§ Mr. Deputy Speaker (Sir Alan Haselhurst)
We now come to the debate on community pharmacies. I should inform the House that Mr. Speaker has selected the amendment in the name of the Prime Minister.
§ Mr. Tim Yeo (South Suffolk)
I beg to move,That this House believes community pharmacies play a vital role in providing for local healthcare needs, with highly qualified pharmacists able to advise on general and over-the-counter medicines and to dispense and to advise on prescription-only medicines; notes that community pharmacies are truly local, with nine out of ten people considering it easy to get to a community pharmacy; and is concerned about any change which might lead to a reduction in the excellent services or accessibility currently provided by community pharmacies.I hoped that the Secretary of State for Trade and Industry would be in her place. Is she on her way here?
§ Mr. Deputy Speaker
Order. I had none, and I got none. I believe that the hon. Gentleman intended to refer to the right hon. Lady.
§ Mr. Yeo
I apologise, Mr. Deputy Speaker. I offer the Secretary of State my commiserations because her hopes of promotion were not fulfilled. It must be galling not to be considering pharmacies from the point of view of the newly appointed Secretary of State for Health—doubly so when one has been passed over in favour of a Scottish Member of Parliament who has no influence on health matters in Scotland, but whose talents, in the Prime Minister's eyes, are superior to those of every single English colleague.
The debate has two purposes. First, it gives hon. Members the chance to express their support for community pharmacies and warn against unnecessary or harmful changes to the current structure. Secondly, it enables hon. Members of all parties to show whether early-day motions have any meaning. The motion's wording is the same as that of early-day motion 815. The Opposition are doing the House a service by giving up half their day to allow hon. Members to debate a motion that, I suspect, the Government would prefer us not to consider or vote on.
By last night, early-day motion 815 had attracted approximately 200 signatures, of which 64 were those of Labour Members of Parliament. I hope that every hon. Member who signed it will vote in favour of the motion at the end of the debate. Last Wednesday, a worrying precedent was set when hon. Members debated early-day motion 572 on post offices and cash payments of benefit to recipients. More than 350 hon. Members from all parties supported the early-day motion. When the Division was called at the end of the debate, however, 128 Labour Members who had signed the early-day 288 motion voted against the motion. I am sure that my hon. Friends will agree that the stench of hypocrisy is overwhelming. Those 128 Labour Members had told their constituents that they supported the early-day motion, and had expressed their concern at the plight of post offices in their constituencies and at the difficulties that elderly and vulnerable benefit claimants will face in receiving cash.
§ Mr. Anthony Steen (Totnes)
Does not this show either that early-day motions are a total waste of time—which they probably are—or that Labour Members will just sign anything, and vote in any way, rather than in support of the views that they have expressed on the Order Paper?
§ Mr. Yeo
It certainly shows that early-day motions might be a total waste of time, so far as Labour Members are concerned. I believe, however, that every single Conservative Member who signed that early-day motion also voted in favour of it in the Division last Wednesday, just as every Member who has signed early-day motion 815 will vote with us in the Lobby tonight.
§ Mr. Keith Simpson (Mid-Norfolk)
A possible explanation for what happened last week that my hon. Friend might not have thought of is that last week's debate took place just before the reshuffle. [Horn. MEMBERS: "Ah!"] If we were to be generous to Labour Members, we might say that many of them were driven by the hope that their talents might be recognised by the Prime Minister. Now that the reshuffle is over and those hopes—including those of the Secretary of State—have been brutally dashed, perhaps they will feel that their shackles have been removed. Perhaps they will now be willing to vote with the Opposition on this issue.
§ Mr. Yeo
My hon. Friend advances an ingenious explanation for the absence of so many Labour MPs from the Division Lobby in support of early-day motion 572. When I tell him that they included the hon. Members for Hackney, North and Stoke Newington (Ms Abbott), for West Ham (Mr. Banks), and for Liverpool, Walton (Mr. Kilfoyle), the Father of the House—
§ Mr. Deputy Speaker
Order. I think that I ought to persuade the hon. Gentleman to deal with the motion before the House, rather than concentrating too much on last week's motion.
§ Mr. Yeo
I am grateful for your guidance, Mr. Deputy Speaker. I think that my hon. Friend the Member for Mid-Norfolk (Mr. Simpson) will now have drawn his own conclusion as to the improbability of hope in certain breasts being the determining factor in the way in which those hon. Members cast their votes.
My concern is that the value of early-day motions is being undermined, that the integrity of Parliament has been threatened, and that some hon. Members are attempting to deceive their electorate. Tonight, however, we have a chance to put that right. Tonight's motion has the very same wording as early-day motion 815, which has the support of 64 Labour Back Benchers. 289 There are, therefore, 64 Labour Members who have the chance at least partially to restore the integrity of the Order Paper and the system of early-day motions.
§ Dr. Julian Lewis (New Forest, East)
Does my hon. Friend agree that the probable reason that so many Labour MPs have signed this early-day motion is that, like me, they have had upwards of 1,000 people either writing to them individually or signing petitions expressing their grave concern about the threat to community pharmacies? The 1,000 people in my constituency came from Hythe, Brockenhurst and Totton—just three locations—and there could have been many more, had similar petitions been organised elsewhere.
§ Mr. Yeo
My hon. Friend's constituents are fortunate indeed in their parliamentary representative. He takes up their cause and champions it through his eloquence on the Floor of the House; he will also vote in favour of the motion tonight. We shall see, in the course of the next two hours and 10 minutes, whether the 64 Labour Members are willing to follow his fine example. I hope that they do, because, if they do, they might start to restore the integrity of the early-day motion process. If they fail to do so, the message will go out loud and clear that the signature of a Labour Member of Parliament on an early-day motion is not worth the paper that it is printed on.
§ Andy Burnham (Leigh)
Will the hon. Gentleman tell us precisely when the Conservative party ditched the philosophy that free, unregulated markets had all the answers?
§ Mr. Yeo
I shall come to the substance of the argument in a moment, and I shall deal with the hon. Gentleman's point with relish. It exposes the fact that, like the authors of the Office of Fair Trading report, he does not understand the difference between community pharmacies and the rest of the retail sector.
§ Mr. James Gray (North Wiltshire)
There is a case in point in the Chamber today. The hon. Member for Stroud (Mr. Drew) was one of those who signed the early-day motion on post offices but then voted against last week's motion. I do not know whether he signed early-day motion 815 on pharmacies, but if he did I hope that he will vote with the Opposition this evening.
§ Mr. Yeo
My hon. Friend makes a telling point. I hope that the hon. Gentleman will make his position clear presently. I have a list of the 64 Members who signed the early-day motion, and I will welcome any interventions that they may choose to make.
We called this debate because the Government are about to publish their response to the OFT's report on pharmacy services. I hope that the Secretary of State will tell us what they think of the report. There is a contrast between the swift and decisive response in Scotland and Wales, where the OFT's recommendations have already been rejected, and the uncertainty caused by the lack of any decision by the Government here in London—uncertainty that is damaging to some community 290 pharmacists. It is also puzzling, in view of the large number of Members—again, in all parts of the House—who want the present structure to be broadly preserved, if the views that they have expressed by signing early-day motions can be relied on.
The key recommendation in the OFT report is that the control of entry regulations for community pharmacies should be ended. The Conservative party believes that accepting that recommendation would damage the existing network of community pharmacies, and would harm the interests of the communities that they serve. We question the need for changes in the present structure, and we are doubtful about the benefits that the advocates of change claim would result from ending the regulations.
The central flaw in the report, and the flaw in what was said by the hon. Member for Leigh (Andy Burnham), is the failure to recognise clearly enough that community pharmacies are not just another part of the retail sector. They cannot be treated in the same way as retailers of food and other consumer products. Community pharmacists are qualified professionals with a specialised and important role to play in the delivery of primary health care.
§ Mr. Peter Ainsworth (East Surrey)
Would my hon. Friend care to point out to the hon. Member for Leigh (Andy Burnham), who made that silly intervention, that it was a Conservative Government who established the 1987 regime in the first place?
§ Mr. Yeo
My hon. Friend's knowledge of the history behind the regulations is impressive. I am happy to tell him that I knew that as well.
There is an interesting point here, on which the Secretary of State may be able to shed some light in due course. The restrictions were introduced by the Conservative Government in 1987—or rather, I think, 1986—at the behest of the Treasury, which feared that the lack of any restrictions on entry to the pharmacy world was causing a haemorrhage of expenditure from the national health service budget.
I wonder whether one reason why the Government are taking their time to make up their mind about what they want to do is that on this issue, as on so many others, the Secretary of State is not her own master. Even had she received the promotion to the Department of Health for which she hoped, she would still not be her own master, because we all know that the dictator of domestic policy in this Government is the Chancellor of the Exchequer. He may well fear the financial consequences of this change, and that may well be why there has been silence so far on what the Government's policy is.
§ Mr. Humfrey Malins (Woking)
In both the rural and the urban parts of my constituency, there is widespread concern among small independent pharmacists about the prospect of being knocked out of business by the giant supermarkets. Does my hon. Friend agree that the vulnerable will suffer rather than the rich? Will not the poor suffer, and the poorer communities in particular?
§ Mr. Yeo
My hon. Friend has anticipated much of what I was going to say, as I would have expected him to. He is absolutely right. Perhaps the only comfort for those who are running community pharmacies in his constituency, and for the vulnerable constituents who will indeed suffer, is the fact that they are represented by a Member who takes such a close interest in their concerns—and who also supports a party that now places at the centre of its agenda the need to help the vulnerable and ensure that no one is left behind. Of course, in view of the appalling muddle that pervades the whole of Government, that same party will soon be taking the decisions affecting my hon. Friend's constituents.
§ Peter Luff (Mid-Worcestershire)
But will my hon. Friend reinforce the point made by my hon. Friend the Member for Woking (Mr. Malins) in his fine intervention? It is not just a question of remote rural communities; those who live in urban areas may actually be the most threatened. I am thinking of communities such as that served by the fine community pharmacy of Badham's, in Bengeworth. If anything undermined the viability of that pharmacy, a relatively underprivileged community would not have the access to pharmacy services that it deserves.
§ Mr. Yeo
My hon. Friend is right to point out that this issue affects urban areas as much as rural ones. Perhaps he will correct me if I am wrong, but when I had the pleasure of visiting his constituency a couple of years ago, I think that he drew my attention to the merits of the pharmacy that he mentions and its crucial role in the local community.
§ Mr. Yeo
In a moment; if I may, I should first like to make a little progress.
Perhaps it is time to touch on the substance of the OFT report itself, which acknowledges that the current system has a great many merits. Paragraph 1.15 confirms that four out of five people live less than two thirds of a mile away from a community pharmacy. The report in fact uses the phrase less than "500 metres", but my hon. Friends would be happier if I used other terminology. It also confirms that almost one person in two live within one third of a mile of a community pharmacy, so not surprisingly, nine out of 10 people consider it easy to get to a pharmacy from their home. Three out of four family doctors have a community pharmacy within easy walking distance, by which I mean less than a quarter of a mile away from where their practice premises are situated.
The message is clear: consumer satisfaction is high, a fact that my own constituency experience confirms. In two decades as a Member of Parliament—an anniversary that was completed last Monday—I have scarcely received a single complaint about the inaccessibility of community pharmacies. On the contrary: there is tremendous support for them in South Suffolk, as evidenced by the petition raised in support of the Moss pharmacy in Hadleigh, which was signed by 292 hundreds of my constituents. Such support was also evidenced in a letter that I received from Clare parish council, which states thatour local pharmacy provides an invaluable service to our local community not only in providing prescriptions and other medical needs but also in the information and advice given by the pharmacist … if it was no longer viable for it to trade due to losing business to other providers our small town would be hugely affected. Not only would this outlet be a great loss to the elderly and young families especially but this would also have a knock on effect to other shops in the town as the pharmacy currently has many customers not only from Clare but from the several smaller villages surrounding it.
§ Mr. Yeo
In a moment.
A representative of the Clare Business Association wrote to the Department of Health earlier this year, saying:The town has a population of 2,200 but above all it serves a rural area including some small and large Villages …Our Pharmacy is not just an outlet for medicines … the Chemist has like the Doctors become the family friend who they can trust confide in, and above all give a personal service.Shopping at Supermarkets is one thing, exchanging your prescription is another …Think of Families with small children, elderly people, those that don't drive …Stop the Government's proposals to allow unrestricted opening of pharmacies.
§ Gregory Barker
Like many of my colleagues on the Conservative Benches, I have received petitions carrying hundreds of names of constituents who are concerned about pharmacies. In particular, the elderly in Bexhill are very worried about the possible consequent withdrawal of the prescription delivery service. They are particularly vulnerable because they often do not have access to the big out-of-town stores that could replace pharmacies.
§ Mr. Yeo
My hon. Friend makes his point very powerfully. [Interruption.] I note the belated arrival of the Secretary of State for Health—the man whose merits are such that even though he is handicapped by being a Scottish Member of Parliament, he is considered superior to all the other would-be candidates for the post of Secretary of State who were lined up in Cabinet last week.
