Five Year Forward View

Oliver Colvile Excerpts

Thursday 23rd October 2014 Commons Chamber

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

May I thank my right hon. Friend for appointing me to be the Government’s pharmacy champion? What role does he perceive pharmacies playing in this, because I think that they are an important part of the whole NHS?

[Mr Hunt]

I had a very enjoyable evening at the pharmacy business awards last night. Pharmacies have an important role to play, because they could save a significant number of A and E and GP visits. The single most important change—my hon. Friend and I have talked about this—is to make it possible, if a patient gives permission, for pharmacists to access their GP record so that they can see their medication history and ensure that they give them exactly the right drugs.

Care Bill [Lords]

Oliver Colvile Excerpts

Monday 10th March 2014 Commons Chamber

[Grahame M. Morris]

I thought I was being fairly clear. In the debate on the earlier group of amendments, we discussed the privatisation of the clinical commissioning function. My concern is that that would lead to greater fragmentation, not greater co-operation. On data sharing, I think it was my hon. Friend the Member for Leicester West (Liz Kendall) who gave the example of a questionnaire she was asked to fill in by her GP, which contained questions relating to alcohol consumption, smoking and so on. If that information was made available to a private health care company and, as a consequence, premiums were increased, people would have concerns. The Minister said that that has been ruled out and that it would not happen, but it is an example of why such concerns have been raised.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

It is very important for there to be as much protection for the individual and the patient as possible. I assure the hon. Gentleman that my medical records are particularly uninteresting, but I would not want them to be leaked to an insurance company seeking to make money out of them or trying to change my premium. I am sure that that is very important in people’s minds.

[Grahame M. Morris]

The hon. Gentleman makes an interesting point which echoes a point made on the Labour Benches a few moments ago. The problem is that a number of private health care companies are also insurance companies, so it would be quite a task to ensure that data are not shared with companies that might have a commercial interest in them. To restrict access in the way we would all want is not as simple as the Government would have us believe.

--- Later in debate ---

[Grahame M. Morris]

I entirely agree. I think that that is vital, because, as we have seen in the case of politicians following the expenses scandal, once public trust has been lost, it is a huge task to win that trust back. There is a mountain to be climbed. I therefore think it important that we get this right.

The Government have an opportunity to pause the implementation of the Bill in order to consult properly, and, in the Bill itself, to address issues that have been raised by Members in all parts of the House and by other interested parties. I believe that if there is to be public confidence in the scheme, the Government should make a gesture by supporting Labour’s new clauses, particularly new clause 25. Given that the misuse and identification of data are the prime concerns of the public, I think that it would be eminently sensible to make them an offence. That is not rocket science, is it? If that is the problem, why do we not address it directly by creating an offence? Similarly, if an organisation makes applications for data from the Health and Social Care Information Centre, it should have to disclose any previous convictions under that offence. I am a big supporter of transparency and the extension of freedom of information. Private health care companies should disclose information that is relevant in those circumstances.

It seems bizarre to insist that the public should allow their private information to be shared with organisations that are allowed to hide their chequered pasts in some cases behind the cloak of commercial confidentiality. Parliamentary accountability, too, should be introduced to the decision-making process. The Secretary of State should retain the duty to approve any applications. The buck should stop with the Secretary of State. If there is a serious commitment to win back the public’s trust on care.data, the buck should stop with the Secretary of State, rather than with a big and unaccountable quango.

It would be of great benefit to the public if data sharing were exercised in an accountable and secure manner. I have always been an advocate of investment in public health. For that to be effective, we need an evidence base on which to plan interventions. The scheme is set to be disrupted unless the Government can demonstrate that they are serious about protecting patients’ privacy.

[Oliver Colvile]

Does the hon. Gentleman think that there will be a problem with patients sharing that information with their pharmacists if that meant that they were going to get better more quickly?

[Grahame M. Morris]

On an individual basis, I do not see a problem with that. The problem arises when dealing with large volumes of harvested data that include not just primary care records of patients in the community but hospital records, where pharmaceutical companies are perhaps able to benefit. Whether that is in patients’ best interests needs further consideration. I do not think that there is any such concern about individual conversations with GPs or pharmacists, but there are still major holes in the Government’s proposals. They need to be tightened further. A good starting point would be Labour’s new clause 25.

G8 Summit on Dementia

Oliver Colvile Excerpts

Thursday 28th November 2013 Commons Chamber

[Hazel Blears]

My hon. Friend is absolutely right. I was horrified to learn yesterday that only 0.1% of research on dementia is spent on prevention. In every other area of public policy, such as education and social mobility, we are aware of the importance of investing in prevention, but in this area there is virtually no grant support, and that must change. I understand that in Norway and Sweden, tests for dementia are the norm. They are cheap once the investment has been made in the equipment, and the vitamin B12 research looks extremely promising. I hope that when the Minister responds he will say that that is something that our own national health service should take up.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

Is the right hon. Lady aware of the excellent work that is being done in Plymouth, not just at the university but, much more important, by the local authority and the Royal Navy at Devonport? They are taking a lead by ensuring that all their employees are aware of the dementia issue, and that, if they need time off, they can have it in order to look after their relatives.

[Hazel Blears]

I am delighted that the hon. Gentleman has mentioned Plymouth, because it is one of the pioneers in this area. Plymouth, Torquay, Bradford and other towns all over the country want to ensure that dementia is not something shocking that we do not know how to deal with, and that everyone is dementia-friendly and aware. They are tackling the stigma, which is a huge issue. People do not like to talk about the fact that their families and friends are afflicted with this disease.

The search for a cure is essential. No one wants to have dementia, and everyone wants to be able to cure it. However, at the G8 I want just as much importance to be ascribed to research on the quality of care. The Evington initiative, which is backed by a number of business leaders including Terry Leahy—who used to chair Tesco—and Sir Marc Bolland are putting their weight behind that initiative. They are asking two questions. First, how can we change the system so that it is driven by users and carers rather than simply by clinicians and producers? Secondly, how can we establish a good, rigorous evidence base in relation to therapeutic interventions, quality and consistency of care and tackling stigma, so that clinical commissioning groups can be confident that the services they are commissioning actually work?

I think that the research is very exciting, but we are not likely to find a cure for 10, 15 or 20 years, and in the meantime 800,000 people are living with dementia. At present, there is virtually no evidence base relating to the quality of care. “Singing for the brain” is fantastic, but does it work, and if so, why does it work? Then there are the arts, the drama, and all the memory work that goes on. We need that rigorous evidence base, so that the commissioners can take the right packages off the shelf.

--- Later in debate ---

[Paul Burstow (Sutton and Cheam) (LD)]

It is a great privilege to take part in this debate and to be presided over by you, Madam Deputy Speaker, for the first time. I congratulate the hon. Member for Chatham and Aylesford (Tracey Crouch) and the right hon. Member for Salford and Eccles (Hazel Blears) on their tenacious pursuit of these issues and on ensuring that we have had two Back-Bench business debates on the subject in less than a year. That gives notice of the fact that this is an issue about which the House and its Members feel passionately and to which they want more attention paid.

Last Thursday, I took part in a local dementia forum in my constituency, which was organised by the Sutton Alzheimer’s Society. It brought together a range of organisations to listen to and engage with people who are experiencing dementia—either as carers or as sufferers who have the diagnosis and are living with its consequences. That was an incredibly powerful experience. At the heart of this issue is how we ensure that people have a good life and maintain good relationships, because dementia can rob them of that. We need to think about how we can ensure that people, whether they be a professional, a carer or someone who is working in another part of the public or private services, understand and are aware of the issues about dementia. We need to build a community that is more friendly towards those who suffer from dementia. Good communication is at the heart of that. The one message that all of us who were speakers at the event got from both the carers and the people with dementia was to slow down. We were gabbling and talking at great pace, because we were trying to get across too much in too little time. With just over three minutes left, I will not manage to achieve that requirement now.

I want to take a slightly different tack from the contributions we have heard so far and argue that the G8 summit on dementia needs to address the impact dementia will have on the development of low and middle-income nations across the planet. As Dr Margaret Chan, the director-general of the World Health Organisation, says:

“The need for long-term care for people with dementia strains health and social care systems, and budgets. The catastrophic cost of care drives millions of households below the poverty line. The overwhelming number of people whose lives are altered by dementia, combined with the staggering economic burden on families and nations, makes dementia a public health priority.”

