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Community Pharmacists
7. Mr. John Healey (Wentworth): What role he plans for community pharmacists in the future delivery of primary health care services. [98932]
17. Mr. Mark Todd (South Derbyshire):
What steps he has taken to increase the role and recognition of pharmacies in primary care. [98942]
The Minister of State, Department of Health (Mr. John Denham):
We have made it clear that we believe that community pharmacists have an important role to play in primary health care. We can do more to realise their full potential. Community pharmacists, who of course offer free advice on the high street and with no appointment, will play a major role in the Department's "Choose the right remedy" winter campaign, and we shall be publishing a strategy document, setting out ways of making better use of the skills and expertise of community pharmacists within the new national health service.
Mr. Healey:
I thank my hon. Friend for that encouraging reply, but can he confirm when the first limited pharmacist prescribing pilots will begin? Will he consider the case for the Rotherham local pharmacists committee to play a part in those pilots, in view of the fact that, for nearly two years, local pharmacists have been advising some general practitioners on prescribing, and that that has led to drugs budget savings and better-quality prescriptions?
Mr. Denham:
There is no doubt that pharmacists can help make better use of prescribed medicines. They can help with more cost-effective prescribing through advice to GPs and through the effective management of patients' medication regimes. We are keen to encourage those developments in several ways, including the involvement of pharmacists with primary care groups. We have supported the Pharmaceutical Services Negotiating Committee's medicines management project through funding, although that project is not yet ready to consider pilot sites. Therefore we are committed to developing the role of community pharmacists, and as part of that process we have had discussions with the pharmacy and medical professions about proposals to enable pharmacists to supply on the NHS some medicines that do not need a doctor's prescription. Again, we are not in a position to introduce firm proposals on that, but it is being given close scrutiny.
Mr. Todd:
I welcome both the Minister's encouraging replies on the subject. The rural pharmacies in my area,
Mr. Denham:
On my hon. Friend's first point, if there are issues of particular concern about the payment of remuneration, I shall certainly be happy to consider them in greater detail. Rural pharmacies play a very important role in the countryside and my hon. Friend may be interested to know that, in the not too distant future, my noble Friend Lord Hunt will meet the Pharmaceutical Services Negotiating Committee and the general practitioners committee of the British Medical Association to consider some of the issues involved.
The global sum for pharmacies was increased by 3 per cent. this year--well above the rate of inflation--and we believe that that is a fair settlement. From time to time, we discuss more detailed issues with the negotiating committee.
Mr. James Gray (North Wiltshire):
It is easy for the Minister to pay lip service to how the Government listen to rural pharmacies. Is he not aware that people, such as the old people and young mothers in my constituency who live many miles from the nearest town, utterly rely on rural pharmacies? The fact that Lord Hunt will have a meeting in the next few weeks will do nothing to resolve the problem. Many pharmacies are close to bankruptcy and will go out of business shortly. By what mechanism does the Minister know how many pharmacies in rural areas are going out of business, and what does he intend to do about it?
Mr. Denham:
I am not aware of any significant trend of the sort that the hon. Gentleman has tried to describe. The position on the supply of pharmacies and pharmaceutical services in rural areas is stable. There are issues that arise because of the conflicts that have come up in the past between doctors who wish to dispense in rural areas and the provision of rural pharmacies. We have said for some time to the negotiating committee and to the British Medical Association that we would be prepared to consider, without obligation, any joint proposals that came forward to resolve the impasse that has existed for some time. It is proposals of that sort that Lord Hunt will be discussing in a few weeks time, but it is too early to say whether that will lead to a resolution of the problem. At least the two sides have got together and made some proposals. That is a considerable step forward.