§ Hywel Williams (Caernarfon)
Returning to the issue of costs, although this Government may have been silent about it, the same cannot be said of Jane Hutt, the Welsh Assembly Minister, who said thatthe removal of these regulations could increase costs to the NHS in Wales resulting from the administration of alternative systems to protect access to pharmaceutical services under the NHS.The Government have been silent, but the Labour party in Wales has given the game away.
§ Mr. Yeo
The hon. Gentleman makes a powerful point. As the debate continues, interest in what the Secretary of State will say in her reply is growing every minute.
293 In my experience, any threat to community pharmacies provokes a positive outburst of support. In the past, concerns have been expressed occasionally—in my constituency and in others—when a family doctor practice seeks permission to become a dispensing practice. If the patients or customers of an existing community pharmacy believe that granting permission will damage their local community pharmacy, they readily say so in robust terms. In respect of today's debate on the Office of Fair Trading report, however, community pharmacies and dispensing practices are on the same side, sharing the same concerns about what might happen.
§ Roger Casale
Hon. Members on both sides of the House, including myself, who have received representations about community pharmacies are making representations to the Secretary of State. However, this is an Opposition day debate, which is usually used to attack Government policy. What we are debating now is not Government policy, but simply a recommendation of the Office of Fair Trading. When is the hon. Member for South Suffolk (Mr. Yeo) going to start debating Government policy on this matter?
§ Mr. Yeo
If the hon. Gentleman does not believe that it is Government policy, there is nothing to stop him voting with us later this evening. The fact remains that we do not know what Government policy on this matter is. We have scheduled the debate in a timely and opportune way to give the Secretary of State the chance to clear up the doubts and resolve the anxieties felt by many community pharmacies around the country.
§ Mrs. Angela Browning (Tiverton and Honiton)
Does my hon. Friend agree that today's Opposition day debate is timely, because the Secretary of State can hear who the stakeholders are and what a sense of community really means in real constituencies? The Labour party espouses the virtues of stakeholders, community, partnership and consultation, so the Secretary of State has an ideal opportunity to hear at first hand from those of us who have presented petitions and made representations exactly what the people want and value.
§ Mr. Yeo
My hon. Friend makes a telling point.
Hansard cannot reflect the balance of attendance in the House, so now is the right moment to draw attention to the fact that, for the time being, the Conservative party has roughly 40 per cent. of the representation that the Government have in the House, but there are four or five times as many Conservative Members as Labour Members attending this debate, which is so important to every constituency represented in Parliament. [Interruption.] Furthermore, every intervention on the Conservative side has been from hon. Members speaking up for the interests of their constituents, but interventions on the Government side—somewhat few and far between—have consisted largely of cheap debating points.
§ Sir Paul Beresford (Mole Valley)
Does my hon. Friend agree that the debate provides an opportunity 294 for the Government to identify some of their blind spots? Rural issues are certainly one of their blind spots. Many villages have pharmacies, post offices, pubs and so forth, but the village pharmacies are being threatened.
§ Mr. Yeo
My hon. Friend is right. I recall visiting his constituency to take part in a conference, which I believe was entitled "Listening to Britain". He may recall that one of the main issues was the anxiety felt by many rural communities about the representation of community pharmacies in their areas. However, it was rightly mentioned earlier that the debate is not about rural communities alone. It certainly goes to the heart of the concerns of many rural communities, but it is equally a matter of concern in many urban areas.
§ Mr. Roger Gale (North Thanet)
The point that my hon. Friend makes has been brought home to me this week, following the receipt of petitions with 2,500 signatures from Payden's and Baxter's and Ferris—not just from Margate in my constituency, but from Garlinge and Birchington, which are urban villages with the community pharmacies right at their core. Is not the Office of Fair Trading report simply about retailing, and nothing whatever to do with the health of people who use the health service?
§ Richard Ottaway (Croydon, South)
Is my hon. Friend aware that the Government White Paper entitled "Pharmacy in the Future" says in the foreword:As one of the primary health professions in the NHS, pharmacy has a vital part to play in delivering the plan. Pharmacists are an integral part of most people's experience of NHS care, whether in the community or in hospitals."?
§ Mr. Yeo
My hon. Friend is right to cite that White Paper, and today's debate will show which side of the House speaks up for the community and recognises all the elements that are necessary for a successful health service.
I could find nothing in the OFT report that suggested that deregulating the sector further would improve access to community pharmacies for that part of the population that uses those pharmacies regularly. Indeed, the fear is that the opposite would be the case. If community pharmacies migrate away from high streets and disappear inside supermarkets, the likelihood is that access will become harder, not easier. As Philip Graham, the owner of two independent community pharmacies in my constituency, in Long Melford and Lavenham, wrote to me in April:The customers who use and need pharmacy services are not those naturally targeted by the grocers, or who are traditional users of those outlets.Four out of five people over the age of 75 take at least one prescription-based medicine. The main users of pharmacy services are the elderly, as well as the infirm and the socially disadvantaged. Those are the very people about whom the Conservative party is 295 concerned. They tend to be the less mobile, and so the convenience that supermarkets do indeed offer many people is not a convenience at all for many pharmacy customers. The flaw in the OFT report is that it considers those people only as consumers, not as patients. A community pharmacy is not a village store or a high-street grocer.
§ Mr. Keith Simpson
My hon. Friend will appreciate that, as the pharmacist in the market town of Reepham in my constituency pointed out, many rural and urban pharmacies are part of a strong support system for our general practices. They are already under enormous strain. If community pharmacies are removed, it will have a knock-on effect on GPs. My constituency already suffers from a grave shortage of GPs thanks to the Government's policies, which the Secretary of State for Scotland—I am sorry, I mean the Secretary of State for Health—will be able to address.
§ Mr. Yeo
My hon. Friend anticipates a point that I intended to make. He is right about the complementary role that community pharmacies play in the delivery of primary health care. In defence of the new Secretary of State for Health, let me say that he is one of the diminishing number of Cabinet Ministers who has only one job to do. He is not a part-timer. Nor is he moonlighting—something of which the hon. Member for Bolsover (Mr. Skinner) often accuses Conservative Members. Let us hope that with the attention that the Secretary of State for Health is able to give the job he will address the shortage of doctors in my hon. Friend's constituency.
Community pharmacies do not compete in the way that supermarkets do—on he basis of price. Indeed, in the case of prescription medicines, which account for the vast bulk of medicines sold in pharmacies, there is no price competition from the point of view of the consumer. What is traditionally the strongest single argument in favour of a more deregulated market—the downward pressure on consumer prices that a deregulated market can exert—simply does not apply to community pharmacies. Even the price of the over-the-counter medicines, which account for about a fifth of the medicines sold by community pharmacies, is likely—in the opinion of the OFT—to fall by only between 1 per cent. and 2 per cent. That is a marginal gain to set against the real disadvantages that Conservative Members have set out.
Surprisingly, the OFT report does not convincingly explain how the present regulations constitute such an insuperable barrier to entry into the market by supermarkets. On the contrary, the report confirms that since 1990—during which time the existing restrictions have been in force—no fewer than 450 new supermarket pharmacies have opened. They now constitute about 4 per cent. of the total network.
One argument that the OFT deploys in favour of more supermarket pharmacies is that they would have longer opening hours. Clearly, there is evidence to support that. Does the Secretary of State for Health want to say something? I should be happy to give way. Does he wish to intervene? No, he has nothing to say. I am glad that he is listening.
There is evidence to support the claim about longer opening hours, but the report presents no evidence that they are a priority for users of community pharmacies. 296 The clear priority for them, especially for the people who are most vulnerable, is that the quality of service currently offered by community pharmacies should be maintained. There is great anxiety about the possible consequences of accepting the OFT recommendation.
The British Medical Association has stated thatwhat little gain it may provide to the consumer in terms of cheaper medicines is insufficient to offset what may be lost. The most vulnerable and the least affluent members of society—the elderly, infirm and housebound—will lose the most if community pharmacies are forced to close.An interesting show of unanimity between the medical profession and part of the private sector backs that up. The Boots company has said:Accessibility to pharmacies would decline as provision moves out of town to supermarkets; and the closure of pharmacies would have a detrimental effect on the viability and vitality of town centres … there is no evidence that this will deliver significant or sustained price reductions across the range ofover-the-countermedicines … The Government strategy for enhancing the role of the pharmacist and relieving pressure on the NHS will be disrupted, due to staff shortages, earnings dilution and market instability.
§ Mr. Yeo
My hon. Friend presents the House with a mouth-watering prospect. Harassing the Government on this issue for a whole year would no doubt mean that the Secretary of State and I would have to joust many times across the Floor of the House. I am extremely attracted by that possibility, but we will have to seek advice from the Government about whether primary legislation would be needed.
§ Mr. Yeo
My hon. Friend assures me that it would.
The truth is that a pharmacy is much more than a retailer of medicines. It is a source of advice for patients about health issues and the use of medicines. Not surprisingly, supermarkets rely more heavily on locum pharmacists. For that reason, the development of a relationship between patient and pharmacist is less likely to be achieved. In those circumstances, service could be less personal: only a third of supermarkets provide home-delivery services.
Caution should be our watchword before we rush in to accept the OFT recommendation, which will mainly benefit younger and more able-bodied people—the very categories for whom the services of a pharmacist are least likely to be needed. The Government amendment refers tothe need for a balanced package of measures".I hope that the Secretary of State will explain what that phrase means.
§ Mr. Yeo
The hon. Gentleman is too late.
297 The Government's close links with the big supermarkets are well known. Their reluctance to defend small post offices is a scandal. Their refusal to support village shops shows contempt for the needs of rural areas. Their refusal to introduce honesty in food labelling hurts British farmers. Their policy on genetically modified crops is concerned more with the demands of multinational companies than with the need to protect the environment.
Every one of those shabby climbdowns bodes ill for the decision that they must take in relation to the OFT report. I hope that, for once, principle rather than expediency will be the basis of the Government's approach. I hope that they will think of local communities before donations to party funds, and that they will at last put patients' interests first.
I commend the motion to the House.
§ The Secretary of State for Trade and Industry (Ms Patricia Hewitt)
I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:agrees that the OFT report on the "Control of Entry Regulations and Retail Pharmacy Services in the UK" provides a useful analysis of the market impact of the current control of entry regulations on consumers and competition and highlights the need for the present regime governing pharmacies to be updated; favours change to open up the market and improve quality and access without diminishing the crucial role that community pharmacies play, especially in poorer areas; and supports the need for a balanced package of measures which plays to the strengths of community pharmacies and enhances the role of pharmacists in the modern NHS.".First, I am delighted to congratulate my right hon. Friend the Secretary of State for Health on his appointment. I know, as do all Labour Members, that he will do an outstanding job. Likewise, I welcome the Minister of State. Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), to her new post.
I welcome, too, the belated recognition from the hon. Member for South Suffolk (Mr. Yeo) that there are limits to markets, especially in health care. That is quite a conversion from the party that gave us the iniquities of the internal market. I welcome the concern expressed by the Opposition for the health of our communities—not something that we heard from the Conservatives when they were devastating our coalfield communities with their onslaught on the mining industry.
§ Mr. Greg Knight (East Yorkshire)
Will the Secretary of State tell the House why she moved an amendment to our motion? Unusually, but not uniquely, the Opposition motion does not attack the Government; it is a statement in support of community pharmacies. Why cannot the Secretary of State accept the motion? What have community pharmacies to fear from her plans?
§ Ms Hewitt
We are improving on the Opposition motion. I have made plain, and will continue to do so, my support and the Government's support for community pharmacies. The amendment reflects the 298 approach that we will take, not merely as we consider the report from the Office of Fair Trading but, more important, as we implement the programme for pharmacies—the modernisation and strengthening of community pharmacies that the Department of Health has put forward.
§ Mr. Mark Todd (South Derbyshire)
My right hon. Friend has indicated that this is an opportunity neither for conservativism or Conservativism, but a chance to work with pharmacists on an agenda for change; for example, by looking into the costs and inefficiencies of patient packs, a subject of great concern to many pharmacists.
§ Ms Hewitt
My hon. Friend is right. In a moment, I shall come to some of the many improvements that can be made to build on the work that community pharmacies are doing already.
In contrast to the rather aggressive attitude adopted by the hon. Member for South Suffolk, I hope that all of us, on both sides of the House, can agree on the vital role that community pharmacies play. We all use them; we all rely on their advice. They help people to lead healthier lives and to live longer. They play a vital role in our communities and are a lifeline, especially for our most elderly, frail and vulnerable citizens, and all of us—without the need to make partisan points—should support them.
§ Brian Cotter (Weston-super-Mare)
I thank the Secretary of State for those words. May I offer an example of the importance of local pharmacies, which confirms that we are all concerned about these serious issues? Last year, Milton pharmacy in my constituency paid out £1,355 on taxi services to supply free delivery of prescriptions to old people and the very ill. I have a copy of the bill. The pharmacy provides an excellent service and I hope that the Secretary of State's awareness of that will help to inform her decisions.
§ Ms Hewitt
I welcome the hon. Gentleman's point and the way in which he made it. That example illustrates exactly the kind of service that should be much more widely offered. Home deliveries, especially for elderly or isolated patients, are exactly the sort of service that we want to develop.
