Community Pharmacies

Esther McVey Excerpts

Thursday 14th September 2023 Westminster Hall

[Esther McVey (Tatton) (Con)]

It is a pleasure to speak in today’s debate with you as Chair, Sir Mark. I thank my hon. Friend the Member for Waveney (Peter Aldous) for securing this important debate on community pharmacies, which are a crucial part of our healthcare ecosystem. I also thank him for his thorough explanation of the current state of community pharmacies and their needs.

I am often reminded that when we feel unwell or something has gone a bit wrong, our first point of call is often to walk into a pharmacy to get advice, support and medicine. Somebody there can put one’s mind at ease. Those who are vulnerable or elderly can also get their medicines delivered to them, which adds to the wellbeing of the local community. However, despite community pharmacies’ immense importance, they face huge challenges. Increasing demands and ongoing pressures are threatening their sustainability. Tatton currently has a healthy number of local pharmacies—18— supporting nearly 70,000 residents. However, pharmacies are disappearing across the country—and in Tatton, too. Government figures show a decrease of 222 between December 2022 and June 2023. The reasons for those closures include inadequate funding, rising operational costs and difficulty in recruiting and retaining community pharmacists.

Tatton community pharmacist Lee Williams, along with his wife and fellow pharmacist Caroline, were two of the first constituents I met at their pharmacy in Knutsford when I became the MP for Tatton back in 2017. They have since had to close their pharmacy. Lee explained to me that, despite it being a busy community pharmacy and having a good reputation—I can vouch for that, as I went there, too—they had very much a hand-to-mouth existence as funding fell and things such as rent, utilities and wages increased, squeezing their profit margin to the point where their business became unviable and the only thing they could do to safeguard their 12 years of tireless work was to sell it. It was a sad day for them, because their dream was for the two of them, married, running this community pharmacy and supporting the local community, but it had become abundantly clear to them for some time that the only way for such pharmacies to exist was to find efficiencies through having multiple branches. But now, even the large multiple retailers such as Lloyds and Rowlands have had to sell off their community stores as they move to remote delivery and go online in an attempt to become profitable. Even they cannot make community pharmacies work.

Adding to the problem of underfunding is, as we have heard, a shortage of medicines, which often results in community pharmacists dispensing medicines at a loss. Even when the NHS decides to increase the price it is willing to reimburse pharmacists for those medicines, it often comes after weeks of pharmacists gambling on what price they will have to pay, which creates huge uncertainty for them and their businesses. Ironically, it is the very low prices that the NHS is willing to pay that drive the shortages. If a manufacturer can sell those medicines for a higher price in other countries, it will prioritise those markets over our own. Community pharmacists find that their staff, in their role as pharmacists, are spending a lot of their time trying to find stock, on top of their crippling workload.

Community pharmacy is therefore at a low—the pharmacists would say an all-time low—which corresponds to much of the results of Community Pharmacy England’s 2023 pressures survey. It found that 92% of pharmacies are dealing with medicine supply issues daily, which was an increase from 67% in 2022; 97% of pharmacy owners reported significant increases in wholesaler and medicine supply issues; 81% of pharmacy staff said they were “struggling to cope” with the significant increase in workload; and 84% had experienced aggression from patients due to medicine supply issues. Worse—if things could be worse—pharmacists face more abuse from the public because of drug shortages.

To keep our community pharmacies afloat, Lee Williams advocates a complete overhaul of how community pharmacies are viewed and remunerated. I therefore welcome the Government’s announcement of £645 million of new funding for Pharmacy First. The Government realise that things need to be done. Much has been done but more needs to be done, and they need to pursue that as well as they can. We can say that with our Prime Minister as an advocate. However, in the light of the first-hand experience of my constituents that I have just shared and those survey results, how is the Minister ensuring the security and consistency of supply of medicines? How will the Government compensate pharmacies for the extra costs of offering additional services such as annual health checks, which require more skilled staff? I appreciate the difficulty of finding more funding for the sector, but I know that the Government will be looking to do that, so will the Minister explain how? Local pharmacies want to be at the heart of the health sector and take more of the workload off the NHS, but in order to do that they need to be adequately recompensed. They provide a vital service, and I know that they want to do even more.