That is why having a G8 summit on it is correct.

We are living through an extraordinary time in human history. A revolution is taking place on this planet, which is remaking societies, the state and so much that we have taken for granted. It is really a revolution in terms of human survival. We are living longer, which is something that we should celebrate. It is a triumph of human ingenuity that is all too often portrayed as some sort of disaster. It is not a disaster, but something that we should celebrate.

Let me put some numbers into my argument. In 2010 it was estimated that, across the world, 35.6 million people had Alzheimer’s disease and other dementias. That number will increase to 66 million by 2015 and to 115 million by 2050. The majority of that increase will not fall in the developed world; it will be in low and middle-income countries where more than 70% of people with dementia will be living by 2050.

As I have said, the number of people with dementia in 2050 will rise to 115 million, but the number of people who will develop dementia worldwide between now and then is estimated to be 600 million, which is roughly one new case every four seconds. In the UK, the national dementia strategy, which, as we have heard, runs out next year, and the Prime Minister’s dementia challenge, on which I had the privilege of working when I was care Minister, recognise the challenge posed by dementia, that dementia is not a normal part of ageing and that concerted action is required.

The G8 summit requires a focus that is not just about the developed world’s research spend; it must also understand the impact of dementia elsewhere in the world.

[Oliver Colvile]

Is my right hon. Friend aware of the stigma of dementia in black and ethnic minority communities? I recently took part in an inquiry in which it became apparent that that is an issue.

[Paul Burstow]

The hon. Gentleman’s point is spot on and leads me on to my next point about an example of research in India. It is estimated that in 2010 there were 3.7 million people with dementia in India, which will rise to more than 14 million by 2050. Approximately half those people will be over 75 and almost 2 million will be over 90. There is a serious lack of awareness about the issues in low and middle-income countries, especially those in Africa. Almost three quarters of people with dementia will live in those countries and that is why I want to ensure that the Minister, as he feeds back into the process of preparing for the summit, will make sure that such issues are on the table.

Pharmacies and the NHS

Oliver Colvile Excerpts

Wednesday 20th November 2013 Westminster Hall

[Ben Gummer]

I could not agree more with the hon. Gentleman. I will address that point.

There are three separate groups that each present different and particular problems. The scandal to which the hon. Gentleman alludes, which was uncovered recently by an excellent piece of journalism in The Daily Telegraph, shows how the NHS, customers and taxpayers have been ripped off by the drug companies that are coming in and double invoicing—they are issuing credit notes to pharmacists but invoicing full amounts to the NHS. That situation is outrageous, but it is inevitable when the market is so complicated and lacking in transparency. That is the first of several problems with special drugs.

Category M drugs are incredibly complicated. In the parallel trading of pharmaceuticals across the European Union—just to take one issue—it was often beneficial to import drugs from Greece or southern Europe to the UK because of the price differences between the pound and the euro. The reverse is now true, which means that there is sometimes a shortage of supply in the United Kingdom.

The situation is addressed by a quota system imposed by the pharmaceutical companies, which inevitably causes difficulties for pharmacists because sometimes five people, rather than three, want a particular drug one week. At that point, the pharmacist rings up the wholesaler and says, “I need two more prescriptions.” The wholesaler will then say, “Actually, I don’t have them.” The pharmacist will then have to phone the supplier to ask for two prescriptions, and if the pharmacist cannot get the prescriptions from the supplier, they have to go into the secondary market to buy from another pharmacist who is keeping the prescriptions in stock. The other pharmacist, completely understandably, takes a margin on selling the drug to the pharmacist who requires the prescription.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

My hon. Friend might be aware that I am vice-chairman of the all-party group on pharmacy. The right hon. Member for Rother Valley (Mr Barron) and I considered the issue about 18 months ago, and we produced a report. Unfortunately, the Department of Health does not seem to have taken an awful lot of action and has rather pushed the report into the bottom drawer. Perhaps my hon. Friend might be willing to meet the chairman of the all-party group and me so that we can share our report.

[Ben Gummer]

My hon. Friend wrote and published his report before the Minister was appointed to his position, so I am sure my hon. Friend is calling on new ears and eyes that are able to consider the problem afresh.

Another problem is that pharmacists are completely at the mercy of the demographic that they happen to serve. The averaging of pricing operated by the PSNC means that if pharmacists happen to be selling a particular pharmaceutical in their area because of a high incidence of diabetes and are making a loss, and if they are not selling many drugs on which they might otherwise make a profit that allowed them to break even or make a small margin, they are immediately disadvantaged—just because of their geography.

If, however, a pharmacist happens to be in another location with a low incidence of diabetes but a high incidence of another condition that requires a high-margin drug, the pharmacist will do very well—not because of business acumen, not because they are running a particularly good service, not because they are friendly to customers, who want to come to see them, but just because of where they happen to be and the health indicators of their particular area. That cannot be right.

The third problem with the regulated market is that, because of the price changes of particular pharmaceuticals that happen every day and every week, it is impossible for businesses to plan, as they are uncertain of their future margins.

Those are all classic problems of trying to regulate a market. It would be good for the Opposition spokesman, the hon. Member for Copeland (Mr Reed), to take note of what happens when people try to regulate a market to the degree that his party—not him, I am sure; he is one of the more sensible members of his party—wishes to on energy prices. Such regulation results in inflated prices across the spectrum, as has happened in many instances in the drugs market in the United Kingdom. Good customer service is not incentivised, and good pharmacists are crying out to be rewarded for quality. Furthermore, innovation and supply are restricted.

I could go into those problems in far greater detail across the sector. The problems frustrate pharmacists and, no doubt, Ministers, who ultimately have to write the cheque on behalf of the taxpayer.

The third area I will address before I give others an opportunity to contribute is the essential problem at the heart of the debate. Of course it is understandable that we have ended up with a regulated system, because there is only one customer for most drugs. Indeed, if I understand things correctly, 80% of prescription drugs are bought by the NHS on behalf of people who are entitled to free prescriptions. Because of the way in which we have set up our health service in this country, it is impossible to extract the kind of value from the big pharmaceutical companies that other countries are able to extract, as there is only one purchaser. I do not know why in this country we have not got to a position of questioning the business motives and ethics of big pharmaceutical companies, as the United States has for many years.

I should qualify all that by saying that, of course, within the pharmaceutical sector there are the most fantastic companies that are innovating, contributing upwards of £12 billion a year to the UK economy and employing thousands of brilliant people across the country. We should be proud of those companies, but it is surprising that we have such an unquestioning attitude to those enormous interests, which have a relationship with the NHS and general practitioners that could be generously described as corporatist. That is unhealthy in driving innovation, in encouraging responsibility and, most importantly, in ensuring transparency. That is precisely why we get scandals such as the one raised by the hon. Member for Upper Bann (David Simpson). If there is an opaque market, frauds will be committed against the interests of the taxpayer.

I have, I hope, opened up the debate a little so that we can discuss some of the issues. I do not have any prescriptions for how we might deal with them, other than the general principle, which I hope the Opposition will agree with, that liberalisation is generally a good thing. If we deregulate this market—not the quality of the people dispensing pharmaceuticals, but the commercial side of the market—to allow pharmacists to offer more services more innovatively and more cheaply, and if we encourage competition in NHS purchasing and price-setting, we will do something on behalf of taxpayers and patients. I have put forward a group of questions to open up the debate, and I am grateful for the contributions that will follow mine.

--- Later in debate ---

[Oliver Colvile]

Plymouth, Sutton and Devonport.

[Mr Barron]

I am sure Hansard will put that right anyway—I could have said “somewhere in the south”. The hon. Gentleman mentioned the all-party group, and we had a session on pharmacies easing the burden of emergency care. We had several witnesses, one of whom—Paula Wilkinson—was the chief pharmacist at Mid Essex Clinical Commissioning Group. She showed us a publication that the CCG was sending round mid-Essex called “Why wait to see your doctor or nurse? See your pharmacist first!” It is part of the health care on the high street initiative that the CCG is running, and she focused the majority of her comments on that initiative, which she said nudged—that is very much Government-speak—people towards using the pharmacy first. Like another witness, she focused on the expanded role that pharmacies could play in serving patients with minor ailments.

