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2.49 pm

Kevin Barron (Rother Valley) (Lab): I congratulate the hon. Member for St Ives (Derek Thomas) on securing this debate.

I am the chair of the all-party group on pharmacy in Parliament and I have been for more than five years. I have a keen interest in public health and lifestyle issues, and I have quite enjoyed chairing the group. After the letter of 17 December, the all-party group—three Members of this House and one from the other place—met the Minister, on 13 January. We had what I described afterwards as “straightforward talking” about the letter—a letter that posed more questions about the future of pharmacy than it gave answers. The Minister was straightforward, and he said that one issue was that, in October of this year—so just for the second half of the financial year—£170 million will be taken out of the community pharmacy budget. That leaves a number of questions to be answered, including that of what will happen in a full financial year.

The Government make great claims about putting an extra £8 billion into the national health service, but the truth is that that £170 million, which is part of the £22 billion of efficiency savings, is being taken out of the NHS, so it is hardly new money. It is not the £8 billion—that comes in a few years’ time. We are talking here about major cuts to vital services.

Since the publication of that letter, it has become clear that as many as 3,000 community pharmacies could close in England alone—a quarter of them. How would that happen? Would it be by stealth, which is suggested in the letter and in the consultation currently coming out of the Department, or is there some sort of plan? We have seen in the letter, and in others, that if there is a 10-minute walk between pharmacies, that might be looked into, but there seems to be no plan whatsoever.

What we have to accept—I put to this to the Minister in that meeting on 13 January—is that pharmacists do not work for the national health service, yet more than 90% of community pharmacies’ income comes from the NHS. The idea that we could change that mechanism and close community pharmacies is outrageous. The pharmacists may not work for the national health service, but their income depends massively on it—I wish it did not.

For many years I have been promoting lifestyle issues and the idea of pharmacists getting paid for doing things other than just turning scrips over, but that is how it works at the moment and there needs to be some serious talking. What happens if someone who has a 10-year lease on a property they took over to run the local pharmacy is forced out of business? All those questions remain unanswered, yet there is the threat of up to 3,000 pharmacies in England closing.

Rachael Maskell: I am following the argument that my right hon. Friend is putting forward. Does he agree that, instead of cutting services, we should be looking at opportunities for community pharmacies to extend healthcare further into their communities? It should be about investment at this time, particularly in prevention, which is all about saving money further down the line.

Kevin Barron: I agree with my hon. Friend. That is one of the reasons I took over as chair of the all-party

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group more than five years ago. I believe that our pharmaceutical services should be taking that route of travel.

It would help if the Government provided details of how they will ensure access to pharmacy services in remote or deprived communities. If the market will drive closures, there will be chaos, and something substantial needs to be in place.

Mr George Howarth (Knowsley) (Lab): My right hon. Friend makes a powerful case. He mentioned the market. Does he agree that one difficulty that smaller independent pharmacies, such as John Davey in my constituency, have is that unlike the big chains they are unable to negotiate favourable deals on the drugs they dispense and, therefore, they are already at a disadvantage in market terms? Before the Government go any further with the programme they need to address that important issue.

Kevin Barron: I do not disagree with my right hon. Friend. I will not use the name of the company, but I can go into the store of one of the major chains, which is not in my constituency but not far away, and it takes me a minute to walk to the prescription counter, whereas in most of the pharmacies in my constituency I can get there in two or three seconds. We must recognise that, at constituency level, we are not comparing like with like.

Another thing is that key payments for pharmacies will be phased out, and there might be a drive towards a commoditised medicine supply service with an increased focus on warehouse dispensing and online services. Again, the possibility of added value in a local pharmacy regarding lifestyle issues potentially goes out of the window, and we really need to look at that. I have no direct experience, but I am told that they have that in the United States.

As well as dispensing medicines, community pharmacy teams help people to stay well and out of GP surgeries, to get the most benefit from their medicines and to manage their health conditions. The NHS spends £2 billion a year on GP consultations for conditions that pharmacy teams could treat. Community pharmacy can and should do more. A national community pharmacy minor ailments service could save the national health service some £1 billion a year. In some of the pharmacies in my constituency, there is already a minor ailments service. I understand that the Government recently changed their mind about developing such a service at a national level, and I would like to know why. Such a service makes great sense to me. It keeps pressure off not only GP surgeries but the local A&E.

In 2014-15, pharmacies delivered more than 3.17 million medicines use reviews, to increase people’s understanding and help them to take their medicines correctly. We get a lot more from our pharmacies than their just turning scrips over. Our communities and our constituencies need that, and if there are to be any changes, they should be carried out in a sensible and planned way, and not in the chaotic way of some of the suggestions of recent weeks.

2.56 pm

Huw Merriman (Bexhill and Battle) (Con): It is a pleasure to serve under your chairmanship, Mr Streeter.

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I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on introducing this important debate.

Some 28% of my constituents, across our 200 square miles of East Sussex, are over the age of 65. Losing our pharmacies would affect all my constituents, but I am particularly concerned about the impact on the elderly and vulnerable. I spoke today with a pharmacist in the village of Ticehurst in my constituency, who told me about his concerns. First, he is concerned that the Government might cut 6% from his dispensing fees. Secondly, he is concerned that they might withdraw the £2,500 that all pharmacists are paid annually. Thirdly, he is concerned that the Government might impose a clawback, meaning that if a budget is overspent, pharmacists might be required to reimburse their fees. Fourthly, he is concerned that the pharmacy will have to cover the welcome introduction of the national living wage and the cost of new pension arrangements.

I understand that it is essential for the NHS to make savings—£22 billion over this term—and it therefore seems reasonable to expect the £2.8 billion pharmacy budget to contribute to that. The Government rightly point out that many of our pharmacies are situated in walking distance clusters, but I am concerned that the proposed funding changes, if not sensibly targeted, could affect not just pharmacies in clusters but the rural pharmacy that is miles from another one and more than just a dispensing chemist. Because a pharmacist knows his or her customers, he or she is able to advise them on solutions more cost-effectively than if they were to utilise the wider NHS, including GPs and A&E.

Mr Steve Baker (Wycombe) (Con): In an unscientific Twitter survey, which I kicked off at the beginning of the debate, 62% of respondents say they would prefer to see a community pharmacist first. Does my hon. Friend agree that the Government should be clear when making their funding allocation about the extent to which people would prefer to make use of community pharmacists before they see GPs?

Huw Merriman: Much as I prefer to disagree with everything that is said on Twitter, I could not disagree with that particular scientific survey.

Julian Sturdy (York Outer) (Con): My hon. Friend is making a powerful argument about rural pharmacies. A pharmacist in my constituency contacted me. He said that, if the proposed cuts go through, he will have to cut staff and the apprentices he is training, as well as reduce opening hours and stop the free services, such as the deliveries to housebound patients. The cuts would not just stop the important services that my constituents and many others get from rural pharmacies; it would also deeply impact on skills, and on skills going back into the services that we have to protect.

Huw Merriman: I very much agree my hon. Friend’s point, and I can give another two reasons why pharmacists are so important. Like the post offices, our pharmacists also act as the eyes and ears for the welfare of certain vulnerable constituents. As a staple part of our village and town centres, pharmacies provide the footfall that allows our pubs, restaurants and shops to survive in an increasingly difficult environment.

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I am not a deficit denier, and it would be hypocritical to be elected on the platform of balancing the Government books by 2020 and then to refuse to countenance savings in this area. It strikes me, however, that a better focus for efficiency is not the fees for dispensing, but the volume of drugs wasted by over-dispensing. For example, some drugs may be dispensed for a period of three months, only for the individual to change a course of treatment or stop treatment altogether. As soon as those drugs leave the pharmacy, they have to be used or destroyed. I wonder exactly how much money could be saved by dispensing for shorter periods of time.

Additionally, I find it extraordinary that pharmacists deliver NHS prescriptions free of charge to all who want that service. I understand why those who cannot collect their prescriptions should get them delivered, but to provide free delivery, effectively on the NHS, appears to be an area that is ripe for efficiency savings. I welcome the Government’s proposal for a pharmacy access scheme. That would provide more NHS funds to certain pharmacies based on factors such as location and the health needs of the population. To that end, I ask the Government to distinguish and make a special case for rural pharmacies and to focus their efficiencies on those pharmacies that are within closer proximity to each other. If difficult choices are to be made, let us ensure that our constituents can still access a pharmacy within their locality.

3.1 pm

Stephen Pound (Ealing North) (Lab): As ever, it is a pleasure to serve beneath your firm but benevolent eye, Mr Streeter. I congratulate the hon. Member for St Ives (Derek Thomas) on bringing this important, relevant and timely matter before us. It is similar to an Adjournment debate I secured in the previous Parliament, to which the right hon. Member for North Norfolk (Norman Lamb) responded, and to a question I put to the Minister the week before last on this very subject. In both cases, the response I received was one of warm words but few concrete proposals and little reassurance for the community pharmacies.

Like everyone else in this Chamber, I happen to believe that the Minister is a good and decent man, but I fear I can see the handcuffs of the Treasury holding him tight. I feel that he is beneath the terrifying thrall of the Treasury. The proposals are nothing to do with improving patient service. They are nothing other than a pathetic attempt to balance the books on the backs of one of the most productive, hard-working, positive and excellent groups of people in our society: the modern community pharmacist. Every day, they perform a miracle on the high street. They have changed from the old-fashioned world of the dispensing retail chemist to the modern world of preventative medicine. In fact, in many ways pharmacies are multi-speciality community providers. It will not have escaped your notice, Mr Streeter, that we have here Members representing the highlands and islands, the Isles of Scilly, the Isle of Wight, Southend-on-Sea, and Members from Armagh to Ealing. This issue is one that the whole nation is concerned about.

Mr George Howarth: I am sure it was an oversight by my hon. Friend that he did not include Knowsley in that long list. I hope that the high street pharmacies are not depending on miracles. I rather hope that they are dependent on science.

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Stephen Pound: Not for the first time in my life, I have been corrected by my right hon. Friend. When I referred to a miracle on the high street, I was referring to the contrast between the traditional chemist that we have known in the past and the modern community pharmacist. To go into the modern community pharmacy is to see a treatment room or an interview room, to get a blood pressure test or travel advice or to get advice on smoking cessation, healthy eating or obesity. Those are all things that we would never have thought of before with a pharmacy. To my mind, that is miraculous, mostly because it has been organic and has not come about by Government diktat. As a great believer in state centralism, I find that quite shocking, but that is all the more reason for this area to be nurtured, supported and not threatened.

The point that greatly concerns me is that the proposals go against the grain of all current thinking—not just the Carter review and the “Five Year Forward View”, which is the NHS document that talks about an enhanced role for the community pharmacist—and against every single professional body. That is not just Pharmacy Voice and the royal colleges. Everyone seems to feel that the proposals are a retrogressive step that will not only make the situation worse, but that cannot be justified because the knock-on costs to overcrowded GPs, A&E departments and urgent care centres will ultimately end up costing us so much more.

This issue concerns me greatly. One cannot imagine a more different constituency from that of the hon. Member for St Ives than mine in west London. I represent a tightly knit urban community. People are close together and tightly packed, as opposed to the great rural beauty of the Isles of Scilly. We are, however, what is known as an under-doctored area, which is typical of the big cities. The typical GP in my constituency is a single-handed elderly practitioner, often operating out of a terraced house. That is changing, but as it is changing there is a period in which a great many of my constituents—many of them are transient constituents who are moving in and moving out, and cannot register with a GP nor wait two or three weeks to see a GP, and they queue up at the A&E department or the urgent care centre and cannot be treated—are asking, “Where can we go?” The answer is that they can go to a source of good, sound advice that is both responsive and preventive. They can go to a person who is qualified and skilled. In many cases in my part of the world, we have community pharmacies with two or three pharmacists who are experts in their area. We can even do minor injuries. There is no reason why we should not expand the community pharmacies.

There is much talk of the seven-day NHS, and the model exists before our eyes. The NHS can be a seven-day service in the community pharmacies and, I profoundly hope, everywhere else. The opening hours of the community pharmacies—they are sometimes found in hospitals and supermarkets—are a great model that we should be working to support. I know that the Minister’s heart is in the right place. I know that he wants to stand up and say, “I will resist the Treasury diktat and support the community pharmacists for the sake not just of all our constituents, but of future generations, too.” Community pharmacists deserve that, and they are certainly entitled to it.