Oral Answers to Questions

Esther McVey Excerpts

Tuesday 11th July 2023 Commons Chamber

[Helen Whately]

First, I commend the hon. Member for his campaign on this issue. He has been a powerful advocate and draws on his own experience, as do I. He is probably asking me to pre-empt the outcome of the consultation. I encourage him and others concerned about this matter to put their views into that consultation, and we will respond once it is closed.

[Esther McVey (Tatton) (Con)]

18. What recent progress he has made in negotiations with the World Health Organisation on proposed amendments to the International Health Regulations 2005.

[The Minister for Health and Secondary Care (Will Quince)]

The UK continues to negotiate on amendments, alongside other member states of the World Health Organisation. We want to ensure that the International Health Regulations are effective in preventing and responding to potential health threats, leaving the UK better prepared for future health emergencies. We anticipate negotiations to continue until the 77th World Health Assembly in May next year.

[Esther McVey]

Will the Minister assure me that the proposed changes to the International Health Regulations being negotiated will not give new rule-making powers, such as those tabled by Bangladesh, to the WHO director general to make binding directions on matters including border closures, quarantining and vaccine passports? Even the WHO’s own expert review committee has raised concerns over such significant increases in power.

[Will Quince]

As my right hon. Friend will know, the UK has a strong commitment and duty to implement international law, but on this matter we have been absolutely clear. I can certainly assure her that we will not sign up to any IHR amendment or any other instrument that would compromise the UK’s ability to make domestic decisions on national measures concerning public health.

Reforms to NHS Dentistry

Esther McVey Excerpts

Thursday 27th April 2023 Commons Chamber

[Esther McVey (Tatton) (Con)]

I congratulate the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) on securing the debate. Together they have acted like a veritable tag team, securing debate after debate, this being the third.

The problem we are discussing is obviously not getting better, and it is not going away. It is clear from what we have heard from Members today that it is becoming a bigger issue in our casework, and that is certainly my experience. I have taken some desperate phone calls from constituents, and have been shocked by what I have heard. It has led me to get on the phone straight away to beg dentists nearby to see some of those constituents. One, an elderly resident of Wilmslow, was losing his teeth and had abscesses. He needed to have his teeth removed and dentures fitted, but he could not find a dentist. When he rang the emergency dentist, there was a recording saying “No appointments”, and then the phone was just ringing out. He was pointed in the direction of a practice in Buxton, but found that it was no longer taking NHS patients, and one in Northwich which had a two-year waiting list. Other constituents who thought that they were fortunate enough to have an NHS dentist found that the Mobberley Road practice in Knutsford was no longer taking NHS patients either, and that they were no longer registered there.

Healthwatch, the independent statutory body, says that this is the No. 1 issue raised with it by NHS patients, and that four out of 10 people who contact it say that they are having difficulty accessing dental care, which is exactly what I am hearing from my constituents. The system is bad and decaying, and has been for some time. Lockdown made things significantly worse. With dentists shut down for the first few months of the pandemic, 50 million appointments were lost, and 3,000 dentists stopped providing NHS dentistry because the restrictions through lockdown made it financially unviable for practices, meaning NHS dentists are disappearing at a rate of knots. Some 90% of practices are closed to new patients, 80% will not even accept children, and in 37% of local authorities there are no practices accepting new adult NHS patients. Reform needs to be radical.

