Investigatory Powers (Amendment) Bill [ Lords ] (Second sitting)

Debate between John Hayes and Peter Dowd

Committee stage & Report stage
Thursday 7th March 2024 Public Bill Committees

[Peter Dowd]

Further to that point of order, Mrs Cummins. May I say a particular thanks to you for chairing this Committee today in such a fantastic and eloquent way?

[Sir John Hayes]

Further to that point of order, Mrs Cummins. Since we are having further points of order, I want to say to the Minister, and the shadow Minister, how grateful I think most of the Committee are for the way this Bill has been conducted. This is a really good example of how a measure can be considered in Committee in a way that is not nakedly partisan or, worse, spiteful. I simply say to the Minister that I do regard the original Act as my child, and I see him as its foster parent, so he had better do a good job.

Bill, as amended, to be reported to the House.

NHS Dentistry

Debate between John Hayes and Peter Dowd

Thursday 20th October 2022 Commons Chamber

[Peter Dowd (Bootle) (Lab)]

Where are we to begin with this? We have been here before, time after time. I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for bringing us this debate. We have discussed this many times and we had a debate in Westminster Hall in the summer, but nothing has really moved on. Nothing at all seems to have changed.

I want to read out part of a letter I received from a constituent, and this is typical of the problem we are facing. I have received even worse horror stories, to the extent that one local dentist told me that they may close in the next few weeks. That is typical and symptomatic of this bigger problem. My constituent said:

“I wanted to take the time to get in touch with you over my experience of getting on the books for an NHS dentist. I have had no luck and have had to have private dental visits. I have luckily not had to have any treatment as I would not be able to afford it. I have reached out to a few dental practices in the area…to be told that they are only taking on children on the NHS.”

That is typical of the experience of everyone in this Chamber. I exhort Conservative Members to stop dealing with this in the abstract, as though it is only affecting individual Members of Parliament; it is a collective issue, and it needs a thorough review and a thorough push by the Government. It is not in the abstract. The hon. Member for Salisbury (John Glen) referred to covid. I completely accept that covid had an impact on the provision of dental services—it hothoused an already challenging situation—but dental services in all our constituencies were under huge pressure before covid. Let us not pretend that covid was the be all and end all of the dental health problem.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I agree with the hon. Gentleman that there are systemic problems, part of which goes back to the contracts agreed with dentists donkey’s years ago, under the Labour Government—the same applies in respect of GPs. That genesis of the problem was there, but we then face the problem of training too few dentists, which I think we do, and the problems in particular parts of the country, including, Lincolnshire, which is among the worst affected. My constituents cannot get an NHS dentist and they need to have one. That particularly applies to young people and children. He is absolutely right on this.

Community Pharmacies

Debate between John Hayes and Peter Dowd

Tuesday 21st June 2022 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

I beg to move,

That this House has considered the future of community pharmacies.

It is a pleasure to see you in the Chair this afternoon, Sir Gary. As a member of the all-party parliamentary group on pharmacy, I am pleased to introduce the debate and glad to see so much support from Members who obviously, like me, recognise the huge value that our pharmacies bring to the NHS, patients and the public generally. I hope everyone here agrees that England’s 11,200 pharmacies play a crucial role in providing important healthcare, life-saving medicines and an increasingly wide range of clinical services to their local communities. Not only that, but as the most accessible providers of healthcare, pharmacies are key to reducing health inequalities: 89% of the population are less than a 20-minute walk from their nearest pharmacy, increasing to 99.8% in the most deprived areas, such as mine. It is fair to say that pharmacies understand their communities to a significant extent—sometimes more than the traditional health services—and as such are ideally placed to engage with the most marginalised and vulnerable groups in our communities.

The wider public appreciate the easy accessibility of pharmacies, which by their very nature are located at the heart of every community throughout the country. Throughout the pandemic, not only did community pharmacies remain open and continue to offer their full range of services, but they played a huge role in the vaccination programme, delivering an astonishing 24 million jabs. They also distributed some 27.6 million covid lateral flow tests and initiated a pandemic delivery service that ensured that 6 million vulnerable patients could access their medicine.