3.7 pm

Oliver Colvile (Plymouth, Sutton and Devonport) (Con): May I say what a pleasure it is to serve under

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your chairmanship, Mr Streeter. I have been involved in the whole business of pharmacies since 10 to 15 years ago, when I worked commercially on the campaign for resale price maintenance. Members may remember that the then Government were seeking to get rid of resale price maintenance on many prescription medicines. So I have been following the area closely.

I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on securing the debate. Members should be aware that I am the Government’s pharmacy champion, as well as the vice-chairman of the all-party pharmacy group. The right hon. Member for Rother Valley (Kevin Barron) is the chairman.

Just before Christmas, the Government announced that they wanted to review community pharmacies, and I very much welcomed that. The Government’s consultation process on community pharmacies needs to ensure that health service money is targeted better on where it can deliver the best results. The consultation process has highlighted that there is an oversupply or clustering of pharmacies in specific locations. The other day, I was driving back to London from my constituency, and I noticed that there were three or four pharmacies within two or three minutes’ walk of each other. To my mind, that has to be looked at.

The issue is how we ensure that the changes to the funding mechanism ensure the desired results, namely, the reduction of clusters while ensuring that we do not damage key parts of the pharmacy network. Using funding to make the changes is potentially a blunt instrument, and it will impact on smaller volume pharmacies in rural areas in particular. They are a part of the network that is desperately needed. What mechanisms are envisaged to achieve those goals? I understand that some large pharmacy groups might be willing to give up the leases on some of their shops, but they want to know whether the Government will give them an assurance that the leases will not be handed over to another chain of pharmacies. Perhaps my right hon. Friend the Minister will explain what approach the Government will take to ensure that that does not happen.

Pharmacies, particularly community pharmacies, are undergoing unprecedented changes. They want to expand and to assist in meeting primary care demand, diverting activity from A&E to support more patients with self-care and in the prevention of ill health. Pharmacy is increasingly seen as a large part of the solution to the shortage of doctors and nurses in primary care. We are watching the spiralling demand for practices and community pharmacies, which is about delivering that patient care.

We need to support the innovation in roles to facilitate change in the infrastructure: information exchange, organisation, and working practices. Current investment in the innovation fund will probably not provide the level of investment needed, and access to transformation funds for this purpose seems unlikely. The change is needed to manage demand more effectively, but, unless supported, we place the system and the patients it serves at high risk. Can we therefore ensure that higher priority is given to ensuring that the changes are effectively supported?

Stephen Pound: On the subject of changes, and bearing in mind that the increase in prescribing is about 2.5% per annum, does the hon. Gentleman honestly believe that

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the Government’s proposal for a hub-and-spoke prescribing model, breaking the link between the patient and the pharmacist, represents value for money, or even sanity?

Oliver Colvile: There are two things. First, it is important that the consultation process reaches a conclusion. For us to try to premeditate on that would be unhelpful. Secondly, there are examples of where the Government have been able to make sure that money is better focused and better used. They can make budgets sweat quite well, and we should certainly take that into account.

I very much welcome the review, as I believe that community pharmacies should have a much wider role than simply dispensing prescriptions. They can take the pressure off hectic GP surgeries and our hard-pressed accident and emergency units. Such venues should provide alternative services such as help with mental health conditions, smoking cessation and suchlike. The Government need to ensure that pharmacies are the first point of contact when patients are looking for minor help, such as flu jabs. We also need to make sure that patients in our rural villages have access to pharmacies, although in urban conurbations, such as my Plymouth, Sutton and Devonport inner city constituency, there should not be a plethora of chemists just for the sake of having them. We need to make sure that patients’ safety is paramount when pharmacies are dispensing medicines.

Over the past five years I have consistently campaigned for the Government to decriminalise dispensing errors made by pharmacies. At present, GPs can be struck off if they make a prescription error, whereas pharmacists can be sent to prison for exactly the same thing. We need a level playing field. Despite being the Government’s pharmacy champion, I am going to be slightly critical of the Government over this issue. We hoped that it would be sorted through secondary legislation before the general election. During a debate on the Access to Medical Treatments (Innovation) Bill, which was promoted by my hon. Friend the Member for Daventry (Chris Heaton-Harris), I questioned the Department of Health’s decision to delay the necessary legislation until after the devolved Assembly elections and the new Executives and Governments had had a chance to introduce their own legislation. This means it is unlikely to be introduced before the summer, so English pharmacists are now dependent on legislation being passed for other pharmacists. So much for fair devolution. When my right hon. Friend the Minister sums up, will he explain why English pharmacies have to wait until the Welsh, Scottish and Northern Irish Assemblies have passed the necessary legislation?

I understand that the Government are keen for pharmacies to be able to share summary care records to ensure that they are fully informed of patients’ medical history when giving medical advice. What progress is my right hon. Friend’s Department making?

Yesterday, I met the General Pharmaceutical Council, the pharmacy regulator since 2010. Various issues were raised by the GPC, especially the Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016, which was in its Grand Committee stage in the House of Lords yesterday. I welcome this section 60 order, as it will bring much-needed transparency to the GPC’s reporting on inspections. There must be transparency. The section 60

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would also allow the GPC to take proportionate action when pharmacies fail to meet essential standards. This is just one of the reasons why I support the section 60 order.

Pharmacy has the potential to play a huge part in community healthcare in Britain. However, we need to address the fundamental flaws in the system so that our communities are better served by pharmacy and our healthcare system is used responsibly.

3.15 pm

Mr Mark Williams (Ceredigion) (LD): I note the time, Mr Streeter, and your stipulation about when Front-Bench speeches will start. I thank the hon. Member for St Ives (Derek Thomas) for initiating this important debate. As I look around the Chamber today, I see that Members from Wales, Scotland and Northern Ireland are outnumbered, which is appropriate, given the letter that was sent and the cuts that pharmacists might endure. In Wales, the issue of health is almost entirely devolved, so much of what is being discussed today will be different in Wales than it is in England. However, the community pharmacy contractual framework is an England and Wales arrangement, so what happens in England could impact on Wales.

The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) mentioned the issue of devolved Administrations and delays. Our understanding is that the consultation will conclude, the Minister will reflect, and an announcement will be made during the Assembly election campaign period. We will not have a health Minister in Wales if decisions made in Whitehall impact on the delivery of services in Wales. I think that it has something to do with the respect agenda and waiting for a health Minister to be in place.

Oliver Colvile: Does the hon. Gentleman recognise that if there were delays in Wales, Scotland or Northern Ireland, the English pharmacies would end up waiting behind that queue?

Mr Williams: The hon. Gentleman should address that question to the Minister. The timing represents an unfortunate mismatch, for which pharmacists in England might pay the price. The timetable is of the Government’s making, not mine, so the Minister needs to reflect on that.

I want to talk about two facets of this debate that have been touched on by the hon. Members for St Ives and for Bexhill and Battle (Huw Merriman): the issue of rurality and the impact of the cuts. The consultation document stated:

“40% of pharmacies are in clusters of 3 or more meaning that two-fifths of pharmacies are within 10 minutes walk of 2 or more other pharmacies”.

Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab): I am sure that the hon. Gentleman is going to make an excellent point about rural pharmacies, but there is another element in my constituency, where I met my local pharmacist, Mike Maguire of Marton Pharmacy. Two of our minor injury units have closed and there is a proposal to close another walk-in centre, after the last one was closed. The collateral impact of the withdrawal of those services reduces the ability of

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the average patient and customer to access services. There is not only the rural aspect but the specific need at the time.

Mr Williams: The hon. Gentleman is right. That has been the message of many contributions. The work of our community pharmacies complements the work of the national health service. When the hon. Gentleman’s constituency is hit in the way that it has been, that represents the proverbial nail in the coffin of decent community-based services for the hon. Gentleman’s constituents.

On the urban point, to reiterate the point made by the right hon. Member for Rother Valley (Kevin Barron), we are talking about well-established community businesses that impact on many people in the locality. Two or three businesses clustered in the same area doing a generally good job will have an impact on the local economy, but the rural point is fundamental. We have heard about the pressures on GPs and the difficulties in getting appointments. In my vast rural constituency of Ceredigion, we have a district general hospital in Aberystwyth: Bronglais hospital. We have a good many GPs throughout the country. We also have a network of very effective pharmacists, and it is a jigsaw that works in providing good services. There are 716 community pharmacies in Wales—in high streets, villages and towns—with 50,000 people visiting those facilities every single day, proving the efficiency of the much-maligned Welsh national health service and bridging the real difficulty that people have in visiting the closest hospital or a GP for something as routine as blood pressure or cholesterol checks. It is really important that the outcome of the debate is that we support community pharmacies. That is fundamental.

In Wales we have developed our services. I visited the pioneering pharmacy of Mr Richard Evans in the town of Llandysul 11 years ago. He was clearly of the view that we could develop services much more, to relieve pressure on the national health service, and he achieved that. In Wales pharmacies have offered NHS flu jabs for at-risk groups for the fourth winter running. Almost 20,000 people in Wales benefited from that last winter. After four years of that provision in Wales, the NHS in England introduced the same service for the first time. Community pharmacies in Wales can treat about 30% of the common ailments that people would normally go to a GP for. That is a huge saving for the national health service. Pharmacies also promote meaningful public health campaigns. I visited the pharmacy in Borth, where there is a campaign on Parkinson’s disease. The staff are doing a good job talking with victims of Parkinson’s disease about their medication, and promoting awareness in the community.

Finally, having praised what is being done in Wales, in a rural area, I want to seek an assurance from the Minister that if his consultation has an effect on the three levels of services in the framework, there will be meaningful consultation with Assembly Ministers in Cardiff, and that any negotiations on changes to the contract will involve Welsh Government officials at the negotiating table. This is one of the small areas where health is not devolved, and that is particularly relevant on the Welsh border; it requires the respect agenda, on anything that the Minister concludes.

Mr Gary Streeter (in the Chair): As a reward for his patience, Mr Graham Jones has eight minutes.

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3.21 pm

Graham Jones (Hyndburn) (Lab): I congratulate the hon. Member for St Ives (Derek Thomas) on securing the debate. It is somewhat of a rerun of the post offices debate mentioned earlier. Post offices provide a commercial service, but the key point is that they also provide a public service. My view is that the UK’s pharmacy network must be protected. They are vital because they are accessible and have good geographical coverage: 95% of the population can currently get to a pharmacy on foot within 20 minutes. For deprived populations, the elderly and young families whose car may be taken to work, such services that can be reached by walking are essential.

Local pharmacies provide advice and reassurance.

Rebecca Harris (Castle Point) (Con): Will the hon. Gentleman give way?

Graham Jones: No, I will not; I am sorry, but there is not enough time.

Pharmacies are also vital because they are beginning to be part of a better national health service, providing a first point of contact; 1.8 million people visit a pharmacy each day. They are an essential part of the pyramid of care that has been mentioned. Accident and emergency departments are stretched, and the solutions that will bring about better healthcare must start further upstream, with pharmacies. A pharmacist wrote to me:

“Pharmacies need to evolve and we have always engaged with the governments in the past to deliver the targets, and greater use of pharmacies must be made to reduce the hospital attendances in the AE”.

There are 36,000 patient visits to my local walk-in centre, which is a fraction of the number of visits to GPs. Yet A and E, the walk-in centre and GPs are all stretched. Local pharmacies are vital for access and as part of a model of healthcare delivery in the UK that relieves some of the current pressures and dispenses advice that puts prevention rather than cure at the heart of healthcare.

My local pharmacy in Baxenden is part of an innovative model of care: the healthy living pharmacy framework is a tiered commissioning framework, aimed at achieving consistent delivery of a broad range of high-quality services through community pharmacies to meet local health needs, improving the health and wellbeing of the local population, and helping to reduce health inequalities. What that means in plain English is that those pharmacies are the first point at which healthcare and health advice is delivered. That includes workforce and workplace development—developing a skilled team who can proactively support and promote behaviour change and improve health and wellbeing. Work done by the healthy living pharmacy initiative has shown that 70% of people who visit pharmacies do not regularly access other healthcare services. Those pharmacies are well placed to support the health and wellbeing of people in the community by, as has been mentioned, providing improved choice, and access to early interventions on such issues as optimal use of medicines, obesity, alcohol and smoking. That should improve outcomes in the short and long term, and have an impact on the cost of care in the future.

The Pharmaceutical Services Negotiating Committee evaluations of HLPs to date found that they

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“demonstrate an increase in successful smoking quits, extensive delivery of alcohol brief interventions and advice, emergency contraception, targeted seasonal flu vaccinations, common ailments, NHS Health Checks, healthy diet, physical activity, healthy weight and pharmaceutical care services.”