Tatton dentists have reached out to me and told me the current payment system of units of dental activity, introduced by a Labour Government back in 2006, has never worked and subsequent tinkering has not worked either. The Minister will probably know how it works, but others might not: a check-up with X-rays counts as one unit; adding a filling or several could count as another two units; and providing a full set of dentures is seven. It does not pay: the formula does not work, which means that dentists lose money, particularly when treating the neediest patients—those who really need their care and attention. Those figures never have stacked up and tweaks will not make a difference. In a nutshell, the business case is broken and a new one needs to be brought forward.

NHS dentistry is not attractive; we need to make it appealing. Interestingly, the number of qualified dentists is at an all-time high, but the number doing NHS work has fallen significantly. Last year, a British Dental Association poll found that 45% of dentists in England were doing an average of 25% less NHS work since the start of the pandemic. The poll also shows that 75% of dentists are thinking of reducing their NHS commitment this year, with almost half considering either a change of career, early retirement or turning fully private.

Bupa, which provides both NHS and private services, recently reinforced these figures, stating that it intends to merge or sell 85 of its 450 practices across the UK because of rising running costs and lack of dentists willing to deliver NHS care. This means nearly half a million more patients could lose their dentist.

Making NHS dentistry appealing is, therefore, a matter of high importance. Some suggestions have been handed to me and I will put them forward—and I know the Minister will be coming forward with bold plans. One suggestion was getting rid of student debt for newly trained dentists; might we remove that if they move into NHS provision? Also, what extra funding will be given and how will we move away from units of dental activity? We all want this to work; it is vital that it works and I certainly do not want to be taking calls from desperate constituents who need urgent dental medical care.

Oral Answers to Questions

Esther McVey Excerpts

Tuesday 24th January 2023 Commons Chamber

[Maria Caulfield]

Local decisions on public health are taken by local commissioning groups and local authorities, and it is for each local area to decide how it spends the money on public health.

[Esther McVey (Tatton) (Con)]

The chief medical officer recently warned that non-covid excess deaths are being driven in part by patients not getting statins or blood pressure medicines during the pandemic. However, when looking at the data on statins on OpenPrescribing.net, which is based on monthly NHS prescribing, there appears not to be a drop, so where is the evidence? If there is none, what is causing these excess deaths? Will the Minister commit to an urgent and thorough investigation on the matter?

[Maria Caulfield]

We are seeing an increase in excess deaths in this country, but we are also seeing that in Wales, in Scotland, in Northern Ireland and across Europe. There is a range of factors. As we saw, there was an increase in December in the number of people being admitted with flu, covid and other healthcare conditions. That was seen not just in this country, but across Europe.

Contact in Care Settings

Esther McVey Excerpts

Thursday 27th October 2022 Commons Chamber

[Esther McVey (Tatton) (Con)]

I congratulate the hon. Member for Liverpool, Walton (Dan Carden) on securing this debate, and I thank my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) for co-sponsoring it.

It has been deeply distressing to hear the stories that have been told in this debate. Human beings have rights, including the right to education, the right to healthcare, the right to bodily autonomy, the right to equality and the right to private family life, free from Government interference, to be able to spend time with their loved ones. It is a sad fact that all those rights came under attack during the covid lockdowns, but we have moved on from those lockdowns, and the covid restrictions have ended, so it is deeply harrowing to discover that it is not the case for some.

In the stories we have heard today, in the stories I have heard from my constituents and in the stories highlighted in The Sunday Times, I am horrified that, seven months after the removal of official restrictions, care home residents are still being denied visits from their families and friends. It needs to be mentioned that some care homes are open and allowing visits, but others are not and continue to prevent family members from seeing one another. That is simply inhumane. It is beyond cruel. Isolation and the loss of social contact has a devastating impact on physical and psychological health. Without the support of family and friends, health outcomes are poorer, as residents lose hope and sometimes even the will to live, and they often refuse treatment. For residents with dementia this is especially devastating, as they do not understand why their relatives have not been to see them. Many also have serious sensory impairments, and for them physical touch and communication with family members might be all they have left.