Paula said—this is quite interesting, and I would be interested in the Minister’s comments—that for people on low incomes, prescriptions often provided a way of gaining free access to medicines that are otherwise available over the counter without a prescription. She said that meant that patients on low incomes were perversely incentivised to attend their GP or an A and E service to get prescriptions. She believed consideration should be given to providing some free medicines without prescription to those on low incomes. Clearly, if a patient has been on a medicine for a long time, that would not be that challenging, and a professional such as a pharmacist could extend the period without having to go through any rigmarole and clogging up the rest of the system.

The A and E report that came out last week showed that 40% of people who attend A and E have nothing whatever done to them, which is an extraordinary statistic. Indeed, 50% of people who are blue-lighted—an ambulance or paramedic goes out to them—are not admitted to hospital. We need to look at certain issues in primary care services and, to some extent, in the acute sector if we are to deal with such people.

Community pharmacy provides a common ailments service—we call it a minor ailments service in Rotherham —in 10% of England, and people are encouraged to go to the community pharmacy as part of that. A nationally commissioned service would reduce pressure on GP surgeries and, subsequently, on A and E. Recent reports suggest that 56 million to 57 million visits a year could be managed by pharmacists, freeing up GPs to manage more complex cases, and I agree.

Pharmacists support people with long-term conditions to manage their symptoms, improving access to care for people in the most deprived areas and increasing capacity to treat patients out of hours and in the community. The Minister will be well aware of this, but about 75% of NHS expenditure goes on people with long-term conditions. This winter, quite a lot of them are likely to end up going to A and E and clogging up the system because they have, for whatever reason—they may be forgetful as a result of other problems, such as dementia—not adhered to their drugs regime at home. Managing such people in the community using professionals such as GPs, nurses and pharmacists is a better way of caring for such people. We have few systems to deal with these things, although the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) will no doubt tell us what is going on in his constituency with healthy living pharmacies, so I will not go into that. These are, however, major issues, and the strengths of pharmacists should be used a bit more.

I mentioned the question of medicines adherence. Under the present general pharmacy contract, it is pharmacists’ duty—and they are paid for this—to take in unused medicines. It is extraordinary that every year medicines costing hundreds of millions of pounds are prescribed and then are unused, for whatever reason. It is a difficult situation. The 2010 report by the York health economics consortium and the school of pharmacy at the university of London suggested that up to £500 million could be generated in England in just five therapeutic areas—asthma, diabetes, raised blood pressure, vascular disease and the care of people with schizophrenia—if medicines were used optimally. Those are all long-term conditions on which taxpayers’ money is spent. The report rightly said that sub-optimal use of medicines and waste undermine the £12 billion investment in medicines by the NHS.

Pharmacists do quite a lot of work which, although it is contracted to the NHS, is not always laid out nationally or used by local health partnerships. The hon. Member for Ipswich pointed out that pharmacists were not included in the publication that he cited. A medicines use review is a review of a patient’s medicines—prescribed and non-prescribed—to promote adherence and to support the optimal use of medicines; 2.8 million MURs were provided by community pharmacies in England in 2012-13. Since 2011, pharmacies have offered a new medicine service to provide additional support to patients who are starting to take certain medicines for long-term conditions. An evaluation of the effectiveness of the NMS is due soon, and more than 640,000 people starting to take new medicines have benefited. That is adherence —making sure that people do as their prescription sets out.

The York and London review, which is entitled “Evaluation of the Scale, Causes and Costs of Waste Medicines”, goes into the question in great depth, and clearly the problem will never be eliminated altogether. Nevertheless it is clear that in this country people sit and write out prescriptions and people take them away and effectively put them on the shelf. The patient might use the medicine for a couple of days. Perhaps they do not like the side-effects, and indeed that is unavoidable on occasion. However, some medicines are stored in bathroom cabinets, and when they are emptied the medicines are taken back to the pharmacist or thrown away, which costs the nation hundreds of millions of pounds. We must question whether some of those medicines, given that they are not used, should be prescribed in the first place. However, that is a wider issue for health professionals, not me.

More than 57 million GP consultations a year involve minor ailments. If we rolled out the scheme that currently covers about 10% of England, we could greatly reduce pressure on those services, and GPs could get on with more important things. The patients could be moved to pharmacies, and more than £812 million of GP capacity could be freed for other things.

In 2009-10, 140,000 people chose their community pharmacy to set a quit date and 62,000 had successfully quit smoking by the fourth week, which was a 13% increase on the previous year. Pharmacists give support in a wide variety of public health roles, including flu vaccinations, international normalised ratio-testing clinics—monitoring and adjusting the dose of the blood-thinning medicine warfarin—and asthma clinics.

There has been much debate in Parliament about changes in the Health and Social Care Act 2012. The Minister was on the Committee that considered the measure. Two things were writ large in that Act. First, we have now put into statute the need to reduce health inequalities—but they are not reducing. Everyone is living longer, but in terms of social class things are still going downwards. Pharmacists could work on reducing health inequalities in areas where there is known deprivation. That should be a major aim. Secondly, the Minister will remember the emphasis on population health. In view of the statistics that I have read out, I think pharmacy has a major role to play in improving population health.

Public health problems were very bad 150 years ago, and they involved the environment—bad housing, bad sanitation and bad water. The public health issues that this century will suffer from will be to do with individual lifestyles. I read out some statistics about smoking cessation and pharmacies, and I believe that community pharmacists are the gatekeepers to the national health service. Far more people visit them than any other part of the NHS and they have a major role to play. The sooner we alter the current mode of contact and move away from the situation where pharmacists get the bulk of their money just churning out prescriptions to one where they cover wider issues within communities and look after the health of the population, the better we shall be.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

It is a pleasure to serve under your chairmanship this morning, Dr McCrea. I congratulate my hon. Friend the Member for Ipswich (Ben Gummer) on securing the debate. I have tried on one or two occasions to get a debate on pharmacy, and he has beaten me to it and introduced the debate very successfully. No doubt he has more pull with the Speaker’s Office than I do. I thank the Minister for attending, too.

I got involved in the pharmacy story when in the 1990s resale price maintenance on non-prescription medicines became a big issue. The chief executive of Asda—I do not think that he was a Member at the time—was very keen to get rid of RPM on non-prescription medicines because he felt the market should be much more open. Quite a debate has taken place over the years on how to liberalise the pharmacy market in a big way.

At that time, community pharmacists were concerned about whether their trade would be reduced and the effect on their livelihoods. We must recognise that community pharmacies play a significant role in the high street economy. People are regularly drawn into town and city centres to spend money and visit the community pharmacy at the same time. I have followed developments with interest. I congratulate and support pharmacists, who do an incredible job. As the right hon. Member for Rother Valley (Mr Barron) pointed out, they are the first point of contact for people who need help.

I understand the concern of my hon. Friend the Member for Ipswich about the lack of liberalisation in the market and the need for transparency. I am always one for a lot of transparency—more sunlight normally produces it. During the 1980s and 1990s, the Conservative Government made sure that town centre retail developments and new supermarkets were assessed, to find out the implications for other supermarkets and food retailers. Regulation of town centres has been going on for a while. That was also to do with the sequential test.

[Steve Baker (Wycombe) (Con)]

My hon. Friend reminds me that we often complain that our town centres are in decline; he may have given us the reason.

[Oliver Colvile]

I agree that supermarkets have had an impact, but my point is about trying to protect small businesses in town and city centres.

[Steve Baker]

That is not quite what I meant. I pointed out that our town centres have been regulated for a long time, and that they are now in decline. Perhaps we should liberalise more consistently, and should have done so for a long time.

[Oliver Colvile]

The bigger issue, frankly, is car parking in town centres. Outside town centres people do not pay charges for car parking, but they do in town centres: so where do they go? In my constituency, I suspect that they end up at the Marsh Mills Sainsbury’s or elsewhere.

Two other big issues affect the pharmacy profession, one of which is the criminalisation of dispensing errors. If pharmacists make a mistake, they can be prosecuted and potentially sent to prison, whereas GPs, for whom I have a great deal of time, do not suffer the same prospect. The Department of Health is looking at that, and I hope that it will come to a conclusion on how we can equalise the situation and ensure a more level playing field.