The report also indicates that the HLP model is working in areas with different demography and geography. I cannot vouch for the PSNC evaluations, but I welcome the actions taken by my local pharmacy to be available to local people and offer better health advice.

Across Lancashire, pharmacists such as Linda Bracewell at Baxenden pharmacy are keen to see HLP rolled out across Lancashire. That requires support from the Government and the NHS. All pharmacies, including HLPs, are a vital part of the healthier Lancashire agenda. Yet today pharmacies are under threat from two directions. Those threats are the reductions in Government support—the 6.1% cut by the Department of Health in community pharmacy funding, which comes to a total reduction in funding of £170 million—and market forces. I want to move on to consider that other threat.

My right hon. Friend the Member for Rother Valley (Kevin Barron) mentioned changes in the market, such as the growth of warehouse pharmacies that seek profit—this is the Amazon model—at the expense of both the public service element and geographical access points. That is a cause for concern. Not everyone is online, or comfortable with such remote arrangements. There is no guarantee that such a method of providing pharmacy services has a role in a healthy living environment, or a better healthcare delivery system. Will it engage with hard-to-reach communities?

Over Christmas I was shown a letter by Linda Bracewell that was sent to a constituent by Pharmacy4U, a mail order pharmacist. Worryingly, it was passed off as an official letter. People would feel obliged to fill it in and send it off. It was personalised, and, crucially, it redirected customers with repeat prescriptions to Pharmacy4U. Worse, Pharmacy4U is just one of several emerging online mail order warehouse companies—box shifters. It was not clear that the letter was not official but a marketing ploy. It is a matter of great concern that the letter was part of a mass mailing, sent specifically to people with existing prescriptions. Their GP practice was named on the letter as though it came from that practice. That is a worry for pharmacies.

How did Pharmacy4U get access to patient practice details? Is it right that the letter I saw was allowed to look like an official document and a request for detail, when in fact it was simply permission to transfer existing prescriptions—a huge business for local pharmacies—to a warehouse pharmacy? Even more worrying was the fact that all the patients of GP practices with electronic data systems had been mailed, while patients of GP practices without such electronic patient systems had not been mailed. Does Pharmacy4U have business connections to the data company that provides GPs with electronic patient data systems, and the patients of those practices? The Minister should be aware that those issues are serious, and that such sharp business practices and models threaten existing pharmacies. The presence of warehouse pharmacies operating on an Amazon model is of concern to me and, I am sure, our constituents, because it erodes the public service element of the current pharmacy network—particularly the healthy living pharmacies.

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In conclusion, does the Minister recognise the public service element of pharmacies? Does he want to preserve the current pharmacy network? Does he see pharmacies as having an increasing role in healthcare delivery? Does he think that there will be more or fewer pharmacies after his review is implemented?

3.30 pm

Roger Mullin (Kirkcaldy and Cowdenbeath) (SNP): It is a great pleasure to serve under your chairmanship, Mr Streeter. As this is a health debate, I hope you will not consider it inappropriate if I start by saying that my thoughts are very much with Pauline Cafferkey. Earlier today she was hospitalised in Glasgow for the third time after contracting the Ebola virus. She is being flown to London for treatment at the Royal Free hospital. I am sure that the whole House will join me in wishing her the very best.

The debate has been extraordinarily good, so I extend my thanks to the hon. Member for St Ives (Derek Thomas) for this timely initiative on his part. I had a standard speech prepared, but such has been the debate that I would like instead to reflect on the contributions we have heard so far. Some might be wondering why a Scot representing a Scottish constituency is here at all. At least some people present have emailed me to say, “Even though this debate is not about Scotland, we would very much appreciate hearing a Scottish voice.” What I bring to the debate is shared by everybody present: a concern to maintain community pharmacies because they are a vital part of all our communities.

When making his compelling case, the hon. Member for St Ives said that patients see pharmacists as the first port of call. They do indeed. My own wife, Barbara, has a condition known as post-polio syndrome, which means that she has to take a wide variety of medicines that often vary. It is essential for her that she is able to go along and talk to a pharmacist as her condition varies over time. If she always had to burden a GP when she needed such advice, that would put an unnecessary strain on local GP services.

Rebecca Harris: A lot of people who go to community pharmacies in my constituency such as Bharat Patel’s and Asif’s go there with problems that they would not wish to burden their GP with, but that are a burden to themselves, so it is a great relief for them to be able to talk things through with someone. Does the hon. Gentleman agree that sometimes people go to a pharmacist because they would be uncomfortable or embarrassed to go to their local, perhaps single-handed, GP? They might want to ask for alcohol advice or about something that they find embarrassing, or perhaps a young girl might want to ask for emergency contraceptive but not wish to see the receptionist, who is her mother’s friend whom she has known all her life.

Roger Mullin: I agree entirely with the hon. Lady’s point. Moving on a little, the right hon. Member for Rother Valley (Kevin Barron) described very clearly the long-term funding consequences of the Government’s proposals. As he indicated, they are planning to insert £8 billion more into the NHS while at the same time seeking to cut £170 million from pharmacies. The use of market forces to cull pharmacies does not really make any sense. The hon. Member for Bexhill and Battle

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(Huw Merriman) made a telling point that relates to the intervention that the hon. Member for Castle Point (Rebecca Harris) just made: he said that pharmacists can act as the eyes and ears of the vulnerable in our communities. That is the other side of the coin to the point she made about people who feel under stress or strain in their immediate circumstances very often seeing the pharmacist as their first port of call.

The hon. Member for Ealing North (Stephen Pound), in his typical style, with quiet presentation, pointed out that the proposals will affect every community, whether up in the highlands and islands or down in Ealing North. Indeed, he said that they will affect every community in terms of both the science and the magic that is involved. Everybody here is, I think, as one in our desire to develop pharmacies, yet, as he pointed out, the Treasury is seeking to put on the shackles for the sake of a £170 million saving. As I have previously spoken in Treasury debates, I made a note to point out that that saving would amount to less than half of what the Government could save if they simply closed the so-called Mayfair loophole. Pharmacists provide a service far beyond that supplied by many financial advisers in our society.

The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) discussed the need to reduce clusters. When he was talking, I immediately thought of the hon. Member for Ealing North, who would no doubt advise him that perhaps we would do better by going back to some old-fashioned central planning to do things more coherently, rather than using market forces. If we use only market forces, the people who are going to be served least well are those in the large rural communities, whether in Wales or many parts of England. The hon. Member for Ceredigion (Mr Williams) made an excellent case about the importance of such far-flung rural communities and the critical services provided by community pharmacies.

Finally, I was very taken by one of the statistics cited by the hon. Member for Hyndburn (Graham Jones) early in his speech. I have to say I was not aware that 1.8 million people visit pharmacies each day, not merely for the dispensing of drugs but to see someone from whom they can get advice and in whom they can place their trust. Everybody who has contributed to the debate has pointed out that pharmacists supply a service to our communities that goes far beyond that provided by what we used to call in the old days the local chemist. They are highly qualified people who can provide a range of expertise. As the hon. Member for St Ives pointed out, many have masters degrees in specialist areas. In all honesty, in some areas of medicine they can provide advice that goes beyond the expertise of a GP. To lose that in any way, particularly in the most vulnerable communities, would be a sad loss indeed. I am very aware of wanting to leave some time for the hon. Gentleman to say a few words at the end, so I simply congratulate him again on an excellent debate.

3.37 pm

Barbara Keeley (Worsley and Eccles South) (Lab): It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Member for St Ives (Derek Thomas) on securing this important debate. I join the Scottish National party spokesperson, the hon. Member for Kirkcaldy and Cowdenbeath (Roger Mullin), in

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sending good wishes to Pauline Cafferkey, which I am sure we all wish to do. It is very disturbing to hear that she has become ill again.

In what has been a wide-ranging debate, we have had heard from Members about the importance of community pharmacies to their constituents. I thank my hon. Friend the Member for Ealing North (Stephen Pound) for not only giving us an impressive list of the additional services available from community pharmacies but, importantly, discussing the role that they can play in under-doctored areas, which is an issue in my constituency. We must of course consider rural areas, but urban areas can also be very short of services. In my constituency, we have lost walk-in centres and other forms of community support, such as active case-management pilots. It is a pity that such excellent services that keep people away from GPs and hospitals are being cut.

As we have heard again and again in the debate, community pharmacies provide an essential service in dispensing both medication and the essential information and advice that can prevent people from having to visit their GP for common health problems. On 17 December, the day the House rose for the Christmas recess, the Government announced a £170 million cut to community pharmacy services, with further cuts to follow. That initial 6% cut in the funding for community pharmacies will put significant financial pressure on many of them and will result in closures and job losses. Can the Minister assure us that the service offered to patients will not suffer due to the cuts? It is hard to see how there will not be a loss to patients. Will he comment on the additional pressures that will be placed back on the NHS as a result of that loss?

As my right hon. Friend the Member for Rother Valley (Kevin Barron) said, the Minister had a meeting with members of the all-party parliamentary group on pharmacy. I understand from the note of that meeting that he estimated that between 1,000 and 3,000 pharmacies, out of the overall total of 11,700, could close. He also recognised that smaller pharmacies are likely to be squeezed. Such a significant number of pharmacy closures will have a substantial impact on the way that the pharmacy sector operates. The sector called the cuts a “profoundly damaging move”, so it is important that the Minister updates us on the number of pharmacies at risk of closure. The Government failed to outline funding plans for subsequent years, raising concerns that there could be even deeper cuts later in this Parliament. Will the Minister tell us what further cuts are planned?

Despite the cuts, the Government say they want

“greater use of community pharmacy and pharmacists: in prevention of ill health; support for healthy living; support for self-care for minor ailments and long term conditions; medication reviews in care homes; and as part of more integrated local care models.”

As with everything else to do with care, a letter from the Department for Health suggests that the reforms can be carried out by integrating community pharmacies into a range of primary care settings. Integration is fine in itself, but it will not be achieved through funding such as the pharmacy integration fund, which is set at £20 million and will rise to £100 million by year five. I understand that the majority of the funding will focus on providing pharmacy services at GP practices, but that overlooks the wider role that community pharmacies play, which hon. Members have talked about in the debate.

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My hon. Friend the Member for Denton and Reddish (Andrew Gwynne) passed me a note about the Windmill Pharmacy in his constituency. In a couple of hours on Saturday, its pharmacists dressed an elderly man’s superficial wound, gave advice on a fungal infection, advised on vaccines and malaria tablets for people travelling abroad, counted and sorted the tablets for many patients with multiple conditions, gave an antibiotic eye drop for a child with an infected eye, gave repeat blood pressure tablets to a patient whose GP was away, and, of course, had their technicians set up the dosette boxes for patients, including those with dementia, who rely on that service. All those services are freely provided in pharmacies. That is an excellent example from my hon. Friend’s constituency. How does the Minister expect community pharmacies to improve their services and continue to do all of those things when they face a significant decrease in funding and are simultaneously being asked to provide greater support to GP practices, care homes and accident and emergency units?

It has been suggested that we should facilitate hub-and-spoke arrangements, but there are real concerns about that system. My right hon. Friend the Member for Rother Valley said:

“Warehouse dispensing, or ‘hub and spoke’, raises questions around safety, quality and access. The supply of prescription medicines cannot be treated like buying clothes and DVDs. High quality, safe dispensing depends on the opportunity for a face-to-face discussion between the pharmacist and the patient. I don’t see how that can be done in a warehouse.”

I share those worries, which were expressed very well by my hon. Friend the Member for Hyndburn (Graham Jones), who asked some important questions about warehouse chemists’ practices and the data security implications of what they do. Most importantly, the Government must tell us how they will ensure that the essential face-to-face contact between pharmacists and patients is maintained.

Pharmacy Voice outlined the negative consequences of the cuts to community pharmacy services. It is concerned that the funding cuts will increase the risks to patient safety and will decrease patient access to medicines and vital support. The cuts risk job losses and will diminish community assets and the long-term potential of community pharmacies. Pharmacy Voice also warned that the cuts are likely to undermine existing health improvement plans and recent initiatives to integrate and develop community pharmacy services. We heard about some wonderful examples of integration and new ways of working in this debate, but all of that will be dashed.

Sue Sharpe, the chief executive of the Pharmaceutical Services Negotiating Committee, said that the plans

“can only impair pharmacies’ contribution to keeping people well and out of GP and urgent care settings.”

The Government are, in her words,

“proposing to drive ahead to radically change the market with a real paucity of knowledge essential for good decision making.”