Dr. Jenny Tonge (Richmond Park):
Does the Minister agree that, with the approach of Christmas and the millennium celebrations, there will be an escalating need for advice on family planning, contraception and the supply of the necessary things? Indeed, a very eminent member of the Labour party has already demonstrated that need--and Christmas is not yet upon us. Will the Minister
Mr. Denham:
The plans made--probably in greater detail than ever before--for the winter and the millennium period include and have included at local level the provision of the widest range of local pharmaceutical services. We have made every effort to ensure that the services that people can normally obtain from a pharmacy at other times of the year will be available over the millennium period as well.
8. Shona McIsaac (Cleethorpes):
If he will make a statement on the use of NHS Direct. [98933]
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart):
NHS Direct currently handles around 100,000 calls a month. Nearly one in five callers have used the service before, indicating a high level of satisfaction with and confidence in NHS Direct. I am pleased to be able to inform my hon. Friend that NHS Direct will be available to her constituents in Cleethorpes from the end of November.
Shona McIsaac:
Does not NHS Direct demonstrate the gulf of difference between Labour and the Conservative party? With us, health care is the price of a local phone call, and with the Conservative party, it is the price of private health provision. Does my hon. Friend have any evidence that health care is being extended through NHS Direct?
Ms Stuart:
NHS Direct is the most visible demonstration that the Government are committed to modernising the national health service, not privatising it. In the House, a previous Health Minister described NHS Direct as "peripheral and frivolous", and that is not true. NHS Direct evidence shows that men in particular are using health advice more extensively; some 2,000 callers a month are directed to call an ambulance and therefore receive more appropriate services, and some two thirds of callers receive advice on treatment or seek GP services. If the Conservative party does not recognise those achievements, that simply shows how out of touch it is with the real world.
Dr. Peter Brand (Isle of Wight):
I am of course delighted that people contact the NHS when it is appropriate, but has the Minister done any work to demonstrate that calls to NHS Direct would not have been made to other services? What is the cost per contact for NHS Direct as opposed to the cost per contact for other services? Will the Minister assure us that where there are well-established out-of-hours services, NHS Direct will not become a competing service but will be integrated with existing services?
Ms Stuart:
Independent evaluation of NHS Direct calls is being conducted, and all the evidence has consistently shown that two thirds of callers take action that is different from and more appropriate than the action that they had originally intended to take. More importantly, all the evidence in areas where NHS Direct works with
The university of Sheffield will publish more extensive research next year which will allow us to validate the current regional evidence, and by the end of next year, national figures will be available when the service is rolled out completely.
9. Helen Jackson (Sheffield, Hillsborough):
What plans he has to improve mental health services. [98934]
The Secretary of State for Health (Mr. Alan Milburn):
Modernising mental health services is one of the Government's key health priorities. We are increasing investment and setting new national standards, and now propose to change mental health legislation.
Helen Jackson:
Does the Secretary of State agree that there is still a great deal of fear and stigma attached to mental illness, which is often characterised by loss of employment and consequent loss of income for families, and that the burden and costs of care frequently fall on relatives and on the communities where the patient lives? Does he agree that extra funds for community health care should be a top priority?
Mr. Milburn:
My hon. Friend is right. There is a great deal of stigma attached to mental health, but the truth is that one in four people in our country will, at some point in their life, have a mental health problem. It is true also that, for far too long, mental health services have been outside the mainstream of the national health services and social services. We are seeking to put that right. I do not pretend, and I certainly do not give an assurance to my hon. Friend, that those problems can be solved overnight, because they cannot. The state of the mental health services that we inherited was simply deplorable, but we shall make them better. We are making them better step by step.
We are investing extra resources. As the Minister of State, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), has just explained to the House, an extra £700 million will be invested this year, next year and the following year to modernise mental health services, not only in hospitals but in the community--because, as we know, the majority of people with a mental health problem are treated in the community. We have to make sure that those services are appropriate, fast and fair, just as we want fast and fair services throughout the whole of the NHS.