The other issue is the sharing of data between pharmacists and GPs. I raised the matter during a recent statement from the Secretary of State for Health on the whole business of how pharmacists could play a part in helping to relieve accident and emergency units. The Government are keen to ensure that more and better data sharing takes place. I have a slight concern in that my understanding is that the process would be run by the Department of Health, but I recently read in an article that the Department was suggesting that the responsibility would lie much more with the local commissioning boards. If the Minister can respond to that confusion, that will be helpful.

We need to ensure that pharmacies play a much better role. They need to be the first point of call for people seeking help from professionals, as that would help to relieve GPs. During the summer recess, I visited the Keyham healthy living pharmacy, which is a brilliant organisation in a deprived community. Life expectancy differs by 11 years between the suburbs of Plymouth and Devonport, which is where the Keyham pharmacy is located. The pharmacy offers not only flu vaccinations, but also smoking cessation services and other such things. It is a service that certainly needs to be available.

Finally, there is concern about how we can improve how people feel about pharmacies to ensure that they are used in a much better way. If pharmacies were used to deliver flu vaccinations, that would take some pressure off our accident and emergency units over the winter. We have discussed an important issue this morning, and I am delighted that you, Dr McCrea, have been in the Chair to ensure that we get some positive comments.

--- Later in debate ---

[Jim Shannon]

I thank my hon. Friend for that helpful contribution. The contributions from him, my hon. Friend the Member for Upper Bann (David Simpson) and others may focus the Minister’s attention.

On the availability of medicines, I have read that the National Institute for Health and Care Excellence has approved fewer than one in three medicines since 2005. A recent letter from nine major pharmaceutical companies to The Daily Telegraph started with something that I agree with. I am sure that any Member and, more importantly, any doctor or care worker in the NHS, will also agree with it:

“Medicines should not just be seen as a cost.”

They should first and foremost be about healing and curing illnesses. The letter continues:

“They are an investment and an essential part of improving patient outcomes. Yet…the proportion of medicines refused by NICE is only increasing.”

That is a concern for me, too. Jonathan Emms, UK managing director at Pfizer, has said:

“Right now NICE is saying ‘no’ too often. It is blocking many innovative new medicines from reaching the UK patients who need them most, medicines that are often readily available in Europe.”

Will the Minister say what contact he has had with NICE about not making available in the UK drugs that are available in other parts of Europe?

Although it is hoped that the agreed deal will save the NHS £1 billion over two years, it is essential that that saving goes into making more drugs available for the healing of those who need them and not simply the healing of the deficit. Will the Minister assure me and the House that the savings made will go into the provision in the UK of drugs that have been widely tested and that are widely available in Europe?

[Oliver Colvile]

Does the hon. Gentleman recognise that drugs and medicines can be dangerous if they get into the wrong hands? Pharmacies also have to face people using the internet to acquire drugs, which is an option that does not carry the same regulation that we expect in the domestic market.

[Jim Shannon]

I thank the hon. Gentleman for that contribution. It is something that many of us have highlighted and I know that the Minister has spoken about it in the past. The availability of drugs on the internet is an anomaly in the system, and perhaps the Minister can give us an indication of how best to deal with it.

Back in April, we were told that the number of cancer drugs on the approved list was to be halved. Will the Minister commit to ensuring that the savings will be used to increase the amount of drugs that might save lives and give a better quality of life?

I read the story of a mother with terminal cancer, who was forced to fund herself a drug that she believed would give her extra time with her young children, after being refused by a special Government fund. I find such stories incredible, hearing about the real heartache and issues that impact on family lives, and yet we—as collective representatives—are unable to help and assist as we should. In America, Obama is trying to bring in a health care system similar to ours. It is referred to as Obamacare—people say that it will make or break him, and it probably will. We, however, seem to be turning ourselves into an American system, whereby we have to fundraise to get treatment. That is certainly not what my constituents or I pay our taxes for, and I am sure that others agree with me.

I want to make a quick comment about Northern Ireland, where our Health Minister abolished prescription charges. That was done on the understanding that cheap generic drugs were not prescribed. Health is a devolved matter in Northern Ireland, and our Minister made a decision, which I support entirely. Will this Minister—I ask this with respect—liaise with the Northern Ireland Minister, Edwin Poots, to ascertain how the scheme is working and how we have been able to stick within our budget in Northern Ireland on prescription drugs?

The right hon. Member for Rother Valley (Mr Barron) made a valuable contribution today. One of the things that he referred to was the drugs that people have and do not use; they sit until they go out of date and are then dumped. In Northern Ireland, the Minister, the GP surgeries and so on have taken steps to ensure that the prescription of drugs is better controlled. Sometimes, people might run out of drugs, rather than having extra in the cupboard, but such steps help and take away wastage in the system. The right hon. Gentleman made that clear in his contribution.

Over the years in Northern Ireland, through the Minister and in co-operation with the pharmacies, we have also tried to reduce the number of people attending accident and emergency. If people have a minor ailment, they should go to their pharmacist or chemist; he or she will be able to give some direction on what needs to be done. There are ways and means of good practice, to which I have referred on many occasions. I say what we do in Northern Ireland with humility, but we actually do some things very well. If such things are done well, they can be a marker for elsewhere.

Time is flying past, but changes clearly need to be made soon. Yes, pharmaceutical companies and pharmacies need to make a profit, but that must be done in the right way; we need legislation in place to ensure that that is done in such a way. Yes, NICE must protect people from drugs that promise all, but deliver nothing, and yet that cannot be used to count pennies and to justify saying no to drugs that will make a difference.

Finally, yes, Government must make savings, but those cannot be taken from the most vulnerable by denying them treatment; any savings should be used for new drugs, to give people a better chance of life, for the sake of our constituents in the whole of the United Kingdom of Great Britain and Northern Ireland. We are not talking simply about numbers on a hospital list—the changes need to be made, and made soon.

--- Later in debate ---

[Steve Baker]

My hon. Friend is absolutely right and I am extremely grateful to him for bringing that up. We pretend that we live in a capitalist society—I have said this in the House before—but if our system is capitalism, I am not a capitalist. We have an absurd hybrid system, in which the state constantly intervenes in order to give people rents. It is peculiar that we call it a free market society.

The purpose of our all being here, of course, is to improve our constituents’ lives. When I say such things, my intention is to ensure that my constituents—all our constituents—have better access to pharmacies. In the House, we have a real consensus about an increase in the services offered by pharmacists being of benefit to all our constituents. What I want is for the Government to get out of the way, not to use taxpayers’ money to provide the payments that my hon. Friend mentioned and to allow pharmacists to get on and best serve the public in a way that is in the public’s best interests—a way that can be discovered only through experimentation and entrepreneurship.

On pricing, I want to make the point that in this country we are not good at haggling. We should haggle over prices and drive them down. The hon. Member for Strangford (Jim Shannon) talked about the scandal of some simple and inexpensive medicines that ought to cost pennies, but cost very much more. What I see at work there could be something that I witnessed when I was a contractor working with Government: Departments are not good at driving down prices. They tend to accept the price that they are given—“Oh, that must be the market price.” No—they should set the market price by demanding that they are charged less and, if suppliers do not provide the goods at a lower price, they should go elsewhere.

That brings me to generics and parallel imports, a subject touched on earlier. We ought to be making sure that the big pharmaceutical firms do not hold the NHS over a barrel. I have heard some of their arguments, and of course producing a new drug is an expensive business, but we should not be held over a barrel. In a market society, people should be held to account to drive down costs and drive up quality.

Johnson & Johnson, based in my constituency, has a wonderful credo, which was written when the basis of a free society was under threat in an earlier time. That credo sets out the principles on which the industry should be founded, and one such should be: no legal privileges, wherever possible.

[Oliver Colvile]

During the all-party group inquiry, we looked at that issue. One suggestion for easy identification of who was exporting and importing pharmaceutical products in this country was to look at VAT returns—when I ran a small business and was VAT registered, I had to fill in a piece of paper that recorded what level of EU trade I had ended up doing. I approached the Treasury on the matter, but it was not willing to participate and help, but that seems to me to be a way in which we could identify who the offenders are. We had some difficulty in identifying the offenders.