We want decisions to be based on better information than we have heard about here.

In my constituency, I have been in contact with the chair of the Salford and Trafford local pharmaceutical committee, Varun Jairath, who is a board member of Community Pharmacy Greater Manchester. He believes that patient safety and welfare are at risk from the planned funding cuts, which means that the community

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pharmacy network will have to reduce staffing levels and the services it offers for free, such as the home delivery of medication, which has been referred to again and again. I went with a delivery driver from a local pharmacy to hand out information to carers in homes who receive medication. Vital extra things such as that can be done, but only with the existing service levels.

The additional services provided by community pharmacies are at risk from the funding cuts. The minor ailments scheme, which was piloted in Eccles in my constituency, was shown to free up capacity and cash for other areas of primary care by allowing GPs to focus on the more complex patients. That service can continue at £3 per consultation only if community pharmacies continue to be funded at current levels. Such services, which improve quality and save cash, are under threat due to the proposed cuts.

As a number of right hon. and hon. Members said, one of the most worrying effects of the cuts is the potential reduction in rural pharmacy services. Access to pharmacy services should not be reduced for people who live in areas with widely dispersed populations. I ask the Minister—he has been asked this question already—what his assessment is of the impact that the funding cuts will have on rural pharmacies.

To reduce pressure on NHS services, the Government have repeatedly suggested that people should visit their local pharmacy for advice and the extra services we have talked about in the debate. Putting extra pressure on GPs through these funding cuts to community pharmacies is risky. GPs have warned that their workload is becoming unmanageable, which is likely to have an impact on patient safety. In a recent survey of about 3,000 GPs, 55% said that the quality of the service they provide has deteriorated in the past year, and 70% said they feel that their workload is unmanageable some or all of the time. I spoke to a local GP in my constituency recently in a practice whose list size had just been increased by 15%. The GPs at that practice cannot cope with that increase plus any extra that they gain from the losses that have been outlined in the debate.

We recognise the need to integrate pharmacy services better with the rest of primary care, but introducing cuts on this scale to community pharmacy services will not improve primary care outcomes. It will do the opposite. I fear that pharmacies will struggle to provide safe, good-quality services to patients. In proposing the cuts, the Government failed to recognise the value of community pharmacies and to put patients at the heart of their plans for pharmacy services. Patients will bear the brunt of these inappropriate cuts to an essential community service. A joint co-ordinated approach to planning and investment is needed across primary care to ensure that the pharmacy sector can play the important role it could fulfil, and, as I know from all the contacts I have had, wants to fulfil, and ensure that patients get the most out of both the NHS and pharmacies.

3.48 pm

The Minister for Community and Social Care (Alistair Burt): As others have said, it is a great pleasure to serve under your chairmanship, Mr Streeter. Thank you for chairing this debate. I also thank my hon. Friend the Member for St Ives (Derek Thomas) for bringing this debate to Westminster Hall and giving colleagues the

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opportunity to make such a range of comments. They all have a good knowledge of things in their areas, and some have more specialised knowledge. We heard from the right hon. Member for Rother Valley (Kevin Barron), my hon. Friend the Member for Bexhill and Battle (Huw Merriman), the hon. Member for Ealing North (Stephen Pound), my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile), the hon. Member for Ceredigion (Mr Williams), the hon. Member for Hyndburn (Graham Jones) and, not least, the hon. Member for Kirkcaldy and Cowdenbeath (Roger Mullin), in whose constituency I have spent many happy hours—my father was born in Auchterderran, so I know the area very well. Although the hon. Gentleman is from Scotland, his contribution was welcome, and he made some pertinent points.

Before I make some prepared remarks, I want to put some things on the record. I would be foolish if I did not understand the widespread interest in this debate. I would also be naive if I believed that this is the last time we will discuss this issue. Many questions were asked, so this will run for a while. Let me set out the background before I make my prepared remarks.

First, we are having this debate at a relatively early stage of the negotiations between the Government and the Pharmaceutical Services Negotiating Committee, which is handling matters on behalf of the pharmacy profession. Many of the questions and issues raised by colleagues on both sides are at the heart of those discussions. What sort of services will there be? Where is pharmacy going? How exactly will the reduction in finance be handled and distributed? Not all the answers are available at this stage because a proper negotiation process is being undertaken. Understandably, colleagues will look at the most adverse potential consequences to make a point when representing their constituents. I understand that, and the points have been perfectly fair. We are at that point in the process. We think we know what the worst may be, but we do not know the outcome or what changes there will be for the better.

Secondly, on finance, we are all realists here. We would love to work in a world where the status quo is not changed except for improvements, where the only issue with money is where more can be spent and where change, if there is to be any, takes forever to bring in. Life is not like that. The Government’s spending commitment for the national health service—an extra £10 billion a year by 2020—has to start being found early. It is not only about extra money, but about the efficiencies that the NHS chief executive identified, which are to be found across the board and could partly come from the pharmacy sector’s £2.8 billion of funding, which the Government propose to reduce. It may be an appropriate place. Again, we often approach such matters with the view that no possible reduction could ever improve services anywhere. That is not true, as we know from the experience of successive Governments.

The third bit of the background is where we are in relation to where pharmacy is going. The Royal Pharmaceutical Society’s November 2013 report, “Now or never: shaping pharmacy for the future”, states that the traditional model of community pharmacy needs to change due to

“as economic austerity…a crowded market of local pharmacies, increasing use of…automated technology to undertake dispensing, and the use of online and e-prescribing”.

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The Nuffield Trust’s report, “Now more than ever: Why pharmacy needs to act”, states:

“Community pharmacy is subject to a particularly complex set of commissioning arrangements, which appear to support the status quo and inhibit innovation at scale.”

We would love to be in a situation where, as the hon. Member for Ealing North described, everything is absolutely great and every pharmacy offers all the services and delivers them marvellously, but that is not necessarily the case. Accordingly, change is sometimes inspired by necessity and can be for the better. That is part of the background to where we are.

Graham Jones: The Minister makes the point that, to pay for the £10 billion increase in NHS funding, funds are being shifted from other sources, including the £2.8 billion spent on pharmacies. However, the principle should not be to shift funding from primary care to secondary care. Our fundamental principle should be to shift—if we have to—money from secondary care to primary care, which is preventive and will cut costs in the long term.

Alistair Burt: The hon. Gentleman makes a fair point, and that is indeed being done in the NHS, but we are looking at where efficiencies can be made and at what different parts of the health sector can contribute. In doing so, we can see what changes are inspired in the service provided to patients.

To emphasise where we are with pharmacy, there are 11,674 pharmacies in England, which has risen from 9,758 in 2003—a 20% increase—while 99% of the population can get to a pharmacy within 20 minutes by car and 96% by walking or using public transport. The average pharmacy receives £220,000 a year in NHS funding. On clusters, which my hon. Friend the Member for Plymouth, Sutton and Devonport mentioned, the Government contend that money can perhaps be saved in one place and used elsewhere for the delivery of new services. That is the reality of life. It would be great if new money was always coming from somewhere, but bearing in mind that the Government are dealing with an Opposition who could not commit to the extra £8 billion that the NHS was looking for, we have to make the changes that others were not prepared to make and still deliver services.

Let me move on to where we are going. Everyone in this room, Government Members included, recognises the quality of the best pharmacy services around the country. We are familiar with the valued role that community pharmacy plays in our lives and those of our constituents. I am grateful to my hon. Friend the Member for St Ives for giving me the opportunity to put on public record the high esteem that we hold them in and to set out our plans for the future.

I am a firm believer that the community pharmacy sector already plays a vital role in the NHS. I have seen at first hand quite recently the fantastic work that some community pharmacies are doing across a wide range of health services that can be accessed without appointment. Many people rely on them to provide advice on the prevention of ill health, support for healthy living, support for self-care for minor ailments and long-term conditions, and medication reviews. There is also real potential for us to make far greater use of community

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pharmacy and pharmacists in England. For example, I am due to speak at an event tomorrow that is looking at the role that pharmacy can play in the commissioning of person-centred care for vulnerable groups.

Our vision is to bring pharmacy into the heart of the NHS. We want to see a high quality community pharmacy service that is properly integrated into primary care and public health in line with the “Five Year Forward View”. I cannot answer all the questions that the hon. Member for Worsley and Eccles South (Barbara Keeley) asked, but she did at least mention the integration fund for the first time in the debate.

Barbara Keeley: There is a difficulty, in that funding for integration should recognise that the extra work needs to be done. The point of today’s debate has been about the Government using blunt instruments, such as a 6% cut in funding, reducing the number of pharmacies in clusters, changing dispensing charges, and the warehouse pharmacy that my hon. Friends mentioned. It is the use of those blunt instruments, not the working with the sector, that is the fault.

Alistair Burt: That working with the sector is ongoing. That is what the negotiations with the Pharmaceutical Services Negotiating Committee are all about. I take the hon. Lady’s point, but those discussions are under way. We are consulting with a wide range of groups, not just the PSNC, including patients and patient bodies.

As part of what we are doing for the future of pharmacy, we want pharmacists and their teams to practise in a range of primary care settings to ensure better use of medicines and better patient outcomes and to contribute to delivering our goal of truly seven-day health and care services. As part of that, I want to work with NHS England to promote local commissioning of community pharmacy within the health community, so that we can ensure the best use of this valuable resource. That is why we are consulting on how best to introduce a pharmacy integration fund to help to transform the way pharmacists and community pharmacy will operate in the NHS of the future. By 2020-21, we will have invested £300 million in the fund.

While it is understandable that the focus of most colleagues’ comments today was access to existing services, little was said about where pharmacy might be going and what new opportunities there will be. That is part of the overall development that we are hoping to achieve, which will include the work not only of the access fund, but of the integration fund.

Colleagues asked several questions about access. I want to provide some reassurance. We recognise that some of the Government’s proposals have caused concern, and that will take some time to distil as the negotiations are worked through. We are committed to maintaining access to pharmacies and pharmacy services. We are consulting on the introduction of a pharmacy access scheme, which will provide more NHS funds to certain pharmacies compared with others, considering factors such as location and the health needs of the local population, both of which were raised today. Qualifying pharmacies will be required to make fewer efficiencies than the rest of the sector. We certainly recognise that rural pharmacies will need to be considered in that, and we want to ensure that location matters in areas of sparsity. That work is ongoing.

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In conclusion, the process has some way to run. I simply put it to colleagues that, in relation to good community services on the high street, there is more for modern pharmacy to do. Looking at the proposals of the past, we hope that the profession shares the Government’s determination to move pharmacy into a new future, and I am convinced that the future will be good.

Mr Gary Streeter (in the Chair): Derek Thomas has 40 seconds in which to respond coherently.

3.59 pm

Derek Thomas: Thank you, Mr Streeter, and I thank Members for their contributions, which have been really helpful. I thank my right hon. Friend the Minister for seeking to the tackle the many issues that have been raised. We all agree that the NHS is a fantastic institution. Community pharmacists hold some of the keys to improving patient care in the community and reducing pressure on GPs and other NHS services. I hope that the debate has gone some way to empower pharmacists to offer the solutions that the Government are seeking in order to secure a modern-day NHS, but this is all about the best care for patients, which we all agree is what really matters.

Motion lapsed (Standing Order No. 10(6)).

[Mr Philip Hollobone in the Chair]

Mr Philip Hollobone (in the Chair): Will those who are not staying for the next debate please leave quickly and quietly? We now come to a very important subject to be addressed by the Member for the sunniest place in the United Kingdom, Caroline Ansell.

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Military Training: Mental Health Resilience

4 pm

Caroline Ansell (Eastbourne) (Con): I beg to move,

That this House has considered opportunities for mental health resilience in military training.

All of us in this place realise the debt we owe to our armed forces personnel and to their families for the sacrifices they make to keep us safe. It has to be acknowledged that unless we, too, have seen active service, faced danger and death, witnessed carnage and experienced loss we cannot fully appreciate or understand the impact and the price that some pay.

I had second-hand experience of such sacrifice when working in a boarding school. I was in loco parentis to 25 teenage girls whose fathers were serving in Bosnia. I saw something of the impact of protracted periods of lives lived apart and of relationships stretched. I saw something of the fear and anxiety of children for their father, and the loneliness and challenge for the parent left behind. Boarding school often provided the continuity that families need and, for the overwhelming majority, service life is one of purpose, identity and fulfilment, with men and women going on to lead successful lives thereafter. For the estimated one in five who bear the unseen scars, however, every opportunity to build resilience or mental toughness needs to be recognised.