Mr. Nick St. Aubyn (Guildford):
Owing to the pressures of life in the fast lane of Britain's economy, mental health services are just as much in demand in our most affluent areas as they are in those that are less-well-off. Does the Secretary of State recognise that? Will the Advisory Committee on Resource Allocation report on the matter, and if so, when does he expect it to do so? Will he take account of the fact that, since this Government came to power, the amount of money
Mr. Milburn:
I would very much like to see the figures to which the hon. Gentleman refers. The Conservative Front-Bench team are always calling for less money for the NHS, describing our spending on mental health and the NHS generally as madness, reckless and irresponsible, yet Conservative Back Benchers are always calling for more spending in their own areas. The truth is that it is more money for the NHS with this Government, and less with the Tories. Since they are always asking for an honest debate about health service priorities and spending, it is time they started to itemise, treatment by treatment and service by service, the spending that they think is reckless and mad, which services they would cut and which patients would have to put their money where the hon. Gentleman's mouth is.
Mr. George Stevenson (Stoke-on-Trent, South):
Is my right hon. Friend aware that progress in improving mental health services in north Staffordshire is made much more difficult by the fact that the area receives £8.2 million below its basic target funding? Although we in north Staffordshire very much welcome the additional resources that the Government have provided for specific NHS initiatives, what assurances can my right hon. Friend give that serious anomalies in basic target funding will be addressed as a matter of urgency, so that we may make the progress in mental health services that we desperately need?
Mr. Milburn:
My hon. Friend has raised this issue with me on previous occasions. Of course we recognise that we must have a funding system that not only ensures that health providers throughout the country get the resources that they need to modernise mental health and other services, but represents a fair allocation of resources. That is why, last year, we announced a fundamental review of the way in which health resources are allocated. That work is going on now, and I expect a report in a year or so. It parallels the review of local government methods of allocation being undertaken by my right hon. Friend the Deputy Prime Minister. I expect the consequence to be not just more money for the NHS, which is what the Government are providing, but a fairer means of allocating extra resources.
Dr. Liam Fox (Woodspring):
Last year, the Secretary of State said:
Mr. Milburn:
The antipsychotic drugs are one of the new forms of drugs and treatment that we have referred to the National Institute for Clinical Excellence. The hon. Gentleman knows that, so I do not know why he raises the issue. He also knows that we have referred to NICE other drugs and treatments for cancer, coronary heart
Dr. Fox:
I apologise for asking a question that the Secretary of State found it awkward to answer, but I thought that that was the point of Question Time. His answer was just as evasive and nonsensical as many of those given earlier by his colleagues on the Front Bench. Psychiatrists are telling us that they cannot prescribe the new drugs as a result of financial restrictions. The drugs have fewer side effects and result in better patient compliance, which is especially important in the treatment of schizophrenic patients. When prescription is refused on cost grounds, it is a failure to fulfil the duty of care, bad for the patient and dangerous in the community. Are not antipsychotic drugs, beta interferon and the new anti-cancer drugs being routinely denied to NHS patients on grounds of cost? Is it not true that Ministers are administering the NHS with a lethal cocktail of complacency and incompetence? Their words are meaningless and their promises worthless, because they say one thing and do another.
Mr. Milburn:
I suppose that was the soundbite. On the issue of the new generation of antipsychotics, the hon. Gentleman knows full well that the Government have made available extra resources to health authorities throughout the country precisely to enable the new treatments to be prescribed. He says that he knows best about the treatments, but it is precisely because we have referred the issue to the National Institute for Clinical Excellence, that we shall, for the first time in the history of the NHS, have clear and authoritative guidance on what works best and which treatments work for which patients. The fact that we have done that signifies the priority that we attach to ensuring that patients with mental health problems receive the sort of treatment that they deserve.
"As now, no one will be denied the drugs that they need. That is a guarantee."--[Official Report, 30 June 1998; Vol. 315, c. 143.]
Will he guarantee that none of the new antipsychotic drugs have been denied to patients as a result of their cost?
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