I think I am correct in saying that all Members present today would like to put on record their thanks and express their appreciation for all pharmacists, pharmacy dispensers, pharmacy technicians, medicines counter assistants, delivery drivers and administrative teams, who worked so hard during that difficult time to maintain the public’s access to the pharmaceutical services that they relied on. We, and the whole country, owe them a debt of gratitude. But we must also recognise that it is not just about thanking staff; it is also about recognising that the conditions they work in are crucial to the maintenance of a good service, whether a member of staff works in a larger or a smaller pharmacy provider.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I congratulate the hon. Gentleman on securing the debate. The point he is making appears to be twofold: first, as well as responding to need, pharmacies can have a role in preventive medicine; and secondly, we now need to shout louder about that. Pharmacies did a heroic job during the pandemic and they continue to do so, but I am not sure that everyone knows as much as he clearly does about what we can do with and at a community pharmacy, and this debate serves the purpose of telling them.

[Peter Dowd]

The right hon. Gentleman makes a really valid point, and I will talk about some of that later. We have to recognise that, despite pharmacists trying to help people, they sometimes got dreadful abuse. We have to help them and protect them from abuse. That is part of addressing their working conditions. Vacancies in the sector are not caused simply by a shortage of pharmacists. It is also about which part of the space pharmacists work in. In other words, if I were a pharmacist, I would ask, “Do I like the conditions, pay and terms of my work?” If the answer is no, people move on.

Pharmacies are not just a shop; they are a healthcare setting and should be treated as such. They are a crucial part of the NHS ecosystem. I suspect that that is why a pharmacist needs to be on site all the time—this is not just a shop operating within a transactional context. Aside from covid, pharmacies are doing an incredible amount of work for their local communities every single day. In the most recent flu season, in 2021, pharmacies mobilised to deliver the biggest flu vaccination campaign on record, administering 4.85 million doses—over 2 million doses more than in the previous flu season, representing a 75% year-on-year increase.

The recently commissioned NHS blood pressure check service has already meant that 100,000 people have had their blood pressure checked in a pharmacy. Anecdotally, pharmacy representatives say they are already hearing that these checks have picked up cases of extremely high blood pressure in patients, who have then been referred on for treatment. This is a very highly valued healthcare intervention, which will save the NHS money in the long run, because it is cheaper to prevent disease than it is to treat it. More than that, however, I am convinced that these interventions will save lives.

Those two services on their own demonstrate pharmacy at its best. PwC estimates that the sector contributes around £3 billion in net value to society as a whole, and it works every day to improve the health and wellbeing of our local communities and our constituents. That is surely why we have the NHS in the first place.

What is the current financial health of the sector? It is no exaggeration to say that the community pharmacy network is under huge strain and that pharmacy staff and businesses are coming under increasing and, indeed, unsustainable pressure. Pharmacy funding is currently flat, with the total available funding envelope fixed at £2.592 billion. In practice, the Pharmaceutical Services Negotiating Committee reports that this means that real-terms funding is decreasing year on year, as inflationary pressures, rising business costs and increasing workload are not taken into account in that funding deal. Despite all that, many pharmacies have remained open, albeit under extremely difficult economic conditions.

However, the PSNC says that some businesses are reaching the limits of what is possible in terms of remaining viable, and that is already having an impact on patients. A recent survey on pharmacy pressures, conducted by the PSNC, found that 90% of pharmacy businesses are now unable to spend as much time with patients as they did before. Perhaps more worryingly, 92% of respondents said that patients were beginning to be negatively affected by the current pressures on their pharmacy. Despite pharmacies being a significant part of the NHS family—on average, at least 90% of their income comes from the NHS—pharmacy funding has not received the annual funding growth of 3.4% per annum that the rest of the NHS has been afforded.

