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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
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
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.
- "in areas where there are no NHS dispensing pharmacies, dispensing by GPs offers a further mechanism to ensure appropriate access to prescribed medicines."
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.
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.
John Mann: Will the hon. Lady give way?
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.
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