I am more concerned that this situation is concealing neglect and abuse. As chair of the all-party parliamentary group on pandemic response and recovery, I heard from campaigners back in April, and more recently, who warned of widespread and shocking safeguarding issues involving medication, hydration, hygiene and a lack of basic care. Families must be allowed full access, to support, protect and advocate for their loved ones when they need it most.

What can be done to end this unnecessary suffering once and for all? It is now beyond urgent that care homes, local authorities, the UK Health Security Agency and the CQC stop blaming each other for these appalling failures of policy and take action. Rather than requiring new legislation, we need to uphold existing laws. Article 8 of the Human Rights Act and the Mental Capacity Act 2005 should have protected against this situation ever arising. Instead, that legislation is being wilfully misinterpreted as an excuse to keep people isolated in care homes; sometimes they feel as though they are prisoners. So I call upon the Minister to get tough on any care homes that block residents from seeing visitors. There should be severe consequences for those who continue to blight the lives of those in care, and they should face fines or legal action.

We are failing vulnerable members of our society and it simply cannot be allowed to continue. We must end all unlawful visiting restrictions and stop this unnecessary suffering and neglect. It is deeply shameful and a stain on our history that our country has allowed this to happen, and that it is still happening so long after covid restrictions have been lifted. Some care homes say that these restrictions are due to staff leaving the sector when mandatory vaccinations were called into use. May I ask therefore what the Minister and the Government are doing to get those staff back into the care homes and into those jobs? It could be that up to 7% of care home staff were lost, which represents 40,000 employees. What are the Government doing to reinstate them and compensate them for losing their jobs? As Professor Robert Dingwall told our all-party parliamentary group at the inaugural meeting last year:

“A good society is defined by life, health, liberty and the pursuit of happiness, not by the prevention of one disease alone.”

--- Later in debate ---

[Helen Whately]

If the hon. Member will bear with me, I am getting to the third of the three considerations, which is what can be done. On that point, back in April 2021, I was questioned by Parliament’s Joint Committee on Human Rights about this very topic. On visiting, I said:

“I want to get to a position where it is as normal as possible. This is something to come back to in the future, particularly if family members and residents feel that the situation is not working as they would want it to.”

Clearly, family and residents do indeed feel that the situation is not working.

I understand that things are not easy for care homes. I understand the staffing pressures caused by the recent increase in covid—and flu, which many residents are vulnerable to. The majority of care homes are allowing normal visiting and, as hon. Members said, many care homes totally recognise the importance of visitors.

[Esther McVey]

Will the Minister give way?

[Helen Whately]

I am short of time—I have two minutes —so if my right hon. Friend will allow me, I will continue.

However, we cannot continue to have a situation in which families and friends are struggling to see loved ones in care homes. That is why I have already commissioned work today—it was my first commission since my appointment—on the steps that I can take to sort this out. On the question from the hon. Member for Garston and Halewood (Maria Eagle), I cannot announce legislation here and now at the Dispatch Box, but I have commissioned work on what I can do to sort this out. I assure all hon. Members on the Chamber and all those listening to the debate that I do not consider the status quo acceptable, and I am on the case.

Oral Answers to Questions

Esther McVey Excerpts

Tuesday 1st March 2022 Commons Chamber

[Edward Argar]

Possibly at some risk to my political prospects, I find myself in agreement with the hon. Gentleman on the importance of good and effective leadership. Of course I join him in his remarks about Ukraine.

I highlight that 84% of our NHS workforce are either clinically trained or are directly providing clinical support to clinicians, but it is also important that we recognise the importance and value of the administrators and managers who support the team. That is why we need the best people in those roles, and it is why my right hon. Friend the Secretary of State has commissioned the review led by two extremely eminent people. We are determined to continue driving up the quality and standards of management in the NHS.

[Esther McVey (Tatton) (Con)]

7. If he will make an estimate of the percentage of (a) doctors and (b) nurses being paid locum rates in the latest week for which figures are available.

