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Lord Montague of Oxford: My Lords, I too rise to oppose the amendment. My reasons for doing so are not entirely the same as those of the noble Baroness. The point at issue is whether there should be a careful review now, as sought by the director general, or whether it
should be deferred for a period of seven years. I believe that what we shall hear in the debate will lead us to the view that the experts should look at the matter now and not defer it for seven years.I am a past chairman of the National Consumer Council and have taken a close interest in the well-being of our pharmacies, which is a very important matter. I wish to draw to the attention of the House some facts which have not emerged during our discussions. Under the Essential Small Pharmacies Scheme, any pharmacy which prescribes fewer than 19,000 prescriptions per year receives a subsidy. The cost of that subsidy is currently about £4 million a year. It is a safety net for pharmacies. Indeed, new pharmacies are opening and using that safety net. One pharmacy receives a subsidy of £32,000 a year. It is not the case that no protection exists to prevent pharmacies from ceasing to trade. As the noble Baroness said, over-the-counter medicines represent only 7 per cent. of pharmacies' business. We should not ignore the fact that pharmacists' income is reviewed annually by a joint committee of the Government and pharmacists.
There are, however, other matters that I hope the director-general or the Restrictive Practices Court will examine. One which causes great concern in relation to the workings of the subsidy concerns doctors who provide pharmacy services. Where a new pharmacy opens under the Essential Small Pharmacies Scheme, doctors can no longer prescribe for a patient who lives within one kilometre of the surgery. That sounds fair because it is assisting the new pharmacy. But it is not very kind to the patients; it is not kind to people who have previously been making one stop when they are unwell, to have to make two stops. It is particularly difficult for elderly people. I hope therefore that whoever reviews this matter will bear that in mind.
There are other aspects to consider--one could go on forever--and we cannot consider them all here and now. The issue is whether all these matters should be considered now or whether they should be deferred for seven years. I suggest to this House that they should be considered now.
Lord Stallard: My Lords, I rise to support the amendment moved by the noble Lord, Lord McNally, for much the same reasons. I have taken an interest in the Bill since at Second Reading, through Committee and Report stages, and discussed it at length with the noble Lord, Lord Morris. As the noble Lord, Lord McNally, said, the noble Lord, Lord Morris, has been unwell, but we are pleased to see that he is on the way to recovery.
I am particularly concerned about a number of matters. I am a life-long supporter of the community pharmacist. I can remember even as a child when the only place one could go for assistance, advice or guidance was to the medical hall or the chemist because we could not afford a doctor in the days when we had to pay for every visit. There is therefore a long history attached to the community pharmacists, and that is being overlooked and brushed aside in the new approach. It is said that what was there before is no good and we must change it. But we cannot change things like the community pharmacy and the support for it in the community.
I have no knowledge of the minute details of this Bill, but I have a great deal of knowledge of the support for the local pharmacy in the communities in which I mix, even to the extent that when people are told that it may cost 6p, 7p or 8p more if they agree to the change, they say that they would sooner pay. Whatever the supermarkets say about the reduction in prices of drugs, medicines and so forth, the balance will be added to other items. They will add 0.5p on the price of a tin of beans or 1p onto something else. People will not save money because the supermarkets will recoup whatever reduction they allegedly give. That is therefore a false argument. People are not stupid and will see through that immediately.
Amendment No. 1 is mainly concerned with the double jeopardy question mentioned by the noble Lord, Lord Morris, and repeated by the noble Lord, Lord McNally. Community pharmacies are entitled to be concerned by the Bill as it stands. They are not arguing for specific protection for all time. Once the Bill becomes law, the transitional provisions will apply. If resale price maintenance cannot be justified under the test of this Bill, at the end of the transitional period it will cease. Why, therefore, did the director-general see fit to begin proceedings in January of this year against community pharmacies? Only he knows because it was only in January that the Bill began its passage through your Lordships' House. Why did he choose that moment to begin those other proceedings?
Many community pharmacies are barely viable at the moment. That has been confirmed many times in the course of the debates. Two sets of proceedings, one under the old legislation and one under the new, will impose heavy costs on pharmacies quite unnecessarily because they will have two separate cases to fight. To add to that, as the noble Lord, Lord Simon, reminded us, there is always the possibility that the European Commission will jump into the ring, and nothing can be done about that. However, we can remove the double jeopardy argument if we have a mind to.
