address some of the points we have heard in the last few minutds, which

:35:42. > :35:46.are frankly, Mr Speaker, al`rmist scaremongering. Mr Speaker, the

:35:47. > :35:51.proposals which I anonced two weeks ago are directed at four mahn areas.

:35:52. > :35:56.First, the need to better integrate pharmacy with GPs, primary care and

:35:57. > :36:01.the NHS more widely. Second, the need for the existing community

:36:02. > :36:05.pharmacy network to move from a dispensing model to a model based on

:36:06. > :36:11.value added services. Third, the need to continue to work with NHS

:36:12. > :36:20.England to envalue for monex for every penny we spend on the NHS And

:36:21. > :36:24.fourth - not yet - the need to ensure as we undertake the reforms,

:36:25. > :36:27.everybody in the country will have access to a community farmlx. First,

:36:28. > :36:31.integration with the NHS, especially in general practice. Over the

:36:32. > :36:34.weekend, Simon Stevens the Chief Executive of the NHS England again

:36:35. > :36:38.reiterated his view of the importance of that and why he

:36:39. > :36:44.supports this process. We know we need to expand the number of GPs in

:36:45. > :36:49.general practice and by 2020, we will have a further 5,000 working in

:36:50. > :36:52.that area. But as well as rdcruiting and retaining more doctors, we need

:36:53. > :36:58.to provide them with further support. The GP Forward View,

:36:59. > :37:05.published by NHS England, Mr Speaker, has set out fully costed

:37:06. > :37:11.plans to recruit a further 0,50 clinical pharmacists, into GP

:37:12. > :37:15.practices by 2020. By then, there will be one pharmacist workhng

:37:16. > :37:22.within a GP practice for evdry 30,000 population. Most of these

:37:23. > :37:27.will be prescribing pharmachsts and all will be producing and doing

:37:28. > :37:32.medicine reviews to leveragd GP time. This is a major investment and

:37:33. > :37:39.it is already happening. Good. I will give way.

:37:40. > :37:42.! Thank you, Mr speaker, I the thank the minister for giving way. The

:37:43. > :37:47.point I was trying to make when I was trying to intervene earlier was

:37:48. > :37:51.to Say that I went to a pharmacy recently in Bexhill, they are making

:37:52. > :37:58.deliveries to every single customer who asks for T not the vulndrable or

:37:59. > :38:01.Ed Dell. They do it because if they didn't, Lloyds would take them out

:38:02. > :38:04.of business. Doesn't it show that there are efficiencies, and the fact

:38:05. > :38:09.it is recycled in the health service has to be good for all of otr

:38:10. > :38:12.constituents. It does show that It is a competitive business. He

:38:13. > :38:17.mentioned Lloyds. Lloyds ard a big player in this. 30% of whom, two

:38:18. > :38:21.players earn 30% of all pharmacies. Intervention there. I'm grateful to

:38:22. > :38:26.the minister for giving way. Tea uks about moving away from a dispensing

:38:27. > :38:30.model to a value added model and I will come to the healthy living

:38:31. > :38:34.model if I get the opportunhty to speak, Mr Speaker but where is his

:38:35. > :38:40.views on warehouse pharmacids then when he talks about that? Otr view

:38:41. > :38:42.on the actual structure of the industry is that it is for the

:38:43. > :38:46.individual companies within the sector to organise themselvds to

:38:47. > :38:50.provide the services they provide as efficiently as possible. It is true,

:38:51. > :38:53.it is true that 70% of all pharmacies are either chains or

:38:54. > :38:58.multiples or public companids. And I will address that in the cotrse of

:38:59. > :39:02.my remarks. I want it make some gross and I will

:39:03. > :39:06.return to that. Secondly, wd want to see an enhanced role for thd

:39:07. > :39:11.community pharmacy network, in terms of value added services. Thhs is an

:39:12. > :39:17.aspiration that we share with them and their representatives. To that

:39:18. > :39:20.end, NHS England has commissioned the King's Fund, Richard Murray to

:39:21. > :39:24.produced an evidence-based report to look at the services that whll be

:39:25. > :39:29.best produced by pharmacists over the next two or three years. This

:39:30. > :39:33.report to be published later this year, will inform NHS England's

:39:34. > :39:37.decisions on how to use the integration fund of ?42 million

:39:38. > :39:41.which I announced two weeks ago and there are many candidate ardas.

:39:42. > :39:45.Long-term conditions, minor ailments, better care home support,

:39:46. > :39:49.more medicine reviews, as wdll as the work that pharmacies do in

:39:50. > :39:53.public health. I'm grateful to him for giving way. Many of the

:39:54. > :39:58.pharmacies in my constituency already provide such servicds but

:39:59. > :40:03.many of them are now threatdned by the proposals that his Government

:40:04. > :40:09.are making. Does he not realise that in a constituency like my, which is

:40:10. > :40:13.number 20 on the list of deprived areas, that the pharmacy vohce

:40:14. > :40:19.research suggested that four in five people who can't see a form cyst

:40:20. > :40:23.will end up - a pharmacist, will end up going to their G that dods the

:40:24. > :40:26.opposite of what he says, hd wants, does he not agree? The impact

:40:27. > :40:29.review, which was published at the same time as my statement two weeks

:40:30. > :40:33.ago, estimated the amount of extra time people would have to spend

:40:34. > :40:37.going to a formcy, even if we had a number of closures, say 100, is a

:40:38. > :40:41.matter of seconds and the ilpact review sets that out in somd

:40:42. > :40:49.details. Over there. Is there an intervention behind me? If the

:40:50. > :40:55.honourable friend would det`ch himself from his device for a few

:40:56. > :40:58.moments. It is very good of him to join us and take an interest in our

:40:59. > :41:03.proceedings. Mr Speaker, I was trying to find something th`t was

:41:04. > :41:09.going to inform my view. Can I thank my honourable friend for giving way.

:41:10. > :41:13.Is he aware that in Devon they recognise that about 5.5 million

:41:14. > :41:18.pounds is wasted in as far `s unused medicines are concerned as well And

:41:19. > :41:23.that needs to do something `bout that. I do realise that and I

:41:24. > :41:27.mentioned a medicine review aspect is something the King's Fund is

:41:28. > :41:31.looking at. I have quoted in this Chamber before now that the model

:41:32. > :41:35.that's adopted for pharmacists in Scotland which we may not adopt in

:41:36. > :41:40.its entirety, it has a lot to commend t and I hope we get a chance

:41:41. > :41:44.to to discuss that later in the course of this debate. If I may

:41:45. > :41:47.before I give way, quote thd chief pharmacist himself, Dr Keith

:41:48. > :41:52.Etheridge who has confirmed that the review we have done will support

:41:53. > :41:55.community pharmacy to support new clinical services, new workhng

:41:56. > :42:01.practices and online support to meet public expectations for moddrn NHS.

:42:02. > :42:04.Mr Speaker, two weeks ago, H announced two initiatives which will

:42:05. > :42:10.proceed in advance of the Khng's Fund report. From December 0st,

:42:11. > :42:15.phone calls made to NHS 111 for urgent repeat prescriptions will be

:42:16. > :42:19.directed not to an out of hours GP service as at present but to a

:42:20. > :42:23.community pharmacy. This will amount to some 200,000 calls a year,

:42:24. > :42:26.resulting in a further revenue stream, both looking at the

:42:27. > :42:33.consultation and supplying the medicine. NHS England also committed

:42:34. > :42:38.to encouraging national covdrage of a locally-closed NHS minor `ilments

:42:39. > :42:42.service. Some areas, like Wdst Yorkshire already do this. We will

:42:43. > :42:48.role it out to the whole cotntry Bey 2018. Both of these initiathves will

:42:49. > :42:52.relieve pressure on surgerids and emergency care centres. Both will

:42:53. > :42:56.result in additional incremdntal revenue for pharmacies but they are

:42:57. > :43:03.very much the start. I'm gr`teful to the minister for giving way. Does he

:43:04. > :43:05.accept the impact assessment view, that independent pharmacies,

:43:06. > :43:10.micro-businesses often, and small chains of up to #20, will bd at

:43:11. > :43:19.higher risk of closure than the larger chains. -- up to 20. In terms

:43:20. > :43:23.of the proposals we have to be blind to the ownership. The facts are Mr

:43:24. > :43:28.Speaker, that the average pharmacy, when they are sold, sells for

:43:29. > :43:33.something like ?750,000, and I do not accept that these proposals will

:43:34. > :43:38.cause closures to those seglents is that the thrust of his question I

:43:39. > :43:42.want to continue, first. Mr Speaker, the third area I wish to address is

:43:43. > :43:52.value for money. I make no `pology for doing this. According to the

:43:53. > :43:57.recent OECD analysis, the UK now spends above the OECD average health

:43:58. > :44:02.care but however much we spdnd, everip pen quli needs to be spent as

:44:03. > :44:05.efficiently as. If that doesn't happen, it means that waiting lists

:44:06. > :44:10.are too long, treatments ard denied and drugs are not available. We also

:44:11. > :44:15.know, it is true, that efficiency savings are required for evdry part

:44:16. > :44:20.of the NHS. Community pharm`cy must play a role in contributing to the

:44:21. > :44:24.?22 billion of savings that we need. I do not apologise for that, Mr

:44:25. > :44:28.Speaker. I'm grateful to thd minister. I certainly support the

:44:29. > :44:33.amendment on the order paper today. Would he agree with me, thotgh, that

:44:34. > :44:37.in terms of efficiency, as he tried to extract from the benches

:44:38. > :44:41.opposite, this issue of catdgory M claw-back is very important. I would

:44:42. > :44:45.just ask him to think again about the ownership blind point hd made

:44:46. > :44:50.earlier on. Since there is ` very real risk, since there isn't at the

:44:51. > :44:52.moment an equal playing field that small independent pharmacies are

:44:53. > :44:57.going to continue to be dond in I do accept that point. We ard doing

:44:58. > :45:03.work on the category M claw,back and I hope to be able it make some

:45:04. > :45:07.progress on that, soon. I'm very grateful to him for giving way. If

:45:08. > :45:11.anybodical square this circle, I think it is the minister given his

:45:12. > :45:15.very extensive experience in this area. Genuinely. We have to sort out

:45:16. > :45:20.this issue but the point is this, and I think it relates to mx

:45:21. > :45:24.honourable friend's point. H am not happy to be subsidising somd of the

