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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.
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".
- "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 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 favour
- "change to open up the market and improve quality and access without diminishing the crucial role that pharmacies play, especially in poor and rural areas".
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:
- "Deregulation 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?"
6.34 pm
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?
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."
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.
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