[The Minister for Health (Edward Argar)]

In NHS hospital trusts to date in 2021-22, there have been on average 14,826 full-time-equivalent agency nurses and 4,621 medical and dental FTE agency staff. It is hard to draw direct percentage comparisons given different methodologies for measuring such percentages, but my understanding is that overall about 3% of nursing shifts and about 1.5% of doctors’ shifts in hospitals are filled by locums or agency staff.

[Esther McVey]

Can we get greater clarity on that information and have it held centrally, given that wages are such a large proportion of the NHS budget? It is essential to know how many hours are paid at the higher locum rate to ensure value for money for the extra billions of pounds that the Government are putting into the NHS to get waiting lists down and for social care.

[Edward Argar]

I am grateful to my right hon. Friend, who is tireless in her determination to ensure value for money for her and all of our taxpayers’ pounds, particularly in this space. We continue to work hard to drive down agency and locum spend, focusing instead on both bank staff and our full-time recruitment, on which the Secretary of State has set out the success that we have been having. Since 2015, we have controlled agency spend through price caps and procurement frameworks. However, she is absolutely right, and we want to see more full-time NHS employed staff working at NHS rates in our trusts.

Organ Donation and Transplantation Strategy

Esther McVey Excerpts

Wednesday 23rd February 2022 Westminster Hall

[Esther McVey (in the Chair)]

I will call Anthony Mangnall to move the motion. I will then call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[Anthony Mangnall (Totnes) (Con)]

I beg to move,

That this House has considered the organ donation and transplantation strategy.

It is a pleasure to serve under your chairmanship, Ms McVey. I thank the Backbench Business Committee for granting the opportunity to debate the important topic of the organ donation and transplantation strategy. I also thank the Minister and her departmental team for their responses to my inquiries about organ donation on behalf of my constituents. Their answers have been detailed, helpful and reassuring.

In the time I have been in this place, I have learned that Westminster Hall debates are not always used to be helpful to the Government and are often used to point out their flaws and failings. I may be guilty of having done that once or twice myself, but I want to use this debate to do three things. First, I want to congratulate the Government on the steps they have taken thus far, most notably with the Organ Donation (Deemed Consent) Act 2019. Secondly, I want to encourage further education and awareness around organ donation. Thirdly, I want to explore future steps that the Government can take in relation to organ donation and transplantation strategy.

In May 2020, the law around organ donation in England was changed to allow more people to save more lives. The Organ Donation (Deemed Consent) Act, which many hon. Members present supported, changed the law to mean that an individual agrees to become an organ donor when they die if they are over 18, have not opted out and are not in an excluded group. The Government’s legislation brought us more into line with other countries but, more importantly, the number of available organ donors increased dramatically, while the number of people opting out of the opting-in initiative only slightly increased. Pre opt-out—before 5 May 2020—the UK had 26,037,200 registrations, whereas the total UK opt-in registration was 27,594,279 on 13 February 2020. By comparison, fewer than 1.5 million people opted out before 5 May 2020, with the total number now standing at 2.3 million. These numbers show that in less than two years, we have had a sizeable increase in the number of potential organ donors, while only a small percentage of the population have chosen to opt out of the initiative.

NHS Blood and Transplant launched a public awareness campaign in April 2019 to inform the public about the prospective law change and the choices available to them. An evaluation of that campaign found that over 75% of adults in England were aware of the new system of consent. The third year of the campaign, which I believe comes to an end in March 2022, looks to encourage people to talk to their families and loved ones about organ donation and their organ donation decisions. With consent rates currently at 68% across the UK and 78.8% in the south-west, it is particularly welcome to see the Government state their ambition to increase consent levels to 80%. A 12% increase is likely to result in approximately 700 more transplants per year and countless lives saved.