The Ministry of Defence recognises mental illness, including post-traumatic stress disorder, as a serious disabling condition, but—importantly—as one that can be treated. My question today is, can it be prevented? In the US Battlemind programme, mental resilience training has been dubbed “armour for your mind”. Can we put mental health resilience on the same footing as physical fitness or, indeed, physical armour?

David Simpson (Upper Bann) (DUP): This is an important debate and I am sure that the hon. Lady agrees with the importance of having full implementation of the military covenant throughout the whole of the United Kingdom. I am sure she shares my frustration that in Northern Ireland we cannot achieve that. The points she is making are very important.

Caroline Ansell: I absolutely subscribe to the hon. Gentleman’s passionate support for the military covenant. I will say more about that later.

The new and growing recognition for mental health and veterans’ care on returning home is very welcome, and I pay tribute to the work of charities, of hon. and gallant and hon. Members and of the Government for their unswerving commitment to the military covenant. We are living amid a sea change in our understanding and recognition of mental health issues as we strive for parity of esteem between physical and mental health in our NHS. Times are changing.

Our commemorations of the centenary of the first world war remind us of a different time, when mental health issues bore a stigma and the social view was that wounds that could not be seen could not really be there. Veterans did not seek help and many could not even speak of their experience. Henry Allingham, God rest his soul, was an Eastbourne resident and a supercentenarian. He only started to share his story at the age of 105, but

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between his 110th and 111th birthdays he is reported to have made more than 60 public appearances. I met him the once.

“It’s good to talk”—the time-honoured role of the padre reflects that and initiatives such as the armed forces’ mental health first aid programme recognise it. After operational deployment, decompression is another hugely valuable opportunity to safeguard resilience. Furthermore, the stress and resilience training centre within the Defence Academy at Shrivenham runs a course called “START Taking Control”. Perhaps the Minister will elaborate on whether such training, which was designed for postgraduate and leadership roles, might soon be extended to initial training.

Mrs Flick Drummond (Portsmouth South) (Con): My hon. Friend is making an excellent speech on a subject that is incredibly important, in particular to someone who has a close relative serving in the armed forces. Alcohol misuse is one of the most frequently reported mental health problems for deployed UK troops. It is the only mental disorder to have increased in prevalence. Comparison of alcohol misuse in the same age and gender group shows that armed forces personnel are more likely to misuse alcohol than the rest of the population. Does she agree that the dangers of alcohol misuse must be incorporated into any training to improve the resilience of personnel?

Caroline Ansell: I acknowledge the great wisdom of what my hon. Friend says. It has been recognised for some time that alcohol abuse has too long been part of a work-hard, play-hard culture. Alcohol has also evidently been used to some extent to cope with the inevitable strains of conflict and combat. It is worth noting that young soldiers between the ages of 18 and 24 are three times more likely than their civilian counterparts to be consuming harmful levels of alcohol. The problem is a serious cultural issue that we must consider, in particular in connection with mental health.

Along with the many good things that the Government are doing to support mental health—I have touched on only some of those—I urge us not to overlook the most effective support system of all, which is the family. The UK Government implemented an operational mental health needs evaluation for those serving in the field during operations in Iraq and Afghanistan. Despite obvious operational difficulties in ensuring a full rate of participation, evaluation of a statistically significant 15% of all serving personnel in Iraq and 16% in Afghanistan greatly aided our understanding of the mental health challenges faced by our servicemen and women. The fact that 99% of those asked to participate did so suggests to me that the military has been successful in breaking down barriers to the point that armed forces personnel want to share their experiences, albeit anonymously.

The results of the survey, as broken down in The British Journal of Psychiatry, also showed the prevalence of the most common mental health disorders, with an incidence rate of about 20%. That, too, is significant. The results were used to match the correlations between family stress and the development of mental health disorders, further underlining how vital it is for us to support military families.

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The past 15 years have been a time of strain for many armed forces personnel, given the extended interventions in Iraq and Afghanistan. We know that the mental scars of conflict can emerge many years after people are relieved of active duty. Many trigger points can be completely unrelated events that take place in the home, far from the field of battle. Problems at home such as financial trouble, relationship breakdown or even child-related stress can all trigger mental health issues. It is therefore imperative that we equip our soldiers and, crucially, their families with all the mental resilience skills necessary to hurdle the challenges of military life and beyond. Family is the best support system, as soldiers themselves testify. How we promote and protect the military family will be defining for mental health outcomes.

Mental health is likely to be a ticking time bomb. According to Combat Stress, the veterans’ mental health charity, 13 years is the average length of time between service discharge and a veteran seeking help. Next month marks the 13th anniversary of the US-led invasion of Iraq, so the demand for mental health services for veterans is likely to increase in the short term. Combat Stress has already seen a 28% increase on 2013-14 in the number of veterans seeking assistance in 2014-15.

I am pleased that we are making it easier for our armed forces personnel to get the support that they need and to come forward in the first place, although a report this week suggests that a significant number of them—perhaps up to 40%—are still not seeking such support. Is there a case for more training, particularly in initial training? The received wisdom is still that prevention is better than cure. Do we need to offer more specific training and dedicate time to building mental resilience, just as we push physical speed, strength and stamina? Does that need to be universally rolled out and not hostage to self-awareness, self-selection or self-referral?

I am a patron to the Military Preparation College. As I shake those graduates’ hands and see them walking off into the sunset, I need to know that we are doing everything in our power to mitigate what is certain occupational hazard, looking overseas for best practice, looking at initial training and training at every stage of military service and beyond. We are looking to change culture by lifting up mental health awareness and we will need to have that as a focus for the foreseeable future.

4.10 pm

The Parliamentary Under-Secretary of State for Defence (Mark Lancaster): It is a pleasure to serve under your chairmanship, Mr Hollobone. I remind the House of my interest as a serving member of the Army Reserve. I start by congratulating my hon. Friend the Member for Eastbourne (Caroline Ansell) on securing the debate to discuss mental health resilience in military training.

The Government are committed to maintaining and improving the mental health of members of our armed forces. According to research, the armed forces generally show similar rates of common mental health disorders to the civilian population. Deployment on operations does not in itself appear to be a factor in mental health problems overall, although exposure to combat is associated with an increased risk of more serious conditions such as post-traumatic stress disorder.

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We are extremely grateful to our armed forces for the work that they do. It is our duty in return to provide care and treatment for them if they become ill. Evidence shows that most mental health disorders can be successfully treated and we have a range of trained medical personnel and facilities to do that, but it is clearly much better to provide our people with the knowledge, training and support that will enable them to build up both their physical and mental resilience before they deploy on operations.

It is important to look at health and wellbeing together, because overall they involve both the mind and the body. Mental wellbeing is very much enhanced by feelings of self-esteem and people having belief in their ability to do the things that they want to do. Good relationships—confidence in leaders and trust in friends and colleagues—are also vital. Good mental health does not mean never experiencing difficult feelings or situations, but it does mean having the strength and resilience to cope when things become difficult.

To that extent, building resilience is one of the principles that underlies all our training programmes, which are designed to be robust, challenging and realistic enough to prepare our people to carry out their operational roles effectively and efficiently, under inspirational and caring leadership. The Defence Academy is a world leader in the provision of military training. It has its own stress and resilience training centre, which is responsible for managing stress and resilience training and educational requirements within the armed forces. Its aim is to build psychological resilience in defence personnel and ensure that compatible training is delivered across the three services.

The stress and residence training centre has developed an all-inclusive stress and resilience training package called “START taking control”. Its purpose is to assist students in gaining the knowledge and practical skills to manage everyday experiences of mild to moderate stress and build psychological reliance to prepare them better to meet the physical, emotional and psychological challenges in defence.

In addition to the stresses encountered in everyday life, service personnel are often required to undertake extremely hazardous duties, which potentially expose them to traumatic and life-threatening situations, risking both physical and psychological damage. Psychological resilience is considered to be an essential component of military fitness. Personnel are taught how to spot potential indicators of a problem both in themselves and in their colleagues such as changed behaviour patterns, isolation and increased use of alcohol.

In particular, concerted efforts are being made to de-stigmatise the issues around mental health and to promote awareness of the professional care and support available. Stigma is one of the biggest obstacles facing those with a mental illness. It prevents many people from seeking help, which results in a worsening of the symptoms to a point where significant damage can be caused to their health, wellbeing and relationships. In many ways, the stigma associated with mental illness can be more disabling than the condition itself. The Army has been running a major campaign called “Don’t bottle it up”, which aims to break down stigma and encourage personnel to seek help earlier as well as signposting the support and treatment available.

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A specially designed project known as mental health first aid has been developed for the armed forces community, which provides the basis for increased mental health resilience among serving personnel and their families. It trains individuals to recognise the signs of problems and offer non-judgmental listening as well as offering help in accessing professional assistance. By making all personnel aware of the services available and by making clear to them that no stigma will be attached to them owing to their illness, we hope to encourage them to seek help as soon as they feel that they might have a problem. That will enable us to provide rapid diagnosis followed by appropriate and effective treatment.

One programme that has proved to be successful, both in the operational environment and back in the UK, is TRiM, which stands for trauma risk management. It is a method of peer-group assessment, mentoring and support for use in the aftermath of traumatic events. Trained TRiM practitioners are usually non-medical staff who are given the skills to enable them to identify those who might have been affected by traumatic events. That enables people’s comrades and leaders to provide them with appropriate support and refer them for specialist help if necessary. A key element of TRiM is that it aims to reduce the stigma associated with mental health problems and its roll-out across the services has certainly made people more aware of the importance of nurturing the mental wellbeing of those on deployment.

Personnel returning from operations normally go through a process known as decompression. Indeed, I experienced it on my return from Afghanistan. It consists of a short period—usually a couple of days—between leaving the operational theatre and return to the UK in which personnel can begin to unwind mentally and physically and talk to their colleagues and superiors about their experiences. That can give them an opportunity to discuss any issues of concern about their mental health and those of their colleagues, which can be followed up as appropriate. People are also provided with a stress brief, which aims to highlight normal reactions to traumatic events and give some strategies to help with readjustment. They are also given advice about risk-taking behaviours and the homecoming experience in general.

To sum up, the overall aim of those training, educational and support packages is to ensure that our personnel are ready both mentally and physically to carry out their duties, however potentially hazardous and traumatic they may be. Our personnel can be confident that any concerns will be treated seriously and sensitively and that a high quality of medical treatment will be provided if required.

My hon. Friend mentioned the importance of the family and the support we should offer service families so that they in turn can support service personnel. She may be aware that, over the next two years, we will allocate £4 million of covenant funding to support families in stress, which is a major step forward. Equally, she will be aware that, at the end of last year, we launched our family strategy, which is specifically designed to begin to address some of the concerns that families face, while they are spouses of serving personnel, in an effort to support them so that they in turn can support members of our armed forces.

I congratulate my hon. Friend again on securing the debate. We are proud of the work that we have done to date, but we are equally mindful that much more work

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needs to be done in the future. I assure her and hon. Members across the House that this subject is at the forefront of my mind.

Question put and agreed to.

4.19 pm

Sitting suspended.

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Motability Car Scheme

4.30 pm

Alan Brown (Kilmarnock and Loudoun) (SNP): It is a pleasure to serve under your chairmanship for the first time, Mr Hollobone. I am glad to be able to bring this motion forward and to have secured the debate, but—

Mr Philip Hollobone (in the Chair): Order. Would the hon. Gentleman be kind enough to move the motion and then do his speech?

Alan Brown: Apologies. I beg to move,

That this House has considered the Motability car scheme.

I am glad to bring the motion before the House today, but in truth it would be much better if this topic did not require consideration at all. The origins of this stem back to the previous Parliament and the change from the disability living allowance to the personal independence payment in April 2013. At the time, some of the changes were dressed up as fairness and giving people more control, but there is no doubt that there were concerns that DLA self-assessment, the automatic qualification process and, sometimes, the fact that there was no follow-up could possibly be abused.

That was the thought process that definitely drove the Tory ideology, and that has overshadowed how best to manage the system to help people with disabilities. Throw in a projected £2.5 billion saving and the fact that an estimated 600,000 fewer people would end up on PIP compared with DLA and we can see that this was just another assault on the disadvantaged. For me, the key change in assessing enhanced mobility was the reduction in the distance of the walking assessment from 50 metres down to 20 metres. Imagine it: somebody can go into an assessment centre and sit down and possibly be at risk of already meeting the walking test.