:45:25. > :45:26.large private companies, like some of the chains that have been

:45:27. > :45:30.mentioned through the systel. I think it is right to look at where

:45:31. > :45:36.they are clusering but we all have and he knows the issue of Kdnnet

:45:37. > :45:40.pharmacy in my constituent, that are doing this very valuable work. How

:45:41. > :45:44.can we help him over the period of this review, to identify and sport

:45:45. > :45:51.services that those pharmaches do, they must not be allowed to close as

:45:52. > :45:57.a result of this policy. I `gree with the intervention and on work we

:45:58. > :46:01.are done, I have set out more money, all above the money we have talked

:46:02. > :46:05.about and the efficiency savings we have to make, will help with that

:46:06. > :46:10.process I thank the minister for giving way. Further to that point,

:46:11. > :46:14.as he knows pharmacists are a highly-skilled and professional

:46:15. > :46:20.resource that are long under used in the NHS. But he has pointed out we

:46:21. > :46:24.have an ongoing Murray revidw and a process going around the cotntry and

:46:25. > :46:28.the concern is these closurds will come about in a random way, rather

:46:29. > :46:33.than a planned process, basdd on particular areas and identifying the

:46:34. > :46:37.skills. Would the minister consider delaying these until we havd all

:46:38. > :46:43.these in place and we can consider this on an area-by-area bashs? Hear,

:46:44. > :46:47.hear. The access scheme that we have set out is the device that will

:46:48. > :46:55.ensure that these things ard not closed in a random way. I w`nt to

:46:56. > :47:02.address the point about closure head-on. My belief, Mr Speaker is

:47:03. > :47:06.there will be a minimal amotnt of closures the impact analysis models

:47:07. > :47:11.100. The facts are, Mr Speaker, the average pharmacy has a marghn of 15%

:47:12. > :47:16.and the amount of efficiencx saving we are asking them to make over two

:47:17. > :47:22.years, Mr Speaker is 7%. Thd facts are in addition to that, Mr Speaker,

:47:23. > :47:26.the average pharmacy, even `fter we have announced these efficidncy

:47:27. > :47:32.savings a year ago, has been trading, when they are closdd or

:47:33. > :47:36.when they merge, for ?750,000 each. That value is retained.

:47:37. > :47:41.I'm grateful to the minister for giving way. The previous minister

:47:42. > :47:45.put a figure on it. Can he tell us what he considers what the number is

:47:46. > :47:49.of a minimal amount of clostres what is the number? Mr Speaker,

:47:50. > :47:52.these are private businesses each with different business moddls and

:47:53. > :47:56.each with a different amount of income from the NHS and othdr retail

:47:57. > :48:00.activities and service. Each finance in a different way. Indeed, 30% of

:48:01. > :48:06.them are owned by two public companies. 70% of them are

:48:07. > :48:15.multiples. And Mr Speaker that is not something we can... Thank you,

:48:16. > :48:20.Mr Speaker. Can reassurance be given that local pharmacies are the front

:48:21. > :48:24.line of primary care and cotld the minister extend the work and

:48:25. > :48:26.responsibility of those loc`l pharmacies, in particularly deprived

:48:27. > :48:35.areas, and give reassurance that that is the focus of this ddbate? Mr

:48:36. > :48:41.Speaker, I spoke to 500 pharmacists this morning and I made thel that

:48:42. > :48:46.precise reassurance. The ch`nges we are making to transfer this sector

:48:47. > :48:51.into a service-based economx, rather than a dispensing-based economy

:48:52. > :48:55.will do just that and it is where they want to go, Mr Speaker and

:48:56. > :49:01.frankly this has all taken so long. I need to make some progress, I will

:49:02. > :49:06.give way in a moment. At prdsent, Mr Speaker, the average pharmacy

:49:07. > :49:14.receives NHS income of ?220,000 a year. That's based on through put of

:49:15. > :49:17.?1 million from the NHS. Th`t translates into a value in the order

:49:18. > :49:21.of three-quarters of a millhon pounds in terms of each pharmacy. So

:49:22. > :49:27.when they merge, or they sell, that's what they are traded for The

:49:28. > :49:28.changes that we are making will not, have not made a significant

:49:29. > :49:38.difference to that. I would like to make the pohnt is

:49:39. > :49:41.that we talked about earlier, 4 % of all pharmacies are located within

:49:42. > :49:46.ten minutes walk of at least two other pharmacies. Instances exist of

:49:47. > :49:53.a dozen or more pharmacies located within half a mile of each other. As

:49:54. > :50:01.I noted earlier, one of these most likely receiving ?25,000 a xear

:50:02. > :50:05.Just to reiterate that. I w`s brought up on the outskirts of

:50:06. > :50:11.Leicester, Siam delighted to tell you that I have indeed been to

:50:12. > :50:14.Leicester. I will also say that within all of these clusters,

:50:15. > :50:26.?25,000 of national health loney is not the best way to spend precious

:50:27. > :50:33.re-sources. In addition, Mr Speaker, I want to say that the additional

:50:34. > :50:39.services the pharmacies will choose to provide, such as winter flu jabs

:50:40. > :50:43.and public health services H simply decommissioned and are unaffected by

:50:44. > :50:46.this reset. There will have been 600,000 flu jabs given our community

:50:47. > :50:52.pharmacies this year and th`t is more than all of last winter. I need

:50:53. > :50:58.to make progress, Mr Speaker. I think it is there to say th`t the

:50:59. > :51:02.harangued to give way, but ht is harangued to give way, but ht is

:51:03. > :51:06.part evident to me he is not going to give way at the moment. Lembers

:51:07. > :51:11.will have to exercise their judgment as to the frequency with whhch the

:51:12. > :51:16.continued to make attempts. I will continue to make progress and give

:51:17. > :51:23.way towards the end of my rdmarks. I do not wish to downplay the impact

:51:24. > :51:33.of the Private businesses that own these businesses. The private sector

:51:34. > :51:39.is an economy made up of prhvate chains and independent. It hs hard

:51:40. > :51:45.to actually predict the imp`ct of the changes on these individual

:51:46. > :51:50.models. What I can say, Mr Speaker, is that the savings that we are

:51:51. > :51:55.making will entirely be recxcled back into the NHS. Every penny of

:51:56. > :51:59.efficiency savings that we `re asking from these community

:52:00. > :52:12.pharmacies will be spent on better patient care, better drugs, that the

:52:13. > :52:17.GP access. I am very grateftl to the Minister forgiving way and hs I

:52:18. > :52:23.totally understand the importance of trying to get as many hangs freer

:52:24. > :52:29.box as possible from pharmacy services, but surely this actually

:52:30. > :52:32.amounts to a significant cut in spending on preventive servhces that

:52:33. > :52:37.seems to need to be completdly counter to what the Governmdnt says

:52:38. > :52:47.it aims to do. Mr when it is taken into account with the ?112 lillion

:52:48. > :52:50.that we are spending on pharmacists in GP practices, I think thd

:52:51. > :52:56.honourable member is incorrdct on that point. I will give way in a

:52:57. > :53:04.moment, I will do that. The final area that I wish to speak to, is the

:53:05. > :53:08.work that we are doing to ensure that all people in the country have

:53:09. > :53:14.access to a community pharm`cy. We have developed a scheme to do that

:53:15. > :53:18.with two components. First, all pharmacies which are more than one

:53:19. > :53:21.mile from another pharmacy will be eligible for additional funding

:53:22. > :53:27.This will mitigate almost entirely the impact of the changes announced

:53:28. > :53:30.earlier. This is designed specifically to protect are`s where

:53:31. > :53:36.current position is quite spread out. In total, it will applx to 1400

:53:37. > :53:42.locations, roughly half of them are urban and half of them are the role.

:53:43. > :53:47.Pharmacies in the high as 24% of prescription volume, therefore the

:53:48. > :53:52.most profitable, will not bd eligible for this scheme. Sdcondly,

:53:53. > :53:59.there is a new in this schele in which pharmacies located up to .8

:54:00. > :54:09.miles each other and are in the 20% most deprived areas, can apply to be

:54:10. > :54:15.reviewed by NHS England at ` special request. The final safeguard is that

:54:16. > :54:18.NHS England has a continuing duty to insure the adequate provision of

:54:19. > :54:23.services. Their role is to commission a new pharmacy in airy

:54:24. > :54:28.area where they believe accdss is inadequate. Is this treaty will

:54:29. > :54:34.continue. I give way. I think the Minister forgiving way. Can you

:54:35. > :54:36.said, there are many corpor`tists said, there are many corpor`tists

:54:37. > :54:42.across the country that provide many community pharmacists in rural and

:54:43. > :54:51.isolated areas. For the purpose of the debate, can can you clarify the

:54:52. > :54:58.distinction between a community pharmacist and a GP pharmachst? It

:54:59. > :55:01.is not clear. The distinction is that he community pharmacies by the

:55:02. > :55:07.privately owned business dispensing and being paid in that way. The ones

:55:08. > :55:13.that we are hiring in the GP practices leveraged GP time, do

:55:14. > :55:20.medicine reviews and I expect them to enable the pharmacy network in an

:55:21. > :55:26.area to work more cohesivelx. It's a very, very welcome and frankly

:55:27. > :55:30.overdue step forward. I need to continue. Taken as a whole, three

:55:31. > :55:34.measures I have spoken about in terms of protecting access will

:55:35. > :55:36.ensure that all people across our country will have access to a

:55:37. > :55:42.community pharmacy is in much the same way as at the moment. Lr

:55:43. > :55:50.Speaker, the future for comlunity pharmacy is bright. The changes we

:55:51. > :55:55.are making will make a 7.4% efficiency requirement over two

:55:56. > :55:59.years. That is proportionatd and will continue to orientate the

:56:00. > :56:04.profession towards services in quality, quality for the first time,

:56:05. > :56:08.and away from renumeration based on dispensing. I would like to finish

:56:09. > :56:12.by quoting the chief pharmacist again. The public can be re`ssured

:56:13. > :56:18.that while efficiencies are being asked of committee pharmacist just

:56:19. > :56:26.asserting of other parts of the there is still efficient funding to

:56:27. > :56:31.ensure that they are convenhent and accessible across England. The NHS

:56:32. > :56:37.is committed to a positive future for pharmacists and community

:56:38. > :56:43.pharmacy. Every penny we ard saving as a result of these efficidncy

:56:44. > :56:51.reviews will be spent within the NHS on better care, on better drugs on

:56:52. > :56:58.our quicker treatment. I urge members to support the amendment

:56:59. > :57:02.later today. Thank you very much. The Minister has very kindlx refer

:57:03. > :57:07.to the system in Scotland which has been running for ten years since the

:57:08. > :57:14.smoking, health and care act of 2005. It took time to introduce

:57:15. > :57:17.that, but in Scotland all pharmacies are a community pharmacies. That

:57:18. > :57:26.means all of them provides services. They do not get the big paylents

:57:27. > :57:31.merely for existing. They gdt ? 730 for existing, that is quite tiny.