The effect of the amendment is to stay the proceedings the director-general began in January for two years. If the provisions of the Bill are brought into force before the two years expire, the proceedings are automatically discontinued. If for any reason there is a delay in implementation, then the proceedings resume. That takes care of the point made by the previous speaker. I argue that the amendments are modest, but extremely important. I do not see why my noble friend the Minister should not accept them and look again at the whole situation.
Baroness Miller of Hendon: My Lords, I was pleased to add my name to those of other noble Lords proposing this amendment. With the permission of the House I should like to reminisce for a few moments about my experience in this area when I was chairman of the Barnet Family Health Services Authority. We wanted then to extend the advice and help given to customers on health matters, primarily to help the consumer, but also to relieve the general practitioners and avoid their time being wasted unnecessarily, and also to enhance the professionalism of the pharmacists.
To that end we launched--as I said at Second Reading--a High Street Health project whereby pharmacies gave up a small part of their selling shelf space in order to create a private area where they gave free advice to customers. It resulted in the saving of a great deal of time and effort for local GPs. It won support not only in our area, but was also used as a pilot in numerous other parts of the country. Of the 6 million people every day who go to pharmacists, 1 million of them do so for their prescriptions. We know that 70 per cent. of customers show their loyalty by going to their regular pharmacist who, having the patient's medication records available, is in the best position to advise the patient.
Buying over-the-counter medication is not like buying cut-price beans or any other consumer product. The consumer cannot obtain advice from a supermarket shelf. I believe that the Secretary of State for Health knows that. Apart from the many statements that he has made in the other place, only as recently as last Monday he said at the Pharmaceutical Services Negotiating Committee's dinner that he wanted to see the role of the community pharmacist extended. He hoped that pharmacists would encourage people to use self-medication where it was appropriate. He wanted to see new and extended roles for the pharmacist in primary care.
If resale price maintenance on over-the-counter products is removed, that simply cannot happen. Removing resale price maintenance will result in around 3,000 of the barely viable pharmacists disappearing. Many more may disappear as well. I note what my noble friend Lady O'Cathain and the noble Lord, Lord Jacobs, said last week about nobody speaking for the consumers. Let me say that the Consumers' Association sent out solid press releases and briefs. The bottom line of all that is that unless there are pharmacies in the high street, the sick, the poor and the vulnerable will not be able to go anywhere for advice.
I understand the Minister's concern relating to competition and pricing. I understand that very well because I served on the Monopolies and Mergers Commission before I was privileged to enter your Lordships' House. But cost in matters such as this is a bad criterion. This is not a matter of competition; it is a matter of the health of the nation. With all the passion that I can muster I ask the Minister to see if he can go some way to accepting the amendment or, alternatively, that other noble Lords will follow us into the Division Lobby.
Lord Walton of Detchant: My Lords, I support the amendment, but with slight hesitation. In general terms, like the noble Baroness, Lady O'Cathain, I am opposed to restrictive trade practices and believe in the benefits of competition in our society. Having said that, and having listened in particular to the speech of the noble Baroness, Lady Miller, I too heard the speech by the Secretary of State for Health on Monday when he gave his support to the role of the community pharmacist.
It is clear that the medical profession and the profession of pharmacy have been having extended discussions over the course of the past year or two in the hope of extending the role of the community pharmacist in giving advice and in persuading people--where appropriate--to buy over-the-counter medicines in order to treat illnesses which do not require the attention of a skilled medical practitioner. I have been persuaded by all the arguments I have heard and read that if this issue is not resolved in favour of the community pharmacists there is a serious danger that many small pharmacies in villages and in the countryside will be forced out of business because of undercutting by the supermarkets and the major chains. I accept wholly what the noble Baroness, Lady O'Cathain, said about the book agreement and the dire consequences which were suggested when that agreement was withdrawn. But pharmacists are in a very different position. We need a period of lengthy reflection before resale price maintenance for over-the-counter medicines is withdrawn. For that reason I strongly support the amendment.
4 p.m.
Lord Campbell of Alloway: My Lords, I support this amendment. I am not concerned with the interests of pharmacists. I am not concerned with the Consumers' Association. There has been far too much heavy lobbying. I am not concerned with the interests of the great supermarkets. I am concerned with the interests of those about whom the noble Lord, Lord Walton, has just spoken. It is their interests with which your Lordships should be concerned. After all, I do not suppose that any of us are members of the Consumers' Association but we are all consumers. Let us concentrate, not on these trade associations, but on the interests of the people in the country.
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