Like the hon. Gentleman and hon. Members on both sides of the House, I, too, have met pharmacists from my constituency who are extremely concerned about the possible implications of the OFT report for their services and their businesses: for instance, Mr. Mattock, who runs a pharmacy just down the road from my constituency office, serving a diverse and disadvantaged ward in my constituency; and my constituent, Mr. Mehta, who is a pharmacist in a Leicestershire village. Both of them are wholly committed to serving their patients and their communities, and of course both of them brought me petitions like those received by almost every Member.
I want to make it clear to our community pharmacists that we value their contribution. We value their role as trained clinicians. Above all, we understand the contribution that they make to deprived and remote communities. 299 We will do nothing that jeopardises that contribution. Indeed, as the hon. Member for Croydon, South (Richard Ottaway) made plain in his excellent quotation, we spelt out in the Department of Health document, "Pharmacy in the Future", that we want to increase and enhance the contribution that pharmacists make as clinicians and professionals in the national health service.
§ Mr. Steen
The Secretary of State says that she wants to improve local pharmacists' facilities, but does she plan to increase the £18,000 a year that the Government pay for the NHS contract to each pharmacy? Will that sum increase? If it does, pharmacists will be delighted, but they will not be so pleased if she gets rid of it.
§ Ms Hewitt
My hon. Friend the Minister for Public Health is discussing with pharmacists a new contract and funding through primary care trusts to ensure that they can innovate and that pharmacy services are responsive to the local needs of their community, because the needs of rural communities will be very different from those of deprived inner-city areas. As "Pharmacy in the Future" says, pharmacy is one of the primary health professions in the NHS; it is an integral part of most people's experience of NHS care, whether in the community or in hospital. It was very clear from the responses that the Department of Health received to that document that the public believe that more use could and should be made of pharmacists' skills and expertise.
§ Mr. David Drew (Stroud)
My right hon. Friend has hit exactly the right note. When I met my local pharmacists to discuss their concerns about the OFT report, they said that they very much welcomed the Government's proactive agenda, but they also want to take a very much more active role in respect of prescriptions. They argue that millions of pounds could be saved with a different prescription policy, particularly in relation to repeat prescriptions. We should be following that up, rather than having a sterile debate on whether pharmacies should continue regardless.
§ Ms Hewitt
My hon. Friend is absolutely right. He makes the very important point that the public and pharmacists are telling us that much more could be done to use pharmacists' skills and expertise to deliver better health care to patients. Only the Conservative party says that nothing should change—typical of Conservative Members. The programme for pharmacies sets out exactly how we will continue to improve pharmacy services. We need to ensure that they can meet patients' changing needs, ensuring that people can get the medicines and pharmaceutical advice that they need easily and, wherever possible, in the way and at the time and place that they choose.
We have heard very little about patient and consumer choice from the Opposition. That is why my right hon. Friend the Secretary of State for Health is taking steps to ensure that patients can obtain more medicines over the counter from pharmacies. We want patients to be able to get their medicines out of hours, when that is what they need. We want more patients to be able to receive delivery of their medicine at home. We want 300 pharmacists to be responsible for far more repeat prescriptions, as that will make life simpler for patients and doctors.
§ Mr. Mark Francois (Rayleigh)
It has already been mentioned several times in the debate today that pharmacists play a very important role, not least in releasing pressure on already hard-pressed general practitioners. My constituency has the fourth highest ratio of patients to GPs in the entire country. Does the Secretary of State appreciate that this is an extremely important point? Has that got through to the Department of Trade and Industry, as well as to the Department of Health, where it was appreciated to begin with?
§ Ms Hewitt
Yes, of course we are aware of that important point and, through the Department of Health's programme for pharmacies, we will also ensure that pharmacists give patients much greater support and advice on using medicines. We need to reduce the amount of illness caused by medicines not being used correctly, and we certainly need to cut the amount of medicines that are simply wasted because patients do not begin or, more commonly, do not complete their courses. All of that will mean better care for our patients and a greater role, not a lesser one, for community pharmacists.
§ Mr. Gale
Does not the right hon. Lady understand that the Opposition agree with much of what she is saying? The problem is that what she is saying is not compatible with shipping out pharmacies to out-of-town supermarkets and putting community pharmacies out of business, thereby denying access to local outlets that will provide precisely the back-up, advice and service to the vulnerable, the elderly and young mothers with children that she seems to be talking about.
§ Ms Hewitt
I think that the hon. Gentleman is tilting at windmills. I hope that by the time I have finished my speech, I will have persuaded him to vote for our amendment. He should not be hostile to the development of pharmaceutical services in supermarkets, all of which are approved by primary care trusts when that is appropriate. I recently visited friends in a village in Suffolk where there have been no shops of any kind for many years. The local supermarket has recently opened an excellent pharmacy service complete with a treatment room and qualified pharmacist within the supermarket. For the people living in that village and others around it, that would be the nearest community pharmacy. He should therefore drop his prejudices and look at the situation on the ground.
§ Ms Hewitt
Let me make a little more progress.
Against that background of our programme for pharmacies and our commitment to pharmacists, we are considering the report from the Office of Fair Trading. I welcome that report, which is a useful contribution to public debate and understanding. The hon. Gentleman referred to the history of the control of entry regulations 301 which, of course, date back to 1987. What he did not know, however, or forgot to mention, is that the situation in 1987 was very different: in those days, payments to pharmacists were being made on a cost-plus basis, with higher payment being made to the smaller pharmacies for each prescription dispensed than to larger ones. The result, not surprisingly, was to encourage more and more pharmacies to open up that were almost entirely dependent on NHS funding and prescriptions. That is why NHS costs kept rising, which is why the Treasury, in 1987, rightly insisted on changes being made. The control of entry regulations gave local health authorities the responsibility of deciding whether new pharmacies were needed, and in doing so dealt with the problem of the perverse incentive, which was driving up costs unnecessarily.
Since then, the cost-plus remuneration system has given way to a reformed payment and reimbursement system. As I indicated a few moments ago, the Department of Health is now negotiating a new pharmacy contract, which will come into effect next year, and will provide new opportunities, particularly for the primary care trusts, to introduce services such as minor ailment clinics, repeat dispensing, supplementary prescribing, home delivery services and some others on which we have touched.
§ John Mann (Bassetlaw)
Does my right hon. Friend agree that the situation in my constituency, which has prevailed for 20 years, is absurd? On a Sunday evening, if someone requires a repeat prescription ventalin inhaler the only way to get it is by going to accident and emergency or calling out a GP. Does she think that that needs attention in the review?
§ Ms Hewitt
My hon. Friend makes an important point. The issue of out-of-hours dispensing is one of those being considered in the Department of Health, with pharmacists, to ensure that as part of the new pharmacy contract and the new arrangements with PCTs, we deliver better services to consumers and patients who often need those services 24/7, 365 days a year, and not simply at times when pharmacies are usually open.
§ Mr. Todd
Does my right hon. Friend agree that it would be worth while for the contract negotiations also to focus on some of the rather perverse incentives in the current contract, including the fact that any gain that is made by more efficient purchasing is effectively clawed back by the Government in a subsequent year? That is an intensely frustrating and unpredictable process for many pharmacists.
§ Ms Hewitt
That is an extremely important point, and I am sure that the Minister of State, Department of Health will take note of it. She may wish to comment on it when she winds up.
The role of the OFT is to promote competition and consumer choice. Just as none of us in the House should have any doubt about the importance of community pharmacies, so none of us should be in any doubt about the importance of competition and consumer choice to our wider economic success. When the Conservative 302 party was in power, it talked about competition, but it has taken this Labour Government to modernise a competition regime that was increasingly inadequate and left us trailing behind other economies. With Labour's Competition Act 1998 and Enterprise Act 2002, we can be proud of giving our country a competition regime that is now among the best in the world.
Greater competition has already brought benefits to all of us who buy over-the-counter medicines. When, in 2001, the OFT used the new powers that we had given it under the 1998 Act to challenge the old system of retail price maintenance, prices of leading branded over-the-counter medicines fell by up by 50 per cent.—in some cases within a couple of hours of the OFT announcing the opening of its inquiry. That was good news for patients and consumers. I would have hoped that Conservative Members would welcome it. Above all, it was good news for low-income families and low-income elderly people.
I have no doubt about the contribution that the OFT can make to our deliberations on how we improve consumer choice. I welcome the fact that, as a result of our reforms, it can look specifically at the impact of the Government regulations that may be holding back consumer choice and competition.
§ Mr. Lansley
The Secretary of State anticipates my question, and I am grateful to her for that. She is responsible for the oversight of the OFT's work, and I am sure that she will agree that it is desirable that it conducts, as it intends to, at least two investigations each year—and certainly next year—into the impact of Government regulations on markets. She understands, as I do, how competition policy works. Competition has to be constrained when public services are involved and competition policy bites only to the extent that undertakings do not provide services of general economic interest—public services, in the European Union jargon. Therefore, why did not the Secretary of State or her colleague in the Department of Health make sure that, when the OFT examined this market, it did not confine itself to the examination of the market impact of the control of entry regulations, but considered the public service obligations that had to be met by community pharmacies? Why did it not construct its report in that wider context?
§ Ms Hewitt
Let me make it plain that it is the OFT's job to examine competition, not to advise us on health policy. On the matter of the OFT's investigations into the impact of Government regulations, we do not leave it to the OFT to make the final decision as we now quite rightly do in merger cases. It is for the Government to make the policy decisions on public services, including the national health service.
I know very well—this debate has already reflected it—the deep concern that there is inside and outside the House that simply abolishing the control of entry 303 regulations might lead to widespread closures of community pharmacies, particularly in rural or deprived areas. That concern is reflected in today's report from the Select Committee on Health. I am grateful to the Committee's members for their speedy inquiry. We will consider their report and conclusions before we take our decisions.
§ Mr. Nigel Dodds (Belfast, North)
The situation in Scotland and Wales was mentioned earlier, but will the Secretary of State welcome the decision made by her colleague the Minister for Work when he was the Under-Secretary of State for Northern Ireland with responsibility for health? He was not a devolved Minister but a direct-rule Minister, and he unequivocally rejected the Office of Fair Trading recommendations for Northern Ireland on 26 March. He cited the detrimental impact that the proposals would have on the infirm, vulnerable and less well off. Would she care to follow her colleague's example?
§ Ms Hewitt
Health Ministers in each of the devolved Administrations made their decisions, which was absolutely right. We shall take our decision when we have completed the consultation and deliberation that my right hon. Friend the Member for Darlington (Mr. Milburn) and I announced before the end of March.
As I was saying, the OFT's job is to examine competition, not to decide health policy. As my right hon. Friend the Chancellor of the Exchequer argued forcefully in a lecture earlier this year, there are limits to markets, especially health care markets. There are certainly limits to competition among pharmacies, and I agree with the hon. Member for South Suffolk that pharmacies are, on average, dependent for about 80 per cent. of their income on revenue received for dispensing NHS prescriptions, the price of which is fixed by the Government. Labour Members are clear that pharmacists are clinicians and not only shopkeepers.
As my right hon. Friend the Member for Darlington and I said on 26 March, we will come forward before the summer recess with a balanced package of measures. We favour change to open up the market and to improve quality, access and choice for patients—hon. Members of all parties have supported those points—without diminishing the crucial roles that pharmacies play, especially in poorer and rural areas. We have already consulted widely and I am grateful to the thousands of people, including many hon. Members, who have given us their views. We shall consider especially the impact of any change on rural communities in line with our commitment to those communities and also ensure that all policies take account of their specific needs and circumstances. The hon. Member for South Suffolk got rather hot under the collar on that subject and I am sure that his failure to mention the fact that rural post office closures have almost stopped was a mere oversight. Closures are occurring at the lowest rate since 1995 thanks to the measures and financial support that this Government have put in place.
§ Ms Hewitt
I know that the hon. Gentleman is becoming increasingly impatient with any change at all. He clearly pays no attention to the fact that the present system of giro books is acutely vulnerable to fraud and extremely expensive to administer. However, that is all that we can expect given that we inherited the system from his Government. The measures that we have implemented to ban any avoidable rural post office closure and the financial support that we are providing for rural post offices, linked with our support for shops in our rural villages, are helping to strengthen our rural communities.
I regret the fact that the hon. Gentleman continues to peddle the idea that the only way to get people to use rural or urban post offices is by chaining them there with their benefit books. He should welcome changes that the Post Office's new management is making to ensure that people with a range of bank accounts may do their banking at post offices and gain other services and benefits when they do so.
§ Roger Casale
I welcome the sensitive and balanced recognition that my right hon. Friend is giving to the need for sensible regulation. I have consulted Paresh Modasia, who is a leading community pharmacist in my constituency, and he and other community pharmacists are keen to work with the grain and the Government. They recognise the need for change, not least keeping pharmacies open later in the evening and developing their role in the new NHS. Will she confirm again that her Department is keen to work with representatives from community pharmacies to develop dialogue so that we can find out how to achieve the best outcome for everyone?
§ Ms Hewitt
My hon. Friend is right. There is a full dialogue and partnership between the Department of Health and community pharmacists, building on the proposals in "Pharmacy for the Future" that are being developed in discussions on the new contract. All of that will inform the policy decision that we make on the particular issues raised by the Office of Fair Trading report.
§ John Mann
The success in implementing the Government's updated drugs strategy requires community pharmacists to provide greatly increased supervised consumption of methadone and other substitute drugs. Will my right hon. Friend comment on the importance of the community pharmacy in the success of that strategy?