:57:32. > :57:36.They get payments based on needs and that reflects an aged popul`tion, a

:57:37. > :57:40.vulnerable and deprived poptlation. These things are taken into the

:57:41. > :57:46.global funding and the glob`l funding in Scotland is due go up.

:57:47. > :57:53.That will go up 1.2%, well here there are talks of reduction of 4%.

:57:54. > :57:56.The services provided is as has been referred to the minor ailments

:57:57. > :58:02.service. There are many pharmacies in England doing this, but ht is not

:58:03. > :58:08.a national system. In Scotl`nd it is a national system which must be

:58:09. > :58:11.provided. Pharmacies have to invest, they have to build a consulting

:58:12. > :58:16.room. They have to change their buildings that they can see people

:58:17. > :58:23.privately to diagnose what the minor ailment is. They were the protocol

:58:24. > :58:26.for a whole list of ailments. Ailments they can diagnose `nd have

:58:27. > :58:30.the ability to treat. These are minor things that many people would

:58:31. > :58:40.experience a different times and it avoids having to go to a GP. That is

:58:41. > :58:44.an important point, if you go into a community pharmacist today xou see a

:58:45. > :58:47.treatment room we can have `dvice for blood pressure, all thotghts of

:58:48. > :58:52.things. Is it not perverse, cruel, utterly irrational, to say to a

:58:53. > :58:55.group professionals have done all this work to change the way they

:58:56. > :59:00.deliver the services, now wd are finished with you, how to go, you

:59:01. > :59:05.done your bit, but we are going to pick you out and close down the

:59:06. > :59:10.pharmacy. I agree with the Government in looking for more

:59:11. > :59:12.services, but this is not the way to work with the profession whdn you

:59:13. > :59:19.actually want them to do more work and to work in a different way.

:59:20. > :59:21.Sadly, in my time in this House we have seen this kind of thing

:59:22. > :59:24.repeatedly, but instead of sitting repeatedly, but instead of sitting

:59:25. > :59:27.down with a professional as was mentioned by one of the members on

:59:28. > :59:32.these benches saying, why not look these benches saying, why not look

:59:33. > :59:39.for ways savings can be found rather than simply making a cut? I was

:59:40. > :59:43.going to make the interventhon to the Minister following up from the

:59:44. > :59:47.chair of the Health Secretary's point. At the time we are looking at

:59:48. > :59:51.bottom-up planning for the first time in a number of years in England

:59:52. > :59:53.with this process, it is colpletely the wrong time to be making a

:59:54. > :59:58.rational and random cuts. I think rational and random cuts. I think

:59:59. > :00:03.we spoke about. We had a debate we spoke about. We had a debate

:00:04. > :00:13.recently on S T the potenti`l they provide. The danger they proposed is

:00:14. > :00:16.financed patient care inste`d of centred. Going back to placd -based

:00:17. > :00:21.planning which we still havd in Scotland, we still have health

:00:22. > :00:24.boards, means you can look ht integrating services and ph`rmacies

:00:25. > :00:27.definitely need to be part of that. They definitely have the potential

:00:28. > :00:34.to be a significant front lhne player. I am interested in the

:00:35. > :00:38.experience of Scotland and well it is not the current system in

:00:39. > :00:42.England, I would be grateful for her experience of watching things about

:00:43. > :00:48.moving pharmacist into GPs, because I think that is personally ` mistake

:00:49. > :00:51.and I would much prefer the Scottish approach were pharmacists are

:00:52. > :00:56.expanding into consulting rooms of their own. We do have both. We have

:00:57. > :01:02.pharmacist in a consulting room with any practice and we have a

:01:03. > :01:07.Government who has put ?85 lillion into taking on an additional 14

:01:08. > :01:12.pharmacist to work in primary care with GPs. Not as has been done in a

:01:13. > :01:16.blast to say that everyone on drug aids changing to a different drug

:01:17. > :01:20.because it is cheaper withott any thought of her videos with the

:01:21. > :01:25.patient, but actually consulting with patients who are often on ten,

:01:26. > :01:28.15 different medications with different side effects and

:01:29. > :01:35.rationalising that in giving the patient advice and providing a

:01:36. > :01:38.clinical service rather than just a chain order service. We are doing

:01:39. > :01:41.both. The Unity pharmacy system has been running for ten years, it

:01:42. > :01:48.quite mature. Patients register with quite mature. Patients register with

:01:49. > :01:53.a pharmacist in the same wax the register with a GP and the `im going

:01:54. > :01:58.forward, I will come to you shortly. If that actually all people should

:01:59. > :02:02.considered their local pharlacist considered their local pharlacist

:02:03. > :02:06.and that means they can accdss minor ailment treatments. It also means

:02:07. > :02:11.people who are on chronic mddication have a chronic dedication sdrvice

:02:12. > :02:13.where they are sent their prescription electronics yot to the

:02:14. > :02:18.pharmacy, the pharmacy keeps track of when it is due so they m`ke sure

:02:19. > :02:21.that patients don't run out of medication. They also provide an

:02:22. > :02:28.acute medication service for people love not signed up to that, but who

:02:29. > :02:32.suddenly find they have not got tablets. They have not thought to

:02:33. > :02:37.reorder them with their GP `nd if they are regulars with that

:02:38. > :02:40.pharmacy, they can prescribd a single round of that drug so that

:02:41. > :02:49.people do not take the gap hn treatment. Our vision is to have all

:02:50. > :02:58.of our pharmacists by prescribers by 2023 and to have our public

:02:59. > :03:05.registered with pharmacists by 020. Think she made two very important

:03:06. > :03:10.points, communities rely just like they rely on their doctor for that

:03:11. > :03:13.sort of facility, particularly the elderly and those who may h`ve to

:03:14. > :03:19.travel miles depending on where the pharmacy is. I think it is

:03:20. > :03:25.absolutely crucial that the service covers all in arrears and that

:03:26. > :03:28.includes deprived areas, pl`ces without good public transport,

:03:29. > :03:32.because distance is not everything, it is how you travel that dhstance.

:03:33. > :03:36.distance may not be that grdat, but distance may not be that grdat, but

:03:37. > :03:43.there simply isn't a bus in that direction. Did want to make this

:03:44. > :03:46.point of the Minister, the closure of community pharmacies werd clearly

:03:47. > :03:50.lead to poorer service, a loss of patient choice and quite cldarly per

:03:51. > :03:56.head outcomes for those in lore deprived parts of the country. This

:03:57. > :03:57.is not just another example of a Government cuts that will ultimately

:03:58. > :04:06.cost us more in the long term? I think if it is introduced badly it

:04:07. > :04:09.will cost more in the long term What the minister aspires to when he

:04:10. > :04:12.talks about a more service-based approach is something more like the

:04:13. > :04:18.Scottish model. I would comlend that. I just feel it is being done

:04:19. > :04:22.backside forward. I need it make a bit of progress. Which is that you

:04:23. > :04:27.need to actually design the services and you knead to design thel with

:04:28. > :04:35.the people who work in them. -- need to. 18% of our population, `re

:04:36. > :04:40.registered and do access thd minor ablement service and that t`kes

:04:41. > :04:43.pressure off both Accident Emergency, out of hours and also

:04:44. > :04:48.from GPs. The fourth servicd we have is the public health servicd. 7 % of

:04:49. > :04:53.all smoking cessation in prhmary care is done within our comlunity

:04:54. > :04:59.pharmacies and these four sdrvices together, minor ailments, chronic

:05:00. > :05:02.medication, acute medication and public health actually covers a huge

:05:03. > :05:07.breadth of service to the community and it is important that those

:05:08. > :05:10.pharmacies in England that `re currently just retail and dhspensing

:05:11. > :05:18.pharmacies, are encouraged to go in that direction. Because, I think

:05:19. > :05:30.that does bring benefit for the NHS. My biggest concern is the r`ndomness

:05:31. > :05:36.if you simply cut and let the dice fall where you will, you will still

:05:37. > :05:42.end up with problems. For it to happen, they have to apply for the

:05:43. > :05:46.health board in Scotland. And it is for the health board to dechde who

:05:47. > :05:50.becomes community pharmacies and it is for them to decide if thdre is

:05:51. > :05:55.need to open a new communitx pharmacy. The biggest mistake in

:05:56. > :06:00.this, I think is the randomness One of the things that were raise bid

:06:01. > :06:04.the member for Wiltshire is looking at some of the profits that have

:06:05. > :06:11.been made by the drugs being sold on. One of the things that the

:06:12. > :06:15.Government could look at is these vertically integrated wholesalers.

:06:16. > :06:18.Back in the mid-2,000s they were not looked at. The Government doesn t

:06:19. > :06:22.know what profit they made. They don't know where the profit is made

:06:23. > :06:32.and it is totally unregulatdd and they control about 40% of that

:06:33. > :06:37.market. With up of the bigghst Alie ans Boots declared profit of 50 ,000

:06:38. > :06:41.and were able to reduce thehr tax bill by over a billion in this

:06:42. > :06:47.country. So we have people laking almost half their profit from tax

:06:48. > :06:53.payers, and yet don't pay their full share of tax and I absolutely agree

:06:54. > :06:55.it'll be the big chains that survive and it will be the small,

:06:56. > :07:01.independent very community-based pharmacies that will get lost.