[Steve Baker]

My hon. Friend has identified what might be a missed opportunity because an enormous effort is going into preventing that fraud. With the opportunities that electronic communication offers today, it should be possible to use some of that information in other contexts. With that in mind, I will turn to the internet.

Clearly, everyone wants to ensure that prescribing takes place properly, but when people have been prescribed medicines it should be possible for them to buy over the internet in appropriate circumstances. I am particularly aware that homeopaths have had great difficulty with the internet because of the need for people to present physically to buy a medicine.

We cannot have it both ways on homeopathy—either the medicines are relatively harmless and can be treated with scorn by the medical profession, in which case they should be freely available on the internet, or they are dangerous and should be tightly regulated. Homeopaths’ experience suggests that people can take responsibility for themselves and buy products on the internet.

Mid Staffordshire NHS Foundation Trust

Oliver Colvile Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

Absolutely. The Minister of State, Department of Health, who has responsibility for care services, has been very focused on making sure that there is proper corporate accountability. Today, we have announced the new fit and proper persons test that will apply to all organisations delivering care to make sure that directors of companies responsible for care homes and domiciliary services in which poor care happens are properly held to account. That is vital, because there should be no hiding place for people who send signals to their staff that lead to our reading the horror stories that, sadly, we have read.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

To my mind, the issue is about patients having confidence in their local hospital. What can we do to ensure that patients in my constituency have a better understanding of how Derriford hospital is performing and whether it is improving?

[Mr Hunt]

This is the heart of the change that we are making this year. My hon. Friend and I know exactly how well all the schools in our constituencies are doing, because there are transparent, independent Ofsted ratings, but we do not know how well our local hospitals are doing. We need an expert to go in and look at hospitals and then tell us, in language that non-clinicians can understand, just how well they are doing, as well as what needs to change when they are not doing well. We will get that with the new chief inspector of hospitals.

Changes to Health Services in London

Oliver Colvile Excerpts

Wednesday 30th October 2013 Commons Chamber

[Mr Hunt]

I can assure the hon. Lady that decisions about the future of A and Es will be based on what is best for patients and on what will save lives and get the best outcomes—that will apply in her constituency, as it will in mine and every other constituency—but that will sometimes mean a difficult decision if we have a change that doctors strongly support, but about which members of the public are anxious. I have said that services at Ealing will change, but that there will be proper public consultation and that at the end of the process there will still be an A and E. The recommendation from the process was that the A and E should close, but I said, “No, I think there should be an A and E at the end of the process.” I am injecting that much certainty, therefore, but I am not going to micro-manage the local NHS by saying precisely what those services should be.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

It is not only A and E units in London that are under pressure; Derriford hospital’s A and E unit is also under pressure, because of our night-time economy. Is my right hon. Friend willing to meet me and potentially representatives from the English Pharmacy Board and my own Devon pharmacists to discuss how they can help to relieve some of the pressure on A and E units, especially down in Devon?

[Mr Hunt]

I would be more than happy to meet my hon. Friend and his local pharmacists. There is a lot that pharmacists can do. One change we are making that could make a big difference, where proper protections are in place for patients, is allowing pharmacists to access GP records so that they can give people the correct medicines, know about people’s allergies and things like that. There are lots of other things as well, though, and I look forward to the discussion.

Community Pharmacies

Oliver Colvile Excerpts

Monday 15th April 2013 Commons Chamber

[Stephen Pound (Ealing and North) (Lab)]

: I am extremely grateful, Mr Speaker, for your generosity and for the way in which you slowed down through the gears. It is greatly appreciated. I am strangely gratified to see such a well attended House tonight, and delighted on behalf of both myself and the Minister that all our colleagues will be staying here rather than miss a word of this Adjournment debate.

There are many reasons why a humble, insignificant Back Bencher should raise an item on the Adjournment. One can seek the ventilation of an issue; one can seek the investigation of an issue. One can seek adumbration or agitation, and possibly even instigation. In my case, it is with some trepidation that I approach a subject that is originally to do with celebration, but that then moves into the dark world of prognostication and, in the case of the Minister, implication.

There has been a quiet but dramatic and extraordinary revolution in the world of the community pharmacist. The traditional model of the dispensing chemist is as outdated as the mediaeval apothecary. I urge all right hon. and hon. Members to visit the new world of the community pharmacist, which will exist in their constituencies as surely as it does in mine.

It would be invidious to mention individuals in the context of the miracle that is occurring in north-west London, but if I were so tempted, the names of Nilesh Morjaria of the Church pharmacy, of Mahendra Gokani of Mandeville road and of C.K. Nathwani of the Ravenor pharmacy would feature strongly, as would Usha and Dilip Shah of the Alpha pharmacy in Northolt. It was at a visit to that estimable emporium, kindly facilitated by the Royal Pharmaceutical Society in the person of the passionate Charles Willis, once an ornament of this House, that the full range of services now available from what we once called our “local chemist” became apparent.

The Minister will be well aware that the core role of the pharmacist—the dispensing of medicines—has grown from 556 million medicines in 2002 to 885 million medicines in 2011, an increase of 56%. I will return to the current figures. The patient or the customer will find the community pharmacist offering services such as home delivery of medicines and medicines use reviews, which ensure that patients gain optimal use from prescribed medicines—2.4 million people took advantage of such a review in the last year and the outcomes were staggering. Forty per cent. of asthma sufferers showed better asthma management and 55% of patients with chronic obstructive pulmonary disease demonstrated a reduction in symptoms following a medicines use review.

The consequential reduction in emergency visits to accident and emergency departments will bring a warm glow to the Minister’s heart and to the hearts of his Treasury colleagues, as will the new medicine service, which advises patients on the therapeutic use of newly prescribed medicines. Evidence already exists that shows that 31% of those who make use of this new medicines service adhere more fully to prescribed medicines, minimising waste and increasing their effectiveness.

Smoking cessation is one of the supreme achievements of the community pharmacists in my part of the world, and Usha and Dilip Shah have not only improved quality of life by their efforts, but actually saved lives, as theirs is one of the most successful smoking cessation services offered. As one who had his last gasper in February 2006, I can speak of the effectiveness of this service from a position of breathless authority.

There are more than 20 different services cited by the health and social care information centre, including the monitoring of anti-coagulant medicines, minor ailment schemes and supplementary prescribing services, but countless additional services are available, from flu vaccine provision to travel clinics. In the case of C.K. Nathwani, the Ravenor pharmacist, a mobility clinic supplies wheelchairs and dispenses walking frames and commodes, all in a friendly and familiar environment close to the patients’ homes and with no queuing up.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

I recognise that the hon. Gentleman is saying that pharmacists do an incredibly good job, and I agree, but does he agree that we should seek to decriminalise any dispensing errors that pharmacists might make? They can go to prison for such errors, but GPs are merely struck off.

[Stephen Pound]

Not for the first time, the hon. Gentleman raises an extraordinarily interesting point. I will discuss later the issue of the level playing field for pharmacists. Far be it from me to suggest that he might wish to seek his own Adjournment debate on that subject as it is one of great significance, but I do not disagree with the points that he makes. I look to the Minister for a similar statement.

The Minister will conclude that I have certainly ventilated the approbation and celebration I referred to earlier, but all is not well—all is not sweetness and light in the well-lit and warm world of the community pharmacy. I hope that the Minister and I can agree that the community pharmacist is the third pillar of the NHS and, just as general practice and hospital care defined the early days of the NHS and were labelled as the two great pillars on which the new creation stood, the changing role of the community pharmacist can come to define a third pillar.

The cruel tyranny of time prevents me from fully detailing this proposition, but I refer the Minister and the House to the excellent 2013 UCL school of pharmacy lecture “From making medicines to optimising health”, given by the chief executive of the Pharmaceutical Services Negotiating Committee, Sue Sharpe. Dr Sharpe identifies the intentions of the 2008 White Paper “Pharmacy in England”, while rightly deducing that even in the short time since then the nature of the community pharmacist has changed over and over again. She should also be credited with allowing me to remind the House of the marvellous quote from Auden to which she refers in her lecture:

“Health is the state about which medicine has nothing to say”.