Those in the sector feel that it is time to put things right. Indeed, the PSNC recently submitted a funding bid to the Department, making the case for extraordinary economic circumstances to be taken into account. When the Minister responds to the debate, I hope she will update Members on whether a funding increase will be granted to the sector.

The PSNC also estimates that the sector has had to make efficiency savings of between 37% and 50% in order to manage the funding squeeze and to keep providing the services it is contracted to deliver, but how much more pressure should we expect it to operate under? Do we want a bare-bones network that delivers only the very basics for patients, or do we want a vibrant, innovative sector that is constantly looking to the future to find new ways of working and providing a personalised and consistently high-quality service for patients, and that is fully integrated with other areas of healthcare and able to be consistently relied on in the future, as millions of people relied on it during the pandemic? Members can certainly guess what my preference is.

One thing is for certain: maintaining the status quo is not an option. So what does the future of community pharmacy look like? I would like to see pharmacies evolve into the go-to healthcare settings for help with minor ailments. There is no need for otherwise healthy patients with minor conditions to continue to see their GP. The truth is that they can get the same expert advice from their local pharmacist, who can exercise their clinical judgment and sometimes even prescribe medicines or offer an over-the-counter treatment at half the cost to the NHS. Indeed, the PSNC estimates that if this policy was rolled out nationwide, the NHS could save a staggering £640 million.

What is more, there would perhaps be no need for people to queue in a waiting room or to visit multiple locations. Pharmacies could be a single go-to place for diagnosing, advising on and supplying medicines for the treatment of minor ailments. As we all know from when we go abroad, that system works in Europe and much of the developed world, so why not here? It would be potentially game-changing for the future of pharmacy and more widely for primary care. I hope the Minister will comment on what plans, if any, the Government have to commission a service of that nature.

Aside from minor ailments, pharmacies are well placed to deliver much of the prevention agenda set out in the NHS long-term plan. They could and should be at the forefront of promoting and supporting self-care. Future services could include a national emergency contraception service, or even the treatment of minor injuries. Pharmacies could also offer help and support to manage long-term conditions. For instance, they could offer a whole host of valuable services for supporting patients with asthma, such as an inhaler technique service or annual asthma reviews. Community pharmacies could do even more than they already do to review patients’ medication and ensure that it is being taken appropriately. That is all extremely important, from a patient perspective.

For the population that is otherwise healthy, pharmacies could play an increased role in promoting health and wellbeing, and in preventing and reducing further healthcare demand in the first place. After all, healthy people do not often visit hospitals or GPs, but they probably pass by pharmacies on the high street regularly. I certainly do. Pharmacies could conduct NHS health checks with enhanced patient follow-up, and they could use personalised wellbeing plans to help people to make healthy lifestyle choices. Pharmacies could also replicate their success with the flu and covid vaccination programmes by expanding into the provision of others such as the shingles and pneumococcal vaccine and NHS travel vaccinations.

When it comes to what pharmacies can do to improve patient outcomes, the possibilities are endless. I know at first hand that, given the capacity and a good working environment, pharmacists and their teams are ready and willing to take on and promote all those new services, but that has to be put into the context of wider deliverability. Let me use one example. Amanda Pritchard, the NHS chief executive, recently announced funding for high street pharmacies to identify signs of early cancer, and for subsequent referrals and follow-up by clinical radiologists. That is a good initiative. Nonetheless, as Anne Brontë wrote,

“there is always a ‘but’ in this imperfect world”.

Workforce and equipment issues are obstacles to a successful roll-out, given that the radiology system is already under pressure. What about an audit and a replacement programme for our increasingly outdated and, in some cases, obsolete imaging equipment? There are no plans to tackle the annual 7% increase in complex imaging demand and no plan to meet the workforce demand, with a 30% shortfall in clinical consultant radiologists. That figure is going up, and there are backlog issues.

The only question is whether the Government will now enable the community pharmacy sector to fulfil its potential by supporting the range of possible services, and by providing it with appropriate support and funding. I sincerely hope that the answer will be yes.