:07:02. > :07:05.I thank her for giving way. The minister accused those who highlight

:07:06. > :07:09.concerns of scaremongering. St George's pharmacy at the eldphant

:07:10. > :07:13.castle in my constituent saxs, they made the fist set of in-year cuts by

:07:14. > :07:18.compromising on the services but the second set of cuts will most

:07:19. > :07:25.definitely place us at a re`l risk of closure. It is right to highlight

:07:26. > :07:30.concerns, especially in constituents like mine where he face loshng 8. I

:07:31. > :07:34.think losing that scale of pharmacies in any area would be a

:07:35. > :07:38.disaster. It is like Groundhog Day, this is the third discussion on this

:07:39. > :07:42.topic we have had in as manx weeks, and he said absolutely therd will be

:07:43. > :07:48.protection in areas but if xou look at the pharmacy access schele, it is

:07:49. > :07:51.still largely comes down to the number of dispensing, the alount of

:07:52. > :07:56.dispensing that is done and the distances. It still doesn't take

:07:57. > :08:01.account of which pharmacies are providing a good service, which ones

:08:02. > :08:05.are set up to provide a good service and how to encourage others to

:08:06. > :08:09.develop. And this is what I feel is completely wrong in what thd

:08:10. > :08:13.Government is doing. It is just slicing money off and leaving

:08:14. > :08:17.individual businesses to decide whether or not they think it is

:08:18. > :08:22.profitable or not. The dangdr would be, if you get a whole load of

:08:23. > :08:27.pharmacies that all decide to sell out and walk, instead of saxing - OK

:08:28. > :08:32.in this area 18 is too many, if they are all around one town squ`re.

:08:33. > :08:37.Which ones are best able to develop a service, let them bid for t let

:08:38. > :08:41.them be inspected and let's see how they take it forward but coling back

:08:42. > :08:45.to the vertically integrated wholesalers, I think that's an area

:08:46. > :08:50.where the Government could take a lot of savings out and I thhnk one

:08:51. > :08:52.of the things we have in Scotland is margin sharing, where there is a

:08:53. > :08:56.price control group that actually looks at the profit that of is being

:08:57. > :09:00.made at different stages, and some of that has to be shared back.

:09:01. > :09:04.Because, we do have people who are trading on the open market `nd

:09:05. > :09:09.moving drugs around, partictlarly within the big chains and I think

:09:10. > :09:14.that, again, as was suggestdd earlier, the idea of sitting down

:09:15. > :09:20.with the profession, and designing a service would get a better result. I

:09:21. > :09:27.also would agree that STPs could provide the model within whhch you

:09:28. > :09:30.lack at, in any STP, how many community pharmacies should you

:09:31. > :09:35.have, where do they need to be and work backwards. I think the danger

:09:36. > :09:39.of this is that it is the wrong way around. Just calling them efficiency

:09:40. > :09:44.cuts doesn't make them efficient. The danger is, you just slash

:09:45. > :09:49.something and it'll fall ovdr. So I don't think that the Pharmacy Access

:09:50. > :09:54.Scheme is enough of a protection or intervention. I think there needs to

:09:55. > :09:57.be planning. I can commend the idea of a proper services' based pharmacy

:09:58. > :10:01.system but the aspiration should not just be a few pharmacies who choose

:10:02. > :10:08.to do it and others who choose not to. The aim should be that hf a

:10:09. > :10:12.patient is walking into a community pharmacy, they know the services

:10:13. > :10:17.they can get and we should be aiming to have that right across the

:10:18. > :10:21.country. THE SPEAKER: Beford I call the next speaker, there is going to

:10:22. > :10:24.be a imlit of five minutes. There are 25 people trying it takd part in

:10:25. > :10:30.this debate. It maybe necessary to drop it down further later on but

:10:31. > :10:34.we'll start with five minutds. It is a shame the front bench have

:10:35. > :10:39.taken long on this matter. H know a lot of colleagues have wantdd to

:10:40. > :10:42.speak. I agree with the minhster to get the greatest efficiency for

:10:43. > :10:45.taxpayer whilst assuring thd best-possible health care for our

:10:46. > :10:50.constituents but we cannot waste money in anyway, shape or form. If

:10:51. > :10:54.we can find a way to redirect money into front line services I `gree

:10:55. > :10:58.with the minister we should do so. As the minister Said, the NHS chief

:10:59. > :11:02.pharmacist has been clear - the current way in which the colmunity

:11:03. > :11:08.pharmacy has been paid needs reform and it is right that we shotld look

:11:09. > :11:12.at T the NHS is labouring under huge financial pressures so we should be

:11:13. > :11:16.looking at any areas where there are inefficiencies or duplication that

:11:17. > :11:19.may lead to precious resources being distributed inefficiently. H believe

:11:20. > :11:23.the public doesp want the money that can be saved in this measurd

:11:24. > :11:27.reinvested in front line services I'm glad the minister has t`ken the

:11:28. > :11:31.opportunity to reassure us on that. My own hospital trust suffers under

:11:32. > :11:35.a massive deficit that has been growing year on year and in their

:11:36. > :11:40.latest financial report it's revealed by 2015-16 they had a

:11:41. > :11:44.revenue deficit ofhoods 41.2 million. We cannot fail to tack he

:11:45. > :11:47.will why the financial pressures and throwing money at the probldm will

:11:48. > :11:50.never be enough if we don't at the same time seek to tackle thd system

:11:51. > :11:54.as well. Surely the party opposite cannot be asserting that thdse

:11:55. > :11:59.matters should never be looked into. And if they actually pledged ?1

:12:00. > :12:02.billion less in this Governlent in their manifesto commitment. I would

:12:03. > :12:07.be intrigued to know when they sum up how on earth they would dxplain

:12:08. > :12:10.they would keep this system in its entirety and at the same tile put

:12:11. > :12:15.more money into the NHS services, which is what I would like to see

:12:16. > :12:18.happen. Gep, like many have said. I wanted the biggest bang or the tax

:12:19. > :12:22.payers' buck and I want the Health Minister to succeed in his `im to

:12:23. > :12:27.deliver the very best pharm`cy service with facilities that help

:12:28. > :12:29.keep patients out of A and doctors' surgeries and at the same

:12:30. > :12:33.time promote good health within the communities. So I agree with him it

:12:34. > :12:36.is important to integrate the community Farrell sis into the NHS

:12:37. > :12:40.urgent care system and into GP services. I did welcome the

:12:41. > :12:44.Government's announcement in October that the pharmacy integration fund

:12:45. > :12:47.will provide up to ?42 millhon to improve on how pharmacists, their

:12:48. > :12:52.teams and community pharmaches operates within the NHS as ` whole

:12:53. > :12:54.but if we are to look at thd establishment payment of ?24,00

:12:55. > :12:59.paid to pharmacies we must be sure we get the right result and we must

:13:00. > :13:05.protect residents who live hn rural or sparsely populated areas and

:13:06. > :13:10.those rows that have alreadx been remarked on, who do not havd access

:13:11. > :13:13.to cars so, they must be protected from small pharmacy closure but the

:13:14. > :13:17.minister says the current sxstem does not do enough to promote

:13:18. > :13:22.efficiency, quality or integration with the rest of the NHS. Hd said in

:13:23. > :13:25.most cases the NHS is giving these pharmacies a guaranteed sick payment

:13:26. > :13:30.regardless of size, quality or local demand. In turn, the aevenlhng

:13:31. > :13:35.pharmacy receives ?1 million for NHS goods and services which provides

:13:36. > :13:41.around ?225,000 direct incole. Our pharmacy provision across the

:13:42. > :13:45.country varies. There are slaller, Valdez local premises such `s the

:13:46. > :13:54.Quadrant in St Albans that H'm due it talk to with on Friday and it is

:13:55. > :14:00.situated in a small chain of shops and others are low as concessions in

:14:01. > :14:07.supermarkets such as in London Colney. And they have longer opening

:14:08. > :14:10.hours, a large car park and a huge footfall of shoppers who get their

:14:11. > :14:14.prescriptions along with thd dog food and Sunday roast. I am

:14:15. > :14:18.concerned since many of those concessions are operated by the

:14:19. > :14:21.bigger chains such as Lloyds pharmacies, that we make sure that

:14:22. > :14:25.they don't, at the same timd ex-sting wish the light of the

:14:26. > :14:28.smaller pharmacies that also operates from London Colney around

:14:29. > :14:33.the corner from the doctors' surgery. So it is important we get

:14:34. > :14:39.this right. I accept there hs an inefficient allocation of NHS fund

:14:40. > :14:45.when 40% of fwarm sis are now owned by three or more. I know it is the

:14:46. > :14:50.case that most people are whthin ten minutes walk. In St Albans' high

:14:51. > :14:53.Street shopping area there `re five dispence Spencing pharmacies within

:14:54. > :15:00.half a mile area. Some are over the road from each other, some `re yards

:15:01. > :15:04.between each other and others are also operating fairly nearbx to the

:15:05. > :15:11.city zone. So that cannot bd a good idea. So Madame Deputy Speaker, we

:15:12. > :15:14.are well-served and not surprised it is also the home of the Nathonal

:15:15. > :15:19.Pharmacy Association. It is right we look at this proposal but wd must

:15:20. > :15:24.get it right. I hope we can look at the quality being provided `nd I

:15:25. > :15:28.hope we can make sure that nobody gets behind that pharmacy ldvels are

:15:29. > :15:35.streamlined and make sure everyone has access to good services. I ought

:15:36. > :15:38.to say I am the chair of thd all-party pharmacy group. I'm sure

:15:39. > :15:43.that many of my colleagues today ll speak about the savings and services

:15:44. > :15:48.that community pharmacies provide to the National Health Service and

:15:49. > :15:51.whilst it is an important point it is, I believe, however essential we

:15:52. > :15:59.highlight the good they provide to patients. They do much more than

:16:00. > :16:07.deliver prescriptions to people but to highlight the scale of this pra,

:16:08. > :16:10.over 11,800 community pharm`cies dispensed over 1 billion

:16:11. > :16:14.prescriptions items in 2015. Community pharmacies are

:16:15. > :16:19.well-prepared to adapt to m`ny different problems presented, help

:16:20. > :16:24.people give up smoking, altdr their diets, make them eighthier `nd also

:16:25. > :16:29.cholesterol management as wdll. They are effectively the front lhne as

:16:30. > :16:32.far as the health public is concerned. I will give way. Into my

:16:33. > :16:37.honourable friend makes an hmportant part. Pharmacies are at the heart of

:16:38. > :16:41.their communities as has bedn mentioned access is vital. Hn areas

:16:42. > :16:44.like his and mine we know bts services are being cut and people

:16:45. > :16:47.are finding it increasingly difficult to access the services.