§ Ms Hewitt
My hon. Friend is right. Part of the way in which we will deal with the menace of growing illegal drug use is by mobilising community pharmacists to supervise much more effectively the treatment of drug addicts within the community. That is one of the many issues that we are taking into account as we consider how to move forward.
§ Mr. John Horam (Orpington)
Does the right hon. Lady recognise the vital point made by my hon. Friend 305 the Member for South Suffolk (Mr. Yeo) that two things are going on simultaneously for which she is responsible—the closure of sub-post offices and the possible closure of pharmacies? Those two together, both in suburban areas like my constituency and in rural areas, pose a threat to small local shopping parades and villages. The worry is that there will be less accessibility to services overall.
§ Ms Hewitt
I understand those concerns, but the hon. Gentleman ignores what I just said and the steps that we have taken to protect and reopen post offices and shops in many of our rural communities. He assumes that changes will lead to the closure of community pharmacies. We will ensure that that is not the case. That is why we made it clear in our statement on 26 March that we will produce a balanced package to achieve the goals, which I hope he shares, of better quality access and choice for patients and a stronger, not a lesser, role for community pharmacists.
§ Ms Hewitt
No, I intend to bring my remarks to a close.
The proposals that we will produce before the summer recess will also be the subject of full consultation and debate within the House.
As our Government continue to improve the NHS, we will ensure that pharmacists are recognised as full contributors to primary care services, as the first port of call for patients and consumers in discussing everyday health problems, and as important partners in reducing health inequalities and in dealing with some of the most serious health problems that our communities face. The Government are increasing investment in the NHS by a third over the next three years. For all the crocodile tears that the hon. Member for South Suffolk shed, we know that the Conservatives would cut investment in health services by 20 per cent. What would that do for community pharmacies, hospitals, doctors and nurses?
We will make the investment that our health service needs and promote the reforms that it needs. We will make that investment and those reforms in the interests of patients and communities. In doing so, we will strengthen the vital role of our community pharmacists. I commend the amendment to the House.
§ Sandra Gidley (Romsey)
Unlike the hon. Member for Stroud (Mr. Drew), I welcome the opportunity to debate community pharmacies. The subject is of great interest to many of my constituents and fellow professionals. Perhaps I should explain that I am fairly unique among hon. Members in that I was a community pharmacist.
Clearly pharmacies are a health issue and should not come under the remit of the Department of Trade and Industry. Although I welcome the thrust of the Conservatives' argument, the hon. Member for South Suffolk (Mr. Yeo) over-egged the pudding.
306 It was with utter disbelief that I listened to his "emperor's new clothes" speech, showing the Conservatives' new, cosy, caring attitude. Personally, I found that hard to take, but he did the health service a big favour by highlighting how the drugs budget could be reduced. Instead of prescribing emetics, a doctor could just give a patient some over-the-top passages from the hon. Gentleman's speech demonstrating the Conservatives' caring nature, and the desired result would be achieved.
There is a lot of consensus on this issue on both sides of the House. Many Members have presented petitions either in the Chamber or to the Department of Trade and Industry, and today the Select Committee on Health, on which I serve, has produced a report on the issue, on which it was easy to secure all-party consensus. Our earlier debate concentrated on the Cabinet reshuffle, one aspect of which, sadly, has not attracted any attention. Five of the six Ministers in the Department of Health have been replaced, and I wish the new Minister with the brief for pharmacies well. I looked up the Under-Secretary of State for Health, the lion. Member for South Thanet (Dr. Ladyman) to investigate the history of his interest in health, and found that he had a doctorate in isotopic abundances in soil development—[Interruption.] The Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton) points out that she has responsibility for pharmacies. I urge her to tell the information unit at the Department of Health, which clearly thought that somebody else did. There is confusion in the Department about who has responsibility for the matter.
Mr. David Hinehliffe (Wakefield)
There may be confusion in the Department of Health, but I think that the Conservatives chose today's debate. Is the hon. Lady surprised that there is one Conservative Back Bencher in the Chamber, making a total of three Tories present, which is disgraceful for an Opposition day debate?
§ Sandra Gidley
I agree entirely. I referred earlier to the emperor's new clothes and crocodile tears, and the Conservatives' absence is a true reflection of how much they care about the deprived.
The need to preserve access to local health services is of fundamental importance to our constituents and, for many, that means preserving access to local pharmacies. I referred earlier to the fact that I was a pharmacist before I came to the House, and I should state at the outset that I am probably the villain of the piece, as for a few years I was that hated figure, the supermarket pharmacist. Prior to that, I had experience in small and medium-sized family businesses, and did locum work for independent pharmacies. I have therefore worked in pharmacies of almost every size.
It is invidious to depict the supermarket pharmacist or a pharmacist in a large Boots as someone who does not provide a full service—a point that I shall return to later. All pharmacists receive the same training, and are highly qualified. The problem is making sure that they provide the range of services that are needed. I fully accept that there is probably a positive bias in favour of small, independent pharmacies that provide a wider range of services, which is often the only way that they can add value to their business.
307 I want to deal with the historical context of the problem. As has been mentioned, pharmacies increased at a rate of approximately 130 a year in the early 1980s, which was unsustainable. The Secretary of State for Trade and Industry rightly said that the Treasury responded to that growth—the big problem was the method of payment, which favoured small, low-volume pharmacies.
Nobody has mentioned another problem, which made that change easier to achieve at the time: the problem of leapfrogging. There was a firm, which I shall name—Lloyds Chemists—that used to open branches between an existing pharmacy and a doctor's surgery and cream off half the business. Many independent pharmacies were threatened, and many people in the pharmacy profession felt that something had to be done about Lloyds, so it was relatively easy to accept the control of entry proposals at that time. The villain of the piece then was not supermarkets, but Lloyds. We do nobody a favour by pretending that only supermarkets could benefit from a relaxation of entry controls. The large firms on the high street, such as Boots and Superdrug, are also looking to expand, and their expansion poses just as much of a problem to existing pharmacies.
Some of the knock-on effects of control of entry were not predicted. The pharmacy profession noted that Lloyds was not stopped in its tracks. Where it was prevented from opening, it simply bought out all the very small firms. I used to work for a small family business with five shops. The owner died, and there was a piece about the business in The Pharmaceutical Journal. People phoned the family asking to buy the shops, not realising that that gentleman had three sons who were pharmacists and who clearly wanted to continue the family business. It was an aggressive time, and Lloyds is now one of the largest chains in pharmacy.
The other knock-on effect was that the cost of the average pharmacy business increased dramatically. I know that because at one stage in the late 1980s, I considered opening my own pharmacy.
§ Andy Burnham
On a point of order, Mr. Deputy Speaker. Is it in order for an hon. Member to read a newspaper while the debate is in progress?
§ Mr. Deputy Speaker (Sir Michael Lord)
That is a matter for the Chair, but the Chair would not normally approve. I had not noticed.
§ Sandra Gidley
The cost of the good will of a pharmacy business increased dramatically, making it almost impossible for somebody without financial backing to open an independent pharmacy. Such a person had to be very cute about a new opportunity opening up—there were people who regularly trailed housing estates to see where a doctor's surgery might open, to try to get in there. Another problem was that many contracts were sold to supermarkets or other large companies that could offer large premiums. That had a 308 detrimental effect on pharmacy provision overall. Jobs advertised in The Pharmaceutical Journal are much reduced and are all with medium to large firms.
Because supermarket pharmacies were offering so much money, nobody else could get in. In my locality there were two independent pharmacies. Both wanted to sell to an independent purchaser, but both were forced to sell to chains because nobody else could afford to pay.
§ Mr. Peter Pike (Burnley)
Is it not a fact that every time a small local pharmacy sells on to a superstore, the service is removed from the most dependent elderly people, people without transport and those who cannot get to the superstore, who depend on the pharmacy not only for their prescriptions, but for the wider primary care service that pharmacies are now supposed to provide?
§ Sandra Gidley
The hon. Gentleman has a point, but the two pharmacies that I referred to still look like small pharmacies. They are just branded with a firm's logo. However, there is no longer 24-hour access to the person above the shop who, if somebody knocked on his door, would go down and provide the emergency inhaler mentioned earlier. That provision has gone. If people do not own their businesses, it is much more difficult to find any who are motivated to provide delivery services. Generally, such services are not paid for by the Department of Health, so they represent an added value that a business subsidises out of its profits.
The new contract has been mentioned. I know that many pharmacists are apprehensive about it because they fear that they will be given the same amount of money, but asked to do a lot more. Will the Minister give some reassurance that extra funding will be available if extra services are being provided? I am sure that that would put many people's minds at rest.
§ Mr. Steen
The hon. Lady will remember that I initiated the first Westminster Hall debate about this matter on 12 March this year, to which she made a very useful contribution as a pharmacist. As I said then, pharmacists in my constituency are concerned about the£18,000 contract that she mentioned. I believe that every pharmacist has such a contract for national health service prescriptions. Does she agree that that is what we want the Minister to deal with? I got the impression from the Secretary of State's speech that the Government were going to play around with that £18,000 and that some pharmacists will get more, but many will get less. Does she agree that it is crucial that that amount is high and that, if it is not, community pharmacists will not be able to survive?
§ Sandra Gidley
The hon. Gentleman makes a useful intervention, and he has a point. I am not necessarily saying that £18,000 is the level that must be set for only the dispensing part of the business. Clearly, he is right that a sustainable level is needed, but the concern is that some of the roles that pharmacists take on require much time and energy and cannot be funded out of any small amount that is left over, so new money is needed.
The buck is often passed back to the primary care trusts. Many hon. Members attended the Pharmaceutical Services Negotiating Committee dinner 309 earlier in the year. The Minister who attended mentioned that the money was available for PCTs to give out, but there was a groan throughout the audience. It came not from pharmacists, but from people at the primary care trusts, who saw it as yet another demand on the money, which could go only so far. We accept that there is more money, but it is still difficult to give it in all the right places.
I admit that the status quo is not perfect. Everyone who gave evidence to the Select Committee on Health agreed that some change was necessary, but there appeared to be an emerging consensus that distribution should definitely take into account local health needs. As part of the reforms, we need to establish exactly what services should be available at every pharmacy, in addition to the core business of dispensing.
Various services can be available. Some pharmacies provide oxygen services, supervised dispensing of methadone and monitored dose systems for old people's homes allowing people to keep a check on their medications, and delivery, prescription collection and 24-hour services. I have provided all those services in my time, and I provided all but the 24-hour availability service in some role in working for a supermarket pharmacy. However, I fully accept that provision in supermarket pharmacies is patchy.
§ John Mann
On supervised consumption of methadone and other blockers, and in relation to drugs, does she accept that the problem of supermarket pharmacies is that the people on supervised consumption will often have a track record of shoplifting and will have been banned from supermarkets where they have previously stolen? That can also be a problem in some of the larger and wider product chains such as Boots.
§ Sandra Gidley
The hon. Gentleman raises an important point. I was going to refer to that problem later, because I have witnessed it myself. Where dispensing provisions have been set up, addicts have sometimes been nicked on the way out for trying to steal, say, a bottle of whisky. That leads to a real battle with the management of the store, who will not allow those people back in.
The report by the Office of Fair Trading suggested that consumers benefit because more people have access to low-priced medicines in supermarkets. The Secretary of State mentioned that earlier. The OFT estimated that the consumer will save £20 million to £25 million on pharmacy-only medicines—that is, medicines that are available only in pharmacies. However, there is a flaw in that argument. The Secretary of State rightly said that there was an immediate drop in prices, but evidence to the Select Committee showed that they have climbed back up. One can get cut-price Calpol from time to time in Boots, but the range of products on offer is extremely narrow and represents only a small percentage of what people buy.
Some people are tempted to travel to buy medicines cheaply. That takes away trade from small independents that simply do not have the purchasing power to compete.
§ Mr. Peter Ainsworth
The hon. Lady makes a compelling point. It was reinforced by the British 310 Medical Association, which said that what little gain there might be to consumers from deregulation—for example, through cheaper general sales list items—would be insufficient to offset the wider cost.
§ Sandra Gidley
I completely agree with the hon. Gentleman, as I shall demonstrate.
The OFT suggested that the pharmacies that will close are those in the immediate environment of a supermarket. I think that it is completely wrong in that assumption, as did many of the people who gave evidence to the Committee. The pharmacies under threat are those in villages and inner-city areas and those that serve housing estates. They teeter on the brink of viability. Co-op chemists and the Pharmaceutical Services Negotiating Committee have independently concluded that there is likely to be a cut of at least 10 per cent. in business, although that estimate is fairly conservative. That could lead to the closure of several pharmacies.
It would be easy, but overly simplistic, to think, "People are going to the supermarket anyway. What's the problem?" The problem has already been alluded to. Different groups of people are involved.
§ Angela Watkinson (Upminster)
Two regular customers who wanted a cough remedy consulted the pharmacist in one of my community pharmacies. He was alarmed by the cough, decided to test the level of carbon monoxide in their blood, and found it to be unnaturally high, whereupon he advised them to go home and have their gas appliances tested. They were found to be in a very dangerous state. Does the hon. Lady think that such service would be available in a large pharmacy or supermarket where there is not that degree of familiarity between the pharmacist and customers?