Children’s Mental Health

Esther McVey Excerpts

Tuesday 8th February 2022 Commons Chamber

[Dr Allin-Khan]

I thank my hon. Friend for her very powerful point. When it comes to mental ill health, no group is unaffected. It is really important that we acknowledge that, while some groups are disproportionately affected, mental ill health can affect anyone. Children can live in a £3 million house, and still feel they want to take their own life or want to self-harm. The pressure that puts on parents is extremely painful, and it causes many parents to give up their job to sit at home and care for their child, because they are so crippled and so worried about what may happen if they leave the house and go to work. That is why it is so important that we acknowledge the real difficulty we have with waiting times for CAMHS.

[Esther McVey (Tatton) (Con)]

Given that the hon. Lady and her party, unlike me, were enthusiastic supporters of lockdown measures and closing schools, and were not prepared to stand up to the teaching unions, does she accept any responsibility at all for this mental health crisis among young people, because those lockdowns have had such a negative impact on our young people’s mental health?

[Dr Allin-Khan]

Do the right hon. Lady’s Government take any responsibility for the tens of thousands of children who are now bereaved as a result of losing their parents because of this Government’s shocking handling of the pandemic? We shall take no lectures from the right hon. Member and her party when it comes to protecting children’s mental health. I shall move on.

When children come to A&E—[Interruption.] Please feel free to intervene: I will take interventions.

Vaccination: Condition of Deployment

Esther McVey Excerpts

Monday 31st January 2022 Commons Chamber

[Sajid Javid]

The hon. Gentleman is right to draw the House’s attention to the importance of vaccination, as other Members have done. As was reflected in his remarks, it is the UK’s first line of defence against covid. Thankfully, the UK has put in place many other defences, such as the antivirals that are used across the UK and our testing and surveillance regime, but vaccines are the first line of defence. He is right to talk about encouraging as many people as we possibly can to take up the vaccine if they have so far not done so, whether they work in health and social care or otherwise. He is right that the best general approach is to educate and inform, and that is what we will continue to do.

[Esther McVey (Tatton) (Con)]

What a disappointment this statement is. Having read the newspapers, I was hoping to be able to come here and congratulate the Secretary of State on the Government’s recent conversion to common sense in halting the mandatory vaccination of NHS workers. Instead, he is making a half-and-half decision today, knowing that the sword of Damocles hangs over those 100,000 NHS workers, because they have to have their first vaccination on Thursday. He will then be sending them on a pathway to unemployment, along with the thousands of care workers who have already lost their jobs. What I want to know is what he is now going to do to help those thousands of people get a job, and what compensation he will pay them.

[Sajid Javid]

I am happy to clarify the point raised by my right hon. Friend. The Government have made a decision on this matter, which I hope I was very clear about in my statement, but for statutory reasons there needs to be a consultation. There will be a two-week consultation and then a statutory instrument will be presented to the House and will be subject to the will of the House.

The Government have made their decision on this, and the Department will write today to all NHS trusts and contact care home providers and wider social care settings, such as domiciliary care, to make it clear that the deadline my right hon. Friend referred to is no longer applicable. I am very happy to make that clear. She has raised an important point. While the decision is subject to this House, there will be no further enforcement of the regulations, for the reasons I have set out today.

Covid-19 Update

Esther McVey Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

I was referring to lateral flow tests earlier, but I think the hon. Lady asked me about PCR tests. I will look into what she said.

[Esther McVey (Tatton) (Con)]

Last week’s Ofsted report was damning about the impact lockdown has had on our nation’s children and the immense harm students have suffered, with the Children’s Commissioner saying that schools should not close again. However, it seems that the Government have left the door open to school closures after the Christmas recess. What specific conditions would need to be met for schools not to open in the new year?

[Sajid Javid]

I welcome that question from my right hon. Friend. What I would say to her is that with the risk we see from omicron at this point in time—the rise in infections, the increased risk of hospitalisation and the information we have on vaccines—we think we have taken the appropriate response. It is a balanced and measured response. It is designed to protect so much of what we love in our country, especially the interests of our children. The most important thing to focus on now is the booster programme.