:16:48. > :16:50.The minister said it is a m`tter of seconds between pharmacies, it is a

:16:51. > :16:53.nonsense. Would he like to comment on how important the access to the

:16:54. > :16:58.community is to the pharmaches? Well, it is and the mechanism, which

:16:59. > :17:03.I may briefly mention that has been put in place, are not going to solve

:17:04. > :17:07.everything. I have to say. When you get Boots in Gatwick Airport

:17:08. > :17:11.supported and yet there is the protension that others may drop off

:17:12. > :17:15.the line because they are ottside of a geographical area, it is something

:17:16. > :17:22.we need to look at. I wanted to say about the issue of

:17:23. > :17:28.population health. Can it bd done by central distribution centres on a

:17:29. > :17:34.pharmacy-based miles athat has no link to the locality. I know they

:17:35. > :17:38.have dropped off this issue of prescribing by the major colpanies

:17:39. > :17:44.and I'm pleased they have. Pharmacists know their customers

:17:45. > :17:47.well and are familiar with their medications and consequentlx the

:17:48. > :17:53.customer feels comfortable hn asking advice from the local pharm`cies. It

:17:54. > :17:57.is shown that these cuts cotld force up to 3,000 community pharm`cies

:17:58. > :18:00.thatch would be one in four across the country, that could potdntially

:18:01. > :18:04.close their doors to the public This will mean people travelling

:18:05. > :18:07.further to their pharmacies and not having the local connection I

:18:08. > :18:13.mentioned previously. Community pharmacies is the gateway to help

:18:14. > :18:17.some 1.6 million patients e`ch day and if anything, that is solething

:18:18. > :18:23.that we really need to get ` good grasp of. A core component of

:18:24. > :18:25.counter-pharmacy services stpports the public to stay well, living

:18:26. > :18:31.healthier lives and to self,care. They play a central role in

:18:32. > :18:33.management of long-term conditions aform cysts currently carry out

:18:34. > :18:39.medicine distribution and everything else. We must remember that over 0%

:18:40. > :18:46.of ex-spend tour on our Nathonal Health Service, both at prilary and

:18:47. > :18:48.acute level is spent for people with long-term conditions and thdy

:18:49. > :18:53.couldn't be a better gatewax for those who get the help and

:18:54. > :18:54.assistance to manage those conditions than through the local

:18:55. > :19:04.pharmacies. I thank my honourable friend for

:19:05. > :19:08.giving way, and I agree, local pharmacies are at the heart of the

:19:09. > :19:15.Gateway, but isn't there a danger that the cuts could end up cast --

:19:16. > :19:23.costing more money than thex save? Well, it is a danger becausd we re

:19:24. > :19:25.not sure what will happen. H want to say, community pharmacies hdlp

:19:26. > :19:33.patients who can't access anywhere else. They are great cars they have

:19:34. > :19:43.no appointment requirements and the opening hours are attractivd. People

:19:44. > :19:47.are saying, do I access comlunity pharmacies, I know there ard some

:19:48. > :19:55.waiting figures in the assessment scheme, but I hope that where there

:19:56. > :20:00.is high level of deprivation, that that might not be inconsistdnt. And

:20:01. > :20:06.that is something we will nded to look at, in my view. I was contacted

:20:07. > :20:11.by a pharmacist in my own constituency to highlight two

:20:12. > :20:18.examples where having a loc`l, community pharmacy was essential. A

:20:19. > :20:23.34-year-old lady with epilepsy had run out of her medication dte to

:20:24. > :20:29.visit lasting longer than expected. She was denied from a walk-hn centre

:20:30. > :20:34.due to the lack of prescription evidence. That is the case because

:20:35. > :20:42.records of joined up not as much as they should be. She then went to her

:20:43. > :20:46.local pharmacy, and you to central access records, they were able to

:20:47. > :20:51.give her a short-term supplx. This meant that a lengthy and stressful

:20:52. > :21:04.visit to accident and emergdncy was avoided, and any possible sdizures

:21:05. > :21:11.also. 45 minutes was spent with a one-year-old for severe crotp,

:21:12. > :21:15.spending that time got the job done and another accident and emdrgency

:21:16. > :21:21.visit was avoided. The diffhculty in getting these sort of examples is

:21:22. > :21:26.because many pharmacists sed this as what they do, rather than any great

:21:27. > :21:31.example of carer of patients. They don't moan, wonder if they `re meant

:21:32. > :21:36.to do this or pass the buck, they just provide the care to thd

:21:37. > :21:41.individual in front of them. Community pharmacies in addhtion to

:21:42. > :21:44.providing extra services ard taking on more clinical roles that were

:21:45. > :21:50.initially done by doctors. That should be welcomed. It keeps

:21:51. > :21:57.pressure of GPs. There was the management of a man with di`betes,

:21:58. > :22:00.plus blood pressure tests, ht's easier to visit your local pharmacy

:22:01. > :22:07.that this service rather th`n going to their local GP. Communitx

:22:08. > :22:23.pharmacists are able to respond to patient sentence using medicines

:22:24. > :22:26.available. I was one of a ntmber of members of this House who presented

:22:27. > :22:35.a petition to number ten th`t has 2.2 million people on it, the

:22:36. > :22:40.biggest health petition we have ever had here, in the UK. I'd like to

:22:41. > :22:46.finish with a quote from a pharmacist in Rotherham who says, I

:22:47. > :22:54.do what I do to deal with p`tients health and well-being. How lany well

:22:55. > :22:59.I pick up post cuts? Probably not because of cuts to staff and I won't

:23:00. > :23:04.have enough patient time. I just want to say to the Minister, I don't

:23:05. > :23:08.see it she -- we should movd away from dispensing model, what we need

:23:09. > :23:13.is security that any move is not going affect our communion ,-

:23:14. > :23:22.community pharmacy and patidnt needs. It's a pleasure to follow the

:23:23. > :23:28.right honourable gentleman. I'd agree with much of what he says

:23:29. > :23:34.about the value of the commtnity pharmacy, and I'd like to start my

:23:35. > :23:37.brief remarks thanking thosd involved in pharmacy, with hmmense

:23:38. > :23:46.courtesy, even though we ard talking about some very difficult things. My

:23:47. > :23:54.local pharmacists from Harthngton are still engaged with me, H was

:23:55. > :24:01.invited at a very difficult time to launch a healthy living pharmacy in

:24:02. > :24:04.the area. What I thought I would do was, instead of repeating the

:24:05. > :24:12.Minister's statement and his commitment to pharmacy, to see a

:24:13. > :24:17.little bit about why we are where we are. What I found when I was dealing

:24:18. > :24:31.with pharmacy and to look ahead to the future. This is normallx the

:24:32. > :24:36.date where this is pressing, that I thought this would be most tnfair

:24:37. > :24:39.and I want to be it is what my honourable friend, and give a bit of

:24:40. > :24:48.background. He can't be herd for the debate. The settlement made in 015

:24:49. > :24:53.between the Department of Hdalth and the Treasury, extra money w`s

:24:54. > :25:02.released for the NHS. Mental health, primary care, it did requird the

:25:03. > :25:07.Honourable Gentleman speaking for the opposition, cuts to be lade as

:25:08. > :25:22.advocated by Simon Stephens. ?1 0 million of the two point 5 billion.

:25:23. > :25:30.I regret the 3000 figure th`t I gave to the right honourable gentleman,

:25:31. > :25:35.the reason for it is that it was an estimate made on worst-case, taking

:25:36. > :25:42.in no account what's changes pharmacies might make in a reduction

:25:43. > :25:53.of finance. It was top ten. The reason I gave it in -- it to

:25:54. > :25:57.colleagues was because we w`nted to work very hard to mitigate ht, but

:25:58. > :26:05.the 3000 figure took on a lhfe of its sign. In hindsight, in ,- it

:26:06. > :26:10.might have been wiser to st`y with exactly what the Minister s`id which

:26:11. > :26:14.is we do not know because the Government doesn't have a plan to

:26:15. > :26:19.close pharmacies, and we don't know what will happen. I don't bdlieve

:26:20. > :26:28.for an instant that it will be as dramatic as what the opposition

:26:29. > :26:32.bench says. We've seen an 8$ growth in ten years. People do this because

:26:33. > :26:35.it's a business and they will make adaptations to that business in

:26:36. > :26:40.order to cope, so we will h`ve to wait and see what happens. But I

:26:41. > :26:47.think the 3000 figure was a figure which I would not use again. I thank

:26:48. > :26:58.the honourable gentleman for way, that he is help Minister sahd that

:26:59. > :27:03.pharmacies could close. That's come from pharmacies not for polhticians,

:27:04. > :27:10.so we need not accept that that s the real situation, as he s`id

:27:11. > :27:14.himself. I said it, so I know why I said it, and I said it becatse it

:27:15. > :27:18.was an estimate and it was based without taking into account any

:27:19. > :27:26.business changes people might make. It was the top end estimate, and

:27:27. > :27:31.accordingly, we wanted to mhtigate. In hindsight, I wouldn't have given

:27:32. > :27:36.that figure, because the Minister said so many pharmacies will close,

:27:37. > :27:41.know I didn't, because it doesn t represent the pharmacies th`t will

:27:42. > :27:44.close. It might have done if we didn't have mitigating meastres or

:27:45. > :27:50.the fact that businesses had changed things themselves. I'm putthng that

:27:51. > :27:54.on the record. I will tell xou what I found. Firstly, there was a

:27:55. > :28:01.discussion in pharmacy about its future. There were plenty of voices

:28:02. > :28:06.said that the model that values volume not necessarily qualhty of

:28:07. > :28:09.service had to go. The profdssion wanted a season changes. I thought

:28:10. > :28:16.that was relevant. There were differing voices in pharmacx, PNC,

:28:17. > :28:21.the committee that represents the pharmacy, but other voices, there is

:28:22. > :28:29.not just one voice. People were looking at what was happening for

:28:30. > :28:34.pharmacies changing. There was a growing maize towards healthy living

:28:35. > :28:38.pharmacies providing more sdrvices through pharmacy. All this was going

:28:39. > :28:42.on at the same time as what changes we needed to make to providd extra

:28:43. > :28:47.funds for the NHS. Where ard we going to go in a future? Firstly, I

:28:48. > :28:54.think we will get through this process. I remember staying -- Saint

:28:55. > :29:01.estate holders, the future of pharmacy weight be decided by this

:29:02. > :29:08.letter, in the future, it won't rest on this, but changes on progress to

:29:09. > :29:15.be made. I think the consultation process with PNC needs to bd

:29:16. > :29:21.changed. But other voices m`y be excluded and that needs to be looked

:29:22. > :29:25.at. The differing voices in pharmacy should try to get together `nd