The enhanced rate is critical. The Motability scheme allows those receiving the highest rate of DLA or PIP to lease a suitable adapted vehicle, powered wheelchair or mobility scooter, in return for their weekly award. The Motability scheme is particularly important for enabling disabled people to be independent and to manage their condition. It allows users to participate in social activities and do the things that many of us take for granted, such as being able to continue to care for their children.

If we look back at the history, the Motability scheme was founded in 1977. It started out with a single car and has grown into a scheme that operates on a completely UK-wide basis, with nearly 650,000 users at present, which includes 15,000 using electric scooters and wheelchairs. It is a massively respected scheme, it is a charitable body and it has been praised by the National Audit Office for providing good value for money.

The Motability scheme plays a vital role for many disabled people across the country. Restricting access to Motability vehicles for those who have relied on them will undoubtedly increase the isolation that many disabled people feel.

Mr Mark Williams (Ceredigion) (LD): I congratulate the hon. Gentleman on securing this very important debate. As he develops his speech, will he reflect on the

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particularly bad impact that the loss of Motability vehicles has had on people living in rural areas, to the extent that when constituents are waiting for an appeal to a tribunal decision, they cannot get to the meetings because there is no alternative transport? There is no public transport and they do not have a vehicle any more.

Alan Brown: That is a fine intervention, and I agree with the point the hon. Gentleman makes. I was not going to focus particularly on rural issues, but he is absolutely right. I live in a rural area and I know that, particularly in England and Wales, the cuts to public transport and dial-a-bus services have compounded the problem of people being unable to manage when they lose their Motability vehicle, so I agree wholeheartedly with that sentiment.

Stuart Blair Donaldson (West Aberdeenshire and Kincardine) (SNP): I congratulate my hon. Friend on securing the debate. My constituent, Claire Ross, is 15 years old. She lives in a rural area and has a brain tumour, meaning that she becomes tired easily. Her Motability vehicle was used to take her to school and to hospital appointments. A recent reassessment removed the component from Claire and now the vehicle sits, unable to be used, at her parents’ house. Does my hon. Friend share my concern for Claire now that the Motability component has been taken away from her, and does he agree that it is shameful of the Government not to respond to my numerous representations on her behalf?

Alan Brown: I wholeheartedly agree, and I find it incredible that nobody has responded following my hon. Friend’s inquiries. I think most hon. Members here will have very similar examples from their constituencies, which highlights how unfair the measures are. I will come back to that, which is something the Government really need to take stock of. They should be working tirelessly to support the independence and inclusion of disabled people, using all means possible through Government channels.

An example of the concerns we have heard is highlighted in a briefing paper from Muscular Dystrophy UK. Trailblazers, which comes under the umbrella of that organisation, is a group of young disabled campaigners aiming to tackle the social issues affecting young disabled people, such as their access to higher education, employment, and social and leisure opportunities. These are young people who fully understand the difficulties they face in life. They are campaigning to raise awareness of this issue and to support others. They also know the possible consequences of the new PIP assessment.

One trailblazer commented:

“I suffer from muscular dystrophy and I am still able to walk, although it is difficult. I frequently push myself to live my life as much as I can, despite fatigue and anxiety that comes with it. I am absolutely terrified that one day, be it tomorrow or in a year, I will receive the letter that tells me I need to be reassessed for PIP. As someone who can stand and does not ‘look’ disabled at times, I believe I will have no chance of retaining my car.”

They added:

“If I don’t have my car, I simply would not go out.”

This is a young person who knows how independent they have become since being able to access a car through the Motability scheme. Imagine being aware of the life transformation that they went through and the absolute dread of being forced to return to the pre-car state.

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Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP): I thank my hon. Friend for giving way and for bringing this extremely important debate to the Chamber today. Does he agree that, given the impact on people’s mental health, including depression and anxiety—at some points, due to social exclusion—as well as the fact that people feel very isolated and the possible risk of suicide, we are at risk of creating an increased call on the NHS through co-morbid mental health problems, as well as physical disability in this case?

Alan Brown: I recognise my hon. Friend’s expertise and agree with her point, which touches on what I was saying. In some cases, it is not even about the stress of losing the Motability vehicle; it is about the stress and panic about getting to that stage, so we are talking about an ongoing mental condition.

Siobhain McDonagh (Mitcham and Morden) (Lab): On the point about increased cost, I would like to make the Chamber aware of my constituent, Lorna George. She lost her higher rate mobility component of DLA when she transferred to PIP and, as a result, lost her vehicle. Because she is in full-time employment, she was entitled to the Access to Work scheme, which meant that she received £150 a week from the public purse to get to and from work, as a result of losing her DLA mobility component of £54 a week. How is that saving anybody money?

Alan Brown: That was another fine intervention. These examples are what make it real for everybody, and I will touch on what I think is the madness of the financials later.

To be clear, we have heard some personal examples, but the statistics back up the concerns that I highlighted from the young person with muscular dystrophy. To date, of the 31,200 people on the Motability scheme via the higher rate DLA who have subsequently been reassessed for PIP, some 14,000 have lost the higher PIP mobility rate and, therefore, their car as well.

Going back to the stress and trauma of losing a car, we are lucky that Motability takes its duties seriously and goes above and beyond to support people in that position. It supports them with financial assistance—for example, through a transitional lump sum that might aid in the purchase of a car. Motability also provides advice packs for customers and advises on insurance, maintenance, adaptation services and even local transport options. We should be clear that Motability should not be filling in these gaps for people who are effectively left stranded.

It is no wonder that 91% of those who left the scheme were satisfied with the support that they had received from Motability. I commend the organisation, but that does not mask the fact that we are still only at the early stages of the PIP reassessment, with the reality that nearly one in two people lose their higher mobility access. I put this to the Minister: are we really to believe that almost half the people on enhanced DLA either exaggerated or fabricated their conditions to access Motability or, at best, suddenly no longer need that support?

In Scotland, 70,000 people are using the Motability scheme, so, using statistical analysis, we know that up to 31,500 people could lose out—I accept that some people

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beyond working age will not be reassessed. If we take that down to the level of my constituency, 1,500 people are using the Motability scheme at present, so up to 670 people are possibly at risk.

I will give the example of one of my constituents. Lynne Paton has written to me to say:

“I am due a new car in July. I haven’t been assessed for 2 years. I have the higher rate at present and I have”

had it

“since my 2 strokes. I have been in the hospital 3 times lately with chest infections. I am now struggling to get up and down my stairs because of the difficulties trying to get a breath. I am now using my electric Scooter again because I now can’t walk very far because of my breathing. The car we have just now was picked because the scooter can go in the car. I don’t know if I will get assessed again in the near future but if we were to lose the car I wouldn’t be able to get out and about. Also John is due to retire so our income will drop and we won’t be able to buy a new car suitable…I hope you can fight for people like me who need their cars. I know you will do your best for disabled people”.

That should be a clear case. If Lynne goes to be reassessed, there should not be a problem, but we all know that there are problems. She could go through a wee bout of better health and suddenly be deemed not to meet the requirements for the higher mobility rate. I should also say that I know Lynne as a fantastic community volunteer, who understandably has had to scale back recently, but with what she has put into the community over the years, there is no way she should have this worry hanging over her head. I dread having to go back to her and say, “You know what? I raised this in a debate at Westminster, but as usual the Government didn’t listen.”

I have already touched on the fact that this is not about giving disabled people greater flexibility and control over their budgets and lifestyle choices; it is part of the austerity agenda. The original suggested saving of £2.5 billion by 2018 confirms that, but it is also worth noting that the Government were willing to give assessment contracts worth some half a billion pounds to be able to get those savings. That is not value for money, and by the way, it can be no coincidence that the previous Minister for the disabled was one of the few Tories who lost their seat last year.

When it comes to the overall PIP strategy, the money has been so well spent and the strategy so well managed that the timescales have been a disaster, with the High Court ruling in June 2015 that the delays were unacceptable and unlawful. At the same time, the Office for Budget Responsibility noted that

“costings associated with structural changes to the welfare system…are subject to even greater uncertainty.”

It highlighted that its previous “Welfare trends report” had

“noted that our latest forecasts suggested higher than expected success rates for new claims to PIP across the forecast, which had in effect reduced the savings originally expected for this reform”.

It is not achieving the savings that were anticipated and, worryingly, with 45% of people who have been reassessed losing access to the Motability scheme, we have to wonder what the real purpose of the original target was. Let us consider the irony of the Tories’ manifesto pledge to halve the disability employment gap and support disabled people. Perhaps it is just me, but I simply

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cannot connect the dots. How does the Conservative party strip the freedom that a Motability vehicle brings to a disabled person from them and still aim to break down the barriers to work?

The Multiple Sclerosis Society, for example, has said that the Motability scheme can have positive impacts in terms of employment for users and their families. It claims that use of a Motability vehicle has enabled many of its members to gain employment, enabling disabled people to have a much more rounded, independent life. The recent Mencap review, “Halving The Gap?”, proved that the Tory policies are driving disabled people away from work rather than into work. That is why access to Motability vehicles is so important.

On a more positive note, the disability charity Scope undertook a report to assess the economic impact of getting more disabled people into employment, which was published in April 2015. It found that the impact on the economy of a rise in the disability employment rate would be significant. Indeed, a 10 percentage point rise would result in a £12 billion gain for the Exchequer by 2030. When we hear Tories in the main Chamber announcing that unemployment in their constituency is down by 50%, we should compare and contrast those statistics with the benefits of small increases in the employment rate for disabled adults. My hon. Friend the Member for Banff and Buchan (Dr Whiteford) has written to the Secretary of State for Work and Pensions to express concern that a lack of access to the Motability scheme will prevent disabled people from getting to work. It is clear that the Government should focus on that, rather than on savings.

Not content with one failure, the Government also have a proposal to cut the employment and support allowance work-related activity group payment, taking £30 of benefit a week from those in need and taking sick people even further away from getting back into work.

We in the Scottish National party are committed to supporting disabled people, which means opposing the regressive and punitive measures deployed by the Tories, not just for those eligible for DLA or PIP, but for the disabled people who rely on ESA and have been subjected to the unfair and failing work capability assessments. The SNP in Scotland are doing all we can, within the resources and powers that we have, to help disabled people, who are disproportionately affected by welfare reform. New powers over disability benefits in the Scotland Bill will provide opportunities to develop different policies for Scotland. In the Scottish Government, the Cabinet Secretary for Social Justice, Communities and Pensioners’ Rights, Alex Neil, wants policies that are

“fairer and ensure people are treated with dignity and respect.”

We must remember that this comes against the backdrop of the UK trying to cut the Scottish budget through the fiscal framework agreement and the fact that, due to the Tory austerity agenda and ideological cuts, the Scottish Government are currently spending £104 million to mitigate the worst aspects of welfare reform.

It is my contention that the Government should think again. All of us here, as lawmakers, owe it to those we represent to protect the most disadvantaged. The SNP has already demonstrated our commitment in that regard and will do so again with new powers over disability benefits, but I repeat: I urge the UK Government to think again.

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Several hon. Members rose

Mr Philip Hollobone (in the Chair): Order. The debate finishes at 5.30 pm. I will start to call the Front Benchers at eight minutes past 5, with five minutes for the SNP, five minutes for Labour, 10 minutes for the Minister and two minutes for Alan Brown to sum up at the end. There are six hon. Members standing. We have just less than 20 minutes. I am a bear of little brain, but I reckon that is three and a half minutes each, so I will impose that time limit, starting with Ben Howlett.

4.47 pm

Ben Howlett (Bath) (Con): Thank you, Mr Hollobone. I congratulate the hon. Member for Kilmarnock and Loudoun (Alan Brown) on securing this debate on a subject that I care about a great deal. I should declare an interest, in that my mother has benefited from a Motability vehicle for more than 10 years.

I want to make it clear that I agree with the Government about ensuring that everyone who needs a Motability vehicle should have access to one. However, for decades, the system has not been reformed and it must be changed in a fair and cost-effective way if we are to ensure its future effectiveness. To ensure that the most vulnerable receive the support that they need, those who no longer have a medical condition need to be told that reform must occur to ensure the future viability of the system. That is only fair to people such as my mother who really depend on the Motability scheme.

Before I move on to my substantive points about improvements to data sharing between the Department of Health, the Department for Work and Pensions and the NHS, I would like to seek assurances from my hon. Friend the Minister that the high volume of appeals that are currently being seen are constantly being reviewed. Although I understand that new systems take a while to embed, as we know from what happened when the previous Labour Government introduced the Atos system to handle work capability assessments, these things should be constantly reviewed.