§ Sandra Gidley
The hon. Lady raises two points. First, she describes a service that is not widely available. I do not know whether it is being provided because of a local decision or the interest of that pharmacist, but such provision is generally patchy.
Secondly, she suggests that supermarket pharmacies are anonymous. I admit that, before I worked in a supermarket pharmacy, I completely agreed with that—in fact, I put off working in one for years because I did not relish the anonymity. It was only because it fitted in with my children—something that will be appreciated by the Secretary of State in her role as Minister for Women—that I bit the bullet and decided to work there. I found that it was not as I had suspected. People came in to say hello when they were buying their bread and milk. A supermarket pharmacy can have that aspect, too. That does not mean that I want everybody to go to their supermarket pharmacy, but it is not the complete villain of the piece that it has been painted as in some quarters.
There are some good supermarket pharmacies, but in some parts of the country, they struggle to provide regular cover. That is not good for anybody in the community because it means that people do not get continued care. A balance must be struck.
There are different groups of people. The mobile population can jump into cars—or even 4x4s, if my hon. Friend the Member for Lewes (Norman Baker) does not 311 ban them. Having to drive a further mile for medicine is a minor inconvenience to that group. However, most of us entered politics to speak for the very people who suffer most: the elderly, the ill, people who cannot afford a car and those in deprived communities.
§ John Mann
Has the hon. Lady considered the impact of the Government's NHS local improvement finance trust—LIFT—policy? In my constituency, it means that three mining villages will get brand new doctor's surgeries in the next year. Every one will have a new community pharmacy as part of the premises: three new pharmacies in three mining villages.
§ Sandra Gidley
Sadly, coming from leafy Hampshire means that I have little practical experience of NHS LIFT. However, I shall deal with the point about pharmacies in doctor's surgeries and doctors dispensing later.
Even if those who cannot afford a car can afford the bus fare, they cannot find a bus, which is a rare sight in many areas nowadays, thanks mostly to the Conservative party. The OFT report is based on competition and market forces, and could benefit the haves and deprive the have-nots. I seriously believed that such politics had come to an end when we said goodbye to Margaret Thatcher. It would appear that I am wrong but I wait to be reassured by Ministers. So little information is forthcoming, even from Health Ministers, that it is difficult to be reassured that financial arguments will not win the day.
The OFT also claims that increased competition would lead to pharmacists offering new services. Let us consider the 1980s when Lloyds Chemists were the villain of the piece. They offered not new services, but extended hours. All pharmacists at Lloyds were asked to work from 9 am to 7 pm without a lunch break. That decision prompted me to work in the supermarket; such hours were clearly not sustainable for those with young families. Working those hours may not sound like a problem, but if pharmacists make a mistake in dispensing medicines, it is not a case of, "Oh well, never mind." The consequences for someone's health could be serious and it is therefore important to remain alert until the end of the day. Lloyds chemists did the industry no favours by increasing hours. Clearly, nobody wanted to work for a couple of hours in the evening.
The OFT report also claims:in areas where there are no NHS dispensing pharmacies, dispensing by GPs offers a further mechanism to ensure appropriate access to prescribed medicines.It has already been said that dispensing doctors oppose the proposals. The OFT report ignores the fact that pharmacies are not simply about dispensing. We will lose access to other services, and the hours of availability, during which people can get their medicines, will decrease because surgeries are not manned all the time.
Although dispensing doctors have improved greatly over the years, there is no compulsion on them to employ a qualified person to do the dispensing. It is called "doctor dispensing", but the doctor does not usually go anywhere near the process. There are no controls such as those over supermarket pharmacies, and dispensing in doctor's surgeries is more expensive.
312 We should ask for an on-site pharmacy in surgeries, but with a qualified pharmacist. There is no problem with siting pharmacies in doctor's surgeries, provided that the correct health professionals are also there, and that it is done more holistically. Problems arise through unqualified staff and reduced hours. The service is not as good as it should be.
§ John Mann
I fear that there is some confusion in the hon. Lady's argument. My local GP's surgery in North Leverton has a dispensary built in. When I go in, along with all the pensioners and others, I see the doctor in one room, the receptionist is nearby, and on the left-hand side next to the reception is the dispensing chemist, who is often the receptionist as well. Having all the services on the one site is a perfect scenario for the elderly and vulnerable.
§ Sandra Gidley
I think that it is the hon. Gentleman who is confused. He has just illustrated the problem by saying that the dispensing chemist was often the receptionist as well. I have to say that qualified pharmacists are not usually receptionists. I would be grateful if he would go back to this doctor's surgery and ask what qualifications those people have. They might have some, but from what he has told me, it sounds as though they are not qualified pharmacists. He mentioned the accessibility problem, which has been solved, but we need to link this up with proper pharmacy provision.
§ Sandra Gidley
No, I want to give other people a chance to speak. It is important that I give the Chairman of the Health Committee some time, so I shall cut my speech short. I have taken a great many interventions, and I must now come to my conclusion.
As I said earlier, the crux of the matter is not who is the good guy and who is the baddie in all this. It has been noted that 79 per cent. of the population have a community pharmacy within a kilometre of their home—I am not ashamed to use metric measurements—and those people have access to a range of services. If that figure falls as a result of deregulation, we will have failed the public. I am not interested in protecting existing monopolies, but in preserving access to a local pharmacist, with all the benefits that that involves. We need to be more prescriptive about what services are provided; that could presumably form part of the contract. We also need to ensure that if a pharmacy is unwilling to provide an enhanced range of services, its contract could be reviewed in some way. The most important thing is to provide services to patients, not to protect vested interests. These services must be funded, and we now have a golden opportunity to change things for the better. The OFT route is not the right one, however.
On behalf of the Liberal Democrats, I will support the Conservatives in the Lobby tonight. May I suggest to Labour Members that they should be wary of the weasel words in the Government's amendment? If they truly want to show that they have no faith in the OFT report, they should walk through the Opposition Lobby tonight.
§ Mr. David Hinchliffe (Wakefield)
It is a pleasure to follow the hon. Member for Romsey (Sandra Gidley), who speaks with great authority on these issues and has recently made an important contribution to the Health Committee inquiry into this matter.
As this is the first—partial—health debate since the reshuffle, I should like to take the opportunity to welcome the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton). It is good to have a Yorkshire voice on the Health team. I also look forward to working closely and warmly with the other new members of the team. I also welcome the Under-Secretary of State for Trade and Industry, my hon. Friend the Member for Bradford, South (Mr. Sutcliffe). I am bereft of my Yorkshire Whip now that he has gone to the Department of Trade and Industry. I shall miss him, although whether he will miss me is a different matter. We have had a very good relationship over the years, and I wish him well in his work.
I pay tribute to the work of my right hon. Friend the Member for Darlington (Mr. Milburn). I deeply respect his decision to be with Ruth and the children; he has many achievements to his name of which he can be very proud.
I find myself in an interesting situation. This is the first occasion that I can recall during my time in Parliament on which I could quite easily vote for either the Opposition motion or the Government's amendment. I am quite happy with both, and I have no difficulty with either position because they both encompass clear concerns, aims and objectives that we can all share.
I find the Tories' position—a significantly increased role for the market in health care—interesting. On an issue such as this, however, when their constituents are expressing concerns about the possible disappearance of local pharmacies, they are actively arguing their case in relation to an OFT report that the Government have yet to consider.
§ Mr. Hinchliffe
No; other hon. Members want to speak, and I want to give them a chance to make their contributions. The hon. Gentleman will be able to make his points when he winds up the debate.
Today, the Health Committee published its report following a brief inquiry, and I shall base my speech on it. I feel strongly that, historically, we have failed to exploit the potential of a number of key elements of the NHS, primary care being a good example. I pay tribute to the Government's attempts to devolve more power to that sector: I think we shall see the benefits in the longer term. Similarly, we have failed for many years to exploit the potential of community pharmacies.
My constituency contains a number of first-class community pharmacies and pharmacists. I am especially privileged to have as a constituent Gill Hawksworth, who last week was elected president of the Royal Pharmaceutical Society of Great Britain. She has badgered me long and hard about the potential for community pharmacies to play a much larger role in the NHS. The time that I spent with her in her Mirfield pharmacy taught me a great deal.
314 I also thank Irene Gummerson, a pharmacist at the Warrengate pharmacy in my constituency, for allowing me to spend a morning in her pharmacy and to see exactly what is done in pharmacies. I learnt a great deal there as well. I have also spent time at Boots in my constituency, and learnt much about what it does as a major player in community pharmacy. Finally, let me thank Phil Bratley, who has been secretary of the local pharmaceutical committee, for his support and advice.
The current regulatory regime was introduced in 1987, and it is right for us to review it on occasion. The Government deserve praise for their detailed examination of the greater role that could be played by community pharmacies, but the OFT review is rooted in economic and competitive arguments rather than arguments about health, as has already been pointed out today.
The Health Committee inquiry was undertaken because of many Members' anxieties about the possible consequences of the OFT report. On one day we took evidence from a range of key players, including the OFT, the Pharmaceutical Services Negotiating Committee, various providers and, of course, Asda, which would be a major player in the event of deregulation. The evidence made it clear to me that there was broad agreement about the fact that the number of pharmacies would increase initially following deregulation, but that in the longer term many pharmacies in rural and deprived areas would be threatened by a loss of dispensing revenues to new pharmacies, especially in bigger stores.
We reached a number of conclusions. First, we concluded that, as the Secretary of State has said, the control of entry regulations need reform and modernisation. In many parts of the country, including parts of my constituency, people have no access to prescriptions out of normal hours. We established that community pharmacists support modernisation, and they would plainly want to be key players in the process of ensuring a more positive service.
The evidence suggested a strong likelihood of closures in the event of acceptance of the OFT report. That would have a particular impact on poorer communities and especially on elderly and immobile people, some of whom would lose their local services. A calculation in our report, which I have no time to quote, shows the exact percentage of community pharmacies that could be lost.
The Committee also felt that the OFT's projected savings were questionable and did not stand up to detailed analysis. In particular, a reduction in community pharmacies is highly likely to lead to people wanting to access more expensive elements of the national health service, such as GPs and casualty units, to get the service and the prescriptions that they need. We felt that there is a need for an enhanced role for primary care trusts to plan the provision of pharmacy services, to ensure that local pharmacies do provide extra services. Indeed, I believe that the Minister agrees that that is the way forward.
I hope that the Government will take note of the points made in our report and in this debate. The key conclusion that I reach is that market forces are not a proper basis for health care provision. I make that point to the Opposition, but I also make it to the Government.
§ Mr. Peter Ainsworth (East Surrey)
It is a pleasure to follow the distinguished Chairman of the Health Committee, the hon. Member for Wakefield (Mr. Hinchliffe), on the day when the Committee produced an intelligent and thoughtful report on a subject of huge interest to all of our constituents. I received petitions containing some 3,000 names, all of which I forwarded diligently to the Department in the earnest hope that they will be taken seriously and that the concerns expressed will not only be listened to but acted on when the Government take their decision on the OFT report.
Let me come straight to the point made by the hon. Member for Wakefield about the Conservatives' position. It is quite simple: where we see that market forces will benefit patients, help to raise standards and help to lever funds into the health service, we are keen to use them. However, where opening up to market forces—of course, we are talking about a system that was put in place by a Conservative Government in the 1980s—reduces access to health care, as in this case, we do not think it such a good idea after all. I have no doubt that my hon. Friend the Member for Epsom and Ewell (Chris Grayling) will have more to say about that issue later.
At a time when we often hear that people are not interested in politics, it is worth noting that an issue such as this can really grab people's attention. People care very much about their local pharmacies, and the strength of the public's response is evidence of that. Indeed, one welcome outcome of the Government's otherwise unwelcome prevarication about the future of community pharmacies is that it has heightened public awareness of the valuable contribution of pharmacies to communities throughout the country. That has enabled this important industry to set out its stall, which it has done extremely well.
The Office of Fair Trading report makes a reasonable case on behalf of the industry, particularly on the issue of access. As we have heard, the OFT says that 90 per cent. of people find access to their local pharmacy easy to achieve. It also states:The UK is currently well served geographically by pharmacies.That part of its analysis may be correct, but we Conservatives believe that it has come up with the wrong prescription. The changes might not affect access dramatically in the first instance, but they will in the longer term, and the Select Committee report endorses that view; more immediately, they will affect ownership. Small, family-run businesses will be at the losing end of a commercial battle with the large supermarkets. Asda, Sainsbury's and Tesco have clearly said that if deregulation goes ahead they will dramatically increase their involvement in this sector. So the debate about community pharmacies is not only about the provision of service; it also touches on the wider issue of the tension that exists between communities and corporations. That is a familiar debate.
Broadly speaking, I support open entry into markets and I am wary of protectionism, but competition is not a virtue in its own right. It may often have virtuous consequences, but its benefits must be weighed against its potential impact on society, individuals, communities and the environment. Competition ceases 316 to be a virtue where the local is sacrificed to the multinational, the trusted and familiar is ditched in favour of the new-fangled, and the community is engulfed by the corporate.