:29:26. > :29:31.present a view that explains what is going on beyond the high street The

:29:32. > :29:39.integration of the NHS, thex could do that better. Why are thex not

:29:40. > :29:51.pharmacies on every single GSC? The NHS this to do more than th`t. -

:29:52. > :29:56.needs to do more with that. This should be the springboard. Sometimes

:29:57. > :29:59.innovation comes at pressurd and not great resources, which we would love

:30:00. > :30:03.to see in a perfect world. Finally, we should see support for a locally

:30:04. > :30:12.-based network. There are models that use this more, but this could

:30:13. > :30:18.be a good start of the future of pharmacy. It's a pleasure to pilot

:30:19. > :30:28.the honourable member the North East Bedfordshire. I know he's trying to

:30:29. > :30:36.be helpful to the new Minister. He did use that figure of 3000

:30:37. > :30:42.pharmacies facing closure, 0-4, he is attempting to qualify it now his

:30:43. > :30:49.defence seems to be that he made the estimate without thinking it

:30:50. > :30:53.through. His successor seems to also make a number of assertions without

:30:54. > :30:58.thinking it through. This sdemed to be a number of questions. Why on

:30:59. > :31:03.earth should we leave what the incumbent says if this is what the

:31:04. > :31:09.previous has said. If the Mhnister's successor won't come and spdak at

:31:10. > :31:13.the dispatch box and say, don't pay any attention to the fellow before

:31:14. > :31:22.me, you didn't know what he was talking about. The Government's

:31:23. > :31:29.impact statement is worthy of a second look. , they are looking for

:31:30. > :31:34.a scenario when no pharmacy closes. Is not a scenario shared by anyone

:31:35. > :31:40.else. When asked about how lany would close, the Minister s`id, I

:31:41. > :31:43.don't know. It goes on to concede that there is no reliable w`y of

:31:44. > :31:50.estimating the number of ph`rmacies that may close as a result of this

:31:51. > :31:56.policy. They literally have no idea. According to this impact assessment,

:31:57. > :32:04.the department is officiallx clueless. Does my friend agree that

:32:05. > :32:11.the knock-on effect could bd a problem? We've heard nothing from

:32:12. > :32:14.the Government about the knock-on assessment and what investigation

:32:15. > :32:23.they done to see what will happen? My honourable friend makes ` good

:32:24. > :32:26.point. It was meant to be the basis of some debate not something

:32:27. > :32:31.published on the day of the announcement. The impact assessment

:32:32. > :32:36.says that cuts to community pharmacies will increase patient

:32:37. > :32:43.benefits by reallocating savings to other uses, the point the Mhnister

:32:44. > :32:51.made, in sharing that's pathent health is unaffected. But it does

:32:52. > :32:59.show that 1-4 patients would make a appointment with their GP if their

:33:00. > :33:03.local pharmacy was closed. There is no consideration in this impact

:33:04. > :33:13.statement about the down cost of the other parts of the NHS budgdt. The

:33:14. > :33:22.pressures on accident and elergency. These cuts are, and I cry, dxpected

:33:23. > :33:25.to lead to the reduction of pharmacists and pharmacy

:33:26. > :33:32.technicians. Local pharmacists, many people who are relied on, wd'll go

:33:33. > :33:37.because of these cuts. Therd will be a corresponding increase in NHS

:33:38. > :33:44.employee numbers so there whll be no effect on the NHS. This is

:33:45. > :33:48.completely without foundation! Are the Government trying to tell us

:33:49. > :33:54.today that for all their talk about support for community pharm`cies,

:33:55. > :33:59.all the pressures on GPs, accident and emergency is, that the work of

:34:00. > :34:06.pharmacists in our local colmunities will be taken up in a responding

:34:07. > :34:11.increase in other NHS staff. The report also says, the modelling

:34:12. > :34:19.doesn't take into any account in a reduction of opening hours which may

:34:20. > :34:27.or so affect access. The national pharmacy Association says f`ced with

:34:28. > :34:32.budgetary cuts, there could be the removal of home delivery of

:34:33. > :34:37.medicines to housebound pathents. 77% of chemists say that thdy will

:34:38. > :34:42.be more pressure to become retail focus, which is exactly the opposite

:34:43. > :34:48.of what the Minister hopes to achieve. 54% are likely to reduce

:34:49. > :34:57.their opening hours which whll limit patient access and

:34:58. > :35:02.The government's own impact assessment, well worth readhng, if

:35:03. > :35:08.only for, the value, it reads like it has been written in hastd on the

:35:09. > :35:12.back of a cigarette packet. It is a Government making up the policy

:35:13. > :35:16.rather like the minister, as they go along. What ministers are asking us

:35:17. > :35:22.to do today is to make a le`p of faith, to turn a blind eye to the

:35:23. > :35:26.evidence, to disregard all of the warnings, to ignore the unanswered

:35:27. > :35:30.questions, the contradictorx statements, the glaring omissions in

:35:31. > :35:34.the government's own case, to brush away expert opinion, dismissed the

:35:35. > :35:38.concerns of the public, basdd on the department's own impact assdssment.

:35:39. > :35:41.How is it possible that any honourable or right Honourable

:35:42. > :35:47.Member can possibly support the Government in the lobby tod`y? Thank

:35:48. > :35:51.you, Madam Deputy Speaker. @s we have already heard in this debate,

:35:52. > :35:54.many of us have seen the considerable value that loc`l

:35:55. > :36:00.community pharmacies providhng our own consistency is. I have seen that

:36:01. > :36:03.myself in relation to the pharmacy in Elstree, which is run by Graham

:36:04. > :36:07.Phillips, to whom my right honourable friend, the membdr for

:36:08. > :36:12.North East Bedfordshire, pahd tribute. I would urge the Mhnister

:36:13. > :36:16.to eat with him. He is a pool of expertise. Similarly, the Crown

:36:17. > :36:22.pharmacy in Boreham Wood. What you see time and time again is that

:36:23. > :36:25.commitment to the customers goes way beyond what you would see from a

:36:26. > :36:29.normal retailer. It is a genuine understanding of the needs of the

:36:30. > :36:34.health and well-being of thd people that use these pharmacies and the

:36:35. > :36:39.services we see range from dementia friendly services, picking tp the

:36:40. > :36:43.early stages of the disease, help with drugs and weight managdment,

:36:44. > :36:48.and smoking cessation services. I think there is agreement on that

:36:49. > :36:53.point. I am grateful to my honourable friend. Can I ask him to

:36:54. > :36:58.his list Nick Hayden, in Newquay, carrying out some excellent work to

:36:59. > :37:04.try to work with local GPs `nd, as I said, find innovative ways to deal

:37:05. > :37:06.with patients. Does he agred with me, how important pharmacies are,

:37:07. > :37:11.particularly in tourist are`s, being the front line can deal with

:37:12. > :37:20.tourists and take pressure off other health services? He's absolttely

:37:21. > :37:24.right, they play a crucial role in relieving the front line of NHS

:37:25. > :37:29.services. That does not mean that reforms are not necessary. Of

:37:30. > :37:32.course, we need to incentivhse this sort of advantageous behaviour. We

:37:33. > :37:34.also need to recognise some of the existing problems with the provision

:37:35. > :37:41.of pharmaceutical services hn this country. We know the basic problem

:37:42. > :37:45.here, it has been referred to by other members. If you look `t the

:37:46. > :37:49.pharmacy budget, that has increased by 40% over the last decade. Even

:37:50. > :37:53.taking into account all of the changes that the Government is

:37:54. > :37:57.proposing, still, funding for community pharmacies will bd 30

:37:58. > :38:03.higher than when this Government first came to office in 2010.

:38:04. > :38:06.Equally, we have the problel of excessive clustering, the shtuation

:38:07. > :38:10.where you have many pharmaches within a short distance of one

:38:11. > :38:15.another. Those that argue that there is no need to reform really need to

:38:16. > :38:23.explain why the money, wherd that money is going to come from. We need

:38:24. > :38:26.to look for other savings, `ll we need to look at lower levels of

:38:27. > :38:30.service in the front line of the NHS, whether that be servicds for

:38:31. > :38:35.diabetes, services for cancdr, there is no magic monetary. You h`ve to

:38:36. > :38:40.take these difficult decisions in order to provide more for the front

:38:41. > :38:44.line. I completely agree with the overall thrust of government policy.

:38:45. > :38:48.Equally, I think we can takd an intelligent approach towards this.

:38:49. > :38:51.As we have heard already, there is a real difference between different

:38:52. > :38:57.types of pharmacies. At one end of the scale, you have these vdry large

:38:58. > :39:02.retail pharmacies. They are often in large retail outlets, superlarkets.

:39:03. > :39:04.They sit at the back of the store. They are there, essentially, to

:39:05. > :39:08.encourage customers to go through the rest of the store, to ptrchase

:39:09. > :39:11.other goods. They could eashly take a larger cut than is being proposed.

:39:12. > :39:17.Essentially, they are just operating as loss leaders for the stores to

:39:18. > :39:25.get customers in the door in the first place. My honourable friend is

:39:26. > :39:29.making an excellent point. H was slightly disappointed that the

:39:30. > :39:30.Shadow minister did not really understand the principle of

:39:31. > :39:35.vertically integrated pharm`cies. That is the point you are m`king,

:39:36. > :39:40.big national companies, and I think that is the point that my honourable

:39:41. > :39:46.friend is making, big companies making a lot of money out of

:39:47. > :39:51.pharmacies at the moment. M`ny such pharmacies really do not provide any

:39:52. > :39:55.of these wider community he`lth benefits. They are essentially just

:39:56. > :39:59.dispensing services. If pharmacies... I will give w`y very

:40:00. > :40:03.briefly. Is not the case th`t the estimate is that those will be the

:40:04. > :40:08.ones that survive, purely bdcause they are and be small, high service

:40:09. > :40:16.pharmacies in communities are the ones that are more vulnerable? This

:40:17. > :40:19.is the point I am coming on to. I think honourable members nedd to

:40:20. > :40:23.recognise that, of course, we are going to need further savings in

:40:24. > :40:34.this area. What I would argte for is we seek to identify ways by which we

:40:35. > :40:37.can ensure these large retahlers and I am not attacking because of the

:40:38. > :40:46.size of them, it is because of those provisions. We look at ways of

:40:47. > :40:52.providing the services on which our constituents are alive. In relation

:40:53. > :40:55.to the pharmacies, the ones that are simply dispensing services, I accept

:40:56. > :41:00.the argument that they are very inefficient. They are highlx

:41:01. > :41:06.labour-intensive. It is just a very expensive way of delivering drugs.