Ever since I began to work alongside the NHS eight years ago, the UK has had a significant problem with data. Although I freely admit that it is not the most interesting subject in the world, it certainly is the most important when it comes to producing evidence-based policy. While I sadly do not have time to discuss the problems with evidence-based data collection and information governance, I want to focus for the last couple of minutes on the need for improved data sharing. All too often constituents come to my surgeries and ask why it is so complicated in today’s digital age to ensure that patient information is shared with the Department for Work and Pensions.

Peter Dowd (Bootle) (Lab): Will the hon. Gentleman give way?

Ben Howlett: I will not give way because I have very limited time.

Sharing information would make a huge difference to all disabled people as well as people on the Motability scheme. It would save so much time and money if there were one joined-up system to enable a GP to identify a disability and to refer that person directly to a DWP contact in a joined-up and efficient way. Currently, it takes two sets of paperwork and a vast amount of time

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and communication, which can only be described as lacklustre at best. I completely back the Government in getting this sorted.

For too long, the most vulnerable have been let down. If there were a joined-up system, the GP could notify the DWP quite effectively if someone was no longer in need of a Motability vehicle. The efficiency savings that would be made could be driven into increasing support for those who desperately need it and would also help disabled people feel that the process is much more joined up when they probably need as smooth a process as possible to get through those tough experiences.

How can the Government achieve this? The Government have to identify weaknesses in the law that prevent data sharing between the Department of Health and the Department for Work and Pensions. As the Government look to produce a Green Paper on the impact of welfare on health and wellbeing, it is important for the DWP to formalise discussions with the Department of Health and consider the benefits of direct and indirect data sharing. Although I appreciate the sensitivities around data protection, charities are screaming out for changes and we should be doing everything that we can to help facilitate that.

I specifically ask for the Minister to work with his counterpart in the Department of Health to look into the Health and Social Care Act 2012 to understand why there is a problem with data sharing. Under that Act, the law allows personal data to be shared between those offering care directly to patients, but it protects patients’ confidentiality when data about them are used for other purposes. While I agree that these secondary uses of data are essential if we are to run a safe, efficient and equitable health service, we should consider new legislation that will further enable swift and effective data sharing between the NHS and the DWP.

4.51 pm

Daniel Zeichner (Cambridge) (Lab): It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Kilmarnock and Loudoun (Alan Brown) on securing this important debate.

I want to tell hon. Members about Lisa, who I recently met in my constituency. After a stroke left Lisa paralysed on one side of her body, she was thrown a lifeline and received a Motability car. For the past 10 years, the specialist car has helped keep her independent and active, meaning that she was able to remain motivated, to fulfil her ambitions and to go to university to study graphic design. Now, after a decade of working hard to maintain her freedom despite the hand she was dealt and the severity of her condition, her car has been torn away from her by the Government. Why did the Government sever her vital lifeline? Because Lisa was two points short under the new disability benefit rules, which are seeing disability living allowance replaced by the personal independence payment. Although she was awarded the enhanced rate of the care component of PIP, she was awarded only the standard rate of the mobility component. When I visited her, Lisa had trouble even walking to the kitchen to make a cup of tea.

We have heard anecdotally in the media, as well as in this Chamber, about other vulnerable people denied the enhanced rate of the mobility component under PIP—those affected by spina bifida, those who have had a leg

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amputated and those who struggle to walk a few metres. Whether those cases are the exception or the rule, it is unacceptable. If such people are not qualifying, it has to be accepted that either there is a problem with the criteria for the enhanced rate of the mobility component or the assessments are not being carried out appropriately.

Lisa’s mother described how it took almost eight hours to fill in the 40-page benefit claim, only to be told that Lisa was two points short. Lisa told me that she does not feel physically able or safe to use the bus. Despite having a decent support network and people who care about her, she worries that now she will be trapped at home.

The Government keep telling us that it is possible to appeal if one disagrees with their assessment. Well, I would appreciate some information from the Minister about the proportion of those appeals that are successful. I fear that for those undergoing that process, the appeals will all too often seem to be little more than kangaroo courts. Furthermore, the length of the appeals process is such that too many disabled people are forced to return their vehicles before the outcome of their appeal.

The Minister has assured us that the appeals process

“enables disputes to be addressed more quickly”—[Official Report, 2 November 2015; Vol. 601, c. 712.]

However, in answer to a written question recently, he stated:

“The Department does not routinely collect information on the numbers of people who have had to return a Motability vehicle nor on whether they were successful on appeal.”

It appears that the Government really do not know about the impact of their policies, so let me tell them a little bit about what we know. In March last year, Motability told us that more than 100 disabled people every week are losing their Motability vehicles. We have now heard that, of those previously on the higher rate of DLA who have so far been reassessed for PIP, almost half—almost 14,000 people so far—have lost their car. Motability has estimated that if three out of every eight of their customers lose their eligibility for a Motability vehicle, the number forced to hand them back could reach 135,000. That estimate looks accurate, if not a little low. Figures show that 45% of those reassessed so far did not secure the enhanced rate of the mobility component under PIP.

It is fair to conclude that we are facing a hidden crisis. For Lisa and for all others across the country like her, I hope that the Minister will—to use a well-known, worn phrase—pause the policy and think again.

4.55 pm

Patricia Gibson (North Ayrshire and Arran) (SNP): It is a pleasure to serve under your chairmanship, Mr Hollobone.

Everybody in this room knows that the removal of the Motability vehicles will cause huge difficulties and distress for those who currently benefit from this scheme. With PIP replacing DLA, we know that the eligibility criteria will increase. It is estimated that the Government expect to save £2 billion. How much will this really cost? It will cost the taxpayer more than it will ever save. What will it cost in social isolation? There is a clear correlation between social isolation and loneliness and

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poor health. Even the Prime Minister has recognised that. What cost in terms of social justice? DWP figures suggest that the number who will lose out could be in the region of 428,000 people. Are we really to assume that all of those people do not really face challenges with their mobility?

Those currently in receipt of the higher rate mobility component of DLA face real and pressing challenges to their mobility every single day. Are these the people the Government wish to remove support from and on whose backs the Government wish to balance the books? We have all heard that those with disabilities must be given all the support they need to access the jobs market. I participated in a debate on that issue in this very room. How will removing the Motability vehicle scheme from those who rely upon it help people to access the jobs market more readily and easily?

Disabled members of our community who are able to work want to do so. Again, even the Prime Minister has recognised that. However, they must be supported into employment. Research has shown that a rise in the employment of disabled people would give significant economic benefit to the whole UK, but this is not just an economic argument and nor should it be. It is an argument, ultimately, about social justice. If we do not address the barriers to employment that exist for disabled people—and they do exist and are very real—we are simply turning our back on whole swathes of people in our communities, the contributions they can make, the skills they have, and the fulfilment that work can offer them.

Many disabled people already work and changing the criteria for the Motability scheme could actually lock disabled people currently in work out of the jobs market. Furthermore, it could slam the door of the jobs market in the face of those who currently qualify for the scheme and are actively looking for work. This cannot be the outcome the Government seek. Surely they must be alive to those dangers?

With PIP replacing DLA, eligibility will change, with the reduction of employment and support allowance by £30 a week for those in the work-related activity group. We now also have the widely discredited work capability assessments. There is a danger that this Government are rapidly showing themselves to be no friend of those who need support due to illness or disability. I urge the Minister to stand up for people who are disabled and to reflect not on how much money it will save the taxpayers, but on how much it will ultimately cost.

4.59 pm

Joan Ryan (Enfield North) (Lab): I congratulate the hon. Member for Kilmarnock and Loudoun (Alan Brown) on securing the debate. I am here today to raise the issue of my constituent Cathy Walsh, though her case is representative of many others. She suffers from severe generalised dystonia, a condition that results in uncontrolled spasms, affecting her limbs and speech. She has been disabled since birth and has tremendous difficulty moving unaided. With a seriously disabling disability, she has been on disability living allowance for 23 years. On Friday 18 December, Ms Walsh was notified that her application for the advanced-rate mobility component of PIP had been turned down, and she was distraught—her car, which had been invaluable in allowing

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her to lead an independent life, would be taken from her. That life-changing decision was based on one assessment conducted over an hour. It took the Atos consultant longer to write the report than it took to undertake the assessment. Ms Walsh’s neurological consultant has

“strong reservations about the value of this assessment.”

I agree. Atos said that Ms Walsh was able to walk between 50 and 200 metres, but her consultant has

“no idea how ATOS’ assessment could have been made, it is clearly incorrect… At best she can walk up to 20 metres and on a bad day significantly less.”

On those terms, it is obvious that Ms Walsh has a very strong case to qualify for the higher-rate mobility allowance. Instead, she has had to go down the extremely stressful route of a mandatory reconsideration and an appeal to a tribunal, which is making her condition worse. Her independence has been severely curtailed, at least until the tribunal decision is known, which could be months away.

Ms Walsh will have to rely on others even to help her cash the £2,000 transitional support cheque from Motability, as she cannot get to the bank on her own. That raises another issue: why cannot this money be transferred directly into her account? Even when the £2,000 has been deposited, Ms Walsh will be in a state of financial limbo. If she wins her appeal but decides to keep the money, she would not be able to return to the Motability scheme for six months.

Let us assume that Ms Walsh wins her case and wants to return to the scheme as quickly as possible, which she is keen to do. She would then have to return most of the £2,000. I do not disagree with that in principle. However, if the tribunal drags on for several months, Ms Walsh will inevitably need to use some, if not all, of the transitional payment to pay for other forms of assistance and transport. She would then be in debt while having to go through the process of reapplying for the scheme when her car should never have been taken from her in the first place. The Government say that what we have now is a “fairer assessment process.” Well, it does not feel fair to Ms Walsh. She is deeply distressed. I do not think it is fair; her friends do not think it is fair; and, more to the point, her consultant, who understands her condition as well as anyone, thinks it is very unfair. If her treatment is typical of the way in which thousands of other cases have been dealt with, the process has not been fair to them, either. The Government must be willing to conduct a thorough review of the process, which is not fit for purpose in its current state. I look forward to hearing how the Minister intends to resolve these issues.

5.2 pm

Corri Wilson (Ayr, Carrick and Cumnock) (SNP): I thank my hon. Friend the Member for Kilmarnock and Loudoun (Alan Brown) for securing this important debate. I represent the neighbouring constituency of Ayr, Carrick and Cumnock, which is not only a beautiful part of the world but is populated by many inspiring and talented people, such as Kayleigh Haggo.

Kayleigh is an exceptional young lady who, through hard work and dedication, has achieved much for someone only 17 years of age. She holds 13 world records and four national age group records and has a real chance of representing Britain in Tokyo in 2020. She was a

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Commonwealth games baton bearer in 2014, and she won three gold medals at the European Paralympic youth games.

Members are probably wondering what that has to do with today’s topic. Well, Kayleigh has a form of cerebral palsy that affects her balance and motor skills, and she is largely wheelchair-bound, which makes her achievements all the more incredible. Although she is still at school, she keeps up a strict training regime that is only possible because of the mobility car—driven by her mum—that she receives as part of her disability living allowance. The car has allowed her to become one of the country’s most promising young disabled athletes, and it is only through her tough training that she is able to walk as far as 20 metres.

Last July, Kayleigh was moved from disability living allowance on to PIP and was informed that she was no longer considered disabled enough. Without her mobility allowance, she would not be able to benefit from her participation in sport. It took a 10,000-signature petition and intense media interest before the Department for Work and Pensions was forced to reverse its decision on Kayleigh’s entitlement to a mobility car. Yes, she can walk 20 metres, but she cannot walk 50 metres. Yes, she has the mental capacity to plan and follow a journey, but she does not have the physical capacity to undertake that journey—she is physically unable to navigate public transport. The withdrawal of her mobility car would have seen Kayleigh’s Paralympic dreams in tatters. It would also have destroyed her dreams of going to university and her hopes of a meaningful career. Where is the benefit to the state of withdrawing that support and leaving people such as Kayleigh confined to their homes, with resultant impacts on their health, their employment prospects and their ability to contribute to the community?

From the outset, the Government made it clear that the aim of PIP was to make savings. Of those previously on higher-rate DLA, more than 30,000 have been reassessed for PIP, and of those 50% have kept their car. PIP should ensure a level of independence for disabled people, and Kayleigh is just one example of many constituents who have contacted me after having their mobility car removed and their independence shattered. I am proud to represent people such as Kayleigh, and the Government should be ashamed of what they are doing to people just like her.