At one level, the picture is one of rosy growth and rude good health. Diversification in over the counter sales has increased the profitability of the pharmacist, and a new form of health care and preventive medicine has emerged almost without notice and certainly without fanfare. The NHS is so effusively documented at every level that I am sure I could find the evidence of my birth in the first week of the NHS in Hammersmith in July 1948, when I was one of the first of what Aneurin Bevan identified as “bundles for Britain’s future”—I like to think that he looked down on me swinging in my white-painted metal bassinet in Queen Charlotte’s hospital and identified me as a class warrior of the future, although I would sadly disappoint him in that area. The fact that I am still alive, however, is a credit to the NHS. In such a system, it is extraordinary that there is a real paucity of documentation relating to the range of services and extent of outcomes of community pharmacy. Hopefully, this will not remain uncorrected, but I freely admit to my concerns about the place of the community pharmacist in the new NHS structures. I very much hope that the Minister will allow me to share these concerns with him tonight, and also allow me to look in gentle supplication to him for some positive suggestions.

The Minister is all too well aware that the Health and Social Care Act 2012 empowers clinical commissioning groups, led by GPs, and health and wellbeing boards to play the key role in shaping local health care services. I contend that commissioning public services on a localised basis may lead to variations in availability, quality and outcomes. I realise that we have discussed this at length, and I do not want to rehash the arguments that wracked the House during the passage of the Health and Social Care Act 2012, but one way in which this apparent deficit could be addressed is through pharmacy representation. There is currently no pharmacy representation on health and wellbeing boards. Such representation could be a catalyst for constructive change in primary care. Even the pharmaceutical needs assessments drawn up by the health and wellbeing boards may lack any input from pharmacists.

The sheer complexity of the arrangements under which the new commissioning arrangements operate can be a barrier to the provision of services. I am indebted to Benjamin Wheatley of Boots for confirmation that individual contracts now require pharmacy contractors to invoice either local authorities or clinical commissioning groups via the NHS shared business services. I have to say that my head aches when I try to contemplate the mechanism whereby one invoices through all these various groups and all the choices concerned. I am all in favour of choice, but sometimes it is ridiculous. In cases such as this, we are actually preventing good people from doing good work. The effect of this additional work load can be catastrophic.

I do not often praise, without reservation, coalition Ministers, with the obvious exception of the hon. Gentleman who adorns the Dispatch Box this evening, but I pray in evidence the words of the noble Lord the Earl Howe, speaking at the pharmacy business awards dinner in 2011—what a night that was—when he said:

“The Government sees pharmacy as integral to every aspect of our plans to modernise the NHS.”

He went on to say:

“there is still some way to go before our reforms are in place. This transition period is an opportunity for pharmacy to make its presence felt.”

I profoundly hope that the transition period does not follow distant historical, if not to say Trotskyist, precedent and aspire to a state of permanent revolution. I sincerely hope that the Government can allow the community pharmacists to do what they do best.

At the present time the playing field is not level, but opportunities there are aplenty. One of the five domains in the NHS outcomes framework—I have to say, Mr Speaker, that the Minister is a good and decent and honourable man, and I have had the pleasure of his company and his acquaintance for many years. I cannot believe that he would ever talk about the “five domains of the NHS outcomes framework.” There are those around us who do and it is to them that we must give credit tonight, but let them come out with this peculiar, strangulated syntax. I hope that the Minister will reply in honest, Norfolk talk.

The NHS outcomes framework refers directly to the quality of life for people with long-term conditions, and this is an excellent opportunity for the community pharmacy, in addition to other qualified health care practitioners, to deliver a key aspect of the Government’s new health care system in England. The pharmacist, as is so obvious when one comes to think of it, may often be the first person to spot a development in a patient’s condition. An early identification can be therapeutically priceless. It is often the community pharmacist who notes that someone has not come in for their medication or, when they are delivering to their home, that the person does not open the door, is looking more tired and pale, or occasionally has something more dramatic such as a nosebleed. This early identification is absolutely priceless, and this is where the role of the community pharmacist has changed beyond almost all recognition. I am seriously worried that such best practice, as recommended by Earl Howe, is threatened by the impact of changing priorities as commissioners change.

The funding passed to CCGs and local authorities is already being used to commission services from community pharmacies, so that for every new service there is a very real possibility that an existing one will be ended. Local authorities will, quite rightly, look to address their own priorities. I referred earlier to the additional pharmacy-led services in England and the huge growth in recent years, but 2012 actually saw a decrease of 5%. It is reasonable to assume that the transition period between commissioners in 2013 and 2014 will see that decline continue. It must be recorded that any diversion from existing services will have an immediate effect on patients. If there is one thing we can all agree on, it is how the community pharmacist has earned the trust of patients and the patient community. It has been so remarkable and beneficial that it cannot be threatened. If there is one thing that patients in long-term care plans in particular are terrified of, it is a change in the structure that could affect their medication and the ability of a community pharmacist to provide for their needs.

The General Pharmaceutical Council is the regulator of pharmacists, and as such pharmacists are not required to register with Monitor or even the Care Quality Commission. This lack of a registration number actually inhibits many pharmacists from applying to provide services under the “any qualified provider” scheme. I do not know why, but they cannot register. I have tried myself to operate the system for registering online. If someone wishes to provide a service, they have to give their registration number, and if they are not entitled to be allocated a number, the whole process stops. I hope that this small but significant and far-reaching improvement is one that, yet again, can be laid at the Minister’s feet, with the gratitude of the people, and that we can be delighted by another Lamb amendment.

Allied with the codification of a requirement for community pharmacist representation within NHS England and the resuscitation of the roles previously identified in SHAs and PCTs, a new model of integrated health care could relieve pressure on general practice, provide local and accessible services, manage long-term conditions and deliver healthy living advice. In my part of the world, we have a huge number of singlehanded GP practices. They are typically elderly men—occasionally women, but usually men—operating in terraced houses. It is most unlikely that they can be sacked—I am not altogether sure they should be sacked—but they need a complementary service, because the singlehanded GP model is simply not appropriate to the dizzying variety of illnesses and conditions that apply particularly in the urban environment at this the beginning of the 21st century. I would like to see a synergy between community pharmacists and general practitioners working together to the benefit of all patients.

Above all, pharmacies can work with the new health bodies, GPs and other health care professions to support a modernised, caring health care system that delivers high standards of patient care. The Minister blanched earlier when I referred to him as a good and decent man. I meant that sincerely. I think that everyone in the House holds the Minister in the same esteem. He is a good and decent man, and I hope that he will consider some, if not all, of the points I have raised tonight and agree with me that a fair following wind from the Government would be greeted with delight and relief by our greatly valued community pharmacists and would go a long way towards ensuring a happy, hale and hearty nation and safeguarding our future.

I have received three messages from parliamentary colleagues inquiring whether this debate is a tribute to that distinguished former chemist, the late Baroness Thatcher. She achieved a great deal in the world of chemistry, and certainly as a woman she was an extraordinary achiever, but community pharmacists perform great miracles every day. Let us hope that the Minister is as convinced of their good will and good work as I am and that tonight he will put his shoulder to that wheel and advance the cause of integrated health care and the role of the community pharmacist.

Dementia

Oliver Colvile Excerpts

Thursday 10th January 2013 Commons Chamber

[Sir Tony Baldry]

I do. I have been trying to encourage organisations such as St John Ambulance to think about providing training for carers. Some people find that, overnight, their wife or husband has a stroke or serious fall and they find themselves as the carer, and others must deal with a gradually deteriorating situation such as dementia. Such experiences are frightening and the people involved often have to grapple with bureaucracy, the health service and so on. I am sure that if it were possible for local training to be provided for carers, a lot of these people would feel much more empowered and much more competent. The question is finding the organisations that can deliver such training.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

Does my hon. Friend agree that one key thing that also must happen is ensuring that Departments also demonstrate a lead on tackling dementia? The hon. Member for Plymouth, Moor View (Alison Seabeck) and I have been very impressed by what HMS Drake has been doing; the people there have been instrumental in Plymouth in fighting for more dementia awareness, including among Departments.

[Sir Tony Baldry]

That was an extremely good point, and it was one made by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) in opening this debate; every Department has a part to play in tackling dementia. Nobody would immediately have thought of the Ministry of Defence as having a role to play in tackling dementia, but every Department, as part of collective, joined-up government, needs to consider what it is doing on dementia.