:41:07. > :41:12.So, we need to identify ways in which we can bifurcated between

:41:13. > :41:16.these providers. I pay tribtte to what the Minister has announced so

:41:17. > :41:19.far. He clearly demonstrate an understanding of that. That is

:41:20. > :41:22.exactly what we have seen in relation to the protection of key

:41:23. > :41:30.local pharmacies through thd community asset scheme, exctse me,

:41:31. > :41:34.community access scheme. In my own constituency, places like Elstree,

:41:35. > :41:39.where you have rural communhties, often with a rural population. No

:41:40. > :41:44.services will be protected. Equally, we see that in the scheme, or

:41:45. > :41:49.recognising wider community benefits. I would urge the Linister

:41:50. > :41:53.to do more in this space. I could briefly make two suggestions. The

:41:54. > :41:56.first is that I think there is a need for more detailed recording of

:41:57. > :42:01.the sort of services that are provided by pharmacies, which take

:42:02. > :42:05.pressure off the NHS. As I understand it, at the moment there

:42:06. > :42:13.is no systematic way in which these benefits are recorded. Essentially

:42:14. > :42:19.we are working off the basis of estimates. We can have a system

:42:20. > :42:22.where the community pharmaches record the benefit they provide

:42:23. > :42:27.they can be better rewarded and we find a means by which you c`n

:42:28. > :42:34.penalised or provide further cuts from those pharmacies that did not

:42:35. > :42:37.provide those additional services. Secondly, the honourable lady, the

:42:38. > :42:40.spokesperson for the SNP, rhghtly made the point about the colmon

:42:41. > :42:45.ailments scheme, which oper`te in Scotland. The Minister indicated

:42:46. > :42:49.that the Government is moving down this line. I would urge the

:42:50. > :42:53.government to go further on this. There is no reason why, if patients

:42:54. > :42:57.are suffering from things lhke the common cold and flu symptoms, head

:42:58. > :43:03.lice and so on, they could be referred from the GPs to thd

:43:04. > :43:05.pharmacies, thereby saving loney from the GPs and providing

:43:06. > :43:13.additional income for those pharmacies. In conclusion, H support

:43:14. > :43:17.the overall direction of reform but I think that the Government could do

:43:18. > :43:23.with engaging more, and as they proceed with the reforms, look at

:43:24. > :43:24.ways of supporting what is best in community pharmacies, whilst

:43:25. > :43:33.providing further savings from those services that do not providd them. I

:43:34. > :43:36.rise to speak in support of the motion that has been put forward by

:43:37. > :43:39.the opposition bench. If I can put on record my thanks for the

:43:40. > :43:44.extremely hard work done by a number of colleagues on this side of the

:43:45. > :43:48.house, particularly by my honourable friend for Barnsley, who I follow on

:43:49. > :43:52.this side. Community pharmacies play a really crucial and critic`l role

:43:53. > :43:57.in my constituency and, indded, right across the country. Wd know

:43:58. > :44:02.from the many statistics, the inquiries and surveys that have been

:44:03. > :44:05.done, that they are trusted. If I listen to my constituents, they

:44:06. > :44:10.trust the pharmacists they dngage with in the community pharm`cies.

:44:11. > :44:14.They also develop very closd relationships with people that work

:44:15. > :44:18.inside them. I see it myself when I go to get my prescriptions locally,

:44:19. > :44:23.they are enormously busy pl`ces I note that the member for he`rt

:44:24. > :44:26.smear, who I followed, he s`id they deliver drugs. They do far lore than

:44:27. > :44:35.just deliver drugs within communities. I was not making that

:44:36. > :44:40.point, I was making the point that there are many dispensaries in

:44:41. > :44:51.supermarkets that do very lhttle other than deliver drugs. Wd need to

:44:52. > :44:55.focus on the community servhces Piggy Honourable Member just spoke

:44:56. > :45:00.in support of the opposition motion. I made this point following the last

:45:01. > :45:07.urgent question that we had. I have listened closely to the Minhster

:45:08. > :45:10.said last time, he said manx pharmacies were not actuallx busy. I

:45:11. > :45:18.made a point of looking through the windows of my community pharmacies

:45:19. > :45:31.to see if any of them are elpty We are going to on the statisthcs that

:45:32. > :45:34.we get. The average amenity pharmacy, they dispense 87,000

:45:35. > :45:45.prescription items over the course of a year. This for 250 people with

:45:46. > :45:52.diabetes annually, 380 people with asthma, 463 unpaid carers, 805 older

:45:53. > :45:59.people, 1317 people with a lental health condition and 1416 pdople

:46:00. > :46:02.discharged from hospital. That last point is extremely important. I am

:46:03. > :46:04.not going to presuppose what the health select committee report that

:46:05. > :46:10.comes out tomorrow might sax about pressures on winter A services,

:46:11. > :46:19.but it is fair to say that lany people are expecting that. Our local

:46:20. > :46:24.services are going to be under enormous pressure. They alrdady do

:46:25. > :46:28.an important job of supporthng constituents and patients that have

:46:29. > :46:32.been discharged from hospit`l. I have had the opportunity to listen

:46:33. > :46:39.to members of my local Liverpool pharmaceutical committee. I asked

:46:40. > :46:47.them what the stats were. I was equipped for the debate. I was

:46:48. > :46:50.struck by what they had to say. Honourable members have alrdady made

:46:51. > :46:56.a pointed response to the Mhnister, regretful that he is no longer in

:46:57. > :47:04.his place, about the assesslent scheme and how well it is ptt

:47:05. > :47:11.together. It does not tribute for deprivation. The pharmacies in the

:47:12. > :47:14.most deprived areas of the country, where patients have greater health

:47:15. > :47:17.needs, are not entitled to claim the payment. I made the point in an

:47:18. > :47:21.earlier intervention, in Liverpool, where we have some of the hhghest

:47:22. > :47:25.levels of deprivation, Kenshngton ward in my constituency is hn the

:47:26. > :47:28.top 20 in the country, I have no pharmacies in my own constituency

:47:29. > :47:32.that are eligible for the assessment scheme payment. There are jtst two

:47:33. > :47:41.across the whole of Liverpool which are. What is in -- what that means

:47:42. > :47:51.is that all of the communitx pharmacies across Liverpool and six

:47:52. > :47:55.distance selling pharmacies face the full cut. We know that the funding

:47:56. > :48:01.cut in this financial year has already had an impact on local

:48:02. > :48:08.pharmacies. Some have already curtailed their free and unfunded

:48:09. > :48:10.delivery service to patient, and my honourable friend made the point

:48:11. > :48:15.about the hours that they often provide. These are a lifeline for

:48:16. > :48:18.housebound and vulnerable p`tients across the country. We know that

:48:19. > :48:25.others are already in the process of making staff redundant. These

:48:26. > :48:29.pharmacies will have to survive on fewer staff, meaning that the

:48:30. > :48:34.pharmacist, in some of our immunities, some of the comlunity

:48:35. > :48:38.pharmacies will inevitably be tied more to the dispensing bench, rather

:48:39. > :48:43.than undertaking the enhancdd role that NHS England, the Department of

:48:44. > :48:44.Health and ministers are expecting them to deliver under the fhve-year

:48:45. > :48:54.forward view. As my friend for Leicester has

:48:55. > :49:00.already alluded to in his ilportant opening remarks, it's outrageous

:49:01. > :49:07.that this scheme, as outlindd, will further widen health inequalities in

:49:08. > :49:14.our country. We have this specific debate to discuss next Tuesday. I

:49:15. > :49:19.think we have a responsibilhty in 2016 to close the gap not whdening

:49:20. > :49:26.it. The scheme at the moment makes no provision for communities with

:49:27. > :49:32.specific characteristics. I know there are many honourable mdmbers

:49:33. > :49:44.who wish to speak. But to m`ke to brief points, members on both sides,

:49:45. > :49:49.there are many cooperatives across our country providing these

:49:50. > :49:56.services. I will stop there. I think the limit has to be dropped to four

:49:57. > :50:00.minutes. Thank you, like many members across the House today, I

:50:01. > :50:05.have been fortunate enough over the years to have seen the brilliant

:50:06. > :50:16.services provided by local pharmacies in my constituency. And

:50:17. > :50:19.from that, as many members have stated, I have seen the important

:50:20. > :50:27.role pharmacies play in delhvering care in the community 's. Wd must

:50:28. > :50:36.put money into the delivery of primary care. I have utmost respect

:50:37. > :50:41.for the new Minister and I wish him well in his new role, but I fear he

:50:42. > :50:48.has been given somewhat of ` hospital pass on this issue. Having

:50:49. > :50:52.said that, I understand why he is looking to make these reforls. I

:50:53. > :51:03.agree we need to offer bettdr service to patients and allocate

:51:04. > :51:09.resources in a better manner, and I'll welcome me Pharmacy Integration

:51:10. > :51:14.Fund which helps to distribtte the money in primary care. But hf we are

:51:15. > :51:21.looking for better integrathon in services, simply for existing, and

:51:22. > :51:25.promote high quality care, then we must further expand the rolds and

:51:26. > :51:31.treatments that pharmacies can administer. This would help to shrug

:51:32. > :51:36.off the lingering perception that pharmacies are simply drug

:51:37. > :51:41.dispensers. For example, code things like flu jabs not be oversedn

:51:42. > :51:45.exclusively by pharmacies. H would like to add my support to the

:51:46. > :51:53.growing calls to the nation`l minor ailments scheme which takes patients

:51:54. > :51:58.away from GP practices. I wdlcome the announcement that NHS England

:51:59. > :52:06.hopes to have a scheme in place by 2018, and I hope that this will be a

:52:07. > :52:11.transformative moment for community pharmacies and primary care, more

:52:12. > :52:18.widely, and I look forward to scrutinising it as it comes forward.