5.5 pm

Siobhain McDonagh (Mitcham and Morden) (Lab): I thank the hon. Member for Kilmarnock and Loudoun (Alan Brown) for securing this debate and for giving me the opportunity to have a quick “round the office” look at some of the anomalies affecting people as they transfer to PIP and its higher-rate mobility component.

I have already spoken about Ms George, who was in work and lost her higher-rate mobility payment only now to receive £150 a week from the Access to Work programme—tripling the amount of money paid to help her mobility, yet causing greater problems for her 13-year-old daughter, who is her main carer and now has to do even more tasks for her mother.

Looking at Ms George’s case for this debate allowed me to follow on to the case of Mr Abrahams, who is also in full-time employment. He suffers from spina

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bifida and cannot walk more than 20 yards. He had a specially adapted car with hand controls, which is about to be removed on Tuesday, so it would be great if the Minister could help us while Mr Abrahams’ appeal is being considered, as he lost his mandatory reconsideration. We are going to get him to apply to the Access to Work programme, so he will probably cost the Government a lot more money than if he had just retained his higher-rate mobility payment.

Patrina Ross suffered a stroke in 2014 and was awarded the lower-rate care component and higher-rate mobility component of DLA. When she was reassessed for PIP, the rates were swapped, so she got higher-rate care and lower-rate mobility. Her car was taken away, but she was paid £25 a week more. She does not want more money; she wants the adapted car.

Daisy Tadros was shifted from DLA to PIP without being informed. The first she knew of the transfer was when she got a letter from Motability saying that her car was going to be taken away. There had been no assessment of her case, yet there is a date for the removal of her car. We discovered that the Atos database does not work with the DWP database, so when Motability was trying to find out the status of Ms Tadros’ claim for PIP, the DWP could not tell Motability her status because the DWP does not have a system that works with Atos’s system. The only way the DWP, Motability and Atos could talk to one another was through the involvement of Ross in my office. He spoke to each of them so that they could co-ordinate and consult each other. The hon. Member for Bath (Ben Howlett) spoke about swapping information and access to information, which is clearly a problem within the system. The Minister might find that lots of people who are entitled to PIP but who are not getting it because of administrative error will have their car taken away without their ever getting as far as Atos or a decision.

5.8 pm

Ian Blackford (Ross, Skye and Lochaber) (SNP): It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend the Member for Kilmarnock and Loudoun (Alan Brown) for securing this important debate. Time does not allow me to reflect on all the speeches, but I thank everyone who has spoken so passionately about the casework they have come across showing that people have been disadvantaged by the changes. I hope the Minister has listened and will respond to what has been said this afternoon.

Restricting access to mobility vehicles will increase the institutionalisation and isolation of disabled people, when we should be focusing on promoting their integration and inclusion in communities. The Scottish National party is extremely concerned that taking transport away from disabled people will make it extremely difficult for them to travel to and from work. The Government have pledged to halve disability unemployment, but their policies for disabled people fundamentally fly in the face of that aim. The Motability scheme provided independence for disabled people and helped them to live as normal a life as possible. As has been said, almost 14,000 disabled people’s specialist cars have already been taken away from them following reassessment. According to Motability’s 2014-15 annual report, 70,000

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people in Scotland use the service. If the current level of loss continues, 31,500 people in Scotland will no longer be able to access this vital scheme, which should shame us all.

We know that we are facing these challenges because of the Tory obsession with reforming welfare. People are losing their Motability vehicles because the eligibility criteria in PIP assessments are different from the eligibility criteria for DLA, as many hon. Members have said. The Government should listen to those who have pointed out the consequences of the changes. For example, the MS Society has condemned them, stating that the Motability scheme plays a vital role for many people with multiple sclerosis. They conducted a survey of MS sufferers and found that the Motability scheme was particularly important to sufferers, enabling them to manage their condition and live more independently, which is something that we should all support. It also helped users participate in family and social activities.

Let us look at a typical case of someone who is being reassessed. Mrs C has been in receipt of DLA since 2014, after being hospitalised for five months, and she still has serious health problems. She got her Motability car in October 2014. As DLA is being phased out, she was asked to claim PIP instead. She did so, and received a decision letter dated 1 January 2016, which told her that her entitlement to DLA would end on 26 January. It also told her that, although she qualified for the daily living component at the enhanced rate, she scored only eight points for the mobility component, four less than the number required for the enhanced rate. Because her award does not include the enhanced rate mobility component, she will no longer be eligible for a Motability car. The letter told her that she had until 1 February to ask for a reconsideration of the decision.

She submitted a letter asking for reconsideration on 20 January, and on following up, she was told that it could take up to nine weeks—until 21 March—for a decision to be made. She had been told that she needed to return the car by 16 February: that is, nearly five weeks before she was likely to know the result of the reconsideration. Mrs C did not know how she was supposed to bridge that five-week gap and was unable to make any proper plans to meet her transport needs beyond 16 February. Should she buy a wee cheap car for just a few weeks? Did she need to find the money to replace her Motability car? Can the rules be changed so that Motability vehicles remain with the claimant pending their appeal? That would be the right thing for the Government to do.

The SNP in Scotland is doing all that we can to help disabled people, who are disproportionately affected by welfare reform. New powers over disability benefits in the Scotland Bill will provide opportunities to develop different policies for Scotland that are fairer and ensure that people are treated with the dignity and respect that are lacking from this Government.

5.12 pm

Angela Rayner (Ashton-under-Lyne) (Lab): It is a pleasure to speak under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Kilmarnock and Loudoun (Alan Brown) on securing this important debate, and I welcome to his place the Under-Secretary of State for Disabled People. We have heard passionate speeches from many Members here about the devastating

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impact of the changes to mobility criteria on the lives of many people who are already struggling with everyday tasks. I thank all hon. Members for their contributions to this debate.

The purpose of Motability is to help those who would otherwise be unable to afford full mobility. As many hon. Members have outlined, the recent change from the disability living allowance to the personal independence payment for people of working age has had various damaging effects on those with disabilities.

Peter Dowd: Is my hon. Friend aware of any action taken by the Government to ensure that the most vulnerable people with disabilities are protected from being isolated in their communities if they lose their eligibility for mobility service under the changes from DLA to PIP? I do not know of any, and neither do many disability organisations, including Muscular Dystrophy UK.

Angela Rayner: Many Members have also raised that concern. I hope that the Minister will respond to it when he sums up.

Many speakers in this debate have given examples involving their constituents and told us of the devastating impact on their needs and self-esteem. Significant numbers of people who currently benefit from the higher rate DLA mobility component will fail to qualify for the enhanced rate mobility component in PIP. That is a deliberate outcome; it is what the Government said up front that they wanted to do. They wanted to cut those benefits. It is not based on need; it is based on making cuts and financial savings.

Many people have had the adapted vehicles that are vital to their lives and livelihoods withdrawn as a result. I thank the hon. Member for Bath (Ben Howlett) for raising the need for joined-up services, and my hon. Friend the Member for Cambridge (Daniel Zeichner), who told us the story of Lisa’s experience and the impact of the cuts on her life. The hon. Member for North Ayrshire and Arran (Patricia Gibson) spoke passionately about the responsibilities of society and community, and the cuts to the work-related activity group of employment and support allowance.

My right hon. Friend the Member for Enfield North (Joan Ryan) spoke of her concerns about the quality of the PIP assessment and the conflict with medical experts who know the person’s needs. It is simply not fit for purpose. The hon. Member for Ayr, Carrick and Cumnock (Corri Wilson) discussed Kayleigh’s experience and how only 50% of people get to keep the car after being assessed for PIP, and my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) discussed the devastating impact of the removal of the cars before an appeal has been heard.

The reality is that £24 billion in support will be removed from nearly 4 million disabled people by 2018. The policy will hinder disabled people, not help them. It is about removing support, not providing it, for people to live and work independently. The Extra Costs Commission has shown that disabled people face an average of £550 in extra living costs a month as a result of their disability, which is the main reason why disabled people are twice as likely to live in poverty as non-disabled people. PIP is meant to help with those extra costs. The Government’s determination to maintain such a flawed

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rule is a direct assault on independent living for many, and it greatly hinders opportunities for those with disabilities to contribute to society.

Any one of us is likely at some time to be affected by disability, either directly or in caring for a disabled friend or relative. I know; my son is registered disabled. I urge the Government to rethink this policy.

5.17 pm

The Parliamentary Under-Secretary of State for Disabled People (Justin Tomlinson): It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to the hon. Member for Kilmarnock and Loudoun (Alan Brown); he is clearly passionate about this important subject and gave a well thought-out and well delivered speech. I also pay tribute to all the other Members who contributed, particularly those who raised concerns on behalf of their constituents, showing that they will always champion the people they represent.

I will pick up on a few of the questions raised before going into my speech, which will cover the rest of them. There are a few points that are slightly away from the subject of Motability. First, we are committed to halving the disability employment gap. We all welcome the fact that, in the last 12 months, 152,000 more disabled people were in work, and the number is 292,000 over the last two years. There is still a long way to go, but we are making considerable progress in that area.

Numerous speakers mentioned a 50-metre rule becoming a 20-metre rule. There never was a 50-metre rule. It is not that if someone can walk 20 metres and 1 cm, they get no benefit, but if they can walk only 19 metres, then they get the full benefit; it is about moving safely to an acceptable standard repeatedly and in a reasonable time period. The rule is a bit of an urban myth, and I wanted to flag that up.

Alan Brown: Will the Minister give way?

Justin Tomlinson: I will make some progress, and then we will see how much time is left.

On the wider issue of the money that we spend on disability support, we are increasing it year on year, all the way to 2020, compared with 2010. It is about £50 billion a year. We are also spending 14.6% more on supporting disabled people and people with long-term health conditions than those out of work for more than two years who are trying to find work.

The hon. Member for Mitcham and Morden (Siobhain McDonagh) mentioned a specific case involving three Departments. I have never heard of that before, which suggests that it is an isolated case. We will talk further on that and try to get to the bottom of it. Also, the hon. Member for North Ayrshire and Arran (Patricia Gibson) said that a decision was reversed on the back of a petition. That had no bearing on the reversal. I will discuss how the appeals process works later, but a petition would have no bearing on it. A decision is either right or it is wrong, and it will go through appeal. Individuals do not need to secure a petition. They may feel that it is an important part of their campaign, but it does not influence how things are done.

Motability is a fantastic scheme that was founded in 1977, following the introduction of mobility allowance in 1976. The scheme was founded by Lord Sterling, who

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I have had the great pleasure of meeting on a number of occasions, and the late Lord Goodman, with cross-party support that still continues today. Before Motability, there was the invalid carriage, which was a small, blue, motorised trike. It had a poor safety record and was unable to carry passengers, so it was of no use for the most severely disabled, who needed carers to drive them, or for those with children. As well as being unsociable, it was—frankly—awful-looking.

Today the Motability scheme helps about 600,000 people and they can choose from 2,600 vehicles. It comes as a “worry-free” package, with insurance and repairs included, and its average cost is more than 40% less than that of the equivalent commercial lease. I have had the pleasure of handing the keys to a Motability vehicle to one of my constituents, so, like many Members who have spoken today, I have seen what a difference the scheme makes to people’s everyday lives.

Most Motability users qualify through enhanced-rate personal independence payment mobility or higher-rate disability living allowance. A small number of people qualify through the armed forces independence payment and the war pensioners’ mobility supplement schemes, which are run by the Ministry of Defence.

DLA was inconsistent, subjective and out of step with the needs of a 21st century welfare system. The reality was that more than 70% of people on DLA had received a lifetime award, yet the conditions of one in three people on DLA significantly changed every year. Because people were on lifetime awards, time and time again those people who might not have been on the highest rate and whose conditions had worsened were not being reassessed, and so were missing out on benefits. It is no surprise that under PIP the percentage of those people who qualify for the highest rate of benefit is about 22.5%, whereas under DLA the figure was only 16%. Therefore, it is wrong to try to convey the impression that DLA was the utopian benefit; there was widespread support for its reform.

There are still things that need to be done and those things are part of our ongoing work. PIP is designed to determine awards consistently and objectively, with most people having a face-to-face consultation with an independent health professional to help them to build their case. Members should remember that the assessors are not awarding benefit; that is done by us in the Department and we set the rules and the levels of benefit. The assessors are there to help people to build their cases. So, rather than being presented under DLA with a complex 50-page self-assessment form, which many people could not do justice to, PIP is there. I have sat through PIP assessments and I have seen how the assessors help to support people, particularly when individuals have a mental health condition or a learning disability and therefore need to be guided through the process, to ensure that their case is as strong as possible.