With the benefit of hindsight, few would fail to see that, before it was checked by my right hon. Friend the Member for Suffolk, Coastal (Mr. Gummer), the growth of out-of-town shopping centres had a huge and adverse impact on town centres throughout the country, weakening social cohesion and encouraging car dependency. Few people now applaud the way in which the growth of supermarkets has led to the steady decline of corner shops. Social cohesion has already suffered enough dereliction in the name of progress. The Office of Fair Trading proposals would, if implemented, only make matters worse.
The case for throwing the network of community pharmacies to the winds of competition is fundamentally flawed for two principal reasons. First, the OFT proposals would deal directly with only 5 per cent. of the total market, but might have enormous effects on the market as a whole, especially on access to NHS prescriptions. Secondly, pharmacies and pharmacists are a key part—perhaps the most undervalued part—of the NHS. That is what makes them different from other commercial businesses. My hon. Friend the Member for South Suffolk (Mr. Yeo) touched on that point in his opening remarks.
§ Angela Watkinson
Does my hon. Friend agree that the viability of community pharmacies would be enhanced if their role in the NHS were enhanced—for example, by giving them prescribing and consultation rights?
§ Mr. Ainsworth
I greatly agree with my hon. Friend. Community pharmacies already play an extremely important role within the NHS, but, I believe, in common with other hon. Members, that that role could be further expanded. Indeed, under the existing regulatory regime, put in place by the Conservative Government, local community pharmacies wasted little time in expanding the range of services that they offered. They have been quick to react to changing circumstances, to move into new housing developments and, as the hon. Member for Romsey (Sandra Gidley) pointed out, into supermarkets. They have shown a welcome degree of flexibility.
§ Bob Spink (Castle Point)
Would my hon. Friend add to his two excellent reasons a third—namely,the protection of the most vulnerable people in our communities, who rely disproportionately on local services?
§ Mr. Ainsworth
I was about to come on to that point and I agree with my hon. Friend. Providing advice on medicines, handing out prescriptions and dealing with drug-related illnesses are very different specialties from selling washing powder or baked beans. We are dealing with a particularly sensitive and vulnerable section of the community. Particular skills are required to deal with them and the normal rules of competition cannot appropriately be applied. Only the most blinkered obsessive for competition could fail to see that that is the case and to act accordingly.
317 People are fearful of losing their community pharmacies. They particularly fear losing the personal touch that they get when they walk into their local chemist's. I received a letter from Mrs. Carol Bacon, the manager of a pharmacy in Caterham, who said:I know many, many of my customers on personal name terms and frequently advise them (free of charge) on all kinds of health matters".Mr. White, of Payden's in Oxsted in my constituency, said:In my own branch we know all customers personally, giving advice, collecting prescriptions from the local health centre, operating a late night service in line with health service hours and being available for any urgent out of hours prescriptions.The support of those people, and others like them, in my part of the world and in the constituencies of my hon. Friends is testament enough to the strong emphasis that communities and individuals place on having a reliable community pharmacy at their disposal in their neighbourhood.
The Government seem to be dimly aware that the OFT prescription is flawed—hence, I suspect, the delay in reaching a decision, and the curious ambivalence of the press release that they put out on 26 March and the amendment that they have tabled today. The press release states that the Government favourchange to open up the market and improve quality and access without diminishing the crucial role that pharmacies play, especially in poor and rural areas".I note that the word "rural" has disappeared from the motion. It appeared in the press release but is not in the amendment. I do not know whether we should read anything into that.
The emphasis on poorer and rural areas—it also appears in the Select Committee's report—is no doubt laudable, but it is important to recognise that pharmacies also play a crucial role for people who do not live in poorer or rural areas. It is not just people in poorer or rural areas who fall ill. People also fall ill in the leafy suburbs and market towns. In many cases, those who rely on their local pharmacies are the most vulnerable—the elderly, the frail and children. The socio-economic mix of the area in which they live is not relevant to them when they need easy access to pharmacy services.
The NHS should treat people equally on the basis of clinical need, not on the basis of geography. I hope that the Government will not cook up a scheme that makes an arbitrary distinction between disadvantaged areas and the rest. The most important factor in this debate is the disadvantaged people who have to go to their pharmacy in the first place—and that has nothing to do with geography. People catch colds and grow old in suburbia, too.
Smallfield, in my constituency, is not particularly poor or rich, nor is it particularly rural. It is a growing village of mainly 20th century housing, and is typical of many communities across the country. Twelve years ago, Andrew Jackson set up the Hogarth pharmacy in Smallfield, to public acclaim. He runs a good business and provides an amazingly wide range of services. He has six staff and receives huge support from the local community. He wrote to me to express his concern for the future. He said: 318Deregulation of the pharmacy contract would lead to an increase in competition for 4 to 5 per cent. of my trade. This situation could close me—so the 85 per cent. of my trade that is so important to our community would be lost to a less accessible and more inconvenient pharmacy … If we go, what will the elderly do? What will the young mothers do? What will the disabled do? What will the unemployed with no expendable funds do? Where will my customers go? How will they get there?Those are the questions that the Government need to answer before swinging the axe of competition at that vital part of the national health service, and vulnerable communities and individuals across the country.
§ Andy Burnham (Leigh)
As one of the few who has been present throughout the debate, unlike some Opposition Members, I can say that a lot of brass neck has been on show. Conservative Members have talked about the poor, the disadvantaged and the vulnerable in their communities, but it is a shame that they showed no regard for those people and communities when they were in office. I do not know how they have the nerve to claim to be speaking up for those communities. Conservative Members should be ashamed of the brass neck that they have displayed today.
In the short time available, I want to say a few words about my most recent visit to a community pharmacy. A few weeks ago, in the recent recess, I was in charge of the children. That happens only rarely. I received an emergency call from my son's nursery asking me to come and pick him up straight away. The problem was very serious—he had nits.
Before my colleagues start scratching and moving away from me, I must explain that I am using this example to illustrate the fine services that community pharmacies provide. I visited the Lowton pharmacy in my area, where the pharmacist spent a long time coaching me in the use of a fine-toothed comb, and about the need to get all the nits out of my son's hair. We were very grateful for that, and I assure my hon. Friend the Member for Wakefield (Mr. Hinchliffe) that there is no danger that he will be infested.
In my experience, community pharmacies offer an absolutely excellent quality of service. One of the premises in the OFT report that needs to be questioned is that the lack of competition in the market means that the quality of service provided is too often patchy or poor. That is not so: most community pharmacies around the country provide an excellent and attentive service to the communities that they serve.
When considering the control of entry system recommended by the OFT, we must try to define how the public interest is best served. Setting aside the specifics for a moment, I believe that we are presented with two options: a planned system under the control of health bodies that provides a spread of outlets according to health need; or a system of unregulated entry to the market, with special measures to protect access where markets fail. The chief benefit of the first option is that it would guarantee access across the country, whereas the second option is based on the premise that the lack of competition denies people the benefits of low prices and better-quality services.
That brings us to two key questions, on which other hon. Members have touched already. Is there a conflict between the interests of consumers and patients? Are those interests the same, or should they be separated?
319 The OFT performs a valuable function in challenging existing practices and norms. Its work is normally based on the assumption that we are all demanding consumers, mobile and able to move our business around to find the lowest price and the best service.
Under the existing system, it is true that costs may be imposed on businesses and consumers, but are they worth paying, in the light of the wider benefits that they bring to society? Although the assumption about mobile consumers may be relevant to other markets, the community pharmacy market is very different, for three key reasons. First, 80 per cent. of the market's value comes from one customer, the NHS, in the form of prescription traffic. Secondly, the products that this market deals with are frequently essential to the people who need them. They are not a matter of discretion, and they can be required at short notice, and urgently. Thirdly, the majority of customers in the market are also the most vulnerable and least mobile members of society—the oldest and sickest, the people on the lowest incomes, and people with children. When we consider any changes to the current system, it is the interests of those people, the biggest users of the service, that we should bear most clearly in mind. For those people, ease of access is vital.
Without doubt, the OFT's analysis contains much of worth, but figure 4.4 of the report shows that localness and convenience are cited by 86 per cent. of respondents as the main reasons that they choose a pharmacy to get an NHS prescription fulfilled. Indeed, the report states:The degree of local access to pharmacies in the UK is currently good, with the majority of consumers finding it easy to get to a pharmacy from their home or from their GP's surgery.Some people may argue that that is a justification of the current system in itself and that, in a market where consumers value access and local service most, access is incredibly good across the country. However, as my right hon. Friend the Secretary of State pointed out, the system was introduced for a different reason—to control the prescribing budget in the NHS. Can we achieve the same benefit of providing the service where it is needed, while also doing more to promote quality in the system? That is the key question.
Finally, one element in the OFT research troubles me. The research assumes that the pharmacies that close when new entrants to the market open will be those that are closest to supermarkets. I do not believe that that is true. People who use supermarkets tend to come from within an area that has a wide radius of at least five miles. In my constituency, for example, I believe that it is the outlying pharmacies that could be threatened by the removal of the controls of entry. That needs to be considered.
My constituency has a large town at its centre; it is a former mining area where rates of chronic illness are higher than the national average and many families are in the lowest income groups. There is low car ownership and public transport services are poor. Areas such as Leigh will lose a lot from the abolition of the current system, but, as my hon. Friend the Member for Bassetlaw (John Mann) pointed out, constituencies such as ours stand to gain the most from the delivery of a much improved community pharmacy system, which is more accessible and provides people with a higher quality service.
§ Chris Grayling (Epsom and Ewell)
In anticipation of a speech from the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), I welcome her to her new position. We are surprised by the scale of the changes at the Department of Health; the hon. Lady will have a lot to do during a difficult and busy time for the Department. I look forward to debating with her.
This has been an interesting and important debate. My hon. Friend the Member for South Suffolk (Mr. Yeo) began it effectively, speaking forcefully about the role of community pharmacists and the importance of pharmacies in the communities that Members on both sides of the House represent. He challenged Labour Members to support our motion, as well as the early-day motion that many of them signed, to send a further message to both the Government and pharmacists about the importance that we attribute to the work of pharmacists for our society.
The Secretary of State for Trade and Industry made what can only be described as a balanced speech, in keeping with her current policy. She talked in glowing terms about community pharmacists, but then referred to the competitive context for the industry. I greatly hope that, when we hear the Government's final verdict, there will not be a sting in the tail for our community pharmacists. Given the interest displayed by hon. Members in this issue, will the Minister of State give us an assurance in her winding-up speech that, when the Government eventually publish their policy decision, they will make a full statement to the House?
We heard an authoritative speech from the hon. Member for Romsey (Sandra Gidley), who brings considerable professional expertise to the subject. However, her speech was spoiled by the fact that she complained about over-the-top comments from the Conservatives while making over-the-top comments herself. I was surprised to hear her say that community pharmacists who did not take on extra responsibilities should risk the loss of their contracts. That would be a great shame. The work of our community pharmacists goes well beyond the call of duty and well beyond the terms of their current contracts, so I would not want them to lose those contracts.
The hon. Member for Wakefield (Mr. Hinchliffe) made a valuable and insightful contribution. I pay tribute to him and to his Select Committee for the report that they published this morning, which is a valuable contribution to the debate that will help to inform the Government's decisions when they are eventually taken.
My hon. Friend the Member for East Surrey (Mr. Ainsworth) made a valuable contribution. He spoke in particular of the threat to small family-run businesses. On the basis of his constituency experience, he described the extent of the personal service and commitment offered by community pharmacists to their customers, which went far beyond the call of duty and the normal requirements of their job.
Lastly, we heard the speech of the hon. Member for Leigh (Andy Burnham). He may talk about brass neck, but I remind him that a Labour Government are considering changes to a system introduced by a Conservative Government that has provided proper protection to our community pharmacists.
321 The future of the community pharmacy is crucial for communities right across the country. Local town and village centres alike are under threat from the Government in a way that we have never seen before. Local post offices are disappearing as part of a programme to close a total of 3,000 outlets, after five years of the Government's gross mishandling of the Post Office.
The current proposals pose risks to another cornerstone of our local communities. All over the country, millions of people, especially the elderly, depend on the chemist's shop for the drugs that they need, as well as for a word of friendly advice and assistance. Without those shops, many elderly people would struggle to reach the larger, more distant outlets that would inevitably take over.
The hon. Member for Wakefield asked about the free market. The free market has a clear and important place in our society, but some parts of our local economy serve a social need and we jeopardise them at our peril. The Opposition would be deeply concerned if the Government made proposals that would lead to a reduction in the excellent services or accessibility currently provided by our community pharmacies.
§ Gregory Barker
Does my hon. Friend share my concern that the Labour Government, with all the zeal of a new convert to the free market, listen disproportionately to the voice of big business—the multinationals and the big players—and that the voice of the legion of small community businesses will go unheard?
§ Chris Grayling
It is very much my hope that, when we hear the Government's eventual verdict, that proves not to be the case. I hope that there is no sting in the tail. We want this issue to be resolved. The OFT report has been rejected already by the Scottish Parliament and the Welsh Assembly and in Northern Ireland. A substantial majority of Members have very clearly set out their views on the issue. Most of us have submitted petitions signed by thousands of people, representing the views of our local communities and saying that we do not want these changes to happen. It is time that the issue was laid to rest once and for all—time to give back stability to our pharmacy industry.