The last point I wish to make relates to research, attitudes and so on. One of the most depressing things about dementia is going into residential care homes and seeing people sitting doing nothing, staring at the wall. That is desperate. I have little fear of death—death at the worst can be eternal darkness—but I have a total fear of getting dementia. It must be a sort of living death for as long as one has it.

A number of organisations are coming forward with ideas of how to improve, if not people’s memory, how they can cope with dementia. An organisation with a strong following in Oxfordshire is the Contented Dementia Trust. Some of its work is supported by the Royal College of Nursing, and Oliver James’s book, “Contented Dementia”, is one of the best-selling books on dementia in the UK. The Contented Dementia Trust has a particular way of helping people with their memory, because from a carers’ perspective dementia, once diagnosed, is best understood as a person’s failure to store coherently the facts of what has just happened in their life—although associated feelings are stored—whereas facts stored long before the onset of dementia remain relatively intact and potentially useful. That is why when one goes to see people with dementia they can tell in graphic detail what they did during the second world war or their childhood, but they cannot say what they had for lunch. The Contented Dementia Trust has worked out a method that, it believes, helps people with that.

I hope that somewhere in the Department an evaluation of the various systems has been undertaken with an open mind, to consider what works. Clearly, what is required is consideration of how to stimulate people with dementia so they do not become part of the living dead. As my hon. Friend the Member for Chatham and Aylesford said, we want to ensure that those with dementia can live with dignity and can live lives of the best quality. That does not mean being stuck in a chair in a communal lounge all day between meals, perhaps getting some stimulation or perhaps not getting any. They require stimulation, help with their memory and the sorts of activities that the right hon. Member for Salford and Eccles identified as taking place in various day centres in Salford.

We all need to share and develop the practices that work best, to ensure that people do not get proprietary about there being one correct way of dealing with dementia. We must all recognise the limits of our knowledge. One of the desperate things about dementia is that those who suffer from it cannot tell us what is happening in their lives, as if they have moved on to another planet and cannot come back and tell us what is happening to them. It is a one-way journey and they cannot help us—we can only sense whether they are happier or more contented. I hope that Ministers and officials will consider the work of organisations such as the Contented Dementia Trust with an open mind.

The debate highlights for us all the sheer scale of the challenge over the next 20 to 50 years. It must continue to be a national priority if we are to get the compassion and care that every one of our constituents and loved ones deserves.

--- Later in debate ---

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) hit the nail on the head when she made the point that everyone knows somebody who has been affected by dementia or some form of Alzheimer’s. I have a stepmother who is very elderly now—she is 93 and is in a home. The last time I went to see her, she was woken up and she looked at me, squawked and went straight back to sleep again. That is very sad—it is incredibly sad—for one simple reason. This was a woman who got a degree at Oxford in 1938, at a time when women did not get degrees. She then became an interpreter at Bletchley Park during the war and played a significant part in defending our country from Nazi oppression. For her to be in that position now is very worrying and concerning for all of us. I very much hope that she continues to have an acceptable life, and I am delighted that everyone there is most certainly going to be helpful.

I pay tribute to the hon. Members for Bridgend (Mrs Moon) and for Oldham East and Saddleworth (Debbie Abrahams), who must have found it very difficult to talk about their personal lives and experiences. I commend them both for being able to do so in this environment and for getting through it. May I also say what an honour it is to share a platform in this debate with the hon. Member for Plymouth, Moor View (Alison Seabeck)? I suspect that, between us, we will find ourselves repeating each other somewhat, although I am in the fortunate position of going first.

The issue of social care is becoming increasingly important. There has been an enormous amount of press attention on how people are cared for in the latter years of their lives. However harrowing the stories may be, they provide us with an opportunity to speak about social care and lessen the stigma that surrounds death and dying. Dementia is already a significant issue and a growing concern that should not be ignored.

I am delighted to say that I represent a constituency in a part of a city that has a really good reputation on dementia, especially through the university. An enormous amount of research is done; indeed, I am for ever getting telephone calls from Ian Sheriff—for whom I have an enormous amount of time—who rings me up and gives me advice on how we should handle this issue. However, I was surprised to find out that there are currently more clinical trials into hay fever than into some common forms of dementia. So I heard that our mutual friend the Health Secretary had announced that spending on dementia research would receive a £22 million cash injection I was incredibly grateful. More funding will most certainly need to be made available to excellent bodies around the country such as the Alzheimer’s Society and to universities such as Plymouth.

Plymouth university conducts a great deal of research into dementia and this policy area. In September the university held a very good conference, which it asked the Prime Minister to attend. Unfortunately he could not come, but we will see whether we can have another go later. Any help that the Minister, my hon. Friend the Member for North Norfolk (Norman Lamb), can give to encourage the Prime Minister to come and participate in the dementia conference would be helpful. Indeed, his lead in the dementia challenge has given the whole thing an impetus. The university also does a lot of work on community engagement and raising awareness. Indeed, shortly after Christmas I went to Stoke Damerel community college, which has done a lot of work on encouraging youngsters to become more involved in community engagement with dementia. May I also pay tribute again to HMS Drake, which is taking a big lead on dementia and ensuring that this happens elsewhere in the Ministry of Defence?

In Plymouth there are around 3,200 individuals with dementia. That figure is forecast to rise by 35% in the next 10 years, but this is just the beginning. The diagnosis rate is 39%, which it is estimated will increase by 27% before 2021. That means that a large number of people in my constituency do not have access to the care and support they need on a daily basis. The new NHS mandate commits to drive up diagnosis, which can only be a good thing for both sufferers and their families. I know that the Government want the clinical commissioning groups and the NHS Commissioning Board to work together on that aim, and I would welcome more information from my hon. Friend the Minister on what plans are in place to ensure that that happens, so that the lives of sufferers and their carers can improve.

GPs are on the front line when it comes to driving up diagnosis rates. They express their concern about mistaking the symptoms of dementia for old age. In some cases, they do not make a diagnosis of dementia because they feel that to do so is futile. I am aware that the Department of Health has put the case for a reward through proactive case finding, which is due to be consulted on this year. Is there a timetable for that consultation to begin? The sooner we start to diagnose those in need, the sooner we can start to help them.

Earlier this week, I participated in a debate on the Liverpool care pathway. We had an interesting discussion, and real concerns were raised. I told a story about a constituent who came to see me about her father. It had been decided to put him on the Liverpool care pathway, but the family were concerned because they knew nothing about that until they were told about it by one of the car park attendants at the hospital. The process was supposed to last for two days, but it went on for 12 days, and the family were very concerned about that. Will my hon. Friend the Minister have another look at that issue, just to make sure that such cases have been included in the review of the LCP?

A number of excellent facilities exist around the country, especially in Plymouth, and I want to pay tribute to St Luke’s hospice, and to the hospice movement in general, for doing a tremendous job. They are certainly appropriate places for people to spend the last few days of their lives. Given that the report on Stafford hospital is to be released shortly, however, it is clear that dementia sufferers often do not have the dignified death that we would expect for them. I am aware that we are all mortal, although I have wondered whether God might make an exception in my case, and whether I might be here for ever and a day. I know that that is not going to happen, however.

It is important to ensure that, when dementia sufferers die, they are able to do so with dignity and without pain. The more work that we can do to ensure that that happens, the better. Vulnerable people need to be properly looked after, as do their carers. We need to ensure that we talk to the relatives as well, to ensure that they understand the processes involved. None of us—politicians or anyone else—likes to be ambushed, and it is important to help those family members to work their way through their suffering as well.

[Neil Parish (Tiverton and Honiton) (Con)]

My hon. Friend is making some good points. Those who care for dementia sufferers need respite care, but we do not always provide for that as well as we should. I am keen to see more respite care being provided for those who care for people with dementia.

[Oliver Colvile]

I agree with my hon. Friend. This is also about the families, who have to deal with dementia on a daily basis.