:52:19. > :52:28.Also the issue of rural pharmacies losing their pharmacies, I `gree

:52:29. > :52:37.that there should be better funding in place to dis- incentivisd this

:52:38. > :52:41.from happening. This brings me onto the one-mile rule. While I

:52:42. > :52:46.understand the principle behind this rule, I do remain concerned that

:52:47. > :52:55.where there it will truly ensure a base level of access and whdther

:52:56. > :53:02.these will be protected. In my own constituency, Fulford pharm`cy, a

:53:03. > :53:09.small, independent business, not from a large chain, sit Sonx 80

:53:10. > :53:13.metres away from this one-mhle rule, and is therefore ineligible for the

:53:14. > :53:24.pharmacy access scheme, and it's not in the most 25% deprived arda. So, I

:53:25. > :53:30.fear that the residents could lose access to this pharmacy, moving to

:53:31. > :53:38.Fisher Gate, some miles awax. I feel that a case-by-case assessmdnt could

:53:39. > :53:42.be introduced so that services particular communities doesn't fall

:53:43. > :53:49.by the wayside. To reinforcd this point, I'm told that two br`nches of

:53:50. > :53:59.Boots pharmacy in Heathrow @irport in terminals 3-5 will receive access

:54:00. > :54:05.payments, despite not serving any specific community, because they are

:54:06. > :54:12.one-mile apart. This debate could not come at a more important time

:54:13. > :54:21.for my constituents, with 42 in operation and 28 centred thdm facing

:54:22. > :54:26.closure. They play a vital role in the packages provided to my

:54:27. > :54:31.constituents. Mine is the fourth most deprived constituencies in this

:54:32. > :54:44.country, and we have much to verse T. -- diversity. In 2014 service

:54:45. > :54:54.patient report it showed my patients -- constituents could access their

:54:55. > :55:09.GP win they needed to. The Linister referred to... In our attempt to

:55:10. > :55:13.maximise impact, we tried that, but pharmacy near to me says thdy have a

:55:14. > :55:18.hundred people walked through their doors with the minor ailments

:55:19. > :55:24.scheme. That would mean we would lose lots and lots, even if 1-4

:55:25. > :55:31.people went through GP appohntment, that means 90,000 extra GP

:55:32. > :55:38.appointments in my constitudncy alone, in one year at the cost of ?4

:55:39. > :55:44.million. So, for me, I'm gohng to get a past example. Over thd last

:55:45. > :55:47.few weeks, in Bradford, we have higher incidence of cancer,

:55:48. > :55:53.diabetes, stroke and Curran every heart disease. That's because of

:55:54. > :56:03.poverty, deprivation and ill-health going hand-in-hand. So, a fdw months

:56:04. > :56:15.ago, my brother has suffered -- mother has suffered three THA is.

:56:16. > :56:24.On the 42nd attempt I managdd to get through to my GP, and all the

:56:25. > :56:29.appointments had gone. That's not a story unique to me trying to get an

:56:30. > :56:34.appointment, that's unique `cross the country, and unfortunatdly, if

:56:35. > :56:38.we are going to close community pharmacies, what will happen is the

:56:39. > :56:44.extra pressure will be on the GPs. I do not see a Government plan to give

:56:45. > :56:48.us an extra 4 million just hn my constituency to give another 90 000

:56:49. > :56:53.appointments every year, and that's just one constituency of thd five in

:56:54. > :57:00.Bradford. We have higher incidences. The reality is that these these

:57:01. > :57:03.proposals will affect those who need the most health care

:57:04. > :57:06.disproportionately. Yes, we have lots of pharmacies, but these

:57:07. > :57:10.proposals don't take into account the complexities of diverse

:57:11. > :57:18.communities and the structure uppercuts. I'm very interested to

:57:19. > :57:27.hear the story of what is h`ppening in Bradford. Five of the 23 in my

:57:28. > :57:34.constituency are threatened by cuts. Can we find out how these ctts will

:57:35. > :57:42.further inhibit the options of the elderly and the infirmed accessing

:57:43. > :57:46.the services? Thank you, I `gree with my honourable friend. When I

:57:47. > :57:57.look at my constituents who have Sony complex health issues, I'm an

:57:58. > :58:01.ex-NHS Commissioner and I'vd argued against cuts. Long-term chronic

:58:02. > :58:07.conditions in communities where there is deprivation is. We've got

:58:08. > :58:11.deprivation, unemployment, `nd we need to look at people holistically,

:58:12. > :58:20.and by taking away services in our computer T 's -- communities, we

:58:21. > :58:24.can't the cut pharmacies ard stand-alone items. They are part of

:58:25. > :58:32.a holistic care package across the board. Let me be clear, the fact I

:58:33. > :58:36.couldn't get through until the 2nd attempt is not a reflection of my GP

:58:37. > :58:41.practice. Kensington street health centre is one of the best places.

:58:42. > :58:44.The staff are amazing. They are trying to fit a square peg hnto a

:58:45. > :58:49.round hole because of the alount of cuts we've already experienced. This

:58:50. > :58:54.is not about GP packages not delivering, they don't have the

:58:55. > :58:59.resources. This is about taking away pharmacies... I would reallx urge

:59:00. > :59:08.the Government to revisit this ill thought idea. It's not taking into

:59:09. > :59:16.account constituencies like Bradford, I am asking them to bring

:59:17. > :59:22.something to the table. We `re aware of the letter received by

:59:23. > :59:25.pharmacists last year when the Government discussed a bettdr use

:59:26. > :59:32.for pharmacists and community pharmacies. Support the healthy

:59:33. > :59:41.living, minor ailments along to and conditions. As part of the lore

:59:42. > :59:46.integrated local care model. We also know that the letter informdd us

:59:47. > :59:50.about reducing funding by htndred and ?70 million. I was forttnate

:59:51. > :59:55.enough to be the first MP to raise this in a Westminster Hall debate at

:59:56. > :59:59.the beginning of this year `nd raise the concern that community

:00:00. > :00:08.pharmacies had about their funding, as this plan has gone forward,

:00:09. > :00:13.intended for October. And issue was raised in a constituency medting in

:00:14. > :00:16.some knives. The general public have been engaged in this. They `re

:00:17. > :00:22.concerned about the future of their pharmacy, and I joined others in

:00:23. > :00:27.this House to present a pethtion of 2 million signatures to number ten

:00:28. > :00:38.in the summer. Every effort is being made to integrate social care, yet

:00:39. > :00:42.community pharmacists see themselves as essential players in a n`tional

:00:43. > :00:50.health service placed with demands by today's society. It is v`lued and

:00:51. > :00:52.depended on and is able to dmbrace new clinical responsibilitids and

:00:53. > :00:57.metered miles of an ageing population, but it's looking to the

:00:58. > :01:01.Government about its future, particularly regarding health

:01:02. > :01:07.funding for community pharm`cy as it goes forward. In my constittency of

:01:08. > :01:13.St Ives, I have several inddpendent community pharmacists. This is

:01:14. > :01:17.because it includes areas of social deprivation which impact on health.

:01:18. > :01:24.A car journey from the north of the South to my constituency takes an

:01:25. > :01:30.hour. In a rural area such `s mine, community pharmacists revivds

:01:31. > :01:35.invaluable access to the NHS, and invaluable support of rural people.

:01:36. > :01:40.I'm reassured that the Government has indicated some protection for

:01:41. > :01:44.rural pharmacy. This is welcome indeed. However, funding of

:01:45. > :01:49.community pharmacy as a whole remains a concern, and the sector

:01:50. > :01:58.has called for the Department of Health to use funds cut frol these

:01:59. > :02:07.pharmacies to happen minor `ilment plan. Where appropriate, medicines

:02:08. > :02:12.should be provided at no cost. This could provide significant s`vings

:02:13. > :02:17.for the NHS by insuring pathents use pharmacies when they have mhnor

:02:18. > :02:21.ailments, which will help whth GP appointments and lower attendances.

:02:22. > :02:27.There should be better valud for money in areas of the NHS. Hn

:02:28. > :02:34.Cornwall and the Isles of Scilly, we are actively drawing up what has

:02:35. > :02:44.been suggested to us by NHS England. I believe this provides the best

:02:45. > :02:47.opportunity to meaningfully integrate health and social care. I

:02:48. > :02:54.also believe that the community pharmacy is essential in achieving

:02:55. > :03:01.this objective. I'm aware of the time, so I'm going to ask a few

:03:02. > :03:08.questions of the Minister. Can he give an idea of what support will be

:03:09. > :03:11.given to rural pharmacies in Cornwall, and can the Minister

:03:12. > :03:21.comment on the community forward view as set out, and the

:03:22. > :03:28.department's response setup by a community pharmacy? Here we are

:03:29. > :03:35.again, debating more slash `nd burn cuts to vital public servicds.

:03:36. > :03:40.Generations and decades of build-up being eroded in a few short years.

:03:41. > :03:44.What's going to be left aftdr this? I accept that if we can makd savings

:03:45. > :03:50.in the public sector then wd should do that, but it is short sighted to

:03:51. > :03:53.take money away from communhty services when the accepted logic is

:03:54. > :04:02.that it will save money in ` long run.

:04:03. > :04:08.In my constituency, local pharmacies and GPs are working collaboratively

:04:09. > :04:11.to build an integrated health centre. Does he agree, the

:04:12. > :04:19.Government says it wants to encourage this kind of workhng, but

:04:20. > :04:24.actions do not match words? I absolutely share that view dntirely.

:04:25. > :04:27.My preferred option is that we devolve that power with thehr

:04:28. > :04:31.funding to local areas so they can decide. The Government have proven

:04:32. > :04:35.time and time again that thdy do not value the public services

:04:36. > :04:40.communities rely on. In old there are 57 community pharmacies. Nine

:04:41. > :04:48.have 100 hour contracts, fotr work for delivery services. That is about

:04:49. > :04:52.25 pharmacies per 100,000 rdsidents. Ask the public how they perceive

:04:53. > :04:58.them. 93% of the public think that the pharmacies are doing a good job.

:04:59. > :05:03.88% of people in old use thd pharmacies, so they are respected

:05:04. > :05:06.and they are also used by the community. When asked, the lain

:05:07. > :05:10.reason why people use the pharmacies was because of proximity and

:05:11. > :05:14.location. People could get to them to get the services that thdy

:05:15. > :05:18.needed. The truth is, we don't need less, we need more. Demand hs going

:05:19. > :05:22.up. It is not just me that says that. The local health and

:05:23. > :05:28.well-being board, in a 90 p`ge document, reviewing pharmacdutical

:05:29. > :05:34.support in old, says so. It says we have enough to meet current demand,

:05:35. > :05:44.but demand is going up. We can now go to the liaison is committee,

:05:45. > :05:55.where Jack Chilcot will givd his report.

:05:56. > :05:57.I will give you a moment to get your papers out. Thank