We have heard from hon. Members this evening that the OFT concluded from its work that removing restrictions on entry into the community pharmacy market would give greater choice to consumers. Of course, there is a strong argument that some people, such as hon. Members—professional, mobile people who are able to collect prescriptions on Saturday mornings when we do our shopping—would benefit greatly from more supermarket pharmacies, but such policy changes should not be directed primarily towards people like us. Will the elderly and young families without easy access to transport—perhaps the family car has been taken to a place of work during the day—still be able to gain easy access to pharmacies? Such things will be much less certain if these changes come to pass.
The ability of small, local pharmacies to withstand the pressures that deregulation and competition would bring lies at the heart of the debate. The message that I 322 am getting from my own constituency—other hon. Members are getting the same message from theirs—is that local community pharmacists believe that their business will disappear if the supermarkets open new outlets and, as a result, local services will disappear although people need them.
§ Chris Grayling
I will not give way now because I only have a couple of minutes left.
We are not talking about a free market in which lower prices will lead to growing sales and competition will improve and increase service standards for all. We are dealing with a tightly regulated and restricted market, where smart business practices cannot increase the size of the available cake. Local pharmacists derive the vast majority of their income—80 per cent. in many cases—from their work dispensing on behalf of the NHS, so they are much more like sub-contractors than retailers. They provide a service to our health service; they are not a part of the retail market, which is the point that the OFT investigators missed.
The danger is that, if a major supermarket opens a local pharmacy, the prescription business that it takes from other pharmacies will come straight off their sales. The risk is that we end up moving around the pieces of the cake and that the loser is the local village or town centre and the local pharmacy, but the ultimate losers are the elderly and those without transport, who will find those services less available to them. It is extraordinary that the OFT report does not seem fully to recognise that risk.
The report suggests that abolishing the control of entry rules would not lead to a substantial reduction in the number of pharmacies, but that is not the case, as I know from my own constituency, where several local pharmacies would disappear if one supermarket in particular opened a pharmacy. That view was reinforced by the evidence contained in the Select Committee report this morning. The Select Committee's verdict was quite clear: community pharmacies will disappear if the control of entry regulations disappear as well.
Of course, the risk is not just to pharmacies. In many rural areas, there are no local pharmacies; instead patients receive their drugs through dispensaries in their local GP practices. Britain's dispensing doctors are as vulnerable to such changes as community pharmacies, and the loss of their dispensaries in rural areas with little public transport could be disastrous for the elderly.
Of course, pharmacists are a vital part of our health service. They are a core part of the Government's health strategy and part of the NHS plan. They are highly professional, experienced people, with considerable medical knowledge and expertise to use on behalf of the NHS. Local pharmacies could take pressure off GPs and other parts of the NHS by providing the first port of call for minor ailments more often than is the case today, but we will not be able to reap that possible benefit if we lose neighbourhood pharmacies.
Our community pharmacists are an unsung part of our health service. They are health care professionals, not retailers. They have skills that have historically been underused. They are also a vital support to millions of 323 elderly patients. They are a cornerstone of local shopping parades and local shopping centres, particularly at a time when the great Post Office disaster is robbing so many of those centres of their local post office branch.
If the Government get the decisions on this issue wrong, they will do untold damage to communities around the country and to people who depend on the services that those community pharmacies provide. The message from the House should be clear: we value our community pharmacies and we do not want to lose them.
I commend the motion to the House.
§ The Minister of State, Department of Health (Ms Rosie Winterton)
We have been discussing an extremely important issue today, and community pharmacists and patients have been ill-served by the churlish way in which the main Front-Bench spokesman opened the debate and approached what is clearly a matter of concern to many of our constituents. His attitude is in marked contrast to that of some of his colleagues, particularly the hon. Member for East Surrey (Mr. Ainsworth) and the hon. Member for Epsom and Ewell (Chris Grayling), whom I thank for their support and welcome. Their contributions were much more thoughtful than that of the Opposition's main spokesman.
I completely understand the conviction and passion with which Members have spoken in support of community pharmacies, and I know that many Members will have personal experience of the excellent work done by pharmacists, the advice that they give, the services that they provide, and the confidence and trust that patients have in them, as was well illustrated by my hon. Friend the Member for Leigh (Andy Burnham).
§ Brian Cotter
I very much support what the Minister said about the Conservative Front-Bench. Notwithstanding that, will she take on board the serious concern expressed by the British Medical Association, the Patients Association and the Health Committee about the report? We are looking for a response from the Secretary of State, which will be critical, and we are hooking for that soon.
§ Ms Winterton
Certainly. As I was saying, I am sure that we all have relatives who have benefited from the personal touch of community pharmacists.
Right hon. and hon. Members have raised many points in the debate today. The hon. Member for Romsey (Sandra Gidley) brought her experience as a pharmacist to the Chamber, and spoke particularly about the issue of pharmacy services in supermarkets. I thank my hon. Friend the Member for Wakefield (Mr. Hinchliffe) for his welcome to me and for his comments about my right hon. Friend the Member for Darlington (Mr. Milburn). I thank him for all the work that he does on the Health Committee and the work that has been clone today in terms of the publication of the report on pharmacy services. It is an excellent report, which has been of great benefit to me in the short time that I have been in this job. I have been able to read about some of the background and to consider the way in which the 324 report acknowledges that much of the evidence that was submitted suggested that reform of the current system of control of entry may be necessary, while at the same time calling for reforms to take account of the wider role of pharmacies within the NHS. I assure members of the Committee that their report will be studied extremely carefully.
As my right hon. Friend the Secretary of State for Trade and Industry said, the OFT report provided an extremely useful analysis of the current market and highlighted the need for reform of the present regime. As many Members have pointed out, however, the service provided by community pharmacists cannot just be seen in the context of competition.
I would completely endorse that approach, and the report also needs to be seen in the context of our firm intention to see an increased role for community pharmacists in providing services to NHS patients, in using their skills and talents to better effect and in helping patients get the very best from their medicines.
Much of our approach was set out in our "Pharmacy in the Future" programme, which was published three and a half years ago and continued by my hon. Friend the Member for Tottenham (Mr. Lammy), who is now Parliamentary Secretary, Department for Constitutional Affairs. I pay tribute to him for the way in which he worked with all those involved to take the policy forward.
Many hon. Members have asked for examples of how services might be improved. The local pharmaceutical service is a key example of how services might look in the future. They will not only help to deliver an improved service for people with extra needs—especially the chronically sick and disabled—but will allow pharmacists to extend the type of work that they cover. We certainly want pharmacies to work more closely with GPs and other prescribers, and the new pharmacy contract and the potential new GP contract, along with new primary care trust initiatives, can all provide opportunities for the minor ailment clinics that hon. Members have mentioned repeat dispensing, supplementary prescribing and even independent prescribing. These are all issues to explore, as is increasing training so that pharmacists can become supplementary prescribers and are soon able to prescribe medicines at NHS expense in partnership with hospital doctors or GPs.
§ Ms Winterton
Our clear intention is for pharmacy to be recognised as a full contributor to primary care services, the first port of call for patients and consumers in discussing everyday health problems and a key driver in helping to reduce health inequalities. Those principles will frame our response, a response that delivers a balanced package of measures, promoting quality, choice and competition, but in the context—let me re-emphasise this—of the wider health policy objectives. It is a package that recognises pharmacy's place and ensures that it makes a full contribution to a 21st-century health service.
In the next few weeks, we will publish our response to the OFT report, as outlined by my right hon. Friend the Secretary of State earlier. Secondly, we will publish the new draft framework for the new national pharmacy contract. The Pharmaceutical Services Negotiating 325 Committee is about to canvass its members on the outline proposals and we will be discussing with the committee later this year the new remuneration regime to support that. Our aim remains to see the framework in place by April 2004. Thirdly, we will publish a consultation paper that will build on the vision set out three and a half years ago for pharmacy. It will take stock of progress and put forward new ideas and new concepts for the future of community pharmacy. We will certainly, as requested, give the House every opportunity to debate these proposals.
The Labour Government have increased investment in the NHS by a third over the next three years. Despite everything that the Opposition have said today, the Conservative party would cut investment in the NHS by 20 per cent. This Government believe in a health system based on need and not ability to pay, and in a health service for all and not just a privileged few.
I understand some of the concerns raised today, but I can assure the House that the Government want to see a community pharmacy service that is high quality, convenient for patients and makes full use of the skills and professionalism of community pharmacists. There will be reforms but those reforms—
§ David Maclean (Penrith and The Border)
rose in his place and claimed to move, That the Question be now put.
§ Question, That the Question be now put, put and agreed to.
§ Question put accordingly, That the original words stand part of the Question:—
§ The House divided: Ayes 197, Noes 338.329
|Division No. 240]||[6:59 pm|
|Ainsworth, Peter (E Surrey)||Burt, Alistair|
|Allan, Richard||Butterfill, John|
|Amess, David||Cable, Dr. Vincent|