Given the appalling events at Stafford hospital, appropriate checks and balances must be put in place to ensure that people with dementia are given the proper quality of care in all hospitals. Further, it should become standard practice that the demands of someone with dementia should be listened to. It is incredibly important that we get better at listening to what they, and their families, are saying. Dementia is a complex illness, and it is often difficult to assess its onset. Whenever possible, however, conversations should be held with the individual and their loved ones about what is happening and the process that is involved. Such conversations would be useful in helping the family through the process.

Dementia is now one of the top five causes of death in the United Kingdom, and it is disappointing that the health and wellbeing boards are being a little slow to consider people’s needs. About 800,000 people in the UK have dementia, and that number is going to go up. It is said that more pressure is being put on the national health service. I do not think that is right. I think that we are making enormous strides in order to deliver better health care for our elderly. It is because we want to do more that our national health service is facing increasing levels of challenge.

For those with dementia, the changes to long-term care are crucial. I am delighted that the Government are looking at trying to take forward the Dilnot report, to which I made my own submission—I have a copy here or I could e-mail it to the Minister. That report must be viewed as a blueprint for how to go forward.

There has been increasing debate with the Treasury since the 1940s. Let me remind everyone of what happened in 1947 when the national health service, of which we are all very supportive and proud, was first set up. The other half of the equation was long-term social care. Over the last 10 or 15 years since I was a candidate for Plymouth, Sutton as it then was—it is now Plymouth, Sutton and Devonport—I have spoken about the divorce of social care from the national health service. If I have a heart attack or have cancer, I will have to deal with it one way, but if I have Alzheimer’s, Parkinson’s or dementia, it will be considered to some extent as being a separate challenge. I believe that we need to bring the two much closer together.

I have some concerns about using insurance. Every time I have had to make claims—on my car insurance, for example—I have always had some difficulty with my provider. We need to look at that, but we need to ensure that people do not see all their savings just disappearing into a black hole. That is something that we need to deal with as a country. There is a danger that the amount of money individuals are asked to pay for their care will remain far too high. We cannot hide from that in our ageing society.

At the beginning of my time in the House, I wrote a paper on the strategic defence and security review, in which I said that there were two important matters of which we needed to take notice. The first was that more money needed to be put into defence—I continue to say that—but the second was that we should devote more money to long-term care for the elderly. That was my No. 2 priority; it has to be incredibly important.

I welcome the Government’s decision to take on the global health challenge—a priority after years of neglecting this growing problem. I welcome the Prime Minister’s commitment and the leadership and extra support he has provided for people with dementia in carrying out their everyday tasks. That shows a shift in the wish to combat the stigma that surrounds dementia and to achieve greater awareness of the illness. We need to learn, too, from the ethnic minority communities that tend to work much more closely together with their families in providing care.

[Mr Robin Walker (Worcester) (Con)]

My hon. Friend is making an excellent speech. I want to support his point about the Prime Minister and the issue of stigma with a quote from Professor Dawn Brooker, who helped found the Association for Dementia Studies at the university of Worcester. She said:

“Stigma and fear are the biggest enemies of achieving”

progress on dementia. She continued:

“What makes the PM Challenge so important is that it says very clearly that he is not ashamed or fearful of standing up and talking about dementia. If he can do this then it makes it safe for every politician and leader to do the same.”

I believe Members of all parties have shown the same courage in taking this issue forward today.

[Oliver Colvile]

My hon. Friend is absolutely right, and the same issue applies to mental health, about which I have also spoken at some length in this place. We need to break down these taboos and move on.

I very much hope I have not taken all the thunder of the hon. Member for Plymouth, Moor View. There must be joint responsibility between Government health boards and staff in the health service to ensure that the diagnosis of dementia and the quality of care improve significantly. In way, we can show that we are on track for the future.

Liverpool Care Pathway

Oliver Colvile Excerpts

Tuesday 8th January 2013 Westminster Hall

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

Thank you very much indeed, Mr Weir, for calling me to speak. It is a pleasure to serve under you.

I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) on securing this important debate. I suspect that I am not particularly well qualified to speak about the Liverpool care pathway, but neither are an awful lot of my constituents. Therefore, it is very important that what we talk about today is how we can look after their interests, and the interests of others, in this regard.

I am very aware of what kind of death I want to end up having. Some six years ago, my father died while driving his car. He came out of his office, at the age of 89, to go and have lunch with the Archdeacon of Canterbury. My father had a massive heart attack, pulled over to the side of the road—thank goodness he did not take anyone with him—and duly died. It was just yards away from the church and I know very well that God decided, probably in his infinite wisdom, that the one thing that he was not going to do was allow my father, a former naval commander, to give the archdeacon a difficult time. However, I am very aware that—frankly—an awful lot of us do not have that kind of option about how we end up dying, if we have an option at all. Many people find themselves having to go into hospital, and dying there.

Many of us have a great deal of notice about dying. So, in the next few minutes, I want to talk about an individual constituency case that I had—an appalling story about the death of the father of one of my constituents in the Derriford hospital in Plymouth. In doing so, I want to ensure that the public are aware of the controversial approach to ending life and that we have a discussion about it.

My constituent’s father went to Derriford hospital from Mount Gould hospital, which is also in Plymouth, in April 2011 because he had become bedridden. He was put on the Liverpool care pathway without any food and water. That was supposed to last for up to two days, but he lived for 12 more days, finally dying on 8 May 2011. My constituent claims that during the time that her father was on the LCP, he perked up and was even watching television. Despite that, he remained on the LCP.

My constituent’s family feel, and I rather agree with them, that giving someone 12 days to die is not what this system should be about. Although Derriford hospital claims that staff spoke to the family on the ward, my constituent and her siblings dispute that. They claim that they did not know that their father was on the LCP until the car park attendant told them.

To give Derriford hospital its due, the chief executive—who is new to the job and was not at the hospital when this case happened—has dealt with the case subsequently, recognising that the clinical teams may not have explained fully to my constituent’s family what was going to happen and what was actually involved in the LCP. The family feel that they were forced to watch their father die under very distressing circumstances. Despite having his food, water and medication withdrawn, the family were horrified to see him biting the sponge that was being used to wipe his lips, because he was so hungry and thirsty.

Unfortunately, my constituent has also had a subsequent —and completely different—experience of the LCP when her brother-in-law died at a hospice. It must be remembered that hospice staff are specialists in helping patients at the end of their lives, and the more that we can encourage people who are suffering in that situation to be dealt with by hospices, the better. Certainly a lot of hospitals are very busy indeed and their staff do not necessarily have the time to carry out the kind of checking that we feel they should do.

I am very aware that the death of a close relative is a traumatic time. One should remember that patients’ relatives do not always take in the full story that they are being told and that they can become confused about what they are being told. However, we must ensure that a system is in place that avoids those kind of complications.

I am very aware that the Government are taking this whole matter very seriously and I am grateful to them for that. I thank my hon. Friend the Minister and his colleagues for the review, about which he wrote to me just today, and their proposal to produce a new pledge on care planning. To help my constituent, and many other people like her, we need to ensure that we have a timetable for that.

I pay tribute to bereavement charities, such as Cruse Bereavement Care. They do an enormously good job in helping families through the whole grieving process. I ask for more training, and for more information for families so that they can be assured that their relatives will get the best care possible. By giving detail to the Government’s proposals, the Minister would be giving certainty to Benjamin Franklin. Members might remember that he wrote, in a letter to Jean-Baptiste Le Roy in 1789, that the only things we can be certain of are birth, death and taxes.

Regional Pay (NHS)

Oliver Colvile Excerpts

Wednesday 7th November 2012 Westminster Hall

[Mr Bradshaw]

Yes, I absolutely agree: the whole thing has been handled extremely badly by the trusts involved.

If the proposals go through, the trusts involved are likely to see an exodus of staff, not only to other regions, but, as the hon. Member for Torbay (Mr Sanders) suggested, to trusts in the south-west that are not part of the cartel.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

The right hon. Gentleman is making a powerful case, but I am curious about one thing. There is a limited amount of money that can be spent in the national health service—the Government decided to increase it, although I seem to remember that the previous Labour Government were considering cutting it—so the choice is simple: we either go for a variation on regional pay or we make people redundant, and I am not convinced that that argument has been thought through. Would the right hon. Gentleman therefore be willing to join me in trying to convince the Government to do something about the tariff that is paid to hospitals in the south-west? We are short of money, and we need to find a way to improve that situation.