|Arbuthnot, rh James||Calton, Mrs Patsy|
|Atkinson, Peter (Hexham)||Cameron, David|
|Bacon, Richard||Campbell, Gregory (E Lond'y)|
|Baldry, Tony||Carmichael, Alistair|
|Barker, Gregory||Cash, William|
|Baron, John (Billericay)||Chapman, Sir Sydney (Chipping Barnet)|
|Beggs, Roy (E Antrim)||Chidgey, David|
|Beith, rh A. J.||Chope, Christopher|
|Bellingham, Henry||Clappison, James|
|Bercow, John||Clifton-Brown, Geoffrey|
|Beresford, Sir Paul||Collins, Tim|
|Blunt, Crispin||Cormack, Sir Patrick|
|Boswell, Tim||Cotter, Brian|
|Bottomley, Peter (Worthing W)||Curry, rh David|
|Bottomley, rh Virginia (SW Surrey)||Davey, Edward (Kingston)|
|Davies, Quentin (Grantham & Stamford)|
|Brake, Tom (Carshalton)|
|Brazier, Julian||Davis, rh David (Haltemprice & Howden)|
|Brooke, Mrs Annette L||Djanogly, Jonathan|
|Browning, Mrs Angela||Dodds, Nigel|
|Bruce, Malcolm||Donaldson, Jeffrey M.|
|Burnett, John||Dorrell, rh Stephen|
|Burns, Simon||Doughty, Sue|
|Burnside, David||Duncan, Alan (Rutland)|
|Burstow, Paul||Duncan, Peter (Galloway)|
|Duncan Smith, rh Iain||Pickles, Eric|
|Evans, Nigel||Portillo, rh Michael|
|Ewing, Annabelle||Price, Adam (E Carmarthen & Dinfwr)|
|Fallon, Michael||Prisk, Mark (Hertford)|
|Field, Mark (Cities of London & Westminster)||Pugh, Dr. John|
|Flight, Howard||Redwood, rh John|
|Flook, Adrian||Reid, Alan (Argyll & Bute)|
|Forth, rh Eric||Rendel, David|
|Foster, Don (Bath)||Robathan, Andrew|
|Fox, Dr. Liam||Robertson, Laurence (Tewk'b'ry)|
|Francois, Mark||Robinson, Mrs Iris (Strangford)|
|Gale, Roger (N Thanet)||Robinson, Peter (Belfast E)|
|Garnier, Edward||Rosindell, Andrew|
|George, Andrew (St. Ives)||Ruffley, David|
|Gibb, Nick (Bognor Regis)||Russell, Bob (Colchester)|
|Gidley, Sandra||Salmond, Alex|
|Goodman, Paul||Sanders, Adrian|
|Gray, James (N Wilts)||Sayeed, Jonathan|
|Grayling, Chris||Selous, Andrew|
|Green, Damian (Ashford)||Shephard, rh Mrs Gillian|
|Green, Matthew (Ludlow)||Shepherd, Richard|
|Greenway, John||Simmonds, Mark|
|Grieve, Dominic||Simpson, Keith (M-Norfolk)|
|Gummer, rh John||Smith, Sir Robert (W Ab'd'ns & Kincardine)|
|Harris, Dr. Evan (Oxford W & Abingdon)||Smyth, Rev. Martin (Belfast S)|
|Hawkins, Nick||Spicer, Sir Michael|
|Hayes, John (S Holland)||Spink, Bob (Castle Point)|
|Heald, Oliver||Spring, Richard|
|Heath, David||Stanley, rh Sir John|
|Heathcoat-Amory, rh David||Steen, Anthony|
|Hendry, Charles||Streeter, Gary|
|Hermon, Lady||Stunell, Andrew|
|Hogg, rh Douglas||Swire, Hugo (E Devon)|
|Holmes, Paul||Syms, Robert|
|Horam, John (Orpington)||Tapsell, Sir Peter|
|Howard, rh Michael||Taylor, John (Solihull)|
|Hunter, Andrew||Taylor, Matthew (Truro)|
|Jack, rh Michael||Taylor, Dr. Richard (Wyre F)|
|Jackson, Robert (Wantage)||Taylor, Sir Teddy|
|Jenkin, Bernard||Thomas, Simon (Ceredigion)|
|Johnson, Boris (Henley)||Thurso, John|
|Key, Robert (Salisbury)||Tonge, Dr. Jenny|
|Kirkbride, Miss Julie||Tredinnick, David|
|Knight, rh Greg (E Yorkshire)||Trimble, rh David|
|Laing, Mrs Eleanor||Turner, Andrew (Isle of Wight)|
|Lait, Mrs Jacqui||Tyler, Paul (N Cornwall)|
|Lansley, Andrew||Tyrie, Andrew|
|Laws, David (Yeovil)||Viggers, Peter|
|Leigh, Edward||Walter, Robert|
|Lewis, Dr. Julian (New Forest E)||Waterson, Nigel|
|Liddell-Grainger, Ian||Watkinson, Angela|
|Lilley, rh Peter||Webb, Steve (Northavon)|
|Llwyd, Elfyn||Weir, Michael|
|Loughton, Tim||Widdecombe, rh Miss Ann|
|Luff, Peter (M-Worcs)||Wiggin, Bill|
|McIntosh, Miss Anne||Willetts, David|
|Maclean, rh David||Williams, Hywel (Caernarfon)|
|McLoughlin, Patrick||Williams, Roger (Brecon)|
|Malins, Humfrey||Willis, Phil|
|Maude, rh Francis||Wilshire, David|
|Mawhinney, rh Sir Brian||Winterton, Ann (Congleton)|
|May, Mrs Theresa||Winterton, Sir Nicholas (Macclesfield)|
|Moss, Malcolm||Wishart, Pete|
|Murrison, Dr. Andrew||Yeo, Tim (S Suffolk)|
|Oaten, Mark (Winchester)||Young, rh Sir George|
|O'Brien, Stephen (Eddisbury)||Younger-Ross, Richard|
|Paice, James||Tellers for the Ayes:|
|Paisley, Rev. Ian||Mrs. Cheryl Gillan and|
|Paterson, Owen||Mr. Mark Hoban|
|Adams, Irene (Paisley N)||Cryer, John (Hornchurch)|
|Ainger, Nick||Cummings, John|
|Ainsworth, Bob (Cov'try NE)||Cunningham, rh Dr. Jack (Copeland)|
|Anderson, rh Donald (Swansea E)||Cunningham, Jim (Coventry S)|
|Anderson, Janet (Rossendale & Darwen)||Cunningham, Tony (Workington)|
|Armstrong, rh Ms Hilary||Darling, rh Alistair|
|Atherton, Ms Candy||Davey, Valerie (Bristol W)|
|Austin, John||Davidson, Ian|
|Bailey, Adrian||Davies, rh Denzil (Llanelli)|
|Baird, Vera||Dawson, Hilton|
|Banks, Tony||Dean, Mrs Janet|
|Barren, rh Kevin||Denham, rh John|
|Battle, John||Dhanda, Parmjit|
|Bayley, Hugh||Dismore, Andrew|
|Beard, Nigel||Dobbin, Jim (Heywood)|
|Begg, Miss Anne||Dobson, rh Frank|
|Bell, Stuart||Donohoe, Brian H.|
|Benn, Hilary||Doran, Frank|
|Bennett, Andrew||Dowd, Jim (Lewisham W)|
|Benton, Joe (Bootle)||Dunwoody, Mrs Gwyneth|
|Berry, Roger||Eagle Maria (L'pool Garston)|
|Betts, Clive||Edwards, Huw|
|Blackman, Liz||Efford Clive|
|Blears, Ms Hazel||Ellman Mrs Louise|
|Blizzard, Bob||Ennis Jeff (Barnsley E)|
|Borrow, David||Farrelly, Paul|
|Bradley, Peter (The Wrekin)||Fisher Mark|
|Bradshaw, Ben||Fitzsimons, Mrs Lorna|
|Brennan, Kevin||Flint, Caroline|
|Brown, Russell (Dumfries)||Flynn, Paul (Newport W)|
|Browne, Desmond||Follett, Barbara|
|Bryant, Chris||Foster, rh Derek|
|Buck, Ms Karen||Foster Michael (Worcester)|
|Burden, Richard||Foster Michael Jabez (Hastings & Rye)|
|Byers, rh Stephen||Foulkes, rh George|
|Caborn rh Richard||Francis, Dr. Hywel|
|Cairns, David||Gapes, Mike (llford S)|
|Campbell, Alan (Tynemouth)||Gardiner, Barry|
|Campbell, Mrs Anne (C'bridge)|
|Campbell, Ronnie (Blyth V)||Gerrard, Neil|
|Caplin, Ivor||Gibson, Dr. Ian|
|Casale, Roger||Godsiff, Roger|
|Caton, Martin||Goggins, Paul|
|Cawsey, Ian (Brigg)||Griffiths, Jane (Reading E)|
|Challen Colin||Griffiths, Nigel (Edinburgh S)|
|Chapman, Ben (Wirral S)||Griffiths, Win (Bridgend)|
|Chaytor, David||Hain, rh Peter|
|Clapham, Michael||Hall, Mike (Weaver Vale)|
|Clark, Mrs Helen (Peterborough)||Hall, Patrick (Bedford)|
|Clark, Dr. Lynda (Edinburgh Pentlands)||Hamilton, David (Midlothian)|
|Hamilton, Fabian (Leeds NE)|
|Clark, Paul (Gillingham)||Hanson, David|
|Clarke, rh Tom (Coatbridge & Chryston)||Harman, rh Ms Harriet|
|Harris, Tom (Glasgow Cathcart)|
|Clarke, Tony (Northampton S)||Havard, Dai (Merthyr Tydfil & Rhymney)|
|Clwyd, Ann (Cynon V)||Healey, John|
|Coaker, Vernon||Henderson, Ivan (Harwich)|
|Coffey, Ms Ann||Hendrick, Mark|
|Cohen, Harry||Hepburn, Stephen|
|Coleman, Iain||Heppell, John|
|Connarty, Michael||Hesford, Stephen|
|Cook, Frank (Stockton N)||Hewitt, rh Ms Patricia|
|Cook, rh Robin (Livingston)||Heyes, David|
|Cooper, Yvette||Hill, Keith (Streatham)|
|Corston, Jean||Hinchliffe, David|
|Cousins, Jim||Hodge, Margaret|
|Cranston, Ross||Hoey, Kate (Vauxhall)|
|Crausby, David||Hope, Phil (Corby)|
|Cruddas, Jon||Hopkins, Kelvin|
|Cryer, Ann (Keighley)||Howarth, rh Alan (Newport E)|
|Howarth, George (Knowsley N & Sefton E)||Marshall, Jim (Leicester S)|
|Howells, Dr. Kim||Martlew, Eric|
|Hughes, Beverley (Stretford & Urmston)||Meacher, rh Michael|
|Hughes, Kevin (Doncaster N)||Michael, rh Alun|
|Humble, Mrs Joan||Miliband, David|
|Hurst, Alan (Braintree)||Miller, Andrew|
|Hutton, rh John||Mitchell, Austin (Gt Grimsby)|
|Iddon, Dr. Brian||Moffatt, Laura|
|Illsley, Eric||Moonie, Dr. Lewis|
|Ingram, rh Adam||Moran, Margaret|
|Irranca-Davies, Huw||Morgan, Julie|
|Jackson, Glenda (Hampstead & Highgate)||Morley, Elliot|
|Morris, rh Estelle|
|Jackson, Helen (Hillsborough)||Mountford, Kali|
|Jamieson, David||Mudie, George|
|Jenkins, Brian||Mullin, Chris|
|Johnson, Alan (Hull W)||Munn, Ms Meg|
|Johnson, Miss Melanie (Welwyn Hatfield)||Murphy, Denis (Wansbeck)|
|Murphy, Jim (Eastwood)|
|Jones, Jon Owen (Cardiff C)||Murphy, rh Paul (Torfaen)|
|Jones, Kevan (N Durham)||Naysmith, Dr. Doug|
|Jones, Lynne (Selly Oak)||Norris, Dan (Wansdyke)|
|Jones, Martyn (Clwyd S)||O'Brien, Bill (Normanton)|
|Jowell, rh Tessa||O'Brien, Mike (N Warks)|
|Joyce, Eric (Falkirk W)||O'Hara, Edward|
|Keeble, Ms Sally||O'Neill, Martin|
|Keen, Alan (Feltham)||Osborne, Sandra (Ayr)|
|Keen, Ann (Brentford)||Owen, Albert|
|Kemp, Fraser||Palmer, Dr. Nick|
|Khabra, Piara S.||Perham, Linda|
|Kidney, David||Picking, Anne|
|Kilfoyle, Peter||Pickthall, Colin|
|King, Andy (Rugby)||Pike, Peter (Burnley)|
|King, Ms Oona (Bethnal Green & Bow)||Plaskitt, James|
|Knight, Jim (S Dorset)||Pond, Chris (Gravesham)|
|Kumar, Dr. Ashok||Pope, Greg (Hyndburn)|
|Ladyman, Dr. Stephen||Pound, Stephen|
|Lammy, David||Prentice, Ms Bridget (Lewisham E)|
|Lawrence, Mrs Jackie|
|Laxton, Bob (Derby N)||Prentice, Gordon (Pendle)|
|Lazarowicz, Mark||Prescott, rh John|
|Lepper, David||Primarolo, rh Dawn|
|Leslie, Christopher||Prosser, Gwyn|
|Levitt, Tom (High Peak)||Purchase, Ken|
|Lewis, Ivan (Bury S)||Purnell, James|
|Liddell, rh Mrs Helen||Quin, rh Joyce|
|Love, Andrew||Quinn, Lawrie|
|Lucas, Ian (Wrexham)||Rammell, Bill|
|Lyons, John (Strathkelvin)||Rapson, Syd (Portsmouth N)|
|McAvoy, Thomas||Raynsford, rh Nick|
|McCabe, Stephen||Reed, Andy (Loughborough)|
|McCafferty, Chris||Reid, rh Dr. John (Hamilton N & Bellshill)|
|McCartney, rh Ian|
|McDonagh, Siobhain||Robertson, John (Glasgow Anniesland)|
|MacDougall, John||Robinson, Geoffrey (Coventry NW)|
|McGuire, Mrs Anne||Rooney, Terry|
|McIsaac, Shona||Ross, Ernie (Dundee W)|
|McKechin, Ann||Roy, Frank (Motherwell)|
|McKenna, Rosemary||Ruane, Chris|
|Mackinlay, Andrew||Russell, Ms Christine (City of Chester)|
|McNulty, Tony||Ryan, Joan (Enfield N)|
|MacShane, Denis||Salter, Martin|
|Mactaggart, Fiona||Sarwar, Mohammad|
|McWalter, Tony||Savidge, Malcolm|
|Mahmood, Khalid||Sawford, Phil|
|Mahon, Mrs Alice||Sedgemore, Brian|
|Mallaber, Judy||Shaw, Jonathan|
|Mann, John (Bassetlaw)||Sheerman, Barry|
|Marris, Rob (Wolverh'ton SW)||Sheridan, Jim|
|Marsden, Gordon (Blackpool S)||Short, rh Clare|
|Simpson, Alan (Nottingham S)||Turner, Dennis (Wolverh'ton SE)|
|Singh, Marsha||Turner, Dr. Desmond (Brighton Kemptown)|
|Smith, rh Andrew (Oxford E)|
|Smith, rh Chris (Islington S & Finsbury)||Turner, Neil (Wigan)|
|Twigg, Derek (Halton)|
|Smith, Geraldine (Morecambe & Lunesdale)||Tynan, Bill (Hamilton S)|
|Vaz, Keith (Leicester E)|
|Smith, Jacqui (Redditch)||Vis, Dr. Rudi|
|Smith, Llew (Blaenau Gwent)||Ward, Claire|
|Soley, Clive||Wareing, Robert N.|
|Southworth, Helen||Watson, Tom (W Bromwich E)|
|Spellar, rh John||Watts, David|
|Starkey, Dr. Phyllis||White, Brian|
|Steinberg, Gerry||Whitehead, Dr. Alan|
|Stevenson, George||Williams, rh Alan (Swansea W)|
|Stewart, David (Inverness E & Lochaber)||Williams, Betty (Conwy)|
|Stewart, Ian (Eccles)||Wilson, Brian|
|Strang, rh Dr. Gavin||Winnick, David|
|Straw, rh Jack||Winterton, Ms Rosie (Doncaster C)|
|Stuart, Ms Gisela||Woodward, Shaun|
|Sutcliffe, Gerry||Woolas, Phil|
|Taylor, rh Ann (Dewsbury)||Worthington, Tony|
|Taylor, Dari (Stockton S)||Wrignt Anthony D. (Gt Yarmouth)|
|Taylor, David (NW Leics)||Wright, David (Telford)|
|Thomas, Gareth (Clwyd W)||Wright, Tony (Cannock)|
|Timms, Stephen||Wyatt, Derek|
|Todd, Mark (S Derbyshire)||Tellers for the Noes:|
|Touhig, Don (Islwyn)||Jim Fitzpatrick and|
|Trickett, Jon||Charlotte Atkins|
§ Question accordingly negatived.
§ Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
§ MR. DEPUTY SPEAKER forthwith declared the main Question, as amended, to be agreed to.
That this House agrees that the OFT report on the "Control of Entry Regulations and Retail Pharmacy Services in the UK" provides a useful analysis of the market impact of the current control of entry regulations on consumers and competition and highlights the need for the present regime governing pharmacies to be updated; favours change to open up the market and improve quality and access without diminishing the crucial role that community pharmacies play, especially in poorer areas; and supports the need for a balanced package of measures which plays to the strengths of community pharmacies and enhances the role of pharmacists in the modern NHS